Episode 51

Episode 51

MY WEEK

On Wednesday may organisation did another roadshow at work on winter preparedness, this time at a community hub mainly attended by people who are vulnerable and many of whom have mental health issues.  In most cases they are dealing with loneliness and isolation and one in particular was facing the prospect of eviction and homelessness in the next two weeks. It is times like this that make me so angry about out of touch politicians. They have no idea what real life is like. We were working in the same building as a regularly used food bank and it had plenty of customers. It’s a sad state of affairs.

On Thursday I saw Bill Nighy and Cary Mulligan at my local cinema in a recording of Skylight, a play performed in 2014 but written by David Hare in 1995 and set in that time when people used the Yellow Pages (a running gag in the play) and smartphones weren’t invented. Came complete with an interval of 20 minutes. Our late autumn cinema was cold but TSM (ever the detective) noted that the audience in the theatre were dressed for summer.

An intense, funny and brilliantly acted and staged play. So worth braving the cold for. It’s a story of love and growing / not growing, a world where you want things the way they were but you can’t have them again, a “starfish on the beach” world where you might save one person but not the whole world. The protagonist’s characters are believable, and the social commentary bitingly relevant thirty years on:

“I’m tired of these right-wing fuckers. They wouldn’t lift a finger themselves. They work contentedly in offices and banks. Yet now they sit pontificating in parliament, in papers, impugning our motives, questioning our judgements. And why? Because they themselves need to feel better by putting down everyone whose work is so much harder than theirs. You only have to say the words ‘social worker’…’probation officer’ … ‘counsellor’ … for everyone in this country to sneer. Do you know what social workers do? Every day? They try and clear out society’s drains. They clear out the rubbish. They do what no one else is doing, what no one else is willing to do.”

Saturday saw me at my Booker Book Club meeting. This loose association of mainly middle aged and more senior self-styled amateur literati revolves around one person, Dr F, who collects people in much the same way that Gertrude Stein used to in Paris in the first half of the twentieth century, except the majority of the people are connected with the NHS rather than being artists and writers. Although actually Stein did complete four years of a medical degree at John Hopkins before getting bored and dropping out so the connection between health and art may not be coincidental. The meetings are like a salon in that there are a lot of strong opinions, occasional bursts of wit, and a lot of gossip and speculation, plus of course quite a lot of food and booze.

I did manage to read another novel before our meeting, which is the one I recommended as the winner.  Western Lane is a novel about how people communicate through proxies because it is too difficult to actually express emotion. And a book about squash – the game, with rackets and small balls and a strange three sided court. A fast, aggressive game where feint and concealment  are as important as hitting hard and clean. Set in the 1990s in a Pakistani family where the mother has recently died, the father is not coping, and the three sisters are taken by him to play squash ‘till they drop. The youngest, who narrates in the first person, turns out to be a prodigy who is also coping with becoming a young woman with all the physical and emotional toll involved in that. You connect with the characters which is always good. They feel real and vulnerable and at times complex. The squash court is also a good metaphor for the need for people to operate in confined emotional spaces which brings security but can also be constraining. There are two or three sharply drawn moments where the norms are shattered by events and it is clear that life sometimes takes you outside of the comfort zone of rules and conventions. Enjoyable and possibly a winner.

On Sunday we rolled down the big screen, fired up our projector and had a home cinema viewing of Page Eight, a curious film dating from 2011. This was also written by David Hare and also starred Bill Nighy as a man copping off with a much younger woman, namely Rachel Weiss as opposed to Carey Mulligan. I honestly don’t know how he does it; the man must have some kind of sexual magnetism. Here he played an oft married old spy who discovers dirty doings within MI5 and a case of injustice and seeks to to address both issues through guile, wit, nonchalance and a Waitrose carrier bag full of cash. It’s tosh really; I think David Hare wanted to do a John Le Carre and couldn’t quite pull it off but it is very well written and acted tosh that you have no difficulty slipping into for two hours.

Monday saw me in work mode again at a carer’s fare where yet again I was talking to real people with real lives and living out the kind of dramas that are so difficult to capture on screen. One man teared up when talking about his wife’s illness and I offered to take him somewhere quiet for coffee but he did the stiff upper lip thing and my heart went out to him. 

On Tuesday I agreed to handle a couple of packages for my son as he was working and return deadlines were looming. One was DPD and the other Amazon. Our local main post office had a sign up saying they couldn’t do it due to IT issues. I managed to get the DPD one returned at Sainsbury’s but they didn’t do Amazon and said try Budgens. Budgens said they only did collections not returns and suggested I try Costcutter. Costcutter  said their machine was broken and to try Tesco Express. By now I had criss-crossed myself several times but no worries. Now there are two Tesco Express in Woking and of course when I got to the nearby one they said they didn’t do it and to try the one on the edge of town going out to Guildford. By this time I was feeling like Joseph K out of Franz Kafka so returned to the car and drove back to our local village post office where finally I managed to get shot of the damned thing.

Wasn’t that an exciting story? Very Diary Of A Nobody.

