My Christmas Day Blog 2016

I started writing my blog in 2009. Early every Sunday morning  I 'post' my blog for the week. Today is Christmas Day, and rather like the Queen, I feel a need to post a brief Christmas message. Since 2009, Christmas Day has only fallen on a Sunday on 1 other occasion and that was in 2011. After today it won’t happen again until 2022. I wonder if I will still be writing my blog then. Confusingly for some, in Western Christianity, the first Sunday after Christmas is actually called 'the First Sunday of Christmas', which this year will also be the first Sunday of brand spanking New Year of 2017! So this is the last blog posting for this year. Many thanks to all of you who choose to read it each week.

A couple of things came to mind when I stopped and thought about what I could write for this blog. I wanted to include a carol, and given I am a long-time fan of the late great Leonard Cohen and thought I might bring you some of his Christmas music, but he never recorded a Christmas album. The only song he ever recorded is 'Silent Night', which he sang with Jennifer Warnes way back in December 1979 – which you can hear here. In case you are wondering, Christmas Day in 1979, fell on a Tuesday. The Leonard Cohen version is not the best one available, but it is better than mine. 

When I was very much younger and lived with my parents in North London, we had a harmonium in one corner of our dining room. It was a magnificent beastie. Black wood, ivory coloured keys, lots of pull out levers, 2 wooden paddles that you operated with your knees to make the sound louder or softer and all worked by 2 foot pedals which you had to pump. I am not aware that any of us 7 children could play, and I am almost certain my parents didn’t either. But as a child it was great fun to play with. The only recognisable tune I could ever get out of it was a one handed version of 'Silent Night'. One of my brothers went on to play the piano in later life, but as I had dreams of becoming a rock star it had to be the guitar for me. I can play 'Silent Night' and other assorted Christmas carols on the guitar and for a small fee I am available to play at a Christmas party near you.

The other thought that came to me was of all those people who will be working over the holiday to keep us safe, warm, healthy, keeping the lights on, the roads moving, the food on our tables, and for all of those giving up their time and energy in 'being there' for others in shelters, on the streets or at the end of a telephone line. Many thanks to you all, and for all that you do for the rest of us. 

And wherever and however you are celebrating Christmas this year I hope you are able to find time to enjoy, laugh, relax and if so moved, sing the odd Christmas carol or song in the company of friends and family. W and me, well as soon as I press 'post' we are off to spend Christmas Day (and the next 8 days) up in the House in Scotland 

Best wishes for Christmas 2016!

All I want for Christmas is some happiness and wellbeing for everyone

This time next week it will be Christmas Day. For many it will mean excitement, laughter and an opportunity to renew friendships and family bonds over a shared meal and the exchange of presents. For many others however, Christmas Day may not hold the same appeal. For example, the Department for Communities and Local Government published a study earlier in the year which reported that during 2015 there will be 3,569 people sleeping rough in England on any one night. In 2015 there were 68,560 households living in temporary accommodation, of which, 78% (53,480) were families containing children and or a pregnant woman.

The Joseph Rowntree Foundation reports that in 2015, there were 13.5 million people living in poverty, some 21% of the UK population. Whilst over 45% of those in poverty don’t live in a working family, there are 3.8m people who have a job yet are still living in poverty. 1.4m children live in long-term workless households, and 69% of the poorest in society have no savings whatsoever. The only group I could see where there were improving data was for those aged 65 or over. Despite there being a rise of 1.7m more people in this age group over the last decade, there are 400,00 fewer pensioners living in poverty.

These are depressing statistics, and although there is no data available for 2016 it is unlikely the picture will be much improved. The impact on individuals, their families and the wider community such difficulties bring cannot be overstated. For many people, it will mean living with daily unrelenting misery and unhappiness, despair and fear. The London School of Economics published an challenging report last week that looked at factors which impact on people’s happiness and wellbeing. One of the reports authors, Prof Richard Layard, noted that the evidence from their study showed that the things that matter most in terms of our happiness and wellbeing were our social relationships and our mental and physical health.

Whilst acknowledging that poverty, unemployment and homelessness inevitably will have a negative impact on individual’s sense of wellbeing, just simply having more money didn't improve people’s sense of wellbeing and happiness. Having a partner, and someone to share life with was seen to be more valuable than even doubling an individual’s income in the context of raising people's sense of wellbeing and happiness. In acknowledging that experiencing depression and anxiety would have the most negative impact on an individual's wellbeing, the study posed the question as to whether it would be better for the role of the State needing to shift from 'wealth creation' to something they called 'wellbeing creation'.  

Layard, who is an international renowned economist, has long campaigned for greater investment in mental health services in the UK. His work has demonstrated that eliminating depression and anxiety would reduce misery by 20% compared to the 5% reduction that would be achieved if the focus was on eliminating poverty. Extra spending on reducing mental illness would be self-financing, as costs would be recovered through higher employment (and increased tax receipts) and a reduction in NHS costs from fewer visits to GPs, in-patient mental health services and hospital A+E departments. Whilst the State has a responsibility for ensuring the availability of appropriate mental health services, families and friends will continue to have a huge role to play in reducing the impact of those experiencing mental health problems. And if you want to know more about dealing with practical issues, this is a great site for help and advice. 

I am part of very large family, and today many of our children and grandchildren will be coming for turkey and all the trimmings, present giving (and opening) and hopefully lots of fun to be had together. This is the start of a number of family celebrations which will end this year with a family party on Christmas Eve. However, this time next week, W and I will be up in Scotland to spend a quiet Christmas Day together with just Cello the dog and Billy the parrot for company. It's the first time we have done this, and surprisingly, I'm quite looking forward to it! 

A new ‘toke’ on the older persons Great British Bake Off?

