When women aren’t given pain relief for invasive gynae procedures

An extended version of the story published in Broadly by Vice on 16th January 2019.

hysteroscopy

If your doctor told you to take two paracetamol before coming in for a small medical procedure, what would you expect? As I went in for my first hysteroscopy—a procedure that examines the inside of the uterus with a small camera to explore heavy or unexpected bleeding, pelvic pain, fibroids, polyps, fertility issues, or diagnoses uterine cancer—I figured it might be like a smear test, or maybe an IUD fitting. The hospital leaflet I was given prior to the procedure told me to expect period-like cramping. I took some paracetamol with codeine to be safe, and laid back with my feet in stirrups.

As the doctor inserted the scope through my cervix I felt my uterus fill with cold water. I thought, this feels strange, but ok. But then the pain started and it was no longer ok. I hyperventilated as I clamped down on the nurse’s hand. Soon I was unable to keep quiet, moaning in pain, and as the biopsy was taken I felt a stabbing electric pain spread from my insides and across my entire body. I shouted out, “Fucking hell!” Afterwards, as I was panting and sweating, the nurse asked me pointedly: “Did you forget to take any paracetamol?”

The nurse’s reaction left me thinking maybe I was unusual. Was I being a wimp? It’s hard to feel bold with water running down your legs as they hand you a sanitary towel the size of your shoe. But in the days and months that followed I couldn’t shake the feeling that something was off. Why wasn’t I given pain relief? But what happened to me is not unusual, and in fact, many women’s experience of hysteroscopy is far worse than mine.

“I was hit with this indescribable pain, like a nerve pain but twenty times over. It took my breath away. I wasn’t able to talk, I couldn’t shout out. My legs were twitching, I started to feel sick and I felt hot all over,” says Lorraine (66) from Leicester, who prefers not to give her surname as she might pursue legal action. “I told the doctor afterwards that if childbirth was a 10 on the pain scale, but that was a 15 to 20. He did not seem at all concerned or bothered.” Lorraine’s counsellor has since diagnosed her with PTSD from her experience: “I’m having nightmares, and actually seeing things in the day. I keep seeing this man,” she says, referring to the doctor.

Pain, it seems, is a routine part of hysteroscopy. The dentist will give you a shot before starting to drill—pain relief is available and common. So why does the NHS continue to send women to have their wombs poked and prodded on paracetamol? And why, when women are in obvious pain, do doctors ignore them?

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NHS guidelines state that the pain levels accompanying hysteroscopies vary: some women feel “no or only mild pain,” but for others it can be “severe”. In a case like Lorraine’s, the guidelines say the procedure should be stopped and options for pain relief discussed, with options including gas and air, stronger pain medication, conscious sedation, or a up to and including a general anaesthetic.

The current guidelines from the British Society for Gynaecological Endoscopy’s (BSGE), the body overseeing hysteroscopy, does acknowledge that it “can be associated with significant pain.” Consultant Gynaecologist Justin Clark, Vice President of the BSGE, told me that hysteroscopies used to be done under general anaesthesia until the early part of this century, when technological advances meant the scope had become small enough to avoid needing to dilate the cervix. “But [the move to outpatient hysteroscopy] has also been driven by patients—by expectations of immediacy of care and getting a timely diagnosis,” says Clark. For women who find the procedure tolerable, this may well be a better choice: “People recognise that admission to hospital can have disadvantages, such as hospital-acquired infections and the risk of anaesthesia.”

Asked about the lack of concern women report about their pain, Clark is not unsympathetic: “A minority will have a very unpleasant experience, and if we could identify those women in advance that would be advantageous [so they can be given general anesthesia right away].” Revised guidelines from the BSGE are due in 2020, but a patient leaflet that addresses pain in a far more realistic way was issued on 19th December. The Campaign Against Painful Hysteroscopy, which has collected a well of women’s stories, has created a community via their Facebook page and it’s in no small part thanks to their work, supported by sympathetic voices within the BSGE and MPs, that more attention now seems to be paid to pain management.

Clark stressed to me that patient comfort is of the utmost concern for the BSGE, and their newest leaflet is certainly an improvement in ensuring women are fully informed. But the problem is that this information around pain management, and advice on how to mitigate it, is often not communicated to patients by their treating physicians, or mentioned in the leaflet that accompanies their appointment letter. While the option of a general anaesthetic is sometimes mentioned, the leaflets are individual to each hospital and often do not reflect the nuanced guidelines of the BSGE. Most women will simply be given a given a leaflet that makes light of any potential pain and go in trusting that two paracetamol and a stiff upper lip is all that’s required. Clark acknowledges this variation may mean not all women get the full picture: “It’s incumbent on hospitals to make sure their information leaflet is valid, and that they speak to the patient in a clear way.” Most women will trust that their doctors are telling them what they need to know, and not go looking for horror stories on the internet.  

Even women who ask directly about the pain ahead of time report that it’s underplayed by doctors, who tell them that most people “tolerate” the procedure well. “When I asked it if would be painful, the doctor and the assistants smiled at each other and told me women get this done all the time,” says Valentina (34) from London, who prefers not to give her last name as she still needs to go back to complete the procedure after it was too painful to endure without sedation. “I wasn’t given the option to make an informed decision.” This attitude from doctors seems typical: “I was told there would be minimal pain like having a smear, and as I’d had children it wouldn’t be a problem. [The doctor said] a local anaesthetic injection into the neck of the womb would be more painful than the procedure, and would prolong the appointment. I decided to grit my teeth and get on with it,” says Liz Vining (65) from Swansea. She describes her experience as barbaric: “I couldn’t believe what had happened to me in the 21st century. 18 months on I still get tearful remembering it.”

