Reflections on our Grand Train Journey

Well, our wonderful Grand Train Journey came to an end yesterday. We flew back into Manchester and took the train back to Blackpool North train station. That is where our trip began. In between, we have been to London, Paris, Zurich, Budapest, Bucharest, Brasov, Veliko Tarnovo and Istanbul. We very much enjoyed the break, and the two weeks has simply flown by. The trip was inspired by an article I read in the Observer newspaper. The person who had written the piece had done a similar trip but had done so in just over a week. When we enquired about it, it became apparent that a week didn’t really allow him to see a great deal of the places he was passing through. 

We wanted a slower pace of life. We chose three overnight sleeper trains, as well as a number of boutique hotels to stay in. This enabled us to both explore the towns and cities, but also to enjoy the countryside as we moved from place to place.  Many apologies to all those folk who will have been bombarded by the many reels, and pictures we have posted on social media along the way. These are for us, at least, precious memories. One life, live it. 

For me, what was also precious was taking two weeks away from work. Although I’m officially retired, I’m Chair of a large mental health NHS Trust which is in ‘special measures’. This followed an undercover exposé into the Trust’s adult forensic services, carried out by the BBC Panorama Programme two and a half years ago. Whilst the focus of the programme was on the abuse found in our forensic services, an independent review commissioned by NHS England revealed the wider organisation appeared to have a toxic culture, was woefully understaffed, and was a Trust where service users and carers had no voice and often received poor quality care. 

I was appointed Chair on 1st January this year and the last six months have been hectic and full on to say the least. Whilst this is not where I thought I might be in 2024, I’m glad I have this opportunity. It is a privilege. It will take a while to resolve the many complex problems and issues facing the Trust, but we have made a great start, and by the end of summer, we will have an almost completely new Board. For me this is an important step as developing a healthy organisational culture will absolutely be driven by the Board. 

As an organisation, we do not stand alone in addressing the challenges we face. Colleagues from NHS England, both at a regional and national level, have been very supportive, as have the Greater Manchester Integrated Care Board. The Care Quality Commission continue to review our services on a very regular basis, and every review is helpful. We work alongside several partners and much of the last six months has been spent re-establishing relationships and starting the slow building back of the trust need to nurture and sustain these and future relationships. 

Now I consider myself to be an experienced and skilled ‘people person’. My leadership style is transcendental, and I strive to serve the needs and ambitions of all the colleagues I work with and who, collectively, deliver the services we provide. An important element of this approach is to build solid relationships with colleagues. Again, this takes time and effort. Over the past six months, I have spent energy on both, but I was certainly ready for a break. 

However, since the start of the year, I have discovered much that fills me with hope. I have found many brilliant colleagues across our organisation, and they are doing great things. There is a job to be done to build upon these pockets of excellence and spread their good work across the entire organisation. I’m ready to return and stand alongside our new Chief Executive, Karen Howell and all the other members of our Board and continue to lead our improvement journey. 

It was a great two weeks away. Reflecting on what we did, I was reminded of the advice from the Institute for Mental Health on how to maintain good mental health and improve our wellbeing. (1) Regular exercise. Well J and I walked miles every day, and strangely, most of these were uphill! (2) Eat Healthy, eat regularly and stay hydrated. That was another tick. 

(3) Make sleep a priority. The difference in time between places meant we often slept in (the exception being J on two of the trains). (4) Try a relaxing activity. We sat and watched light and music shows, visited countless churches and mosques, and read, explored and embraced every different cultural opportunity we could. (5) Set goals and priorities. I had printed off our trip to the enth degree with details of all the train times, connections and how to get from A to B, and despite J’s expectations, they all worked. (6) Practice gratitude. We were met with kindness and human warmth wherever we went, and more so where the folk we met didn’t speak much English. (7) Focus on positivity. We didn’t kill each other, we’re observed to be in love, and we never missed a train. (8) Stay connected. Yes, we were. Except for my Trust. They have an authenticating system that blocked my access to any emails. There was an abreaction in the middle Monday when, inexplicably, my inbox was filled with the missing emails. I didn’t look. And that was actually very good for my wellbeing!

Foods (and umbrellas) that can shorten your life!

