In our own way, we can all be champions

One of my brothers has been a lifelong fan of Millwall Football Club. I don’t think they have been in the Premier League, and probably never will. Currently they are 12th in the EFL Championship League. Their position in the league table, and all their various successes and failures, have never deterred him from following his team. Likewise, I have a friend on social media who is a Manchester City fan. Goes to all the games, wherever they are being played. I think it’s fair to say that the 2024 season was excruciating for the Man City fans. Did it stop my friend from going to the matches? Not a bit.

Now I don’t do football, but I do like snooker. I grew up watching the likes of Alex ‘Hurricane’ Higgins, Steve Davies, Jimmy White and Stephen Hendry. They were all great players, but for me, the absolute best player ever is Ronnie O’Sullivan. He has been simply phenomenal. Over the last couple of years, however, his game has suffered. He is now ranked fifth in the world. Despite where he stands in the snooker rankings, if I see he is playing, I will always try and watch him.

By now, regular readers of this blog will have realised this week’s posting is not about football or snooker per se, but about League Tables. Last week saw the reintroduction of league tables in the NHS. Those of you who have been around for as long as I have will remember that it was Tony Blair’s Labour government that first introduced league tables for hospitals back in 2000. They were cunningly disguised as ‘star ratings’. In 2000, the Secretary of State for Health was one Alan Milburn. Spookily, today he is the lead Non-Executive Director for the current interim NHS England, and Chief Advisor to Wes Streeting (our current Secretary of State for Health and Social Care).

The ‘star ratings’ approach didn’t work, and any gains made to the transparency of services being provided did not lead to noticeable overall improvements to NHS services. The ratings were abandoned in 2010. I argue that league tables didn’t work then, and I cannot see them working now. The UK media had a field day when the tables were published, reporting that four out of five NHS Trusts were failing. However, the financial metrics used in the league tables has (perhaps unintentionally) skewed the results, and the outcomes published don’t always reflect the totality or the quality of care being provided. Sadly, I think most folk won’t understand the nuances of the current league tables, and even if they did, they probably have limited choices when it comes to where they receive their health care.

My local Acute Trust is Blackpool Teaching Hospital NHS Foundation Trust. It was ranked 125th out of 134 acute providers nationally. I have been a Non-Executive Director there, and yes it does have its problems. However, when Jane and I had to use its Urgent and Emergency care services earlier this year, the care and treatment we got was simply brilliant, and truly lifesaving.

That episode of care ended with a transfer to Lancashire Teaching Hospitals Foundation Trust, over in Preston. They are ranked 127th out of 134 acute trusts nationally. Jane spent nearly two months in their neurological high care unit and the treatment she received was first class, and the care given was a brilliant example of what compassionate person-centred care looks like. In both cases, Jane had nowhere else to go to receive her health care.

A bigger potential problem than a lack of patient choice, might be that health care professionals might avoid seeking employment in a ‘failing’ health care organisation. Likewise, unless Wes introduces a ‘transfer’ scheme similar to how football clubs operate, I don’t think financial incentives will persuade leaders of high performing organisations to take on a failing organisation. Other than moving to Taiwan it’s always good to keep an open mind with changes such as these league tables come along. Time will tell if they do better than the previous ‘star ratings’. As for Manchester City, Millwall and Ronnie, I wish them, and those who support them all the very best for this year’s games.

Making Descartes smile, I think?

Now I’m not going to pretend I understand Latin. I don’t. However, I do know that Cogito, ergo sum is the famous Latin philosophical assertion by Rene Descartes – meaning ‘I think, therefore I am’. It means that in doubting your existence proves your existence. He asserted that you cannot doubt unless you are a thinking being that actually exists. It was the foundation of Descartes’ philosophical work, and the basis for what became to be known as Cartesian teaching.

Although I have never been a pure Philosophy scholar, I have long been interested in Descartes’ approach to the question of promoting knowledge acquisition, and how I might bring this into the classroom. Whilst many books have been written about Cartesian teaching, it is fundamentally based on the idea that all knowledge begins with doubt, and that the best way to acquire knowledge is through systematic questioning – and in particular questioning our assumptions. 

Simply put, (and this is a 750-word blog after all), it involves asking four basic questions: what, how, why and what if? Answering these questions in a systematic way will often allow you to truly understand the problem or issue, identify potential solutions and make better and informed decisions. I did say it was simple. Over the years, students have approached these questions in many ways, but not always successfully perhaps.

When I was working towards my doctorate, I would spend many an hour in the library reading and making notes. I was completely unsystematic in my search for knowledge, too easily seduced by the rabbit holes I fell into, while reading papers and books. That said, I did gain my PhD. It’s safe to say that teaching and learning have been something I have enjoyed being involved in, all through my various careers, but in particular, when I was working at the University.

Much of my writing and research has been around preparing nurses for practice, both the stuff they need to know and the knowledge they acquire, but also the bit in between, how to deal with what it is they don’t know. These days I still keep a watchful eye on nurse educational development. Last week I saw a post on the Mental Health Nurse Academics UK (MHNAUK) group. It was from a colleague at the University of Huddersfield; a colleague who has been in nurse education for many a year. His concern was the student use of Artificial Intelligence (AI) in higher education.

Whilst being aware of the many benefits AI can bring to healthcare and our lives in general, his concern was about students using AI to write their assessments and the over reliance on theoretical knowledge gained in this way. It is a fair challenge. Using AI in this way can be very seductive. I’m not sure limiting its use by students is necessarily the best way of dealing with the issue. AI provides another repository of knowledge, and it’s how this is engaged with, that is the real challenge for teachers and students.

The debate on the MHNAUK group is heating up, and as there are some very wise heads in the group, I will continue to watch with interest. One contributor from the University of Ulster sagely noted that ‘Wikipedia was predicted to make teaching obsolete, and before that, the internet itself. Even the calculator had its detractors. However, none of these brought an end to teaching’. I’m in this camp.

