The Long Good Bye, Hello Van Life !

Van life here we come! I’m back at work but all my time is consumed with my preparations for beyond my retirement on the 29th April and the transition into van life with adventure sports travel as it’s central ethos.

The Long Goodbye is a 1973, American neo-noir thriller film, directed by Robert Altman and based on Raymond Chandler‘s 1953 novel. 

The phrase “the long goodbye”, is also given to the terminal phase of dementia, a slow demise to death endured by those suffering, their families and friends.

I don’t fancy that, not just yet anyway! For me, “the long goodbye” began on my return to work on the 11th January, after a 4 month absence in the wake of my knee surgery and is the prelude to my transition into the next chapter living the van life with all it has to offer.

In 1989, I qualified as a Doctor and after 1 yr as a “house man” at The Royal Liverpool, began a career in Anaesthetics. Initially, in Liverpool moving, a year later, to Wythenshawe Hospital, Manchester, after meeting Christina. Realising, it wasn’t for me, and unsure of what I wanted to do, I decided to do a 6 month post in Obstetrics and Gynaecology. A job, I had been offered whilst anaesthetising on a gynaecology theatre list, where I’d expressed my dissatisfaction with my current predicament. You need to work in different areas of clinical practice, to broaden experience when in this position, so it worked for me. In addition, I thought it could be used as part of a GP training scheme, as that’s where I seemed to be heading.

Work became enjoyable again and under the care of my then Registrar Pierre Martin-Hirsch, now a Gynaecological Oncology Surgeon in Preston, I began to forge an unplanned career in Obstetrics and Gynaecology. After a further 6 months at Wythenshawe, I moved to The Countess of Chester Hospital for a year as a “Senior House Officer” on the Registrar rota, “cutting my teeth” learning to manage labour ward and perform basic gynaecological surgery independently. It was stressful, but if you’re not allowed to get in the water you’ll never learn to swim!

Thinking about learning to swim reminds me of the ‘Charlie says’ series of public information films in the ’70s when we were kids. Watching this clip, really catches the essence of life as a kid back then.

I won’t bore you with the rest of my training, suffice to say, after acquiring a registrar 3 year rotational training post within the Manchester Deanery and a couple of years doing research in Central Manchester St. Mary’s, I was appointed a Consultant in Wigan, early September 2003. Billinge Hospital as it was then, was one of very few, stand alone Maternity Hospitals in the country. Until it closed in 2004, when services were transferred to the main site in Wigan, at The Royal Albert and Edward Infirmary.

The maternity hospital, where thousands of expectant mothers from Wigan, St Helen’s and West Lancashire gave birth, opened in 1968. After closure in 2004, the unit was demolished in 2007 to make way for new housing after falling derelict.

I was a consultant in Wigan for 12 years; a happy time, where I became Clinical Director in 2012 and led an extensive service transformation programme. This was made possible with the development of the Hanover Diagnostic Treatment Centre, which opened in July 2013. I ensured Gynaecology had a stake in the new Centre. Developing “one stop” services in out-patient gynaecology, utilising new innovative procedures, turning a loss making department into a productive, efficient team, delivering the highest quality modern care in a fantastic setting. Within 12 months, we were contributing a positive EBITDA to the organisation.

The Hanover Diagnostic Treatment Centre opened by Andy Burnham MP. Yes that’s me doing an impression of Tommy Cooper with Andy. Nice guy even though he’s a labour MP!

Following this success, I was “headhunted” by Wythenshawe Hospital in 2015 to help lead and re-develop the service there, as their new Clinical Director. I don’t regret the decision to take on the challenge presented to me but my Christ it has been roller coaster of a ride. Particularly when we merged organisations with Central Manchester in April 2018, when I was appointed Clinical Head of the Gynaecology Division. I stepped down to the “back benches” in September 2019 when I decided to change life’s course and retire and travel. And that, is where I am now. Living out this last long goodbye!

My NHS

After over 30 years in clinical practice, over 17 of them as a consultant , I feel I have had a good career; always trying to provide safe care to the highest quality, whilst causing no harm. But now, it’s time to say goodbye and start a new chapter in my life.

I am not retiring in the conventional sense but moving on, embarking on a life of travel, adventure sports with my wife and writing about our escapades. Safe in the knowledge, I do not need to work, to sustain either myself or my family beyond what is already a very comfortable existence. For that, I am very grateful. Whilst it has been the result of much hard work, a good marriage and great kids; one must always look to the sky, whether your religious or not and give thanks.

I have had the privilege to work in many hospitals and organisations since 1989 when I first qualified. A proud moment for me and my parents having come from arguably relatively humble beginnings.

