Will a little of what you fancy do you some good?

Well, I’m back, back in the UK that is. The rain and wind, and a slightly colder start to the mornings have been invigorating. Kenya was absolutely wonderful, but when all is said and done, there is nothing like your own bed to snuggle into. Last Friday, I only had one work meeting, so I thought I would reacquaint myself with our beach. I was fortunate to enjoy some very ‘emotional’ weather. It’s that combination of wind, rain, and brilliant, brilliant sunshine all in one walk. It makes me feel good.

My walk eventually took me to my favourite people-watching bar, The Shipwreck. Glass of red poured, I was joined by a group of regulars, average age 65 (at least) and all women. They were a hoot! All had an opinion about both world affairs, as much as they had an opinion about local services, neighbours, their last doctor’s appointment, whether they had been over charged last week at the bar and everything else in-between.

Usually, when visiting The Shipwreck, I would have a bowl of cheesy chips with my glass of wine, but recently I have lost much of my appetite. So last Friday, I didn’t. I think I manage my health very well, for a man that is. However, I also know when I need to seek help and I have a forthcoming GP appointment to start that discussion. I’m from the generation that still has faith in medical knowledge and the power of good science to keep us healthy.

Other generations, however, appear to choose other ways to keep healthy. Last week I read about those folk in the TikTok generation, who seem to have developed a blind faith in vitamin patches. These patches are said to provide an energy boost, improve one’s mood and where used in sport, are able to boost performance. Absolute bunkum of course! These so called ‘wellness’ or ‘supplement’ patches can only contain minute amounts of vitamins and/or other substances. More importantly, perhaps, is that there are very few medicines that can be delivered via patches (for example, nicotine patches to aid smoking cessation, or hormone replacement therapies). Our skin acts as an effective barrier to prevent water, bacteria, and most modern medications from entering our blood stream.

As an almost lifetime vegetarian, I would suggest that having a balanced diet full of fresh vegetables is likely to keep you a lot healthier than a few stick-on patches. The exception might be, for example, pregnant women, who might need temporarily, additional vitamin D and folic acid supplements. You would be better spending your money on fruit and vegetables, as you will definitely feel much greater benefits. Fruit and vegetables also provide necessary fibres for a healthy gut, and many contain antioxidant and anti-inflammatory properties too.  

Indeed, I read an article last week that suggested that the ‘five a day’ recommendations suggested by the NHS, should, instead, be replaced by eating 30 plants a week. Although on the face of it, 30 plants a week sounds remarkably like eating five portions of either fruit or vegetables a day, it’s not. The 30 plants a week approach is built around six main groups of food: Fruit, Vegetables, Whole grains, Legumes (beans and pulses), Nuts and seeds, and Herbs and spices. It is using these ingredients to create our everyday meals that is the key. Whilst it’s possible to include canned and frozen versions of these ingredients, fresh is better. Immediately that you start using these ingredients to create your daily meals, a number of benefits start to occur. You will stop eating ultra-processed foods as a major part of your diet; preparing a meal becomes a more satisfying and fulfilling thing to do; it’s easier to batch prepare meals, saving time and money, whilst reducing food waste.

Your shopping basket might start to look different, but unless you only eat fresh ingredients, the cost of your weekly shop shouldn’t increase. All my meals while in Kenya were created with these ingredients, and every meal was freshly prepared in front of me, both in the Maasai Mara game lodge, as well as the Nairobi hotel. The exception was Emirates, who kept on serving me completely vegan meals despite my ordering of vegetarian meals. I do like a bit of cheese, and to be frank, a non-dairy cheese board simply doesn’t appeal.

Finally, I came across another exception to the rule last week. It was the 107-year-old Owen Filer, who lives in Cwmbran, Wales. He put his longevity down to living a simple life, working and not over eating – oh, and a diet of fish and chips. Maybe a little of what you fancy really does do you some good?

It happened just like this, a sigh, cry, hungry kiss*

The phrase ‘kick the bucket’ can be traced back to 1785. The author Francis Grose included it in his wonderfully-titled book, ‘A Classical Dictionary of the Vulgar Tongue’. The phrase ‘kick the bucket’ is usually used to describe someone dying. The associated phrase, ‘bucket list’ is, however, much more recent. Although it can be traced back to the 1960’s, most people connect it to Justin Zackham, and his personal account of things he would like to do before he kicked the bucket. This account was the basis of the screenplay for the 2007 film ‘The Bucket List’ starring Morgan Freeman and Jack Nicholson.

A bit of a continuity leap, but stick with it. This week’s blog comes from the Maasai Mara Game Reserve in Kenya. It was one of the big trips still left on Jane’s ‘bucket list’. She wanted to have an ‘Out of Africa’ experience. It is something she has harboured for many a year. The film and book are one of her favourites. Arriving in Nairobi, there was plenty of time for us to visit Karen Blixen’s house (now a museum), whose book the film is based upon. Just being in her surrounds was emotionally moving. She published her book in 1937 under the pseudonym Isak Dinesen. In those days, women were thought not to be able to write! Just how wrong has that proved to be.

The film came much later. It was released in 1985, and starred Robert Redford and Meryl Streep. 

Just as their romance started with a tentative kiss, so did Jane’s and mine. However, that’s where the similarities end. Karen’s life was a troubled one, and ended in a very sad way. Truth be told, it was not because of anything she did. Thankfully, we both feel we are in a very different place. Importantly, and for those who know her story, we flew into Kenya on an Emirates double decker Airbus and not a Gypsy Moth Biplane!

Emirates got us safely over the troubled Middle East and into Nairobi. The service was, as always, excellent. It was Jane’s first experience of having a drink in the bar lounge onboard the plane, something she thought was amazing, and it was. More amazingly for me however, was being able to feed giraffes in a game reserve just outside Nairobi city. It was a conservation centre, where the giraffes could roam free, but every morning they came to the centre compound to be hand fed. To get that close to what is still a wild animal, and to be able to feed them by hand, was simply magic!   

From Nairobi it was a short 45-minute flight to our base near the Mara river. I was the ‘co-pilot’, an experience I greatly enjoyed. Our part of the river seems to be a favourite place for hippos, who can be seen and heard from our sundeck. It has been a brilliant experience so far. The wildness is immense; something we have experienced from the daily safaris. We have seen all the animals we had hoped for, and more. 

For example, although I have kept pigs in the past, there was something quite special about seeing a mother warthog with her young, trotting across the countryside, as you pass her by in your safari truck. There have been some slightly scary encounters though. I have never been just a few feet away from cheetahs, lions, or elephants. We did become slightly blasé about the zebra and Thomson gazelles - there were simply hundreds of both. Our safari guide, Ezekiel was brilliant at finding the animals, often way ahead of other guests. 

Yesterday was World Mental Health Day. The theme for this year was ‘Lived Experience Heard’. I’m always on the look out for something that might improve the way in which mental health care might be provided, and this year’s theme was personified at our stay in the absolutely brilliant Ashnil Mara base camp. We were provided with a personal assistant Edwin, who looked after us all throughout our stay. And he really did look after us well. Over a glass of fine Kenyan red wine, he asked us to tell him some things about us, what we liked, what made us feel happy, and what did we think he might be able to help us with. He was an attentive listener, keen to hear from us how our lived experience could be improved. When he left and over a second glass of that fine red wine, I reflected and thought about the ‘named person’ in the Mental Health Personalised Care Framework. Edwin personified an approach to this role that we should all try and emulate. 

