A day spent well, brings a happy sleep

Wow last week was a busy one, but immensely varied and interesting. Tuesday was the first of several long workdays. Much of the day was spent at my Trust headquarters, a day that also included my annual appraisal. Thankfully it appears folk felt the last year had gone well, and we were making great progress with our recovery plan. It was good to hear the feedback and reflect on both where we had come from and where we were headed.

That evening, I joined colleagues from the Jewish Action for Mental Health group. I had been invited last March to meet with them to discuss how we might work more closely together. There are large Jewish communities across the areas in which we provide mental health services, so it makes perfect sense. I really enjoyed that initial meeting and pledged to work more closely with them. I provided them with an introduction to colleagues at the Greater Manchester Integrated Care Board.

Last week’s meeting was different. It was the premiere showing of a film that explored the notion of suicidality in orthodox Jewish communities. Last year I had been able to go and observe the film being made. It was a different day out for sure. Last Tuesday I had been invited to be part of a panel to discuss suicide (and as it turned out), other more general questions about mental health services. The film was excellent. I was thankful it had subtitles, as some of the words and names used were beyond my understanding and/or awareness.

The panel was a chance to explore how individuals, families and communities might recognise and respond to someone contemplating ending their life through suicide. The World Health Organisation notes that 720,000 people globally end their life through suicide. In England alone, 17 people a day die through suicide. It is the third biggest cause of death among people aged 15-29, particularly males. The welcome I received and networking opportunities over the course of the evening made the very late ending of the day worthwhile.

Wednesday was another long day. It was Day One of this year’s NHS Confederation annual conference. Fortunately, it was held in Manchester, so I was able to do a couple of hours work in the office before catching the tram into Manchester city centre. I got there about 10am and was absolutely stunned by the sheer number of delegates. Now several colleagues were also in attendance, but over the whole day I only saw two other colleagues from our Trust. Jane’s youngest was also there, and it was complete serendipity that I bumped into her. She appeared to be really enjoying the experience.   

Whilst it was crowded, it was a great opportunity to network, and I was able to catch up with some longstanding friends and colleagues from around the UK. The standout presentation for me was from the NHS England Chief Executive, Sir Jim. His was the most popular session by far, and the audience filled the large auditorium, and an almost as big conference hall too! His was a perfectly paced presentation that touched upon a number of existential issues facing the UK and the NHS, but always with pragmatism and an inclusive tone.

I had seen Sir Jim just eight days earlier at a meeting of North West NHS System Leaders in downtown Bolton. I didn’t know he was going to be speaking there until the day of the meeting. In my blog the previous Sunday, I had been talking about the announcement of the so-called mental health emergency units. I ended the blog by saying that if I could have a conversation with Sir Jim, I would talk to him about investing in community and neighbourhood services. Two days later there he was so my opportunity arose. As I told the meeting, it was like a dream come true – which made my colleagues laugh.  I was pleased to be able to ask him a question which last week he built upon in his presentation, referencing the Bolton meeting.

However, what made the day a long one was my attending the evening drinks and canape reception. There was plenty of food and wine, and great company too. However, my hotel was a good 30 mins tram ride away, and when I got there, I still had an hour’s work to catch up on. But like my evening with the Jewish Action for Mental Health colleagues, I did go to sleep once again thinking it had been a worthwhile way to spend a day.

Climbing the continuous care mountain

There comes a time in everyone’s life when tackling clearing out the loft is a must do. We are in our ‘forever home’ now (at least I hope we are) and decided to take a look in the loft to see what we could get rid of. We thought it was better we do it than leaving it to the children to do, when we are gone. We didn’t get very far. I pulled out a couple of rucksacks that contained my old climbing gear. Taking out all the bits of equipment brought back many great memories.

As Jane and I talked about these memories, it was clear that nothing else was likely to be removed from the loft, and the hatch was once fastened again. The one critical bit of equipment missing from my rucksacks were my climbing shoes. Climbing was the only sport I was ever good at* - but without climbing shoes, I was never getting off the ground again.

For some reason, probably prompted by the nostalgia generated by my talking about my climbing exploits, I decided I needed to buy a new pair of shoes. We both got a bit carried away with the idea. We visited our local sports centre and were shown around the fantastic climbing and bouldering walls. I signed up – but still didn’t have any shoes. They are not the kind of thing you can buy online. We tried a few outdoor shops, but without success. I’m still looking; which actually is strange.

These days climbing a ladder is something I try and avoid. So, contemplating climbing a crag, rock face or a mountain felt a little strange. I have no problem with heights, but these days I’m much more aware of the possible consequences of falling, tripping up, slipping and injuring myself. I wonder (maybe worry) who might care for me should that happen. This is something brought home to me following Jane’s brain injury.

Whilst her Central Brain Fatigue (CBF) is still a day-to-day problem, physically Jane is fine. The CBF is linked to her short-term memory problems, and whilst her brain can process familiar tasks and activities, new and novel experiences can be a real challenge. Following her discharge from hospital, we had just one out-patient appointment and nothing since. It has been nearly 4 months since she left hospital. We have carried on and coped as best we can. At times it’s felt like a mountain of a different sort we were climbing. We found out last week, life could have been so much better.

A few weeks ago, I contacted the hospital and spoke with the specialist neurological nurses and explained that Jane was still experiencing the same problems as when she was discharged from hospital. The nurse said as Jane had been discharged, she wasn’t under their care now. However, they would make a referral to our local Community Services. And so it was that last Friday, Iris** knocked on the door, ready to undertake an assessment.

Iris was a quietly spoken, calm woman. She was an Occupational Therapist and specialised in working with people who had experienced a brain injury, disease, stroke or other life-changing brain events. I stayed in the room during the assessment, as Jane had given permission and wanted me there to help her remember the discussion. It was such a relief to talk with Iris. Not only was she knowledgeable, but she was also reassuringly confident about helping to make a difference to Jane’s quality of life. She embodied compassionate care. Over the two hours she spent with us, we realised that had we been able to start some of the therapeutic interventions earlier, Jane’s recovery might have progressed much more quickly. Thankfully, Iris will start her therapeutic work with Jane next week.

Reflecting on our experience, I was reminded of the large number of people we have in our acute and mental health beds, who don’t need that level of care. What they do need is some form of ongoing care and interventions closer to home that will keep them well and able to enjoy a good life. Often that might not be readily available, so they stay in hospital. We describe such folk as Clinically Ready for Discharge. In times past, they would been described as ‘bed blockers’ - a dreadful term.

