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. 

Being wrong, wary and slightly worried: will Cinderella get to the Ball?

Last week, I ended my blog saying that I was off to see my GP on the Monday for a possible shingles vaccination. Given I’m into Day 28 of a shingles episode and still feeling pretty horrible, I didn’t expect to be given the vaccination. I was wrong. My GP advised that I should have it, so I did, and she gets the associated £12.06 fee. I felt I really did get a lot out of my 7-minute consultation. I’m a fan of primary health care, and it was a good experience.

Later in the day on that Monday, I found myself standing on a train, bound for Nottingham and the Health Partnership Network (HPN) Mental Health conference. I stood all the way from Manchester to Sheffield, before the hundreds of students got off and seats became available. It was a very hot and unpleasant journey. Arriving at my hotel, I rewarded myself with a delicious glass of Malbec (which actually cost £1.30 more than the shingles vaccination fee). But it was worth it.

The conference was different to any other I had been to, but more about that later. That said, the entire conference arrangements reflected how mental health care is still a Cinderella service, when compared to acute services. There was an acute conference running in the hotel concurrently with ours. Theirs was held in a large, air-conditioned room, with many white-clothed tables, loaded down with bottled water and sponsor goodies. You could see the screen from any table in the room.

In comparison, our venue was in a cramped room, with portable air conditioners that barely troubled the hot air. We sat in tightly-packed rows of seats. There was no water, and certainly not any sponsors’ gifts. Viewing the screen depended on how large the person in front of you was. We were made to feel very much like the poor relation. I’m not sure why they didn’t combine the two groups as the conference’s foci appeared very similar – the emergence of neighbourhood health care; the use of new technologies, particularly AI; what a mess the changes to NHS England, ICBs and the Department of Health and Care were; population health and more AI. 

Indeed, the NHS 10-year health plan mentions AI 100 times across its 168 pages. Now I’m not a great fan of is AI (artificial intelligence). Many of my colleagues are, and now routinely use AI as part of their everyday work. I don’t really want to engage with AI, either on a personal or professional level. It’s probably the philistine in me.

What made the conference different was that the sponsors had arranged 15-minute sessions with individuals, rather like speed dating, I guess. When booking a place on the conference, you were asked to describe the challenges facing your organisation; something I didn’t get around to doing. So, someone did it for me, and it transpired that our challenges were: AI, reducing talking therapies waiting lists, and how a crack team of psychiatrists could (for a fee) come and sort out any problems we might be experiencing with our consultant psychiatrists. Strangely, (not sure that is the right word) only one of these ‘challenges’ was relevant.

Now don’t get me wrong, some of the presentations and conversations were very interesting. I might even go as far as saying ‘inspiring’. There was one company that took us through the system they were showcasing, via a case study. Two things struck me as interesting. The first was a telephone number that allowed for a single point of access to services, and which in true AI style could hold a conversation with the caller. It wasn’t a chatbot, and through audience participation (asking random questions), it wasn’t a pre-recorded response either.

The programme could speak in 45 different languages and used everyday words to both seek further information, or in responding. It was very clever. The second part of the system both impressed and worried me. It used agentic AI. Agentic AI systems don’t simply answer a prompt (how can I stay cool in this hot weather?) but take many ‘actions’ to reach a conclusion or answer: reading records, conversing with other systems, accessing data sets and information repositories.

What we weren’t told was the cost of such services. They are not run using familiar licences (Microsoft, ChatGPT and so on) which can be used as much as you like for the set licence fee. Apparently, agentic AI utilises a costing model that charges for every action undertaken. So, some AI tasks might actually cost more to an organisation than the salaries of staff such programmes were meant to replace. The assumption, that a digital worker is cheaper than a human one, will really need challenging!  Whilst AI will have a place in future health care, in mental health care, as with other health and care services, people will always be important, and even Cinderella got to go to the ball.

Good day sunshine!

Today is the longest day of 2026. It’s the Summer Solstice, which this year officially happens at 09.24 BST. That is when the Sun hits its highest point in the sky today. While it is the longest day of the year, the amount of daylight you can expect to enjoy differs depending on where you live. For example, if you are unfortunate enough to be living in London you can expect just 16 hours and 39 mins of daylight. Come up North to sunny Blackpool, and we will be enjoying 17 hours and 11 mins of daylight today.

People have been celebrating the Summer Solstice for thousands of years. The most familiar place associated with celebrating the solstice is, of course, Stonehenge in Wiltshire. Whilst I have visited Stonehenge a couple of times, I have never seen the solstice sunrise, and I won’t be doing so this year.

I was able to witness the sunrise from the comfort of my bed this morning. We don’t have a single curtain in the house and so I have an unhindered view of the sky changing and the daylight arriving. I have always liked the rawness of our weather, and simply enjoy looking out and seeing what the day might bring weather wise. Jane is not so keen on no curtains, as the summer light can interfere with her ability to sleep.

Light shining in at daybreak doesn’t worry me at all. I usually have no trouble dropping off to sleep and I wake naturally any time between 04.00 - 04.30. That said, I do tend to go to bed around 22.00, and I’m usually asleep within minutes. Around 6 hours sleep seems to suffice, and that is 2 hours more than what Maggie Thatcher was said to sleep each night.

