The NHS sets leaders up to fail – and then recruits more in the same mould

It’s my job to support and develop senior NHS managers. And I’m deeply worried that we’re setting them up to fail – then recruiting more in the same mould.

I’m a former primary care trust director; I now work as an executive coach, helping NHS executives to improve their skills. Many of my clients lead trusts whose leadership has been deemed “inadequate” or “requires improvement” by the Care Quality Commission – but few of them are genuinely bad leaders. The problem is that they were hired to do one job, and the requirement is now for something quite different. Yet they’re not being helped to change their approach, and when their trusts run into trouble they are being replaced with people likely to encounter exactly the same set of problems.

Most of these leaders were hired to lead foundation trusts at a time when NHS providers were being encouraged to compete with other trusts for business; to invest in new services; to develop their own organisations at the expense of other providers. To make use of the freedoms granted to foundation trusts – including the ability to borrow money at commercial rates – they hired leaders with commercial, transactional and financial skills: hard-edged, competitive businesspeople who could expand their market share.

But then the environment changed. Trusts were – quite rightly – put under greater pressure to improve service quality and patient safety. And demand rose much more quickly than budgets, so the tariffs paid for trust services were cut year after year. Soon, many new services were struggling to repay the investments made in them. In a world of shrinking revenues, those skills in business growth suddenly looked out of place.

Meanwhile, health system leaders began pushing a new agenda – one built around collaboration between organisations, professionals and sectors. To protect healthcare nowadays we need people to work together, rather than to compete: the emphasis is on building services around the patients’ needs, rather than the providers’. The Sustainability and Transformation Plans and the Five Year Forward View create a need for leaders who have emotional intelligence; who are approachable and listen to their staff; who put the public’s needs above those of their trust; who can share power and responsibilities with other organisations. And in that context, the skills and approach of many NHS leaders look hopelessly outdated.

Too often, leaders are remote and isolated. Poor links between ward and board mean that board members often remain unaware of emerging problems. To deliver great care, you need your staff behind you – but we’ve spent years recruiting empire-building business leaders who have no feel for the kind of hands-on, visible leadership required.

The characteristics once seen as assets have become liabilities

We end up with chief executives who find themselves receiving a lot of criticism, and being pushed out – creating huge damage to their careers and reputations. But it’s the system that’s let them down, not them letting down the system. Nobody’s given them the right advice or development or challenge, and the characteristics once seen as assets have become liabilities.

Unfortunately, trusts’ recruitment practices haven’t changed to reflect the need for a new kind of leader – so when these more commercial, transactional managers fail, trusts are too often replacing them with new figures cut from the same cloth. Many trust chairs are still stuck in an empire-building mindset; job descriptions focus on financial and operational experience; and recruiters are often cynical about the softer skills required for staff engagement and partnership working. So the trusts select new managers well-suited to facing the challenges of five years ago, and organisations head off towards a fresh set of failures.

What’s to be done? For a start, trusts need to refresh their recruitment practices – taking their cue from NHS Improvement’s new leadership framework, and shifting away from a narrow focus on technical competences towards a values-based approach. The solution is not simply to swap our existing leaders for a new set. The NHS cannot afford to lose a swath of senior managers. Many of these people could develop the skills we need, we just need to help them to do so. After all, we require doctors and nurses to refresh their skills regularly, revalidating their qualifications; and these days, the disciplines of management and leadership are changing just as fast as medical practice.

It’s hard for senior leaders and managers to reflect, train and change their approach. Most already work 60 hours a week, and seeking new skills is too often seen as a confession of weakness or incompetence. But this is a nettle we must grasp. For many of our senior leaders are ill-suited to the task in hand. If we are to serve the interests of NHS organisations, staff, leaders themselves and, above all, patients, we must reshape our leadership cadre – equipping it to understand and address the vast new financial and organisational challenges facing the NHS.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

The NHS sets leaders up to fail – and then recruits more in the same mould

The NHS sets leaders up to fail – and then recruits more in the same mould

It’s my job to support and develop senior NHS managers. And I’m deeply worried that we’re setting them up to fail – then recruiting more in the same mould.