Hmm, well in a week where I got to see Sir Rod Stewart, who at 71, gave the Manchester audience a fantastic show, and Sir Mick Jagger, now 73, celebrating the birth of his 8th child, all I managed was to catch a cold. Actually it wasn't even a full blown affair. I had those horrible symptoms that lurked just outside of being a streaming cold, but were sufficient to give rise to a headache, sneezing, sore itchy throat, a tickly cough and general fatigue. LemSip, and Whisky (but not in the same glass!) were the order of the day, and as I write this blog the cold has been kept at bay. I have always been an advocate of self-medication, and I know that many minor ailments are self-limiting, so I’ve not had a problem. It appears I’m not alone.

Many older people have to deal with a multitude of different chronic illnesses. Its been reported that for some people living with conditions such as cancer, glaucoma, multiple sclerosis, arthritic pain and even Alzheimer's taking cannabis has helped them. Allegedly, it is said that one joint can do the same job as a cupboard full of different medications. Recent research in the US has revealed that over the last 10 years there has been a 71% increase in cannabis use by people aged 50 years and older. Although the use tails off in those aged 65 or over, there has still been a rise in cannabis use amongst this group as well.

Over 50% of all States across the US have now legalised medicinal cannabis use, and 8% have gone further and legalised the recreational use of cannabis. It may well be that in the US purchasing cannabis is a cheaper and easier option than buying prescription medication. Here in the UK more than 15m people admit to having taken illegal drugs; 3m continue to do so. Whilst the biggest users of drugs are in the age group 35 - 44, like the US, there has been an increase in those over the age of 50 using illegal drugs. The middle classes and those who live in Scotland (not necessarily the same thing) show the greatest use, and cannabis remains the most popular drug.

Interestingly, the studies show that only a tiny number of people (4%) started to use cannabis after the age of 35. One consequence is that older users are probably more experienced and have a lower risk of harming themselves or others after use – although a particular concern appears to be the increased risk of falls. Prof Dame Sally Davies, once named as the sixth most powerful woman in Britain, and now holds the post of the UKs most Senior Medical Advisor was one of those who once tried cannabis. She has never smoked but baked it in cookies while she studied medicine at that other Manchester university in the 1970s.

Now aged 67 years old, last week she was offering advice on how the baby boomer generation (those born between 1946-64) could stay healthy. Cannabis didn't feature. However she recommended as we got older we stayed working or once we retired we took up some kind of volunteering work. 30% of British workers will be over 50 by 2020, and 12% of this group are older than the current pension age.

It would seem that many people are living much longer than ever before. Of concern to these people is the fact that there are changes on the horizon as to what the future pension age might be. You can find out here when you might be able to draw your pension. Interestingly my state pension age is the same (May 2021), in both England and Scotland. I was able however, and if I had so desired, to get a free Bus Pass in Scotland back in May 2015, although, I would only be able to use it on buses in Scotland.

Time for a quick recap – I am happy to self-medicate when I am ill. I am soon to retire from my job in England, to live in Scotland. I don't smoke, but I enjoy baking. I won't receive a state pension until 3 years after I retire so will be poor. But I get free public transport on buses to anywhere in Scotland. I enjoy meeting people and I am quite good at sales, and the Chief Medical Officer says I need to keep active to stay healthy – methinks there might be a niche market opportunity somewhere in all this. 

I am pleased to report that the week ended on a different kind of high. I traveled down to Cardiff to see my Mother and Father, both of whom are from the generation that preceded the baby-boomers. They both look amazingly fit and well, and it was a lovely day. As far as I know they don't use cannabis, but interestingly my Mother had a baked some good looking cakes that had us all smiling for hours after we ate them. And just before anyone rushes to complain about this week’s blog subject – please accept that the blog was written slightly tongue in cheek, and of course I would not and do not want to advocate any use of illegal drugs!

If you’re really smart, you won’t bother trying to get an appointment with your GP

Despite there being 33m landlines in use in the UK, a growing number of the population, around 14%, live in a mobile only home. OfCom 2016 research report noted that mobile phones are the media device most adults would miss the most. In 2014 it was their TV (and it still is for those aged 55 and above). So perhaps it shouldn't have been too much of a surprise to sit in a meeting the other day and watch a colleague endlessly switch from looking at (and using) the 2 mobile phones she had. There was almost something rhythmic to what she was doing in her constant scanning and responding to her emails. Amazingly, she also appeared able to actively participate in the discussions.

One phone is more than enough for me – but there must be lots of folk in the UK who routinely have and use more than one mobile. Indeed worldwide there are over 7bn mobile phones in use. The UK has a population of just over 64m. However, and interestingly there are currently 83m mobile phones in use and over 91m active mobile subscriptions. 93% of the UK population personally own or use a mobile phone, although only 71% of these users have a smart phone.  

It seems that the smart phone is becoming the preferred device to use for 60% of our on-line activities. There is a 10% increase each year in the numbers of people who only use smartphones or tablets to go on line rather than a PC or laptop. Most of us (87%) use the internet however, and the only group where this is not true are those aged 75 years and older In this group most (65%) don't use it at all. However there is one area of use where on-line access is still not generally fully developed - the NHS. The Nuffield Trust recently published report - The Digital Patient: transforming primary care? builds on previous work in this area. For example it acknowledges the way in which digital tools are already changing how many people manage chronic health conditions such as diabetes or asthma.

But equally many of the 165,000 health apps available today have not been properly assessed. And of those that have been assessed, many have been found to be inaccurate or ineffective. This is slightly worrying when its known that 51% of people using search engines cannot correctly identify what might be an advert or sponsored link. 62% of users accept that some websites will be accurate and unbiased, and some won't. However, 18% of users, and predominately people aged between 18–34, think that if a website has been listed by a search engine it must be accurate and unbiased!