My reflection made me realise that ‘discharge’ can be such an inappropriate term. For many people, their treatment and care is simply taken up by another provider. This should be a seamless and consistent approach. Sadly, this is not always the case. Whilst I will always continue to strive for such improvements, I think perhaps I will give up my search for climbing shoes and stick to walking!

*I was ‘lured’ into the world of climbing by a senior clinical psychologist working at the hospital at which I am now the Chair, albeit that was 40 years ago. He kept me physically and psychologically safe, whilst introducing me to my first climbing experiences. Thank you CM.

**not her real name

Creating a place of calm in Bedlam?

When Jane had, at the time an undiagnosed, brain bleed, our first port of call was our local Urgent and Emergency Care (UEC) services - (in old money, the A&E department). We were seen and triaged within 10 minutes of arriving. The waiting area was quiet, warm and welcoming. All very encouraging, I thought. However, as I sat and watched ambulance after ambulance roll up, I thought we were going to be in for a long wait. I wasn’t wrong. The passage through the unit took many hours. At times, Jane was cared for on a trolley in the unit’s corridor. Eventually, and thankfully, she was blue lighted to a specialist neurological unit at a different hospital.

It was clear that the demands on the emergency service were unrelenting. There was a degree of chaos about the place, but everyone we encountered was calm, civil and sympathetic. That didn’t stop me feeling almost overwhelmed by a sense of being totally unable to help or protect Jane in her moment of need.

Crowded emergency departments result from a range of reasons. It’s estimated that over a third of people presenting at an emergency department, don’t need to be there. Their issues are either self-limiting or can be treated by primary or community care services. However, these people still need to be seen. Some folk who present with non-life-threatening problems, may be diverted to a Same Day Emergency Care (SDEC) centre, or an Urgent Treatment Centre (UTC) either at the hospital or in the community. Both these service provisions have been around for some time but the demand for emergency care services keeps growing.

One other issue is the availability of a bed, if someone needs to be admitted. Again, SDEC and UTC services can help here. There can be large numbers of patients already in a hospital bed who are medically fit for discharge, but for various reasons cannot be discharged. Often, it’s because their continuing health needs can’t be appropriately or effectively met by community services. These difficulties stop the ‘flow’ of patients through the hospital. It is a national problem, and not just for those with a physical illness. The problem applies equally to those with mental health issues, whose needs could be better met in the community rather than a hospital. Often such services are simply not available.

In many parts of England, the available health resource is disproportionately focused on the provision of hospital-based care. As I noted in a recent blog, hospitals are still viewed by most people to be the ultimate safe provider of health care. There are not enough health and social care staff or adequate community facilities available to shift this dial. Perhaps reflecting how difficult it is to free up transpositional funding (from hospital to community), back in 2023, the then UK government announced a £150 million allocation to improve UEC services for those people presenting with a mental health crisis.

Last week, NHS England announced it would be using this investment to develop a national network of dedicated mental health emergency units. We already have some of these types of units operating. They do indeed promise to see everyone within 10 minutes, assess their needs and start whatever intervention is deemed appropriate to meet those needs. The announcement was largely welcomed by many involved in providing mental health care, and I too welcome any additional investment in future mental health services. That said, I do wonder about this approach.

UEC departments can be a frightening place. Having somewhere that is calm and welcoming would clearly be helpful for someone experiencing a mental health crisis. There are examples in the UK and the US, where such services have been set up and which do appear to provide a more appropriate alternative to the more general UEC service. However, the same issues described above that slow down the ‘flow through’ current UEC services would also apply to a dedicated mental health UEC. The availability of beds to admit people into, already means that people can be placed a long way away from their home if an admission is required.

As yet, we don’t have a range of comprehensive community services that might steer people away from a hospital admission, and the national difficulty in recruiting to the mental health workforce adds to these problems. If I were talking to Jim Mackey (Chief Executive NHS England) I would be urging him to focus more of the available funding on early intervention services and community services that are intentionally integrated, and which reflect local neighbourhood needs. It might be literally a case of watch this space.

Experiencing a good death at the end of a good life

Academia is a great place to meet folk. During the ‘active’ period of my academic life, I was fortunate to meet many interesting and generous people. One of whom was Andrea Pokorna. She is a nurse by background and works at Masarykova University in Bruno, Czech Republic. I met Andrea many years ago on an Erasmus Exchange programme. We met each other again, a few years later, when we were both part of a European Union funded Lifelong Learning Programme project entitled ‘Empowering the Professionalisation of Nurses through Mentorship’ (EmpNURS). It was a project that involved seven European countries: Romania, Finland, the Netherlands, Lithuania, Czech Republic, Hungary and the UK. It ran from 2010-2013 and was great fun, as well as having very tangible outputs to improve the clinical learning environments for student nurses. It was my last big research project.

A year after the project ended, Andrea invited me to speak at a conference exploring ‘End of life care’. This wasn’t an area in which I had particular expertise or experience, so I promptly offered the place to a colleague who worked in my School, and who was most definitely an expert. I learned a great deal from him, including the notion of what a ‘good death’ might mean. Unfortunately, he couldn’t attend the conference and as I didn’t want to let Andrea down, I went.

My paper started by critiquing the ‘Liverpool Care Pathway for the Dying Patient’ (LCP). This was a so-called evidenced approach to the care of the dying person. It was a protocol-based approach to providing healthcare treatments. In my opinion, such approaches can be somewhat indiscriminate, putting protocols before the person. Along with my long-term writing partner Prof Sue McAndrew, I have published many a paper on this issue, see for here for example. In the case of the LCP, it often became a self-fulfilling prophecy. If you were put on it, you were said to be dying – even if you weren’t.

By the time I was presenting my paper in Bruno, the LCP had fallen into disrepute as a compassionate way to care for a dying person. It was following the care provided to a relative of the then MP Rosie Cooper, that its inadequacy as a way to provide dignified and compassionate care at the end of someone’s life received the greatest political scrutiny. Rosie (no longer an MP) is now Chair at Mersey Care NHS FT, a stone’s throw away from where her relative was treated. The LCP was thus phased out as an approved approach. Alternative, and more patient-centred approaches were introduced. It was these that I spoke about at the conference, particularly the emergence of the Advanced Care Planning concept.     

