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.