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.  

There’s a lot to reflect upon this week

We always begin our public Board meetings with a story. These are accounts of a service user’s experience of the care they have received. Colleagues work with the service user to find out how they want to tell their story. Their story is then developed into a narrative, which is shared at the Board meeting through PowerPoint slides. Board members then have the opportunity to reflect, ask questions and engage with the service user themselves.

Last Thursday was our monthly Board meeting. The first 30 minutes were devoted to hearing Georgia’s (not her real name) story. It was a powerful and a very difficult account to hear. My fellow Board members and I felt challenged and emotionally impacted by what we heard. Georgia’s story was one of harm and trauma, rather than of compassionate care. Her story demonstrated sadly how far too often Georgia’s wishes had been ignored or trivialised. Georgia’s mental health issues were constantly reduced to mere diagnostic labels, and by so many different professionals. Often these were contradictory and completely unhelpful.

Whilst there were some good periods during Georgia’s journey, these were few and far between. Like many others before her, Georgia had a list of things that she would like to see us change in the way future services might be provided and care given. Her list not only gave us something to reflect upon in the moment, but it provided colleagues with a plan of action that we could come back to in terms of measuring our responses and hoped-for improvement.

Earlier in the week I had also reflected on one of my daughters’ experiences of accessing health care. Like Georgia’s journey, it was a story of discontinuity and broken connections, of professional voices drowning out those of the people being cared for. My daughter’s partner, Graham (not his real name), had, a long time ago, been involved in a horrific life-changing motorbike accident. He had his right arm and hand amputated as a result. For many years afterwards, he had struggled with severe pain in the hand he no longer had. It is a problem many people, who have had a limb amputated, experience, but Phantom Limb Pain (PLP) is poorly understood.

There are several treatments that can be deployed, most of which involve some kind of pain relief. Eventually these can lose their ability to deal with the pain. This was the case with Graham. Fortunately for Graham, he had a GP who managed to refer him to a specialist NHS clinic who successfully manage to treat folk like Graham using neurostimulation. More importantly, perhaps, is that the professor who performs this microsurgery is the only one outside of the US who is able and qualified to undertake the surgery. He practices in London.

So down to London they went. Following a day of assessments, including the ubiquitous MRI scan, they were told Graham was a good candidate for the operation. A date was set for a pre-surgical assessment, which involved another trip to London. The assessment took just 40 minutes, but again involved a 6 hour round train trip. Frankly it could have been performed at Graham’s local hospital, with the results being sent to the team in London. A final ‘consent’ appointment was set up, which entailed another trip to London for a conversation that could have been easily undertaken on MS Teams. A date has now been set for the surgery, but he is required to go down two days in advance to have another MRI scan, a scan that again could be done by Graham’s local hospital at any time between now and the planned operation, with the results sent to London.

The final disappointment for me (and for Graham and my daughter) is that in addition to the three days’ post operative care he might need, they then have to stay down in London for another five days so the team can remove Grahams sutures. I once had a minor operation in Manchester, which meant the wound being closed with half a dozen sutures. When they told me I had to come back in a few days to have these removed, I explained that I was going to be in Chicago so was unable to come. The folk treating me argued that I could not leave the UK. I said I was going to a nurses’ conference, and I was confident that I could possibly find one of the 100’s of nurses attending who would be able to remove my sutures. And I did.

Both Graham and my daughter work, but the financial burden of so many trips to London, hotel costs, childcare and so on are horrendous. They do have the Bank of Mum and Dad to help, but that is not the point. Whilst I can accept that the specialist treatment can only be performed in London, the rest of the assessments and discussions could easily have been done using existing technologies and without any need to travel to London so often.

Today is the UK Day of Reflection for the Covid-19 pandemic. The day provides folk with the opportunity to reflect on all those impacted by the pandemic. They include people who died or those still living with the consequences of contracting Covid. And here is a Public Health warning, Covid has not gone away. As I reflect upon those days, I can’t help but think about the way so many services across the NHS and other public services came together to make sure people didn’t slip between the stools of organisational boundaries. It was a time of innovation and creativity, of partnership and collaboration. Yet here we are, just some five years later and those professional and organisational silos and barriers appear to have been resurrected and remain impenetrable.

Please reflect on that thought today and perhaps consider what difference you can make tomorrow to really ensure truly person-centred care is available to all. 

Knowledge and experience: the chicken and egg of acquiring wisdom

It was one of my favourite and life-affirming interests that drew my attention last week. In a word, it was a story about chickens. I have kept hens more or less for the past 50 years. So let’s start with a question about a question. Who was it that first asked the question ‘which came first, the chicken or the egg’?