I’m a former primary care trust director; I now work as an executive coach, helping NHS executives to improve their skills. Many of my clients lead trusts whose leadership has been deemed “inadequate” or “requires improvement” by the Care Quality Commission – but few of them are genuinely bad leaders. The problem is that they were hired to do one job, and the requirement is now for something quite different. Yet they’re not being helped to change their approach, and when their trusts run into trouble they are being replaced with people likely to encounter exactly the same set of problems.

Most of these leaders were hired to lead foundation trusts at a time when NHS providers were being encouraged to compete with other trusts for business; to invest in new services; to develop their own organisations at the expense of other providers. To make use of the freedoms granted to foundation trusts – including the ability to borrow money at commercial rates – they hired leaders with commercial, transactional and financial skills: hard-edged, competitive businesspeople who could expand their market share.

But then the environment changed. Trusts were – quite rightly – put under greater pressure to improve service quality and patient safety. And demand rose much more quickly than budgets, so the tariffs paid for trust services were cut year after year. Soon, many new services were struggling to repay the investments made in them. In a world of shrinking revenues, those skills in business growth suddenly looked out of place.

Meanwhile, health system leaders began pushing a new agenda – one built around collaboration between organisations, professionals and sectors. To protect healthcare nowadays we need people to work together, rather than to compete: the emphasis is on building services around the patients’ needs, rather than the providers’. The Sustainability and Transformation Plans and the Five Year Forward View create a need for leaders who have emotional intelligence; who are approachable and listen to their staff; who put the public’s needs above those of their trust; who can share power and responsibilities with other organisations. And in that context, the skills and approach of many NHS leaders look hopelessly outdated.

Too often, leaders are remote and isolated. Poor links between ward and board mean that board members often remain unaware of emerging problems. To deliver great care, you need your staff behind you – but we’ve spent years recruiting empire-building business leaders who have no feel for the kind of hands-on, visible leadership required.

The characteristics once seen as assets have become liabilities

We end up with chief executives who find themselves receiving a lot of criticism, and being pushed out – creating huge damage to their careers and reputations. But it’s the system that’s let them down, not them letting down the system. Nobody’s given them the right advice or development or challenge, and the characteristics once seen as assets have become liabilities.

Unfortunately, trusts’ recruitment practices haven’t changed to reflect the need for a new kind of leader – so when these more commercial, transactional managers fail, trusts are too often replacing them with new figures cut from the same cloth. Many trust chairs are still stuck in an empire-building mindset; job descriptions focus on financial and operational experience; and recruiters are often cynical about the softer skills required for staff engagement and partnership working. So the trusts select new managers well-suited to facing the challenges of five years ago, and organisations head off towards a fresh set of failures.

What’s to be done? For a start, trusts need to refresh their recruitment practices – taking their cue from NHS Improvement’s new leadership framework, and shifting away from a narrow focus on technical competences towards a values-based approach. The solution is not simply to swap our existing leaders for a new set. The NHS cannot afford to lose a swath of senior managers. Many of these people could develop the skills we need, we just need to help them to do so. After all, we require doctors and nurses to refresh their skills regularly, revalidating their qualifications; and these days, the disciplines of management and leadership are changing just as fast as medical practice.

It’s hard for senior leaders and managers to reflect, train and change their approach. Most already work 60 hours a week, and seeking new skills is too often seen as a confession of weakness or incompetence. But this is a nettle we must grasp. For many of our senior leaders are ill-suited to the task in hand. If we are to serve the interests of NHS organisations, staff, leaders themselves and, above all, patients, we must reshape our leadership cadre – equipping it to understand and address the vast new financial and organisational challenges facing the NHS.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

The NHS sets leaders up to fail – and then recruits more in the same mould

Older patients seeing same GP each time "key to reducing hospital admissions"

Seeing the same GP each time they visit the doctor can reduce avoidable hospital admissions among older patients, a study published in the British Medical Journal has found.

But the government’s focus on increasing access to GPs, such as through longer hours, may have unintentionally affected the continuity of care patients experience, the authors warn.

The study, by researchers at the Health Foundation charity, found that older patients who saw the same GP most of the time were admitted to hospital 12% less for conditions that could be treated in doctors’ surgeries than those who had a lower continuity of care.