Napoleon Bonaparte was once asked how many hours’ sleep people need. It is reported he said: ‘six for a man, seven for a woman, and eight for a fool’. However, research suggests that it is the quality of the sleep that is more important, not the quantity.  Jane will often give me a report on her sleep. She knows how long she has been asleep and what were the periods of quality sleep. It is all information to found on her Fitbit.  

I’m still not sure how a device worn on the wrist can determine what different stages of sleep we are experiencing, but park that to one side for the moment. Every night we will all go through a number of stages of sleep. Each stage typically lasts 90 minutes. We normally will experience several cycles of each sleep stage every night. Stages 1 and 2 are both characterised as ‘light sleep’, with stage 2 making up the bulk of our total sleep time. These are called Non-Rapid Eye Movement (NREM) as is Stage 3, ‘deep sleep’. This is the most restorative stage of our sleep, both from a physical and mental health perspective.

The final stage, Stage 4, REM sleep, is a rather interesting stage. It’s where we are likely to experience vivid dreams, but it’s also where learning and memories are consolidated. As the night wears on, the REM sleep stage becomes longer within the 4 cycles of sleep. The proper cycling through all stages is required to ensure physical restoration, effective cognitive functioning and emotional health. It is Stage 4, REM sleep where our memory, and other essential brain functions are most protected.

Tomorrow I’m hopefully going to experience a different approach to protecting my brain functions. Totally ironically, having lived with shingles for 3 weeks, tomorrow, I’m due to have my shingles vaccination. I doubt they will give it to me. My body has, over the past 3 weeks, been busy making antibodies and generating a memory legacy of B and T cells for future use should I come into contact with the virus in the future. We will see.

Last week it was reported that the shingles vaccine lowers the risk of dementia by 25%. In the UK, 77,000 people die of dementia each year. If you are over 65, talk to your GP about getting the vaccination. Shingles is a horrible condition. It is probably the most painful condition imaginable, but hopefully lasts just weeks. Dementia is far worse, and there is no cure. That said, I’m sure there are many ways we can help ensure we all get to see many more sunrises!

Don't wait for Godot, live for today, tomorrow might never come!

It was the romantic poet, author and politician, Victor Hugo (of the Hunchback of Notre-Dame and Les Misérables fame) who said ‘Dreaming is happiness. Waiting is life’. This past week I have done a bit of both. The dreaming came courtesy of the antivirals I have been taking for my bout of shingles. The dreams were really weird. It felt like I was hallucinating and doing so on an endless loop. Very strange and disturbing. I woke up not rested at all, and the debilitating fatigue that followed was incredibly frustrating.

The shingle blisters have gone, leaving red and very inflamed skin patches behind. However, the nerve pain is still there and ever present. I know the shingles will eventually pass; I have just to be patient and wait for it to do so. I also have to be patient while I wait for my CT Scan results. I agreed to be part of an NHS lung cancer screening programme. This involved a telephone assessment, and yesterday, a CT scan.

The scan was over and done with in less than 10 minutes. However, I now have to wait 6 weeks for the result. I don’t have any of the associated symptoms of lung cancer, so I’m not that perturbed at having to wait. I was selected for the screening because of my age and because I once was a smoker. Other folk who might be waiting for health assessments or treatment are perhaps not so fortunate, although there has been a slight improvement in the numbers recently. 

In April this year there was 6,108,384 people on a waiting list. Some 2.53 million of these patients had waited over 18 weeks, and around 100,000 had been waiting over a year to receive their care. Being on a waiting list is not good for anyone. Research by the Nuffield Trust found that many patients experience a deterioration in their condition, sometimes resulting in more complex interventions being required. The research also noted the negative impact being on a waiting list can have on a person’s mental health and wellbeing.

Additionally, there are over 3000 patients each day who are receiving care in corridors and other ‘inappropriate’ settings. Often patients have little privacy, and such settings can be obtrusively noisy. Not a great environment for patients to flourish in. The use of such settings reflects the lack of beds for those assessed in A&E departments as requiring further in-patient care. So, until a bed becomes available, they have to wait in corridors.  

Both type of waits are not new phenomena. There was a growing waiting list problem before Covid 19, and the pandemic just exasperated the capacity issues secondary care services were increasingly facing. The NHS as a whole has been struggling to fully recover. Which brings me to Dave. On our recent Grand Lancaster Canal Adventure, we were forced to wait a day for canal services to open in order to buy some much needed diesel.

We had moored up at Galgate Marina. The marina boasts a nearby pub which we had frequented on our outward journey. We were looking forward to another good meal. Unfortunately, we arrived 5 minutes after the kitchen had closed for the evening. Sitting with a compensatory glass of wine and a G&T we fell into conversation with a chap at the next table called Dave. He had a magnificent handlebar moustache and a great story to tell.

Dave lived on his canal boat, but worked across the Lake District cleaning windows. He was very content with his life and was looking forward to his girlfriend finally joining him to share a life afloat together. He had also been a nurse. A very skilled nurse working in both intensive care and theatres. The stress of nursing through Covid had proved too much for him and his mental health began to deteriorate. He left the NHS soon after the pandemic started to settle. I didn’t disclose that I had also been a nurse, it was his story. I did thank him for his service and wished him well. Sad as his departure from the NHS might be, I admired him for not simply waiting for things to change for him, but to get out there and make things happen. He had long dreamed of living on a narrow boat, and leaving the NHS allowed him to do so. Dave described his life as being calmer and more settled these days. He was content. Listening to Dave's story reminded me we have but one life, so don't waste time waiting, get out there and live it.  