Well we have come to the end of week one on our #GrandTrainJourney. In a few hours time we travel to Veliko Tarnovo, in Bulgaria. We are there for a 3 day stopover, which is great as it’s where one of my brother’s lives and we will get a chance to spend some time with him. It is the first time that either J or I have visited the country. And it’s certainly a country with an interesting past, a past that has included having a close relationship with Russia (and communism) as well as the European Union. Both relationships, have at different times been difficult. These days Bulgaria is a member of NATO, which at least provides some protection from any Russian aggressive intent.

What I didn’t know before choosing to come here, is that Veliko Tarnovo is the largest producer of plastic bags in all of Bulgaria. It’s a great Bulgarian pub quiz answer. However, given the climate crisis, I’m not sure this is much of a claim to fame! What I did know before coming here is to be wary of folk coming towards me, carrying umbrellas. Older readers will remember that way back in 1978, the BBC World Service journalist and Bulgarian dissident, Georgi Markov, was murdered in London.

He was apparently injected with a lethal poison from the tip of an umbrella, as he was walking along the street. Much later, in 2000 he was posthumously   awarded Bulgaria’s highest award, the Order of Strat Planina, for his contribution to Bulgarian literature and his opposition to the communist authorities.

The closest I have ever been to Bulgaria before now, was actually Romania. On our visit last week, we took a trip out to Dracula’s Castle! Forget Whitby, Transylvania is where it’s at. Last week’s visit wasn’t my first, I originally went to Romania in 2013, while undertaking an EU-funded research project that involved 11 partner organisations from the Czech Republic, Hungary, Lithuania, Netherlands, Finland, UK and Romania. It was a three-year project and one of the grant conditions was that we hold at least one project meeting in each of the participating countries. This was academic tourism at its best. I know I was very privileged, and I loved it. The research project was called EmpNURS and aimed to empower the professionalisation of nurses through mentorship.

One of the great things about such a project was that once the ‘project meeting’ had been completed, usually over a day, there was always an opportunity to experience something of the country’s culture and, also, to visit local health services. It was an important element for all of us involved, as we gained a better understanding of the cultural differences and similarities across the partnership.

As J and I have crossed Europe, we haven’t really looked at each country’s healthcare system and thankfully we haven’t needed to experience any, either! However, looking through the news, (and we have been on some long train journeys) I was interested to read the latest research report published last week by the World Health Organisation. It was hard hitting. The headline news was the assertion that powerful industries across all parts of Europe were driving up ill health and early deaths by using marketing campaigns that are misleading and which cut across governments’ efforts to prevent major causes of death such as cancer, heart disease and obesity.

The report noted that smoking (tobacco), ultra-processed foods (UPFs) and alcohol kill 2.7 million people a year in Europe. That is about 7,400 deaths per day across the 53 sovereign states that make up Europe. Smoking has been the biggest bane of our trip. People smoke everywhere, even at the next table to you in a restaurant. It has been like going back pre 2007 in the UK where folk smoked wherever they liked. It won’t be different in Bulgaria. Despite a smoking ban in all public spaces being in place for several years, a staggering 38% of adults still smoke. Nearly 23,000 people a year die from smoking-related conditions. Don’t get me started. 

The other focus for me was on UPFs. It was the Brazilian nutritional scientist, Carlos Monterio, who is said to have first coined the term UPFs. However, whilst there is no agreed definition as to what UPFs are, there is much research that shows the link between UPFs and ill-health. See here for example.

I’m a long-time vegetarian, and try and avoid UPFs wherever I can. Not always possible of course. I’m addicted to cauliflower cheese, and while I can make this dish from scratch, I will often simply buy a ready-made one from M&S or Tesco. Total UPF on a plate to be sure. When I first started travelling to and across Eastern Europe, some 30 years ago, it was hard to find vegetarian meals anywhere. For example, in 1998, at my very first visit to Slovakia for a conference, upon telling the serving lady I was a vegetarian and didn’t eat meat, she simply scooped the meat off my plate and handed it back. These days whilst it can still be difficult to find good and  interesting vegetarian meals, the choice is getting better. Equally, there are UPFs meals everywhere! I’ve eaten a lot of salads these past few days for sure. Like our #GrandTrainJourney, it seems we have a way to go yet in really helping folk live healthier longer lives. Next stop for us, after Bulgaria and an overnight journey of 13 hours, is Istanbul!! 

 

We are on our travels with Chocolate and Clozapine along the way!

