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.

Time spent with animals is never wasted*

A number of years ago, I brought a house in Scotland. It was for my retirement years. Plans change, and although I’ve reached retirement age, I’m not ready to stop just yet. Since that time, I’ve bought a new home to retire in, when the time comes, that is. One of the things I miss from my time in Scotland are the highland cattle. Where I lived, they were used to clear scrub land, and return it to better quality grazing land. They were magnificent creatures for sure. I spent many a happy hour watching them do their thing, as they majestically meandered through the tangled undergrowth.

I was reminded of this time by one of the many animal stories I read last week. There was Larry the 10 Downing Street cat, who was filmed joyously playing with a mouse he had caught. Not bad for a 19-year-old cat! Then there was the hoax story about Jonathan, the world’s oldest tortoise. Jonathan is 193 years old, and last week it was claimed he had died. Thankfully, he was found under a tree, fast asleep, enjoying the sunshine. However, it was the story of the Hothfield Heathlands Highland cows that really struck me.

Like the herd in Scotland, they were at the nature reserve to revive and maintain the grasslands by wild grazing. Unfortunately, the cattle had to be removed as they had become ‘distressed’ by people trying to film and take selfies with them. It was a consequence of a Tik Tok post that went viral. This breed is over 1000 years old, and here they were being stressed out by the impact of social media! Just like humans, when stressed and under pressure, cows will become distressed, and can show real changes in their behaviour.

While not wishing to anthropomorphise (attributing human emotions and feelings to animals), I do believe that animals, in their own way, react to changes in much the same way we do. You might well have recently seen videos of cattle being let out of their winter quarters and kicking their heels, as they run out to the green fields. I defy anyone to not think they were happy and pleased to be out in the fresh air once more!

We had a similar experience with our hens last week. Over the winter, they live in their house, which has a large covered outside run attached to it. This protects them from the weather (and foxes), but allows them to enjoy the fresh air. Last Monday for the first time since December, we opened the poop hole to their outside grassed area, a run shared with the goats. The older hens were straight out, scratching the ground for worms and bugs, running around flapping their wings and appeared to be really enjoying themselves.

Three of our hens and this year’s cockerel, Chick Jagger, all hatched during the winter months, appeared highly suspicious of the poop hole. For a long time, they refused to go through it and join the other hens. Chick Jagger seemed incensed that his ‘girls’ had deserted him and he couldn’t get to them. He crowed, flapped and tried every which way to bring his hens back into the covered run with him. They weren’t having it. Eventually, he bravely stepped through the poop hole and peace and quiet was reestablished.

The goats seemed happy the hens had reappeared and once again they could chase them around. The hens dodged the goats’ attempts and enjoyed dust bathing and picking at the grass, all the while making soft cluckling noises. Willow and Clemmie came to view the new arrangements, but being cats, they soon appeared to lose interest and returned to their slumber. Dylan, being Dylan just ran around excitedly barking – but that’s his usual response to any change. Billy, the parrot, was inside the house, and as he’s perpetually happy, didn’t seem impacted by seeing the chickens roaming outside once more.

Now there is a lot of evidence that shows there is a direct relationship between accessing nature and improving people’s mental health and wellbeing. This might include walking on the beach or in the hills, gardening or simply just sitting in the sunshine on. It works for me, and I’m sure for many others. If I need to think through a problem or come up with a plan, I go for a walk. A long walk will brighten my mood, makes me feel good, and refill my mind’s resilience store. Getting out in the garden and getting dirt under my fingernails gives me a huge sense of satisfaction. Now although I have no science to back it up, the ‘evidence’ from my week last week appeared to show all living things might benefit from being in, and being part of nature.

*with apologies to Sigmund Freud