A slow boat to a healthier population

Sometimes life gives you an unexpected surprise or two. It’s the second week of our Lancaster canal cruise. We had made great progress and having reached Tewitfield Marina at Carnforth, we explored the last 14 miles of what are called the Northern Reaches. We had to take a bus into Kendal to see the very end of the old canal, now marked only by single post fixed adjacent to the local recycling plant. Sadly, these days, it’s not possible to get past the Tewitfield Locks. Back in 1960, in a grossly triumphant road versus canal decision, a connecting road bridge was constructed to cross the M6 motorway with its foundations and subsequent backfill, plonked squarely in the canal. There remains a somewhat hopelessly ambitious desire to reconnect the Northern Reaches to the rest of the Lancaster canal. It is unlikely to happen in my lifetime – there isn’t the money these days for such a project.

Having completed the first half of our journey, we were ready to start on our return last Monday. The weather had changed, but we were determined to carry on. The night before we should have set off, Jane noticed a horrible looking rash covering much of the right side of my upper body. The rash had numerous small blisters and was beginning to be very painful. I had felt off for a few days, but assumed I was either coming down with a cold or it was my age. At about 03.00 in the morning I suddenly woke up and thought it had to be shingles. 

So instead of setting off, we caught the first bus into Carnforth, and found a pharmacy that opened at 08.00 and I was seen straight away. Definitely shingles was the conclusion and antiviral medication, prescribed and dispensed. We had a brief encounter under the station clock and then Ubered back. I have to say the whole process was caring, compassionate and made me so proud of the NHS - when the system works well, it works really well. 

I have never had shingles before, but being a bit of a stubborn man, I thought let’s get going, a bit of pain and torrential rain was not going to stop me. Jane had other ideas. She told me to go back to bed, rest and gather my strength. Several hours later I awoke once more to find it still raining hard, and Jane telling me the Lune Aqueduct, was closed. It was the gateway to our route back to Lancaster. Both the shingles and the navigation closure were real surprises and made us reconsider what we could, should or even wanted to do. 

There were two more surprises for us to contemplate. One was waiting a whole day while the Canal and River Trust (CRT) removed two huge trees that had fallen during the nights storm and were blocking the canal. The next surprise came just 48 hours later, and was a four hour hold up due to a CRT boat that had drifted free from its moorings, and was wedged across the canal, blocking it. The best laid plans and all that. Now canal cruising is a slow affair. These days we are not allowed to travel at more than 4 mph. Many a time, walkers on the tow path catch us up and walk right on past us. 

Paradoxically, life on a canal boat is both leisurely but can be sheer hard work. We have adapted our days to suit this way of being. We cruise first thing, perhaps stopping for lunch and then find a mooring for the night. We have a full galley kitchen, so if not going out to eat, we can prepare a meal ourselves. So as I was still feeling far from well, we decided to stay another day. Jane used her bus pass and explored more of the Lakes. I looked after myself. Jane did however, give me written instructions on when I had to take the medication.

During the day I played catch up with papers I have stored up, waiting for a moment or two to read them. My computer is like my dads old shed, filled with things (in my case papers, stories and reports) that I don’t want to delete (or throw away in my dad’s case) as they might one day be just what I need. Yes, you guessed it, I found two stories that got me thinking. The first was a story about the UK Department for Work and Pensions (DWP) about four trials where ‘Fit  Notes’ won’t automatically issue when a person presents at the GP with a health problem. They may be offered an initial fit note, but it will be to enable a referral to an alternative community health service provider. Others won’t necessarily even get the initial fit note, but will be referred to other community services. These won’t always be clinically led services either.

Currently, some 11 million fit notes are issues each year, with some 9-10 declaring the person unfit for work. This can’t be right. So often such a fit note condemns a person to longer term unemployment, without actually helping them to help themselves. Employment in one shape or another is one of the really important underlying factors in keeping someone mental health and improving their wellbeing.

I think the four pilots are a great idea, and overtime, will help us really invest in the resources to be found in our local neighbourhoods and communities. There are other things that we might do to help keep ourselves healthy. My second story described how the supermarket Morrisons (there are other supermarkets available) have teamed up with the NHS in a project to raise people’s awareness of, and ability to recognise a potential cancer.

Morrisons have designed a series of new shower and bath products that all have cancer advice on the labels. The messages include ‘be body aware’ and ‘know the signs of cancer’. In using these products, folk are encouraged to look out for skin changes, lumps, unexplained bruising and so on when they are in the bath or taking a shower. Most won’t be cancerous, but if people discover any such changes, they are advised to seek medical help asap. This can make all the difference to someone’s treatment outcome if indeed, the changes are signs of cancer. If something doesn’t feel right with your body, don’t go on line for Dr Google, talk to a health professional, whether that is your GP, Practice Nurse, or like me last week, your local pharmacist. You know it makes sense. Just do it and stay well.

May is the month of expectation, the month of wishes, the month of hope*

And so May 2026 ends. For me, it’s been a month of change, memories, challenge, opportunity and celebration. Jane and I have enjoyed celebrating five different birthdays across the whole of the month. It was also the first anniversary of my mother’s death last year. My mum was 91 when she died. The folk who cared for her in those last few months made sure she had a good death.  Her passing made me realise how fast time flies and how important it is to make every day count. We have but one life, it’s important to live it.