This week’s blog comes from Zurich in Switzerland. I cannot remember the last time I visited Switzerland. At one stage in my life, my family and I often visited here. My mother’s parents and some of her brothers and sisters lived there, in the fascinating city of Basel. When I first visited the city, I was too young to really understand much about the place. I was just a young lad. I do, however, have lifetime memories that include real candles on the Christmas tree, chocolate porridge, snow and cold, and wonderful art installations by the artist Rowland Emett. His kinetic sculptures have since become world renowned.

What I didn’t know at the time was that Basel was and still is known as the cultural capital of Switzerland, and has more museums and galleries then anywhere else in the country. The first zoo in Switzerland opened there and it is the main centre for the pharmaceutical industry, with both Roche and Novartis located there. In 1938, Albert Hofmann produced the first psychedelic drug LSD at the Sandoz laboratories. Some 20 years later Clozapine was synthesised by the Swiss pharmaceutical company, Wander AG, a company eventually taken over by Sandoz. Clozapine marked an important point in the development of treatments for people experiencing serious mental illnesses, such as schizophrenia. It was the first so called ‘atypical antipsychotic’ medication available for folk for whom other more traditional approaches had not worked. These days, whilst more generic forms of the drug are used, Clozapine remains on the World Health Organisation’s List of Essential Medicines.

But I digress! I’m not in Basel, but in Zurich. Yesterday J and I left our little house in the care of Tom and his sister Amelia, who look after our house and animals when we are away. We boarded a train from Blackpool North Station, bound for London, then onto Paris by  Eurostar, and eventually to Zurich. We are here for a couple of nights, before moving on to Budapest via an overnight train. We are travelling across Europe to Istanbul entirely by train stopping off in France, Switzerland, Hungary, Romania and Bulgaria, before flying back to Manchester.

An enjoyable part of everyone’s visit to Switzerland often includes sampling the delicious chocolate they make. We have and it is undeniably sublime. Like that famous Danish lager, Swiss chocolate is probably the best chocolate in the world. My children will tell you that top of my list of favourite Swiss chocolate has to be Toblerone. These days, there are many variations of the triangle shaped bar, and I love them all (even the white chocolate version). On the other hand, J would never eat white chocolate, but loves rich dark chocolate.

Probably the most famous Swiss chocolate is that made by Lindt. When I was a child, this chocolate was always viewed as a luxurious treat, only to be enjoyed on very special occasions, and then, only in small amounts. I have long maintained that a little bit of chocolate now and then is good for you. Apparently, the darker the bar, the better it is for your health. Last week, I read a story that suggested we (humans) have been consuming chocolate for hundreds of years. Much of this time, it wasn’t chocolate, as we recognise it today, but a rather bitter liquid called cacao, made from the cacao bean.

This drink, because of what it contains, is probably good for your health. The Kuna Indians, who live on the San Blas Islands of Panama drink it on a regular basis. They add a little sugar, which turns the cacao into cocoa, and they drink at least four cups of this a day.  They generally have low blood pressure, which unlike us in the West, doesn’t rise as they get older. They enjoy low rates of cardiac problems, strokes, diabetes, and cancer and tend to have many more healthy later life years than us folk living in the West. It’s when we add a lot of sugar and milk (and shiny packaging) that we run into problems.

It was our very own Joseph Fry, who in 1847, created the first chocolate bar that resembles something we would be familiar with today. He mixed cocoa powder, sugar with melted cocoa butter to create the world’s first bar of chocolate. His crude bar of chocolate will have contained high levels of flavonoids, which is the element that helps reduce the risk of heart disease and stroke, something confirmed in many random controlled trials. The darker the chocolate the higher the levels of flavanols, thus the greater health benefit there might be.

What interested me though in this article was another element – theobromine, something that is also only found in coffee. It is a psychoactive substance. Clearly not as powerful as LSD, but a substance that can produce a significant ‘high’ if taken in reasonable quantities. Clearly chocolate is never going to be considered a health food, and J and I have no interest in taking any substance that might give us an artificial high. In fact, simply being away together on our train trip makes us feel happy and better able to enjoy the world around us. That said, the Swiss chocolate we had today was simply divine!

Waiter, waiter, there’s a fly in my soup!