The number of women who report their hysteroscopy to be very painful varies, but a is around 20-30 percent. A 2014 study, whose findings are in line with similar studies, found that 20 percent of women described the pain as “intolerable”, 46 percent said “moderate” and 34 percent said “mild”. The pain is usually worse for women who’ve not given vaginal birth, or who’ve gone through menopause. Clark at the BSGE told me that a study of 1,600 outpatient hysteroscopy patients, soon to be published in the British Medical Journal, found that most women tolerate the procedure well: “The acceptability rates are high, over 90 percent. The pain scores [out of ten] are in the region of three to four.”

But it is important to note that this study was just for diagnostic hysteroscopy—entering the uterus with a camera and looking around—and did not include any biopsies or polyp removals. While talking to Clark I realised that the “looking around” part of my hysteroscopy was indeed a three or a four out of ten, but spiked to a nine only during the biopsy. This distinction during clinical research may explain why so many doctors tell patients that hysteroscopy is “tolerable”, but when I was in the stirrups I experienced it as a single event. Consequently, I felt like the doctors had not been truthful about the prospect of pain. Clark conceded this point: “I agree the biopsy is far more uncomfortable that a well-conducted hysteroscopy.”

Consultant Gynaecologist Edward Morris, Vice President of Clinical Quality for BSGE’s umbrella organisation Royal College Obstetricians and Gynaecologists (RCOG), told me that it’s been important to them to listen to women’s experiences ahead of the new guidelines in 2020: “We are aware of some women reporting that they did not feel well informed about the procedure and their options.” Morris told me that women should discuss concerns about pain with their doctors, as an outpatient procedure (without proper pain relief) isn’t right for everyone: “[For example] if she faints during periods because of pain, if she has experienced severe pain during previous vaginal examinations, if she has previous traumatic experience, or if she prefers not to have this examination while awake”. A 2014 study also found that pain may be worse for women who’ve not given vaginal birth or who’ve gone through menopause.

A chilling fact is that hospitals have actually been financially incentivised to perform outpatient hysteroscopies on women. In 2013, the NHS doubled the rates that hospitals would be paid to perform hysteroscopies as an outpatient procedure, and lowered the rates paid for anaesthetised hysteroscopies. The procedure used to be commonly performed under general anaesthetic, until a shift around 2001 in part due to the influence of NHS’s National Clinical Director for Cancer Sean Duffy. In 2001, in response to comments about outpatient hysteroscopy research, Duffy wrote in the British Medical Journal that while a “small proportion of patients do, undeniably, experience considerable pain”, he concluded that for most patients the “minimal discomfort” is worth the convenience of having an outpatient procedure. “Too much emphasis is put on the issue of pain surrounding outpatient hysteroscopy,” wrote Duffy. “A small proportion of patients do, undeniably, experience considerable pain, but most patients do not, and they trade off the minimal discomfort they experience with the convenience and interaction of outpatient hysteroscopy.”

When MP Lyn Brown spoke in Parliament on 11th December she said the NHS’s Best Practice Tariff system encourages quick-and-easy hysteroscopies in a way that prioritises savings over women’s dignity and humanity. Brown said: “The national target is for the risky outpatient hysteroscopies to increase to 70 percent of the total, up from 59 percent. The Department for Health is not working to reduce pain and trauma for women—it is incentivising hysteroscopies without effective pain relief and is taking our choices away.”

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Historically, women’s pain is taken less seriously by doctors. One 2001 study found that some doctors believe women have a “natural capacity to endure pain” due to the stresses of childbirth. Deb Drinkwater (56) from Salford says her hysteroscopy took away her dignity, as it left her screaming, crying, and losing consciousness. Drinkwater had previously had a bowel screening, a similar exploration of the back passage where patients are routinely offered sedation (Clark at the BSGE said that colonoscopies and gastrointestinal endoscopies, where the scope goes down the throat, are sedated because the tube goes further into the body and “around bends”). Based on her experiences with both procedures, Drinkwater says she can’t help but wonder if there’s a gender bias: “Colonoscopy is something that both men and women do.”

Drinkwater says she’s really not a wuss: “I know what pain is. I’m not an anxious patient.” But after her hysteroscopy, as she was struggling to stand, she made a nervous joke to the student nurse: “I said, I hope I hadn’t put her off nursing by being in such a state. She said to me, no lie: ‘Don’t worry about it, the woman before you screamed the whole way through it.’”

NHS England performed almost 39,000 “unspecified diagnostic” hysteroscopies last year, and the number is set to rise. 75 percent of women do find having a hysteroscopy bearable, but for the remaining 25 percent who don’t, their experience would be vastly improved if everyone knew in advance they could ask for sedation. If nothing else, being met with understanding when they experience painand an awareness that they’re not weak nor even unusual if they require pain medicationwould go a long way. Katy Wheatley (46) from Leicester initially felt shame and blamed herself for not being able to get through her hysteroscopy, even when the pain sent her into clinical shock. “But when I look back at it—they must have seen it so many times. No one in the room reacted when I went into shock. You could tell it was routine for them—that in this room, this is what happens to women.”

Doc Horn: Making the connection

Hedge Magazine, March 2019. Original article p30-32.

Interview with Doc Horn, Head of Total Return Equities at Pictet Asset Management

Doc Horn, an American in London, loves it here. “In the States, not even in New York, you don’t have the depth of history and cultural diversity of London. It’s so different than anything you can find in any city in the States,” he says – Horn has been living here for seven out of the past nine years, returning to London in the summer of 2017 when the opportunity arose to join Pictet Asset Management as Head of Total Return Equities.

We’ve met in Pictet’s offices in the City, enjoying the view from high up on a cold and sunny winter day. Horn looks sharp in a dark blue suit and green patterned tie, coming across as straight up professional on the topic of work yet open and cheery on other subjects; when they came back to London, he tells me in his mild-mannered way, they lived opposite Hugh Grant in Notting Hill for a time – the ultimate American in London experience.

Horn’s work at Pictet is very much one of being the boss, overseeing total return equity strategies as well as ten small global teams working on different approaches. “What I enjoy most are the conversations I get to have with all these bright minds, and how I get to help them formulate new investment ideas and help them understand risk in their broader portfolio. It’s an incredible opportunity, to be that connector.”