The Nuffield report focused upon a number of digitally based services. For example, online triage programmes; symptom checkers; wearable technology; on-line appointment systems; and video consultations. One of its conclusions, was that the evidence around the effectiveness of health apps also applies to some of these other digital services. Leaving such quality issues aside (I'm sure someone somewhere will find a way to address these concerns) there is still the issue of the modern day equivalent of Horse, Trough, Water and Drinking going on here. Patients will not make use of the emergent digital services if they are not shown how they might benefit from doing so, and some people will simply not be interested in finding ways of increasing self-care.

In the UK, it is the NHS England's strategic aim to get at least 10% of patients to use one or more [official] on-line service by this year and 20% by 2017/18. The GP Forward View aims to ensure every GP practice is able and equipped to gain the benefit of high quality wi fi services and as such can make better use of technology in enhancing our experience of contact with health care services. A quick recap – we all use mobile phones, more of us own and use smart phones to access a wider range of services. The NHS is playing catch up but getting there. GP practices are to be equipped to ensure we start to access health care services in the same easy way we buy a take away, order a taxi, fill in our tax returns and find our way when lost. 

That might have been the end of this week's blog – and a good place to end it would have been. That was until I read about those good folk at NHS Somerset Clinical Commissioning Group (CCG). They have joined a growing group of CCGs who have started to ban GPs from prescribing a range of 25 items that are considered suitable for 'minor ailments'. It is one way to get people to think more about 'self-care' I guess, but some might think about it as another example of care rationing. If this is the case for you and you are already reaching for your smart phone to look for someone to complain to – I have saved you the effort – you can click on the hyperlink here.

Hungary for advanced nurse practice, a glimpse of naivety, and a placed booked for a longer life

Péc is a lovely city in the Southern part of Hungary. I have been before and was privileged to be able to spend some time there last week. I had been invited to present a paper at an international nursing conference organised by the University of Péc's. The focus of the conference was Advanced Nursing Practice. We had run such a programme in my old School for over 10 years and, I had invited my colleague Anabella, the programme director to present her experience. Unfortunately she was unable to make the trip due to other commitments. So I came, and I am very glad I did.

There was a real sense of energy about the conference, an energy that clearly underpinned a determination to develop and put in place the concept of advanced practice in taking the nursing profession forward. There were other international speakers there, from the US, Slovenia, and the Czech Republic. The International Council of Nurses was represented as was the Hungarian Secretary of State for Health. The presence of the latter was an unprecedented show of political will and support. The papers delivered on both days enthusiastically stated the professions' ambitions and assertively identified the issues and challenges that will need to be dealt with. The energy and enthusiasm was infectious and I am very confident that progress will be made.

Many of the issues appeared universal – a lack of funding; the difficulty in designing a curriculum that reflects the profession of nursing and its attributes whilst also educating and training in areas usually associated with medicine; who should teach the students; the poor image of nursing; and of course medical opposition to the proposed changes. In some ways, it was an event that very much reflected the discussion I'd been part of at a meeting in London last Monday. I attended the Nursing and Midwifery Council thought leaders group looking at the educational preparation for graduate nurses in 2025-30. The discussion was powerful and focused, well that was until colleagues from one of the big 5 consulting companies came to speak with us about the ongoing educational framework review.

Now I don't mind naivety in others, in fact sometimes I think it can be both cathartic and very productive. I wasn't convinced this was the case with these consultants. I think they were just naïve. Geraldine Walters, the recently appointed Director of Nursing and Midwifery Education, Standards and Policy at the NMC joined us and she at least appeared to have an open mind in terms of what the role of NMC might be in determining the future shape of nurses education in the UK.

Yesterday as I travelled the 200 km back to Budapest I was able to reflect on the differences and similarities of both these sets of discussions. There were many. Both nations are politically, economically and demographically challenged and current models of health care are unsustainable. Demand for health care exponentially outstrips our capacity to provide it. The shape and rapidity of change in health services almost out paces our ability to develop the skilled and knowledgeable workforce required to provide it. However, I was buoyed up to see that psychology, and the recognition of the importance of the interpersonal relationship were being foregrounded in both conversations.

This was something reinforced in my dipping into a book given to me as a gift by my new colleague Aniko. She has claims to citizenship in Serbia, Hungary and the US, and is currently working in Ohio improving the quality of care provided by medics and nurses. The book Complications, by Atual Gawande is written in the style of one of my favourite authors, the late and great Oliver Sacks, the Poet Laureate of Medicine. Amidst the technology of medical intervention, the despair of disease, both Gawande and Sacks successfully remind us of the importance of remembering the person who should be central to our work – the patient, and another human being. 

I have to confess, I have not read an actual book, as in something printed on paper for a number of years. Apparently 1 in 3 people in the UK rarely or never read for pleasure. But that is not what I am talking about. I meant that these days most of my reading happens on line, or through my Kindle (other readers are available). Not that how you read matters when gaining the benefits of reading. In a study published recently in the journal Social Science and Medicine, Avni Bavishi and colleagues claim that reading is not simply an indulgent pastime, but a form of life support. Their paper claims that people who regularly read books tend to be healthier, richer and better educated in general, all of which could contribute to a longer life (and there is no need to read the small print)! 

Removing the Gilded [Eli] Lily’s Mask with Sticky Fingers

Last Wednesday evening I found my hands covered in that kind of sticky substance that seems to get everywhere, clinging to skin, clothes and hair. I was packing the car at the time and checking a case of Christmas present wine when I noticed my hands were sticky. One of the bottles had leaked and black sticky gunge was the consequence. Whilst I was able to wash my hands and was soon on my way, it seems what I should have been more worried about was what I couldn't see on my hands. Professor Pieter Dorrestein, from the University of California, San Diego School of Medicine, reports that there are at least 1000 different microbes living on the averages persons skin.