Now coming to Kenya was a Jane’s ‘bucket list trip’. However, it was not my first time here. Some 25 years ago I came to Nairobi to help nurses, who had been educated and trained to diploma level, move up to degree level. It was an experience that has never left me. The project was organised and delivered by the University of Dundee. Time has erased from my memory, as to where the funding came from, but I do know it was a multi-year fund. I was an External Examiner at the university at that time, and I was asked if I would be willing to go out and teach on the programme. I was much younger and more foolhardy then, so I said YES without really knowing what I was letting myself in for.

The 40 or so ‘students’ came from all over Kenya. During the two weeks of taught input, they stayed in what was fairly rudimentary accommodation in the hospital grounds. They were eager to learn and worked hard at their studies. The days were long, but enjoyable, humorous and intense. They could also be at times, very frustrating. There was no white board, digital or otherwise, and teaching aids consisted of slides thrown up using an ancient overhead projector, and that was when the electricity was running! I taught with another lecturer from the University of Dundee. Unfortunately, he got food poisoning in the first few days of our trip and spent a good number of days either in the toilet or in bed. We haven’t experienced anything like that, thankfully.

Kenya was a grand country then and still is now. At a very challenging time in my career, which as I hinted at in last week’s blog, might be drawing to a close, being able to share once more another one of Jane’s bucket list ambitions felt most welcome and appreciated. And thank you to Ezekiel, Edwin and our honeymooning companions Alex and Ricky for helping to make it special.

*Thank you Leonard Cohen

The end is in sight (maybe)

And so here we are, entering the last three months of 2026. The year has rushed past and it feels like we are hurtling towards 2027 and a rather uncertain future. And goodness, over the year so far, there have been some changes to a world with which we might all have felt familiar. The wars in the Middle East feel as if they have stalled, and the war in Ukraine feels like it is escalating with no end in sight. I was reminded (as if we need reminding) of just how long the Russian - Ukraine conflict has been running (as of this morning, it's been1681 days) when explaining why I was wearing one yellow clog and one blue clog.

I first put them on, as a sign of solidarity with the Ukrainian people, in the first week of the conflict, and have worn them ever since. Almost inevitably, when people see them for the first time they do one of three things: women tend to say they 'like my clogs'; men ask why I’m wearing them; others simply look away, don’t say anything and don’t make eye contact. I was at an NHS Alliance Leaders event in London, when I was asked the question, this time, about my clogs.

Now it might have just been me, but for the most part, there didn’t seem to be much energy in the room. To be fair, there didn’t seem to be as many people in the room compared to other similar leaders' events I’ve attended. I could only imagine that, with all the organisational turmoil across the NHS at present, and an ever-increasing demand for care having to be met with ever diminishing resources, many leaders and managers might have difficulty in giving up a day to attend this type of event.

As the day started, the first speaker noted that, as he was speaking, Yvette Cooper (Secretary of State for Health and Social Care) was on her feet speaking at the Labour Party Conference in Liverpool. It’s beginning to become clear, as to what she is focussing on, and what her priorities might be. Interestingly, it seems the 10 Year Health Plan is becoming more of a reference point, with her focus very firmly on population groups. In an approach reminiscent of the original NHS ‘cradle to grave’ ethos, her focus is on maternity care, children and young people, the frail elderly, people with cancer, and people with mental illness.

In many ways, addressing these groups is also congruent with the new Prime Minister's commitment to creating a National Care Service. I was part of a breakout groups asked to discuss this ambition. The group was made up of three Mental Health Chairs, and just one Acute Chair. There were two outcomes we all agreed on: the first was a desire to see a modern-day equivalent of the successful ‘Sure Start’ initiative; and to stop thinking about 'frail elderly people' as being somehow a homogenous group.

The elderly are (he says with no tongue-in-cheek intended) an important group in society. Their contribution to the wider society has gone before them, and in so many different ways. As they reach their twilight years, their needs are clearly also going to be different. Some will be frail, but others at the same age, won’t be. Despite not being eligible for a Covid vaccination when I got this year’s flu jab, due to my age, I’m now officially in the elderly age group. Whilst some things now feel more difficult (climbing into a tree to trim the branches with my chainsaw, for example) for most aspects of my life the only difference is I might be a little slower. In some situations, that can be a good thing.

For me, 2026 does feel as if it is rapidly coming to a close. However, there are plenty more things that I want to do before the year ends. Things that will hopefully make me feel good. And that is the thing. I hope that, the National Care Service, when it comes, is underpinned by an unchangeable principle of helping everyone to live their best life, and live well. It is a principal that should apply to us all, whatever our age.

As for me personally, as the year moves to its close, I’m beginning to think about my future. Maybe my working life is also moving closer to an end point – who knows, but watch this space folks.

Paying lip service to the need for change in mental health care?

I’m officially old. Well, that is according to our youngest child. On Thursday we were discussing her lips. She had her lip filler dissolved recently and wasn’t sure if her lips now looked like she wanted them to look. Jane and I had a look and both said they looked lovely and she had a great smile. ‘Yes’ she said ‘but you are an old man and woman’, I think implying we wouldn’t know what ‘good looked like’ when it came to lips or smiles.

There were lots of things last week that might have made me feel a little depressed, but being reminded I was an ‘old man’ wasn’t one of them. In fact, the reverse was true and we had a chuckle about her comment, which proved a source of amusement throughout the evening. That said, anxiety and depression for all kinds of reasons seem to be rising at an alarming rate. The Department of Health and Social Care (DHSC) recently published an interim report of their independent review into mental health conditions. It’s an interesting, if a somewhat long read, have a look here. I found it a fascinating account.

It is clear that there has been a rise in the numbers of people experiencing anxiety and depression and psychological distress over the last two decades. This rise is particularly prevalent in young people and young adults. There has been an epidemiological shift too. Historically, the evidence showed that people experienced these common mental health problems in midlife, more so than when folk were younger. Today the situation is reversed. It is younger people rather than those in their 40s who report higher levels of distress. It’s a trend that predates the Covid 19 pandemic uptick in mental health diagnoses, and can be traced back to starting in the 2010 years.

Interestingly, it is the common mental illness and distress that seems to be on the rise. Rates of people experiencing severe mental illness, such as schizophrenia, bipolar disorder and other serious conditions seemed to have remained stable. The exception appears to be eating disorders where prevalence rates have risen (again with younger people). However, whatever the severity of the mental health problem, the impact upon the individual and the wider society can be challenging and disruptive.

What is important in all cases, is that for the individual, their experience of distress or poor mental health, will be real. All providers of care need to understand that individual experience, even where the person’s presentation doesn’t fit into a clearly defined diagnostic category. This is not a new concept. Professor Sue McAndrew and I have published a number of papers that explore the impact on individuals where a person’s lived experience is ignored.

