Category Archives: Diet & Fitness

Jeremy Hunt launches review into handling of vaginal mesh scandal

Jeremy Hunt, the health and social care secretary, has launched a nine-month review into how the NHS addresses concerns about medical treatments, including vaginal mesh devices.

Speaking in the House of Commons, he admitted the government had failed to respond adequately to a series of public health scandals caused by the side-effects of medical treatments, citing the surgical mesh scandal as a key example.

The review will also look at the regulation of the hormone pregnancy test drug Primodos and the anti-epilepsy drug sodium valproate.

The review, led by the former Conservative health minister Baroness Cumberlege, will also consider whether there are grounds for wider inquiries into the failings alleged by campaigners.

Hunt admitted responses to the issues “have not always been good enough”. Pledging to come up with a quicker and more balanced system, he admitted that the stress and frustration felt by campaign groups on these issues had often “added insult to injury”.

“We must acknowledge that the response to these issues from those in positions of authority has not always been good enough,” he said.

“Sometimes the reaction has felt overly focused on defending the status quo rather than addressing the needs of patients, and as a result patients and their families have spent too long feeling that they were not being listened to, making the agony of a complex medical situation even worse,” he said.

In the past decade, more than 100,000 women have had vaginal mesh surgery to treat urinary incontinence, which is common after childbirth, according to NHS figures. But there is disagreement about the scale of problems linked to the devices, with campaigners saying women have been exposed to unacceptable risks.

Most mesh devices were launched without clinical trials, meaning the complication rates were never established prospectively.

Official guidance has suggested the figure is 3-5%, but recent research has suggested the true complication rate could be between 10-15% and a Guardian investigation found that up to 1 in 15 women subsequently require partial or full removal of their implant.

Last month, a full retrospective audit of women who have undergone vaginal mesh surgery was launched by the government to establish how many have experienced complications following the procedure.

The Labour MP Owen Smith, who set up the all-party parliamentary group on surgical mesh implants that looked into the safety of mesh devices, welcomed the review but criticised the government for failing to suspend the use of mesh until after the review has concluded, as has happened in New Zealand.

The shadow health secretary, Jonathan Ashworth, agreed, saying the review “falls short of the calls for a full public inquiry that campaigners have been (demanding)”.

Kath Sansom, the founder of the campaign group Sling the Mesh, pointed out that women have had to fight for years to get their voices heard, “often being dismissed as mad, hysterical or a minority suffering”.

“So many women’s and families lives have been shattered by medical devices and drugs that were never tested on humans before being released en masse to women globally,” she said. “We were human guinea pigs.”

Jeremy Hunt launches review into handling of vaginal mesh scandal

Jeremy Hunt, the health and social care secretary, has launched a nine-month review into how the NHS addresses concerns about medical treatments, including vaginal mesh devices.

Speaking in the House of Commons, he admitted the government had failed to respond adequately to a series of public health scandals caused by the side-effects of medical treatments, citing the surgical mesh scandal as a key example.

The review will also look at the regulation of the hormone pregnancy test drug Primodos and the anti-epilepsy drug sodium valproate.

The review, led by the former Conservative health minister Baroness Cumberlege, will also consider whether there are grounds for wider inquiries into the failings alleged by campaigners.

Hunt admitted responses to the issues “have not always been good enough”. Pledging to come up with a quicker and more balanced system, he admitted that the stress and frustration felt by campaign groups on these issues had often “added insult to injury”.

“We must acknowledge that the response to these issues from those in positions of authority has not always been good enough,” he said.

“Sometimes the reaction has felt overly focused on defending the status quo rather than addressing the needs of patients, and as a result patients and their families have spent too long feeling that they were not being listened to, making the agony of a complex medical situation even worse,” he said.

In the past decade, more than 100,000 women have had vaginal mesh surgery to treat urinary incontinence, which is common after childbirth, according to NHS figures. But there is disagreement about the scale of problems linked to the devices, with campaigners saying women have been exposed to unacceptable risks.

Most mesh devices were launched without clinical trials, meaning the complication rates were never established prospectively.

Official guidance has suggested the figure is 3-5%, but recent research has suggested the true complication rate could be between 10-15% and a Guardian investigation found that up to 1 in 15 women subsequently require partial or full removal of their implant.

Last month, a full retrospective audit of women who have undergone vaginal mesh surgery was launched by the government to establish how many have experienced complications following the procedure.

The Labour MP Owen Smith, who set up the all-party parliamentary group on surgical mesh implants that looked into the safety of mesh devices, welcomed the review but criticised the government for failing to suspend the use of mesh until after the review has concluded, as has happened in New Zealand.

The shadow health secretary, Jonathan Ashworth, agreed, saying the review “falls short of the calls for a full public inquiry that campaigners have been (demanding)”.

Kath Sansom, the founder of the campaign group Sling the Mesh, pointed out that women have had to fight for years to get their voices heard, “often being dismissed as mad, hysterical or a minority suffering”.

“So many women’s and families lives have been shattered by medical devices and drugs that were never tested on humans before being released en masse to women globally,” she said. “We were human guinea pigs.”

Jeremy Hunt launches review into handling of vaginal mesh scandal

Jeremy Hunt, the health and social care secretary, has launched a nine-month review into how the NHS addresses concerns about medical treatments, including vaginal mesh devices.

Speaking in the House of Commons, he admitted the government had failed to respond adequately to a series of public health scandals caused by the side-effects of medical treatments, citing the surgical mesh scandal as a key example.

The review will also look at the regulation of the hormone pregnancy test drug Primodos and the anti-epilepsy drug sodium valproate.

The review, led by the former Conservative health minister Baroness Cumberlege, will also consider whether there are grounds for wider inquiries into the failings alleged by campaigners.

Hunt admitted responses to the issues “have not always been good enough”. Pledging to come up with a quicker and more balanced system, he admitted that the stress and frustration felt by campaign groups on these issues had often “added insult to injury”.

“We must acknowledge that the response to these issues from those in positions of authority has not always been good enough,” he said.

“Sometimes the reaction has felt overly focused on defending the status quo rather than addressing the needs of patients, and as a result patients and their families have spent too long feeling that they were not being listened to, making the agony of a complex medical situation even worse,” he said.