I don’t use AI and have no desire to. For teachers and students, however, perhaps there is value in thinking about AI as being simply yet another development in how we all might acquire knowledge, pursue truth, and find certainty in the truest Cartesian tradition. We already help prepare students for their studies by using introductory courses to critical thinking, research, and academic writing - why not an introductory course on how to effectively use AI?

Most of the common AI programmes note, albeit in the small print, that all answers to questions posed are dependent on the data that has been collated, or is readily available to the AI search engine. They all suggest that answers therefore might be inaccurate and should be checked. The best way of doing this is by posing different versions of the original question. Wise advice, and I think (therefore I know), Descartes would be proud.

Bee Happy!

There are several things I like about being an early riser, sunrises for example. This week, the sunrises have been spectacular. I’m usually driving on the motorway, so seldom get to capture a photo of the skies all lit up, at the start of a new day. Another source of joy is listening to the Radio 4 programme, Farming Today. There is always something interesting to listen to. Last Thursday, I heard all about the delicate art of bee insemination.

Yes, I did a double take when the item was introduced. Bee insemination? Apparently, it has become an important part of keeping the national bee population healthy. It was a fantastic listen. The captured Queen Bee, slightly anaesthetised, walks backwards in a test tube, towards the insemination ‘device’, which is just 0.16 mm in diameter. You can find the story here.  

Bees per se, seemed to have featured in my life last week. Many media outlets picked up on the article published in the prestigious Proceedings of the Royal Society B: Biological Sciences journal*. The story reported on long-term research, undertaken by the Northwestern University and the Chicago Botanic Garden. Their joint study explored the eating habits of bees. What we might observe as random buzzing between flowers is actually ‘strategic snacking’– well there is probably a more scientific name for this, but I like the idea of ‘strategic snacking’. In bee nutrition terms, it helps keep both the individual bee healthy, as well as the rest of the hive community. It’s a collective and collaborative approach to wellbeing.

Bees are able to balance their intake of protein, fat and carbohydrates. The balance between each of these changes with the seasons; a kind of bee equivalent of salads in the summer and stews in winter. Healthy bees are critically important to the fate of the human race. Whilst they are not the only pollinator in the insect world, they are the most prolific. But the bee population is on the decline, hence the bee insemination programme being so important. Bees are becoming increasingly vulnerable, due to exposure to pesticides, climate change and habitat loss.

So, it was interesting to read last week of the ‘corridors of nectar-rich plants’ to be found on the sloping alleyways of Bristol. Just a year ago these areas were uncared for, litter-strewn, neglected pathways. Just 12 months on and thanks to the pollinator pathways project, locals have transformed these spaces with insect-friendly flowers grown in pots, and murals painted on the walls. You can do something similar, see here. The project is a powerful indictment of what can happen when a few like-minded folk get together to make their community a better place to live – such a contrast to what appears to be such troubled times seen in so many communities across England right now.

As well as being critical pollinators, bees, of course, produce honey. Nature intended this to be a source of food for the bees themselves during the long winter months. Early on, mankind realised the value that honey has to our diet. In 1851, the American, Lorenzo Lorraine Langstroth invented a beehive, whose design is essentially what all bee keepers still use today. Now honey is said to have many health benefits. It is full of beneficial antioxidants. There is some research that suggest eating honey regularly can help protect you from heart disease, cancer, reduce cholesterol levels, diabetes and aid wound healing if applied locally. 

At this point I’m going to shift left – not those currently being discussed across the NHS, but as my sat nav would say: “make a slight turn to the left’’. Forget Trieste, Sweden has in the past two years been recognised as the leader in the provision of great mental health care. It has a totally patient-centred approach and superb care facilities. Factors such as the majority of swedes having an abundance of personal free time, retaining strong family connections and eating little ultra processed food, alongside great government investment in all aspect of mental health and wellbeing, all contribute to the maintenance of positive mental health. 

As does eating honey. Swedish honey is highly symbolic, almost sacred, and people are justifiably proud of their mainly organic honey, and its consumption throughout the year is highly valued.

Finally, driving home last Friday, the short story that afternoon was about a bee, who inadvertently flies into a car and causes an accident. Don’t worry it is a delightful story, and well worth a listen to.

 *Proceedings B is the Royal Society’s flagship biological research journal, accepting original articles and reviews of outstanding scientific importance and broad general interest. The main criteria for acceptance are that a study is novel, and has general significance to biologists. Articles published cover a wide range of areas within the biological sciences, many have relevance.

Cherish your yesterdays, dream your tomorrows, and live your todays

Jane returned home from our holiday in Portugal with Covid. We are not sure where she contracted the virus, but within 24 hours of landing she felt very unwell. One Covid test later and there it was – two red lines as bright as anything. As I write this blog, she is much better, and we are reassuringly down to just one red line. I didn’t test* positive at all – and I do wonder if that is a consequence of all the age-related Covid vaccinations I had been given. In fact, and here’s tempting fate, I’ve never had Covid at all.

Jane’s experience prompted me to look at where the Covid19 Inquiry had got to in its evidence gathering. Over the past five weeks, the Covid19 Inquiry has been hearing testimony from all those involved in the adult care sector. This has included residents of care homes, their families, and of course the former Secretary of State for Health and Social Care, Matt Hancock. He has given evidence to the inquiry on more than one occasion. At the beginning of July this year, he was once more in front of the inquiry panel; this time to discuss, in detail, decisions he took around protecting the residents and staff living and working in care homes.

He was given a tough ride. Not for the first time, he was accused of employing empty political rhetoric in describing the attempts that the Government of the time made to cast a protective ring around care homes, as the pandemic became more widespread. In his defence, Matt Hancock said that the decision to discharge patients from hospital to care homes when testing was not available, was ‘the least worse solution’.