However, sometimes the plans we have don’t always come to fruition. I have long wanted to climb Mount Everest. My heart still has this as an ambition, but my head tells me I’m now probably too old to try. It’s an itch that won’t go away. We travelled to Nepal in 2023, an extension of our Golden Triangle tour of India. Knowing we were so close to Mount Everest, we took an airplane flight up to, and around, Everest. It was a fantastic trip and I’m glad I got to see it up close.

It may not just be my age that makes me feel it’s unlikely I will get to climb Everest. This May saw the largest number of folk climbing up the mountain ever. A couple of weeks ago now there was one day where 274 people were recorded climbing Everest at the same time. There was literally a queue to get to the top. I think at £12,000 a go I would be really cheesed off to stand there in such a queue!

These days my ambitions are a little more modest. I write this blog from our wonderful narrowboat Bluebell. We are currently cruising the Lancaster canal, traveling from one end to the other and back again. At one time due to the fact that there are no locks to worry about, the journey from Preston to Kendal could take as little as 10 hours. In its heyday, the canal was used to transport coal from Lancashire, and limestone from Cumbria earning itself the nickname of the ‘black and white’ canal.

We have planned to take up to 10 days to do the same journey. This is day five, and so far, so good. The weather has been kind and Bluebell has behaved herself, and there has been no problems. Indeed, my recent episode of sciatica appears to have resolved itself, and I’m now largely pain free. And finally, the rather large and very colourful haematoma on my left arm is beginning to fade.

The latter was a result of my latest blood donation. For some reason, the folk at the blood donor centres seem unable to find a vein in my right arm, so the left arm gets used every time. The problem is that whilst they can find a vein to use, it apparently ‘jiggles’ making it more difficult to get the needle in. When this happens, as it did last week, I get a rather spectacular bruise. 

It is no fault of the donor carer folk. They are highly skilled practitioners, in whom I have every confidence. The NHS Blood and Transplant (NHSBT) service collects over 1.6 million donations of blood and blood products in centres across England every year. No, we have collectively come to the conclusion it’s my ageing body that is the problem. However, that said, in my local area, the oldest donor is now 81 years old, so there is hope for me yet!

Giving blood has always been a great experience for me. The folk that care for me all through the donation process are absolutely person-centred people. Unlike our canal journey which is slowness personified, I sense that they are up against the clock to get donors seen, blood collected and stored. However, you wouldn’t know it. The NHSBT folk always make me feel as if I’m the sole focus of their attention. Always calm, and always professional. Every one of them has, of course, received formal training and are appropriately supervised, but it’s their passion for people that you really notice. As in many areas of health and social care being able to be there and with people is what really makes the difference.

 

*Thank you Emily Bronte 

Once a nurse, always a nurse

This time last year, the UK government announced that it intended to make the title ‘Nurse’ a legally protected title. At present, only ‘Registered Nurse’ and ‘Advanced Nurse Practitioner’ titles are legally protected. Without such legal protection, it’s possible for anyone to call themselves a nurse and practise as a nurse; this is a situation that does not protect the public. There have been many cases, where a registered nurse, having been struck off the Nurse Midwifery Council (NMC)’s register, continues to present as a nurse. This is something that is not only potentially harmful to individual patients, but also risks undermining the hard-won reputation of the nurse profession.

The Early Day Motion calling for the title ‘Nurse’ to be legally protected was long overdue and most welcome. The former Secretary of State for Health and Social Care, Wes Streeting, fully supported the motion and a potential three-month consultation across all four nations of the UK was proposed. As far as I’m aware, and please dear reader if you know something different, we are still waiting for the consultation to start and conclude.

New legislation can take a long time to reach fruition. Of course, Wes has been busy over the last 12-months trying to manage the self-inflicted chaos of the reforms (not reforms), aimed at bringing together NHS England and the Department of Health and Social Care. And now he’s gone, hoping to become the UK’s next Prime Minister. We now have a brand-spanking new Secretary of State, James Murray. He has assured us that there will be no changes to the pace and purpose of the reforms (not reforms). So, watch this space folks, but please don’t hold your breath for too long.

Just as an aside, the UK has had 11 health Secretaries of State since 2015. Only two have been in the role for more than three years. The average time in office is just 487 days. Wes lasted for 677 days. Probably the most inappropriate health minster was the cigar-smoking, wine-drinking Therese Coffey who, thankfully, lasted just 49 days in the role.  

Hmm, well that has been a very long introduction to what I wanted to write about this week. We held our first Nursing Awards Day at Greater Manchester Mental Health Trust last week. I was fortunate and privileged to attend and take part, as was our Chief Nurse, Chief Operating Officer, and our Chief Executive Officer. All four of us were, or still are, practising nurses. For a large mental health organisation such as ours, this fact alone made me feel very proud.  

As well as announcing some of the winners, I had also been asked to introduce the afternoon and say a few words. My starting point was to share that I was a nurse. When I retired, I also took myself off the NMC register. As such I cannot practise as a nurse (see above), but my belief is, ‘once a nurse, always a nurse’. In my introduction, I told of the work of both Virginia Henderson and Carl Rogers. I think the hundred or so nurses in the audience were more familiar with the work of Carl Rogers and in particular, his concept of unconditional positive regard, when we work with our patients (and colleagues too, I suggest).