In the past decade, more than 100,000 women have had vaginal mesh surgery to treat urinary incontinence, which is common after childbirth, according to NHS figures. But there is disagreement about the scale of problems linked to the devices, with campaigners saying women have been exposed to unacceptable risks.

Most mesh devices were launched without clinical trials, meaning the complication rates were never established prospectively.

Official guidance has suggested the figure is 3-5%, but recent research has suggested the true complication rate could be between 10-15% and a Guardian investigation found that up to 1 in 15 women subsequently require partial or full removal of their implant.

Last month, a full retrospective audit of women who have undergone vaginal mesh surgery was launched by the government to establish how many have experienced complications following the procedure.

The Labour MP Owen Smith, who set up the all-party parliamentary group on surgical mesh implants that looked into the safety of mesh devices, welcomed the review but criticised the government for failing to suspend the use of mesh until after the review has concluded, as has happened in New Zealand.

The shadow health secretary, Jonathan Ashworth, agreed, saying the review “falls short of the calls for a full public inquiry that campaigners have been (demanding)”.

Kath Sansom, the founder of the campaign group Sling the Mesh, pointed out that women have had to fight for years to get their voices heard, “often being dismissed as mad, hysterical or a minority suffering”.

“So many women’s and families lives have been shattered by medical devices and drugs that were never tested on humans before being released en masse to women globally,” she said. “We were human guinea pigs.”

‘The magic of cinema’: the club supporting older people with HIV

Inside the Regent Street cinema in Marylebone, London, a group of men and women are in high spirits singing along to a dancing Doris Day. It is a gloomy Wednesday in February but these filmgoers, aged in their 50s to 80s, are determined to enjoy their weekly trip, on this occasion to see the 1955 film Love Me or Leave Me.

As members of the Silver Surfers club, they have one thing in common apart from age and a love of cinema – a diagnosis of HIV.

Simon Horvat-Marcovic, 53, a Silver Surfers regular and former retail manager, was made redundant around the time of his HIV diagnosis in 2015. As someone who lives with depression, he struggles on days when he does not speak to “a single human being”. For him, the club means “you’re not wallowing”.

“Having people understanding how you’re feeling, what’s going on inside your head and who you don’t have to explain yourself to. For me, that’s been brilliant,” he says.

The film club was launched in October 2017 and has 15 members. It is an initiative from the Health, Wealth & Happiness project, a Terrence Higgins Trust (THT) programme offering support to older people with HIV.


The magic of cinema is you go in as a stranger and come out as friends. It brings you together with others

With visits to see classics like Gentlemen Prefer Blondes and High Noon, Silver Surfers came about after research by THT into the reality of life in the UK for people growing older with HIV.

At least one in three people accessing care after a diagnosis are aged 50 and over, and they are three times more likely to experience loneliness than the general population, according to the charity. Their social isolation can be compounded by the death of friends during the 80s and 90s, when Aids was at its peak, by no longer being part of the gay scene, and by their reluctance to discuss their diagnosis.

The health of those who are HIV-positive is generally stable thanks to advances in antiretroviral medication, so GPs do not consider them in need of additional support. The result is that their psychosocial needs may be overlooked, a gap in care that can be filled by initiatives like Silver Surfers, according to Clive Blowes, a national coordinator for THT.

“It can be a challenge to bring up the personal in a routine discussion with your GP,” says Blowes. “And if you’re a gay man then doors close to you, like the club scene, once you’re 50-plus.” The film club provides an alternative outlet, where people feel safe to discuss their physical and mental health issues over tea before the screening, he says. One woman in the group is less reliant on counselling services, for example, after joining outings, says Blowes.

For Mary Jones* the film club offers more than the opportunity to enjoy a classic film, have a laugh and chat about films. Despite being diagnosed in 1995, she has never disclosed her HIV status to even close friends because of the stigma and her fear of “being defined by it”. The club provides an essential support network for the 74-year-old, who can compare health notes, share problems such as side-effects of medication and pick up tips without fear of being judged or misunderstood.

Older people with HIV may encounter specific health problems. Ageing may mean the liver is less able to withstand the toxicity of HIV treatment, leading to symptoms such as jaundice. HIV drugs may also interact with other medications, triggering issues such as high blood pressure, which Jones has been experiencing. One club member helped by recommending a new app. “You feed in your information and it tells you exactly what drugs can and can’t be taken together,” says Jones, who contracted the virus from a partner who eventually died from Aids.

“Not even my GP knew about this. They’ve all had HIV training but you get some who are more interested in your condition than others,” she says. Through swapping contact details at the film sessions, Jones has access to peer support when she requires it.

The need for services offering direct health support, such as integrated HIV and cardiology care, for older people is beginning to be recognised by the NHS, according to Tristan Barber, an HIV consultant at Chelsea and Westminster hospital. However, he says there is still a way to go, especially on the psychosocial side, which is why clubs like Silver Surfers are vital. “This is more than just going to see a movie – it gives people a chance to share their stories with others like them and realise their psychological needs,” he says.

David Munns is a clinical nurse specialist for mental health and HIV at the Kobler clinic, part of Chelsea and Westminster hospital. Increasingly, he is getting referrals for over-50s with HIV needing mental health support, partly as a result of people living longer as treatability improves.

Munns has seen the psychological benefit of cinema for patients, including those with HIV, through MediCinema, a scheme set up in 1999 at St Thomas’ hospital offering film screenings to those receiving treatment. He recalls one patient with HIV who was moved to tears after seeing a particular film clip because it reminded him of friends lost to Aids. Now Munns is planning to set up his own cinema support group for people over 50 with HIV.

He says: “It can be a lonely future if you’re getting older, you’ve lost your partner and you’re living with the stigma of HIV. The magic of cinema is you go in as a stranger and come out as friends. It brings you together with others, it gets you talking about and sharing your own experiences.”

* Name has been changed

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Writer of IVF play blasts ‘privatisation of reproduction’

IVF treatment in the UK has become a money-making racket, according to a writer who found her own personal experience “brutalising” and has written a play inspired by it.