This was an approach that engaged with an individual who might be facing a life-shortening condition, their family, and the professionals involved in that person’s care. It is an approach that builds upon conversations between all these folk. These conversations allow for careful and informed consideration being given to the person’s future wishes and priorities for their care. Whilst these conversations can happen at any time, it is good if they can occur before decisions about someone’s care become critical. One of my sisters and I were able to have such conversations with both my parents. At the time my mum was beginning to show signs of dementia. The four of us agreed that my sister and I would become Lasting Powers of Attorney for both my mum and dad, and for their health and welfare (finances).

Last Tuesday, my mother died. Her healthcare journey over the past couple of years has been interesting, but at times challenging. My mum spent a long time in an inappropriate acute setting, before being finally admitted to a residential care home. Along the way we have participated in several ‘best interest’ meetings with both health and social care professionals. They have always taken time to hear our views and in the main, these have been respected and acted upon.

I have no complaints about the care my mum received in the care home. My dad visited my mum every day and the staff there made him feel a valued part of the care family. When last week, my mum died, I would say she had a good death. She was pain free, comfortable, and had her husband and some of her seven children with her at the bedside.

My mum was an incredible person. As well as bearing seven children, she fostered countless others over the years. Alongside my dad, she worked with many more children and young people, whose lives I’m sure they enriched through their care, compassion and wisdom. It has been a strange, almost surreal week, but I write this blog in a spirit of thankfulness, knowing my mum is finally at peace. 

In my case, getting to 70 years old calls for a glass of champagne!

Apparently, people like me are keeping the UK economy going. More of which later. First, last Thursday, Jane and I enjoyed a champagne afternoon, thanks to Sue, my best friend and longtime co-writer, who had gifted me the champagne for my birthday. Jane’s birthday gift to me was a week cruising the Calder & Hebble Navigation in a wonderful narrowboat. Drinking champagne, whilst relaxing on our little red boat, turned out to be a great birthday treat. Last Thursday was my 70th birthday, and as we sat in the sunshine, with the boat gently rocking, sipping our bubbly, it was a chance to talk, laugh and share seven decades of memories.  

Childhood memories were, for me, the hardest to recall. However, I did remember some of the TV programmes. Andy Pandy and The Magic Roundabout, and through my children’s and grandchildren’s eyes, the Wombles, Telletubbies, Pingu and In the Night Garden. Watching television as a child was strictly limited, and always a family event. The television was black and white and had just three channels. Compare that with what is available today. We have four giant flat screen TVs in our house but rarely watch any television these days. The choice of what to watch can be almost overwhelming.

The same is true of music. I first started listening to music via Radio Caroline, a pirate radio station broadcasting from way out at sea. It was the precursor to Radio One, Top of the Pops, MTV and all that followed. Now via my phone or Alexa, I have instant access to thousands of different music tracks. YouTube means I can also see my favourite groups, as well as hear them, and again, completely on demand whenever I want.

However, I have always preferred live music. I’ve seen many famous artists and bands play live; some of them more than once, including Bob Dylan, Rolling Stones, Rod Stewart, Leonard Cohen, Coldplay Led Zeppelin, U2, Coldplay and Pink Floyd. Sadly, I have never been to Glastonbury, nor the Last Night of the Proms, and I missed going to Woodstock due to being a couple of years too young. I also like to play music and have been collecting guitars for many years. Last year I was able to purchase a Gibson Les Paul (Studio) - if you know you know.

Over the years, I have had some great jobs too. I was a Sainsbury’s management trainee, living above the store, later a window dresser for a large tobacconist, as well as a healthcare assistant, Student nurse, Staff nurse, Charge nurse, Nursing Officer, Corporate NHS director, Lecturer, Senior Lecturer, Professor, Head of School, Dean, Pro-Vice Chancellor. I’m not sure which of these roles I enjoyed the most. I loved being a nurse, and the building of therapeutic relationships. But my time spent in academia was probably one of the most rewarding. It was (is) a real privilege to have my research and opinions published and then to see others making use of my work to further their own exploration of the world.

Keeping the UK economy going? Well, it appears that ‘70 is the new 50’. The International Monetary Fund in its recent publication The Rise of the Silver Economy noted that many folk in their seventies are fitter, sharper and healthier than previous generations. They found that people in their seventies today generally had the same cognitive and physical capability, as people in their fifties had over a decade ago. These folk who choose to continue to work, fill the skill gaps across many sectors. For some, continuing to work past the normal retirement age is a financial necessity. Others, and I include myself here, choose to work past retirement because it is a pleasure, and very fulfilling. That said, I won’t keep working indefinitely. I have other interests to nurture these days.

Ironically perhaps, while much of my research was based around ‘relationships’, I’ve not always been very good at these in my personal and family life. However, that is a topic for another blog maybe. I have, however, found my soul mate in Jane, my wife. We share a very happy life. It is a love story that is nurtured by taking time to make memories together. Last week, as we travelled slowly along the canal and river, we made many more.

Back in January, following Jane’s brain injury, I wrote a blog that considered the importance of a healthy life-work balance. We really do only have one life. We should never get so busy making a living that we forget to make a life. And occasionally, why not try and have a glass of champagne. It is good for your heart physically, and it’s good for your heart emotionally too.

Remembering those who gave us this day, and remembering to make every day count

Last week was an interesting one for sure. Thursday was VE80 (Victory in Europe) day. The day celebrates and remembers, in equal measure, the ending of World War II, 80 years ago (well in Europe at least). I was born 10 years and 7 days later. During the week leading up to the 8th May, we, in our little community up here on the Fylde coast, demonstrated our remembrance and thanks with flags, bunting and door knocking on each other to share thoughts and memories.

Unfortunately, on the Thursday, I was at work. It was our Board Day. At Board, I reminded folk of the ongoing conflicts across the world and the fact that we provide mental health care for those traumatised by conflicts old and new. We observed a minute’s silence before we started our meeting, and that felt like the right thing for us to be doing.  

Currently, I’m writing this blog somewhere on the Calder & Hebble Navigation. It is Day 3 of our canal journey. The trip was partly inspired by watching the Timothy West and Prunella Scales TV programmes showcasing their many canal trips, and partly by my desire to retire and live on a narrowboat. At the moment, neither seem likely, but Jane thought I should try a short break, living on a narrow boat. She organised the break as a surprise birthday present. And here we are. 

