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.