Yin and Yang: County Halls and Garden Centres

Some weeks can be fun, others a challenge, but as I grow older, I find every week interesting. Last week was a Yin and Yang kind of week for me. Yin and Yang is the concept in Chinese culture that captures the balance and harmony of two opposite and complementary forces or energies in the universe. I experienced a mixture of both last week. On Thursday, I was down in London to attend the NHS Providers’ inaugural Quality and Improvement Conference. I have to say I really enjoy these sorts of events. Not only do I learn something new, I very often get to people I perhaps haven’t seen in a while, or have only met on social media.

This was the case on Thursday. One of the first people I bumped into was my former colleague, Maxine Power. It was great to be able to catch up on what we had both being doing, since last seeing each other a few years back. Tori Cooper tapped me on the shoulder and said hello. I didn’t recognise who she was, as her name badge said Victoria! Tori has long supported my weekly blog and I always welcome her insightful comments. It was lovely to meet her in person. Then there was  CharlesKwaku-Odoi who was speaking at one of the breakout sessions. I had never met him before, but felt I knew something about him as I have read his CV twice now in the last three years. It was a great pleasure to be able to shake hands with him and introduce myself.

The conference was at the rather splendid County Hall, right by the Thames and across the way from the Houses of Parliament. The conference started with a brilliant paper from the equally brilliant Charles Vincent. I have heard him speak before and he always uses real life experiences to illustrate his points. In this paper, he spoke about the importance of open communications when standards of care fall short of what is expected and/or required and adaptations get introduced. He also challenged us to look at the way in which safety checks can evolve and mutate to become more of a hindrance then a helpful tool.

This was a theme that came up again in one of the breakout sessions that looked at identifying and calibrating organisational risk. I took away four ideas to ponder upon. (1) being a custodian of a set of values and principles required to protect patient safety and improve the quality of care (2) the often laziness of language used when considering risk and how to respond (3) the bear trap of the normalisation of the unacceptable and (4) the importance of curiosity, underpinned by compassion. Although these ideas were predominantly set in the context of acute care, I was struck by how closely the ideas resonated with my current experience of being Chair of a mental health NHS Trust.  

These are not necessarily new ideas. Indeed, listening to the discussion, I was struck by how familiar they felt. In a previous life, I would start of many of my presentations or lectures by telling the audience how I saw the world. Somewhat pretentiously (hindsight is always good) I would declare these as being ‘my postmodernist Machiavellian manifestations’. I rather grandly talked about the ‘panacea of evidence-based health care’ of ‘rhetorical prescriptions of professional practice’, the rise of the ‘calibrated organisation’ and the ‘rituals of verification’. With my long-term co-author, Professor Sue McAndrew, I published many a paper exploring these ideas and the often perverse impact they can have on both organisations and on the folk receiving care. These days I spend much of my time trying to navigate my way through impact of these challenges. So, it was wonderful on Friday, to find myself in a very different place with folk who thought about mental health care in a very different way.

I had been invited by Paul Baker, Co-Founder of CHARM (Communities for Holistic Accessible Right-based Mental Health) to a meeting with a group of mental health workers from Brazil, who had been visiting mental health services across Manchester. Their visit had been arranged and organised by CENAT (Centre for New Approaches in Mental Health) in Brazil and CHARM. The meeting was held in the Hulme Community Garden Centre, in Manchester. I was delighted to be able to attend, and blown away by the setting for the meeting. If you happen to be visiting Manchester, take time to have a look at this wonderful place. It is not County Hall, but goodness, I knew in which I preferred to be, gardens will win every time.

The meeting was truly an exchange of learning and sharing. I was last in Brazil 30 years ago, so was keen to hear how things had progressed. There were many innovative approaches that were not hospital-based, but were person and family-centred and approaches we should consider building into our place-based ambitions for future care provision. I was challenged by what I heard at both events, but for very different reasons. What I would say though is that in both events there were many people passionate about make a difference to the life and wellbeing of others and that, I find, is reassuring.

The last word, is rather poignant. Two of the visiting colleagues from Brazil, live and work in the areas currently being devastated by catastrophic floods. I hope you will join me in keeping all those impacted by this disaster in your thoughts and prayers.

Step by step, you will leave footprints on the world: just don’t make them all digital

Way back in 1986, I was given my first computer. Well, it wasn’t really a computer as such, more a word processer with extras. It was made by Amstrad, had a green screen and you were required to save everything onto a thin cassette disc (called a floppy disc). There was no such thing as Word, Excel or PowerPoint. These came along two years later when Microsoft Office was launched. I loved my little Amstrad PCW and have been using computers in my work and personal life ever since.   

