In praise of chocolate...

The silly season for health news continues with several reports of studies regarding the benefits of chocolate. To be fair, maybe this research doesn’t really fit into my ‘duh’ category for pointless research as it would appear that chocolate really can be good for you (and not just from the pleasure perspective)

I believed from an early age that women who like chocolate are sexy, but extensive research (i.e. I googled it) doesn’t throw up any proof for this fact so I wonder if maybe my mother made it up….

According to a recent study published in the British Medical Journal, chocolate may ‘protect the brain and heart’. Data from over 110,000 patients suggests that eating ‘high levels’ (apparently more than 2 bars per week) reduces the risk of heart disease and stroke by a third. But – surprise, surprise – the researchers have warned that ‘excessive consumption can lead to other illnesses’. Does that qualify for a ‘duh’? Diabetes and obesity spring to mind.

There is a great quote by Victoria Taylor from the British Heart foundation ‘ if you want to reduce your heart disease risk, there are much better places to start than the bottom of a box of chocolates’. I’m not sure if Forrest Gump would agree with her…

Another study, this time from the US, reports that older women who eat dark chocolate once or twice a week could lower their risk of heart failure, but those eating it every day would not benefit from this protection.

It would appear that, like so much else that leads to a healthy life – the key is moderation. Shame. As the philosophical gardener Linda Solegato says:

‘A little chocolate is like a love affair – an occasional sweet release that lightens the spirit. A lot of chocolate is like marriage – it seems so good at first but before you know it you’ve got chunky hips and a waddle walk’

But I prefer this quote by the chemist Baron Justus von Liebig ‘Chocolate is a perfect food, as wholesome as it is delicious, a beneficent restorer of exhausted power. It is the best friend of those engaged in literary pursuits’

Phew! Thank goodness I’m a writer…

When medical research can be a waste of money

In my third year at University, I specialised in clinical pharmacology, an option heavily biased to research. It is a fascinating subject and I took part in several clinical trials designed to assess the efficacy and safety of beta blockers. I am therefore an advocate and close follower of medical research, but I am bemused at the nonsensical studies that are on the increase. The latest of these is the mind blowing discovery that marriage and/or divorce can cause an increase in women’s weight. This is the type of study that I now label as ‘duh’ research. (The urban dictionary defines ‘duh’ as ‘no sh*t Sherlock’ or ‘thank you Captain Obvious’ – love it)

The study, recently presented to the American Sociological Society followed over 10,000 people, measuring changes in marital status and Body Mass Index. Apparently newly married women are at greatest risk of health gains according to the authors from Ohio State University.

As a spokesperson from the British Nutrition Foundation said ‘these are significant changes in someone’s life. It can change their living situation and the types of food they eat’. Sorry – but that statement warrants a ‘duh’ too.

During my research days, I was taught that there are three fundamentals to a valid study:

1)     The objectives should be clearly stated

2)     The measurement methods must be robust and where possible, completely objective

3)     There must be a point to the research

Alas, in my opinion, this study fails on most counts. There are so many other variables not measured that the results are of little value. And what does the health sector intend to do with this information I wonder?

We are bombarded daily with new research, often with very little real value. Yes, mothers who over eat during pregnancy often end up with fat children. Not really rocket science. Yes, in many women (and men) emotional triggers play a key role in eating behaviours.

Much health research is life saving and life enhancing. Drug trials of course are a given, and retrospective studies such as links to baby sleeping position and cot death and the effects of smoking are dramatic examples of the vital work that researchers undertake.

I wish that researchers would stick to the basics, and academic and medical institutions closely assess the cost benefit ratio of each protocol before they proceed. These fluffy and inconsequential studies are affecting my emotional wellbeing….. now where’s that biscuit tin….?

New Term, new habits

Forget the weather, there are two ways that I am reminded that Autumn is on the way. Firstly, the football season starts, and watching Manchester United’s first home match at Old Trafford brought back the familiar thrill and anticipation of many injury-time goals to come. Secondly, not so exciting – the shoe shops are full of Mums buying school shoes for their children.