Details have been announced of the premiere in June of a play at London’s Hampstead theatre. The 40th anniversary of the birth of Louise Brown, the world’s first “test tube baby”, on 25 July will coincide with the play’s run.

Its writer, Jemma Kennedy, said her experience of private IVF treatment was so bad she felt compelled to write a play.

Kennedy recalled going in for treatment in a state of “blind panic and emotional chaos”, which she said was common for most people.

“It is a very charged time and I came out of the experience feeling brutalised. It was nothing physical, it was the attitude of the private sector … It felt like it was all about money,” she said. “It is the privatisation of reproduction, the final frontier of capitalism.”

Kennedy, who has previously written about her experience in the Guardian, spent £4,500 to have her eggs frozen, not really appreciating the slim chances of the process being successful.

It was an emotional time, but there was no counselling. “Nobody sat me down and said: ‘Have you really thought about why you are doing this? What are the options? Where are you with your partner? Can you afford it? What’s going to happen if it doesn’t work?’ It all just felt like a business transaction, and that’s what I felt was brutal.”

Her play, Genesis Inc, explores the experience of four couples at an IVF clinic and will be directed by Laurie Sansom, former artistic director of the National Theatre of Scotland.

It is a comedy, which Kennedy believes may have put some theatres off staging it. “I think some people feel you can’t laugh at this subject, whereas I feel the opposite.”

Kennedy, whose previous plays include The Gift at the New Vic and The Prince and Pauper at the Unicorn Theatre, is also a novelist and screenwriter who is to adapt Iris Murdoch’s The Sea, The Sea for BBC television

She believes the IVF industry trades on fear and hope. “Nobody did anything illegal,” she said of her experience. “Ultimately they are a business, but they masquerade in this feminist narrative of helping women preserve their reproduction, and frankly I just don’t buy it.”

The new play was one of three announced for the summer of 2018 by the theatre. Others were a new play by Fiona Doyle, The Strange Death of John Doe, which is based on real events and tells the story of an unidentified body found face down in a suburban street; and the UK premiere of Describe the Night by American playwright Rajiv Joseph.

How burnout became a sinister and insidious epidemic

In a bedroom in North Yorkshire at 2am, Sara Cox lay next to her sleeping husband in the dark, her eyes open and her jaw clenched shut, anxious thoughts whirling. For the previous two years, the stress of her job at an independent local pharmacy had gradually become intolerable. That night, in June 2013, she made a plan. She crept out of the bedroom and sat at the kitchen table with a pen and a piece of paper. She says now: “I just thought: ‘I can’t do this any more, I need a safety net. I’m going to write out my resignation letter, keep it in my handbag, and if I have another really bad day, I’ll just quit.’” She wrote it out by hand and put it in an envelope, signing herself a cheque for freedom that she could not yet give herself permission to cash.

Over breakfast, she told her husband what she had done. “He told me: ‘That day has come. I’m going to drive you to work and you’re handing in your notice today. We will cope,’” she says. “So that’s what I did.”

In September 2017, in the headquarters of a London high-street bank, Adam was celebrating having completed a major project on deadline. But, moments later, he felt a sharp pain in the side of his abdomen that went on to keep him up all night. The next day, he took 30 minutes to walk from the station to the office – usually just a 10-minute journey. A colleague sent him home, and later that week he found himself rolling on the floor, clutching his stomach in agony. The following week, he was back at the office. “Even though, physically, I was better, I couldn’t focus or think straight,” he says. “I would stare at my screen, unable to engage my brain to send a simple email. I couldn’t remember how to solve a simple problem on a spreadsheet, or who to call – all of which would have been instinctive before. I had blurred vision, like a fog hovering over me. That’s when I realised that what I was experiencing was mental burnout.”

Burnout is what connects Cox, 51, with Adam, 32, both of whom contacted the Guardian in answer to a request to hear from readers who have experienced psychological breakdown following stress at work. They were among 80 teachers, accountants, social workers, architects, students, lawyers and more, aged between early 20s and late 60s, and drawn from all over the UK. According to the Health and Safety Executive (HSE), 526,000 workers in the UK suffered from work-related stress, depression or anxiety in 2016/17, and 12.5m working days were lost as a result over that period. The independent watchdog’s research shows that workers in health care, social care and education are more likely to suffer than those in other industries – a recent review found “a worryingly high rate of burnout” among UK doctors – and women are more likely to suffer than men. Clinical psychologist Rachel Andrew finds that burnout-related symptoms are taking up more and more of her time in the consulting room. “I have certainly seen more of it over the last 15 years that I’ve been practising, and I’ve particularly seen an increase in men,” she says. “I don’t think that’s a negative thing; I’m seeing it earlier on, and seeing more men talking about how they are feeling.”

The most poetic definition of burnout appears in the ICD-10, the World Health Organization’s International Classification of Disease, which characterises it as “a state of vital exhaustion”. Although burnout manifests in our mental health, says Kate Lovett, consultant psychiatrist and dean of the Royal College of Psychiatrists, “it is not considered to be a mental illness, but rather a form of chronic workplace stress”. It encompasses a spectrum of experiences, says Andrew: “At the extreme end there are people who entirely shut down and end up in hospital having physical investigations; at the other end is someone showing signs of anxiety, low mood and feeling detached from day-to-day life.” In the ICD-11, due for publication this year, the condition is described as “not a single event but a process in which everyday stresses and anxieties gradually undermine one’s mental and physical health”.

City workers take a break


City workers take a break: 12.5m working days were lost in the UK in 2016/17 due to work-related stress. Photograph: Christopher Furlong/Getty Images

That’s what makes it so insidious, says Brian Rock, psychoanalyst, clinical psychologist and director of education and training at the Tavistock and Portman NHS Foundation Trust. He describes it as, “a drip, drip, drip. Patients will say: ‘I didn’t know this was happening to me.’ It’s like a mission creep of sorts, where you find yourself working a bit later, taking calls on weekends, being less inclined to play with your children or feeling more isolated and irritable.”