It was a chap called Plutarch. He was a philosopher, priest, historian and magistrate. The question stems from the fact that all chickens hatch from eggs and all chicken eggs are laid by chickens*. Plutarch wrote about this dilemma way back in the first century. He was a man ahead of his time. One of the things he challenged was whether white, old men were the right kind of people to hold positions of power in public office. Given the appalling events in the Oval Office last Friday, he may have been correct. Plutarch was also vegetarian. Even before the term was first coined, he was writing about the ethics of eating meat.

It was another ‘man of the cloth’, the Reverend William Cowherd who in the 19^th century is said to have been the catalyst behind the term vegetarian. He set up, what at the time, was an alternative church in Salford (Greater Manchester) in protest to the Wesleyan form of Methodist worship. John Wesley and others like him avoided meat because they thought it was good (they avoided sex for the same reason). Cowherd and his followers on the other hand avoided meat because they thought it was bad for one’s health and out of compassion for animals. Like me, who’s been a vegetarian for over 50 years now, they did however, eat eggs and cheese. The Vegetarian Society was established in 1847, by which time the movement was no longer associated with the church or religion.

Plutarch’s question has, over time, moved through religious and philosophical considerations, and these days this casual dilemma is addressed through science, and in particular, evolutionary biology. It’s clear that when thinking about eggs only, they came first. It appears that the first hard-shelled eggs capable of producing life on land, rather than water, evolved some 312 million years ago. How such eggs were then produced by chickens is less clear. Most modern-day chickens can be traced back to red jungle fowl, and quite how they evolved to produce hard-shelled eggs is much less understood.

One of the first questions posed to the AI programme ChatGPT was Plutarch’s ‘what came first, the chicken or the egg’? The AI response was ‘the egg’ – when asked why, the software simply replied ‘evolution’. Interesting but worrisome. I wonder whether future generations, or even the current generation, might lose their sense of curiosity of how our thinking has developed over time? Will they worry over what issues or concerns might have influenced our understanding of the world? Will they even be interested in finding out more than just a simple AI answer? I hope not.

These days I see countless examples of AI-generated communications, stories and explanations. Indeed, my laptop will ask me if I would like the assistance of AI to improve my blog writing. I always decline. No need, when I have Jane, whose recovery journey is definitely one of improvement, and she is always on hand to help find ways to enhance my writing!

It is the process of thinking and learning involved in creating each week’s blog that truly interests me. I don’t think AI will ever replace the learning that comes from experience. A ‘knowing through doing’ approach to life, which is where I return to that chicken story. It’s a story of the impact in the US of rampant bird flu. It is devasting chicken flocks, no hens, and the scarcity of eggs, is pushing the price of eggs to almost unaffordable levels.  

Just like during the Covid pandemic, when people realised about the vulnerabilities in the food supply chain and started to grow their own vegetables, people have started to keep chickens in their backyards. In doing so, they are discovering that it’s not a cheap and easy way to get eggs. Predators, bylaws, the price of feed or unhappy neighbours, are just some of the problems folk are encountering. And that presupposes they are able and could afford to buy the chickens in the first place. All problems that are surmountable of course, but it does take experience and the ability to learn from experience to do so. It was Isaac Asimov who said ‘the saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom’ – for all our futures, I hope this doesn’t continue to be the case.

 

*we currently have a chicken sitting on a clutch of eggs, some are hers, but most were laid by the other hens in the same nest box. Her eggs will never hatch as she has consistently refused to allow our cockerel Gregory Peck to have his wicked way with her, and as such they remain unfertilised.

A disrupted rhythm of life, and a new normal

And just like that, one day you are walking hospital corridors, the next you are running up and down stairs. Yes, my wonderful wife Jane came home from hospital last week. It hasn’t been quite the smooth ride Bianca*, the Sister-in-charge of Jane’s last ward promised. In fact, you might say, since last Monday, at times, it has been a bit of a nightmare. Assuming of course, that you had slept and might perchance to dream.

Today is only day six following her discharge home, and so it’s early days of course. We both believe that Jane’s memory will improve, and her disorientation and confusion will diminish by having the next steps of her rehabilitation and recovery here at home. Care at home, or closer to home, when appropriate, will always be better than inappropriate care in hospital. Currently, across England, there are over 14,000 people each day who are medically fit to be discharged but who remain inappropriately in a hospital bed. They do so because care closer to home or in their home is simply not available to them.

I’m fortunate as, in the short term, much of what I do as an NHS Chair, can be undertaken by working from home. I’ve a great team too! It means in these early days of Jane’s recovery at home, I can be here to help her when necessary and keep her safe. She is doing well. That said, night time and sleeping are proving problematic, hence the notion of a nightmare above. At times, Jane has struggled to get to sleep, or to stay asleep. For the past six nights she has been restless to the point of agitation. Things will improve, but right now the disturbed sleep is certainly taking its toll.