We should have been on the Rochdale Canal but because it’s been so dry, it was closed. We were very disappointed as both Jane and I are familiar with the area, and love the hills and towns that line its length. We were also going to have a birthday catch up with friends and family at the wonderful town of Hebden Bridge. It was not to be, and we will celebrate at Brighouse instead later today.

I was also disappointed that we were not going to be on the Rochdale Canal as it has a unique place in British social history. Despite being a hugely busy canal in its heyday, by 1952, most of the Rochdale Canal had fallen into disrepair and was unnavigable. It remained closed for many years. It took from 1974 to July 2002 (plus a grant from the National Lottery Millennium Fund) to fully restore the canal and to make it once again navigable along its full length from Sowerby Bridge to the heart of Manchester city centre. 

Interestingly, the restoration of the Rochdale Canal was helped by folk on the 1975 Job Creation Programme. This was a programme designed to provide jobs (often short term) that had some ‘social value’. Although initially it was aimed at young people aged 16 -24 and those aged 50 and over, it was later opened up to anyone who was classed as long-term unemployed.

As far as the Rochdale Canal was concerned, the Job Creation Programme was a great success. At its height, some 450 folk were working on its restoration. As the programme only allowed people to stay on it for just 12 months, over the years many thousands of people were able to acquire a range of skills and experience to help them gain fulltime employment. Being gainfully employed is good for our mental health and wellbeing.

The World Health Organisation notes that some 60% of the world’s population are employed. That in itself is clearly a good thing. Work can promote good mental health and wellbeing by providing a sense of purpose, and an opportunity to develop positive relationships with others. Being employed also establishes a routine and helps build self-confidence and a sense of achievement. The opposite of this is true of course. Poor and/or unsafe working conditions, job insecurity and oppressive organisational cultures are likely to have a negative impact upon our mental health and wellbeing.

For me, the wellbeing of colleagues is paramount. Like the rest of my team, we all regularly ask each other how things are, and are they okay? It is of course, okay not to be feeling okay. I’m also rigorous in ensuring folk take their annual leave; I know from my own experience that when you don’t take sufficient rest, it’s something that can lie you low. And that is a good place to end this blog. I’m going to sit and watch the world wake up before getting under way once more.

Remembering Mavis, who made the ordinary extraordinary

Back in 2004, one of my PhD student's successfully defended her thesis and was awarded her doctorate. She was a colleague, friend and a mental health nurse. Back in the day, she worked as a Community Psychiatric Nurse (CPN). I knew her from her university days. Sadly, after a battle with breast cancer, she is no longer with us. She came to mind this week, as I made my way back from spending a day interviewing, more of which later.

Mavis (not her real name) chose ethnomethodology as the way to undertake her research. Her study focussed on nurses working in acute mental health in-patient units. In true ethnographic style, Mavis spent many shifts, both as a participative and non-participative observer, in several mental health services across the North West of England.

Ethnomethodology, as an approach to sociological research, was first described by the American sociologist, Harold Garfinkel who explored how jury members used common sense, evidence and social position when determining whether someone was guilty or not. In his work, he was interested in understanding what the ‘social order of being’ might be in a particular setting.

For Mavis, this gave her a focus on how mental health nurses saw themselves as nurses, therapists and builders of therapeutic relationships with patients being cared for in an in-patient setting. What she succeeded in revealing was the often extraordinariness of what others (including the nurses) saw as ‘just’ being ordinary encounters.

So, helping a patient with their laundry doesn’t usually get described in nursing practice textbooks as a defined therapy. However, Mavis observed ordinary, everyday encounters like this and in so, doing witnessed either the development of a therapeutic relationship, or the nurturing and strengthening of an existing one. Over the 24-hour period, Mavis saw many such micro therapeutic interactions.

It was only in holding up the ethnomethodological mirror that the nurses were able to see the value in what many of them thought of as being routine, non-therapeutic encounters with the patients they cared for. It was a powerful message. Some 21 years later, it is still one that mental health nurses should not ignore.

Some of the work Mavis observed the nurses doing has since been ‘delegated’ to others. The development of the Support, Time and Recovery (STR) workforce is one such example. It is a contemporary example of what Mavis found within the mental health nursing workforce. STR colleagues provide what I think is a truly supportive service, and in many cases, the work they carry out enables a range of these micro-therapeutic opportunities. Over time, and with the appropriate support and training, such opportunities can be truly beneficial to patients. It is the little things that so often can be the really big things in people’s experiences of health care.

That interview that sparked my reflection? Well, the interview was for a new Chair at one of the mega group acute health care NHS Trusts. Being on the interview panel is one of the things I enjoy about my current role, and I recognise the great privilege I have to be involved at the start of something new, and something exciting. The interview last week was one of these opportunities. It was the second time I had been involved with this Trust; the first time they were unable to appoint. This time round, they did. I wish the successful candidate well; they have a tough job ahead of them. It felt like a good day, but of course, the unsuccessful candidates might not have seen it that way.

On my way home from the interview and being stuck (which feels almost inevitable these days) on the M6, I reflected on the day. I thought about the folk I had been sitting around the table with over the course of the day. Every one of them, including the candidates, were in different ways, ‘extraordinary’. Yet, you wouldn’t know this, if you sat beside them on the ubiquitous Manchester omnibus (younger readers think Tram). They were all good people. In their own way, each was making an extraordinary contribution to the mental health and wellbeing of others. In a highly troubled world, I felt sure Mavis would have approved.

A once in a lifetime (well mine anyway) opportunity to change UK health care

Last Wednesday, I attended the NHS Confederation Annual Mental Health Network Conference. It was held in the rather grand Cloth Hall Court building in Leeds. Hooray, we didn’t need to travel to London. Sally Warren was one of the speakers*. For those folk who perhaps have not been keeping up, Sally is leading on the development of the NHS 10 Year Health Plan. She has the rather grand title of Director General.

The plan is due to be published in June. Sally was never going to tell the conference what the plan would say. However, she did share information about the consultation around it, some of the emergent themes, and what had been said about current and future mental health services. You can find out more about how the consultation was undertaken and how the 10 Year Health Plan is being developed here.