At times such as the pandemic, where there was great uncertainty, anxiety, complexity and of course lots of unknowns, there can often be no prior experience to draw upon. In such situations, it can be almost impossible to take a decision that delivers the best outcome. As in this case, the ‘best’ that one can hope for is the ‘least bad’ outcome. Hopefully, the outcomes from the Covid19 inquiry will help better prepare us for any future pandemic-like phenomenon.  

However, some decisions can be easier to take. I took the decision to retire, but not retire. Taking the decision to retire was an easy decision; what to do in my retirement proved more difficult. I have been fortunate to able to continue contributing to the NHS, and in particular to mental health services. My role as Chair of a large mental health NHS Trust is a real privilege and provides me with a great deal of pleasure and satisfaction. I don’t work every day, but every week brings me opportunities to help and support others, to discover new knowledge and experiences, and to enjoy the social benefits of working as part of a team. It seems I’m not alone in enjoying life in this way.

Researchers from the University of Haifa, in Israel, recently published a research paper in the wonderfully entitled Journal of Happiness Studies, that concluded that true life satisfaction past the age of 67 comes from not retiring at all. Slight qualification, this outcome applies to men and not so much to women. The research found that the men, who enjoyed this stage of their life most, were the ones who continued to work. Working full time, past the official retirement age, appeared to give the most satisfaction and greater emotional wellbeing. But working part time also provided for great life satisfaction and an enhanced sense of wellbeing, compared to those men who stopped working altogether.  

Many governments around the world are actively considering raising the official age of retirement. In the main this is due to the impact of demographics and the economic need to have a viable workforce contributing to taxation-based national services. Services such as health, defence and welfare for example. In the UK, 70 is being mooted as a possible new national retirement age by 2040.

Extending the work lifespan looks as if it might become a reality and/or a necessity. Perhaps freeing up people’s time when they are younger, and likely to have more energy, could mean people can enjoy ‘retirement like’ periods earlier in life. The Covid19 pandemic showed just how unpredictable life can be. None of us knows what life might bring tomorrow, or how healthy we might remain. It was Mahatma Gandhi who said ‘Live as if you were to die tomorrow. Learn as if you were to live forever’. Wise words.    

*You can buy single test kits from B&M, Amazon and other retailers, all for about £1.99 a kit. 

Becoming Me, Myself and Mine

Depending on when I’m driving my car somewhere, I get to listen to some very interesting radio programmes – I have only just discovered BBC Sounds, which allows you to listen to any programme at any time. Anyway, as I was driving home last Thursday I tuned into the wonderful Sideways, hosted by Mathew Syed. Last week’s episode was called Me, Myself and Mine – you can hear it here on BBC Sounds - and it posed the question what does it mean to own your body?

The programme provided a fascinating insight into what people think about how they look and the impact this might have on their inner sense of who they are. Importantly, the person you feel you are, can impact upon your self-confidence, motivation, resilience and of course how you perceive your place in the world. Whilst the body modification discussed in the programme sounded extreme to me, since the introduction of weight loss jabs, many people may have been adopting something similar.

We have a couple of friends who started using these jabs earlier this year. One friend was obese, but the other could best be described as plump. And before those folk who regularly troll me start complaining, both terms are used clinically, the former to describe a medical condition, the latter, to describe a fuller body shape. For the individual however, how they perceive their body shape is going to be the overriding concern.

In our friend’s case, it was for these reasons, and not primarily health reasons, that they first started using the fat loss jabs. At first the results were stunning. As the continued weight loss became visible, and their body shapes changed, I thought they began to look gaunt, and unhealthily so. They have continued to take the jabs. Now they aren’t taking these through an NHS prescription, but through a private supplier, in my mind never a good thing to be doing. It costs them around £125 a month to purchase the jabs, around £1500 a year.

To put that into perspective, if you were to smoke 20 tobacco cigarettes a day, it would cost you over £6000 a year, E-cigarettes just over £500 a year. If, like me, you are a nonsmoker but like a glass (or two) of wine in an evening, it’s likely to cost you just under £4000 a year (if you are content with supermarket plonk). So, each to their own.

It will be interesting to see what the impact of the proposed price rise of Mounjaro in September has on those who use this brand. Potentially the cost will rise from £220 to £330 for a month’s supply. Expect other brands to also raise their prices. The [Gilded] Eli Lilly, one of the world’s largest pharmaceutical companies, and maker of Mounjaro say the price they charge the NHS will not change. Private suppliers will have to negotiate a new deal.

Having just spent a week enjoying some great Portuguese red wines, I’m on an alcohol-free regime. Now I’m not obese, and would never use a weight loss jab even if I were, but I do know that a month’s detox will help me shed a few surplus pounds, as well as save some of the other type of pounds! Latest estimates from the NHS reveal that obesity will cost the NHS over £11.4 billion every year. Wider costs to society are estimated to be around £74.3 billion each year. These are big sums of money. £1 billion would pay the salary of 8,200 consultants for a year, or the salary of 24,800 a year. It would run the NHS in England for just 2.1 days.

So, anything each of us might be able to do in taking better care of ourselves and reducing the need to access health care services has got to be good for us, our families, the communities we live in and wider society. That said, I personally think there are better ways to lose or control our weight than using fat loss jabs.

Finally, I will end this blog post by mentioning another Radio 4 programme also heard last Thursday. It was the Today programme. There was a feature on the forthcoming Women’s Rugby World Cup. The discussion touched upon the ‘body shaming’ that some of the players had experienced. It quoted Zoe Aldcroft, the new team captain, who had said we want different things from different team members, different skills and abilities, and that comes from having players of all shapes and sizes. It may be rugby, but it made sense to me.

Mountain top thoughts

We are in Portugal for a long weekend. Up in the mountains, and in a tiny village called Monte Frio to be precise. Jane and I are here with my oldest friend Keith, who has moved out here permanently. It is a beautiful place. It is also festival time and very hot! Yesterday we were all sent texts to remind us that there is a high risk of a wildfire. This is our first trip abroad since Jane had her subarachnoid haemorrhage in January. So despite there being no physical reason for us to be anxious about flying again, we were a little stressed – but to be honest, that could have just been down to flying with Easy Jet.  