Apparently, the longest time someone has gone without sleep is 11 days and 25 minutes. It was a world record set by the 17-year-old American, Randy Gardener in 1963. For my part, I’m beginning to feel like a dad in the first few weeks of the arrival of a new baby in the house. There were close to 600,000 live births last year, which will account for a lot of crying babies and disturbed nights for parents. I have been there, so know what it can be like.

Most adults need between seven to nine hours’ sleep each day to stay healthy. Young people probably need more, and older folk like me, often need less. Interestingly, you should not need to set an alarm to wake up in the morning. If you do need an alarm call, it is more likely than not, that you are not getting enough sleep to keep you healthy. I never use an alarm clock, and I rarely go past 4.30am, before waking up.

The effects of sleep deprivation are well researched, and the loss of sleep doesn’t have to be in the extreme form above to have a negative impact on someone’s wellbeing. In the short term a lack of enough sleep or disturbed sleep can result in irritability, lethargy, fatigue, memory problems, mood changes (particularly depression), and in some instances, raise a person’s blood pressure.  

Many years ago now, I attended an interesting lecture on the possible impact of ‘out of kilter’ circadian rhythms on a person’s mental health. Circadian rhythms ‘tell’ the body when to sleep, wake, and eat. In turn, they are governed by a group of neurons called the suprachiasmatic nucleus, located in the hypothalamus in the brain. It is the group of neurons that translate cues from a person’s environment into directives for the body to act upon. Such cues include light, noise, temperature and so on. So, for example, darkness can result in the production of melatonin, the hormone that promotes sleepiness. It is possibly these circadian prompts that are a little out of alignment for Jane at present. I also think, however, that it has been the disturbed rhythm of our lives over these past seven weeks that have also contributed to our current challenges.

Jane was fortunate (not sure the that is the right word) that her subarachnoid haemorrhage did not impact on her motor functions, and her speech; but it was still a serious brain injury. It was an injury that paused our joint life clock, and the familiar rhythm of our lives. There is a ‘new normal’ for us to embrace and nurture, but as we do, we will make the most of every day. Yesterday, Jane wrapped up warm and we went for a walk in the snowdrop-bedecked gardens of Lytham Hall. Something neither of us thought possible a week before. There truly is only one life, and we should all try and live it to the very best we can. We have made a start on our new normal and recapturing the rhythm of our lives.  

 

 *Two days after Jane was discharged I went back to the ward to pick up a Fit note for Jane, Bianca said ‘I thought you might have looked a bit more tired…’ – I just smiled and said thanks for the sick note.

Dr Who: observations from the anthropologist’s apprentice

One of the outcomes I treasure most from my PhD was my introduction to cultural anthropology. I had an academic giant of a supervisor. He allowed me to stand on his shoulders and get a very different view of the world. He opened my mind to so many possibilities, particularly what it might mean to be a person. I explored what factors make people do the things they do, what they believe in and how their experiences shape the way they behave and interact with others. That said, I’m not a ‘qualified’ anthropologist.

However, in our house, I’m the anthropologist, and Jane is the apprentice. It is a long running private joke that comes partly from the different ways we have of viewing the world. I have a ‘film track’ running in my mind that is constantly fuelled by observing what is going on around me. Some of the things I see get instantly discarded. There are other things I observe which linger in my mind, and it is these that make me pause, question or reflect. It is a more nuanced form of ‘people watching’ that exchanges superficial fantasy for a possible analysis reflecting someone else's reality.

This way of being, (or rather my way of being), sometimes surfaces in me asking Jane if she saw, or heard, of felt something I might have just observed. More often than not she will say no, and I will nearly always respond with ‘well you are not a trained anthropologist’. And we laugh with each other as we both know, however much I might posture, neither of us are. Critically, observation is the key factor in cultural anthropology studies, whether this happens through being as an active participant, or as a non-participant observer.

Now during the time Jane has been an inpatient in hospital she appears to have honed her observation abilities and her anthropological analytical skills too. Last week, following her successful shunt operation Jane was moved from the high care ward to a step-down neurological ward. My word what a difference a short corridor trip can make. Now despite what follows here, Jane continues to make progress, albeit it slowly. Once again thank you to all the readers of this blog who have steadfastly supported us both.

So, the spacious 4 bedded high care ward, the calm, and the quiet, has long gone. Replaced instead with an overcrowded (19 beds in a 16 bedded ward), noisy, hot, and often a seemingly chaotic environment. There is little privacy. It took me 3 days to get Jane a bedside cupboard and she is still eating her meals off a tray, on her lap, as she lays in bed. The hospital pharmacy has allegedly been unable to source her medication for over 48 hours. I have now fetched her long term and necessary medication from home. 