Last Monday I visited one of our Early Intervention Services. As always, it was an informative and interesting afternoon. Talking to my colleagues, it was absolutely clear that intervening early, and particularly with people under the age of 35, helped ensure that many individuals don’t go on to have a lifetime’s engagement with secondary mental health care. It is an approach that the DHSC report makes clear requires further investment.  Again interestingly, the report also tackles what at times, are perceived to be increases in the prevalence of ADHD. Often both politicians and the public share this perception. The evidence, however, is clear. Epidemiologically, over the last 10 years, ADHD prevalence rates have remained stable. What is different is a substantial change in the recognition of the diagnosis. Probably more importantly, is the link of a diagnosis and access to clinical services and disability benefits such as personal independence payments (PIP). Last week it was reported that every day 1000 new individuals are claiming PIP. That is each and every day. Think about that for a moment.

Such a situation is not sustainable or desirable. There is no date agreed for when the final DHSC report is to be published. I hope I’m not too much older before it is finally published. I also hope that it will contain strong, evidence-based and affordable recommendations as to how we change the current situation.

Later this morning Jane and I will be attending our church Harvest Festival. It is one of my favourite services of the year. I may indeed be an ‘old man’, but I will enjoy singing the familiar hymns first heard when I was a school boy! It is a service that always brings a smile to my lips, although I might just check them before I go.     

While men argue, nature acts

Last week was a busy one for sure. For all kinds of reasons, strangely, there was just as much waiting around for meetings to start, as there was time spent in the actual meetings. On one of these occasions, I was standing waiting and chatting with Chris Oliver, our new CEO and he was admiring our in-house library. It is wonderful to have this facility available to colleagues and those using our recovery academy. However, as I pointed out to Chris, at one time we had a much larger library, which was housed in a magnificent building called Century House. Sadly, the building is no longer there.

The building had Virginia Creeper growing up three of its walls and in the autumn the reds and orange leaf colours made for an eye-catching display. A lifetime ago, I spent many happy Saturday mornings there reading, discussing life, the universe and all things mental health with a consultant psychiatrist named Som Soni. He was a man who possessed enormous patience and kindness. Som lived in a large house in Hale, a very upmarket area of Manchester. Each summer, he would invite those that worked with him to a garden/pool party. Such was his generosity, he always insisted that on these occasions you brought nothing at all, except yourself.

Som was generous in other ways too. My very first ever published paper was written with him and two other colleagues. I was immensely proud, when it came out. That was in 1989. The world and attitudes have changed greatly since that time, but I think much of the discussion in our paper can still be seen as being relevant today.

The world has changed in many other ways since that time, something I was reminded about last week when the NHS England Chief Executive, Sir Jim Mackey, visited our Trust. He met with the Board and senior leaders from across the organisation. He has an accent I could listen to all day long. He also has a very calm measured way of speaking that inspires confidence. One of the things he noted was how the world was changing, as a consequence of climate change. He talked about the impact of climate change in the context of productivity, which across the NHS had dipped during the summer of 2026.

Last year the UK experienced four heatwaves. This year, since May, we have experienced five distinct heatwaves; another one is promised for parts of England in the coming week. Trying to deliver comprehensive health during the heatwaves has been a real challenge and in many parts of the NHS, services almost ground to a halt. Operating theatres were closed, ambulances services were almost overwhelmed in some parts of the country, and staff found themselves working in intolerably hot conditions.

Whilst it has been a challenge in 2026, I’m not sure that the NHS has woken up to the future challenges resulting from such climate change. If I look at our Board Risk Register, climate change doesn’t feature on it at all. It’s becoming increasingly clear that the world, as we know it, is heating up more rapidly than the science had predicted it would. The consequences have been easy to see. There have been floods and wild fires, the like of which most of us have never seen. It’s not just here in the UK, the devastating floods in Nepal are said to have been caused by the effects of climate change.

There are some effects that are harder to see, which will begin to have just as great an impact, as the floods. Food production and food security for example. We are already seeing scarcity in some food products, a situation likely to only get worse, as farmers struggle to plant next year’s crops. It’s estimated that the UK needs 120% of its normal rainfall over the next seven years, in order to deal with the effects of this year’s drought.

Possibly we are too late to completely reverse the impact of these changes to our climate. Leading experts and concerned citizens have produced a call-to-action film The National Emergency Briefing; you can watch the trailer here (thank you to Chrissie Cooke for the link). If you go on their website, you can find out where there might be a screening near you. The hope is to get the film screened on national television. Whilst setting out the stark reality of where we are now, the film does however, offer hope. And if we act now, that hoped-for future, could still be realised.

Silence and life’s ticking clock

I was in my colleague Leena’s apartment in Finland when I saw the news of a plane flying into one of the twin towers in New York. I watched the TV with a mixture of horror, fascination and impotence as the second plane crashed into the other tower. It’s hard to believe that last Friday marked a 25-year anniversary of that dreadful day. I have been to New York a few times, and went up the twin towers a few times on those visits. I have visited New York three times since the 9/11 attack.

The last time was in 2018 when Jane and I were able to visit the 9/11 memorial and museum. It is a humbling place. The memorial has a strong, powerful emotional impact on one’s sense of self, and where we all stand in the historical passage of time. I felt something similar on our recent visit to the Auschwitz camp in Krakow.

In both places, one of the things you become aware of, is the silence. In Auschwitz that wasn’t surprising. The camp is away from any major town or city. The 9/11 memorial, however, is just a few hundred yards from the bustling streets of New York. In a world that can often be filled with noise, distractions and challenges, embracing moments of silence can be a powerful part of mindfulness.

Silence can also form an important part of therapeutic conversations. The late psychoanalyst, Andrea Sabbadini, argued that silence is a form of communication in its own right. Writing in 1991, he used the lovely description that silence was a ‘container of words’. Much earlier it was William Penn, the American statesman and philosopher who said, ‘Let silence be there - let’s not disturb the sound of silence as within the sound of silence there are more words than spoken speech’.

However, it was Sabbadini who described there being ‘different silences’ which can have ‘different meanings’. This can clearly be problematical in therapeutic encounters. Different types of silences can also be problematic in non-therapeutic encounters. Last week I enjoyed an absolutely uplifting experience when I visited a group of my colleagues providing psychotherapeutic care. It is always  great to go and spend time with colleagues, and I’m always grateful for the time they give me.

Last week's visit was no different. I had a warm welcome, and following a tour of their facilities (once again car parking for colleagues was an issue), we retired to their seminar room for a group discussion. I was left on my own while colleagues were rounded up and tea and coffee brewed. Sitting there, in the silence, I gradually became aware of the clock ticking away on the wall. To start with, the sound was slightly hypnotic and reassuring. It was the passing of time, one tick at a time. After a while, however, that same tick began to sound quite menacing.

Now I’m very comfortable with silence. I don’t undertake any clinical therapeutic work these days, but even in my everyday encounters, I’m very happy to embrace silence. So, I cannot account for my uncomfortableness at sitting there listening to the clock ticking. There will be a reason for sure, and on reflection, I was probably in the right place, with folk with the right skills to help me understand my lived experience. However, I think we had a much better conversation.

One of the things that they wanted to talk about was the use of the term ‘service user’ when talking about the people we work with. It was a great challenge, and one that I have heard several times recently. I prefer person and people, but I think we are a while away from this becoming the norm. Labelling people can often have unintended consequences and raise challenges for people. I shared with them an experience of writing a paper about people who were given the label of having a borderline personality disorder. The publishers refused to allow us to use the Miss Nomer in the paper's title, insisting we use misnomer instead. It didn’t make much sense to us, judge for yourselves here.

