The Friday Blog: Be Kind at Christmas
I was up early last Saturday. Well, these things are all relative. I was up early last Saturday. For a Saturday. It was a lovely, bright morning and the Doctor’s back was playing up, so she decided that if she was going to have to endure pain, she may as well do it sat on the sofa in front of the television rather than remain in bed and removed for the supply of analgesia in the kitchen cupboard. Having gone downstairs, she put the heating on. In our house, on a chilly morning, putting the heating on just about hides your breath in the front room, but makes the experience of walking into the bedroom akin to stepping off an aeroplane for the first time in Colombo. In other words, not conducive with hiding under the covers for a little longer.
Anyway, I like to be up to prepare myself for Saturday Kitchen, and this week was a classic. Jane Baxter, who always plays Matron to Matt Tebbutt’s naughty, flirty public schoolboy, made a pot pie which was basically Christmas encased in pastry. Theo Randall did a duck ragu which had me on the verge of ignoring Tier Three guidelines and jumping on a train to enjoy a late and very long lunch at his Park Lane restaurant. Nigella was on with a sticky toffee pudding and Richard Osman was plugging his novel, The Thursday Murder Club. I had seen it everywhere and it sounded right up my street, but because it was everywhere, and clearly popular, the horrible, highly unedifying snobbery with which I am afflicted, cause me to avoid it. Having now seen him talking about it, I am going to buy it. He is a top bloke and I want to read it before the film comes out, and Spielberg has already acquired the rights.
The other consequence of being up a little earlier than I otherwise might, was that I saw more of the news. There was an item on one of the poorer parts of Liverpool which featured an interview with Nikki, an intelligent, proud young woman who was trying to do the best for her family. She came across as the kind of girl that, if I had taken her home for tea, my mother would have been very happy. But Nikki was struggling. She was worried about Christmas, and she and her husband had been skipping meals to be able to feed the kids. Things reached a head during the first lockdown when she realised that the electricity was about to run out and there was nothing to put in the meter. In absolute desperation, and because she had nowhere else to turn, she phoned the Headteacher of the children’s school. The school has subsequently fulfilled the role that would more traditionally have been played by the local Pub, had there been one and had it been allowed to open. The pupils pay distanced visits to local old folks’ homes, and there is a foodbank for the needy like Nikki. It transpires that Nikki’s issue was that she was a complex care worker on a zero hours contract, and the pandemic meant that were not many hours. Let us think about that for a minute. A complex care worker on a zero hours contract. This is someone doing work of almost incalculable value, looking after the most vulnerable people in our society, and we reward her with a zero hours contract, which means if she does not work there is nothing to put in the meter. What have we become and how can we place such a low value on professions based almost 100% on human compassion and kindness? You may be made of stronger stuff, but here, listening to Nikki’s story there were tears before breakfast.
You would like to think that we might learn from all of this, and certainly be kinder to one another, although human nature is to revert to what we know best. We all certainly breathed a sigh of relief when China came back online, perhaps too big a one. The government has a strategy to make more PPE locally and thus protect the NHS supply chain, which is not an unreasonable response. It remains to be seen if the market will stand locally manufactured products, even if the trade-off between cost and security of supply is recognised.
Also heard on the media at the weekend were some rather worrying questions from small businesses on end of transition period arrangements. All the information currently available can be found on our site, which will include details of emergency contacts over the Christmas period, as and when things move. And they will, doubtless, be moving. Talks on a deal with the EU continue and there are signs of concessions. I have pontificated ad nauseam on fish and how the delta is so small that something must be possible. The supposed fears the EU has that the UK will suddenly weaken standards on employee rights, terms and conditions and unilaterally unlevel the playing field, cannot be serious. The UK was never going to become a regulation free, banana republic off the coast of Europe, undermining global standards, it is not in our interests to do so. Talks continuing up to a Christmas break, with something being cobbled together the following week is my bet. And then we will enter an implementation period. Beyond that, our relationship with the EU will continue to evolve in the months and years ahead, China has been in discussions since 2007. But more good news this week on continuity agreements, with pen going to paper for Mexico along with a commitment to take things further next year and progress accession to the CPTPP.
