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.