Finally, I welcomed seeing the introduction of a minute’s silence at the 9/11 remembrance services this year. It recognised not only the 2,977 people who died on the day, but also the more than 9,000 people who have died of 9/11 related illnesses since. It feels important to remember that those 2,977 people went to bed on the 10th September never imagining they would be dead the following day. Let’s all try and live, love, and make the most of each and every day; nobody knows what is around the next corner of life.

The older I get, the better I used to be

I start this week’s blog with a reference back to my blog posting of 23rd August (see here). In that post I warned that the UK may, as a consequence of climate change, see a rise in diseases up to now only found in places like Africa and Southern Europe and Asia. Well last week the UK Health Security Agency reported that Aedes aegypti mosquitoes had been found with larvae in East London. These mosquitoes can spread the Zika virus, dengue fever, and yellow fever; none of which you want to get! You have been warned.

There was a different kind of warning posted by the Department of Health and Social Care last week. The warning was about the shortage of a common antidepressant, Venlafaxine. The shortage is likely to last until the end of the year, and guidance has been issued regarding restricting new prescribing of the drug. We know from the Office of National Statistics that mixed anxiety and depression are the most common form of mental health disorders. Young people aged 16-29 have the highest rates of depressive symptoms, with just over a quarter of this group reporting moderate to severe symptoms.

This data is a cause for concern. Doctors from the Royal College of Paediatrics and Child Health reported that there had been a 36% rise in the numbers of children and young people presenting at A&E departments between 2019 and 2025. A&E environments are not great places for anyone in distress, but 8% of young people are still having to wait over 12 hours to be seen. That said, many families are ‘forced’ to use A&E services, as gaining access to appropriate children and young people’s mental health care in the community can be almost impossible.

Whilst the current mental health service offer for children and young people is not broken, often they appear to operate on the basis of only offering services when a child is ‘unwell enough’ to qualify for an intervention. That is unacceptable, and unacceptable to those in need and to those providing care.

There are signs that the current government has a growing awareness of the need to both improve and transform mental health services for children. Improvements to children and young people’s services feature in the Government’s 10-Year Health Plan – see here. A new mental health strategy is due to be published later this year. I just hope the improvements and the availability of new resources can be achieved at pace. In England so far this year, 894,212 children and young people have accessed mental health services. Just in June there were 538,766 children and young people with an open referral.

I drew this data from the fabulous NHS Digital website. I mention this as apparently, in a report published last week by Age Concern, only one in six folk, over the age of 65, are confident about being able to use online services. The rest of this group struggle in different ways to access services such a banking, council services and health care. Interestingly, the report notes that whilst 1.6 million older people are ‘digitally included’, 1.4 million never use the internet at all. So, the majority of people in this age group (7.9 million) are somewhere in the middle. Sadly, I find myself increasingly in that middle group. Fortunately, Jane is totally digitally literate and does everything on her phone. So when I run into problems and lose my patience, she simply says ‘would you like me to help?’ and these days I gladly accept her offer.

She is a whizz. Jane can find emails, reports, booking confirmations and so on that as far as I am concerned have disappeared for ever, and can’t ever be found.  Unfortunately, there are many people who don’t have access to a Jane. Like Age Concern, I firmly believe that we are never going to reach a time where everything we have to do we have to do online. I get so frustrated when I can’t simply pick up the phone and speak to someone, a real person that is, and not a chatbot. And don’t get me started about security codes…

I’m an active campaigner, as is Jane, for there always being a non-digital alternative to accessing public services like health and local council services. My GP practice understands this. One outcome from a recent visit was the decision to have a fasting blood test in 3 months’ time. My GP sent me a text reminding me of this, telling me I didn’t have to go online to book an appointment, the practice receptionist would do it for me if I called in. Perfect service.

Every challenge stretches the edges of who we are

In 2023, Jane wanted to go to India, so we visited the ‘Golden Triangle’. I had long wanted to go to Katmandu, in Nepal. So, we did both at the same time. This week, I watched with much sadness the absolute destruction wrought by the recent mudslides/floods in Nepal, Tibet and China. On our trip to Nepal, we saw the legacy impact of past earthquakes on the lives of people living in Katmandu. I cannot imagine what the recent mudslide/floods will mean for the communities caught up in this disaster. The pictures on the news were simply horrifying. We have been able to communicate with folk we met in Katmandu, and thankfully they are all safe and well, although one is still seeking news of three of her close relatives.

Katmandu was somewhere I had always wanted to go to as a teenager. It was during my hippie era. Sadly, I was just a couple of years too young to do so (story of my life, although I’m making up for it now). At the time I am sure my teenage years caused my parents much anxiety. Like many other teenagers of my generation, I thought I was a rebel, hell bent on saving the world from evil politicians, fat cat businessmen, and that the way to create a better world was through ‘free love’. I was a Greenpeace supporter, campaigned to ban the bomb (CND), and had a copy of Mao’s ‘little red book’. That said, I think the recent events in Middlesbrough brought home to me just how different my teenage years were from that of the five young men. who died in the awful car crash last week.  

As well as the five young lives lost, there were two other deaths. They were policemen, hit by the five young people’s car. Both were long-serving policemen. I’ve really struggled with trying to make sense of what happened. The loss of any life should, normally, always be a cause for sadness. Yet when I think about the seven lives lost, I’ve found it hard to grieve for the five young men. Whereas, like many others, I mourn the deaths of PC Matthew Blades and PC Tom Clough. Just like on many other days, on 22nd August, this particular group of five young men set out to break the law; the law they had already shown little respect for.  Matthew Blades and Tom Clough set out that day to uphold the law and keep communities safe, and in so doing, became innocent victims of a truly tragic and avoidable accident.

Three days later, there was more sadness to contemplate. On 25th August Dolly Parton died. Like Matthew Blades and Tom Clough’s death, the news of Dolly’s passing prompted an outpouring of grief. There was worldwide recognition of her life and contribution to music and the arts. Although she had often experienced challenging issues, hers was a good life. She used her good fortune to help others.

Unlike many other similarly very wealthy people, Dolly was immensely generous. She supported LGBTQ+ charities, medical research, including donating £1million to help find a vaccine for Covid-19. Most famously Dolly established and funded the ‘Imagination Library’ which, over her lifetime, gave 332 million books to children worldwide. Here in the UK alone, she donated over 7 million books.  What a fabulous legacy!

There were some good things about last week, however. Last Tuesday I was able to visit colleagues in one of our neighbourhood mental health services. The service is based right in the centre of Wigan town. Leaving the hustle and bustle of the shopping centre behind me, I walked into an oasis of calm and a welcome that was warmer than the last heatwave. It is one of the best parts of my role as Chair to be able to go out and visit our services, and have conversations with colleagues and the folk who use them.

During my conversations this time, we touched upon how colleagues are making access to the service easier. A co-produced move away from the terminology normally found in NHS services really interested me. For example, they had changed Services User to Person/People; Discharge to Friendly farewell; Care plan to Shared plan; Risk assessment to Safety plan; Assessment to Initial conversation; and Expert by experience to Lived experience. These simple, yet effective, changes flowed through all the interactions colleagues had with people, written or otherwise. I was impressed, and thank you Kieran, you were truly inspirational.  