For investors, the choice is to either access the Pictet multi-strategy diversified alpha fund – a “hyper-diversified” fund of 17 strategies with low to no correlation to each other. Or they can pick an individual strategy or region and invest directly: “The idea would be to have numerous differentiated strategies that are focused on either a unique universe of coverage, or style or region of investing.” Three of the single-strategy funds are in Asia – Horn cites the China long-short fund as one of the most compelling strategies in the mix right now. Part of Horn’s job is to identify new strategies – most recently he brought in a specialist in merger arbitrage – that can be added to the mix. They take a long time to hire their managers, says Horn – when they have chosen someone, they invest in them and ensure they have the support of Pictet’s resources. “Then after a time, if we think it’s a viable product that investors would like, and if there’s still capacity or left-over room for more money to come in, then we’ll launch that as a stand-alone fund for investors to access directly.”

Sometimes Pictet will bring in fully formed teams who might have been working together for years, and the ideal approach may well be to pretty much leave them alone. “They know best how their strategy needs to be managed, and the less meddling that we do, the less chance of style-drift,” says Horn, who seems to be relatively hands-off with the process. “We spend a lot of time communicating with the teams, trying to understand the exposures that they have on their positioning, the way they’re thinking about the markets and about risk. We use that to help inform other teams [in the group] and find commonality in exposures or in themes that they’re playing, and connect different teams if necessary.”

Horn says the ideal outcome is when the teams actively work together. “I think that’s a key differentiation from many of our other hedge fund peers. We see collaboration as key to how these teams operate – the whole is greater than sum of its parts,” says Horn. “The knowledge base that exists from a global team [means we have] the ability to share a wealth of data and knowledge, and that is really beneficial to all our investors.”

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Horn (39) comes from a small mountain town in Colorado. “I grew up raising llamas” – yes it was unusual, and no, they weren’t for any purpose other than fun. “We had several animals, including a few llamas which I was mostly responsible for.” Horn estimates being trusted with this task from about the age of five. “They were a nightmare when they got out of the stable because they don’t like to come back. You’d get the neighbourhood together for a llama search party,” Horn laughs. He left for New Orleans at 18, studying business at Tulane University. He was “fascinated” by finance: “It just made sense to me. But I’d be lying if I said I was getting the Wall Street Journal delivered to my house at the age of fourteen.” The moment of conviction came at university when he took part in the Burkenroad Reports, a securities analysis programme where students became equity research analysts for a semester. “You’d meet with the company management and you do a full buy-sell-hold report. I had a little oil field services company called Trico Marine. … That was the thing that helped me get into equity research.”

Horn moved to New York after school and joined Fulcrum Global Partners. It was an interesting first job: “My first company meeting was with Ken Lay, the Enron CEO, on the same day the Wall Street Journal published the first article about potential accounting issues within Enron. That meeting was a fascinating entrée into the business. Ken was very smooth. He was an incredible speaker and presenter, probably not a fantastic manager in retrospect.” Asked how the experience shaped his view of the world, Horn says it’s imbibed a certain skepticism. Fulcrum continued to tote Enron as as a Buy recommendation after that day: “I was very junior at the time. As the stock dropped day after day, and more bad news came out, we failed to adapt our opinion on Enron to reflect the new facts. We allowed emotions and stubbornness to guide our rating, and it resulted in a poor recommendation to our clients.” It became an important life lesson: “You have to be pragmatic, and you have to cut your losses. Probably one of the things that has helped me succeed as a portfolio manager, and a manger of team, is a real willingness to look at both sides of the argument, and be willing to change my view.”

Before joining Pictet in 2017, Horn spent almost 12 years at UBS O’Connor, which provided exposure to a range of sectors and later, a variety of geographies including his first stint in London as head of the European team. “My career hasn’t been that long, but the cycles have been more compressed. Experiencing 2001, living through 2008, being in Europe during 2011, seeing the many crises and bubbles that have formed along the way. The one commonality in what I’ve been doing is risk awareness, and taking a very market-neutral approach.”

It can be easy to become a superstar for two years, but then flame out and never recover: “You can have five phenomenal years and one terrible year, and everybody will leave you on the side of the road.” Horn describes himself as a “smart risk-taker” who minimises the amount of volatility he’ll allow in his portfolios. Asked if that’s a controversial position, Horn says it’s more rewarded now in the post-2008 world: “Many investors have gravitated towards a much more risk-conscientious mindset in the past decade, and you see fewer hedge-fund cowboys. Our investors are the same way. That’s the mindset that we cater towards.”

Live to fight another day, in other words. Horn and his wife Lauren have four children aged between two and seven, which takes care of the question of what he does outside of work. He likes going out to eat though: “My favourite restaurant in London right now is a small Italian place, it’s looks like a gelato store front in Camden. But when you go in it’s a phenomenal restaurant, a BYOB place with no charm but outstanding food. It’s called Anima e Cuore.” It’s got increasingly hard to get a table there, says Horn, but he’s got a trick for that: “When you have four kids at home, you’re happy eating at 5.30pm when no one else wants a table.”

One last thing. Why do they call him Doc? His full name is Stanford Everett Zachariah Helms Horn. “My dad thought it would be a funny name for a child to have in nursery,” says Horn – it’s what he’s been called since he was a kid. Funnily enough, his brother Cash is the one who became a doctor, and Doc is in the “cash” business. “My parents got the right industries, just the wrong way around,” he laughs.

Everything and its opposite // Interview with Kathryn Joseph

Published in Oh Comely magazine, February 2019. 

Everything and its opposite

There’s so much want in Kathryn Joseph’s music. It’s right there in the title of her new album, “From when I wake the want is” – that feeling that sits there, under the eyes, under the tongue, and there’s nothing you can do except watch as the ache turns into a pleasure. At least that’s how sensations float together in Joseph’s music: “I think you need that sore part to make anything that’s beautiful.”