When Adam was promoted in the summer of 2015, he says: “I knew it would be a great opportunity, but I also knew people in similar roles had suffered burnout – you would hear horror stories about the pressure and the hours. My reaction, instead of saying, ‘I need to be careful and have open and honest conversations with my employer,’ was to say, ‘I’m going to do it better than everyone else. I’m going to be the guy to buck the trend.’” And, at first, he thrived. “I loved being the last man standing in the office, when the lights turned off around me because no one had moved on my floor, and even the security guards had gone home.” But, two years later, he could see the damage he had done. “I definitely wasn’t happy,” he says. “It was such a warped mentality.” He started drinking every day, and neglected his marriage. “I was so irritable and grouchy, my wife was afraid to talk to me,” he says. “She really suffered for a long time.”

Before stress overwhelmed her, Cox had thrived on the challenges of working in a community pharmacy: “I liked the responsibility, the learning and the knowledge, and I was so proud to have that career,” she says. But after nursing her mother for her final two years, she had only one week off to arrange the funeral. Around that time, an experienced colleague left and was replaced by well-meaning but inexperienced staff, so Cox felt she was having to help them with their jobs as well as doing her own.

She says: “It wasn’t the hours; it was the nature of the work. Time away didn’t alleviate it. Every Sunday, I had that feeling of dread that the next day I was going to have to juggle everything all over again. I put on weight. I’d wake up exhausted, it felt like every day I was walking through thick mud.” She would grind her teeth until they cracked and she had to pay for expensive night-guards and remedial massages to alleviate the pain in her jaw. “All I was doing was masking the problems caused by the pressure I was feeling at work,” she says.

Andrew understands burnout as a defence against intolerable pressure and stress: “In the people I have met, it can be quite functional – the only way your mind and body have left to keep you safe, of protecting you when there are no other options available. But it’s not a decision that you make; it happens unconsciously.”

So whom should we blame? The experts warn against leaping to conclusions about incompetent and aggressive management, or “snowflake” employees with no resilience. Rock argues that we need to think in a systemic way, and see experiences of burnout as symptoms of an ailing organisation, rather than a sick individual. To this end, the Tavistock also works to support organisations in the corporate sector. Robyn Vesey, organisational consultant for Tavistock Consulting, says the question of blame itself is symptomatic of a burnt-out workplace: “Blame is indicative of the problem in the first place: there can be an atmosphere and a system which is supportive of collaboration, sharing out the stress of the team and creating a sense of shared purpose and healthy interaction – or there can be one that leads to blame and people reaching a point where they can’t carry on.”

Beyond the workplace, we live in an age when society itself seems to be burning out, with austerity, rising poverty and the uncertainty caused by Brexit pushing people to and beyond their limits. “Burnout could be seen as a condition of our times,” Andrew agrees, as cuts to services are making it harder and harder for people to cope: “Alongside cuts to social care, there are cuts to the voluntary sector, projects around domestic violence, for parents, for older people. Stopping a group for carers of people with dementia might seem like a tiny thing, but we have reached a critical point of extremely limited support, and if you’re in that situation, over a period of time, it makes complete sense that your body and mind would shut down. I see strong, capable, independent people who have reached a stage where there is no other option.”

There are certain factors that protect a workplace from burnout, says Vesey – a sense of purpose, a sense of belonging, and a management style that finds “a balance between clarity and presence, but also offer people autonomy to allow them to get on with what they need to get on with”. Without these, a business and its employees are more vulnerable. Rock is realistic that businesses need to prioritise performance, but says: “It’s about thinking how you get the best performance out of your people. We should not move the way a charity operates into the financial sector – it would lose its competitive advantage very quickly – but there are things managers can do to support their staff, such as creating an environment where people can talk about what’s happening in the organisation, what’s happening for them.” What Cox suggests a boss should say is: “We recognise you’re having a tough time. What can we do to help you?”

After working her notice, Cox took 10 months off. A counsellor helped her grieve for the loss of her mother and of the career she had worked so hard for. “It helped me see that I hadn’t failed,” she says. At first, she was scared to leave the house, but she forced herself out for a walk each day. She went swimming. She says: “I thought I’d walk into the pool and it would be full of gorgeous people with great bodies, and they would see this frumpy woman plod in. It was mortifying. But as soon as I got in the water, the sun shone through the glass walls and I could feel it warming my skin. It felt so good.” She learned to knit: “It’s so therapeutic; doing something with your hands and counting the stitches with your brain. If anything pops into your mind that’s stressful, it can’t stay there long.” A few months in, she says, “I turned to my husband in the kitchen and he gasped and said: ‘You look 10 years younger.’”

Woman with head in her hands


‘I see strong, capable, independent people who have reached a stage where there is no other option,’ says one clinical psychologist. Photograph: Alamy Stock Photo

Adam was signed off work for two months with stress-related illness on the understanding that he would have a phased return to work and find a new role within the company. He took short-term medication to help with anxiety and insomnia, and for two months saw a counsellor, who challenged his beliefs about success and failure. He spent time reading, visiting family and cooking for his wife, making time to reconnect.

Now back at work, Adam has been helped by a supportive team, but says: “Being rescued by colleagues was humbling for me and difficult to accept. Looking back on it, I realise I should have been relying on them much earlier and accepted the fact I’m not Superman.” He has thought about how to protect himself in future: next time, he says, he will notice the warning signs. He will rest. He has removed all phone chargers from the bedroom so he cannot check his email in the middle of the night. He now gets his adrenaline from playing regular tennis games rather than working until the early hours. “My wife and I are going to see a movie tonight – I can’t remember the last time we did that,” he says.

But he doesn’t have it all figured out. “I still feel broken – I’ve got a broken mindset,” he says. “I’m aware of what the issue is, but the issue is still there. Everyone’s got a boss, and if the top man is stressed, the people below get stressed. I do know people who have somehow found a level of tranquillity in that environment, who don’t let that get to them – that’s where I aspire to be. It’s a difficult journey, but if I want to make it to 40, I’ve got to do it.”

Cox now works in a small museum, running the shop and admissions desk. “I bounce to work now,” she says. “But there is a sense of loss, and regret. I had to mourn my old job.”