Remembering that ‘new school year feeling’ – new shoes, a blazer three sizes too big and lots of pristine pens and exercise books, as always, I turn my thoughts to health. The NHS is facing it’s most challenging term of all and maybe now is the time to suggest some new habits that all of us could adopt to improve patient care and enhance the efficiency of the services we provide. This list of ‘new term resolutions’ is applicable to us all involved in the future of our state funded health system – Health administrators, nurses, doctors, therapists, commissioners, community workers – all 1.5 million of you (or however many are currently employed in the NHS)

Be nice:

Yep – I’ve said it before and I’ll say it again. Rude emails, bad behaviour in meetings, a curt tone with confused patients really should have no part in the business of healthcare. Of course, we are all human, and have the odd off-day, and I can hold my hands up and admit that I have given colleagues short shrift before, but I do try not to make a habit of it.

Respect each other’s profession:

We all have a part to play in making the NHS great, all of us. A patient needs a pharmacist just as much as he needs a doctor, care worker or even hospital chef! And whatever you do – don’t criticise a colleague in front of a patient.

Remember that not everyone knows what you know:

I have blogged before about assumptions in healthcare, and assuming knowledge or understanding is one of the biggest dangers for integrated care. If a patient or colleague appears confused, take the time to bring them up to speed. But also remember that they might, and in fact do, know plenty that you don’t know!

Give up jargon:

One of the most annoying aspects of the NHS is the jargon they use. A few years ago the Daily Telegraph  printed some examples of confusing language used for patients – including one letter to a patient signed by ‘your intestinal failure coordinator’ and another being told that their case was ‘embedded within an indication of needs matrix’ Aaargh! .The NHS Information site lists in excess of 500 acronyms currently used including HAZ (Health Action Zone) and WIRG (Workforce Information Review Group) When I first started running projects in the NHS, I was constantly online trying to decipher what people were actually saying to me!

Make your meetings count:

Strong meeting management, decent preparation beforehand, good timekeeping and clear goal setting could transform the approach to many administrative and clinical issues.

Take pride in your environment:

One particular bugbear of mine is scrappy notices, often in health centres, stuck up in public areas, with tape – crooked, out of date or irrelevant. Regular readers will remember my pain at the tissue left on the floor of a busy ward, ignored by all comers. Own it – own your workplace and look after it.

Think ‘integrated’:

The single most important habit to adopt. I am delighted that the NHS Future Forum has added a fourth workstream – focussing on integration. I’m less happy that the co-chairs are the Chief Executive of a Borough Council and a Commissioning GP. What about those big buildings with beds and patients in them – a key part of the integrated pathway? Hopefully there will be plenty of hospital professionals included in the working group. The key to cost savings, improved outcomes and efficient patient care is to consider the entire patient journey. Yes, I know I am becoming a bore on this - but if you have to adopt just one good habit for this new term, this really should be our top priority.

As Aristotle said, ‘Quality is not an act – it is a habit’

So, before the harvest is safely gathered in and the chestnut trees begin to drop their conkers, let’s keep the good habits we already have and start the autumn term with some new ones too.

NHS reform – Wot? More listening?

When I’m feeling pretentious, I can call myself an international healthcare entrepreneur, but when I keep it real I’m a consultant and commentator. Whichever hat I’m wearing, and despite it thankfully being the start of the weekend, I must confess today to feeling confused and pretty grumpy.

I have just read an article in the Health Service Journal (www.hsj.co.uk ) that David Cameron was today due to launch the ‘second phase of the NHS Reform listening exercise’. I’m not sure how I missed this initiative, and I certainly remember some talk of ‘ongoing consultation’, but the plans for a second listening exercise had somehow escaped my consciousness. In the same way that a brain blocks out traumatic memories, maybe my psyche just couldn’t cope with more listening.

I thought that I understood the progress of the Health and Social Care Bill and hadn’t appreciated that there was much more listening to be done before the inevitable ‘tweaking’ is completed.

The phrase ‘fiddling while Rome burns’ and ‘shifting deck chairs on the Titanic’ has been applied many times to the coalition’s approach to these reforms. And never have these clichés been more true. The NHS continues to operate with blurred boundaries, unclear ownership, confused responsibilities and unconfirmed budgets. Is that any way to run a multi-billion pound organisation?