Over the last nearly four decades, computers have become more powerful, smaller, and relatively speaking, much cheaper. I flirted with Apple Mac computers, but couldn’t settle with the operating systems. That said, I love my iPad and have been upgrading mine every couple of years. I use Microsoft Office and goodness has that suite of programmes advanced exponentially! I haven’t yet had time to look at the new iPad Pro, but the advertisements boast this is ‘the most powerful iPad ever and also the thinnest’. My interest was piqued by the allegedly controversial advert. I make no apologies for probably being the only person in the world who actually liked the advert. I thought it was very clever, but then I have sometimes been called a philistine. If you didn’t catch it, have a look here.

One of the criticisms of the advert was while it was visually stunning, the content possibly hints at a future where our creative endeavours are entirely confined to digital screens. As such, there being no room for creativity being captured in a physical sense. I once worked with a university Vice Chancellor who, when he retired, had his portrait displayed only on a digital screen, and not a physical painting. Interestingly, once he left, the screen was unplugged. However, the march of technology is relentless. It’s true that technology can be transformational. Today my iPhone is 1 million+ times more powerful than the computer that sent Apollo 11 to the moon.

I have a device on my wrist that tells me how steps I have taken in a day, what my heart beat is, how many calories I have burnt in a day and how many hours of sleep I enjoy each night. It can do much more, but I can’t be bothered to read the instruction book. In truth I only use it to see how far I have walked and to check if I’m still alive. Both have proved useful over the years. My Fitbit sends the information to my phone, which keeps a record of how many miles I have walked each week.

I have been a long-time supporter of the #NHS1000miles initiative. This was started in 2018 to mark the NHS 70th Birthday. Every Sunday I join thousands of other folk who at 7.30pm, post the number of miles they have walked, run, cycled, or swam during the previous week. Most also post photos taken while doing their activity. In that first year, I walked over 1,000 miles. Since then, I have consistently walked at least 2,000 miles each year. I’m secretly pleased to have now walked well over 11,000 miles since that first year. I’m up to nearly 1,000 miles so far this year.

While walking is my thing, everyone can join in the #NHS1000miles challenge. It’s not a competition, J who likes to run, has this year consistently clocked up more miles per week than me. Aiming to get to 1,000 miles in a year means trying on average to clock up 2.74 miles a day. For some people that is easier than others. What is important is not the number of miles, but that folk are active, and are active on a regular basis.

We have just come to the end of this year’s Mental Health Awareness Week. The theme for this year is Movement: moving more for our mental health. Like the #NHS1000miles, persuading more people to become active, however they choose to do so has been the aim of the week using the hashtag #MomentsForMovement. There is now a great deal of evidence that shows the benefits that keeping active has on our physical and mental health and our wellbeing. The Mental Health Foundation (the home of mental health awareness week) produced a brilliant report that brings some of this evidence together, alongside further research undertaken this year with some 6,000 participants. I’m not sure if there is a physical print version of the report, but you can read the digital version here (on your computer, tablet or phone).

Their research shows that whilst 82% of people believe that regular physical activity is important in keeping mentally well, 34% of folk do not even meet the exercise recommendations set out by the World Health Organisation. The research sought to better understand why this might be; what is it that stops us from regularly keeping physically active. The usual suspects came up. Almost one in five people said that they didn’t have time in their week to exercise. Likewise, the weather, living with a long-term condition, cultural expectations, stress, and costs all featured as reasons for not exercising. I also think that the word ‘exercise’ can also give rise to the perception that all physical activity must somehow fit into a recognisable form of activity. And of course this is not true.

I looked at my digital record of miles walked so far this month. On the 1st May, I moved over a thousand roof tiles from my next-door neighbour’s garden. She had just had her roof re-tiled and didn’t know what to do with the old tiles. I said I could use them to build some more goat mountains for our two little goats, Hansel and Gretel. That day I clocked up 13 miles walked! Many of which were clocked up simply moving the tiles, a dozen at a time, in my wheelbarrow from her house to ours. It was a win-win outcome for all. Our goats love the new additions to their playground, which is just as well as they don’t know how to use a computer to play games.

Time to stop digging (if you want to get out of the hole)

Now if you want to see the potential consequences of different organisations and agencies working in silos have yourself a water leak, or a gas leak – or to make life even more exciting, why not have both at the same time? This was our story last week. We had received a stern letter from our water provider who told us we were using 615 litres of water a day! They were now going to charge us three times the amount per month that we had been paying. There is only J and myself in the house and we don’t take eight baths a day, or use the washing machine 11 times or even use the loo 82 times a day, as they suggested we might be doing. We assumed there must be a leak somewhere, although nothing was obvious.