Shining a light on an epidemic of health stories

As I was thinking about how to make sense of the various stories I read last week, the word ‘prism’ came into my mind. I couldn’t think why, but it was a persistent thought. You might remember from school days, a prism refers to a transparent solid used to refract or scatter a beam of white light. Later that same day, a post in my social media time line made me laugh out aloud - Where do bad rainbows go? To Prism. It’s a light sentence, but it gives them time to reflect (thanks to Liz Ann) and I thought okay, prism it is.

The prism I shined my light through were the surprising number of health-related stories published last week. There were quasi health stories like Wetherspoons banning customers from playing music on their phones or facetiming using their phone. The ban was introduced to promote the Weatherspoon mission of ensuring tranquillity in their pubs. Tranquillity as in peace of mind, being calm and freedom from anxiety or anger.

I’m also at an age where I enjoy tranquillity in my life. However, I am also of an age that puts me in danger of what has been called ‘uncompensable heat stress’ (UHS). According   to a study published in the Lancet Planetary Health last week, the recent heatwaves have raised my risk of serious health problems or even death for folk aged 60 and above. Its the consequence of the body losing its ability to cool itself. Just to reassure folk, I had my older man’s health MOT recently and all appears fine. One heatwave is okay, a succession of them, maybe not so.

I don’t think there was much sun shining at a Dumfries and Galloway farm last week. A case of Bovine spongiform encephalopathy (BSE) was confirmed. Daily Mail and Sun readers might be more familiar with the term ‘mad cow disease’. Back in 1990, BSE was a disaster for UK agriculture. Four million cattle were slaughtered in an attempt to contain the outbreak. Sadly, 178 people died after contacting Creutzfeldt- Jakob disease through eating BSE infected beef. A tragedy indeed.

Then there was the frightening story of Donald Trump declaring the MMR vaccine (Measles, Mumps and Rubella) given as a combined vaccination could be, in his words ‘quite lethal’. Not as lethal, perhaps as actually catching measles. It is a high contagious disease. In 2025, 960 people died of measles in the UK. In a disease that is more likely to kill young children, the largest group of these folk who died from measles were those over the age of 35.  We have been here before.

In 1998, the now disgraced Andrew Wakefield (a gastroenterologist, and not infectious diseases expert) caused a massive drop in measles vaccinations and an increase in deaths from measles in the UK during the late 1990’s and early 2000’s. Just like Trump and his medically unqualified Secretary of Health, Wakefield’s assertions that there was a connection between the MMR vaccine and autism is completely without scientific evidence.  It is a sad case of putting populist politics before hard science. The results are likely to be devastating for many generations of US communities.

Politics play a part in my penultimate prism scattering of health stories. There is a major outbreak of Ebola in the Democratic Republic of the Congo. The current outbreak is the result of a mutated virus called Bundibugyo. There is no effective vaccine or antiviral. Nearly 5000 cases have been reported, and last week over 2300 deaths had been recorded so far in this outbreak. Despite this already being the second worst outbreak in history, media coverage is almost completely absent. The silence is deafening.

The main province affected, Ituri, is a politically unstable region, and routine public health services such as childhood vaccinations have been severely disrupted. Equally, the US and to some extent, the UK, have stepped back from providing overseas aid which doesn’t help this situation. Under Trump, the US stopped its membership of the World Health Organisation, the only viable organisation capable of mounting an international aid response. They did so, very successfully in 2014, but the world has changed significantly since then, and so far, there is no international response.

You might think none of these matters to us here in the UK, but I suggest it probably does. Let me use my last shard of light to illuminate my thinking. Yesterday, the Cyprus Ministry of Health confirmed that a 74 year old man was being treated in an intensive care unit for a case of West Nile virus. It is a life-threatening disease. Again, there is no approved vaccine for this disease. It is a mosquito-borne infection, and he had never travelled outside of Cyprus. As the world appears to be heating up, the spread of mosquitos moves inexorably across western Europe. Perhaps take a little time to reflect on that thought.

The circle of life: birth and death

I start this week’s blog, with the sad news that Jason Arday has died. Although there has been no official cause of death announced, it appears the campaign of misinformation, and media hounding proved too much. As I noted last week in my blog, such intense and often unfair media scrutiny would undoubtedly have an impact on his mental health and wellbeing. Sadly, it seems I might have been right. Whatever else people might think, Jason was a father, brother, son, and partner. I hope he is finally able to rest in peace.

On a slightly more positive media topic, every week, NHS England posts an online news update. Last week’s headline included the announcement of the ‘Big Conversation’ giving people a chance to say what they expect/want from a National Care Service. However, it wasn’t this announcement, as welcome as it was, that caught my attention. It was an article further down the newsletter. It talked about the hundreds of thousands of women, who have accessed the morning-after pill in the first five months, since it was made available free of charge. Up until March this year 305,000 doses of the morning after pill were dispensed. The report doesn’t make it clear if this was 305,000 women though.

It is a brilliant intervention. As well as getting the morning after pill, women can also get advice about contraception and even take away a supply of contraceptive pills without the need to see their GP. In the 12 months to February 2026, the number of new women starting regular contraception doubled to 115,000. It’s a great example of preventive and health-promoting care. Reading the story, however, drew me down a new rabbit hole; one where I was left wondering whether this service contributes to the declining birth rate?

Indeed, birth rates have been steadily falling since 2010. In 2025, the UK saw its lowest number of live births, some 585,000, which was 10,000 fewer than year before. It was also the lowest overall figure since 1977. This meant that the estimated number of children born per woman was just under 1.4 in 2025. In order for countries to maintain a healthy population, the fertility rate needs to be more like 2.1 children per woman. It’s a worrying trend for future generations.  

Whilst there has been an overall decline in fertility rates, the most dramatic fall is to be found in those women aged 20-24 and 25-29 age groups. These are the so-called Generation Z. Today, the average age of first-time mothers is 30.9 years. It’s perhaps easy to see why women might be choosing not to have children. Clearly people have more choice over how they want to live their lives. We live in an increasingly turbulent and volatile time, and many will feel it’s not the best time to bring children into such a world.

It’s also an increasingly expensive world. The rise in the cost of living has not abated. Many people today are focusing on career pathways, getting a better salary, getting onto the housing ladder (40% of people aged 25 are living with their parents). Many women in Generation Z don’t see marriage, as something they necessarily want. Whether in a relationship or not, many men and women are happier with the freedoms not having children allows them. I’m a Baby Boomer, and moving closer to the death point on the circle of life and death. But I do worry not only for Generation Z, but the new Generation Alpha folk (those born after 2013).

There was one more baby* story last week, that as a provider of health care, left me feeling very challenged. I attended a webinar hosted by Penny Dash, Chair of NHS England. It was an opportunity to discuss the outcomes of both the Amos and Ockendon reviews into maternity services. These reviews showed both poor quality and unsafe practices were sadly the norm across too many maternity services. We heard some of the verbatim evidence submitted by parents who had experienced poor care and from some, who had lost their babies at birth. It was harrowing, and I could understand the fear that women might have in contemplating the birth of their child.

Interestingly for me, it was folk from mental health services, who were the most vocal contributors to the webinar, perhaps recognising the importance of compassionate care. One of the ‘take home’ messages for me was the notion that when things go wrong, which unfortunately they sometimes will, an apology should not simply be an event, but should be thought of as a process. Something, perhaps, the detractors of Jason Arday might want to think about.