Now my old English teacher Miss Floyd, adopting a Shakespearian tone, once reminded us school kids, that ‘making comparisons was odious’. So ‘don’t do it’ was her advice. But, finding myself in my friend’s house tucked away in the mountains, I thought it would be interesting (and fun) to do what Miss Floyd told us not to do.

There are some predictable comparisons. Here is what the data says: Portugal is 91.550 Km² which is considerably smaller than the UK (241,930 Km²), as is the size of the population. Portugal has 10,410,642 people, whereas the UK has 69,551,332 people. This means that in Portugal, there are 114 people per Km² compared to the UK, which has some 287 people per Km². No wonder it can sometimes feel crowded here in the UK.

A cursory scroll through on-line data tells me that both countries have a National Health Service (NHS). And both are universal provisions. In Portugal there are additional insurance-based schemes that folk can also have alongside NHS services. Speaking with another ex-pat, John, he pays €120 a month for his scheme, which gives him speedy access to specialist care. He told me the facilities and service were second to none. John did note however, there can still be waiting lists. The organisation of health care is like that in the UK. In Portugal, it is the Portuguese Ministry of Health that undertakes the policy guidance and strategic planning, and which also has a regulatory role as well. In 2022 a NHS Executive Directorate was established that is largely responsible for the monitoring and implementation of the Portuguese National Health Plan. Local Health Systems are responsible for commissioning, co-ordinating and managing health care providers. 

Sounds very much like rather the UK health care system, only we are currently trying to dismantle and refocus some of our versions of these organisations. In the UK we spend just over the international average GDP spend; Portugal, just under this average. However, a higher percentage of resources is spent on primary care with 53% of all doctors in Portugal being GPs (31,673). Here in the UK we are playing catch up with just 28,271 full time equivalent GPs. Indeed, there has been very little increase in GP numbers in the UK since 2015.

Tackling this shortfall in primary care is absolutely critical if we are to achieve all of the three ‘left shifts’ outlined in the recently published UK 10 Year Health Plan. Nursing shortages and skill mix is another area that will clearly need similar attention in terms of recruitment and retention. It’s clear that looking after the NHS workforce, both here and in Portugal will become increasingly crucial. The wider demographic changes and the declining populations seen Europe are already impacting on the numbers of folk available to become part of the workforce. It will only get worse over the next 10 years.

In recent weeks, both in the UK and here in Portugal, we have seen how the consequences of a dissatisfied health care workforce can result in industrial action. In the UK, we recently had a five-day strike by Resident doctors seeking higher salaries and changes to a variety of their employment terms and conditions. Last December and January, it was reported in Portugal that as many as 300 Junior doctors (equivalent to our Resident doctor) had opted not to continue their training into specialist areas of medical practice. They wanted better funded training, working conditions and higher salaries.

Urgent and emergency care doctors working at one of Lisbon’s largest acute hospitals are threatening industrial action over pay and conditions, and in a separate dispute, doctors and nurses working in a acute hospital in the Algarve went on a 24-hour strike last Thursday in a demand for better salaries and greater employment opportunities for doctors, nurses and other health care professionals.

Sounds familiar, doesn’t it? Maybe Miss Floyd was right when it comes to making comparisons, don’t go there. However, it is somehow reassuring in a non-reassuring way to know the issues we face in contemporary health care in the UK are also to be found elsewhere in the world. But, the sun is up and it is already warm. It’s time to get ready for today’s festival activities, which seem to include much beer drinking, eating, dancing and generally having a great time. 

It’s the little things, and kindness, that matter

Now I don’t do football, never have, and probably never will. I don’t see what the attraction is. Mind you, it would be remiss of me not to mention the Lionesses’ triumph last Sunday. I confess to having watched the game. It was both entertaining, nerve-wracking but an easy way to spend a couple of hours. That said, in an increasingly turbulent and volatile world, a world of politicised tariffs, dreadful conflicts, devasting famines and natural and man-made disasters, the football match was a relatively small thing.

Okay, it was a small thing, but clearly for many it was a big deal. In the moment, it made a difference to the lives of many folk. People were happy; there was a sense of togetherness, a few moments’ respite from everyday life and all the challenges that that might bring. Going forward, that women’s European cup final and perhaps the entire tournament that led up to it, is also likely to be inspirational for many young people, particularly girls. Others have said it before me, but it bears saying again, sometimes it is the small things that can really be the big things when these get experienced by others.

Our award-winning in-patient facility, North View (take a look here) was developed and created in partnership with service users, carers, clinical colleagues, architects, designers and of course our estate colleagues. Each added their own unique input to the overall design of the building and the way it was to be used. Bringing together all this combined knowledge, experience and ideas ensured that everything down to the smallest detail was considered, and where appropriate, included in the final building outcome. The result is stunning. The environment is simply breathtaking; the culture it promotes enhances the services and care provided to our service users. Compared to where colleagues and service users were previously, this really is a big thing.

But back to little things for a moment. Have you any idea how big a weevil is? I didn’t, until last week. There are over 97,000 species of weevils known. The most common type really is tiny - just 1/4 inch long. They are generally viewed as a pest. For such a small creature, they can wreak enormous amounts of damage to crops, both standing crops and stored grain. Now you might be wondering what this has to do with either football or mental health services. Not a lot at face value, but what a great question to ask!

The surprising answer perhaps, is canals. Having recently acquired a 35-foot-long narrow boat, our maiden voyage was somewhat blighted by the huge amount of different types of weeds choking the canal, making travel even slower than normal and difficult. Cruising required much 'toing and froing' between forward and reverse gears, and clearing the propeller of weeds. The latter job isn’t especially pleasant to be frank.   