The stoics in the NHS accept that the reforms may not be to their liking and may not agree with many of the specific changes that are being suggested. But they are prepared to make the best of it, roll up their sleeves and try to make the reforms work. But they can only do that when the way forward is confirmed. How long can Andrew Lansley, UK Secretary of State for Health, prolong this agony?

There is a great comment on the HSJ website from an anonymous contributor (in other words, someone who actually works in the NHS). He or she says ‘Carry on listening... in the meantime, that gurgling you can hear in the background is the PCT/commissioning brain drain’. Yes, with every day that passes and every unclear statement or wishy washy soundbite, talented individuals will continue to vote with their feet.

Maybe the events of 2011 will provide a new cliché in English folklore…

 ‘If too many cooks listen, the broth will spoil’

Hush, hush whisper who dares?

When you are a parent you quickly learn from the toddler stage right up to late teens – if they’re not making a noise, they’re probably up to no good. As you try to track down your silent, but potentially deadly offspring you hope that whatever you find won’t involve too much mess or damage or a trip to accident and emergency department.

Speaking of which…

There is an uneasy quietness about all things NHS at the moment. Yes – it’s the silly season for news, and of course recent yobbish behaviour in the UK and the global financial challenges are taking up most of the serious headlines. But as our attention is briefly diverted – the time bomb known as the Health and Social Care Bill continues to tick….

Sitting quietly and unobtrusively in the House of Commons, the controversial Bill faces one more report stage and final reading on the 6^th and 7^th September. Then the NHS reform plan, the rather bloodied and bruised brainchild of Andrew Lansley, UK Secretary of State for Health, will start its journey through the House of Lords. This could be interesting and I suspect there is little chance of simple rubber stamping at this stage.

In the meantime, what’s happening at the coalface?

Yes, there is still a huge amount of excellent care being provided by many well-managed units across the patient pathway. But signs of financial pain, limited resources and most of all, a creeping (or is it galloping?) uncertainty are beginning to show.

The audit commission has warned that a quarter of NHS Trusts have ‘notable weaknesses in their arrangements for securing financial resilience’. Although £4.3bn savings were delivered in 2010/2011 through ‘clinical productivity and efficiency’ 19% of targeted savings were not achieved.  It was judged that 23% of savings were ‘one-off fixes’ such as temporary recruitment freezes, and not long term strategy.

This coming fiscal year will be much tougher and the audit commission states ‘Organisations that have up to now managed their finances well will find financial pressure increasing as the need to deliver high quality services without the funding growth will begin to impact’ .

Jo Webber, deputy director of the NHS Confederation fears that this could be ‘the calm before the storm. Many of our members have told us that they are expecting the financial situation facing their organisations to be the worst they have experienced’

All this in the context of ever increasing demand on resources.

So that’s what the silence is – people holding their breath as they tighten their belts…

Who really has the power in the NHS?

I recently met a master’s student, Sara Haque, who is just finishing her dissertation on power dynamics between doctors and nurses in the UK. Her interim results are fascinating, but I won’t steal her thunder as this is still to be submitted and I shall publish the link as soon as it’s available. But our discussions got me thinking about the role that power has to play in the Health and Social Care Bill.

One of the key elements of the NHS reforms planned by Andrew Lansley, UK Secretary of State for Health is, in effect, a shift of power. Large tranches of budget (and he who holds the budget, wields the power) are to be moved from Strategic Health Authorities and Primary Care Trusts (PCTs) to the GP Consortia. He also plans to give greater empowerment to patients – ‘nothing about me without me’

The latter is, of course, a worthy aim. But how practical is this and how is power manifested day to day throughout an acute care trust or GP practice?

As an inpatient, however knowledgeable and stroppy I may be, I quickly learnt that the power in my ward depended on who I was interacting with at the time. Whatever the doctor may say, as soon as he or she left the ward, the nurses were back in charge. I also acknowledged that he who holds the needle, holds the power. I wrote recently how annoyed I was at the delay in my medication due to lack of cooperation and coordination between doctors and nurses, but that didn’t get me my IV antibiotic any sooner. The nurse held the power in that instance. And how powerful is a Chief Executive of a Hospital trust? Yes, they are in charge, but still have to bow to their paymasters.

Abraham Lincoln once said ‘Nearly all men can stand adversity, but if you want to test a man’s character, give him power’ How true.