In a study he published last week in the Proceedings of the National Academy of Sciences, he reported that we leave trace chemicals, molecules and microbes on every object we touch, and these can reveal much about us. Even washing hands thoroughly cannot hide the presence of these molecules. By analysing the molecules left on peoples mobile phones, the researchers could tell the likely gender of the person, whether they drink coffee, wear sunscreen, prefer beer over wine, like spicy foods and whether they are taking medication for depression. 

We know that worldwide, mental health problems account for £1.6 trillion worth of economic burden. That’s more than the combined costs of dealing with cardiovascular disease, chronic respiratory disease, cancer and diabetes's. We know that 1 in 4 of us will experience a mental health problem each year. We know that 1 in every 10 people will experience this as depression. We also know that the average age of onset for depression today, is 14 years compared to 45 in the 1960s.  What we don't know is what causes this mental health problem and what the best way might be of helping people through a depressive experience.

Indeed it's difficult to find a study that provides any degree of certainty. When I was becoming a mental health nurse (something I increasingly think of as a lifetimes work) I was taught that depression was caused by low levels of the brain chemical serotonin. Much treatment has thus been focused on prescribing antidepressants that correct this imbalance. However there have been many studies that show most of these drugs don't work. The most recent, published in the Lancet earlier this year, found that of the 14 leading antidepressant medications only Fluoxetine (Prozac) helped young people with depression more effectively than placebo pills. The rest were reported to have no effect on symptoms but could give rise to serious side effects (suicidality being one of these).

There is evidence that other factors could be responsible for depression in some people. Professor Carmine Pariente, from Kings College London published a study in July this year that focused on the use of biomarkers which can measure inflammation in the body. The study showed that those people with high levels of inflammatory markers also made up the group who are most likely not to respond to antidepressants. One outcome from this result is the possible conjecture that inflammation in the body, caused by the body’s immune system reacting to an infection and or stress may be responsible for an individual's depression in much the same way that our experiences and environment might.

In children and young people this is an important consideration and adds to what we already know. In the UK, there are 850,000 children aged 5 – 16 who have mental health problems, of which 80,000 have a diagnosis of severe depression. Dr Valarie Mondelli (also from Kings College London) has published a study that found that children who experienced high levels of infection or trauma in childhood may have compromised immune systems. They were found to have higher levels of brain inflammation and were more susceptible to developing depression as an adult.  Indeed, 50% of all lifetime cases of mental ill health (including depression) begin by the age of 14. 

I have long thought that medication as a way of treating mental health problems with young people is not the most effective response. The evidence appears to support my view. For me and many others, finding ways of building emotional resilience in our children and young people is the key to making a difference. There is a nothing new to be known in how we do this. For example, play and learning, particularly with others, is important in gaining a sense of self, self-worth and self in relation to others. Likewise, diet and exercise, physical as well as mental can help ensure physical and psychological development is balanced and sustained.

This is not rocket science! In my experience of being with and around children of all shapes, sizes and ages is that most either don't mind or really dislike getting their hands dirty. But most will really enjoy taking part in activities that might result in this state of being. Its up to us to make sure this happens, and occasionally be there, ready with the wet wipes.

We’re alright, but our shoes are covered in blood…

I woke up on Friday to the sad news that Leonard Cohen had died, aged 82 years old. Some said the album he released in October was his way of saying goodbye to the world. We will never know. I was fortunate to see him perform in Manchester a couple of years ago, and in my youth I once met him in a hotel bar in Kensington, London, not quite the Chelsea Hotel, but close. It was a powerful encounter.

For different reasons, the 2 days I spent last week at this year’s HAELO HOSTS were also about powerful encounters. Alongside Salford Royal Hospital NHS Foundation Trust, Salford City Council and Salford Clinical Commissioning Group, the University of Salford is a stakeholder partner in Haelo. Just 3 years old, Haelo is an innovation and improvement science centre with expertise in digital connectivity and building capability in improvement science. They work collaboratively to deliver large scale improvement programmes in health and social care. You can find out more about them here. 

The theme for this year's Haelo Hosts was 'Daring Greatly', a theme that was brought to life, sometimes very starkly, by the telling of people's stories. The first of which was Michael Woodford's. He was the former President and CEO of Olympus (the medical equipment and camera manufacturing company). In 2011 he uncovered the biggest corporate criminal fraud ever committed in Japan’s history. He was sacked and endured great stress and defamation of his character and reputation. It was an interesting story, vividly told, but a story for me that lost some of its gloss when I discovered that he had been awarded a reported £10 million pounds in compensation.

Other stories of daring greatly followed. There were a couple of really confident young people telling their tale of developing a youth manifesto in Salford as part of the work supported by the Reclaim organisation. Reclaim work with young people from pressurised communities. They were followed by a colleague from Virginia, in the US, who told of his work reducing gun crime in the City of Richmond (home of the world’s first electric street care system). Amazingly he managed to persuade the City officials to employ the gun toting criminals in developing the successful solution – daring greatly indeed.

Ian Jolley, former soldier who had served over 22 operational tours told of his journey through the horrors of Bosnia, the Gulf War, Northern Ireland, Kosovo and Iraq. His quietly spoken narrative of how he dealt (was dealing) with mental health problems caused by the trauma he witnessed was emotionally challenging as were the words of Fiona Murphy.She spoke of the work she has been engaged with in making end of life care an experience filled with humanity, respect and dignity. There were a lot of tissues being used.