As bad as some of the conditions are (and I will pursue my concerns somewhere other than in this blog), what is more disheartening are the apparent attitudes of some of the folk working on the ward. For example, Jane, drawing upon her growing anthropological knowledge and skills, observed that none of the doctors caring for her introduced themselves while conducting the daily ward round or when undertaking a procedure. Nearly 12 years after Kate Granger started her #hellomynameis campaign, I found this both sad and hard to accept.

For those readers who don’t know of Kate Granger, she was a medical doctor who was also a patient living with terminal cancer. During her inpatient treatment, she found it frustrating that so many of the health care professionals caring for her failed to introduce themselves. Health care professionals introducing themselves to patients is not just common courtesy, it is something more fundamental. Kate Granger described such simple introductions as the ‘first rung on the ladder to providing truly person-centred, compassionate care’. Absolutely. It is the bedrock upon which effective approaches to active listening and therapeutic conversations can be built.

Please don’t get the wrong impression. I know, understand, and deal with the extraordinary pressures facing the NHS every day. The underlying factors causing these pressures have all been captured many times by folk who can describe them more eloquently than I will ever be able to do. But for me (and more importantly, for Jane) it’s just not about poor buildings, aging equipment and a depleted skilled professional workforce: its the lack of kindness in human interactions that matters. Kindness always matters and in the health care setting, being kind toward those you are caring for can positively impact upon a persons sense of self and aid their recovery.

Kindness to others, kinship and relationships have long featured in cultural anthropological research. Indeed, my PhD examined the professional and non-professional relationships between GPs in a so-called quasi health care market. Many of the anthropological studies have consistently noted that the factors that promote and foster kindness includes providing people with the opportunity to observe kindness of others. I think that an overcrowded neurological ward, where everyone can observe and hear the conversations of others, provides a great place to test out this idea.

Shedding a tear (or two) at the sound of silence

Last week, as dry January came to an end, I saw a social media posting that caught my attention. It was a picture of a hand holding a glass, in which, was a generous measure of a dark malt whisky – the caption read ‘Hello darkness, my old friend’. Just for clarity, it was not my posting, I’m still alcohol free, and will remain so until Jane comes home, and we can celebrate with some champagne. After all she has been through, I think it will be at least two bottles at that!

The caption is a line from Simon and Garfunkel’s classic song the Sound of Silence. I was never a great fan of Simon and Garfunkel songs. Perhaps if I say I thought the Rolling Stones (I Can't Get No) Satisfaction released at the same time, was more my kind of music, you will perhaps understand why. However, time passing can sometimes mellow opinions, and the social media post did strike a chord. So, I listened to the song once again. You can too, here. The words resonated.

Paul Simon was writing about a very troubled time in the US and the worlds history - not that the US troubles have got any better or the world has become a better place either. Whilst some 60 years later, the song possibly still reflects the current zeitgeist, the song’s lyrics resonated with me for very different reasons, more of which in a moment.

Now, some of this blog’s readers will recognise that silence is often used in therapeutic conversations. Sometimes as a prompt to someone to say something about the issues they are facing without interruption. Or to enable the person to process their thoughts and feelings without distraction; and to reflect and gain clarity on possible ways forward. In a therapeutic sense, silence can be a powerful and enabling approach for the therapist to draw upon. However, it seems to me that in a non-therapeutic context, silence is often viewed a as space to be filled somehow.

For example, why do so many folk have their tv on, even when they are not watching it? We are just as guilty. As a couple, we love music, listening to it, making music and apart from Taylor Swift, we share a similar taste in music. However, whilst Jane always drives with her music playing, I like to drive and talk. She has her music headphones on while she runs, I walk in mindfulness silence. Billy, our parrot hates silence, and will chatter away all day to avoid it. Sometimes he makes sense other times he just whistles the blues.

And be honest now, how many of us have fallen out with a loved one where the result is a stony silence between you and them. A silence that can last an hour, a day, or even longer. I know I have. At such times, I have sometimes been accused of sulking, or not wanting to address the cause behind the falling out. Whatever the reason, sooner or later someone needs to speak to break the silent deadlock. This type of silence can be corrosive. But it is not the only type of a silence that can be damaging.  

Since Jane has been in hospital, I have encountered silences that can be equally challenging. You have probably had similar experiences. You know that silence that becomes all engulfing as you wait for a promised phone call that never comes (in my case, from the staff on Janes ward). And the associated silence, that’s punctuated by only of the sound of an unanswered phone ringing, as you finally give in and ring the person who promised to ring you.  