This is a heartbreak album, but unless I knew that Joseph wrote it in response to lost love I don’t think I would have been able to tell. Joseph leaves such a wide open space in her soundscapes that it could be about anything, as long as you’re willing to meet here there. The title reminds me of that quote by Poe: “Sometimes, I’m terrified of my heart, of its constant hunger for whatever it is it wants; the way it stops and starts.” I’m fascinated by the idea that there’s you and then there’s your heart, or your want – and that your want isn’t necessarily looking out for your best interests.

Joseph’s music seems to come from a place outside of her control: “Songs start off as noises, then I fit the words into it. I don’t really understand it.” The music swells behind the sparse yet sharp lyrics, delivered in Joseph’s sometimes brittle, sometimes cottony, voice. But there’s no self-pity there, as she sings it almost matter-of-factly: “How do I get rid of all this fucking love?” The song soars, creating a sense of floating as the soreness transcends into something almost comforting. You know when you’re experiencing something so intense that it flips over into its opposite? Like when you eat something so extremely sweet that it starts to taste acidic?

I’d been thinking about this for a while, long before I heard Joseph’s song – “From when I wake the want is” was released in August 2018. When I call Joseph at home in Glasgow, a few days after she opened for Neko Case in London, I don’t expect her to necessarily understand what I’m on about, but of course she does: “I am obsessed with the feeling that I am everything and its opposite at all times. It’s what I find almost disturbing about myself. I think my songs are that too.”

The new album follows on from Joseph’s 2015 debut, which won the prestigious Scottish SAY Award. But nothing about her story suggests she was expecting this success, or even really courting it. At 43, you could call Joseph a late bloomer, except that she’s always been making music – just, you know, for herself. “I’d been a waitress since my twenties,” Joseph tells me, describing her new life of making a living from music as something she just didn’t think she’d ever reach. She hated doing the things you need to do in order to get your music out, as it made her feel out of control. And her life before was good: “I loved my job, and I loved that it gave me a safe routine that was good for me. Then I could write however I was feeling it, and it didn’t matter how often I was doing it.” So going pro, if you will, was not ever something she actually planned to do, but then she moved to Glasgow and her neighbour happened to be Marcus Mackay, now her producer. Still, everything about Joseph’s journey has been a hide and seek experience – she recorded the first album without any expectations, and had it not been for the initiative of Claire Mackay, who runs the Hits the Fan label with Marcus, it never would have seen the light of day: “I was so paranoid about it, thinking it wasn’t anything that anyone would be interested in hearing,” she says. “I would never have done anything with it.”

I pause for a moment. I can see the appeal of keeping the thing you’re passionate about “untainted” by keeping it separate from any money-making ventures. But still, most people would be tempted to at least try? Joseph thinks about it. She loved her previous job and the people she was working with – she really liked her life, you know? She tries to explain: “I’ve lived in really beautiful places in Scotland … it made sense to me. It made me feel…” She stops, starts again. “I went to university when I was much younger, and my sister got really ill so I didn’t last long. I remember feeling, ‘I need to feel okay every day.’” This shift in thinking made it hard for Joseph to do things she didn’t like in the hopes of future rewards: “I still don’t feel like I’ve got that ability. Everything I feel is very immediate, and what I react to is very immediate. I’m not into long-term planning.”

Releasing the albums has been a far better experience than she expected, though. “The world has turned out to be a lot nicer than I thought it was going to be!” She laughs. “I love that this is my job now. I love getting to do it.” And it came at the right moment too – Joseph was actually offered a record deal when she was in her 20s, but felt very much out of her depth at the time: “I’m just so glad I waited until I was absolutely sure how the songs should sound and be.”

One of the most delightful things about Joseph’s lyrics is how frank they are – the words are sparse, but all the more effective for it. It’s a surprise at first, to hear these gorgeous, swoony songs liberally sprinkled with the word “fuck”. And not just as a swear word either – these lyrics are pretty sexual at times, describing one of the most fundamental wants. The tenderness of Joseph’s delivery means the songs can carry it, and of course, the weight of age and experience behind these lyrics makes them beautiful, whereas singing about fucking might have just been crude at 22. “I love that word. I use it a lot in real life as well. But I’m aware that I don’t want to use it in front of my child.” Joseph laughs – her daughter is seven years old. “But that’s the thing about being human I love best – I think sex is one of the most beautiful things we get to do as humans. Playing live and fucking are the only times when I don’t think about myself.”

Kathryn Joseph’s album “From when I wake the want is” is out now on Rock Action.

 

The case for the four-day workweek

BL Magazine, January 2019. Original article p54-57.

Sharing the spoils: The case for the four-day workweek

Automation leads to improved efficiency – but who benefits? Until now, the spoils of technological advancement has gone straight to the business bottom line, as staff keep working the same hours no matter how much time is “saved” by technology.

We were supposed to be working 15 hours a week by now, predicted the economist John Maynard Keynes – in 1930 he anticipated that technological advancements in “progressive countries” would mean we’d be enjoying more leisure. But it hasn’t happen, even as data is now automatically input, documents effortlessly shared across devices, reports instantly assembled, and hardware spontaneously alerts us when it needs attention. In spite of warnings that automation will put people out work, Britons put in some of the longest hours in Europe – we rack up £32 billion worth of unpaid overtime, according to a Trades Union Congress (TUC) survey from September.

And people resent working so much. 81% want to work less, the TUC found, and out of those, about half would love to have a four-day workweek. The TUC has thrown its weight behind this idea, calling it a way to ensure productivity gains are distributed fairly. “Bosses and shareholders must not be allowed to hoover up all the gains from new tech for themselves. Working people deserve their fair share,” TUC General Secretary Frances O’Grady said in a statement. “If productivity gains from new technology are even half as good as promised, then the country can afford to make working lives better.”