This attitude is crucial for recovery from burnout, says Andrew. “Your body and mind are saying: stop. You need to take a break and have the space to reflect on how you have reached that point, either on your own or with support.” The danger, Rock says, is when people come back fighting. “If you say, ‘I’ve had burnout but I’m going to get on top of this, beat the burnout and get back to work; people may have lost confidence in me, so I’ll work even harder to prove them wrong’ – well, you can tell that’s not necessarily going to end well.”

Rock sounds optimistic when he speaks of recent developments: there is the new network Minds@Work, while Lord Dennis Stevenson and Paul Farmer, CEO of Mind, have published Thriving at Work, an independent review of mental health and employers. Both emphasise the responsibility of employers to take care of their employees’ mental wellbeing. “I think that is resulting in a change about how people think about limits and vulnerability,” says Rock.

A senior colleague recently told Adam: “I saw that coming, I’m sorry I didn’t intervene.” Can we all learn from his regret, to support our colleagues, to notice if someone is struggling and to offer support? Rock says the right approach is the same for a psychoanalyst, supervisor, colleague or partner: “Being open.” That is why Cox and Adam have spoken out; they want to be open about their experiences, so they can help others. Cox says: “It’s one of those hidden things in the workplace, that people are suffering with stress and pressure, and they’re ashamed to talk about it because it’s seen as a sign of weakness, and it shouldn’t be.”

This is about all of us. As Andrew says, “People say that one in four people suffer from mental health difficulties. It’s time to move away from that thinking. It’s not ‘us and them’; it’s each of us living a life with peaks and troughs, and anyone suffering from enough pressure could be at risk of developing burnout.”

Five signs you could be suffering from burnout

People in the throes of or heading towards burnout might experience the following symptoms, say psychologists Rachel Andrew and Brian Rock:

You feel exhausted, with no energy to do anything. You might experience disturbed sleep, and some flu-like symptoms.

You have difficulties concentrating, and feel as if your mind is zoning out, going into a daze for hours on end.

You feel irritated and frustrated, often becoming self-critical.

Supermarkets and similar places begin to feel overwhelming – the lights are too bright and there is too much noise.

You feel detached from things you used to love.

From rinsing to whitening – why you’re looking after your mouth wrong

A Twitter discussion has revealed that you don’t need to moisten your toothbrush before using it. Here are five other tips for top-notch oral hygiene

Young girl brushing her teeth


It goes a little something like this … Photograph: LightRocket/Getty Images

A recent lively Twitter discussion revealed, as these things often do, the existence of a group of utter barbarians: people who do not wet their toothbrush before brushing their teeth. It is almost impossible to believe such people exist, let alone that their method works, but it does. Apparently, it is a matter of preference. “A dry brush increases friction with the bristles and won’t dilute the fluoride in the toothpaste, while a wet toothbrush adds moisture and, for most people, makes the brushing experience more pleasant,” says Damien Walmsley, a scientific adviser for the British Dental Association. “Whatever your preference, what really matters is that teeth should be brushed twice a day, for at least two minutes, with a fluoride toothpaste, including last thing at night.” So, if it is not necessary to add water, what else might we rethink in the dental area?

Don’t brush straight after meals or after certain drinks

Orange juice


Photograph: Getty Images

“If you eat anything with sugar or carbohydrates in it, the enzymes in the mouth create an acid,” says Derek Richards, a consultant in dental public health and the director of the Centre for Evidence-based Dentistry. This can weaken the surface of the teeth. Sugary drinks or fruit juice “will dissolve the very superficial layers of the teeth; if you brush your teeth straight away, you’re going to start brushing that [surface] away. If you want to brush your teeth straight after fruit, wait 10 minutes or rinse out with water and then brush.”

Spit, don’t rinse

“You shouldn’t rinse your mouth out after you’ve cleaned your teeth because that washes away the fluoride that helps harden your teeth,” says Richards. “Most of the real improvement in the reduction of tooth decay since the 1970s is largely down to toothpaste manufacturers and the fluoride they’ve been putting in.”

A knocked-out tooth can be saved

Sometimes. Rinse it and put it back in the socket immediately, then get to a dentist. If you can’t put it back in or can’t face doing that, put it in cow’s milk – not water – while you seek dental attention. “If it’s put in milk within five minutes, the root’s cells can be preserved for up to an hour,” says Monty Duggal, a former head of paediatric dentistry at the University of Leeds.

Good bacteria might prevent bad breath

Mouthwash


Photograph: Getty Images/iStockphoto

In 2013, Scientific American reported that researchers were looking at whether supporting the mouth’s good bacteria could improve bad breath. If this is the case, antibacterial mouthwashes, which kill off all bacteria, could do more harm than good. You can buy oral probiotics, but a review last year of the small number of studies concluded that the data was “deficient”.

Don’t get your teeth whitened by a beauty therapist

It is illegal, although some unscrupulous people offer it. It is possible to buy home whitening kits online, which may conrain unsafe levels of hydrogen peroxide and cause burns or tooth loss. As long as it is carried out by a dentist, teeth whitening is considered safe.


I love my job as a nurse – but I’m not sure how much longer I can carry on | Anonymous

Despite what Jeremy Hunt may say, NHS professionals aren’t properly rewarded for what they do. Our wellbeing is at risk

Nurses protest about their pay in July 2017.


Nurses protest about their pay in July 2017. Photograph: Szymanowicz/Rex/Shutterstock

I’m a nurse. While I don’t hate my current job, I don’t love it. I no longer feel the burning desire to help people the way I used to.

Don’t get me wrong, I care greatly about my patients and I find real satisfaction in helping others get better. I don’t, however, find any real satisfaction in helping to quite literally save lives and being incredibly undervalued for it. If that makes me a bit of a brat, then so be it.

I became a nurse after solid advice from my mother: “You don’t have to pay fees [this has now changed] and you’re pretty much guaranteed a job for life unless you kill someone.” There is no sarcasm in the use of “solid advice” here – my mother was right – I didn’t pay fees and I got a job before even graduating from university, as a result of my first and only interview. I have worked in an intensive care unit since then.