Then there is the silence that comes with its own soundtrack. In the 32 days since Jane’s brain bleed, I’ve watched everything on tv I wanted to and much that I didn't. I soon turned to asking Alexa to play my favourite music instead. So, she obliges, and I sit of an evening listening to music I have already heard many times. 

Paradoxically, this produces a different kind of silence. In that silence, I have found that for the first time in a long time, I’ve heard loneliness knocking at my door. Please rest assured dear reader; despite shedding some tears on more than a few evenings recently, I’ve sent loneliness packing. I thank you all, for the support you have unconditionally given Jane and I. It is appreciated, although you will perhaps never know how much.

Jane has endured her own sound of silence this past week. A promise of a life affirming operation, only to be dashed at the last moment. Not once, but twice. This was a frustrating silence and pause in her recovery. Thankfully, yesterday Jane had her much needed operation. It was an anxious afternoon. I was able to take her to the operating theatre, tell her I loved her, and sealing our love with a kiss.

What seemed like a long 5 hours later, she returned to the ward. Jane held my hand, opened her eyes and gave me a smile. It was a special moment, and I gave her a welcome back kiss. Everything went as planned with the operation, and this felt like a big step forward on Janes recovery journey. I was silent on my drive back from the hospital, but it was a truly grateful silence.        

Now I try to never judge or condemn others. Unconditional positive regard is my watch word. But I also have my failings, see above. It seems to me however, that those who could reassure and/or confirm what might be happening to folk like Jane in these moments of high anxiety, are too often unable to do so. I don't know why. On Jane's ward the busyness is something to behold. I have sat there as the ward phone has rung and been left unanswered. I don't believe for one moment that those who have been caring for Jane have intentionally remained silent. I guess in the moment they have other priorities to address. That said, our experience has made me reflect on how my own NHS organisation communicates with service users, carers, families and colleagues. As I have found, the sound of silence, whatever the reason, is never going to be right or helpful.

Memories are the key not to the past, but to the future

Goodness it’s February 2nd already. January has come and gone, and what a month that was. This past week has been sprinkled through with memories of the past, some of which were good, others were rather more challenging. It has been 5 years since Brexit. It’s hard to identify what has been good about Brexit, well certainly not in this house anyway. Sadly, Marianne Faithfull died aged 78 last week. She was born in the same place as me, Hampstead, in London, albeit 8 years earlier. She was the 1960’s ‘it girl’ (younger readers please ask your parents what this means) a singer and an actress. For a while she was the muse and partner of Mick Jagger.

Although she died in 2016, there was another Marianne (Ihlen) who was the muse and partner of Leonard Cohen. He wrote a song in 1967 which although written for ‘his’ Marianne, I think captures the spirit and zeitgeist of the time. Listen to it here. All 4 of these folk featured one way or another in my teenage years.

More poignantly, last week we also remembered the liberation of the Auschwitz 80 years ago. Last Monday (27th January) Along with many others I’m sure, I lit a candle and placed it in our front window. It was a symbolic shared testament to our solidary, respect and remembrance for all those killed in the death camps. As our King said on the day, ‘the act of remembering the evils of the past remains a vital task’ – we cannot let todays generation or our future generations, ever forget the most wicked act of inhumanity against others the world has ever known.

I have been to Poland a few times. Mainly to Warsaw, which I discovered last week is now one of the top 20 vegan cities of Europe. I have never been to Krakow, the nearest city to Auschwitz. It just 30 miles away and today is a popular tourist destination. For many reasons, none of which I wish to go into here, I have never wanted to visit Krakow and by its association, Auschwitz. Jane went last year and was able to visit Auschwitz and the other concentration camps nearby. Her visit had a profound impact on Janes sense of self. Watching the memorial services this year convinced me that I should make that trip. Jane has promised to come too.

And travel memories featured this past week as well. I spent a lovely couple of hours with Jane going through the photos of our travels together. There were over holiday 6000 photos on my phone (the curse of camera phones I guess). What made the time together special was Jane being able to recognise the various places and tell me stories of what we did and saw on our travels. Given her short term memory is still not where it should be and confusion still reigns supreme, this was a positive and very welcome glimpse of my Jane.

Her confusion caused consternation last week. In the middle of the night, Jane decided she was being poisoned and being held prisoner by a group of people she didn’t know. So, like anyone finding themselves in such circumstances, she rang Lancashire Police. They were confused. Jane was confused. The ward staff were confused when, after tracing Janes call, the police contacted the hospital. Her phone was confiscated, explanations provided, and we all got back to sleep.

The following day Jane had no memory of the incident, and to be honest we had a bit of a laugh about it all. However, consequently, and with her permission, Jane’s phone is now locked up overnight. Unfortunately, Janes current treatment regime is still not helping her. This being the case, she is scheduled to have a permanent shunt fitted this coming Tuesday, and that should be a big step forward for Jane and her recovery journey. Keep her in your thoughts and prayers please.