But working four days per week – while being paid the same as before – would it actually work?

screen shot 2019-01-10 at 15.43.41Initial reports suggest a four-day week may lead to improved productivity, even with fewer hours in the office. When researchers at Auckland University of Technology tracked a four-day workweek initiative at a 240-people-strong trust and estates company, they found that staff were less stressed and reported more motivation and commitment to their work, which in turn resulted in better performance. This makes sense: 12.5 million UK work days were lost last year because of work-related stress, depression or anxiety, according to the Health and Safety Executive, and the single biggest cause was workload.

The four-day workweek isn’t just some futuristic pipe dream. The fact that this idea has been floated at this point in time is no coincidence: we are finally at a point in technological advancement where it might actually be possible. There are already several businesses in the UK who’ve implemented a four-day workweek. The companies BL spoke did have the altruistic goal of sharing the spoils of technological advancement, but they also genuinely believed it serves the business financially.  

For NautoGuide, a digital mapping company in Swindon with five employees, the decision to move to a four-day week in September was motivated out of a desire to have more time to work on strategic goals. “We had a project that we really wanted to deliver long term as an investment, but we never got round to it because we were always firefighting,” says Dave Barter, CEO and Founder of NautoGuide. The company realised the answer wasn’t to have more resources or to be more efficient, but to have more time to think. “When you’re all in the office you never [take that thinking time], because the phone rings, email comes in, and people want things. The only way we could see to achieve that was by taking ourselves out the office.”

The staff at NautoGuide now work regular hours Monday to Thursday, and Barter thinks it’s fostered an appreciation that this is a place where you get rewarded for your good work right now, rather than maybe someday. “I think there’s also a benefit to being seen as having an open and forward-thinking culture, as [clients] see that and understand it will translate to our work too,” says Barter.

Rich Leigh is the Director and Founder of Radioactive PR, a dozen-people-strong public relations company in Gloucester. “I’ve got incredibly happy staff,” says Leigh, who started the four-day workweek initiative six months ago. The company is making more money than ever before, although the initiative has made a difference to the margins as Leigh has had to hire sooner than he probably would have otherwise needed as he doesn’t want to “squeeze five days into four”. The initiative has made the company an attractive place to work, Leigh says: “We get so many CVs. Inevitably we’ll be finding the very best people.”

Becky Simms, CEO and Founder of Reflect Digital, a marketing agency in Kent with a staff of 55, has also found that business has been good since moving to a four-day workweek in October: “We’ve closed the most business and had the most revenue.” The initiative was inspired by a desire for staff to be their best in the office, says Simms – agency work is high pressure: “You’re really worn out by the time you reach the weekend. [The four-day week] was inspired by that buzz you get after three day weekend. Now we can have that time to relax, but still really work hard while we’re in the office.”

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While these early day experimentations with the four-day workweek are promising, it is very early days – it is hard to say for sure just how this change will affect companies’ bottom line. But while people on the Channel Islands put in just as many long hours, corporations in finance, professional services, and tourism industries may be less inclined to opt for less time in the office as a means of passing on the benefits of automation, at least for now.

The Channel Islands are “not as advanced as the UK in terms of digital transformation, says Pierre Jehan, Client Services Director of Resolution IT, an IT outsourcing specialist in Guernsey. Pointing to the 2,000 vacancies in the Guernsey finance sector alone, Jehan says it’s clear that automation has a role to play in closing this gap: “But with the shortages that they have, employers may be reluctant to offer a day per week off.”

But employees on the Channel Islands are still seeing other benefits of automation and digital transformation passed on to them, with opportunities for remote working and flexible hours: “Automation can also make workers’ lives more enjoyable by taking mundane tasks away and making them more efficient, and letting them concentrate on the nicer things in their jobs.” Jehan strongly believes in rewarding the people who create the savings – if a department comes up with new methods for saving hours, they should directly benefit from it. “Companies, in whatever sector, should empower staff to use these technologies in order to become more efficient and innovative through digital transformation. And in the same breath, they should reward their staff for doing so.”

While agreeing that Channel Island companies should be looking to robotic process automation or AI to help fill the worker shortages, Justin Bellinger, Chief Digital Officer of Channel Islands telecommunications supplier Sure thinks there are fundamental issues that needs addressing before the four-day workweek will make it onto the agenda. This will include tutoring and retraining: “We need to work out what machines can do that will benefit our businesses. What do I want my people doing it instead of manual input? The answer will be more interpersonal skills and emotional intelligence – things that will add value beyond the basic grind.”

This has already started happening on the Channel Islands, says Bellinger, pointing to the fund insurance and trust sectors: “As we come under ever-increasing regulatory scrutiny in the financial services sector, I firmly believe that regulators will start to automate compliance. … We’ve already started to see that in the gaming industry.”

The proponents of the four day workweek have an uphill battle ahead to convince business leaders that more time away from the desk could actually mean better overall job performance. “But how long that person has spent at their desk is a false way of looking at productivity. We’re not working at cotton mills anymore,” says Bellinger. Most people can only focus for five or six hours per day before fatigue sets in and quality starts to decline; when a Swedish retirement home ran a six-hour workday experiment in 2016, they found that nurses were less stressed, got sick less often, and had more energy to spend on quality interactions with their patients. It’s a fallacy to think that keeping people at work automatically means getting more out of them.” Research backs this up – most people can only focus for five or six hours per day before fatigue sets in, so it’s a fallacy to think that keeping people in the office automatically means getting more out of them.

For Rich Leigh, the change to a four-day workweek has had the benefit of positioning his company as forward-looking and innovative. “We’ve had clients come to us as a direct result of this, saying they we like the fact that we don’t just talk the talk, but walk the walk too.” Ultimately, Leigh cares about ensuring his staff are happy: “These are people you spend the majority of your life with. Why wouldn’t you want to give them the best time that you can?”

Hotel

Published in Lionheart Magazine, the ‘Bright’ issue, in November 2018. 

Hotel

“Stay as long as you like,” he said as he headed out the door. “Take anything you want from the minibar.” That’s quite the offer, isn’t it. It was already late in the morning, but the moment was irresistible: I was in a hotel robe, the sun was filtering into the perfectly air conditioned room, and the sounds of the world were muffled by thick glass and even thicker carpet. It was a moment that seemed to exist outside of time.