On a former part of my life journey, I was the Dean of one of the largest nursing schools in England. Twice a year, I would welcome eager new student nurses, and like last week, share the works of Henderson and Rogers. I would also talk of how it was the work of Michel Foucault and his notion of the importance of revealing ‘the language of the silenced voice’: that is listening, with attention to what is not being said, that helped shape my own practice.

Whilst last week’s Nursing Awards were a triumph, it was sad to read a survey published by the Royal College of Nursing last Monday. This reported that 64% of nurses taking part in the survey believed there are too few of them to keep patients safe and provide good quality care. I think there is a great deal of work going on nationally, on what safe staffing might mean in practice. We are doing similar work in our Trust, but I don’t think that safe staffing levels can purely be about numbers.

However, I don’t want to end this blog on such a downbeat note, especially as our Nursing Awards event was such a celebration of both individual and team achievements, of pride in the contributions being made across our improvement journey. It was an absolute testament to the powerful contribution nurses continue to make to improving the health of our nation and the varied ways they continue to make a difference to the lives of others. I was left with a warm feeling that the profession was in good hands.

Lemur-inspired steps to improve my mental health and wellbeing

One of the great things about having a dog is that, at least twice a day, they need to be taken outside for a walk. It doesn’t matter what the weather is doing, rain or dry, hot or cold, out for a walk Dylan and I will go. Sometimes, usually early morning, he can be reluctant to leave the house and will try and hide somewhere. He always gives himself away, as I call his name and he starts thumping his tail! I tell him that exercise is one of the five steps we can take to improve our mental health and wellbeing.

One of the other reasons I like walking with Dylan, is that we invariably meet other folk. Even on our first morning walk at 5am, there are other people out and about. Most of these people I know only by sight, but it’s always good to exchange a greeting, a smile and maybe a word or two. Although we have various routes we tend to take, we always walk through streets and across fields. It never ceases to amaze me how much wildlife there is to be seen, so close to the houses. I often see foxes, and this Spring we have enjoyed watching and listening to a little woodpecker.

On Friday, I had a rather different animal experience, however. I got to hand feed a troop of ring-tailed lemurs at our local zoo. It was a birthday present from Jane and it was a wonderful experience. I had a bucket full of kebab sticks threaded through with fruit, raw vegetables and boiled potatoes. Crouching down, these lovely little creatures came and held onto the sticks I was holding, while eating the fruit and veg off them. Boiled potatoes and grapes were the favourite choices. These were wild animals and they were both bold and also suspicious. Knowing how to ‘be’ with them was a new one for me. Although perhaps not in the same league as the David Attenborough mountain gorilla moment, I can now add ‘ability to commune with lemurs’ to my CV.

When we got to their enclosure, a huge space which allows them to run free, climb trees and so on, they were collectively all sunbathing. It was a most amusing sight, they sat upright facing the early morning sunshine, looking like a Bank Holiday crowd on a sunny Blackpool beach. Visitors can walk through their enclosure and get up close to the lemurs. I was very fortunate to meet Shelley, a 30 year old, red-ruffed lemur, seldom seen by the public. She just appeared from the undergrowth, and I was able to stroke her as she took food from my hand.  

Strangely, just being with Shelley made me feel somehow humble. In lemur terms, she was an old lady. They don’t usually live past 20 years. Her calmness and simple presence elicited a wonderful mindfulness moment in me. It was a moment to add to my resilience store. Last week, also gave me another moment to reflect upon. I was out with Dylan, and it was a mid-morning walk. The sun was shining, the birds were singing and I felt at peace with the world.

As we were walking across the fields, a man came into view, also walking with his dog. As we passed, I said, ‘it’s a gorgeous summer’s day’, he responded with ‘I think you think every day is a summer’s day. Now I don’t know him, although we often see each other, as we walk our dogs. I think his observation was a reference to the fact that I habitually wear shorts, whatever the weather. However, it made me think just how different we might feel, if we treated every day, as if it was a gorgeous summer’s day. Of course, it’s not always possible to feel like that all of the time. I know there have been times in my life where whatever was going on has felt overwhelming and even depressing. In such times, it is being connected to others, however tenuous that relationship might be, which can provide help and support.  

I write this blog on the last day of this year’s Mental Health Awareness Week. The theme this year has been on action – awareness of mental health is one thing, but taking action ourselves, and for, and with others, is where positive change can occur. Have a look at this fabulous Mental Health Foundation website to see what you might be able to do, to improve your own mental health and wellbeing too.  

A pocket full of wisdom, and taking snooker as my cue

Like many folk I guess, I watched this year’s Snooker World Championship games with huge enjoyment. My favourite snooker player of all time, Ronnie O’Sullivan went out fairly early on in that competition, but I enjoyed watching him play while he did. He is a real crowd pleaser, always drawing packed audiences wherever and whenever he plays. No sooner was the World Championship over than Ronnie was back on our screens, playing once more at the famous Crucible venue.

Aged 50, this is the first time he is taking part in the World’s Seniors Championship tournament, which has been running all last week. As I write this Ronnie is struggling, and appears to have lost his mojo a little. That said, he is in the final later today! Whilst many of snooker’s greats are taking part, actually any professional player aged 40 or over can participate. There was a slight divergence of opinion in our house on discovering the competition was on TV. Whilst Jane observed that ‘Seniors’ implied it was an old man’s competition, I thought of it being a competition of skilled players, as in the dictionary definition of someone who has the training and experience to do something well, usually better than others – think consultant doctors versus resident doctors for example.