The researchers looked at ambulatory care sensitive conditions: these include long-term conditions such as asthma, where flare-ups can be reduced by high-quality GP care, acute conditions such as gangrene that can be prevented by timely treatment, and illnesses such as flu and pneumonia that can be prevented through vaccination.

Admissions for these types of illness are expensive for the NHS: hospital admissions for conditions that could be treated at doctors’ surgeries cost £1.42bn in 2009-10, or more than £170,000 for each GPs’ practice.

Under changes to the GPs’ contract introduced in 2014, all patients in England must have a named GP who is accountable for their treatment. But researchers at the University of Bristol warned in response to the BMJ study’s findings: “There is evidence that continuity of primary care is actually declining in the UK.”

In an editorial for the BMJ, they called for policies to help ensure greater continuity of care.

Seeing the same doctor more of the time could reduce hospital admissions because it “builds trust and a sense of mutual responsibility between patients and GPs”. Older patients were particularly likely to appreciate seeing the same GP, although they were less likely to receive it, the researchers said.

The editorial added: “A primary care system that is increasingly fragmented, in which neither patients nor doctors feel strongly connected to their local general practice, provides the setting for patients to choose to attend an emergency department.”

Difficulty in getting appointments at GP surgeries, “which are at least as overwhelmed as emergency departments”, compound the problem.

Improving the proportion of the time that patients saw the same GPs would improve doctors’ job satisfaction, and was “very likely” to reduce pressure on hospitals, they added.

The Health Foundation researchers analysed patient-level data for more than 230,000 people in England aged between 62 and 82, focusing on older patients because they make up a high proportion of GP appointments and avoidable hospital admissions.

Patients who experienced a medium level of continuity of care had almost 9% fewer avoidable admissions, while those who saw the same GP a high proportion of the time saw just over 12% fewer avoidable hospital admissions in comparison with patients who had a low continuity.

The researchers found a particularly pronounced association between continuity of primary care and reduced hospital admissions among patients who were frequent users of primary care, which they defined as more than 18 visits over the two-year period covered by the data.

The study was observational, and did not prove cause and effect, the researchers emphasised. But improving the continuity of care could reduce hospital costs, especially for the heaviest users of the system, they added.

A spokeswoman for the Department of Health said: “This government is committed to making sure patients can get the right care at the right time from well-resourced GPs and, from April 2015, all patients have had the right to continuity of care through a named GP, as part of the GP contract.

“This remains a key part of our plan to reduce pressure on hospitals, and is in no way diminished by extending access.”

Older patients seeing same GP each time "key to reducing hospital admissions"

You Will Never Look at Beets The Same Way Again After Reading This

You Will Never Look at Beets The Same Way Again After Reading This

Prisoners "should get same healthcare as general population"

Prisoners should receive the same level of healthcare as people in the general population, a health watchdog has said as it released new guidelines for the wellbeing of inmates in a drive to improve the situation.

Prof Mark Baker, the director of the National Guideline Centre, which is funded by the National Institute for Health and Care Excellence (Nice), said that it had become clear that healthcare provision in prisons was often poorer than in the general community and not sufficient to meet the needs of prisoners.

“Something had to be done, I think, about defining what healthcare should look like in custodial settings,” he said.

From 2006 NHS primary care trusts commissioned healthcare for prisoners, with the responsibility for prisons in England transferring to NHS England when it was set up in 2013.

Baker said that adequate healthcare provision for prisoners would reduce pressure on community services later. “If their health needs are not properly cared for while they are prisoners, then their demand on the NHS afterwards is going to be that much more difficult to handle,” he said.

The recommendations, issued for prisons in England, include carrying out a healthcare assessment on arrival – with questions on physical health, mental health and alcohol and substance misuse, testing for TB within 48 hours of entering prison, and offering tailored advice on issues such as exercise, diet, smoking and sexual health. The guidelines also highlight the need for confidential testing for hepatitis B, hepatitis C and HIV.

Some of the recommendations, says Baker, are subtle, but important. “HIV testing is offered, but it should be done in a way which encourages people to take it up, rather than avoid it, which is sometimes the case now,” he said. Other recommendations include ensuring that condoms, dental dams and water-based lubricants are easily and discreetly accessible to prisoners. “Condoms are made available in prisons but currently you have to make an appointment with a doctor, whereas outside prison that is not the case at all,” said Baker.