We did all the checks, as advised by the water company, and finally arrived at the conclusion that the leak could only be between the water meter situated on the pavement and our house. This was unfortunate, as it meant we were liable for the cost of repair. Thankfully our house insurance covers such eventualities. On Friday, a jolly and very optimistic water and drainage engineer called Henry arrived. He was very reassuring and confident he would soon get things sorted. As J left for work feeling assured the problem was well on its way to being solved and happily singing Bernard Cribbins to the engineer, I was left to deal with him.

At first this involved turning stop cocks on and then off, peering down the hole that contained our water meter and lots of muttering. It soon progressed to the digging of holes. Now our drive is made of concrete and, as I subsequently found out, concrete that is three inches thick. The first hole was very deep, but Henry persevered, found the water pipe, but no leak. As the water pipe was made of lead, he told me it would need to be replaced and that would require further holes to be dug. He used an electronic device to find the best place to dig hole number two and, sure enough, he discovered the other end of the lead pipe. ‘I will just cap this off and we can then narrow down where the leak might be’ he said. With that he got his pipe cutters out and proceeded to cut through the pipe.

Now Henry was smoking a cigarette at the time. As he cut into the pipe he said ‘I can smell gas’ and bent closer just to make sure, still with his cigarette in his mouth. He was very casual about it all and simply said he would call the gas board. An hour late, a gas safety officer called John appeared, set out his large ‘no smoking’ signs and every 15 minutes came and checked the house for any build up of gas. He also knocked on neighbours’ doors to let them know we had a gas leak. That went down well. Eventually we had four vans and six engineers; all of whom seemed to find Henry’s mistake very funny. They stood around scratching their heads, but didn’t actually do much. Henry called it a day, saying he would return when the gas folk had done the repair.

Some time later, they decided they needed to dig another hole, and work commenced. It soon stopped and when I asked why, they showed me the reason. There were cables and pipes, all belonging to different utility companies, and all of which were crossing each other or lying on top of each other making hole digging almost a work of archaeological dimensions. In turn, the gas folk cursed BT, the electricity folk and the water companies for the way in which they just dug their own trenches and holes, laid their pipes or cables with no regard whatsoever to what was already there. 

Whilst they did eventually find our gas pipe, this too was made of lead and instantly condemned. What they couldn’t find was where it joined the gas main. So, they dug a further hole, disconnected the gas from the mains, and said they would be back tomorrow to try and replace the pipe and reconnect us.

Yesterday they did return. After two more holes were dug, they were able to use a clever mole like machine to re-pipe the gas from the mains. We now need to go through the same appointment booking procedure with the water company again to get a new water pipe fitted. I asked the gas fitters if they would not refill the holes, so as to make it easier for the work to be carried out next week, but sadly I was told that wasn’t possible and they had to refill each of the holes and make good the damage they had done. And we still have a water leak. I cannot begin to describe my utter frustration. However, I did see what can be achieved when all stakeholders work together to achieve a desired outcome.

I was fortunate to take part in a ceremony to bury a time capsule at our new in-patient unit in Manchester. This is a £105 million development. The new facility is called North View and will provide 150 new in-patient beds. It is the first all-electric mental health unit in England, supporting the NHS’ overarching aim of becoming net zero. Right from the start, service users, carers, colleagues, regulators, colleagues from Manchester Council, the architects and the main constructors have worked together to design and future proof this state-of-the-art facility. Representatives from all these groups were invited to the ceremony, including children from three local schools who had won the competition as to what should go in the time capsule*.

North View is a series of interconnected very impressive two-storey building's. There are even gardens on the first floor. The design, finish and layout of rooms have all been decided by service users, cares and colleagues working with the contractors and project team. It was still an active construction site, so we were required to all wear PPE. Like our drive, there were still many large holes and unfinished parts of the building to be seen, but it is still on target to open in November this year. Hopefully our own building work will be completed then too.  

  

*The capsule was crammed-packed with many artefacts including: poems, newspapers, artwork, photographs, coins, stamps, a USB stick with videos and a timeline of the historical development of mental health services on the Manchester site. The time capsule portrays a snapshot in time which captures the spirit of our people, mental health services, history, and aspirations, for future generations to one day look back on. Who knows how different their lives may be?