Consultants are regarded as senior doctors, whereas resident doctors, until recently were referred to as junior doctors. Arguably, both possess knowledge, have or are acquiring skills and experience. It is the specialist knowledge and how to use this, that sets both groups apart. What I would call wisdom. The recent bouts of industrial action on the part of resident doctors provided a good example of this. Many services managed well, and in some areas, better than normal.

It is thought this might be because consultants (who stepped into the space left by absent resident doctors) are much less risk adverse, do fewer tests and investigations and can see and treat people faster, more safely, and with greater confidence. In the words of Martin Luther King Jr. ‘knowledge is a process of piling up facts, wisdom lies in their simplification’. These days, most doctors who become consultants do so in their mid-thirties and 40 is the average age overall for doctors to become consultants. However, only 25% of all doctors in training become a consultant.

When a doctor becomes a consultant, is of course, dependent upon many factors, such as their chosen speciality, employment opportunities, work/life choices and so on. But clearly, age isn’t necessarily one of these factors. However, age can be for other changes to our lives. As I have grown older, my hair line has receded and what remains has turned almost grey (I think white), I have wrinkles where there were none before, and I can go upstairs for something and then not remember what I came up for. I’m nowhere near as strong as I once was, both physically, and in some situations, confidence wise too.  

For example, I once worked with a senior clinical psychologist called Clive. He taught me how to climb, and he helped me nurture my love of rock climbing. At my peak (sorry), I was taking on extreme routes and even free climbing (no ropes). I practised on indoor climbing walls three or four times a week and went out with Clive, whenever he was free. I learnt a lot from him and in so doing, learnt a lot about myself. Over the years, age began to catch up with me. Creeping arthritis in my hands began to make me doubt my ability to rely upon them. Although good climbing is more about legs, feet and balance than just holding on with your hands, feeling confident about using every part of your body is important. I guess that is where wisdom kicks in.

Despite my skill, knowledge and years of experience of rock climbing, the gradual erosion of my confidence and my physical prowess, the wise thing to do was to stop climbing. So eventually, I did. These days I walk, although I have dusted off my snooker cue and have enjoyed a few friendly games. Truth is, like Ronnie, I’m struggling, but at least I’m safe. However, the month of May is a great month in our family. Jane celebrates her birthday as does one of my children, and a young grandson celebrates his birthday too.

May is also my birthday, so even if I can’t climb Malham Cove any more, or score a maximum 147 when I play snooker, I have to say right now, life is good, and bring on whatever the next adventures might be.

Population health and condom sense

The Dutch philosopher, Desiderius Erasmus, in the 16th century, popularised the phrase ‘prevention is better than cure’. Today, it has become the adage for so many things in life, but particularly when it comes to public health and health prevention. It is a concept that underpins one of the three ‘left shifts’ set out in the NHS 10 Year Health Plan (from hospital to community; from analogue to digital; from sickness to prevention).

This is not a new idea. For example, the Sure Start scheme was very effective. The use of early intervention, providing help and support to new parents, made such a difference to the wellbeing of families and enabled many children to thrive and enjoy better life chances. Sadly, the scheme was abandoned almost in its entirety after 2010.

Norman Lamb, the former MP and Minister of State for Care and Support has been a long-time advocate of joined-up health care. He championed a greater focus on preventing ill health. He has long campaigned for mental health to be given the same priority, as physical health. Last week, he published an article in the Health Service Journal on what the 10 Year Health Plan might mean for mental health care and services in England.   

His article focuses on many areas of mental health that he feels need reforming. Rightly, he notes that demand for mental health care is growing exponentially, and in particular with young people. Currently services cannot, or do not, meet this growing need. Norman shares his concern, a concern shared by many others, that too many young people are turning to chat-bots and other AI sources for help and advice. The evidence is mounting that many of these online services are potentially harmful. I absolutely agree. As the NHS moves from analogue to more digitally-resourced service provision, we need to find ways of distinguishing what might be truly therapeutic and what isn’t.  

In so doing, not only will it require governmental direction and support, but also greater clinical leadership.  Such leadership must combine the best that primary care can offer, with greater accessibility to specialist consultant-based care. There are early signs that this is happening, but I would argue, it is probably not happening fast enough. However, speed is not always the answer.

Last week, saw the passing of the Tobacco and Vapes Bill. It’s a very clever piece of public health legislation. Essentially, anyone born on or after 1st January 2009 will now never be legally able to buy tobacco products. From 2027, the legal age for the sale of tobacco will rise by one year. Currently the legal is age is 18. Generally, if someone hasn’t started smoking by the age or 20, they are unlikely to ever start. Over time, the number of people who will be able to legally smoke will become smaller and smaller. A good thing!

The law relates to those who sell tobacco products, not to those who choose to consume them. It’s an important distinction, but I do wonder how it might be policed. That said, I foresee similar approaches perhaps being considered over the sale of alcohol and ultra-processed foods, both of which cost the NHS millions of pounds in treatment costs for the conditions both can cause. What I didn’t foresee, however, was the condom crisis.