I promised you a bit more on the NHS Integrating Care document, having offered up a taster a couple of weeks ago, so I am going to send you in to the holiday period with a bit more thinking to do about the implications of the latest epoch of health and care reform. To make sense of ICSs, you first have to get you head around the concept of place versus system. Place will be the building blocks of ICSs, and place will be different in different places. The original “ICS,” The Greater Manchester Health and Social Care Partnership, is one system but organises itself into five places covering the city’s 10 Boroughs. Some services will be provided at place level, because it makes sense to organise them that way, and within each place services will be joined up by Primary Care Networks. What is significant is that Local Authorities and the voluntary sector are key actors in place. A notable element is that a focus on very local delivery, will inevitably concentrate on prevention and wellbeing, and this includes budgets. Other services will be delivered at system level, such as those that are specialised, and more specialised services will be delivered across ICSs or nationally. Place, and system, will need to be relevant to the areas they serve. Birmingham, for example, is a city that can be quite self-contained, offering a full range of specialised services within its boundaries. Cornwall, on the other hand, has no specialised services within the county, and many more services will need to be provided on a multiple ICS basis, and what Cornwall can provide only at an ICS level, Birmingham may be able to offer at place.
Within ICSs, there will be increased Provider collaboration, drawing on experiences of mutual aid and shared waiting lists that emerged during the COVID pandemic. Finance, including sustainability funding will increasingly be managed at a local level. Much of the real transformation will take place after April 2022, once the legislation needed to affect change has been passed. However, by April of next year a number of things will need to be in place, notably system-wide governance and leadership arrangements, including for place and provider collaborations, whilst individual organisations will need to describe their accountability relationships and partnerships.
At the heart of the changes will be better, more connected digital and data capability. Systems will have to produce digital transformation plans and develop shared care records between health and social care. Digital and data will be at the heart of transforming patient pathways and citizens will be put at the centre of their own care through virtual channels, including the roll out of remote monitoring. There will be much more from me on this as ICSs begin to take shape in earnest over the next year.
I have been getting all nostalgic for my schooldays again. You may remember what set me off last time was daughter getting the gumpf about her new school through the post. This time, I am putting it down to the season. The one festive period I cannot get out of my head at the moment is the one of my lower sixth year. It was the only time I have felt like I might have something like the life of one of the characters form the Last Christmas video. It was when I had the largest circle of friends to whom I was close, people who I had grown up with, we had shared early life experiences and we were now beginning to feel ever so slightly like adults. It was also the year that it finally happened between me and the girl from Poulton. Paula Goodall. I had been chasing her since the first form and she had broken my heart about 150 times. At one point she was even going out with my mate Johnny Williamson, one of only two of my brain dead, academically under achieving cohort who managed to get to Medical School, and who is now a GP in Garstang. I realised I was finally in with a chance at Judy Smith’s party, the one that perhaps defined that era of my life. Every time I hear Wonderful Christmastime, I am transported back to one night in Little Eccleston almost 40 years ago, I can see the faces, hear the music and taste the drinks (the four-pint Bodkan was de rigueur). I sealed the deal shortly thereafter at the Sixth Form Club Christmas party, and I was a catch having somehow been elected as Treasurer. We had the obligatory slow dance, she was dressed as a wee Scottish lassie and I was wearing a pink Tutu which had been made for me by Poppy Das, whose father was a Layton GP I would later call on as a sales rep. It seemed that our union was anointed by magic, because on the first Sunday we were together it properly snowed. In Blackpool. Let me tell you it properly snows in Blackpool about once every 15 years. I know that because I was living there again the next time it happened. But that December day in 1981 was truly remarkable. It was the day of the school carol concert, and we entered Holy Trinity Church on Bond Street under clear blue skies. When we emerged two hours later, there was, quite literally, three feet of snow on the ground. The story went that the Fylde Coast had three snow ploughs at the time. One had never worked and one broke down as soon as it was deployed. I remember my mother, a nursing Sister, joining the hordes of others walking miles along carless streets to begin their shifts at Victoria Hospital. Paula and I were the school’s golden couple for a few months, and she went on to become Head Girl. Of course, I managed to screw it up in the end, something which I have always felt a bit bad about, although the main thing I missed about us not being together was the opportunity to sit and drink sherry with her mum. Dorothy was an absolutely wonderful lady, and busted every music hall, mother-in-law stereotype. At that time, the main exponent of such characterisations was Les Dawson, whose children were also school friends, and nicer, more genuine and down to earth people, you could not wish to meet. Les was actually also ok, but Meg, his first wife, taken tragically early by cancer at just 49, was an absolute diamond.
I hope you are enjoying some festive nostalgia, maybe by rediscovering some old tunes, Nuttin’ for Christmas (Fontane Sisters version) is rocking my world at the moment. Whatever is doing it for you, and whatever your plans are, I trust you will carry them out safely. Please be kind to those closest to you this Christmas.