THE NEWS WEEK

The news continues unabatedly grim although at least in Gaza a hostage exchange and a four day ceasefire has been agreed. Meanwhile there are still plenty of people out there who are jumping on and off bandwagons without actually knowing anything about them and others who are being just downright nasty. By way of example a lesbian and gay lobby group has demonstrated in supported of Hamas, presumably in ignorance of the fact that in Gaza they are almost certainly going to be locked up, beaten and even executed as there is zero tolerance of homosexuality under that regime. On the simply abhorrent front was the individual who carried a banner at a pro Palestinian march claiming that HItler had had the right idea when it cam to dealing with Jews. 

A friend of mine recently sent me a rather brilliant link to a YouTube video by Robert Habeck which is in German but with very clear English subtitles. Habeck is a German Green politician and writer who has been serving as Vice Chancellor of Germany and Federal Minister for Economic Affairs and Climate Action in the German Government since 2021. His articulation is precise and unequivocal. Do watch it, as it will give you all the non-lethal ammunition you need to stop the ignorant and the wilfully anti-semitic in their tracks, although I suspect the latter group will just shout at you and walk away long before you can make your point.

I have mentioned in previous podcasts that in my view Vladimir Putin had a key role in the timing and initiation of the 7th October attacks on Israelis living on the border with Gaza, and as I predicted the loss of focus on the Ukraine is now significant in the media. It is incredible to think that in the new year we will be facing the two year anniversary of the Russian invasion and a complete re-evaluation of where we are globally and in Europe is now inevitable. 

As ever Johnathan Freedland continues to be one of the most articulate writers on both the war in Gaza and the wider situation, with a very telling article in the Guardian  recently which he concluded as follows:

“Washington, Brussels and London currently back Israel because they agree that no peace is possible without the removal of Hamas. They are much less clear that no peace is possible without the removal of Netanyahu and his henchmen. Yet both can be true. Western governments, and those filling the streets to condemn them, need to be clear-eyed about the nature of their enemies – and their allies.”

In America the bogeyman that is Donald Trump continues to appal us with his uncompromising agenda for the future, Earlier this month, on Veterans Day, Trump pledged to “root out the communists, Marxists, fascists and the radical-left thugs that live like vermin within the confines of our country”, whom he accused of doing anything “to destroy America and to destroy the American dream”. This wasn’t the frothing maniac in full flow, but read from a speech that was prepared and on the teleprompter in front of him. His use of the word vermin and language elsewhere comparing people that he doesn’t like to bugs and cockroaches was highlighted by historians and observers as being exactly the same as that used in the third reich to vilify opponents. 

The election of Javier Milei as the new Argentinian president ushers in another era of extreme right wing politics on the South American continent and his success inevitably earned him the praise of Trump and Bolsanaro. In a country with 40 percent of the population living below the poverty line and inflation at 140%, he is offering  LizTruss style solutions to complex economic problems but may only make these far worse, particularly if the international finance community respond adversely to his election. Those of us old enough to remember the terrible regimes in Chile and Argentina in the 70s and 80s before their return to democracy have no doubt where the real danger lies.

Lastly came the Sam Altman affair, the story of the man who was CEO of OpenAI, sacked by the Board, and then reinstated five days later. This may seem like a simple story of corporate coups and big business deals but it is in fact a very simple tale of choosing between high and low risk takers when it comes to AI future developments. Altman is one of those who wants to go fast forward into an AI future whereas his board is concerned about the implications of that, as are many others around the world. This is the big issue. Are we going to let entrepreneurs and business leaders run the debate or will state regulation play a significant role? Or will AI simply take off with a momentum of its own and leave both the bosses and the politicians looking back and wondering where the collective opportunities were missed. We still struggle to regulate the internet which is now three decades old, and bemoan its effects on society and young people in particular. The impact of AI could be exponentially greater. Our individual choices may become irrelevant when AI rules the world. Listen to this from a recent New Yorker article  about Geoffrey Hinton who along with Altman has been a big hitter in the debate:

There are many reasons to be concerned about the advent of artificial intelligence. It’s common sense to worry about human workers being replaced by computers, for example. But Hinton has joined many prominent technologists, including Sam Altman, the C.E.O. of OpenAI, in warning that A.I. systems may start to think for themselves, and even seek to take over or eliminate human civilization. It was striking to hear one of A.I.’s most prominent researchers give voice to such an alarming view.

FEATURES

Goodbye to all that: leaving the NHS after 42 years

I remember going to an NHS conference in 1993 and hearing a delegate talk about the case for reform of the mental health tribunal system. He recounted a story of one case where a psychiatrist was asked to explain why he thought a patient was behaving bizarrely and should be forced to stay in hospital under the mental health act. Could the doctor give examples of psychotic behaviour?

“Well” said the psychiatrist “the other day he was walking around the ward telling everyone that he should be given his rights under The Patient Charter…”

As I finally leave the NHS this month after a 42 year career, it is tempting to be cynical about the state of the NHS but in fact anyone travelling in a time machine from the 1980s or 1990s would probably be in awe of much of what we have. I am not making the case for complacency as everyone knows where we want to get to and the scale of the challenges the we face. It is right that in heath and social care we should always aspire to do better and not accept the status quo. But sometimes we should stop and feel some sense of pride as to how far we have come.