Apparently, the conflict in the middle east and the shutting of the Strait of Hormuz is pushing the cost of the raw materials used in manufacturing condoms to unacceptable levels. The result is a steep rise in the cost of condoms. The fear is that such a price rise will stop people using them. Now for some, the condom is the ultimate symbol of prevention (think HIV, sexually transmitted diseases and unplanned pregnancies). Indeed, when I read the story, I was reminded of a conference I attended with a couple of colleagues in Evora, Portugal. We sat in the audience listening to a speaker from a university in Liverpool, talking about research she had undertaken into the sexual health of sailors in the Port of Liverpool.  

I’m ashamed to say that my colleagues and I started giggling like school children, as she referred to her participants as seamen and not sailors. In my defence I would point out it was 24 years ago, and I have hopefully somewhat matured since then. Interestingly, I looked up when it was, we presented the paper at that conference. I was intrigued to see that the paper’s title seemed very apposite: The NHS Plan: A health rhetoric and an unhealthy reality? I hope today’s NHS 10 Year Health Plan proves to be neither.            

The hidden voice of mental health unveiled

I had one of the best professors ever supervising my PhD, Joel Richman. Joel was a medical sociologist of great esteem. He was also an anthropologist, a disruptive academic, and at times a rascal*. He used his knowledge, talent and courage in a way that touched many people’s lives, mine included. He helped me embrace ethnography, as a way of observing the world. He gave me a different lens, with which I could try and make sense of the world. Joel really did leave me interested in observing people’s behaviour, what they say and at times, listening to what they are not saying.

Last week I was at the NHS North West System Leaders meeting. This was part of an NHS England Board regional tour. They are currently visiting each of the seven regions across England. All the Chief Executives and Chairs were invited to join the national team in exploring progress, ambitions, challenges and so on. It was also a chance for each of the three Integrated Care Systems in the North West to showcase how they were delivering the three ‘left shifts’ outlined in the NHS 10 Year Health Plan. In particular, how was ‘neighbourhood health care’ beginning to be developed and delivered.

I have to say the presentations from the national team were, for once, positive, congratulatory, and at times humorous. Unusually, there was an early nod towards mental health services. My colleague Anthony H from Pennine Care FT presented the work we had done together to eliminate ‘out of area placements’ over the past 18 months.

Out of area placements are used where service users requiring inpatient care can’t get this in Greater Manchester, as there are no available beds. They are then placed in services often many miles away from their home and family. It is a failure on our part that we used such placements. Eliminating these placements was a tremendous achievement on the part of my colleagues, and it was great to see their story being shared with colleagues from across the region and beyond.

Then, as is so often the case, the conversations returned to urgent and emergency care, and reducing waiting lists and waiting times. Mental health was put back in its box. Saying that, the local service presentations were interesting. The use of new technologies in transforming services was impressive, and the use of data to develop population health initiatives was encouraging, and in particular appeared to be really making a difference to preventing ill health and reducing the need for expensive hospital care.

But throughout the presentations there was no other mention of mental health. I wondered why - there is no health without mental health. One of the people who had been part of the Greater Manchester presentation was a GP called Claire. I grabbed her before she could leave and talked to her about when she thought her data programme might include mental health services. Her answer both surprised me and excited me.

She told me they are already looking at the related mental health problems that might result from the physical conditions their data had focused on. Anxiety, depression, generalised stress were all factors that they were now beginning to build into their data programme. Likewise, employment status, housing conditions, family and community, relationships were also increasingly recognised as being important health determinants and were now being incorporated into the data base.

Claire hadn’t mentioned any of these developments, and to be honest, I should have ‘heard’ what she didn’t say. But then, perhaps others wouldn’t have thought about the mental health and wellbeing consequences of Cardio Vascular Disease, Diabetes, Asthma and Chronic Kidney Disease either. Folk are probably more familiar with the physical consequences of such health problems. It was a lesson for me in terms of helping people think about mental health differently.

Travelling home on the train, I wondered what Joel would have made of my day. He sadly died on a plane, on his way back from a three-month speaking tour in Hong Kong in 2008. Health care, and how services are provided have changed out of all recognition since then. Thankfully, as was evident at the meeting last week, health care continues to transform, and hopefully for the better.  

 

*Joel once kept his Dean of Faculty a prisoner in his office as a protest at the termination of his contract. The police were called and he was arrested. After the Jewish Chronicle published his story, he was reinstated and carried on working for a number of years before his death in 2008.

A quick walk around the Wrekin?

Last week, I visited Birmingham. Although it’s a little tedious to get there by train from where I live, the city is an interesting place for sure. There has been a settlement of one kind or another since the Stone Age. Today, it is often referred to as England’s second city – although I think the folk in Manchester might challenge this assertion. Reading up on Birmingham on the train down, I was surprised to learn that its industrial revolution started much earlier than that found in the North West.

In Manchester and its surrounding towns, the industrial revolution was driven, in part, by economies of scale in terms of production, coupled with plentiful low-paid, often unskilled labour, all employed in producing bulk products like cotton, coal and wool. Birmingham on the other hand succeeded through the adaptability and creativity of a largely skilled and diverse workforce. Inventiveness, innovation and the ability to be transformational were the key ingredients of Birmingham’s early success. Finding this out seemed very appropriate to the reason I was in the city.

I was attending the very first NHS Alliance conference since the NHS Confederation and NHS Providers were merged into one new organisation. The conference was the Mental Health and Learning Disabilities Annual Conference and Exhibition. Not only was it a first for NHS Alliance, it was a first for me too. One of the most positive things about such gatherings, is the opportunity to network, and it was wonderful to catch up with many familiar faces. Likewise, it was great to be able to discuss topics with the next generation of people, who like me, have a passion for improving mental health care.