It has been a journey of discovery that’s for sure. Descartes’ philosophy that the mind and body are conceptually distinct has underpinned much of western culture and medicine for centuries. Illnesses are thought of as being either ‘physical’ or ‘mental’. I have long advocated that there can’t be a separate category of illness that this idea suggests. I’m with the World Health Organisation in that there is no health without mental health. This blog is not the place to explore the brain and what we might think of as our mind. However, as we have found out, a bleed on the brain, can have a huge impact on the way our mind works. Thankfully, in Janes case, her memories are still there, and we will make new ones soon for sure.

Never get so busy making a living that you forget to make a life

There are so many good folk out there. We are on day 17 of Janes recovery. Although things aren’t going quite to plan just yet, I’m staying positive and taking each day as it comes. It is not easy. What has made a difference over these past 17 days has been the kindness of others. This past week has seen me eat meals prepared by my wonderful neighbours (and take some freshly baked cakes in for Jane); had two huge bouquets of stunningly colourful flowers delivered; had so many cards through the post that our post lady asked if it was someone’s special birthday; had two supportive conversations with two complete different men of God; and received many, many messages, texts and emails of support. So, I say a big thank you for all the kindness shown. All of which has considerably helped with my wellbeing.

By sheer coincidence, (now is there such a thing?) last week in my NHS Trust we held a wellbeing week. This wasn’t the World Wellbeing Week which starts on the 24th June, it was our attempt to start the year right by helping colleagues focus on their health and wellbeing. There was an impressive range of activities and ways in which folk could get involved. It was also an important reminder that we cannot look after others if we don’t look after ourselves as well. Sadly, and across health care professions in particular, our own health and wellbeing can often be something that gets neglected.

Where this happens, it can become harder to care for others. Over time, this can really skew our work-life balance, and to such an extent that we can’t function well in either area of our lives. Something, over many years I have found out to my cost. Unlike me, it seems increasingly these days, finding a job that fits in with the rest of people’s lives has become equally if not more important than how much people are paid.

Working at home and other forms of flexible working are tangible examples of this approach in practice. How many of us pre-pandemic knew about Zoom, MS Teams and so on. Now it’s an integral part of many peoples working lives. Indeed, right now, without MS Teams, I would find it difficult to continue to play an active role at work while also supporting Jane. Despite its detractors hybrid working is clearly here to stay in one form or another.

What risks being lost with non-traditional ways of working however, is the sense of community that physically being with other people can bring. I have found it very interesting to be a non-participant observer as I sit in Janes hospital bay. It is easy to see the community that exists withing the nursing team that cares for patients there, but also with the wider neurology unit staff, and I would think with the community that is the nursing profession. It is powerful example of an effective community of practice.      

Likewise, the anthropologist in me was also interested see evidence of what Lipsky described as ‘street level bureaucracy’ where policy and procedures are enacted within the discretion and hierarchy of the nurses on duty. The same could be found with the doctors I have spoken with – they often act as interpreters of medical knowledge and decision making, carefully, but implicitly reinforcing the power differentials at play – and all done with plenty of smiles.

These recent experiences have caused me to reflect on whether I’m also guilty of these approaches in my working life. I hope not, but it is, of course for others to say. But there is one more aspect of the work/life balance that I’m aware of and actively cultivate. At work, it must be said, I embrace the opportunity to be ‘on the stage’. I like the performance elements my role entails.

However, in my non-work life I embrace anonymity. I seldom tell others of my work life, my position or professional standing. Despite being very self-confident, I like to nothing more than to blend into the background.

At the hospital caring for Jane I know both the CEO and Chair well, and have known them for many years as our career paths have crossed. However, whereas Jane might say something, I would never disclose this to the folk looking after her, preferring to simply being her husband, a role more important to me than any of the others I have. So I was amused somewhat, by being really told off for attempting to sit Jane up the other afternoon (it affects the pressure drain she has fitted). I didn’t explain I was trying to get Jane to lay back down not lift her up. Telling me off, was the correct thing for the nurse to do, although she might have been kinder in the way she did so. I’m not sure that to protest my innocence would have helped her or my sense of self. And I'm sure that such a conversation would not have added anything positive to our sense of wellbeing either. We only have one life, and sometimes its better to just smile quietly to oneself, and carry on, and in doing so, try to make the most of every day we are given.  