The new guidelines also focus on the growing pressures of an ageing prison population, with older inmates more likely to have multiple conditions and a higher risk of chronic illnesses such as diabetes and heart disease. What’s more, said Baker, “they are sicker and more likely to have complex health needs than people of an equivalent age who are living in the community”.

According to recent figures, there are more than 4,400 prisoners aged 60 or over in England and Wales, nearly three times that in 2002, making it the fastest growing prisoner age group.

Inadequacies in monitoring chronic diseases, and in making sure that care is continuous when prisoners are moved between custodial settings such as prisons or courts, or are released, need to be addressed, said Baker.

“Doing that and maintaining that continuity is not only good for the health of the prisoners,” he said. “But it is much better for the operation of the prison system as a whole and reduces the burden on both the prison service and the NHS in having to deal with emergencies that could have been avoided if chronic disease management had been good enough.”

Mark Day, head of policy and communications at the Prison Reform Trust, welcomed the new guidelines. “People in prison should receive the same treatment and care as they would in the community, but too often their health needs go unrecognised and unmet,” he said. “With an ageing prison population and rising numbers of deaths, both natural and self-inflicted, behind bars, ensuring that people get the physical, mental health and social care they need is vital.”

Day added that new guidelines on mental health, currently in draft form, are also much anticipated.

“The new Nice guideline is an important and welcome step towards achieving parity of healthcare for people in prison,” he said. “We hope the forthcoming guideline on mental health will do the same for the high proportion of people in prison with a mental health need.”

Adam Horner, national lead nurse from Care UK, which provides healthcare for people in around 30 prisons, said: “Whilst we haven’t yet had an opportunity to review the guidelines in full, we welcome their publication. We are certainly seeing a growing number of older prisoners with long-term conditions such as heart disease, cancer and dementia.”

Prisoners "should get same healthcare as general population"

This victory on abortion has empowered Polish women. We’ll never be the same | Krystyna Kacpura

They call us Nazis and say that we are no better than Hitler because we think a woman should have be able to choose whether she gives birth to a seriously sick child – but we are used to such comparisons. They say these things about us because they are frightened. The government of Poland did not expect such huge protests against its proposed ban on abortion. In the last week, 7 million women were on strike all over Poland to protest against the draconian law and pushed the government to back down.

In Warsaw our protests, involving over 30,000 people, locked the city down. I was trembling at the sight of all these women. I have worked in reproductive rights in Poland for 25 years, and we used to be happy if 200 women attended our protests.

At first politicians ignored us, then they enraged us with their words. The foreign minister, Witold Waszczykowski, said: “Let them have fun. They should go ahead if they think there are no bigger problems in Poland … We expect serious debate on questions of life, death and birth. We do not expect happenings, dressing in costumes and creating artificial problems.”

These words mobilised even more women. I have never seen such huge protests. Something snapped in Polish women; we are empowered and we won’t stop. The protests were so spontaneous: with barely a few days’ notice thousands of women were walking out of work, and if they couldn’t get the day off, many told me, they said to their bosses they would not return because they could not work alongside people who did not believe in their rights.

Poland signals U-turn on total abortion ban after protests

On Saturday, at one of the protests, I gave a speech to the crowd that was directed at Polish gynaecologists. “Where are you?” I asked. “Why don’t you care about your patients? We need to rely on you, but instead we are afraid of you. We are afraid of your ‘conscientious objections’, we are afraid that you won’t tell us the truth when you are examining us or giving us blood-test results. Break your silence. We are your patients and we need you to support our health.”

Afterwards I received several anonymous messages from gynaecologists telling me that they will help Polish women, promising that they will work in their regions to tell the ruling party the truth about the real threat to women’s health if a ban on abortion was passed. I have been seeking this kind of support for years, there are maybe five or 10 doctors in the whole of Poland who will speak out for women’s rights, so for me this was a personal victory.

Although the Catholic church is seemingly silent in Poland, we know it was the bishops who also rejected the stop abortion law, despite helping to instigate it in the first place. They are threatened, and now they say they “don’t want women to be punished”. Women make up the majority of the people who attend mass, who give money. Many people have left the church lately.