 

*Actually, there were two other baby stories – the second one noted that the most popular date for giving birth is 28^th September, and has been for several years, and in England and Wales, babies are least likely to be born on Boxing Day.

Unlocking the door to greater access to mental health care

There was much in the news last week that made me stop and think. For example, the recently published outcomes from a study undertaken by researchers in Taiwan and the US. This looked at the link between medication (Viagra and Cialis) used to treat erectile dysfunction and the increased risk of blindness. Specifically, the development of glaucoma, a condition that affects over a million people in the UK.

Possibly because of the way my mind is wired, I thought about the work of Ivan Illich, and his notion of iatrogenesis. This concept can be found in his seminal work ‘Medical Nemesis’ published over 50 years ago. Essentially, he posited that in the case of health care, iatrogenic consequences (harm) can happen even where there has been the ‘correct’ application of medical interventions. In modern terms, maybe think protocols.  Thankfully the researchers were keen to note that their research could not point to a definitive correlation between taking the little blue pill and going blind.

Turning a blind eye appears to be what the great and the good might have been doing at Cambridge University. I don’t know if that is the case or not, but you can’t have helped noticing the plight of Jason Arday. He’s the Cambridge professor accused of plagiarism and embellishing his CV. It is not for me to say anything about these allegations; that is for others to work through. I was more concerned about the way in which he has been treated by both mainstream and social media.

I puzzle over the motivation for such behaviour from these keyboard warriors. Indeed, no sooner had his letter of resignation been published, than folk on social media had run the script through ChatGPT announcing that there was a 90%-100% certainty it had be written using AI. Whatever the truth regarding the allegations against him, to be hounded day after day must have had an adverse on his mental health and wellbeing. I sincerely hope he is able to get the help and support he might need to regain some welcome equilibrium back into his life.

The big announcement last week, which will impact upon anyone seeking help for their mental health was the £343 million investment in neighbourhood community hubs and mental health emergency departments. It is welcome news for sure. Across England, mental health services have always fared badly compared to physical service provisions. In recent years there has also been a reduction in the resources for mental health care, yet the demand for such care has steadily increased.  

This announcement is significant and follows a number of recent and important changes to mental health policy. A new national mental health strategy is being developed, alongside a Modern Service Framework for severe mental illness. Earlier last month, the Mental health personalised care framework: the modern care programme approach was published. This is aimed at improving services for all people with a severe mental health problem. There are clear new expectations of service providers, around the assessment and management of risk. It needs to be an approach that ensures better quality and safe care is provided, both for hospital care and when people are discharged back into the community. These are not and should not be changes in policy that lie dormant on a shelf somewhere. Responding to these changes will require improvements in what we currently do and the future transformation of the services being provided.

The new money, announced last week, brings with it opportunities and challenges. Not least of which is how such centres could be run; what operating model is likely to be the most effective in bringing about change; and where will the staff come from? All of which, we are currently looking at in our organisation.

Fundamentally, anyone with a mental health problem should simply have just one front door to pass through to gain help. This can be a physical or a ‘virtual’ door (just have a look here at what they are doing in Singapore). Deciding on how to best meet a person’s needs should be a joint endeavour and not one determined simply by a professional or care group response. New buildings are always welcome, but how these are used is probably more important, if we are to avoid future iatrogenic consequences for our service users and their carers.

Let’s care about the future of care

Back in 2024, I was invited to a 200-year anniversary dinner at the University of Manchester. The pre-dinner speaker was Sir Chris Whitty, currently the Chief Medical Officer for England. He spoke about how the population’s health has changed over those 200 years. Chris is a great speaker, and uses data very effectively in getting his point across. One of my take aways from that evening was the notion that if we live long enough, we will all get cataracts and some form of dementia. It was a sobering thought.

The last couple of weeks have seen much discussion about UK social care, much of which has been focused on the financial and emotional costs of caring for someone living with dementia. The Prime Minister’s father lives with dementia. My mum lived with dementia in the last decade of her life.  Despite the very best efforts of my dad, my brothers and sisters, eventually mum’s needs meant that she could no longer be cared for at home, and she was admitted to a residential care home. She died aged 91.

Hers is a familiar tale. In March this year, there were nearly 800,000 people aged over 65 who were said to have dementia in the UK. Nearly 500,000 had been formally diagnosed with dementia. It estimated that by 2040, there will be 1.4 million people living with dementia. Currently the cost of dementia across the UK is £45 billion. By 2040 it is estimated this will increase to £90 billion. These are State borne costs, and account for almost 78% of local councils funding across most of England.

Individual families are often faced with meeting the costs of their loved one’s care. Residential care averages at around £1000 a week. Where nursing care is also required, such as that my mum received, the cost rises to an average of £1300 a week. My mother’s care was funded through the NHS due to her primarily having health-based needs. The dementia just added to her overall complex care needs. While help with such costs is available there are strict criteria that often make accessing such financial help difficult. For example, if you have savings of more than £23,400 you are not eligible for any financial help. People can require residential nursing care for many years, and the overall costs of such care can run into £100’s of thousands. Many families have to sell off their parents’ house in order to pay for the costs of care.

Surprisingly, a survey undertaken by the Kings Fund last year revealed that 33% of those asked believed such care was free at the point of use, with a further 18% stating they didn’t know. Despite what Chris Whitty had to say about if we all live long enough, we will all get dementia, currently 1 in 3 people alive today will be diagnosed with dementia.

Last week saw Baroness Louise Casey announce the start of her ‘Big Conversation’ as part of her review of adult social care in the UK. The review is said to provide the evidence required to create a National Care Service. The ‘Big Conversation’ is aimed at both gathering people’s experiences of the current system, and educating people about the realities of social care. Against such a background it is perhaps not surprising that our new Prime Minister has set solving the problems of creating a National Care Service as one of his high priorities. Last week he bluntly observed that the NHS is likely to collapse without the effective reform of the current social care system. The delivery of the outcomes of the Casey review has now been brought forward by 12 months.

However, Burnham has a tough task. Securing cross political party support is but just one issue, persuading people to pay (in one way of another) for social care services, is also likely to be difficult. Finding people with the skills and knowledge to provide such care will require a different way of thinking (maybe a unified national health and care workforce) as much as it will require future investment. I don’t know what the solutions might be, but I feel that none of these challenges should be seen as insurmountable problems.  

I’m on the waning side of the Chris Whitty life trajectory. That said, I am an early baby boomer. Over my lifetime I have benefited from greater economic opportunities, had the best the NHS has been able to provide, and continue to benefit from the triple locked UK pension system. I’m living a life far removed from poverty, (although of course there are many folk my age who are not so fortunate), and touch wood, I enjoy good health. However, for the sake of us all, I sincerely hope this time around we can achieve a breakthrough in what has so often been seen as intractable issues in delivering a national care service.

Those who have health, have hope; and those who have hope, have everything*

Regular readers of this blog will know I try and steer clear of politics, but this week I want to make an exception. Now none of my observations here should be interpreted as a sign of political allegiance. We have a new Prime Minister, Andy Burnham, and a commentary feels irresistible. The new Prime Minister is a familiar face to those of us living up North, not so much for those living south of Watford.