Leadership is an opportunity to serve, not a trumpet call to self-importance

Many years ago I lived in Wales. I had a smallholding and enjoyed some of the best years of my life, being both a nurse and a hobby farmer. The house was located on the side of a valley and the views went on for miles. Most of the time the valley was quiet, with just the occasional tractor to be heard in the distance or the lowing of cattle and the calls of mother sheep trying to locate their lambs. That was until I got a pair of peafowl.

I had always wanted peacocks and eventually decided to get a pair. They came from Norwich. All those years ago it was quite common to buy live birds and have them delivered to your nearest train station. I was very excited when they came. They were stunning, the male had bright blue plumage and his missus speckled white feathers. 

However, their most striking feature was their call. It is a cross between a ‘meow’ and a ‘yowl’ emitted at full volume and which can be heard over long distances. It is unmistakable and once heard will be instantly recognisable thereafter. They were inclined to call at the slightest thing. Now I love the sound, but many people don’t and whilst it was fine in the Welsh countryside, they are not really suitable for urban environments. So when I moved to Manchester, they couldn’t come with me and were donated to friends. The couple are no longer my friends…

This lovely memory was sparked by reading the story last week of a Russian zoo that had sent a pair of peacocks to the frontline in Ukraine. This rather bizarre gift was aimed at lifting the mood of the Russian troops and allow them to find some spiritual tranquillity through contemplating and admiring the beauty of the birds. I may be completely wrong, but on the front line of what is an unremittingly brutal war, I’m not sure the continuous sound of a pair of peacocks screeching is going to help raise morale or bring spiritual tranquillity to the soldiers. Being a soldier at war is a high stress job.

And so, apparently, is being a politician*. Last week I read the story of how many politicians experience poor mental health and mental wellbeing. The story was prompted by the Prime Minister of Spain, Pedro Sanchez openly contemplating resigning, because he was mentally exhausted. He has eventually decided to stay on. It is the toxic nature of contemporary politics that seems to be taking its toll on our senior political leaders. Something noted last week by my former colleague at the University of Salford, Dr Ashley Weinberg. He is one of the few researchers who have collected data on politicians and their mental wellbeing. Ashley noted that ‘we want people in all kinds of occupations to be in the best possible frame of mind and state to do their work’, and ‘we are hearing many politicians now saying there’s only so long I can do this work’.

In recent times there have been many examples of skilled and experienced political leaders resigning because of the impact that stress has had on their health and wellbeing. In recent times Leo Varadkar, Jacinda Arden, Sigrid Kaag have all unexpectedly resigned cited how the pressures of the role impacted on their health and the wellbeing of their families. Likewise, in his resignation speech last week, Humza Yousaf described politics today being a ‘brutal business’ and ‘it takes a toll on your physical and mental health: your family suffer alongside you’. No one should be subject to the type of abuse these folk have reported experiencing while undertaking their public service.

In 2023 the Apolitical Foundation carried out a study with over 100 current and former political leaders. When asked, 41% of these folk reported having low or very low mental wellbeing. This is a much lower level of wellbeing than that reported by police, emergency fire and rescue responders and paramedics; professions consistently acknowledged as being high stress professions.   

Some of the pressure comes from long working hours, political accountability, often unrealistic public expectations, and managing situations like the Covid pandemic, global conflicts, the climate crisis and so on. These days, instant news-sharing on social media also plays a significant role in creating stress and harm. The ability for anyone to easily communicate with those in power or communicate their thoughts about those in power just adds more pressure. When email was first introduced in 1971, I would perhaps get two to three emails a day. These days I can get 50 to 100+ emails a day, and some of which are hurtful and verge on harassment. The same with social media. When Twitter (X) started in 2006, I would get just a few tweets a day, now it can often be 30 – 40 tweets, and again, some are not pleasant to read. I’m not famous, and only have a modest following on social media. I cannot imagine what it must be like for those folk constantly in the public eye.

I don’t know how we might improve this situation. I do know it certainly wouldn’t involve donating a pair of peafowl to each political leader. However, peacocks can teach us something. They have 15-20 different and distinct calls. Most are aimed at warning other peacocks of impending danger. Perhaps we all need to be more attentive when our politicians call out for help - folk like Pedro Sanchez - and collectively find ways of supporting them as people first and politicians second. In a very turbulent world, we need more of our political leaders to be physically and mentally well.

  

*I was amused to read that the biggest political peacock (or possibly turkey?) of recent times, Boris Johnson, was turned away from his local polling station after forgetting to bring acceptable photo ID with him. It was his government that introduced the ‘no ID, no vote’ policy in 2022.