The unremitting sunshine, fertiliser ‘run off’ from the fields, and an atypical seasonal lack of rain have all combined to result in a surge in weed growth. The body responsible for our water ways and to whom we pay our licence fee - the Canal and River Trust (CRT) - have come up with a environmentally-friendly way to tackle this problem, weevils. These are not just any weevil, these are super weevils from South America. Unlike the common weevil, these Argentinian weevils are 1.2 inches long and have voracious appetites. What they love best to eat is the pennywort weed. This is a non-native invasive weed that is clogging up our rivers and canals. See here why it is such a menace.

This unassuming insect has been introduced into a growing number of sites across England since it was cleared for use in 2021. Their impact has been huge, with large areas of clogged rivers and canals being cleared. Just last week, these little creatures have been released by the CRT into our canal, the Lancaster canal, so whilst it may take time, we are looking forward to seeing them munch their way through this weed!

So yes, there is a connection between a football match, designing and running a new mental health service and canals. It is the little things that can often make the biggest difference. Saying please, thank you, holding a door open for others, being present, attentive listening, sharing a smile or a kind word, are all examples of little things that can make a big difference to others. We won’t always know what other folk might have going on in their lives, and we might never know what impact being kind might have on others, but kindness matters, always.

Shifting left: challenges we can all relish!

It is thought that the phrase ‘a legend in your lifetime’ was first used to describe the life and work of Florence Nightingale. She was, of course, a nurse first and a medical reformer second. It was said that Florence Nightingale ‘combined the intense vitality of a dominating woman of world with the mysterious and romantic quality of a myth’ - a description that reflects her passion, knowledge, courage and determination to make a difference.

On a slightly lighter note, Peter Hawkins, in his 1969 play ‘The Dynamic Death-Defying Leap of Timothy Satupon the Great’ describes his hero as a ‘legend in his own lunchtime’. In the play, Timothy, although being a reasonable and a likeable lad, day dreams of future greatness, but in reality, he never quite makes it or indeed, ever makes a difference.

Now I’m proud to be a nurse, albeit I stepped off the register a while ago now and no longer practice. Although I never attained the greatness of Florence, equally, I don’t think I’m a Timothy either. There is, perhaps, a legendary place somewhere between the two. My musings over Florence and Timothy arises from where we find ourselves as a national health service since Friday. Once again, resident doctors have chosen to take industrial action. It is, of course their right to do so. Their reasons for doing so this time, however, appear somewhat contestable. It was something I touched upon in a previous blog, posted just 14 days ago. 

However, it is not my intention to argue whether the industrial action taken by the resident doctors is justified or not. Currently, most doctors, including Resident doctors in the NHS work in hospitals. Inevitably despite what both sides of the dispute might say, harm will occur to individuals, families and the wider NHS. When that happens, it will be an outcome that is sad. The recent publication Fit for the Future, the Government’s 10-year health plan, provides a unique opportunity to change the UK’s approach to how we approach health care. And in my view (and the view of plenty of other folk I think), an absolute paradigm shift for good.

Whilst Florence was busy establishing a fully trained and regulated nurse profession, she was also reforming the function and practice of hospital-based care; moving it from a place of last resort and despair to somewhere people trusted and where they would receive safe and consistent care. Ironically, perhaps, one of the major so-called ‘left shifts’ outlined in the 10-year health plan is to move care from the hospital to the community, and in so doing make hospitals a place of last resort, but for different reasons!

A second ‘left shift’ is from illness to prevention; moving help upstream and earlier to prevent folk needing to access more expensive secondary care services. This will have an enormous impact upon the ever-increasing demands asked of health and care services. Florence recognised many of the underlying detriments that give rise to health inequalities, and poor life opportunities. Her ideas around the importance of good housing, sanitation and nutrition are ideas which continue to be built upon by others and which have helped societies around the world reduce the number of life-shortening diseases and avoidable health issues – but there is still a long way to go.

The third ‘left shift’ in the Fit for the Future plan -  ‘analogue to digital’ - would, I think, have enthralled and inspired Florence. She was a great statistician and knew how to use data to ensure informed decision-making and promote evidence-based care. Increasingly we will want (and probably need) to use data to fully gain the benefits of the many emergent digital developments, certainly in how we use artificial intelligence (AI).

As I write this blog, we are still anticipating that the industrial action will continue until 7am on Wednesday. I would like to say a big THANK YOU to all those nurses, porters, midwives, catering staff, occupational therapists, managers, doctors, and many other colleagues who will have stepped up during this strike in order to minimise any potential harm to patients from occurring. Alongside our communities and neighbourhoods, it is these same folk who, in the coming months, will also be called upon to take the ambitions of the 10-year health plan forward – I have great confidence they will rise to, and relish the challenge.

What’s in a name?

How time flies. Some 50 years ago now, I can remember sitting on buses in downtown Swansea confidently diagnosing my fellow passengers. Of course, then as now, I’m not qualified to diagnose any form of health or illness issue. But back then, with a modicum of nurse training and education, I thought I could. I was wrong on so many levels. That’s not to say that my nurse education was worthless. It wasn’t. It helped me on a journey from Nursing Assistant to a Professor, and Dean of a successful university School of Nursing.

I had a great student nurse experience. It wasn’t anything like today’s nurse education, but I loved the hands-on aspects of my programme. Theory was brought to life by some very wonderful nurse tutors. But it was far from a comprehensive course. I never worked in Urgent and Emergency Care (UEC), which I really wanted to do. I did just three months in a physical care hospital, and my placement was in the acute hospital dentistry department. As a young student nurse, it was a brutal and bloody place to spend time in.

Fast forward a few decades and as a Non-Executive Director, I have been fortunate to visit many UEC departments. UEC departments are often frenetic places. The numbers of folk walking through the front door or delivered by emergency ambulances can, at times, feel unremitting. That said in my experience, UCE departments are where you can see much compassionate care in action. I saw something very similar last week. I was able to visit our nationally renowned Addiction Services, well the inpatient side of the service at least.

