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

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

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

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

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

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

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

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

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

 

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

Easter happiness and chocolate eggs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  

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

Comfortably Numb? – the need to change

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

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

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

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

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

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

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

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

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