There were some lighter moments. Jim Easton, CEO of Care UK, the largest independent health care provider in the UK summed up the first day with both pathos and humour. His organisation provides health care in many UK prisons. He recalled contacting his colleagues who had dealt with the recent organised stabbings at Pentonville Prison to ask how they were. He was told they were 'all alright' but as their 'shoes were covered in blood' could the company 'buy them new shoes'… …he also had a wonderfully humorous range of [true?] Mother-in-Law stories. And then there was the Haelo Film Festival. My colleague from the School of Arts and Media, Dr Kirsty Fairclough, joined me for the dinner and presented the prize on behalf of the University for the 'My Story' category.

However, the story that has stayed with me was one from Day 2, and it was the account of Martine Wright. On the 6th of July 2005, it was announced that London would host the 2012 Olympics. Martine went out to celebrate, and the next morning had an extra 10 mins in bed. Subsequently, the underground train she caught on the 7th of July was later than her normal train. She sat 3 feet away from a suicide bomber, who then detonated his bomb.  Martine was the last survivor to be freed from the carnage. She lost both her legs and almost 80% of her blood.  52 people lost their lives. Her story was initially heard in complete silence, but as she told of how she slowly overcame the changes and changes to her life, the hall filled with laughter. She not only went to the 2012 Olympics, but went there as a member of the British floor volleyball team. She married her boyfriend, and now has a son, she learnt to fly and ski, yes ski! And she hasn’t stopped - 'Daring Greatly' indeed - she took personal inspiration to a completely new level.

Returning to last Friday's news. A couple of nights before, my wonderful eldest daughter had asked what I wanted for Christmas. I said 'the complete box set of Leonard Cohen’s studio albums'. She texted me on Friday to say Amazon had come up with the goods, but she had just heard the sad news. Before she married her equally amazing husband, Stewart, and took his name, she was named Jennifer Warne. There was a different Jennifer Warnes, who was a lifelong friend and sometimes backing singer for Leonard Cohen in the 1970's. In the 1980s she released a critically acclaimed album 'Famous Blue Raincoat', in which she covered some of Cohen's best songs. This album was credited as being largely responsible for reintroducing Cohen's greatest work to the world again.

RIP Leonard, you were also a man who dared greatly!

I’m not an arsonist, I just have a burning obsession

Last night was Bonfire night. At my Bolton home, the 6 houses on my lane have a shared apple orchard that has a small wooded area running around it. For over 20 years that I can recall, we have made a clearing, built a bonfire, and got the children to make a Guy. Friends and families have gathered around for an evening of shared food, drink and good conversation. We occasionally have one or two fireworks, but mainly it’s about relaxing company, a good fire and a chance to catch up. And so it was last night, although I may have enjoyed a beer of two more than I should have. Whilst celebrating around the bonfire each year is probably not a ritual as such, for most of us it definitely has a ritualistic flavour.

Rituals serve a very functional purpose, which is why they are so often found in religious ceremonies. Ritual is both a mnemonic device and a trigger. As a mnemonic device rituals serve to mark an event as being important or significant. So while I sometimes struggle to remember what I was doing last month, I can clearly remember the last bonfire, a year ago, and bonfires before that. As a trigger, preparing the bonfire, and food, buying the drink and eventually lighting the fire sets the stage for what is about to happen.

Throughout our lives most of us will come into contact with rituals at different life stages - births, bar mitzvahs, coronations, graduations, marriages and funerals and so on. However, for some people ritual becomes a part of their everyday life. For example, those with a obsessive compulsive disorder (OCD). This is a common anxiety disorder. In fact about 1 in 50 people, males and females equally, will experience a OCD at some point in their lives. In the UK that is just over 1 million people. A number of familiar and famous people have lived with an OCD, including: David Beckham, Justin Timberlake, Cameron Diaz, Charles Darwin and Florence Nightingale.   

Donald Trump describes himself as being 'borderline OCD' (whatever that might mean) but apart from possibly being obsessive about becoming President of the US he does not have an OCD. He reportedly won’t shake hands with people, particularly teachers who he believes have '17,000 germs per square inch on their desks' but this is a phobia and not a sign of OCD.  OCD involves people experiencing distressing and/or frightening repetitive thoughts, which however irrational they may seem, keep coming into their mind. They do so despite whatever the person does to resist or ignore them. Compulsions are actions that people believe they must repeat to feel less anxious or in order to stop these obsessive thoughts.

Compulsions commonly include excessive checking, cleaning, counting, and other ritualised behaviours, which whilst sometimes providing temporary relief from anxiety often get repeated in order to 'get it right'. However, unlike the compulsive and obsessional behaviours associated with drug and alcohol use or gambling, or even those that run every day – all behaviours that are usually pleasurable - the signature of OCD is that the compulsive behaviour never gives pleasure, and the behaviours are always experienced as an unpleasant demand or a burden. 

OCD is a much misunderstood condition. It is the distortion of the familiar - (counting, checking, cleaning) - things most of us do, that can be the most difficult aspect of the disorder to understand. Most of us will have checked for the 10th time that our passport is in the inside pocket just as it was 5 minutes before. Such temporary states of compulsion and obsession are ameliorated once we are on the plane or whatever. For those living with OCD, the situation can be very different. 

However, these days there is a wide range of help and successful treatments available for those with an OCD. While mental health services continue to be under-funded and there can be problems in accessing care, these are generally peripheral elements in why people don't always seek help for their OCD. Often the reason for people not seeking help is that they don't want others to know they need help. So it can take a long time before people with an OCD seek support from mental health services. Some will go to great lengths to hide their ritualistic behaviour, and many will experience overwhelming shame because they are unable to stop such behaviours.