‘In Warsaw our protests, involving over 30,000 people, locked the city down. I have worked in reproductive rights in Poland for 25 years, and we used to be happy if 200 women attended our protests.’ Photograph: Janek Skarzynski/AFP/Getty Images

The rejection of the proposed law, which would make all abortions illegal – even in cases of rape or when the woman’s life is at risk, with prison terms of up to five years for women seeking abortion and doctors who perform them – is only a small victory in the ongoing battle for women’s reproductive rights. We are expecting the church and the ruling party to prepare a compromise which would allow abortion when a woman has been raped, or there is a direct threat to her life, but they will seek to withdraw access to legal abortion if the fetus is damaged.

We want women to be free to make a decision on whether she gives birth to a seriously sick child herself. It is her right to choose, and if she does choose to have the child we advocate that she should be supported economically and psychologically, but all women should not be pushed to give birth in such circumstances because the politicians have ruled it so.

Women make up the majority of the people who attend mass, who give money. Many people have left the church lately

At the protests I spoke to many women and girls, young and old, and talked to them about how we are second-class citizens in our country. That the existing law is restrictive on paper, but even more so in practice. We don’t have adequate sex education, we don’t have access to modern contraception and we barely have access to legal abortion. In southern Poland nearly all doctors have signed conscientious objections making access to legal abortion all but impossible.

So our fight must continue. There is such solidarity among Polish women right now that we will take our fight to the European level and find a space to seek protection under EU law. We have international backing, and I have never been so proud of all the empowered, European, Polish women. We will never be the same again.

This victory on abortion has empowered Polish women. We’ll never be the same | Krystyna Kacpura

Why Meat And Protein Are Not The Exact same

In the final week alone, there is been ample conflicting research on meat to turn a man or woman veggie (and that may well not be a bad way to go). Amongst the most recent study results, animal protein will give you heart condition and breast cancer, and probably kill you. On the upside it might save you from a stroke, and it aids build muscle. There are obviously some caveats at play. One situation is that even within a offered group (e.g., animal protein), the overall health results can differ tremendously. The other question is no matter whether we can have also significantly protein all round, even of the “purest” kind. While eating more protein is not needed for most Americans – we consider in an terrible good deal previously – the place we get our protein is the question.

So what do we do? The reply really hasn’t altered extremely a lot in excess of the many years, in spite of the apparent uptick of conflicting proof: Eat ample but not excessive amounts of protein, definitely from plants, and probably from fish, eggs, and poultry. And if you’re going to indulge in red meat (and there is evidence that some folks possibly need to), just about everybody advises to do it sparingly.

(Photo credit score: Wikipedia)

Here’s a recap of the research in the final week. One particular study discovered that red meat was linked to an increase in the risk of breast cancer, in a review of in excess of 88,000 nurses in the Nurses’ Overall health Study II. Nuts, beans, fish, and poultry, didn’t seem to be to post the very same threat, even so, and poultry alone was linked to a decrease threat of breast cancer.

Another study located, not remarkably, the meat consumption was linked to heart disease in a study of 37,000 middle-aged males – but there was difference when the researchers broke it down and looked at processed vs. unprocessed meat. Men who ate mainly unprocessed red meat didn’t have any better danger of heart illness, but guys who ate largely processed meats – hotdogs, sausages, and this kind of – had a significantly increased danger of heart disease and cardiac-relevant death.

Ultimately, one particular research appeared at 1st glance to give a ray of hope for the meat lover, finding that high-protein diets may possibly decrease the danger of stroke, very likely for blood-stress lowering factors. Animal protein was connected with a considerably diminished danger of stroke in a meta-examination of above 250,000 people. But once more, a caveat: The authors say the findings do not lengthen to red meat, since it’s recognized to enhance the threat of stroke. For that reason, headlines touting the truth that “protein lowers stroke risk!” along with a picture of steak are misleading, and readers need to comprehend that the source genuinely does matter.

There are a number of reasons why protein may each healthier and unhealthy, dependent on the kind, quantity, and stage of existence you’re in. Proteins are made up of amino acids, which are essential in just about each and every component of our cells’ framework and function. Some amino acids can be created by the physique, but other people can not, so we have to eat them. The presence or absence of these vital amino acids, of which there are 9, are what make a protein “complete” or “incomplete.” Animal sources of protein are generally full – eggs, dairy products, and meat/poultry/fish. Veggies typically supply only incomplete proteins, which is why it is crucial for vegetarians to pair various plant sources. (Quinoa may possibly be the exception.)