So, I’ve now been back at work for 4 weeks, with a further 6 to go and unlike the Kurgan from the film Highlander, I’m not sure if it’s better to burn out rather than just fade away.

In my last post http://2020-annus-horribilis-or-not, I used the phrase, “the good, the bad and the ugly” to describe my own observations of the devastating effect the Covid pandemic has had on people’s lives. Like before, I think it’s a useful way of recording how I feel about the NHS, as a result of my own experiences in my long career. Hopefully without being libellous or being accused of bringing any hospital or organisation into disrepute!

The Good…….

The NHS is a great British institution, that does tremendous good from it’s creation in 1948, under the leadership of the then Health Minister Aneurin Bevan, to this very day. Not only has it allowed me to have a great career, it has and continues to look after me and my family well.

I will have served little under 32 years in the NHS come my retirement this April. Overall, a successful career and for the most part a happy time. I have been very privileged to work with some wonderful people, particularly in Wigan and more recently at Wythenshawe. I never developed a “Private Practice”, choosing to serve one master and live within my means. You don’t have six children if you aspire to be wealthy now do you!?

Wigan remains close to my heart and I had the honour of working with some great characters. Special mention to the theatre staff, Geoff x2, Andrew, Vicky, The Washy bros, Daryl, Daren, Billy, Hedley, Shirley and even Eddy, whose permanent miserable scowl would cheer you up, even on your darkest days. One character, who I will always remember fondly is Dennis (Murphy) The Porter, who I worked with “portering” for a week as part of a “return to the floor” initiative for clinical leaders. Jackie Kelly, Carol Fairhurst and Karen Blackwood need special mention as they helped me during my time as Clinical Director of Women’s services at Wigan between 2011 and 2014.

I have no regrets going to Wythenshawe back in 2015. In fact, a new challenge was what I needed back then. Being able to cycle 22 miles a day to and from work via Styal, has also been a real plus. In fact in recent times, often better than the job itself.

2015 to 2017 was tough, but we (not all, but those that cared) made some real change for good. Supported by the Trust Board, with a strong managment team particularly Keeley Hegarty, now a close friend. Achievements acknowledged by the Royal College of Obstetricians and Gynaecologists, on a return visit following their service review a year earlier. This success was equally echoed by the CQC report of 2017.

The Bad…….

Wythenshawe is where I finish and not a minute too soon. The NHS finds itself in a precarious position because of the Covid pandemic, but this has been coming for a long time; pandemic or no pandemic! Every success in the NHS to keep people alive, adds further burden to it. It will never keep up with itself. Every advancement costs more, for people to live longer finishing with a slow demise (aka the “long goodbye”) into dementia, unless something doesn’t “get them” beforehand! And I’m sure, I’ll be no exception!

Anyone who knows me, knows I like to call out “the elephant in the room!”. Never one to shirk the truth, personal integrity is just far to important to me for that.

In essence, I feel the NHS has deteriorated since I was a junior doctor. But more so, since the 2012 Health and Social Care Act was brought in by the coalition government led by then Conservative Prime Minister David Cameron. Where competitive tendering for contracts, sometimes involving private contracts, just led to these companies “cherry picking” the “worried well” diagnostics and dishing out unnecessary treatments. Where as those with serious disease and emergency care, which is often very expensive, was left to the good old NHS.

Covid has undoubtedly put and continues to put pressure on the NHS. That said, its fair to say, some parts of the service will fair better than others. Particularly, if they were well run before hand. A strong core business model is the foundation that provides resilience in any service at times such as this. Like a close friend once said, any business “needs some fat on it’s back” in order to survive when times get tough.

I think in many ways, the NHS has been teetering on the brink for many many years. But, we now see, a further deterioration as a result of this lack of resilience, so the problems faced cannot be blamed solely on Covid.

The “house ” was already falling down, poor foundations with cracks everywhere held together by the sticking plasters of denial despite everyone knowing it’s been like this for years!

But, that is what appears to be the tag line touted by Senior NHS leadership and Government. A line, only likely to be rolled out repeatedly, as a recurring excuse in the months and years to come.

And the Ugly……

Now I’ve worked in many hospital organisations and as a consultant in 3 different Foundations Trusts, each very different entities for sure. It’s just a pity that I can’t tell you “the good, the bad and dare I say it, the ugly” of each!

Over my career, I have seen the vulnerability of the NHS’s longer term viability, as a consequence of unaddressed poor clinical performance, poor service delivery models, inefficient “old fashioned” working practices and inconsistent governance processes. These issues were frequently tolerated, and if addressed, not always addressed well. Where following process or procedure and “not rocking the boat”, was seen as more important as “doing the right thing”!