As with all mental health problems, and OCD is no different, the more we can talk about it, the sooner we can reduce the stigma surrounding the experience of mental health problems and the easier it will become to reach out and help people. And thankfully, we don't need to always light a bonfire to get people together and start talking...

...although bonfires are fun!

Forget 42, the answer is actually 0.06% – and I wouldn't be at all surprised if Edith isn't turning in her grave

I've 2 people to thank  for my extra hour in bed this morning. The first is Judith S who at 12.15 last night reminded me I had an extra hour to write my blog and of course William Willett. Now Willett, (like Judith, was a member of the #EarlyRisersClub - that is people who start their day around 05.00) liked to get a round of golf in first thing in the morning. He didn't understand why so many people stayed in bed while the sun was shining. Willett lobbied the British Government to introduce Daylight Saving Time (DST). He died in 1915 before this was introduced in May of the following year. We have been putting our clocks forward in the Spring and back by 1 hour in the Autumn ever since.

Research on the effect of DST has consistently shown that burglary, violent crime, traffic accident rates all fall when the clocks go forward in the Spring. On the down side, researchers at the Karolinska Insistute in Sweden, found that heart attacks rose by 5% during the same period. More prosaically, DST meant that dairy farmers often had problems with confused cows needing to be milked. Today many UK farms use robotic milking systems, where cows are free to walk into a milking parlour at any time and be milked by a machine, and completely free from human intervention.

However, human interventions did feature in my reading last week. I read the recently published report The Use of Psychological Therapies (IAPT) in England. IAPT services are NHS approved brief intervention therapies for people with depression or anxiety. Last year there were 1,399,088 new referrals of which 953,522 resulted in people entering treatment. Just over 50% completed their course of treatment, with 55% of patients from the least deprived areas recovering whereas only 35% from the most deprived areas did. Challenging socio-economic factors and the stigmatisation of mental health problems continue to be contributing factors that result in these disappointing outcomes.

Predicting outcomes in health care is often difficult to do. Take the example of the creased ear lobe and its link to a higher risk of heart disease. Franks sign, as it's sometime known as, is a diagonal ear lobe crease that was named after Dr Sanders Frank. In 2014 a large Danish study involving some 11000 participants clearly showed there was an association between ear lobe creases and cardiovascular disease. It is an association and not a predictive sign. And before you rush to your mirror there are other more reliable tests available. 

Demonstrating reliability and generalisablity in research is critical. I'm not sure the claims made in the Cavell Nurses Trust report 'Skint, shaken, yet still caring'. published last week really demonstrated this. Edith Cavell was a British nurse who during the First World War saved the lives of soldiers from both sides without distinction or favour. The charity provides support and help to the 2152000 nurses, midwives and health care assistants who work in the NHS. Last year they helped some 1400 individuals who for various reasons found themselves in difficult circumstances last year as well as providing £500,000 in financial support.

The Cavell report uses Daily Mail style headlines in publishing its results. It compares nurses, midwives and health care assistants with other groups in the population. Nurses were said to be twice as likely to be unable to afford the 'basic necessities' of life. These were described as a home in decent state of repair, being able to replace broken furniture or repairing a faulty fridge or cooker. 61% of nurses said their health was good - 74% of the rest of the population claim good health. Nurses were said to be 3 times more likely to have experienced domestic abuse in the last year. Most nurses and midwives are generally as happy as the rest of us, but they reported higher levels of anxiety than other groups. Disappointingly there was no discussion as to what might account for these findings.

According to the Office of National Statistics the average UK salary is £27,600. The average nurse salary is £26,252, which compares well to the average salaries of some other employment groups; Occupational Therapists £26,037; Dispensing Opticians, £23,458; Bus Drivers £22,176; Teachers £18,604; and Care Workers £12,650.  For others groups the comparisons are not so good; Pilots £90,146; Doctors £69,463; Professors £49,679; Quantity Surveyors £41,086; and Midwives £29,448. Its not clear to me as to why such differences might mean that nurses have greater financial problems than the rest of us.  

It is absolutely true that the UK health care system is experiencing huge pressures. For all those working in the NHS will feel the impact of these pressures. Stress, physical illness, anxiety and sheer exhaustion are likely to be the result for many.  However, I doubt these experiences would give rise to greater rates of domestic abuse being experienced by nurses than the rest of us. The Cavell Trust Action Plan, sets out a series of  'good deeds' but these don't really help in answering these questions. And sadly, apart from being slightly sensationalist, I'm not sure what this report was aimed at achieving, and I don't think it does anything positive for those it purports to champion... 

...and by the way, the clocks go forward again on March 26^th 2017. 

Just how BIG is ‘big data’? - the answer is blowin’ in the wind

I read with interest the mixed views on Bob Dylan being awarded the 2016 Nobel Prize for Literature the other week. He was cited as bringing new poetic expressions to the great US song tradition. For many he was a Marmite type of performer. People either liked him or they didn’t. His music was part of my youth and I was in the camp that liked him. His words are always elegant and eloquently constructed even if at times discovering the meaning behind his words took a bit of work. However, since 1959 he has sold over 100 million records. And that's a big number.

An equally big number is 3,000,000,000 (3bn). That’s the number of genes in the human genome, and in 2003 the last of the base pairs were finally identified. It must have been an amazing moment for those involved. 50 years before little was known about how genetic factors contribute to human disease. It was in 1953 that James Watson and Francis Crick described the double helix structure of deoxyribonucleic acid – more commonly known to most of us as DNA. DNA is the compound that holds the genetic instructions for building, running and maintaining living organisms. It was the Human Genome Project that eventually led to the cataloguing of the complete set of DNA in the human body.