Andy has a hard-won reputation for championing the underdog, and challenging inequalities of every kind. For example, tackling the issue of rough sleepers. It was a policy ambition he announced just before he walked in through the front door of No 10 for the first time as Prime Minister. His vision of health and wellbeing is fundamentally about prevention and dealing with the social determinants that so often cause ill-health.

Personally, I think he made a great choice for the new Secretary of State for Health and Social Care, Yvette Cooper. In a previous regime, Yvette was an under-secretary of state for health. In this role she implemented the Sure Start programme – a brilliant bit of health and social care policy that really did make a difference to families and children’s lives. So, we have someone who is an experienced minister of state, and knows something about health care and if anyone can sort out social care, Yvette can.

Andy is also a committed devolutionist. He passionately believes power (political and professional) should be devolved close to where actions and decisions are required. We don’t yet know what this might mean for health and care services in England. There is, however, the little matter of Yvette’s predecessor’s policy legacy. As I write this blog, Wes Streeting’s NHS Modernisation Bill (Health Bill) is slowly working its way through parliament. The Health Bill was meant to become law in March 2027. I do wonder if it will complete its journey through parliament on time, and remain unchanged in its intent.

Briefly, the Health Bill aims to move power, decision-making and functions from NHS England (NHSE) to the Department of Health and Social Care (DHSC). This includes transferring some powers directly to the Secretary of State. The NHSE Regional Offices and Integrated Care Boards (ICBs) will take on new roles around performance oversight and strategic commissioning. The abolition of the consumer groups Healthwatch, and Councils of Governors within NHS Trusts, will be replaced by a new patient voice department within DHSC. All of these changes move power and decision-making away from local government and communities.   

For many people, getting to this point has been brutal. The DHSC, NHSE, Regional Offices and ICBs have all had to reduce their costs by 50%. This has meant people losing their jobs. Whilst it is difficult to get accurate figures, the original estimates were said to be around 18,000 job losses. Likewise, it is estimated that the cost of these redundancies has been in the region of £1 billion.

I suspect for many, the personal costs, in terms of the negative impact on their mental and physical health and wellbeing, will be immeasurable. Whilst many of the people who have lost their jobs won’t have been frontline care providers, the loss of knowledge, experience and skills arising from these redundancies will undoubtedly have an impact on the quality of future health care provision. Likewise, there are hidden costs associated with these reforms, as leadership and organisational energy are diverted from tackling everyday issues of service provision.

Don’t get me wrong. In any organisation, there will always be a need to review what might be required in terms of numbers, skills and so on in the workforce. It’s probably also true that part of the work undertaken by some of these people can now be better done by new technologies and transformed service models. But there will still be a lot of functions and jobs that will still need to be done by someone, and I do wonder if we may have thrown the proverbial baby out with the bath water. I hope not.

Wes Streeting was reported as saying to parliament that these reforms could save the NHS £500 million to £1 billion each year. This may be true; it’s difficult to get an accurate figure. Whatever the eventual saving turns out to be, I sincerely hope it is given to Yvette to help reform our social care services. Andy Burnham has already demonstrated his commitment to tackling the social determinates of health that lead to health inequalities. I wish him well as he pursues this commitment on a much more complex and bigger stage than the Greater Manchester region.

 

*Today’s blog title draws on a quote from the historian and writer Thomas Carlye. I wonder what Thomas would have made of Andy Burnham? Thomas Carlye was famous for his ‘great man’ theory – an interesting theory and worth looking up.

Looking back over a quality week

Last week was a good one, and a busy one too. Matilda came into our lives following the untimely and unexpected death of our ragdoll cat Willow, 6 weeks ago. I had my first flying lesson, including taking controls of a Cessna plane at 2000 feet. A fabulous experience for sure. We also went to the Great Eccleston Agricultural Show yesterday, always interesting, although the price of food and drink seems to go up exponentially every year. Note to self, next year take a picnic! Everyone looked hot, including the animals, but it was great to see so many families out in the sunshine and clearly having a great time.

Work was also good, and there were two things from last week to note. One was visiting colleagues in one of our community older adult services. Always wonderful to meet colleagues and to hear about both their achievements and challenges. They did not disappoint!

The second was having a first read of the NHS Quality Strategy published last week. I wasn’t particularly inspired. However, there is nothing in the guidance that anyone would want to argue with. It provides a bit more of the detail, as to how the NHS 10 Year Health Plan might be best taken forward. I was left with a feeling there were lots of things promised for the future, with even more detail to be worked through. That said, there is much we can do in interpreting the guidance to ensure the decisions we take are ones we own. I have set aside time tomorrow to have a second and more purposeful read.

One of the things that caught my eye was the desire to develop and publish a Modern Service Framework (MSF) for Mental Health. The 10 Year Health Plan sets out the notion of MSFs being the means for improving outcomes associated with serious health conditions where there are high rates of avoidable deaths and ill health. In the first instance, these will include a MSF for cardiovascular disease, frailty, dementia and mental health.

It’s said that each MSF will set out an ambitious long-term outcome goal (a so called ‘moonshot goal’) for the particular service MSF. Take a look at the current cardiovascular disease MSF which, whilst having 12 immediate priorities, sets out a much bigger ambition for the future. I thought the scale of ambition was truly impressive. 

In our Trust, we are not sitting back waiting for the Mental Health MSF. We know our immediate focus has to be on continuing to reduce out of area placements (something we are already succeeding in), improving timely access to support for children and young people (we are not doing so well at) strengthening the continuity of care, and ensuring folk receive the right support at the right time (for us this means particularly upping the pace of our community transformation programme). All of which we are focused upon.   

I think one of the reasons my interest was piqued by the mention of a new Mental Health MSF was, actually, I have been here before. It was way back when I first started my academic career. Through my PhD supervisor Professor Joel Richman’s generosity, I was able to stand on his shoulders to see the world from many different perspectives. For that I will be forever grateful. He was a great PhD supervisor, but Joel wasn’t the only one to help me on my academic journey. The late David Skidmore was a steadfast guide, and Ian Stronach and Sheila Stark became the best mentors anyone could want.

In my earliest days, both were more than generous in allowing me to be a named author on what I think was one of my most favourite papers. The paper was tilted ‘Towards an Uncertain Politics of Professionalism: Teacher and Nurse Identities in Flux’. Hopefully, you can read it here. It became an enormously well-cited paper, and in my day, to become a professor, one had to write good quality papers for refereed journals, be an active researcher, secure research funding and successfully supervise PhD students to get their doctorate. It’s sometimes very different these days.

Our paper referred to the original Mental Health MSF, published in 1999. Frank Dobson was the Secretary of State for Health back then, and the world was a very different place. To be honest, I didn’t think much of that MSF. Did it improve mental health care? I think probably not. Will the forthcoming MSF improve mental health care? Well, I think the ‘improvement momentum’ is with us, and so I’m confident it will.   

Government’s helping hand can never truly replace the helping hand of a neighbour

I read a headline last week from the Health Service Journal (HSJ). I couldn’t read the whole article, as it’s behind a paywall and I absolutely don’t want to give any of my hard-earned cash to the HSJ. The headline suggested large acute Trusts in the NHS were shouldering unreasonable risk, because their funding had been ‘top sliced’ to pay for ‘well-meaning’, but unproven neighbourhood health schemes.