On being alone but not lonely

Ok, we are in blog form proper this week, but before I get started, I just want to say a huge thank you to all you wonderful folk who have sent messages of support, offers of help, and kept Jane in your prayers and thoughts. The number of people reaching out to us this past week has been absolutely truly humbling. I have passed on every message to Jane, and even where she has not been able to speak, she has shared a smile that sends a thousand words of gratitude. It is day 10 of Jane’s recovery, and in the past week she has had two operations on her brain, spent time in critical care, and is now back in the neurology high care unit, her home for at least the next 3 weeks, but maybe for the next 3 months. Jane is making progress, slowly, but steadily, and for that I’m grateful.

From almost day one, Jane has been missing her phone, something she’s very attached to, more on which shortly. And it was partly a phone story that caught my attention last week. Despite all the dreadful things going on around the world, one of the less serious news papers chose to print a story that purported to tell us, based of a collection of international research, when in any given day the most optimal time was to do various things. So, to reduce your risk of having a heart attack, wake up and drink your first coffee of the day at 06.50. The optimal time to have breakfast is 07.11 (I can’t imagine sitting at the table waiting for the big hand to hit 11 before diving into my cornflakes). The report lists many activities from when to take exercise (08.15), seeking the sun (11.55) and when to have the best sex (22.20).

It is the precision of the timings that amused me, but it was the photo that accompanied the section on when was the optimal time to eat dinner (18.14) that saddened me. The photo, (Credit to Getty) shows a group of folk part way through the meal, but who are all looking at their phones. The half-finished plates might indicate they are between courses, but I know when Jane and I eat dinner it is not only a chance to enjoy good food, but good conversation too.

I come from an age where the phone was tethered to the wall, usually the hall wall at home. Having a conversation with your friends was a high-risk exercise in case mum and dad, or worse still, a brother of sister overheard what you were saying. And goodness was there arguments about the amount of time you could be on the phone! As I have got older, I have lived through a very real technological and digital revolution. I’m sitting here typing this blog out on an iPad that has more computing power than most of the early clunky computers I owned. Likewise, my phone now gives me unlimited opportunities to communicate, search for information and take photos.

While all of this is wonderful of course, I do reflect on the possible negative impact such unlimited access to a digital world might have on our mental health and wellbeing. Childline published their latest data on the reasons children contacted their helpline last year. The NSPCC, which runs the service, reported that the number one reason for contact was loneliness*. It was loneliness caused by many things, like moving home and having to make new friends, being bullied by their peers at school, and seeing their friends having fun on social media and feeling they are somehow missing out and not being included. I guess these are challenges children across the ages will have experienced, so why should there be such a high number of children reporting their sense of loneliness. Being able to share how they feel is much easier these days of course, and the phone makes it even more so.

However, I can’t help but think a young person sitting in their bedroom, alone with their phone, experiencing the world digitally isn’t as helpful or as healthy as being with other young people exploring what the world has to offer together.  Probably it’s my rose-tinted glasses, but back in my day, being in your bedroom was to be avoided at all costs as it usually meant you had done something wrong. I’m pleased to see a growing number of schools banning phones being brought into a school. It’s a start, but as adults we also need to play our part and put our phones away and start to have different conversations with each other.

Back to Jane and her phone, despite much confusion and disorientation still, Jane got her phone back on Friday afternoon. She promised me she wouldn’t use it for emailing or messaging. Reading, watching tv or scrolling through social media isn't at this stage, particularly helpful for her recovery. Knowing this didn't stop Jane as I got messages at 00.28,  04.14 and last night at 03.38. All rather mixed up conversations. Was I cross? A little I guess, but in the end I just rolled over, a smile on my lips, knowing my Jane was close by. I may have been alone, but I wasn’t lonely.  

 

  

*In 2023, the World Health Organisation (WHO) declared loneliness to be a rising global threat, with its effect s on an individuals health being equivalent to smoking 15 cigarettes a day.

My heart's not in it

I had already lined up some stories to use when writing this weeks blog. But to be honest, my heart's not in it this week. Following a subarachnoid haemorrhage (a bleed on the brain), my wonderful, beautiful, funny and brilliant wife Jane is lying in a bed in a high care specialist neurology centre. 

Last week, Jane had what was described as a ‘funny turn’ while on a Teams meeting. Her colleagues alerted her HR department, who rang me to make a welfare check. Fortunately due to overnight snow, I had decided to work from home on that day. I found Jane sitting in a pool of vomit in her office, totally bewildered as to how she found herself there. I could write about the importance of all organisations having up to date emergency contact numbers for all staff, but my heart's not in it other than to say thank you to Janes colleagues for raising the alarm so swiftly.

I could write about the wonderful folk at NHS 111 who I then contacted, or the emergency ambulance service who came to assess Jane later in the day. Sadly, whilst all her vital signs were normal we couldn’t persuade her to go to the A&E for further tests. Some 48 hours later, and with her eldest daughters help we persuaded Jane to go the the A&E department. Thankfully, over those first 48 hours, she slept for much of the time. Although I was able to keep her fluid intake at a reasonable level, my anxiety levels rose with every passing hour. However, my heart's not in it to write about these emergency services other than to say thank you to the various emergency folk for all they were able to do for us and do for so many other people too.