So protein is essential, but in substantial doses, some have recommended it could also be detrimental. A single explanation is that it appears to trigger the production of a growth issue, IGF-I, which is linked to cancer cell proliferation. Some scientific studies, like this current 1, have found that any type of protein, but animal protein in distinct, is linked to an elevated cancer risk. Valter Longo, who headed the study, says that “[a]lmost everyone is going to have a cancer cell or pre-cancer cell in them at some level,” says Longo. “The query is: Does it progress? Turns out 1 of the main factors in figuring out if it does is protein consumption.”

The other issue is that we do not consume protein alone: It comes with fats, carcinogens, and hormones. Red meat in certain looks to be in a class of its very own. It has been proven in a amount of scientific studies to increase the danger for colon cancer there is less proof that other kinds of cancer are linked to red meat. Despite the fact that the mechanism is not completely clear, some researchers have recommended it is the type of iron in red meat that may possibly trigger the formation of cancer-triggering N-Nitroso compounds. Others have recommended that it’s the heterocyclic amines (HCAs) — carcinogens are released when meat is cooked below greater temperatures. And red meat has been linked to heart disease several times in excess of, but probably for causes related to unwanted fat articles, rather than protein.

So a single concern is that meat and protein are not precisely interchangeable, since any variety of protein carries along with it plenty of other compounds. Steak and turkey breast could have very various results on the entire body. And once again, the tougher query is whether or not large doses of protein from any source pose overall health hazards. Longo stresses that from his research, at least, all varieties of protein have been linked with cancer, even that from plants. “Keep in thoughts that for cancer, plant proteins at large ranges are still connected with a 3-fold higher mortality. But this is not as negative as that for animal protein (4-fold). For overall mortality rather, the animal-to-plant switch can make a massive difference.”

The protein-wellness connection will need a lot far more study before recognize it totally. The effects of a single molecule in meals made of a lot of, several molecules are very difficult to isolate. In the meantime, maintain protein intake moderate: Most organizations suggest swapping out red meat for other sources, and taking in about 46 grams per day for women, and 56 grams per day for males.

So have a tiny protein, but stay away from the fats, hormones, and carcinogens, in which you can. Plants, fish, and eggs are possibly ideal, if you crave it, a burger each and every now and then possibly won’t destroy you. Of course, consuming plant-primarily based proteins also provides you the peace of mind that you’re not contracting Mad Cow Condition along with it. Whilst the current scare seems to be largely a technical glitch, and not any true biological lead to for concern, the vegetarians out there will breath a signal of relief that the problem doesn’t pertain to them.

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Why Meat And Protein Are Not The Exact same

Marriage in recovery: I goad R in the same way my mom goaded me when I was a youngster

‘I have an odd compulsion to tell folks to do factors I have nevertheless to try out out myself.’ Photograph: Guardian

In the crime-fiction corner of my new favourite store, R has chosen three books he’d like to get. Over in graphic novels, I am selecting out an X-Guys comic for my elder son, concerned that too considerably publicity to superhero capabilities and bulging muscle tissue will make him expand up to come to feel inferior.

We are nonetheless in a different city, waistbands now straining a minor as our bodies try out to burn up all the great food we’ve eaten in a week. This lovely bookshop is our last quit just before the airport. I’ve been scanning its shelves, selecting presents for the youngsters and gifts for myself. Right after kitchenware floors in division shops, bookshops are my favourite way to commit a couple of hours, and with R – right after we’ve talked much more on this holiday than we have in a decade – a silent stroll all around this store is excellent.

I spot the monochrome spine of The Alcoholic wedged in between Batman and Spiderman. Jonathan Ames, its writer, is a identify I recognise and remember as being brilliant, and finding this kind of a book although not looking is like finding a £20 note in a scrumpled receipt.

If specific books could talk to me, this a single would most undoubtedly shout the loudest. “Purchase me! You are going to discover things inside that are all about you and your husband’s lives, and all the broken, crazy folks you’ve acknowledged and the mad, embarrassing items you and they have accomplished.”