Intensive care units are remarkable places. Every single day patients and families suffer both the most traumatic and uplifting moments of their lives, and we are there beside them. I have spent Christmases away from my own family, holding the hands of someone who had just lost a loved one. I have spent Saturday nights covered in bodily fluids and preforming CPR (cardiopulmonary resuscitation) on people I was speaking to moments before. I have done all this with an army of other nurses by my side, plodding along with very little argument, because that’s what nurses do, among about a thousand other things that people just don’t see.

However, having trained for three years and undertaken additional training in my own time and at times my own expense, that same job I got straight out of university could well be the job I have until I retire.


I never expected to become a millionaire as a nurse, but I would like to feel valued for the work I do

You see, while there are opportunities for development within the NHS, they are few and far between and often come with a large jump in responsibility without a matching increase in pay. I started on a salary of about £22,000 a year – a reasonable graduate salary. As a Band 5 – my current position, a position in which many nurses stay for their whole career, my salary will never surpass £28,500. For comparison, a friend of mine working in marketing is earning in excess of £35,000 a year, working nine to five, Monday to Friday, without the very real burden of other people’s lives resting on their shoulders.

In short, the NHS is, for a multitude of reasons, unable to pay and treat its staff the way it should. Despite what you might end up believing if you listened to Jeremy Hunt and Theresa May, nurses and doctors (and all other healthcare professionals) work exceptionally hard, 24 hours a day, 365 days a year, to care for you and your loved ones – and they aren’t rewarded in the way they deserve.

I am aware that what I have written might make me seem ungrateful for my secure (for the moment) job. I am ready for responses along the lines of “nurses aren’t nurses for the money”, and “you knew all this before becoming a nurse”. While this is true – I never became a nurse with the expectation of becoming a millionaire or owning a Maserati – I do, however, hope to some day be able to become a homeowner and, aside from any material gains, I would like to feel valued for the work I do. I am beginning to feel, along with more of my colleagues than I can count, that a career in nursing is unlikely to ever provide me with these opportunities. It’s all very well and good helping to improve the lives of others, but, perhaps selfishly, I would like to be able to do this without such a great cost to my personal wellbeing.

I am immensely proud of working for the NHS. The very fact that any person in the UK can walk into a GP’s surgery or hospital and be treated and cared for without paying a single penny is something we should all be tremendously grateful for. The NHS is grossly underfunded and yet remains free at the point of care, for everyone. It employs some of the most gifted and caring people in the world.

Having been a part of that amazing system I know that, in one sense, I will always be a nurse. For the time being, I am still employed as one. I just don’t know how much longer I can last.

The writer is an ICU nurse for the NHS

Cancer, Clare and me: actor Greg Wise on the death of his sister

A year after the death of his beloved sister, Wise talks about caring for Clare in her last days, and the blog, now a book, they wrote together

Greg Wise and his sister Clare, London, autumn 1995.


Greg Wise and his sister Clare, London, autumn 1995. Photograph: Rose Smith

It is more than a year since Clare Wise, sister of the actor Greg Wise, died of cancer. She lived just down the street from the West Hampstead house her brother shares with his wife, Emma Thompson, and their daughter, Gaia. As Greg opens his front door and leads the way into his kitchen, one can see, within minutes, why he was such an indispensable carer to his sister during the last weeks of her life. Today, he has organised elevenses with good coffee and patisserie. As an actor, he is routinely cast as a reprobate (Mountbatten in The Crown a debatable exception). In life, he could not be nicer if he tried. And that’s precisely it: he does not appear to be trying – the charm is not fake. When I ask him how he is feeling about Clare’s death now, his eyes fill.

“I’ve had very few days when I’ve not been actively doing something about Clare, be it probate, sorting out her flat, moving furniture – or just the book.” The book is Not That Kind of Love and is a shared effort, written by Clare and Greg. It is fuelled by wisdom and wisecracks, a story of brotherly, and sisterly, love. Clare was 18 months Greg’s senior (he is 51) and worked for the UK Film Council and as vice president of Universal Pictures. She started a blog in 2013 (although the first lump in her breast was found in 2007) and her take on illness drew a crowd – 96,000 hits (by 2015). No wonder: her style is gallant, funny, self-deprecating. It was not until June 2015 that cancer made its terrible comeback into her bones and Greg moved into her flat to take care of her and Grably (her attention-seeking cat). He also took over the blog when she became too sick to write.

Clare’s devotion to her brother (she described him as her “best friend”) is the book’s brightest thread. She relies on him to come with her to hospital appointments knowing he will charm the nurses, tell the right jokes, keep her going. And as to taking on the blog, Greg explains this was a practical decision to protect them from “endless phone calls, emails and texts” and Facebook messages. “It was our way of saying: ‘Please, please, leave us alone. This is what’s happening. Don’t panic.’” Greg’s contribution, which makes up the book’s last third, starts as an update on how Clare is and becomes a meditation on life, on the importance of cherishing the small things – the bark on a silver birch tree in a certain light, matching socks, a slice of cake (he speculates on how differently we would feel were the cake “eternal”). The book ends with Clare’s death at home and is an unedited, un-dolled-up reproduction of their blogs. The writing sometimes has a rough-at-the-edges quality, and this is because Greg insisted it be published as first written: “The thing I felt most violently was: we can’t edit this. This is a real-time piece of writing.” He later discloses, “I’m lucky in that I’ve always been very present” (a good quality in an actor).


I didn’t lose Clare – she died. Passing. Losing. Slipped away… Please. We have to be able to speak death

Now, returning to the question of how he is, his voice wobbles slightly: “When someone goes through a life-limiting disease – and you never know, at the time, how limiting it will be – you have to be careful not to pre-grieve. And yet I couldn’t help grieving for the state my sister was finding herself in. And when she died, I felt, fucking hell, thank God, because this was untenable. Bone cancer is excruciating and this was hard, hard, hard. A part of you is grateful and then you try not to give yourself a hard time for being grateful. I know I’ve not necessarily learned this – and, oh God, I sound like the Dalai Lama – but grief and pain and misery are important. They’re what make us. Life is going to throw shit at you and it’s how you deal with it. It will give you the opportunity to see who you really are.”