I believe that one of the reasons that people associated with the NHS are feeling so uncomfortable right now is because it is very difficult to judge where the power lies. Human nature requires an understanding of the hierarchy at any particular instant. All good parenting manuals talk about boundaries. Management gurus impart the importance of clear goals, roles, responsibilities and accountabilities.

The general public hears the sound bites about empowerment, but find that they are reduced to thankful and/or fearful wrecks when faced with the mighty force of perceived superior qualifications, knowledge and status in unfamiliar surroundings. Are patients more unsettled now they feel they should be taking more responsibility for the decision about their care? Are GPs in danger of becoming power-crazed dictators or will they find the additional power an uncomfortable shift in the status quo? A bit of both I suspect. And the poor souls currently working in PCT’s? As a friend of mine used to say – they are ‘betwixt and between’.

The philosopher Foucault hypothesised that power is not a thing but a ‘relation’. Power ‘operates at the most micro levels of social relations’. So perhaps anyone who works in, or is treated by the NHS is only as powerful as their most recent interaction. Despite the transient nature of power, I feel we would all benefit from further clarity on the powerbases of the ‘new NHS’

And doctors and nurses? In the context of much mutual respect, they’ll still bitch about each other behind their backs.

Plus ca change.

How important are role models in the workplace?

There has been much discussion over the recent looting and criminality taking place in many UK cities. I refuse to say ‘rioting’, because I suspect that these low-lifes are actually not politically motivated or even rioting against anything in particular. This is (to quote one of my facebook friends) ‘opportunistic theft and vandalism. A breakdown in family, morals, discipline and respect has held a generation back’

Well said. Politicians have been banging on for several years about ‘family values and ‘role models’ and it would appear that those swept along on a tide of violence and inhumane behaviour must be lacking suitable role models in their troubled lives. Sadly, I suspect that some of these ‘feral rats’ (to quote a shopkeeper who lost her entire stock) may actually have been previously reasonably well behaved, captivated in the moment, and lacking suitable structure or discipline at home.

Many of the England football team have spoken out individually against the violence, some with eloquence, some not. (Wayne Rooney’s tweets had some spelling errors, but hey, the sentiment is genuine I’m sure). Some commentators have mocked this initiative, especially as these sporting role models have been well known for bad behaviour on and off the pitch. But I applaud them for trying and even if their words persuade just one young person to stay at home and avoid trouble, then their efforts have not been wasted.

Various current social problems are blamed on a lack of suitable role models in pockets of society. Even the great philosopher, Aristotle's idea of ethical behaviour ‘relies substantially on the effects role models have on people. Aristotle believes that we learn to be moral (virtuous) by modelling the behaviour of moral people’ (William F Lawhead)

So does this principle apply to the workplace too? Of course it does.

I have written previously how leadership style flavours the culture of an entire organisation. Likewise, suitable role models at every level of the workplace hierarchy can have a highly positive effect on individual achievement and growth. In the same way that a good teacher can frame a pupil’s attitudes for the future, a good boss or benevolent mentor can be life changing.

I found this great definition of a role model: ‘An individual who is looked up to and revered by someone else. A role model is someone who other individuals aspire to be like, either in the present or in the future. A role model may be someone who you know and interact with on a regular basis, or may be someone who you’ve never met, such as a celebrity’

Many years ago, I worked with a charismatic doctor who was the chief executive of a healthcare company. In my opinion, she had everything – she was (and still is) charming, compassionate, highly intelligent, gracious, ambitious, professional, commercially minded and a great leader. I have always aspired to be like her and on some occasions have even felt I could emulate her. I adapted my style to mimic her – non confrontational but with steely resolve. I don’t always pull it off but this approach works more often than not. I was also fortunate to have great parents, an amazing grandmother and many workplace soul mates along the way who continue to guide my path.

One of the major issues affecting wellbeing at work is lack of guidance, behavioural benchmarks and aspirational goals. In the NHS, I feel this is particularly crucial. If a ward sister has a bad attitude, often the rest of the staff may follow suit. Likewise in any other organisation,  if a Chief Executive appears to be concentrating solely on budgets, and their own PR, why should the senior management team behave any differently?

The American Theologian, Tyron Edwards once said ‘People never improve unless they look to some standard or example higher and better than themselves.’