The Human Genome Project provided researchers across the world with freely available data and in so doing, opened up opportunities to better understand human diseases and how we might more effectively diagnose, treat and prevent them. To date, some 1800 disease genes have been identified, and there are now more than 2000 genetic tests for human conditions. The project would not have been achieved (and 2 years before schedule and under budget) without the possibility of harnessing 'big data'. This term was first used in a 1997 paper published by NASA. Big data is both ubiquitous and increasingly readily accessible.

I am not a statistician, but I love numbers and what they can tell us. Having access to big data opens up a whole new world. Let me take you for quick stroll through some of the numbers that make up this world. More data has been created in the last 2 years than in the entire history of the human race; about 1.7 megabytes of new data will be created every second for every human being living on the planet (currently 7.4bn people); the digital universe is expected to grow to 44 Zettabytes by 2020 (a Zettabyte contains 1000 Exabyte’s – a single Exabyte can stream the entire Netflix catalogue more than 3000 times); we perform 40000 searches on Google every second (3.5bn per day, 1.2 trillion per year); Facebook users send 31.25 million messages and view 2.77 million videos every minute; there will be 6.1bn smart phone users globally by 2020; 300% of all data passes through the cloud (Google uses up to 1000 cloud networked computers in answering a single query in no more than 0.2 seconds). And if you want more, have a look at this!

What is also interesting is that only about 0.5% of all this data is ever analysed or used. It’s estimated that in the US better use of big data could save the US health care system US$ 300bn a year. Of course the problem is that most of us lack the ability to manage and interpret large data sets, and that is true for both organisations and individuals (Barrack Obama has well over 1 million Facebook friends for example).

The internationally respected management consultant group McKinsey, note that there is already a world shortage of skilled data analysts and this is a situation unlikely to improve in the short term. I work for a University, and knowledge creation and knowledge exchange is our business. I think we have a responsibility to respond to this skill gap in the future workforce. In the CBI/Pearson Education and Skills Survey published last week, most employers report being satisfied or very satisfied with their graduates attitudes, relevant work experience and skills. Satisfaction with graduates' numeracy was 91%; technical skills 88% and literacy, 86%. Maintaining these high levels of satisfaction in a rapidly changing technologically enhanced workplace is crucial.

This was something the University leadership community discussed at length at our Planning Day last week. We also noted that in a rapidly changing world, we need to use big data ourselves to more effectively deliver an intuitive learning experience for our students and in shaping our relationships with our industry partners. As Socrates said, 'the secret of change is to focus all your energy not on fighting the old, but on building the new'. As with the triumph of unlocking the secrets of DNA, understanding and using big data can help us better understand how we can more effectively do this. Without being able to use it, as Dylan nearly said, 'the answer[s] my friend, will be blowin’ in the wind'.

Reflecting on the need for psychological first aid in 2016

Last Monday, (10th October) was World Mental Health Day (WMHD) 2016. Established 24 years ago by the World Federation for Mental Health, every year a different theme is used to both raise awareness, generate ideas for change and to share experiences. This years theme focused on the need for psychological first aid (PFA) and the support that should be provided to those in distress. We live in a world that at times feels characterised by unprecedented levels of conflict, natural and man-made disasters and personal trauma (such as abuse, neglect and sexual exploitation). Recognising what we can do to 'be with' and 'help' people experiencing trauma and crisis is important and critical to their mental health and well-being.

However, I think the risk of not recognising the trauma being experienced by others is very real. We are bombarded by 24 hour news stories from around the world and as a consequence, its easy to see why we might become inured to the impact on the mental health and well-being of others that such crisis's can bring. For example, on Wednesday evening when I returned from work, the main news item on the 10 o'clock news was the fact that Marmite was disappearing from our supermarket shelves as a consequence of a pricing dispute between one of the UKs biggest supermarkets and its main supplier. Sadly, the humanitarian crisis in Syria was way down the list of news items presented, and even then the story was framed in a dispute between the motives of both Russia and the US involvement in the dispute. Not good.

Of course recognising a mental health and or well-being problem is not always easy. Most mental health struggles do not occur in isolation to other experiences in our lives. I know from my research into the relationship between childhood sexual abuse experiences and adult mental health problems that experiencing trauma or some other crisis and its impact on one's mental health and well-being can be immediate and for some people also happen over a long period of time. I was reminded of this 'impact gap' last Tuesday during my journey back from London to Manchester.

I had left plenty of time to make the journey on the London underground, to get to the mainline station, buy a sandwich and small bottle of wine, and wait 10 minutes for the train to start boarding. It wasn't to be. I could see that the underground platform was already crowded as I approached it, but as there was a tube train already there I assumed that people would get on and the platform would become less congested. The train doors didn't open, and an announcement was made that there was a problem further up the line, and we would be delayed. After 15 minutes the numbers of people on the platform continued to grow, and my anxiety levels started to rise to such an extent that I started experiencing physical distress. I had to leave the station and get a taxi in rush hour traffic resulting in my missing my train back to Manchester.

It wasn't just the anxiety of missing my train that I was experiencing. On reflection I think it was also a memory of what happened on the same tube line way back in 1975. Then a train didn't stop at Moorgate station and crashed into the tunnel wall killing 43 people and injuring many, many more. I was living in London at the time, and I had travelled to work on the train before the one that crashed. I moved to Wales later that year, but for the 7 months between the crash and the move I never travelled on a tube train again. It was many years later that I finally started to travel on them once more. Coincidentally, I started my mental health nurse education and training in the October of 1975.

Thankfully my state of anxiety was short lived, and it wasn't really a crisis that required PFA. Unfortunately that is not always the case for many people caught up in a distressing traumatic situation. Critically, PFA is not something that only professionals are able to do. If you want to know more, about PFA, the WHO have produced a wonderful guide. However, in use, PFA does not necessarily involve a detailed re-telling of the event that caused the distress, but it will involve listening to people; its about providing practical care and support, which does not intrude; it might be about assessing concerns; and helping people address their basic and immediate needs. Absolutely it will involve comforting people and helping them feel calm; and protecting them from further harm. 