It was a wonderful visit and a real pleasure to meet such a brilliant multi-professional team. They deal with some many complex and life-threatening health conditions and work closely with other healthcare providers in acute and mental health care across England. I even got to meet a tortoise, a very happy parakeet, a rabbit and guinea pig; all of whom were part of a pet therapy intervention. I was in my element, and it was clear, so were many of the service users taking part in the session.

A special delight for me was meeting Liz, one of our Nurse Associate's. She told me that back in 1988, I had interviewed her for a job, which she got. She has been working at our Trust since that time and told me she loved her job. I don’t know who had the broadest smile, Liz or me. Nursing Associates were first introduced in 2016. It is a role that bridges the gap between a Health Care Assistant and a Registered Nurse, and much needed.

We are likely to see many more new entrants to the once traditional and (undoubtedly) limited health care workforce, as the NHS 10 Year Plan: ‘Fit for the Future’ begins to gather momentum operationally. Of course, caution needs to be taken to ensure that as these new roles are developed, the scope of practice is carefully regulated. Something that was in the news last week following the publication of Professor Gillian Leng’s report into the role and practice of Physician Associates. Professor Leng is the current President of the Royal Society of Medicine. She had been asked to undertake the review by Wes Streeting (Secretary of State for Health and Social Care) following a number of high-profile deaths linked to the work of Physician Associates. One of which was that of Emily Chesterton. She died, aged just 30, from a pulmonary embolism having been misdiagnosed on two occasions by a Physician Associate.

I feel the need to add some context. I have no wish to defend those responsible for what might have been Emily’s avoidable death. However, according to NHS Resolution, in 2023/24 the cost to the UK of harm or death caused by medical or clinical negligence was some £5.1billion. The greatest number of claims arise from urgent and emergency care, with maternity claims’ costs being the most expensive.

Now every day, there are some 1.6 million individual patient contacts with the NHS (it includes people attending GP appointments, having an operation or those on a follow up outpatient appointments); the majority by far, being with GPs. Fortunately, there are over 1.3 million people working in the NHS who provide for those who need care. Sadly, mistakes will be made that might result in individuals being harmed rather than helped by the NHS. Hence the need to constantly look at ways of making health care safer and safe every time. I guess time will tell as to whether Professor Leng’s recommendations, which includes a change of title to Physician Assistant, will help keep patients safer. I hope so. I also hope her report does not leave us less confident in continuing to broaden further the traditional health care workforce.

A return to the tribe that wears white

Thoughts about the focus for my weekly blogs come from many sources. Top of the list will be things I have read, followed in no particular order by things I might have heard, seen or experienced. I often hear something that piques my interest on the Radio. Radio 4 is my favourite station. The variety of programmes means there is always something interesting to listen to, as I drive. Last week, driving home, I listened to the Radio 4’s PM programme. One of the reports was a follow up to an interview the day before with Melissa Ryan. She is one of the co-chairs of the resident doctors’ committee.

Resident doctors were formally known as junior doctors. Last week they announced they would be taking five days of industrial action later in July. The threat of industrial action results from the government refusing to agree to the British Medical Association’s (BMA) demand for a further 29.2% pay rise. Resident doctors agreed a two year 22% pay uplift last year. This year they have been offered a further 5.4% pay award. However, the BMA argues that when inflation is factored in, doctors’ real-term pay has actually fallen since 2008.

The PM discussion explored measuring inflation. It was a discussion that took me back to my MBA studies when we were taught how to calculate the future value of money and those net present value calculations which we had to do for our capital business cases. Horrible!!!

There are two main ways of calculating inflation, the Retail Prices Index (RPI) and the Consumer Prices Index (CPI). In the UK, since 2008, the agreed gold standard for measuring the rate of inflation, is the CPI. The BMA have chosen to use the RPI. Now to demonstrate why these two different measures are important, I turn towards the independent health and social care ‘think tank’ - the Nuffield Institute - for help.

Comparing changes to pay over different points in time will sometimes give differing outcomes; so will using different measure of inflation. Absolutely so. The Nuffield Trust compared the impact on resident doctors pay since 2008 using both RPI and CPI measures. They have calculated that by the end of this financial year (2025-26), if RPI were used, doctors pay would have decreased by some 17.9%. However, using CPI as the measure over the same period would result in a fall of just 4.7% since 2008.

Now as regular readers of this blog know I try and avoid politics, so I don’t want to delve into the political consequences of untangling and resolving this situation. I am however, interested in the potential sociological consequences that are beginning to emerge. When I wrote my PhD thesis I drew amongst others, upon the work of Melvin Konnor, a brilliant anthropologist.  One of the books he published in 1993, was called The Trouble With Medicine. I urge you to try and get a copy to read, as it is remarkably prescient when thinking about today’s health care zeitgeist.

In the book, he, at one point, describes doctors as the Tribe that Wears White. It was an interesting idea, and reflected the often familial, but definite professional ties that bind doctors together as a single powerful profession. Allegedly, if you upset one doctor, you run the risk of upsetting them all. This hasn’t been my experience, but clearly there is a sense of loyalty to each other not seen in many other professions. We saw this loyalty in action during the previous 11 occasions that resident doctors took industrial action. Consultants and other senior doctors stepped into the gaps left by striking resident doctors. It felt like an act of beneficence that saw their junior doctors exercising their right to take industrial action while reducing the potential harm to patients. There are signs that the social cohesion evident across the medical profession is beginning to splinter.

Notably, the immensely popular professor, TV doctor and pioneer of IVF treatment, Lord Robert Winston, resigned from the BMA last week. He had been a member for 64 years. He noted that taking industrial action now ran the risk of damaging people’s trust in the profession. It was a view echoed by Lord Ara Darzi, who had recently undertaken a review of the state of the NHS. Recent polls suggest there is very little support from the public for further industrial action. Large numbers of people across England are struggling in so many ways. Often people’s lives are fragile and precarious. Lord Winston noted that: ‘strike action completely ignores the vulnerability of people in front of you’.