She started her presentation with a question. If you asked a room full of people, the kind you find on the ubiquitous omnibus, would they like to be in hospital today, what would they be likely to say? I can almost guarantee that nobody would put their hand up and say ‘yes please’. Yet surprisingly, Sally noted that the majority of people would inevitably say that the hospital is the best place to receive their health care.

It was an observation about hospitals noted by many people during the consultation process. However, the number one concern that participants raised was around access. People were concerned that they couldn’t gain access to their GP, A&E or to dental care. When people did get access to health services, they reported experiences that were fragmented and uncoordinated. The more people interacted with NHS services, the more uncoordinated people found their treatment and care to be. Linked to this was a concern, expressed by healthcare professionals. Many felt they couldn’t always maintain their professional standards when providing care to those they looked after.

People wanted what we have now to work better. There was, however, an almost universal agreement that more could be done to tackle the underlying determinants of poor health and health inequalities. That said, it appears that many people found it hard to visualise, and understand, what a future health service might look like. This was particularly the case over the increased use of digital technologies.

Comments from NHS colleagues suggested something similar. Collectively, we tend to underestimate what might be possible over the next 10 years, and overestimate what can be achieved in just one year.

From a mental health perspective, there were several observations that sadly resonate with those of us working in mental health services. Top of the list was a desire for parity with physical healthcare services. There was a particular concern that we should make funding for mental health services compared to physical services, a lot more transparent than the current situation. I’m not sure this will really help achieve parity, sadly.  Stigma still seems to get in the way of folk seeking early help. Rightly so, there was concern that we are still not meeting the needs of children and young people effectively. We need to banish out-of-area placements for people who need a mental health bed; reduce the length of time people spend in hospital; and for those ‘stuck’ in hospital, to find better community-based solutions for their continued care. There was much more to be told, but readers of this blog will have to wait for the plan to be published to learn the full picture.

Intriguingly, the plan, when it is published, will seemingly not have individual chapters on various services. Cancer, mental health or cardiovascular disease for example. However, Sally did not elaborate on how the findings will be presented instead. Hence my intrigue. Of course, having a plan is one thing, implementing it will be the acid test. Arguably, over the course of several different political parties promising to make the NHS better, the social contract between the public and the NHS appears to have been broken. I hope this is not the case. NHS colleagues, local authorities, communities, and voluntary organisations need to hear the voices of those who participated in the NHS 10 Year Health Plan, and act. It really is a once in a lifetime opportunity to change.   

 

*Other speakers included Claire Murdock – ‘be angry and don’t sleep’ and Jim Mackey ‘if you are not living in mental health services, you see mental health as a single entity’

Easter happiness and chocolate eggs

In April 2022, Jane and I went to the Holy Land. It was a pilgrimage and something Jane had always wanted to do. Originally, we were going to do it for our honeymoon. Like so many things, Covid19 got in the way. We were able to follow the life journey of Jesus on our pilgrimage, visiting places only known through reading the bible. We were there for Palm Sunday and joined many others tracing the walk that Jesus took on his way into Jerusalem. The whole experience was both humbling, exhilarating and totally fascinating.   

We took communion in a rudimentary open-air chapel on the shores of the Sea of Galilee. There was a stillness that reminded me of Easter Sunday. Here in the UK, most shops are shut, and that usual Sunday bustle is missing. There is a stillness to the day that I have always found special and uplifting. Easter itself is both a Christian and a cultural festival. For Christians, Easter Sunday commemorates the resurrection of Jesus Christ three days after his crucifixion. Although we decided to give the sunrise service on the promenade a miss this year, we will be going to our church later this morning. We do so as an act of celebration and worship, as I’m sure many other folk will be doing across the world.

For some, Easter is simply a cultural event. There are many traditions associated with it. Some are quite bizarre. For example, in Poland, they drench each other with buckets of water. People in the Czech Republic decorate long sticks with ribbons and tap women with them apparently to transfer the stick’s fertility to the women. Italians are fond of Exploding Carts. These are carts filled with fireworks, which after being paraded through the streets, are lit, treating the crowds to a wonderful display.

On the other side of the world, Australians have ditched the Easter Bunny in favour of the Easter Bilby. This is an endangered and curious looking marsupial, the numbers of which are falling. Rabbits are still considered pests in Australia, so no Easter bunnies. There is a Greek Easter tradition whereby eggs are dyed red (symbolising the blood of Christ). After the mass on Easter Sunday, these eggs are used a little like conker fights. Each person cracks their egg on another person’s egg, the winner is the last person with an intact egg. Colouring eggs at this time of the year is something that many people still do. I wonder how many people today actually know why.   

Likewise, I wonder how many people know why we give chocolate Easter eggs to others on Easter Sunday. Interestingly, the origin of the Easter egg pre-dates Christ’s crucifixion. As a tradition the Easter egg has its roots in both Christian and pre-Christian customs. The egg has long symbolised new life and fertility, something celebrated by many ancient civilisations across the world. The egg symbolised the return of spring and the rebirth of nature. Indeed, four of our hens have gone broody and are sitting on eggs.

Early Christians adopted this symbolism, associating eggs with the resurrection of Jesus. Indeed, in times past, during the period leading up to Easter, called Lent, eggs were not allowed to be eaten. They were often boiled, stored and then given away on Easter Sunday. It’s a tradition that over the years has metamorphosed into the giving of a gift of chocolate Easter eggs today. In the UK we buy some 80 million Easter eggs each year. That’s a lot of chocolate eggs. If they were laid end to end, they would stretch along the entire length of the Great Wall of China.

I will shortly be delivering little Easter bags for our neighbours. These are filled to the brim with Easter goodies, including, of course Easter eggs. We have done this every year we have lived here. It is a small gesture of friendship, of reinforcing our sense of belonging to a community, and we hope, a gift that also makes our neighbours smile.

In a world where self-interest, greed and conflict can sometimes feel all consuming, spreading a little happiness feels like a good thing. Perhaps I can slightly tweak John F Kennedy's famous line and say: 'Do not ask what the world can do for your happiness - ask what you can do for the happiness of the world'. It doesn't always need to be a big thing; sometimes it is the little things that can really make a difference.

Life is what happens to us while we are busy making other plans…

I’ve been a Rolling Stones fan all my life. Last Summer, I took a long weekend trip to Vancouver, Canada, to watch what I thought might be one of their last ever concerts. I was not disappointed. The cost, and the time spent travelling, was worth it. In my youth, you were either a Rolling Stones fan or a Beatles fan. Both were great rock groups. These days, it’s only the Rolling Stones who are still making music and playing stadium concerts. That said, using some state-of-the-art digital magic, in 2023 the Now and Then single was released. It became known as the last Beatles song ever.