Before I’ve even opened it, I tell R he ought to study The Alcoholic. I have an odd compulsion to inform people to do items I have however to try out out myself: with R, it’s a kind of parental goading, the sort my mum used on me all the time when I was a child, a ploy to get me to do factors she had once needed to do herself: “You employed to enjoy dance. Why not try out out the tap class at the civic hall?”

When I advise R, I consider I am undertaking it out of enjoy. But actually I’m bossy and really feel that no matter what I’m recommending (passively, aggressively, at times both), will boost his understanding of existence.

R seems to be at me and sighs a plaintive sigh, as if to say: “Go through it first, then when you happen to be not looking I might pick it up, go through it, enjoy it, then pretend not to have read it due to the fact I do not want to give you the pleasure of admitting that I have appreciated some thing you recommended.”

I read The Alcoholic on the plane journey home. It is a darker tale than I would have imagined, but funnier in parts than I could probably predict. Ames describes currently being the victim of a disease without truly taking part in the victim. He gives us the straight-up version of what it is to live in a body and mind that – when intoxicated – ends up as some thing he isn’t going to own and can not control. It is an typically hilarious, at times heartbreaking story, rather than a limitless outpouring of grief. And the specifics, when I compare them with R’s experiences, are all as well acquainted.

As he sleeps beside me, I want to nudge R awake and say: “See this bit where he stays in bed for 3 days and drinks himself in the direction of death? Keep in mind last August?”

And then there are a couple of instances when Ames’s excellent friend tries to assist and suggests he goes to an Alcoholics Anonymous meeting. Ames toys with the notion, but never ever goes.

There was a time in our house when I taken care of AA like the physician. Every single time R slipped into a state of wretchedness, I suggested he went to a meeting. My voice became my mother’s when she “suggested” that I go to dance classes. And like her with me, I stored on and on, till R last but not least capitulated.

I needed him to inform me how significantly they aided, how satisfying they have been. It is only now that R tells me he went out of a duty to me, rather than a duty to himself. He could return a single day, but if he does it will be due to the fact he needs to and not because I informed him to.

R’s honesty now is admirable. Of course, deep down I would love him to be singing from the very same song sheet as me, stepping into the comfort of group therapy in wood-polish-scented church halls and out-of-hours classrooms – simply because I still attend Al-Anon meetings frequently, and locate them an invaluable assistance.

And nevertheless, as we hit the rippling runway on a vibrant summer time morning, R sober on a plane for the 2nd time in his adult lifestyle, I think: “This is progress.” I undo my seatbelt, not fairly resisting the urge to slide The Alcoholic into R’s bag when he’s not hunting. But at least I comprehend that R’s recovery is his: it will always be his and never ever mine. So I can go through all the books I want, do what I want to do, go the place I want to go. But I can’t always assume R to come with me.

Marriage in recovery: I goad R in the same way my mom goaded me when I was a youngster

Mindfulness has altered my existence. And it could do the same to yours

I had no idea what mindfulness meant. All I did know was that a handful of my most senior clients, and a quantity of close close friends, talked about it as a completely indispensable portion of their lives. As a end result of this, I signed myself up for a 5-day program in the middle of Herefordshire titled The Artwork of Meditation, taught by a meditation expert known as Burgs. It was for beginners – and its intention was to educate the fundamental art of meditation to a assortment of folks who’d by no means meditated before in their lives.

By the finish of the 5 days, spent in total silence, I came away feeling that I had begun a procedure that had the possible to be as truly important as I had been led to feel. Sitting nonetheless, being conscious and, probably most crucially, finding out again how to concentrate – all perceptibly this kind of easy traits – have been the key drivers behind the five days.

What did I understand about myself? I learnt that to focus on sustaining a quiet and uncluttered thoughts was something that I identified practically not possible. Nevertheless, obtaining, for the extremely briefest of time, the feeling that you have genuinely entered the space of still and quiet is 1 of the most potent feelings that I have ever experienced in my life. Entirely rejuvenating, individuals momentary occasions of complete calm allowed me to review so numerous daily ideas and anxieties with a totally fresh and far more rational viewpoint.