Melvin Konnor expanded his thinking about who has infiltrated the tribe that wore white, ‘the tribe under study is all of us; doctors, nurses, hospital managers, government representatives, bureaucrats, lawyers, and last but not least, patients, a position that sooner of later includes us all’. The governments recently published ’10 year Health Plan; Fit for the Future’ gives us all a chance to really change the way health care is provided in the UK – I hope we don’t blow this opportunity.

A slow, but a positive journey towards improvement

Last week was an interesting week, for sure. On Monday, I had arranged to visit our Low Secure Forensic services, as I hadn’t been there for a while. The Lowry Unit, as it is known, provides a lovely environment, particularly the outdoor spaces which have fabulous murals on the walls. The two wards were brightly lit with natural sunshine, and were beautifully decorated. The atmosphere was one of calmness, yet there was lots of activity going on. The whole place felt warm and welcoming. I was hosted by Hayley, one of our Matrons. She was a great host and was happy to both let me see anything I wanted and arrange for me to talk to her colleagues.  If culture is set from the top, then Hayley showed how it could be done well.

She was justifiably proud to have started her career as a healthcare assistant, and had over the years worked herself up into her current position. She remembered me from her nurse training at the University of Salford, and told me I had signed her certificate when she graduated. I was kind of proud too that she had done so well. A couple of other colleagues also remembered me from their nurse training days. Sadly, I couldn’t say the same was true, but it was good to hear, that in a small way, I had been able to make a difference.

On Tuesday, Jane and I bought a canal narrowboat. It is the second time in my life that I have done so; a first for Jane. Just to be clear, we are not going to live on it, but will use it to enjoy the plentiful canals up here in the north west of England. Well, that’s today’s decision anyway…  …who knows? My Summer cold, which had started on the Tuesday, had abated yesterday, so I spent the day on our boat, as I started to take it up to our permanent mooring. It was fun. The weather was kind, and I had great company too. It’s a start of the next chapter of Jane and I making memories together.

Wednesday was a washout. My cold was full blown and so it was a Lemsip and life admin catch up day. Whilst it is important to keep on top of life admin, it’s not my favourite way to spend my time for sure. Every day is precious, and I would rather have been in our garden or walking on the beach.

Thursday was a full-on day. I started very early to avoid the traffic, which meant I found myself sitting in a car park in downtown Ashton reading my current book at 6.45am. I was there to take part in the interviews for a new Chair at Pennine Care Foundation Trust, an organisation with whom we have pledged to work more closely and collaboratively with in the future. I wasn’t due to report in until 8.45am, and by the time I walked through the doors, I was desperate for the loo. Thankfully this was a resolvable problem, and I was well looked after.

My part in the selection process was completed by midday and I whizzed back up the motorways to join in with our first ‘All Colleagues Forum’ at the Trust. For the second time in the week, I felt a sense of pride. Some 500 colleagues joined the call and my Executive Director colleagues took us through our revised organisational, people, and care strategies. There was an update on the return of Oliver Shanley, who back in 2023 undertook an independent review into the issues raised by the undercover Panorama programme into poor care and abuse in our forensic services. He is coming back to see how much progress has been made on our recovery journey. And there is some great improvements to show him and his team. There was also a chance to alert colleagues to our Star Awards celebration in October, a night that is always enjoyable.

Later on Thursday, I joined a national call hosted by the Chair of the new (interim) NHS England. A thousand people from across England joined the call. It was an opportunity to consider some of the ambitions set out in the NHS 10 Year Plan, which had been published earlier in the day. This is not the blog to explore the plan, I will do soon, but it was great to finally receive the 168-page document and see the aspirations it contained.

Friday was a day to be out and about. Which is what we did. As I was out and about, I reflected on my Monday visit to the Lowry Unit. I realised what a milestone that was in being able to reopen the service up for new admissions, something the team there have done successfully since late last year. As a Trust, we have moved forward in terms of improving the safety and quality of care we provide, and even if at times it might feel akin to the maximum 4 mph of a canal boat speed, we are moving forward. And that also makes me proud of all my colleagues who have made this possible. A big THANK YOU to you all.

The Ministry of Magic meets the NHS

This time last year, Jane and I were enjoying the sunshine, the hustle and bustle, the sounds, smells, food and drink of Istanbul. It was the last stop on our two-week train journey across Eastern Europe. We travelled from Blackpool to Istanbul by train. In swapping one coastline for another we went through so many beautiful places; many unspoilt and unchanged for centuries. Whilst we were able to see the benefit of many European-funded improvements to infrastructure, we also saw a great deal of poverty.

Like many of the places we visited on that trip, back here in Blackpool, the population struggles with the consequences of much health inequality*. Indeed, last week our Secretary of State for Health and Social Care, Wes Streeting, chose to visit Blackpool to make a speech about how he intends to tackle these long-standing issues. It was good news for Blackpool and other coastal areas around England.  

The provision of health care in many of these areas fails to meet the needs of the local population. This is not a new issue. It is an example of what that famous Welsh GP, Julian Tudor Hart described as the ‘inverse care law’. Back in 1971, he posited that the availability of good health care tends to vary inversely with the needs of the population served. Additionally, he argued that the concern of a population for its own health tends to vary inversely with the actual state of health of that population.

It is a powerful and not a difficult proposition to understand. That said, I do like how Tudor Hart chose to explain his thinking a few years later. He said ‘to the extent that health care becomes a commodity, it becomes distributed just like champagne. That is, rich people get lots of it. Poor people don’t get any of it’. An earlier Secretary of State for Health, Frank Dobson, was even more pithy in describing this inverse care law. He said ‘inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you will die sooner because you’re badly off’. Frank died in 2019, aged 79.