However, the Beatles’ popularity has merely dimmed slightly, not diminished. I once came across a Beatles’ karaoke festival in Tokyo, drank a cocktail in Lennons, a rather swish bar in Bangkok, and here in Blackpool, we have our own Beatles-themed bar, the Yellow Submarine. All these places celebrate the huge contribution the Beatles made to music*. 

Last night, we shared in that celebration. My middle daughter’s Christmas gift was a pair of tickets to go to a concert at the Cavern Club in Liverpool. The Beatles played there 292 times during the early part of their musical career. Jane and I had only been there once before and that was just a tourist visit. Last night was a ‘Saturday night with the Cavern Club Beatles’ experience – a fantastic tribute band, a great atmosphere and a wonderful opportunity to step off the roundabout of life for a bit. We had decided to stay over and make it a bit of a date night and I’m writing this from the comfort of our sumptuous hotel bed.

Now some readers will have recognised this week’s blog title, which was made famous in John Lennon’s song, Beautiful Boy (Darling Boy). In fact, it was Allen Saunders, an American cartoonist and writer who is credited with first using the phrase, way back in 1957. Indeed, John Lennon slightly tweaked the original in his song. His tweak: ‘Life is what happens to you while you’re busy making other plans’ resonates for lots of reasons.

At my NHS organisation, we have been working on our next five-year strategy. It has been a long process of consultation and co-creation. I read the latest draft last week, and I wasn’t thrilled. The strategy had all the elements you might expect, but absolutely didn’t reflect that ‘life’ had been ‘happening’ while colleagues were writing the plans. In the NHS context, we have witnessed an almost seismic and sudden shift to an organisation we were all familiar with, perhaps even at times, comfortable with. The NHS hasn’t always been perfect, but most of the time it’s been a service you would turn to, when you needed help.

For many folk working in the NHS, that comfortable and familiar world changed dramatically on 13th March this year. The government announced that NHS England (NHSE) would transition and become part of the Department of Health and Social Care (DHSC). For this to happen, a 50% reduction in the number of folk working at both NHSE and DHSC was called for. Likewise, Integrated Care Boards have been ordered to reduce their expenditure by 50%, and NHS organisations like mine will also have to reduce corporate costs by 50% too. Undoubtedly, this will result in redundancies for many, both voluntary and compulsory.

Now, I am lucky in that I have never been made redundant. All my career choices and changes have been made, because at the time, it felt like the right thing to be doing. I have always felt in control of those decisions. Of course, this was entirely delusionary on my part. We can never control every aspect of our lives, and it’s true that life happens while you are busy making other plans. We had planned to travel around Africa this year. Jane’s brain bleed means we won’t be doing that in the foreseeable future. Cancelling our travel plans was disappointing. However, it is not anywhere near as devasting as perhaps the choices open to all those in the NHS, who may now be facing redundancy and an uncertain future, no longer within an NHS career.

It is not important for me to say whether I think these changes are the right thing to do or not, but it is important for me to be compassionate and caring towards all those impacted by these changes. Michael West, in describing compassionate leadership, noted that we should make those we lead and work with, feel valued, respected, and cared for. Difficult to do with those facing such unexpected changes to their careers. I hope those currently leading the national and local changes find ways of managing these compassionately.     

  

*One of the lesser-known facts about both groups was that The John Lennon/Paul McCartney song writing partnership inspired Mick Jagger/Keith Richard to move away from playing cover songs to writing their own legendary songs. However, one of the first hits for the Rolling Stones was ‘I wanna be your man’ a song written by Lennon/McCartney.

Comfortably Numb? – the need to change

The Fylde Memorial Arboretum and Community Woodland is but a hop, skip and a jump from our home. Dylan and I often take a walk there. It is a place to simply pause and reflect on what the memorials mean. It is a tranquil place. A place that remembers the courage and sacrifice others have made on our behalf. It recognises a range of wars and conflicts, but conversely is a place of peace. There is a poignancy about the arboretum that I find hard to describe in words. It is the only one of its kind outside of the national arboretum in Staffordshire.

One of the memorials commemorates those who fought in the Sino-Japanese War. This was a war such as we are currently witnessing in Ukraine and Gaza and other parts of the world. It was a cruel and bitterly fought war. Most of those fighting came from Australia, New Zealand, Holland and Britain. Much of the conflict occurred in Burma, a key strategic country for the Japanese armed forces at the time. Sadly, many of those fighting the Japanese were captured and forced to work on constructing what became known as the Burma Railway.

Over the course of just one year, prisoners of war were forced to build some 258 miles of track. They did so in an incredibly harsh tropical environment.  Many thousands of prisoners lost their lives due to the intense heat of the jungle which they were unaccustomed to, the long hours of labour (often 18 hours a day) and inadequate access to food and water. Diseases such as dysentery, cholera, malaria, ulcerated sores and other skin conditions were rampant.

Older readers of this blog will perhaps recall how this forced labour was portrayed in the David Lean’s film adaptation of the book by the French author, Pierre Boulle ‘Le Pont de la riviere Kawai – The Bridge over the River Kwai’. It’s a film still worth having a look at. Burma is now known as Myanmar. On the 28th March this year, the country experienced a 7.7 magnitude earthquake. To date, over 3,000 people have died, as a result, and nearly 5,000 have been injured. There are many hundreds of people still missing.

Rescue efforts have been severely hampered by the lasting effects of four years of civil war in the country. Myanmar has been an almost closed society for many years, but the ruling military party has asked the international community for help in dealing with the disaster. The international community has started to respond. It is not the first time they have done so. They did so in challenging the treatment of Aung San Kyi. She is a Myanmar politician, diplomat, author and more latterly, a political activist. She was born just four months before the end of the Sino-Japanese War and the ending of World War 2.

Whilst she hasn’t always enjoyed a trouble-free political life, Aung San Kyi is credited with successfully moving Myanmar from a military-led nation to one that has begun to take its first few steps towards democracy. The personal cost to her, however, has been immense. She spent some 15 years under house arrest and is currently in prison once more.  In 2022, on a range of what appear spurious charges, she was sentenced to a further 33 years’ imprisonment (later reduced to 27 years). The United Nations, UK and US have remained resolute in condemning her incarceration, which they denounce as being politically motivated. I feel impotent to help her, other than raising awareness of her plight.