So how do you get started to empty the cluttered and challenging minds that we all carry all around with us on a day-to-day basis? We have been taught to concentrate on our breathing, to adhere to and to feel about our breath as it moved into our bodies. We have been taught that this kind of a straightforward factor as to focus on the breath and to sustain concentration on this for as extended as achievable, has the capability to engender a feeling of calm and insight into the thoughts and the body. In specific, that the mind is not one thing that sits in isolation, but is wholly connected to of the rest of our bodily currently being.

Over the final eight many years I have had the privilege of working with leaders across all sectors. My company has also worked with young individuals, “leaders of tomorrow”, and kids. I’ve worked on authentic self-expression with all of these folks. There is a typical denominator behind all these distinct groups in their yearning for a greater sense of self-awareness, as properly as locating the time to sit still, without having books, music or any other distraction.

My 5 days on this course renders me a complete novice but it has awakened me to a signifies or a process via which people from all walks of life, by way of the most simple of strategies, can discover a sense of stillness and calm reflection that, to my quite cluttered mind, could be invaluable.

Anthony Gordon Lennox is the founder and CEO of AGL, a communications agency. He is a visiting fellow at Saïd Company College, University of Oxford.

Mindfulness has altered my existence. And it could do the same to yours

Billy Connolly: I discovered out I had Parkinson"s and cancer on the same day

‘I believe they are really closely relevant, deep despair and laughing,’ says Billy Connolly. Photograph: Luke Macgregor/PA

Billy Connolly has disclosed that he was diagnosed with Parkinson’s illness and prostate cancer on the exact same day.

The 71-yr-old comedian, who is married to the psychologist Pamela Stephenson, described how the mobile phone phone telling him he had Parkinson’s came only hours following medical professionals had broken the information of his prostate cancer last September.

“I remember I went by means of to the bedroom to answer the mobile phone,” Connolly told the Radio Occasions. “Pamela was behind me – I considered she was gonna catch me. And she type of held me and I went, ‘Oh Jesus’.”

However, Connolly stated the double-diagnosis had not dented his very good humour.

“Aye, it just took place,” he mentioned. “I consider they are extremely closely related, deep despair and laughing. And I was not in any ache.”

Describing the second he was told he had cancer, Connolly extra: “When he said ‘First of all, you are not gonna die,’ I was shocked. I said, ‘Of program I’m not going to fucking die.’ It by no means crossed my mind. It was all really businesslike.”

Connolly, who has five youngsters, underwent profitable surgical procedure on his prostate in the US – which he described simply as “in and out, completed” – and was provided the all-clear in October.

However, it was the discovery that he had Parkinson’s – soon after a possibility encounter with a physician in a hotel lobby in Australia who advised him he was exhibiting symptoms of the incurable degenerative brain ailment – that prompted Connolly to embark on his latest documentary, exploring the taboos close to death.

In the two-component programme, Billy Connolly’s Large Send Off, the comedian and actor visits a convention of funeral directors in Texas, a pet cemetery in San Francisco, a drive-thru funeral parlour in Los Angeles, and ultimately his favourite cemetery in his hometown of Glasgow.

Jo Clinton-Davis, who commissioned the documentary for ITV, stated: “Billy Connolly’s a huge fan of existence he is effervescent, energised and inspired by it, but he’s also genuinely fascinated by the way we as people treat death – a topic that is quite actually the greatest universal knowledge, but so often prevented.”

Connolly says he has integrated his Parkinson’s signs into his stand-up demonstrates. Holding up his left hand, he informed the Radio Times: “We had been laughing about it because when the strain will get massive, this hand commences to shake. And I am like ‘look, look, seem, look’. And I do it on stage – I present the audience this hand creeps up on me.”

In an interview last month, Connolly unveiled he stopped taking his medication for Parkinson’s. “It is a weird medicine,” he informed a US chat present. “Medical professionals took me off … they reckon the side effects have been more powerful than the results.”

Connolly informed the Radio Times it was “early days” and he would go back on the medication “when the signs come back”.

The documentary, which will air on Wednesday on ITV, will also see Connolly candidly examine his very own thoughts on death. “I will not feel I want a resting spot,” he explained. “I want to be scattered on the wind.”

Billy Connolly: I discovered out I had Parkinson"s and cancer on the same day