Sunday, 24 August 2025

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

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

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

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

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

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

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

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

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


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


Sunday, 17 August 2025

Becoming Me, Myself and Mine

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

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

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

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

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

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

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

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

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

Sunday, 10 August 2025

Mountain top thoughts

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

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

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

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

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

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

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

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

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

Sunday, 3 August 2025

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

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

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

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

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

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

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

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

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