I say this because despite all her troubles in 1990, she was awarded the Sakharov Prize for Freedom of Thought and the Nobel Peace Prize one year later. Aung San Suu Kyi used the Nobel Prize money, some £1.1 million, to establish a health and education trust for the Myanmar people. Just to perhaps put that into perspective, the NHS costs £500,000,00 a day to run.

Last week, I was back in the room with Sir Jim (Mackey) and my fellow NHS Chairs and Chief Executives. The mood was different to that of our earlier 13th March meeting. The former was all doom and gloom. Last week’s meeting was more about recognising the need for change. Folk were up for making a difference and doing things differently. And we need to. Covid19 showed how we could do things differently and why we needed to be more open to embrace different ways of thinking. 

As a nation, we need to spend more time on both primary prevention (getting people to live healthier lives), and also secondary prevention (not always turning to the NHS for help as a first response to health-related problems). Thankfully, we don’t have the awful imperative currently facing people in Myanmar, to change and work collectively to relieve widespread societal suffering. I think we have perhaps lived in an age characterised by folk being comfortably numb accepting that the State would always be there to help with whatever problems they might face. Today there is a new reality. In it, we all need to help each other to embrace the emergent challenges and work together as communities to support each other. Sadly, like resolving the troubles in Myanmar, this might be easy to say and more difficult to achieve. But try we must.

We can’t always choose what happens to us, but we can choose what we do about it

I try and steer clear of politics in this blog, but I have to say, I have become a bit more Canadian of late. The way in which Canadians have started to boycott goods and services from the US in retaliation to the toxic and turbulent politics of the Trump administration has impressed me. I share their dislike of current US politics. Following their lead, I have stopped buying anything made by Heinz (a big US company). This includes one of my favourite foods, baked beans. I have now started to buy Branston’s baked beans, which I think are much better tasting and are healthier too. But there are plenty of other brands to choose from – see here.

The power that comes from consumers exercising choice can have a huge impact. It can disrupt the machinery of the normal, shape policy, politics and the way global enterprises do their business. When, just recently, I said I was boycotting Amazon for a week, Jane, however, didn’t think it would make the slightest difference. Jane may be right in that acting alone, I may never be able to boil the ocean. However, I believed that if enough people all boycotted Amazon at the same time, Jeff Bezos would soon realise the difference this could make to Amazon’s bottom line. Indeed, most of the shares in Amazon are now held by institutional investors and they can be quick to respond to changes in consumer behaviour.

Just like in the ‘Starfish Tale’, we can all do one thing, however small, which can help make a difference. As my fellow blogger, Roy Lilley is oft heard to say, ‘sometimes it’s the little things that are really the big things’. This is certainly true in health care. We can all be somewhat careless in the way we take for granted the surgeon’s or therapist’s skill and knowledge. We perhaps assume that it is there, and we don’t necessarily think about it in the moment when being cared for. It is the little things we often notice more.

When Jane was in hospital, she clearly benefitted from the neurology staff’s skill and knowledge and experience. It was lifesaving. I think she also benefitted from the many day-to-day elements of her care. For example, ensuring her water jug had fresh water, her bed sheets were not tangled, patiently allowing her time to choose her meals, and so on. On their own these were little things. However, collectively they helped ensure the provision of compassionate care for Jane.

Now home, Jane looks well – her hair is finally growing, although it is devoid of the vibrant colours she favours. She can do many things and to the outside world, Jane looks as if she has made a full recovery. That is not the case. This month has been Brain Injury Awareness Month. Rather like not all disabilities being visible, brain injuries can sometimes bely a range of invisible problems. Despite not losing any motor functions, nor her speech, for which we are both truly grateful, currently Jane experiences many of these hidden issues.

This is also the case for high-flying broadcaster Clemency Burton-Hill who in 2020, had a devastating brain bleed, aged just 38. Her early story of recovery was told in a BBC documentary last week, ‘My Brain: After the Rupture’. You can see it on catch up tv here. It is a powerful story and both Jane and I were emotionally impacted by it. Clemency has struggled with far greater physical issues than Jane. Loss of speech, and a loss of sensation on the right side of her body. These were devastating consequences of her brain bleed.

Clemency was a writer, broadcaster and brilliant musician. She loved to play the violin, something she initially lost the ability to do. There is a poignant scene where she starts to work at recovering her musical ability and manages to scratch out a crude version of ‘Twinkle, twinkle little star’. Given she was playing Bach aged four, some might think this wasn’t much of an achievement. It was a tiny step, but you could tell from the expression of pure joy on her face just what a big thing this was.

With both Clemency and Jane, there was no element of choice or conscious decision-making involved in experiencing their brain injuries. In a world where sudden unwanted and unexpected limitations might dominate, it is the little things that can make life less of a challenge. There are still plenty of opportunities to exercise choice, and in so doing, continue to make a difference to how life is lived and experienced. One life, live it. Together, we can. 

A Knockout of Boxers

For the second time in as many months I have a Simon and Garfunkel song running through my mind. Today it is The Boxer. However, I don’t seem to be able to get past the verse:

In the clearing stands a boxer
And a fighter by his trade
And he carries the reminders
Of every glove that laid him down
Or cut him till he cried out
In his anger and his shame
"I am leaving, I am leaving"
But the fighter still remains…

I have played the song on my guitar many a time and depending on how many glasses of the red stuff I have consumed, the Lie-la-lie chorus can be both rowdy and long – you can listen to how the song should be sung here.

The song has probably been prompted in my mind by the many boxer and boxing stories I have heard this past week. Frank Bruno, a great British boxer, and a man of the people. He is someone who has lived with his own mental health problems. Since retiring for boxing, his charity helps folk work through their mental health issues. Last week the story broke of his recent health problems. He cancelled his speaking engagements because of an undisclosed virus that has laid him low. We wish him well and hope he is returned to full health soon.

Bruno comes from a slightly later era than that other great boxer George Foreman. George died, aged 76, last week. He lived a life! Married five times, with 12 children, including five sons, all named George. He was an Olympic Gold Medal winner, and a double heavyweight world champion. Although he lost the famous fight - the so called ‘Rumble in the Jungle’ - to Muhammad Ali, he won 76 of his fights, almost double that of Ali. Indeed, he only ever lost five of his matches. Interestingly, Foreman made nearly as much money selling his George Foreman grills, as he did from boxing.