I guess I could write about the A&E department, which when we arrived was pretty empty, but rapidly filled up over the ensuing hours. Janes triage went swiftly as did the bloods and ECG assessment. But it was a very long wait to be seen by a doctor. I could write about the whole assessment process, the duplication of questions and the countless retelling of Janes story. I could also write about the corridor care the lack of information as to what was happening as the hours went past or the compassion and consideration of the doctor who told me about the outcome of Janes CAT scan. But my heart's not in it other than to say a big thank you to all these folk for the treatment and care everyone afforded Jane during our time at Blackpool NHS FT. 

So please forgive me for not writing my usual blog this week. My heart's not in it as I sit and wait for news. My guilt at the delay in getting Jane sorted sooner rests like a heavy stone in my heart. I will travel to the neurology centre shortly to be with Jane and the start of what might be a challenging road to recovery for her and us. Please keep Jane in your prayers and thoughts, I know she will need them.

Corridors, culture and a challenging year ahead

This is my first blog of 2025, my 17th New Year blog, and the 804th consecutive weekly blog since I started posting them in 2009. A big THANK YOU to all my regular readers, your continued support is always much appreciated. It is also day 5 of ‘Dry January’. I don’t think I want a life of sobriety, but it is good to have an annual detox. Here is what happens to your body (courtesy of the Sun) when you stop drinking alcohol. These days thankfully there are so many great zero alcohol drinks available that it is pretty easy to avoid alcohol, even when out and about.

The other event I’m celebrating in this blog is being at Greater Manchester Mental Health NHS Foundation Trust (GMMH) for one whole year. I joined GMMH on the first of January 2024. It was not where I thought I might spend 2024, but looking back, I’m thinking what a great place to have spent the last 12 months. I last worked at GMMH 40 years ago. Coming back in January last year absolutely felt like coming home. For a moment or two at least.

In many ways, 2024 was a very challenging year. As I mentioned in last week’s blog, I was asked before Christmas what did I think had changed at GMMH in the 12 months since I had taken up the role of Chair. It was a great question and really made me stop and think. To be trueful, the first six months felt very strange. All the cues indicating an effective organisation with a healthy culture were missing.

I sometimes use the corporate office corridor as an example of what this felt like for me. That is where the Executive Directors and I have our offices. During those first six months, the corridor would, in the main, be deathly quiet. All the office doors would be closed and there was very little movement of people. It was silo working personified. Partly, this was a result of the original Board having been almost entirely replaced by interim folk. All of whom, undoubtedly, had the requisite skills and experience for their roles. Unfortunately, there was little evidence of team working, trust, or a concerted willingness to challenge some longstanding and endemic issues and move GMMH forward. I firmly believe it is the Board that sets the tone for the culture of an organisation.

Fast forward to 2025 and things feel very different. We now have a substantive Board, and it is a Board that is made up of folk operating at a high level of effectiveness, working together and absolutely unafraid to tackle those difficult issues. I describe these folk as having ‘skin in the game’ - others might describe it as a high degree of commitment and purposefulness.

That corridor itself is also now so very different. Office doors are often open, I hear laughter, banter, and there is much movement. Some of the offices now reveal something about the people who use them, with plants, pictures and other personal items aplenty to be seen. People are visible and it is wonderful to be introduced to so many new faces of folk working across GMMH, visiting my Board colleagues for meetings and so on.

Of course, the difference in the corporate offices is not the most important change I would describe as having occurred over the past 12 months. However, it is indicative of a wider change in the organisational culture and level of ambition to be found right across GMMH. It is something I observe every time I visit a clinical service or one of our professional support departments. Colleagues are increasingly willing to own many of the longstanding and emergent issues and work together in finding solutions and new ways of working. The safety and quality of care provides a solid bedrock for decision making. Service user and carer voices are increasingly being heard and responded to. There is a sense of pride when things are working well, and a determination to do better when we don’t get things right

Whilst there is a great deal more optimism and positivity to be observed, we have a long way to go. It sometimes feels like every week brings a new issue or problem to address. That said, I think one of the greatest differences now from 12 months ago is the leadership that is beginning to emerge across GMMH, from Board to Ward. It is a transcendental leadership that people can believe in, trust and draw upon on our journey of improvement. It is clear that for the whole of the NHS, 2025 is going to be an incredibly challenging year. More so than any year before. I’m glad to be working with folk who I think will be able to respond creatively, positively and with energy to any, and all of these challenges. And that is a huge difference from what I found at the beginning of January last year.