Staying in a hotel in the city where you live may well be the ultimate indulgence. I didn’t need to be in that room – I live in London and my house was just a couple of miles away. But from the top floor of a hotel you can actually see across this flat city, as it sprawls on and on. Try as you might, but you’ll never be able to get a proper view of London – the place defies clarity. But we keep trying: Faced with an open view from a hill, or a floor-to-ceiling window in a tall building, we can’t help but stop for a long, slow while and look.

Dwarfed by thick white cotton, I crouched down by the minibar and contemplated a Coca Cola and some salted almonds. This is the breakfast of Joan Didion, a heroine of the in-between moment if there ever was one. Didion would get up in the morning, have her Coke, and get to work. Drinking soda for breakfast is not classy – for that you want black coffee and probably some kind of French pastry. But Joan Didion is one of those people who’s so razor sharp in her elegance that anything she does becomes classy by association. Didion would spend a lot of time in hotel rooms too, bringing with her a typewriter and a mohair shawl along with cigarettes and bourbon.  

I’m not usually one for morning soda, but the moment seemed to call for it. I mean, the minibar Coke came in a glass bottle. Apparently it really does taste better from glass than from plastic, and it’s not something I’m imagining. The sharp sweetness is enhanced further by the heaviness of the bottle in the hand, and the way the fat glass lip feels against your mouth. It’s such a treat: Haven’t we all been trained from childhood to never, ever touch the minibar? It’s wildly expensive compared to the shop just a block away. But if you think about the experience, it’s actually a bargain. For a mere £4, you get to drink a mini bar Coke in a oversized robe in blissful quiet, luxuriating over the view of your own city as the day is just starting.

A trip too far?

BL Magazine, Sept-Oct 2018. Original article p44-46

On the health impact of business trips, and how employers need to take more responsibility

To have the life of a business hotshot, putting in a couple of hours for meetings before lounging at the pool for the rest of the day – nice work if you can get it, right? But of course you can’t, because this version of business travel doesn’t exist anymore, if it ever actually did. Any lingering luxuries afforded to work travel disappeared with the 2008 credit crunch, and economy flights and tight turnarounds have been the norm ever since. “The guys here take the mickey out of me when I’m going to Dubai, asking if I’m going to the swim-up bar,” says Trevor Norman, Director of Funds and Islamic Finance at VG in Jersey. “But it’s not all fun – business trips are work.”

Seven million business trips are taken every year by UK residents, according to the Office of National Statistics, a number that’s typically risen by 2.8% per year since 1980. A survey by Bristol Airport found that those who travel with their jobs typically head out eight times a year. But frequent business travel can have serious negative effects on health – mental as well as physical. Because there’s a lot going on when you’re travelling for work: you have to get to the airport on time and pass through security, and maybe the plane is late. Trying to sleep in an economy seat is never fun, and you land late at night and maybe there’s only junk food available. You have a few drinks – it’s been a long day – and you skip the gym before crashing into bed for some restless sleep while fighting your body clock. Tomorrow is a day of back-to-back meetings.

There’s a proven link between a high number of days spent on the road and a risk of long-term health issues like heart attacks and strokes. But a study published last December in the Journal of Occupational and Environmental Medicine suggests it may be causing some more immediate problems too. People who travel a lot for work are more likely to see their mental health suffering, by having trouble sleeping, being sedentary, smoking, and drinking more alcohol. Anxiety and depression also spiked for those who found themselves frequently on the road.

While most of us probably travel less than 14 times per month – the frequency which the study identified as being particularly harmful – the negative effects can be felt at more moderate levels too. A World Bank study found that the business travellers among its staff were three times as likely to file psychological insurance claims. Health risk appraisal surveys at large corporations routinely show that international business travel is associated not just with poor health, but that it also makes it harder to keep up with the pace of work. This means it’s not just an individual’s problem, but a corporate concern.

“The opportunity to travel is often touted by companies as a benefit in their recruitment of talent, but the accumulating evidence linking extensive business travel to chronic disease health risks needs to be factored into the cost-benefit analysis of the practice,” Dr Andrew Rundle, lead study author and Associate Professor of Epidemiology at Columbia University in New York, wrote in the Harvard Business Review. “Employees simply need to be aware that business travel can predispose them to making poorer health decisions.”

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Dr Bob Gallagher, who heads up occupational health at Queens Road Medical Practice in Guernsey, says that companies are getting better at taking responsibility for their employees’ well-being while on the road. The issue should be considered as part of a company’s risk assessment: “Work travel can cause problems that can make people unwell, or it can make pre-existing mental or physical health conditions worse – or both, as these things are often linked,” says Gallagher. At his practice, Gallagher meets people who travel “an awful lot”, sometimes for weeks at a time. “It’s rare to meet someone who travels often for work who says it’s something they enjoy doing,” says Gallagher – for most people it’s something they have to do for the job and it can be a source of stress.

Common ill effects of work travel include heartburn, acid indigestion, digestion problems, and trouble sleeping, says Gallagher. “If you are below par because you haven’t slept, you’re a bit hungover, you’ve eaten too much food, you haven’t exercised, are you performing at your best? Probably not.” While some of this is down to the individual, companies are starting to realise that it’s their responsibility too. “Organisations need to look at this. They shouldn’t cram the day full of meetings so people can’t have some rest. Make sure people have a bit more time,” says Gallagher.

Ensuring employees don’t return from a mad-dash business trip too tired to drive home from the airport is also a matter for companies’ duty of care, says Andrew Perolls, Director of Business Travel Direct, a travel management company. “Companies have to be more careful about how they look after staff.” This also means ensuring staff aren’t staying in hotels in unsafe parts of town, considering things like access to medical facilities, and also, ensuring the company knows exactly where everyone is in case of a natural or political event.