You don’t have to be in a senior management position to be a good role model. You don’t even have to be employed. Whether you are a parent, sibling, boss, friend or colleague – be aware. Your attitude, actions and words may have a much more significant and far-reaching effect than you realise.

NHS - who should be the whistle blowers?

The recent scandals surrounding abuses by staff in care homes has sent the subject of whistle-blowing in healthcare up the agenda again. The shocking images in the BBC left no doubt that vulnerable patients were being treated terribly. This sparked the obvious debate – surely someone must have known this was going on and why didn’t they speak up?

Whistle blowing in any organisation is fraught with major pitfalls. The whistle blower can face bullying, loss of employment and huge emotional turmoil. There is a danger that innocent colleagues can be accused of bad behaviour by a jealous or spiteful associate and often the ‘crime’ for which they are being accused is difficult to prove. Although anonymity can afford the accuser some protection, this can mean less opportunity for the accused to clear their name.

Andrew Lansley, UK Secretary of State for Health launched a new whistle blowing guide last year saying ‘the publication of this guide is an important step to developing a culture of patient safety. NHS staff need to be free to raise patient concerns and shielded from any backlash…’ The department of health have spent around half a million pounds on this initiative over the past three years, working with the Charity, Public Concern at Work, and I have no doubt that some important inroads are being made into encouraging staff to report bad clinical practice or inappropriate treatment of patients.

But what about staff who are probably clinically sound but demonstrate actions that are mildly incompetent, rude or just plain mean? This is where patients and their carers must take the lead.

A friend (I’ll call her Jane) witnessed an unacceptable level of care this weekend. Jane’s elderly mother had a fall on Friday evening. Suffering from an ongoing back problem, the fall caused her severe back pain and she had also banged her head. The accident was complicated by the fact that this lady she had been drinking heavily, sadly a daily occurrence.  Jane called an ambulance, which attended the scene quickly.

The paramedics were kind and understanding and recommended that the lady should be taken to hospital. Jane followed a few minutes later in her car. When she arrived in the emergency department of the local hospital, Jane found her mother sitting in a wheelchair quietly waiting to see the doctor following triage by the nurse on arrival. So far so good.

Some time later a doctor came through the doors to the emergency department waiting room and ‘spat out a name’. (Jane’s words) Jane wasn’t sure if it was her mother’s name so waited until the name was shouted out again. Yes it was. She lifted her hand and said ‘over here’. The doctor said nothing, stayed where he was and held the door open, waiting for the patient to enter the clinical area. ‘She can’t walk’ said Jane. ‘Bring the chair’ was the reply. Jane replied that she didn’t know how to take the brake off and she was also concerned that as her mother kept slumping forward she may slip and injure herself. With a loud sigh and rolling of eyes, the doctor grudgingly came into the waiting room and wheeled the patient into the assessment area. Jane quietly told the doctor that her mother had been drinking and that she had an ongoing back problem. Twice the doctor replied but his command of the English language was so poor that Jane had to ask him to repeat every sentence. ‘She’s drunk’ he said loudly. ‘Yes’ said Jane ‘I have advised you that she has been drinking heavily, but her back is causing her considerable pain’

‘Get up on the couch’ – he snapped. Jane had to advise the doctor that her mother had difficulty standing and had to ask the doctor to help her mother get into the couch. At that point– and these are Jane’s precise words ‘the doctor poked my mother’s back with one finger. Mum yelped in pain. He didn’t say a word. Then one more time, yet again with just one finger he poked her again – to produce another yelp’

End of consultation. Diagnosis – back in spasm.  Sent home with a prescription for a painkiller that the paramedics had advised Jane that her mother could not take while she was under the influence. Yes, her mother was drunk, but she was also a vulnerable, confused old lady in considerable pain. She wasn’t being a nuisance, just sitting in her wheelchair, whimpering quietly.

Forgive the length of this fairly uninteresting story. But that’s the point. Jane’s mother received the right treatment. Fast access to an ambulance, Speedy admission to an emergency department. Acceptable wait for assessment by a doctor. But the doctor was rude, unintelligible and mean. Not a case for whistle blowing by a colleague. But a case for complaint by the patient’s carer.