There are so many positive points of difference between now and when I started in the NHS in 1981 that it is difficult to know where to begin, but mental health is as good a place as any. My first job was as a nursing assistant at the Maudsley in London, which is in a deprived area of Camberwell. In those days even the most compassionate hospitals and community mental health services tended to act on the basis of what they thought was best for the patient and the 1983 mental health act, although a good stepping stone, was far from perfect as the above story illustrates. Demanding your rights was definitely not considered normal behaviour if it meant wanting something outside of an imposed rather than agreed treatment plan, whereas today we would aspire to support people with advocacy and help wherever possible.

Another good example of how we have made progress is in the area of confidentiality and respect for privacy. In 1987 I came to Surrey to set up a Citizens Advice Bureau in a psychiatric unit with funding provided by the NHS and Surrey Social Services. The CAB’s ethos was way ahead of the state’s in those days and nurses and social workers would often appear in my doorway asking for information about people who had come to see me and which I refused to give without their consent. This ruffled a few feathers at first. One particular social worker threatened to report me for withholding information on a person’s income and welfare benefits. But over time we established trust and it was recognised that nine times out of ten patients were happy to consent to information sharing but also enjoyed maintaining the dignity of being asked for that consent.

By the time it got to the 1990s we were beginning to see some dramatic shifts in engaging patients and the public in both the design of services and the delivery of their care and their treatment. Once again the culture change was established through the application of principles to practice. In those days I was Chief Officer of a Community Health Council which was a precursor to what we know today as Healthwatch. A Chief Executive once complained to my chairman that I was being heavy handed when I took to reminding him that we reserved the right to refer decisions on service closures to the Secretary of State. Again he later came to realise that in drawing up boundaries I was not erecting fences – rather the opposite. But talk about closing an entire acute hospital was under consideration and the boundaries were there to ensure that the engagement with the community was done properly. 

One of the biggest insights I had at this time was running focus groups with carers. We used cutting edge technology, namely a cassette recorder and an audio typist, to capture conversations and turn these into reports that we hoped would influence the then Health Authority. It was humbling to sit in a room with a dozen people, nearly all of them women, talking about the burden of caring. We rapidly learned that as well as a microphone we had to provide boxes of tissues as tearful stories came tumbling out.

By the time I had gone from poacher to gamekeeper and was working in service commissioning things had changed for the better. I went to work in London and consultation with families and service users had become an established principle, if imperfectly observed. Concepts such as patient choice radically changed the landscape. Primary Care was slowly changing as a new generation of GPs gradually took over and the number of single handed practices began to diminish, although some remain to this day. There was a desire to involve patients at practice level and reduce the boundaries between different bits of the NHS by bringing the culturally very different family health services under the same managerial umbrella as acute, community and mental health. At the time it was radical and often abrasive and it felt like you were living in an episode of Yes Minister, as eager graduate trainees started to clash with old fashioned hospital administrators. 

But the pace of change was undeniable and driven by technology and shifts in wider society. I needed a hernia repair at that time and was able to research different methods on the nascent World Wide Web. This meant I could talk the options through with my consultant before consenting to surgery. But it was very evident from discussions with patients and their representatives that this challenge to clinicians was not the sole preserve of NHS managers who were also patients. The internet, and later social media, knocked down the walls of established institutions with a Jericho like speed and ferocity. Clinicians were no longer viewed as god like figures  but as professionals whose services needed to be professionally delivered as part of a team. Long waits were not tolerated although the ways of addressing them were often controversial, and since Covid we have taken some steps backwards in achieving timely intervention.

One of my most rewarding roles came with managing community paediatrics, health visitors and school nurses. I negotiated to share an office with the senior consultant and we learned a huge amount from each other about our respective roles. In particular I came to realise how the burden of a high clinical caseload is so demanding, and she came to understand that I had the best interest of the service at heart and was keen to find solutions to the financial, workforce and other issues we faced. We were aided and abetted by a shared desire to talk regularly with service users and by an over-fondness for biscuits.

In my last few weeks in the NHS I have been on an internal secondment to the Commms Team and have spent much of my time helping out with the winter roadshows that have been going around the county giving people information and advice and listening to their stories about experiences. This has bought me full circle, particularly one event in a community hub where the majority of attendees had mental health problems and were users of the local food bank. I can honestly say that as I retire the best thing I could have done was to get out and meet people again, particularly after a decade and a half in corporate governance. It has once again been a humbling and uplifting experience, although 42 years on it is also more exhausting! 

So I leave the NHS with three pieces of advice for everyone still in it: stay in contact with the real world which is one of people and their stories not just numbers and national policy, important though these are; look after your own health and work / life balance and make sure you have the stamina to keep going; and leave on good terms at a time when you can still enjoy life. 

Oh and go easy on the biscuits.