While Perolls can testify to the fact that the life of the work traveller has sped up – going on a one-day business trip to the US is not unheard of – he also thinks this might be improving. “What people are prepared to put up with is changing,” says Perolls, adding that staff are increasingly bristling at being told to fly budget airlines at the crack of dawn. Especially the millennial generation, who’re now in their 30s, are more attuned to work-life balance: “We know that in specialist professions, they may even look at the travel policy before deciding to join a company if the job involves a lot of travel.”  

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Letting employees choose where to stay (within a budget) is one way to keep people happy – that way they can pick a hotel with a gym, or something in walking distance of good food options. Allowing people to fly out the night before will also prevent stress, as well as ensuring there’s downtime between meetings. Giving people a leisure day or two at the end of their trip is a good way to ensure the trip is a positive event, says Perolls: “It’s a shame going all the way to Bangkok only to see the airport.”

Ensuring you don’t have to run through airport security is always a great start to any trip, but ultimately, travel is an exercise in unpredictability. “Stress can be defined as a perceived lack of control, which is common when travelling,” says David Brudö, co-founder and CEO of Remente, a mental health app that aims to promote wellbeing through planning. Brudö explains how he recently used Remente to plan a trip to Japan, from booking flights and choosing restaurants to scheduling in his meditation sessions on the plane. “When you’re travelling you’re a bit disconnected from the outside world, but this means you actually have some time to take care of yourself. A plane is a great place to just sit and meditate, read a book, and invest in yourself,” says Brudö. Remente also works with businesses looking to improve employee wellbeing: “We see that the more balanced people are, the more productive they are. That’s something businesses are increasingly realising.”

It’s hard to get around the need for business travel – video conferencing is constantly improving, but it’s not a substitute for a handshake. But a stressed organisation is not a smart organisation, and it’s clear that companies are realising that taking care of people is ultimately a sound business decision; Deloitte found that 88% of UK businesses are working towards improving work-life balance for staff. That also means helping people stay healthy on the road, by booking the hotel with the nice gym, or providing resources for meditation or cognitive behavioural therapy. Ultimately, it also means picking the people who enjoy travel to go on trips, while letting those who’d rather not stay home.

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The lifetime flier

Trevor Norman took 90 flights last year, having gone on 18 business trips from his home in Jersey. “I’m constantly travelling,” says Norman, Director of Funds and Islamic Finance at VG, a Jersey-based independent provider of fiduciary and administrative solutions. “My father was BA staff so my mother flew with me even while pregnant. I’ve flown all my life, literally!” He laughs. “I was lucky enough to fly to all sorts of places before people were really travelling. That’s carried on in my business career.”

Norman’s BA record shows he’s flown almost 600,000 miles. He’s got the routine down pat: “In our spare room I have travel drawers with all the bits I need. I have a bag of electrical leads that I just drop in my case. It’s almost instinctive by now.” As he usually flies to the UK first, Normal likes to get that leg done the day before, as he’s done with risking still sitting in traffic on the M25 as his plane boards. “Also, I always allow time between meetings, for something to eat and a comfort break. … I try and relax as much as I can no the plane, have a snooze and try and arrive fresh. I can sleep just about anywhere and don’t tend to suffer much with jetlag – I’m lucky that way.”

Missing home used to be more of a problem when the children were young. “That was stressful for my wife,” says Norman. Although now that the kids have left home, his wife often comes with him on trips, which makes for a lovely time for them both. “I enjoy the travel to see different places and learn about different cultures. I try and see the positive side of it.”

Jerry del Missier: Starting a new chapter

Hedge Magazine, August 2018. Original article (p42-45).

Starting a New Chapter

Interview with Jerry del Missier, founding partner and chief investment officer of Copper Street Capital 

Jerry del Missier – what’s he like? We might as well start with that, as that’s what everyone asked me after I went to meet the financier at the HEDGE photo studio in South London earlier this summer. Because Jerry del Missier is a name that’s been heard far beyond the usual financial circles: he was the highest paid senior executive at Barclays Capital before resigning in the midst of the Libor manipulation storm. That’s six years ago now, and we’re here to talk about what he’s been doing for the past three: running his own investment company, Copper Street Capital.

If the air at the top was thin, it’s a far more down-to-earth situation for del Missier these days. Much has been made in the press about his modest offices in Maidenhead, near the train station just by the Travelodge. “I feel like we should be getting paid by the Maidenhead Chamber of Commerce for all the publicity we’re getting the businesses around there,” says del Missier, laughing. “But Copper Street Capital is a commercial venture. It’s not a vanity project.” And Maidenhead is really close to Heathrow. “I never fussed much over the trappings of office. I’m perfectly happy being in a small office again, with like-minded people.”

From the way that he talks, he’s clearly content to be in a different season of life, and equally, he’s happy to clean the office coffee machine if the light comes on when he’s using it. (The only difference is, he owns part of the company that makes the coffee. More on that later.) There’s no arrogance to be detected in del Missier and he’s surprisingly modest, at least until you see his shoes. Today he’s wearing a grey suit with waistcoat over a blue shirt, complemented by an orange tie dotted with little zebras. His cufflinks are leather and there’s a Rolex Explorer on his wrist. He seems to know a little bit about everything and a lot about more than most. It doesn’t take long to realise that he is very intelligent and also, clearly interested in the world around him, with an uncanny knack for seeing the big picture.

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There’s about a dozen people at Copper Street Capital now, and del Missier tells me he is looking to add a few more, including in North America as he wants to start covering those markets, too. Del Missier’s dozen has quite the pedigree: he’s been hiring heavyweight names from the likes of Deutsche Bank and Barclays. The premise of Copper Street is to capitalise on event-driven opportunities in the financial services sector, and del Missier says the people are the key differentiator: “There is a core block of operations experience and expertise that allows us to really bring not just that operators perspective but also that insider perspective. You can put yourself in the shoes of the decision-makers inside the banks, because a number of us were those decision-makers not too long ago.” Maybe that’s obvious, del Missier adds, but seriously, the sector has undergone unprecedented change since the financial crisis – massive regulatory reform, upending of capital structure, and an unprecedented macroeconomic environment where central banks have had to resort to low or negative rates for long periods of time. “Direct intervention in asset markets has had a very disruptive impact on underlying businesses – assumptions about profitability are out the window. So if you’ve been on the inside and living through that whole transformation, I think it gives you a perspective that hard to replicate.”