This claim came from Shane DeGrais, who is the Group CEO of Barts Health. St Bartholomew’s Hospital is the oldest hospital in England and is one of five hospitals that make up the Barts Health Group. Developing and investing in neighbourhood health centres is part of the NHS 10 Year Health Plan. It is one tangible example of what moving care from hospitals to the community might involve; one of the so called ‘left shifts’.

A couple of things struck me, as I read the headline. One: - for many years, the acute sector has enjoyed a disproportionate amount of national NHS funding, in comparison to mental health services, primary care, and community care service. The acute sector has grown exponentially over the past few decades. Two: - the acute side of health services has been and probably will always be, a political hot potato.

Long waits to be seen in A&E departments, long waits on waiting lists, too many patients stuck in hospital, because community care services are not readily available, are what keeps most Secretaries of State for Health and Social Care awake at night. And of course, the media loves to tell a story about health care failings. The HSJ is no exception.

Reality is a little more nuanced, however. Last week, I read with glee, an article published in the BMJ, written by one of my favourite commentators on NHS services, David Oliver*. David is a consultant in geriatrics and acute general medicine. He practises in Greater Manchester. His observations would give any cultural anthropologist a run for their money. David questioned whether the ‘home good, hospital bad’ credo is a possible false binary. His is a well-articulated and fair article. You can read it here.

Among other things, David puts forward the case that hospital stays can both be harmful in some situations, but allowing a patient to stay in hospital for a day or two longer if they are not ready to leave, might be a good thing. Based on an average cost of £2300 night for an acute stay, those folk responsible for managing hospital finances might challenge this latter assumption. Acute beds are nearly always scarce, hence why so many acute hospitals resort to using corridor care. One in every eight NHS beds are filled by those, who are clinically ready for discharge, but where appropriate community care to meet their ongoing needs is not available.

It’s a complicated picture for sure. In such circumstances I seek to be grounded by my own experiences. Regular readers of this blog will know I’m a great fan of primary care services. Where I live, near Blackpool, we have both great primary care services and fairly comprehensive neighbourhood health care. Last week I received a letter stating that following my recent CT scan, I was not showing any signs of lung cancer. Phew! The CT scan was carried out a few weeks ago by mobile scanning services set up in a rather dodgy carpark in South Shore Blackpool.

Also last week, I had the results of my 24-hour blood pressure (BP) assessment. Apparently, I’m perfectly normal for a man of my age (Jane might have a different opinion). The test was carried out by an assistant pharmacist – and I received a five-page report of my BP, pulse and changes to both, over the 24-hour test period. I received it just 2 days after taking the test. Brilliant service delivered five minutes away from my home in a health centre that has a large gym, an assisted gym, a swimming pool, café, two GP practices, a community mental health team and a pharmacy. It also has an allotment, and we are soon to have a ‘free to use’ benefits advice centre.  

Now don’t get me wrong. When Jane needed specialist neurosurgical care, she got it from a great NHS specialist service just 10 miles down the M55. A fantastic intervention that saved her life. Improving her subsequent quality of life, well that came from a brilliant community neurological service firmly embedded in our wider neighbourhood health care services and the exercise referral team. So, I’m thinking, if others can benefit from such services, then sorry Shane, but let’s move the money. Reach out your hand and together we will make a difference.

* You can follow David here David Oliver (@mancunianmedic) / X

Nurture Hope: as it’s the last thing we might ever lose

It’s been a week! Sunday saw Jane and I at the Blackpool Grand Theatre. It really is Grand with a capital G. One of the many gifts she gave me last Christmas were two tickets to see Think Floyd, a superb tribute band for the wonderful Pink Floyd. They started the night with a fabulous rendition of ‘Arnold Layne’. It was a song I first heard over 55 years ago, from the album ‘Relics’. Apparently, it’s a song about a man, who stole knickers and bras from washing lines.

It was a great night, and the band also played my favourite Pink Floyd song ever: ‘Coming Back to Life’ from the album ‘Division Bell’. I plan to have it played at my funeral. The song contains words that are special to me – ‘while you were hanging yourself on someone else’s words, dying to believe in what you heard, I was staring straight into the shining sun’. Essentially it is a song about hope. More of which in a moment.

Last Tuesday saw Karen Howell, our former Chief Executive Officer, retiring. A poignant day for sure. Full of emotion. Karen had joined us in June 2024, following 45 years in a range of NHS roles. It’s clear that our Trust, its service users, carers and the communities we serve have all benefited from her wide and varied knowledge and experience. It’s felt like an enormous privilege to have been able to stand beside Karen over these past two years. Whilst we still have much to do, Karen really helped us move forward on our improvement journey. She provided so many of my colleagues with the hope that we can improve, and become an outstanding provider of mental health service.  

And as for hope, we have spent the last four days in Krakow. Baking hot, 32+c and a busy bustling city, full of colour and movement. On our first day we visited both the Auschwitz I and Auschwitz II (Birkenau) camps. Our visit was totally overwhelming and challenging, both emotionally and psychologically. 1.3 million people were sent to Auschwitz. Of these, 1.1 million were killed. Some 960,000 of these victims were Jews.

In Auschwitz many of the buildings held artifacts, shoes, prayer shawls, cases, glasses, hair shaved from the prisoners and so on. All of which served to remind us of the utter barbaric treatment and deaths of so many people. We had a Polish guide who graphically took us through the history of Auschwitz. It was a very difficult story to hear.

Auschwitz-Birkenau just a short journey away, was even more stark. Only when the camp was liberated by the Russian army did anyone leave the camp alive. Many of the buildings were hastily destroyed by the Nazis as the Russian army advanced, but there were enough left to again tell the story of the suffering so many people went through, Jews in particular. Their treatment was inhuman, brutal and sadistic.

On Friday we walked to the old Jewish quarter and were able to visit the Remuh Synagogue. It was built many centuries ago and for Jews living in Krakow, it was the most scared place in the city. It had endured fires, the Black Death, and the occupation of Poland by the Nazis.  The adjoining cemetery was ransacked by the Nazis, with many of the tomb and gravestones smashed and scattered. It is said that a German soldier who attempted to break Rabbi Moses Isserles’ (referred to as Remuh) matzevah was knocked unconscious by a bolt of lightning.

706 of the original tombstones have been discovered through archaeological digs, and these have been re-erected. Sadly, many others were broken into fragments that made it impossible to piece them together again. However, these have been incorporated into the wall that surrounds the cemetery, aptly names the Wall of Tears. It was a truly moving experience standing and walking through the cemetery in the quiet and bright sunshine.

Sitting in the peaceful synagogue itself was equally moving. It wasn’t a large place, but its history and all that the building had witnessed over the years seemed to me to be present. In contrast, we visited the Krakow Cathedral – a fabulous building with vaulted ceilings, and much of what I would describe as catholic sculpture and religious iconography. I have to say I was secretly pleased, when trying to purchase a concessionary ticket, to be asked for proof of my age. 

Whilst being very different places of worship, both in different ways symbolised hope and triumph of good over evil. Without hope, we have nothing. We were told that in Auschwitz the dreadful conditions meant that most of those taken there died within three months. In Auschwitz-Birkenau it was often just one month. I have struggled to comprehend what surviving in both these places must have been like and how people kept hope burning in their hearts and minds. For me, I hope all of us never has to witness anything like the holocaust ever again.