What not to wear at a funeral

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

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

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

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

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

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

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

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

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

A day spent well, brings a happy sleep

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

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

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

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

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

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

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

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

Climbing the continuous care mountain

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

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

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

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

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

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

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

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

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

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

**not her real name

Creating a place of calm in Bedlam?

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

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

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

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

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

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

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

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