Some people will need PFA immediately or very soon after their crisis experience, others may find it useful slightly further down their road of recovery. It will very much depend upon an individual's experience, resilience store, and their emotional and physical resources. PFA appears to be most beneficial when the actions and responses help others to feel safe, calm and hopeful; able to access social, emotional and physical support; being connected to others, but also feeling able to help themselves as individuals and communities. Thankfully most of us won't find ourselves in a position of needing PFA, or of a need to provide it. But WMHD 2016, more so than in other years, helped me, to quietly reflect on all those whose lives will have been changed through such lived experiences. 

Thinking About Women, Dogs, Long Lives and Care Free Days

I've just enjoyed 2 'free from' days. Last Friday (an annual leave day) I decided after tweeting 'good morning' to the wonderful folk that are the #earlyrisersclub (those people who start their day around 05.00) that it would be good to spend some time free from email, phone calls, text messages, tweets and so on. I found the experience a liberating one. I wasn't tempted to communicate with the outside world – well at least not digitally. I did speak to Mary, and took her dog out for a walk with Cello, and spoke with Kevin who was tending to his boat  on the beach. It was a quiet yet enjoyable couple of days. I did wonder if life might be like that in retirement (now just 2 years away). Of course a 'free from' couple of days will be different from living a life 'free from' workplace conversations, conference presentations, meetings and so on.

I do know that one of the things I am going to do when I retire is to write a book of collected stories of older women and their dogs. It's not such a bizarre idea as it sounds. I am an ethnographer, with leanings to social anthropology with much of my research drawing on psycho-dynamic theory. I am interested in how people build and engage with relationships, and have often used thoughts about the construction and use of interpersonal relationships to frame my writing. I am a people watcher and whilst I've been accused of sometimes being too silent, I do like listening to conversations. It is easy to do both activities in my small village in Scotland.

There are 140 people living there. The village has 2 hotels with bars, 2 slipways for launching boats, 1 village high street, a community hall (complete with a newly acquired defibrillator), a lifeboat station and a tiny, newly open tea room and shop. A number of the houses and cottages are owned by people who don't live in the village but come for holidays and so on. It's a great place to be. And if your mental health and wellbeing isn't where it should be, leaving aside my professional qualifications, there are 2 psychotherapist's, 1 GP, and 1 specialist in acute medicine, a retired dentist, 2 retired psychiatrists, and a slightly colourful lady who will offer you a range of alternative therapies, living in the village.

Like many small communities people care about others and will go out of their way to help. This is particularly true in terms of looking out for the elder members of the village. The oldest resident, Paddy, who is now aged 101, was once the former village GP. The 2011 census showed there were 91 people over the age of 65 living in the village, and 66% of the population were female. A large number of people sharing both demographics are for a whole host of reasons single. Women continue to live longer than men, but the life expectancy gap is getting closer. In the UK, women aged 65, can on average, can expect to live for another 21 years, whereas for men it is only a further 18 years. In my village, a lot of these older single women also have dogs and I often come across them as I walk Cello. I would love to capture their life stories and at the same time hear something about how they came to choose their dogs and the contribution their dogs make to their quality of life.

The World Health Organisation assesses Quality of Life (QoL) as being based upon an individual's perception of their position in life, in the context of the culture, and value systems in which they live and in relation to their goals, expectations, standards and concerns. Such perceptions will reflect everything from their physical and mental health, family situation, education, wealth, employment, religious and cultural beliefs, and the persons lived environment. Internationally, the UK is ranked 13th for its QoL (see here) but perhaps not surprisingly, only ranked 23rd for its Happiness Score.

In a world characterised by both dispersed families and a growing number of multi-generational homes, maintaining one's QoL in later life can be a challenge both for those growing older and at times for those around them, their family and friends. At a societal level, an increasing concern is that as the numbers of people living beyond 85 – 90 continues to grow, will there be enough younger people available to support those of a pensionable age. At an individual level, the challenge can become too difficult for many. A growing number of people seek to live out their last years in a residential care setting, and for some this will be due to frailty, poor health and a need for care to be available 24 hours a day.

Today, 1 in 7 people in England over 85 live permanently in a residential care setting. Even so there is a great deal of evidence to show that many of such people don't always have their needs properly assessed and responded too. The consequence is that many have have repeated and often unnecessary admissions to acute hospitals, something that should be entirely avoidable. It is the Care Quality Commission who are responsible for checking the quality of care in residential care homes. They say there are some 15400 care homes (other independent bodies recognise there are some 22000 residential care settings). It doesn't seem to be working, and so I was interested last week to get my hands on a copy of the NHS England report The Framework for Enhanced Health in Care Homes, which was published late September.

Unusually the report was co-developed and co-produced by health and social care staff, families, older people themselves as well as the usual policy suspects and experts. It is brilliant in its assertion of a number of principles that should shape successful enhanced health care in such settings: Person centred change – that is putting the needs of the older person at the centre of any changes (and supporting carers and families to accept this); Co-production of care – making sure the whole system acknowledges the interrelationship of services they provide; Quality – drawing on both research informed evidence as well as evidence from experts by experience; Leadership – effective leadership that is able to transcend organisational and disciplinary boundaries. 

Many of these principles are not new, and perhaps some will think they should be underpinning current services – but clearly they are not. The report is worth a read, but more importantly, we all need to contribute to delivering the necessary actions required to make the QoL for the elder members in our society better, wherever it is they choose to live, whether this be in caring communities such as my village, residential care settings or anywhere else.