It is often the case, that those trying their best to make a difference are marginalised. Occasionally, being asked to step down, because those responsible for providing leadership support, choose a “let’s get rid” approach rather than addressing these “elephants in the room”. I’ve seen and heard of it happening time and time again.

Concerns have been raised repeatedly by healthcare professional and the media alike. It angers me, not just as a clinician but also as a father to 6 children, that it has come to this. We will only get a safe and sustainable service for the future if the leadership is strong.

The NHS does great good and will always do so, but there is huge potential for harm and it happens, repeatedly. Clinical governance systems are (we are told) well established to learn from mistakes, improve care and patient safety. So why does it fail time and time again.

Every recent safety scandal within the NHS has been the result of “whistle blowing” by passionate healthcare professionals, disillusioned with ineffective governance processes. So much so, they feel they have to speak out. Angry patients and relatives who feel let down or even worse, fobbed off by these organisations, similarly approaching media outlets, as their only chance of recourse. In the main, not a fight for monetary compensation, but a last ditch plea to be heard, get the truth, in the hope no one else has to suffer in the way they or their loved ones have.

I don’t profess to have the answers and I’m not a martyr to any cause but over the years, I have experienced the toxic application of clinical governance and how ineffective if can be at addressing the real issues. For example, persistent poor clinical performance. Not learning or improving, which is what it should be doing, but penalising – creating a culture of fear. This “weaponisation” of governance, wheeled often to attack those who challenge the system itself, like me.

I don’t think I’ve come across a colleague who has disagreed with my synopsis of the current position. They just won’t say anything. Until the culture of fear is tackled, when principled employees with integrity can be heard without censure…..nothing will ever change!

So, I’ve said my piece, And now the end is near and I have nothing more to say, as I’ve said it clear. I’ve stated my case of which I am certain, for My NHS career is now over, confined to room 101, never to be discussed in any public forum such as this again! So I will be travelling each and every highway….

And more, much more than this…. I did my way!

I DID IT MY WAY

And now the end is near
So I face the final curtain
My friend, I’ll say it clear
I’ll state my case of which I’m certain I’ve lived a life that’s full
I’ve traveled each and every highway
And more, much more than this
I did it my way

Regrets, I’ve had a few
But then again, too few to mention
I did what I had to do
And saw it through without exception

I planned each charted course
Each careful step along the byway
Oh, and more, much more than this
I did it my way

Yes, there were times, I’m sure you know
When I bit off more than I could chew
But through it all when there was doubt
I ate it up and spit it out
I faced it all and I stood tall
And did it my way

I’ve loved, I’ve laughed and cried
I’ve had my fails, my share of losing
And now as tears subside
I find it all…

The lyrics of this great song, echo my experiences, reflections and feelings over my long career. Expressed in part through this blog over the last 18 months when I remembered what I set out to do in my mid-twenties! Thus far I have lived my life “My Way”, something I’m very content with.

“My Way” was popularised in 1969 by Frank Sinatra set to the music of the French song “Comme d’habitude” composed and written by French songwriters Claude François and Jacques Revaux, performed in 1967 by Claude François. Its English lyrics were written by Paul Anka and are unrelated to the original French song.

The song was a success for a variety of other performers including , Jocelyne, Elvis Presley, and Sid Vicious. Sinatra’s version of “My Way” spent 75 weeks in the UK Top 40, which is 2nd place all-time.

The lyrics to the song were adapted by Sid Vicious when he recorded it in 1979. The bassist gave the song a punk-rock makeover for his star turn in The Great Rock ‘n’ Roll Swindle shortly before his death in 1979. When people finally saw it, upon the film’s release in May 1980, it became one of Vicious’ most iconic moments. I just love it’s raw passion.

TIME TO SAY “GOODBYE NHS, HELLO WORLD”

So as the clock ticks and my time peters away, I do have a sense of excitement tinged with apprehension . I am retiring, not to fade away on a golf course, tend to an allotment or push round a grandchild in a pram; but rather to travel the world in the hope of meeting many interesting people and seeing some beautiful things! And I will do my level best to share it with you. In the hope it inspires and encourages others to do the same.

VAN LIFE UPDATE

So Mercedes have confirmed build date of 6th March which will take one week to build with 2 weeks to ship. Hopefully I should have it delivered to Mclaren some time late March. That said, It may well be late because of Covid, who knows! The build isn’t due to start until May so we have plenty of “wiggle room”.

In the meantime, I’ve been working on the internal and external spec. The document below is the document in progress. For more detail check it out, click the button below. Future posts, will focus on the build as it progresses to delivery hopefully mid July. Then onwards to distant shores………………………….

Going, going, gone……..

COUNT DOWN TO NEW LIFE