The Dalai Lama quip is typical Greg. What is so beguiling is that his seriousness refuses to part company from his talent for seeing absurdity in himself and in life: “It’s essential to be able to have a laugh and Clare was able to do that. Our sense of humour was similar. We loved puns – the groaningly bad sort – and, because of our history, we were able to vibe off each other, to jam, which is a glorious thing.”

I want to know more about Clare. There is a beautiful photograph, on the cover of their book, of Clare and Greg, taken when she was well. She was a generous beauty, with Titianesque red hair, and a teasing smile. She has one hand over Greg’s eyes. What would it have been like had she been with us this morning? “She was open, ebullient, loved socialising. She would have had the croissants at the ready. She’d probably have had a fire on. She might have given me a row for wearing a slightly scruffy top [a crushed, long-sleeved white cotton shirt] but be pleased I’d had a shave. She’d be able to talk well about anything you asked her. She was a ridiculously bright girl [she had a double first in history from Cambridge]. She was cerebral, a huge reader, artistic and wrote beautifully.

“We shared a lot of traits but were very different. It was more than just a boy/girl thing. We were brought up in Northumberland [they lived in Newcastle and had a weekend cottage in the country]. Clare was a city dweller, she couldn’t do countryside.” The cosmopolitan sister was also a virtuoso aunt: “Aunts are fantastically important. On the odd occasions I’ve been asked to be a godparent, I’ve said: ‘I don’t believe in God, but can I please be a rogue uncle? I might be a bit shit for the first years but once they get to 17/18, I’ll take them out and get them pissed.’” Clare was “a rogue aunt” and “an extraordinary travelling companion”. She had a rapport with both their children. Tindy is Greg and Emma Thompson’s adopted son – now 31 – a former child soldier from Rwanda whom they met at a Refugee Council event when he was 16 and who is now a human rights lawyer. In the book, Greg describes Clare as having been “a powerful figure” in Tindy’s life: “She drove him around showing him his new country; introduced him to the sea (where he rushed in fully clothed) and to his first gay couple; got him his first bike; taught him what a ‘holiday’ is; taught him lessons about family.” She was equally close to Gaia (18) who, by the sound of it, could come up with her own version of Travels With My Aunt. “Gaia has been lucky. It is so important to have someone of your parents’ generation who you can go to and say: ‘My dad is such an arse.’ And they can go: ‘He’s always been an arse.’”

Greg Wise


‘You have to be careful not to pre-grieve’: Greg Wise photographed by Antonio Olmos for the Observer New Review.

In the book, he explains the closeness he and Clare shared as a united front against a “tricky” upbringing. Why tricky? “I would opine that perhaps our parents should never have married (“opine” comes across as a joke choice of verb, suggestive of his caution about getting launched into the subject at all). “It’s difficult because although my parents are dead, I don’t want to upset folk who knew them. Yet anyone who knew the set-up would know it had a reasonably tricky dynamic which made Clare and I work together well, play well and keep our heads down.”

Their parents were architects and Greg initially studied architecture himself and still has plenty of practical flair. Being a carer, he volunteers, is about “minute by minute problem solving” and “trying not to catastrophise”. He goes on: “Generally, if you sit and think – and one of the things you do most as a carer is sit – you can work things through.” He has a sympathetic sensitivity to the potential imbalance between sick person and carer. He maintains that Clare’s “focus on trying to find solutions” helped them both. He would try to “facilitate” whatever she dreamt up. Most importantly, he writes, “It is a hard thing to do, to accept help. It is so much easier to give.”

The impression I am getting is of someone not as different from his description of Clare as he makes out. Like Clare, he is an avid reader and determined to come to grips with what he has been through. In his non-aggressive way, he is a man on a mission. Our “dysfunctional” relationship with death, he suggests, may be about to change: “Almost daily, there are pieces on the radio and television about death and dying. It is the zeitgeist. And it may be because we have never been more anxious about our future, with Brexit, Trump and North Korea. And books like Atul Gawande’s Being Mortal and Paul Kalanithi’s When Breath Becomes Air – about a surgeon dealing with critical illness, and about a surgeon dying – hit the public imagination.” He also raves about Kathryn Mannix’s recently published With the End in Mind. He is convinced that we are frightened of death partly because we don’t “see” it.

Caring for Clare has given him the keenest sense of how much the UK depends upon its carers. “There are 7m carers in the UK and generally with little help and almost no support from government. If they all went: ‘We can’t do this any more,’ and made the state responsible, the NHS would be bankrupt overnight.” Clare was treated in the NHS’s Macmillan Cancer Centre, “a huge, beautiful, bespoke building with extraordinary people in it”. And even though they sometimes had to wait hours before being seen, he remains a passionate champion of the NHS: “We must fight to the death against the NHS being sold off,” he says and wagers: “I’m pretty sure people would accept a ringfenced increase in tax to pay for it.”

Clare and Greg as children at Wallington Hall, Northumberland, circa 1969.


Clare and Greg as children at Wallington Hall, Northumberland, circa 1969.

What particularly preoccupies him is that “hospitals are not designed for people to get better in. Most people want to die at home but end up dying in hospital. Did you know that most doctors die at home? We have to sort this out as a society. We must demedicalise death. At the point where the palliative care needs to kick in, we have to be professional enough to have that conversation.” He recognises that palliative care has become a fine art: “It is extraordinary.” And he explains: “One of the main conversations you have as a carer is: what is the trade-off between pain management and still being able to be active, if that is what you want to be?”

He briefly speculates, too, about why there is a cancer epidemic at the moment. He does not buy into the idea that it has anything to do with stress: “African subsistence farmers are more stressed than we are,” he says. But he wonders whether certain food manufactures will, one day, be sued for the toxicity of their products – as the tobacco companies once were. And then he adds quietly: “No one is to blame for getting ill.”

It was on 12 September 2015 that Clare described in her blog the moment of being told: “Clare, you have incurable bone cancer…” Her reaction? “WTF, I THINK IS WHAT THE MODERN KIDS SAY…” It was a bombshell that was cruelly timed. She had been about to go with Greg, Emma and Gaia on the “holiday of a lifetime to Greece”. Instead: “I called Greg. Poor Greg – for the second time in his life he had to get a phone call from me saying, ‘Drop everything, it’s cancer.’” What is most striking is that she never had the slightest doubt that Greg would drop everything. There must have been times when being taken for granted was a burden? “Of course – but this was my choice. It was not to do with her. Or maybe it was equally about us both. For there was a contract struck between us that went all the way back to when we were three.” But he then adds the emphatic afterthought that he was not a one-man band.