There were so many ‘take away’ thoughts for me. Some appeared seductively simple, but were actually quite complex. For example, whilst undoubtedly mental health services in general have led the way in co-production, recognising and embracing people’s ‘lived experience’, I hadn’t thought of the concept of ‘living experience’. It was a great concept of an ever-evolving repository of experiences that might challenge our values, thinking, behaviours and sense of self – and probably importantly, our sense of self in relation to others. For the first time in a long time, I feel a paper calling….

There were many other interesting discussions. There was a very challenging panel discussion on whether we were doing enough to help people with a mental health problem gain employment. Clearly, we are not. A great deal more could be done to help people back into employment or even to gain their first job. The corrosive impact of not having a meaningful job were powerfully illustrated by Craig Cleeton, an expert by experience, who told of his own journey into employment.

Likewise, there was a brilliant session on what makes for effective foundations in developing neighbourhood mental health services. Predominately the discussion was led by Emma Tiffen, a national GP advisor for community mental health and primary care. You could see why she was an award-winning GP! What she described wasn’t rocket science. It was an approach predicated on a real commitment to working together across the primary and secondary care interface. I feel a trip down to Cambridge, where she is demonstrating day after day what might be possible is on the cards.

Some of the discussions were less inspiring. The ‘early days’ new national priority director for mental health, learning disabilities and neurodevelopmental disorders, Nick Broughton, gave his first major speech since being appointed. Perhaps in a career-ending comment, (but it’s always good to speak truth to power) it was a rather underwhelming speech. Coming from someone clearly hugely experienced and qualified, with a great clinical track record, I was disappointed. More so as he was making the speech in a place of historical inventiveness, innovation and the ability to be transformational.

In the interest of fairness, I have been suffering (the right word) with sciatica all week and had left my Tramadol at home. Maybe it was my ‘lived experience’ on the day that may well have coloured my impressions. That said, and see above, there were some totally inspirational moments during the day.  

 

The uniqueness of being you

Although probably best known for his role as the maverick rifleman Richard Sharpe in the television series Sharpe, Sean Bean is a prolific actor, and one who has very successfully taken on very different roles. He’s played a Bond villain, the noble Boromir in the Lord of the Rings films, a quirky cowboy, and a Russian mercenary amongst many other film roles. Back in 1986, he began to establish himself as a sex symbol; first in the film Caravaggio, and later in 1993, Lady Chatterley. As you might have guessed, I’m a great fan of his work.

Last week, I was reminded of something he once said – ‘listen to people and treat people as you find them. There is an inherent goodness in most people. Don’t pre-judge people – that was me Mam’s advice anyway’. I try to have a very similar outlook on life and relationships. I have long tried to practise the Carl Rogers concept of ‘unconditional positive regard’. I say tried, as sometimes I have found it very difficult to be non-judgmental and accepting (and caring) in response to someone’s behaviour, motives or decision making.

When I find myself struggling in this regard, I have to mentally take a step backward, pause and try and understand why the situation and person has evoked such a response. The latest round of doctors’ industrial action is a good example. Most of the doctors I have come across in my career are good people. They use the skills and knowledge acquired over many years of experience to care for others. They are there for us, when we are unable to care for ourselves and need help.

However, such an embedded way of being feels a long way from a decision to take industrial action, in the full knowledge of the consequence this might have for so many people. Often people who might have been waiting a long time for the help and care the doctors could provide.

I’m not being political, but the challenge to my unconditional positive regard for my medical colleagues was made more difficult last week. I found out that, whilst the British Medical Association (BMA) was demanding a pay rise of around 26% for resident doctors, they were offering a below inflation pay rise of 2.75% to their own staff. The BMA do so on the basis they cannot afford a higher pay rise due to the pressures on their budget. The last five-day resident doctors’ strike was estimated to have cost the NHS £300 million. Over the past three years, there have been 15 separate periods of industrial action, estimated to have cost the NHS some £3 billion. This is money that is not in individual NHS organisation’s budgets and adds to the pressure of having to make savings.

It appears it is perhaps not just me, who is struggling with the reasoning behind the current industrial action. Last week a YouGov poll showed that 55% of the public opposed the resident doctors’ industrial action. Whilst the recent British Social Attitudes Survey showed a marginal improvement in people’s levels of satisfaction with the NHS, waiting times and access to primary care were still top of the concerns reported.

Of course there are always at least two sides to every situation. My struggles over my medical colleagues’ decisions are mirrored in my struggles at times in understanding the government’s response. Consultation and negotiation will lead to consensus and agreement far quicker than threats, prescription and criticism of the doctors. I hope all interested parties can once again get around the table and start talking. Keep talking would be my message.

Last week, I was fortunate to be part of a great conversation between a doctor and his patient. I wasn’t the patient, but someone I care for very much, was. It was their first encounter and right from the off, it was clear that the doctor’s focus was on the patient. He listened, he gently questioned, and carefully summarised and allowed the patient to tell her story.

Unconditional positive regard starts with the individual. We are all unique and we should remember and embrace this concept. What impressed me last week, was the way the doctor made this a reality for his patient. Despite the patient experiencing a life-changing event, accepting themselves for who they were now was a big step forward. Take home message for me was, whilst medical records and diagnosis are important – listen to the person in front of you and treat them as you find them.