As discussion surrounding NHS reform, restructure and cost cutting occupy everyone’s thoughts there is a danger that we are losing sight of the core values that makes this organisation so special. One of the issues the NHS faces today among staff is bad attitude, bad manners and poor service which are becoming acceptable and unchecked. The majority of staff are caring, efficient and kind but as stress levels rise and anxiety about the future build, there appears to be are a growing number of cases of bad behaviour going unchecked.  I am not advocating a patient revolt. But please, if you experience unkind treatment, rudeness or mean behaviour by a member of staff, complain in writing to the hospital chief executive, senior partner or head of whichever establishment you are attending. The bad eggs are giving the good eggs a bad name. if you see what I mean.

If I had been Jane, very early on in the event, I would have asked the doctor’s name. If he refused to give it, I would find it out anyway. I would then note down in detail, every word and action that caused me concern and then write a measured, unemotional letter of complaint.

Patients must and should expect better.

Kidneys from live donors for sale in the UK? No!!

I always try to give measured opinions in this blog, but occasionally a topic crops up that leads me running, screaming from the fence. And the sale of live-donor kidneys is one of those subjects.

A researcher at the University of Dundee, Sue Rabbitt Roff, has suggested that people should be allowed to sell their kidneys for around £28,000 to provide more kidneys for the thousands of patients waiting for transplants.

No! No! No!

Ms Rabbitt, who, in my opinion is as ridiculous as her name, goes on to suggest that donors could ‘make enough money to pay for instance pay off university loans’

As I said before … No! No! No!

Dr Tony Calland, Chairman of the British Medical Association’s medical ethics committee, was measured in his response and said that organ donation ‘should be altruistic and based on clinical need.’

Writing in the Personal View section of the BMJ (British Medical Journal) website, Ms Roff proposes that the arbitrary figure of £28,000 per kidney is equivalent to the average income in the UK so she felt it wouldn’t be the poor who just sold their kidneys. Oh yeah, right, so you have no debts but would still consider selling your kidney – in which specific region of Lala land would that happen?

And she suggests that we should consider that selling your kidney is an acceptable means to pay off your student debt? There is already huge controversy surrounding student fees, with cries of ‘unlevel playing field’ and ‘university for the rich, not the poor’. So now would we add another slope in this already bumpy arena? ‘Physical fitness’?

I am fully aware of the fact that there are currently 8000 people waiting for organ transplants in the UK and supply does not meet demand. 1 in 3 kidney transplants last year used ‘living donor’ organs. Many parents, siblings, husbands and friends have all given the ultimate gift to their loved ones. Free of charge. For love. Not for money. I have huge sympathy for anyone who watches someone precious cope with the life limiting effects of regular dialysis and the ravages of kidney disease. Yes, I know that a live donor can live well with one kidney, but there are risks associated with major surgery, which would be far more distressing if not being undertaken to help a loved one. And what sort of society would encourage the mutilation of individuals to offer their organs solely because they are desperate for money?

The new initiative by the government to boost the donor register is an excellent initiative. There are now tick box questions regarding organ donation that must be completed by all online applicants for new driving licences. This is expected to significantly boost the number of donors on the UK register. This figure currently stands at 17 million, around a quarter of the population. Surely efforts are better directed towards building the transplant register for ‘non heart beating donations’?

The National Kidney Federation states on its website: ‘At present, not enough deceased kidneys are donated to meet the demand. Changes in seat belt laws and improvements in medicine mean that fewer people now die from accidents or illnesses that would have made them suitable donors’

Would Ms Roff suggest that we stop using seat belts and training our emergency healthcare teams I wonder?

To join the UK organ donor register please visit http://www.uktransplant.org.uk/

NHS – Is the mood of the employees affecting progress?

Linkedin professional groups seem to indulge in discussions ranging from the banal to the fascinating and one recently started by NHS Professionals Network sits somewhere between the two.

The question posed was: ‘What one word best sums up how people who are working in the NHS feel at the moment?’

On the face of it – an interesting conundrum to while away a couple for minutes of boredom at the pc. The discussion point prompted a myriad of replies giving a thought provoking insight to the diversity of agendas of those associated with the state health provision. All comments were personal, some selfish, some insightful, some ridiculous and some didn’t even follow the rules and used more than one word!