Back in 1974, ‘that fight’ was hosted in the Democratic Republic of Congo (DRC) to help boost tourism. Today the DRC is in the midst of a humanitarian crisis. The International Rescue Committee reported last week of a ‘catastrophic deterioration in health service and humanitarian conditions’. The DRC crisis is putting some 11 million people at risk, but sadly their plight is largely overshadowed by the equally dreadful events in Ukraine and Gazza.

And last week I came face to face with Manchester’s own boxing legend, Ricky Hatton. He has been a world champion in 2 different weights, and although now retired from boxing, he is a great supporter of mental health charities. Like Bruno, in the past, he has lived with some difficult mental health problems. He was the VIP guest at the official opening of North View, our Trust’s award winning and state-of-the-art inpatient facility. 

Costing some £105 million, it provides 150 beds in what Ricky described as a ‘5-star hotel’ environment. It is a great place for sure. The building has taken nearly three years to complete, but it came in on time and on budget. Much of the design of the building, and how it might be best used was co-produced with carers, service users, members of the community and with many of my colleagues.  

I was pleased to host the event, and whilst I agreed with Ricky that the facilities were indeed 5-star, it is the folk who work in North View that can make the biggest difference to service users’ experience of mental health care. Ricky was a fabulous co-host, and one of the kindest and confident people I have met in a while.

His presence last week reminded of a visit I once made to Lagos, Nigeria. I had been invited by the East African Nurses Association to speak at their annual conference. For all kinds of reasons, I found Nigeria to be one of the most frightening places I have ever visited. I delivered my paper, but was totally unprepared for the crowds as I left the conference centre. I was surrounded by hundreds of nurses all wanting their photo taken with me. It was a terrifying experience. It was 15 minutes of fame I didn’t like. Last Friday, unlike me, Ricky was completely at ease by the massive attention many of my colleagues gave him. He posed endlessly and uncomplainingly for photos with colleagues and guests alike. He was a consummate professional and absolutely the right person to officially open our new service. Thank you Ricky - Lie-la-lie!

Beware the Ides of March?

It was Oscar Wilde who once said ‘the optimist sees the doughnut, the pessimist sees the hole’. I guess whether you are a optimist or a pessimist might be reflected by the context, or a particular situation. That seemed to be the case last week. The NHS had its own ‘Trump moment’ as the Prime Minister announced that NHS England was to be absorbed by the Department of Health and Social Care (DHSC) over the next two years. It would do so with the loss of 9,500 jobs.

Now for many NHS people this will be devastating news, and for many NHS folk this decision will have come as a complete surprise. It came after the earlier news that Amanda Pritchard (NHS England Chief Executive) was stepping down and being replaced by Sir Jim Mackey. He has been described as a ‘transition Chief Executive’ and perhaps we can now see why.

Back in the second week of July 2024, I posted a blog which expressed my concerns about what would happen to the NHS under the newly elected government. For me, the writing was on the wall after reading that Wes Streeting (Secretary of State for Health and Social Care) had brought both Alan Milburn and Paul Corrigan in to help him tackle the issues facing the NHS. I also noted that despite promises of no restructuring of the NHS, I wasn’t convinced we wouldn’t see change. There have been nine changes of government since the NHS was created in 1948, and all have tried to reform and restructure the NHS. I think however that last week’s news takes restructuring to a new level.

Last week, all NHS Chairs and Chief Executives had to attend a meeting in London to hear some of the detail of the proposed changes. I duly went along. However, there wasn’t much in the way of detail. The questions asked often failed to be answered by anything other than headline responses. Some of these were, frankly, alarming. On top of the reductions at NHS England and DHSC, it was announced that the 42 Integrated Care Boards (ICBs) would need to reduce their costs by 50%. It seems likely that the only feasible way to do this will be by reducing staff numbers. There are some 25,000 people currently employed by these ICBs, so this could lead to a further 12,000 jobs being lost. Likewise, all NHS Trusts, will need to reduce their corporate back-end services (Finance, Human Resources, IT and so on) costs by 50% too.

I think both these ‘asks’ will not be easy to achieve, and if they are achieved, it is likely chaos will ensue and be extremely detrimental to effective organisational functioning. That, in turn, will lead to care being impacted, both from a quality and possibly a safety perspective. But perhaps I’m guilty of ‘only seeing the hole and not the doughnut’. I’m sure, however, that I’m not alone in being worried. What did surprise me was the number of folk, both those whom I spoke to in person last week and others commenting on social media, who are rejoicing at the passing of NHS England.

It surprised me because Amanda Pritchard (and Sir Simon Stevens before her) was a popular leader, but perhaps that was only felt by people outside of government. It’s true that NHS England could sometimes be stifling, controlling, very conservative and slow to act, but my personal experience has been one of support, consistent leadership and helpfulness. They were an effective countervailing force to some of the chaos we experienced from the previous government during the challenging times of the Covid pandemic. And for that reason alone, I will always be grateful they were there.

The catalyst for these changes were said to be unacceptable variations in productivity, and financial sustainability. We still haven’t got back to the levels of productivity seen before Covid. There are a number of good reasons why this might be. However, it was the fact that the first draft operational plans submitted this February showed a £6.7 billion gap between what the NHS had been allocated and what the services themselves felt they wanted/needed. The changes referenced above are expected to save at least £500 million a year. Sounds like a great deal of money, but it represents just 0.25% of the NHS budget, and I can’t see how it will fulfil the government’s promise of more money for the ‘frontline’.

Much more importantly, for me, at least, is the trauma, sense of betrayal and impact these changes will undoubtedly have on so many colleagues who have worked in the NHS for so many years. As a group, they also represent a great deal of experience, knowledge and skill. Letting this go will be difficult to replace in the future.

Finally, last week the Care Quality Commission (CQC) published its latest report on the use of the Mental Health Act. It makes for grim reading – see here. It’s abundantly clear that mental health services across the board, but particularly those supporting children and young people, need considerable investment. At the same time as Wes Streeting said there would be no major reforms for the NHS, he also pledged to prioritise mental health and children’s services. On this matter, I’m firmly an optimist, so I sincerely hope we see this promise being delivered.