It’s the little things that matter. Every Friday, I take the five black shirts I have worn during the week to be cleaned and pressed at my local Timpson’s (there are other cleaners available). I started doing this a couple of years ago, when I got fed up with our washing machine adding lots of fluff to every shirt each time they were washed. Now I simply take them to Timpson’s. They are cleaned, pressed, hung on hangers and smell wonderful. Jo, the new Timpson’s manager, always greets me by name, writes out the ticket, including my telephone number, which she knows off by heart, exchanges a few words about how the world is treating her and takes the shirts. Sunday, I get a text to say they are ready to be picked up. I must be one of many customers, but Jo always makes me feel special. It is the type of personal service that comes complete with a smile and immaculately laundered shirts.

Receiving good service is something I’m very keen on and it doesn’t matter in what context the service is being provided. Dylan, our little dog, has his coat cut once every six weeks. Where we lived before, I had to drag Dylan through the groomer’s door. He hated going there and I strongly suspect he was ill-treated while he was there. These days we have a different groomer. When we go, he jumps out of my car, runs to the door and once let in, gives Donna the groomer a big cuddle. He loves it there and even though the price of his hair cut has gone up, I wouldn’t change groomers at all. It’s service with a smile and a rather smart looking dog.

In my mind, good service trumps all. If I don’t get decent service, I refuse to try for a second go (much to the chagrin of J, my more tolerant wife). The restaurant, shop, garage, or pub is simply crossed off my list of places where I might choose to spend my money. In some circumstances, that can be a big loss. I change my car every three years, and if I don’t feel the service is good, I won’t return to the salesroom and will probably choose a different make of car to buy. 

It is not just how people treat you that is important. For example, if I order a hot meal, I like it to arrive at my table hot, not warm. These days if the meal arrives warm and not hot, I no longer ask for it to be exchanged, I simply don’t eat it and let the waiter know at the end of the meal. I have complained in the past and I have received replacement meals. However, as a long-time vegetarian, I’m not always confident that the replacement meal won’t have been contaminated in some way as a form of chef’s revenge. Service with a snarl and soup with a fly in it.

Of course, all these are examples of situations where I have a choice. I choose a different make of car, a new restaurant and so on. There are some situations where we have little, or no choice. Unless you have private healthcare insurance or are super rich, most of us rely on the NHS to treat and care for us when we are ill, or have had some kind of accident. Despite all the well-known challenges to the service - lack of money, lack of staff, poor environments, and long waiting times - for much of the time it is a very good service. Sometimes it’s not.  Last year, the NHS received 229,458 reported written complaints. This was an increase on the year before of nearly 4,000 complaints.

There were lots of complaints about delays in receiving treatment and access to care, but by far the greatest number of complaints were concerned with communication. This included not being told something, often a tricky area for families of a loved one to navigate; delays in receiving information, test results, doctors’ letters and so on; and how people were communicated with as well. Poor attitude, rudeness, bluntness, and a lack of compassion were all cited as poor interpersonal communication behaviours that patients and families found unacceptable.

It is not just verbal communication that is at play here. The way we sometimes write to patients and families can be just as damaging. Last week, I was looking at some of the responses we have made in the past to patients’ complaints. The language we use is always going to be important, and I thought we might have sometimes been a little kinder and clearer in the choice of words used. For example, I saw a lot of ‘I’m sorry that you feel…’  being used. It is a phrase that perhaps conveys that an individual’s perception of an event or an experience is not relevant. I have long held the view that perceptions can often be just as important as facts and need responding to with equal care. In saying this, I am in no way casting aspersions on my Customer Care colleagues. They do a fantastic job. Laying blame at their door would be the same as me blaming the poor service I get on the waiter, or salesman. Totally inappropriate.

There will always be something we can learn from every complaint and how these are responded to. However, I also know that, judging by the number of emails I get, where folk are concerned about their care or a loved one’s care, finding the time to step off the complaint investigation and responding processes to reflect, learn and grow can be challenging.

Perhaps where and when things don’t live up to expectations, we might try harder to find a way of putting things right earlier and before frustrations escalate to the written complaint stage. In any event, even if it is difficult to do that, all NHS colleagues are bound by a Duty of Candour. This is such an important responsibility and one we should cherish and not be afraid to draw upon when required. Of course, getting things right first time would be better still. Like the weekly laundering of my shirts, we can all aspire to experiencing and/or providing services that are timely, appropriate, and successful.     