Right now, one of the ways in which Copper Street is “heavily involved in the transformation in the financial services industry” is the situation in Europe, and the three key factors that’s driving driving change there. The first is recapitalisation – European financials have shrunk their balance sheets, raised new capital, and created entire new instruments. “This has created some significant distortion and opportunities, and the complexity of the environment makes it very difficult unless you are a specialist.” The second is restructuring of business portfolios, as new regulation has meant European banks have had to sell off assets. And thirdly, there’s reengineering of business models. “There’s a chart that illustrates this,” says del Missier, digging it out; most European banks still operate below 10% return on equity. “I think you’re going to see consolidation within countries, and in some cases you’ll see banks disappearing as they get broken up and parts get sold into others. “There’s still an awful lot of work to do, and a lot of opportunity to participate in this transformation.”   

The best part of the job, says del Missier, is to be an active participant. “And hopefully, a driver of a constructive transformation of the sector. A healthy banking system is critical to the underlying economic success of a country or a marketplace.” It’s an extraordinarily interesting time, he adds – we’re at a crossroads that people will be talking about in 100 years. There’s tremendous satisfaction in being in it: “I firmly believe that taking Europe from where it is today and up to where it could be is critical for the European economy, and it also represents a huge investment opportunity.”  

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Del Missier was born in Northern Ontario in a mining town called Sudbury. “My parents had immigrated from Italy a couple of years before I was born. My sister and I grew up in an Italian household, and so did everybody else around us – everybody was first generation.” His first job was at 15, taking night shifts at the bakery where his mother worked before switching to construction jobs. “Everything that was made was saved for university,” says del Missier – it was always clear that he and his sister would go on to further education, something their parents never had the chance to do. Del Missier graduated from Queen’s University with a degree in chemical engineering and an MBA in finance. The engineering part was the influence of his father, “as I think that’s what he would have done had he had the chance,” but then the Canadian oil industry collapsed during his undergrad years. This was the 1980s and del Missier realised there was a lot of interesting things starting to happen in finance owing to the massive deregulation: “So I decided I wanted to be an investment banker.”

Del Missier started his finance career in 1987 at Bay Street, the Wall Street of Toronto. The papers often called him a “rising star” at Barclays, but del Missier is quick to point out he was “fairly senior” by the time he started at the British bank. He was in fact ten years into his career, having worked his way up from Scotiabank to a Senior Managing Director of Derivative Products for Bankers Trust, a place he describes as “an extraordinary organisation, a collection of extremely bright, creative people”. That business hit the wall in 1994: “You go through a period where the banks’ reputation has been damaged and the business that you’re a part of suddenly stops and it needs to be rebuilt. … As a firm, you call your fundamental values into question.” Those three years became the most valuable experience of del Missier’s career, he tells me. I ask him what the lesson was: “How you do business is more important than the results that you achieve.” He pauses. “If you compromise on values for performance it’s only a matter of time before you have problems.”

Del Missier has a three year gap on his CV between leaving Barclays Capital and starting up Copper Street, initially with $100m of internal capital before opening the fund to external investors a year ago. The newspaper articles from July 2012 tell the story of how del Missier, then newly appointed COO, left Barclays after 15 years. I’m not going to ask del Missier to recount this – instead I ask if it was a difficult time. He’s not one to look backwards, he tells me. “I’m not bitter about it. It’s life. I’d spent 25-plus years going at full throttle.” The lesson, he says, is that when you’re operating in a regulated industry you have to accept that things can happen when you achieve a certain level of seniority. “Our industry remains in a very political space.” Now though, he prefers to remember the good times. “I’m extremely proud of what we built, extremely proud of the people I worked with. I participated in some of the seminal events of recent times. I mean, my dad was a janitor and my mum worked in a bakery. I’ve been blessed.”

But, I press, when he set up his own company there must have been things he wanted to do differently. “Yes. You have a greater flexibility when you’re a dozen people than when you’re 28,000 people. In many ways the principles are the same, but it gets harder to keep those principles as you grow.” The point, he stresses, is to stay focussed on building the business in a sustainable manner, and not deviating from what you want to do. “I was raised to work hard, and keep my feet on the ground. The one thing you can control is how hard you work,” he says. And also, learn from your mistakes. “I was never afraid to take risk – I’m not talking about trading risk, but I learned long ago that it’s always good to feel a certain discomfort, and never let yourself get too comfortable.”

Del Missier is married to Jane and they have nine-year-old twins – a boy and a girl. “My family is everything. I spend as much time with them as possible.” Asked about hobbies, he tells me about the coffee chain he’s got a hand in, it’s called Boréal, but you can find it by googling “Best coffee in Geneva”, he laughs. I’ve checked and it’s true. He’s also involved in a Burmese restaurant in London called Lahpet, which has me do a double take – you can’t find Burmese food! “Exactly,” he says, looking pleased. I tell him how one of my favourite dishes is the fermented tea leaf salad from a Burmese place in San Francisco, and as I gush about it del Missier shows me the restaurant on Instagram – “lahpet” actually means tea leaf, he tells me. “This is fun stuff – it’s real and it’s not sitting at a computer. But the business takes up a lot of time. … I really want this to be a legacy project.” You want Copper Street to be the thing that people remember about you, I suggest, and he nods: “Yes.”

Copper Street is still at the whims of investor interest and the markets, del Missier says – that hasn’t changed. “But it’s my thing, and I want it to be an extremely interesting experience for everybody who works there. I want it to be the most meaningful thing that they do as well. I stepped into this under no illusion as to how difficult it is to build something from scratch.” He shrugs. “But I always tell the kids, anything that’s worth having is worth working hard for.”