When Wes came to Blackpool last week, he spoke about it being a place he enjoyed visiting when he was younger. However, sadly Blackpool was a place he now needed to visit to highlight health inequalities across the nation. He announced an additional £2.2bn boost this year to pay for more resources in both staff and equipment. Just to be clear, dear reader, this is not all coming to us on the Fylde Coast!

This extra funding for coastal and other areas of deprivation was described as a ‘down payment’ for future funding. Now we know the mythical money tree, just like the Sycamore Gap Tree, no longer exists, so where is this extra money coming from you might ask?

It's a clever political move (I know I don’t do politics here, but bear with me). The £2.2bn is money that was due to be distributed to the 215 NHS Trusts across England for what was described as ‘deficit reduction’. All of the four NHS Trusts I have worked in as a NED or Chair have run with deficits. This is not the blog to explore why these deficits occur, but across the NHS, they have been a financial blight for many NHS organisations. This money will no longer be available to cover such deficits.

As Jim Mackey (the NHS England Chief Executive) has told all NHS organisations, they must henceforth, balance their books. Now, I’m really growing to like Wes and Jim’s approach. Along with Penny Dash (NHS England Chair) they are the Harry, Hermione and Ron of our ‘NHS brave new world’. But think on this. The Trust that I Chair has a deficit. We were looking for some financial cover to address this. Without it, we are likely to have to make additional cost savings. Inevitably, this will include changes in how we provide services, and who we ask to provide those services in the future.

Whilst I wholeheartedly welcome the proposed redistribution of NHS funds in addressing health inequalities, particularly as I live in Blackpool and I’m not getting any younger, I do worry about what the unintended consequences might be for the wider population. Finally, if you have not decided on this year’s holiday destination, whilst Istanbul is a lovely place, you will find a warm welcome here in Blackpool.

 

*Louise Gittins, the Chair of the Local Government Association, said: “Health inequalities are estimated to cost the NHS an extra £4.8bn a year, society around £31bn in lost productivity, and between £20bn and £32bn a year in lost tax revenue and benefit payments. Health is therefore a major determinant of economic performance and prosperity.”

What not to wear at a funeral

It’s funny what you can have a disagreement over. Last week Jane and I had a slight disagreement over what to wear at a funeral, if it rains. Apparently, ‘it often rains at funerals and funerals are always on a Friday’. I’m of an age where I go to more funerals than weddings these days. In the last couple of years, I have attended too many funerals. Only one of them took place on a Friday, and although some were held on an overcast and grey day, it didn’t rain at any of them.

So, I’m not sure why last Sunday we were having a discussion as to what might be appropriate to wear at a funeral, if it rained. My choice was a large all-weather Paramo hiking jacket. It is black, comfortable and completely waterproof – but apparently very unsuitable wear for a funeral. I don’t possess a raincoat, and my only non-Paramo coat was a long wool coat, alright in the winter, not so great in the summer.   

Deciding that there was no win-win solution this time, I packed the car, including my Paramo and off we set, destined for Cardiff. It was a tedious journey. It should have taken us around four hours, but instead took six. We were in Cardiff for a funeral; my mum’s funeral. She was 91 years old and had lived with dementia for a number of years, getting frailer all the time. For most of the last two years, she had lived in a residential care home and was extremely well cared for. My dad, 94 years old, visited her every single day.

My parents had chosen to be buried at the Cardiff and Vale Natural Burial ground; some 20 minutes’ drive out of Cardiff city centre. It is situated at the top of the Tumble, above Culverhouse Cross. Standing at the site of my mum’s grave, I was able to take in the views across Cardiff and the Caerphilly mountains, and although I couldn’t see them on the day, towards St Fagans and the fairytale Castell Coch – places both my mum and dad were fond of.  

There are no headstones. Each burial plot is marked against a fixed point. The meadows will continue to be farmed, and more tree planting is planned. My parents bought adjacent plots, which I thought was very romantic. They had been married for 71 years, and being apart these last couple of years had hit my dad hard. The laying to rest of my mum was tranquil and respectful, punctuated only by the sound of birdsong. The service was attended by many of her seven children, 19 grandchildren, 22 great-grandchildren and others from her close family.

Interestingly, my parents chose the Natural Burial ground mainly because it’s in a beautiful setting, but partly because it was very difficult to get a burial spot in Cardiff itself. Mum’s coffin was made of woven bamboo, and the whole approach to providing such a wonderful place to lay someone to rest reflected a commitment to a sustainable and environmentally-friendly future. It was truly an approach that respected those that had passed, whilst helping to protect the world for those still living and others yet to be born.

After the burial, we returned to Cardiff for a memorial service for my mum. My parents had both been long-term members of the Cardiff City Church. It is an evangelical Baptist church and was their spiritual home. The preacher who officiated was definitely a graduate from the Billy Graham school of preaching (Billy Graham died in 2018, aged 99 years old, but his six ‘beliefs’ absolutely resonate in today’s turbulent world).  

The preacher’s enthusiasm aside, mum’s memorial service both mourned her passing, but as importantly, celebrated her life, and was an opportunity to say thank you for all the joy and happiness she had brought to the world. My dad spoke passionately about his ‘Hil’ (mum’s name was Hildagarde), one of my brothers and one of her great-grandchildren read from the Bible and one of my sisters recited a poem. I shared some memories. They spanned a lifetime that saw mum washing our hair once a week over the Belfast sink in the kitchen, to her embracing new technology and Facetiming us all on a regular basis. She was a mum to her own children and over her lifetime, a mother to many more children and young people.

It was a good day. The Monday dawned bright and dry. There was no rain, and the Paramo to Jane’s relief stayed in the boot of my car. On Tuesday, the route planner app lied once again. The journey home took another six hours. The remainder of the week passed in an emotionally fatiguing blur. I say a big thank you to my colleagues who stepped up to the plate in my absence. The past week once again reminded me that we are here just one time. That being the case let’s all try and make the most of each and every day. Rest in peace mum.

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.