Bridging the gap: children and young people’s mental health

The second house I bought when I moved to Manchester was in Little Lever, a small village just outside Bolton. Little Lever has a huge country park nearby and the Bolton and Bury Canal runs close by. I was lucky in that my house had a large garden, which allowed me to keep goats, ducks, as well as my hens, and still grow vegetables. I became famous for walking my goats on a lead to the country park. I had many wonderful years living there and only moved, because I wanted a house with an even bigger garden.

For whatever reason, I have never been back to Little Lever, which is a shame as there were plenty of wonderful places to walk there. One of my favourites was along the canal towpath towards Bolton Town Centre, past a strange and mysterious place called Nob End. Whilst the canal still had water in it, it was no longer navigable. The locks had disappeared and many of the buildings along the canal were derelict and mere sad reminders of a much more prosperous past. Nob End was the setting for the iconic film, Spring and Port Wine, a story about a stern father and a lenient mother dealing with the challenges of raising their four children in working-class Bolton. If you haven’t seen the film, it is definitely worth watching on DVD.

Many years ago now, I saw both Little Lever and Nob End in the news. The artist Liam Curtin designed and built a footbridge over the canal made entirely from Meccano parts, all of which, including the nuts and bolts, were accurately scaled up by ten times.

Now some readers might have to be of a certain age to know what Meccano is, but as a child, I loved playing with it. Basically, it is a metal construction kit, where children can build all kinds of things simply by bolting together metal parts that are punched with holes. It was/is a brilliant toy that allows a child to give full reign to their imagination. There were Meccano children and there were Lego children. I was a Meccano child. Same kind of toy, and these days both offer far more creative and contemporary versions than those in my childhood. I think today, Lego is probably more popular. My grandchildren love Lego, and the last gift I bought for one of them was the Ford Anglia from the Harry Potter film.

Lego was first created and sold in Billund, Denmark. Today there is a visitor’s attraction, just a few hundred yards from the original Lego factory - somewhat predictably, perhaps, it is called Lego House. Apparently, it is a place that contains some 25 million Lego bricks and has some of the world’s largest and most complicated Lego structures. It offers a highly interactive opportunity to explore the Lego universe. All for a day ticket costing just £30 (plus flights to Denmark). The experience sounds a million miles away from the experience offered last week at the Brick Fest Live event in Birmingham, which is actually just 869 miles away from Billund.

It was billed as having over a million Lego bricks on display or that you could play with and would allow families to enjoy mind-blowing creations from around the world. The reality was apparently something quite different. Reportedly, there were just a handful of stalls, a Lego play pit and a very expensive café in the vast exhibition centre at the NEC. It did cost just £18 (plus trains to Birmingham) to gain admission. It resulted in a huge backlash on social media, with people complaining it was a waste of their time and money. Judging by the sheer volume of comments, to say visitors were disappointed would be an understatement.

Last week, I found myself in a place where I could empathise with the Brick Fest visitors. I attended a workshop facilitated by our (Greater Manchester) Integrated Care Service colleagues. It was held in Manchester, and there was no admission fee, although car parking came to £9.50. The workshop explored population heath and prevention. The aim was to provide an overview of the approaches and priorities for improving population health and tackling health inequalities across Greater Manchester. All the workshop participants were Non-Executive Directors from NHS provider Trusts across the city. We were there to look at how NHS Trust Board members could address health inequalities and prevention as part of our core business. We had been provided with a 56-page slide pack that provided some context, and examples of the priorities being pursued. I was both disappointed and dismayed that mental health (and wellbeing) was not mentioned on a single slide. Whilst getting people to stop smoking and reducing avoidable diabetes and cardiovascular disease is clearly important, many of our emergency departments are filled with folk, who present with mental health issues. Some of these folk are using emergency departments as their access to ‘primary care’ and others because of the long waiting time from referral to receiving care from services.

This is particularly the case for children and young people. There are more than a quarter of a million (270,300) children and young people, who are still waiting for mental health support after being referred to mental health services. In 2023, some 40,000 children and young people had waited over two years for the help and support they needed. The opportunity for children to grow, learn and explore the world through play is important. Toys such as Meccano and Lego are brilliant in this regard. However, as children and young people grow, ensuring health and care services are available to help them as they encounter life’s challenges is equally important.  We need to build bridges to better mental health and wellbeing, and not out of Meccano or Lego. The bridges we need, must be built with love, compassion, understanding and shared care.