Clare had a true friend in her sister-in-law. In her blog, she thanks “Em” for her love, strength and “overwhelming generosity and kindness”. And for the laughs. It was Emma who looked after her after her breast cancer surgery. It was Emma who gave herself a new role as hair stylist. On 23 November 2015, Clare writes: “I feel pretty good – have a new trendy pixie haircut (courtesy of my sis-in-law).” It was Emma who took on the not unchallenging task of giving her a shower. Greg’s later efforts used “every bath towel in north London”. Her steadfast qualities were a match for her husband’s. Just before the bone cancer diagnosis, Clare writes: “Em decided she couldn’t stay away with me not being well so gave up her holiday to look after me.” At the same time, she “instituted a very strict and healthy eating regime (also very tasty)”. Clare seemed to relish the side-effects of having a mega-celebrity as sister-in-law. It involved more than going to premieres of films (although this was an undeniable perk). It turned hospital itself into an event. She reports that hospital staff were respectful of Emma until Clare was discharged but that they then “all wanted selfies. As most of the staff there are from the Philippines, I suspect that Em is now more famous than Imelda Marcos.”

Seven months before she died, Emma took Clare to India. “They had a remarkable couple of weeks in an Ayurvedic clinic in Kerala,” Greg says, “Clare was pretty sick. But they had moments when it was just the two of them and they were able to talk.” In Kerala, Clare admitted to Emma that she wished she had let a different sort of love into her life. Greg writes: “She had an extraordinary amount of love in her life – she knew that – but not that kind of love…” And he now recalls: “The day Clare came back from India, I’ve never in my life – or hers – seen her look more beautiful and happy. She was radiating happiness and peace. But then literally the next day, she took herself to bed.” That was, in a sense, the end of her life – although there were to be gruelling clinical trials ahead.

Greg Wise and Clare, London, autumn 1995.


Greg Wise and Clare, London, autumn 1995. Photograph: Rose Smith

When I ask whether losing Clare taught him any big things, he reacts instantly – not cross but urgent: “I didn’t lose Clare – she died. We’ve got to be clear about that. Passing. Losing. Slipped away. Please… We have to be able to speak death. We don’t know how to talk about death which is odd because we’re all going to die. So: my sister died, she didn’t go to sleep… or pass… or whatever else.” And yet he knows from his own experience that we end up, for all sorts of reasons, skirting around the subject – as his experience of filming The Crown reveals. The first series was made while Clare was ill, and Greg did the job because Mountbatten was a small role. The filming of the second series began two days after Clare’s funeral. “Only the director, producer and first assistant producer knew. I didn’t talk to anyone else.” Protecting yourself? “I was protecting them as well – because people are going to think: oh God, what can I say? This was the first day of a seven-month shoot and everyone was excited. I thought: OK, make sure you know your lines, do them as well as you can.” When he watched the second series, he anxiously scrutinised his face to see whether he had given himself away (he hadn’t).

The big thing death teaches is, he believes, that life is unpredictable. The night before Clare died, Greg had no idea her death was imminent. He quotes from William Goldman’s Adventures in the Screen Trade – a “spectacular” book, published 30 years ago: “Goldman said the most important thing to know in the film business is that no one knows anything. We forget that. We never know what is going to happen.”

Towards the end, Clare couldn’t countenance the idea of anyone other than Greg looking after her, although she admitted to a friend, shortly before she died, that she knew her brother needed “time away”. She never said this to his face, afraid, presumably, of being without him. With hindsight, it seems possible that in registering Greg’s need to get away, she was also registering her own. He does not fail to record her last moments and characteristically assures Clare (he wasn’t lying) that he is sorting everything out:

“I wiped Clare’s face. I held her hand. I kissed her forehead. I told her I loved her. I said how unbelievable we had both been, but I said it was all just getting too fucked-up now. I told her that she didn’t have to worry, that everything was sorted. And I told her she could go now, if she wanted to.”

She died – a minute later – holding his hand.

Not That Kind of Love by Clare and Greg Wise is published by Quercus (£16.99). To order a copy for £14.44 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99

Will Self: ‘I’m fitter than I’ve ever been’

The novelist, 56, on the health benefits of eating less and walking more

Will Self


‘You’ve got to make your peace with getting older. It’s the key to good mental health in later years’: Will Self. Photograph: Rex

When I was a child and my parents separated, I went on walking holidays with my dad. My rubric’s always been to walk from home – I’m not a rambler. It’s about a sense of being and place and engagement with the environment around me.

I like wild swimming, particularly in the sea – I swim out, then float and look at the horizon. I think that’s extremely good for the imagination. I still cycle even though I was knocked off my bike a few years ago, but mostly in the summer – it’s too dangerous in the winter in London.

I’m on meds for a blood condition, which lowers my immunity so I can get a bit snippy with people if they’re breathing snot in my face. I’ll say: ‘Look, it’s really not great for me to get a cold.’

At 56, I’m up a few times in the night because of prostatitis. I have terrible trouble sleeping and I’m guilty of all the things we tell our children not to do – I stay online, I have my phone next to the bed as I’m concerned about my kids and want them to reach me.

You’ve got to make your peace with getting older. It’s the key to good mental health in later years. In adjusting to it lies a great deal of acceptance of mortality and the reality of your life.

I’m not 100% vegetarian, I’m that awful thing they call a flexitarian. I will have a bit of fish or meat because there’s nothing else available. Red meat just started to look unappealing. The ethical stuff is secondary to an aesthetic reaction to it. It’s eating a corpse and having it rotting inside you.

I’m an unlikely health guru what with 20 years of serious polysubstance abuse, but all things being equal I’ve had a healthy life of being Dorian Gray – my fittest years were my 40s, everything went into reverse. All you have to do is walk a bit more and eat a bit less and you’ll be fine. And don’t smoke.

Phone by Will Self (Penguin, £8.99) is published on 1 March