The personal ones, which appeared to be talking about the individual rather than ‘people’ included such plaintiff wails as ‘Bedraggled’ ‘Undervalued’ ‘Disillusioned’ and ‘Bullied’. Ouch.

Others wanted to display their command of the English language with ‘Somnambulant’ ‘Discombobulated’ (which means state of confusion – I looked it up). A few hopeful, positive souls used ‘Resilient’ Opportunity’ and ‘Interesting’

Others used the platform to vent their particular frustrations or promote their businesses. Interestingly, none of these self promoters could manage that in one word. A few brave souls commented ‘let’s stick to the question’. My point entirely. But what does this all mean?

I think this discussion thread sums up perfectly the biggest challenge facing the NHS. There are so many personal agendas coming into play. There is nothing wrong with looking out for yourself, especially as most employees within the NHS also care deeply about their jobs and the people in their care. But where is the shared vision? When I first read the question, my immediate thought would be to answer it on behalf of all people working in the NHS, to try to capture the mood, and some of these one word answers have achieved that.

But where is the consistency in views? Read any management manual on successful team building and without fail it will stress the value of a shared vision.

As Winston Churchill said ‘The empires of the future are empires of the mind’

In my opinion, one of the most vital areas for reform in the NHS is the mindset of individuals and the emotional intelligence of the organisation as a whole. It is entirely understandable that there are so many differing views, even in this straw poll. But as a matter of urgency, the leaders within hospitals, care centres, remaining Primary Care Trusts and all other areas need to find the Winston Churchill within and lead, encourage and motivate.

I was heartened by a lovely comment on this Linkedin discussion by a nurse, Jan Potts who posted:

‘When the going gets tough, the tough get going, come on guys take some control here, when its been bad before admittedly not this bad the best innovation has appeared. Think of the things that are going well and build on them however few they maybe at the moment. Never give up’.

Well said Jan.

And my one word answer to the original question? ‘Surviving’

Perhaps politicians should drink more tea!

As a big cricket fan, I found that yesterday’s events at the England/India test match provided a fascinating insight to human behaviour and the concept of ‘play nice’

Briefly – due to some confusion as to whether a ball had gone for four runs (i.e. hit the boundary ate the edge of the field), the England batsman Ian Bell was technically run out when an Indian fielder removed the stumps as the batsman was leaving the ground for the tea break at the end of the afternoon session. It was a simple misunderstanding – England thought the ball was out of play and India took advantage of the situation to claim a sneaky, but entirely legal wicket. The umpire confirmed the out decision which was within the rules, if not the spirit of the game.

‘Just not cricket’ a phrase used in the UK, and maybe overseas, describes ungentlemanly behaviour in any context and this incident was ‘just not cricket’. But in the true spirit of the game, after a cup of tea, India withdrew their appeal, Bell was reprieved, and resumed batting in the next session. The very sporting decision of the Indian team was praised universally and Phil Tufnell, a BBC commentator said ‘I think after a cup of tea the right decision was made’. Laugh out loud – what a wonderfully British comment!

But joking apart – maybe we shouldn’t underestimate the value of a cup of tea. I remember when my daughter was five years old there was a news item about the troubles in Northern Ireland and she asked me to explain why people were fighting. I did my best and then she said – ‘perhaps they should just have a nice cup of tea and sort it out’. If only. Bless.

With brinkmanship threatening the deal between the Democrats and Republicans to raise the US debt ceiling and the bickering amongst the UK coalition regarding NHS reforms, how good would it be if all these people just ‘played nice’?

How great if every time one politician slated another or one stakeholder belittled another – there was a shout of ‘hey that’s just not cricket’

And how wonderful if all these discordant groups really could just sit down and have a nice cup of tea and sort things out.

Apart from the ‘time out’ effect that having a cup of tea can have, the benefits of this age old beverage are manifold and well documented. The European Journal of Clinical Nutrition reports that tea does not dehydrate but it actually rehydrates just as well as water and also protects against heart disease and cancers. The anti-oxidants have been shown to prevent cell damage, protect against tooth decay and strengthens bones.

Other suggested benefits are to boost immune system, increase alertness and lower stress hormone levels.

So there you have it. Sport so often reflects society in general and in the silly season for news I make a plea to all those involved in heated debate regarding health and finance especially – play nice and drink more tea!