The Good Life 40 years on

The sermon at the Easter Day service brought up a view point which made me take stock. The vicar reminded us with a little humour that we are now in the midst of a general election campaign. But he cleverly highlighted the use of military language by the media when referring to a "political battle" or a "moral victory" or a "robust defence" - the list goes on.
In fact, he highlighted most of the real problems with the modern political system. The point scoring mentality of the military has been adopted by our political masters. What we really need though is a more collaborative approach. During the war, that approach was not optional as the national interest superceded all else. What has changed? For one thing we have become more affluent and with affluence comes greater political power. I suspect therein lies the problem.
Working for the common good can assume several guises. It can be achieved on a societal level or just simply at home.
The Good Life became one of our best loved and most enduring sit coms. The backdrop was beautifully simple. Two surburban neighbours. One pair are social climbers keeping up with the Jones's and their neighbours have eschewed that life in favour of self sufficiency. Isn't that dream lingering inside all of us. The satisfaction of working your little piece of land to yield produce is surely the ultimate dream. It focuses on the real rewards of sustainace rather than the perceived rewards of materialism. I would welcome any political voice which promoted the Good Life.

24 Hour GP Access

The announcement that Teresa May has today demanded that GPs in England remain open from 8am until 8pm follows on from David Cameron's aspiration to achieve seven days per week GP access by 2020. It will achieve many outcomes, some good, some not so good.

In the first instance, prospective medical students and junior doctors toying with a career in primary care will now have second thoughts. Under the existing system, a career in primary care has traditionally attracted those who wish to put family life first and enjoy a role at the centre of their local community. The idea of working Monday to Friday from 8.00 until 6.00 has traditionally been deemed conducive to a stable family life. It seems as though those days are now numbered and many would argue that this is long overdue.

Oh that it was that simple. Primary care is currently facing two huge problems. On the one had, it is being swamped with patients as never before and on the other hand, there is a national recruitment crisis. Planning to stretch the existing GPs to seven day working will inevitably make some think seriously about early retirement - and many already have.

This presents two huge challenges for primary care. In the first instance, they need to start addressing why it is that so many medical students continue to look upon a career in primary care as a last resort. Speaking from my own experience, too many doctors in hospital medicine continue to express ill informed comments about GPs. The medical students very quickly start to believe these judgments and become reluctant to even consider a career in primary care for fear of the perceived stigma. But as medical students, the medical schools themselves should be doing more to present a more balanced view of the available career options. During my time, I could have been forgiven for thinking that hospital medicine was the only option - that is a huge problem.

The second massive challenge for the next government is how to address the insurmountable numbers currently presenting to their GPs. It is well documented that up to 30% of those presenting do so with either no identifiable ailment or a condition for which there is no justifiable treatment. Just addressing this alone would have a huge impact on the working practice of our GPs. Another inescapable problem is that we are currently failing to make best use of the IT which is now at the fingertips of just about everyone. Anyone with a smartphone will probably have a camera on their phone. This means that many more consultations can be done utilising existing technology currently at the fingertips of most people. This will reduce patient travelling times while still giving the doctor the opportunity to assess the severity of the clinical picture in front of him or her. Although I would be the first to bemoan the impersonal nature of such an approach, it remains a viable, pragmatic solution. Given the recent news headlines relating to the detrimental effect of excess diesel emissions on our health, any solution which will reduce this can only be a good thing.

There is also the question of women doctors. Primary care is currently attracting women doctors on an unprecedented scale. There is nothing wrong with this except that many women doctors understandably wish to start a family and work reduced hours. Although this is a welcome development from the standpoint of obstetrics and gynaecology because many women understandably prefer to be seen by a female doctor, the part-time working hours can then exert even more strain on the finite numbers of GPs out there able to come in and fill that gap. This is another reason why seven day access needs to be thought through very carefully. If they get it wrong, they will just drive even more medical students and junior doctors towards hospital medicine. This will make the current crisis in GP recruitment even worse. But where do patients go when they can't get a GP appointment? Accident and emergency! And A&E departments up and down the country are at breaking point now!

But why is primary care so important? Put simply, if we don't get primary care right, hospital medicine won't stand a chance and we can kiss our NHS goodbye in it's current format ie. free at the point of access for every man, woman and child. It is an established fact that those countries which invest the most in primary care enjoy the best health outcomes. The only way we can begin to address the huge numbers in our hospital beds is to have more GPs to better manage them in their homes and in their communities. This is an inescapable fact. The current state of affairs is now futile. We have to do something different and while I welcome seven day opening in principle, I would warn strongly against the short and long term consequences for primary care in the UK. The current system of GP out of hours services works really well but I suspect that many people (through no fault of their own) are not always aware of how to access it.

If seven day access to full GP services is important, the same must also apply to hospital medicine. At present, hospital medicine continues to run a skeleton service at weekends. I suspect the real issue underpinning this debate is that doctors across primary and secondary care must accept that they will now have to work rota systems seven days per week. If these proposals are to work, they must be applied equally to primary and secondary care because the current divisions between the two are bad enough.

In a recent article in the Spectator, Rod Liddle wrote an interesting piece on this subject. Essentially, he was writing about our consumerist approach. But it is not just in healthcare that we have adopted this approach. "Black Friday" is necessarily a new concept driven by the ever greedy marketing men whose very existence depends on us all buying in to their carefully crafted strategies. This week, it was announced that the people of Britain continue to throw away tonnes of uneaten food but at the same time we read constantly about the growth of food banks for those facing destitution. When I looked out of my window on the day of the post-Christmas refuse collections, it was mind-boggling to see the endless rubbish waiting to be "taken away". Out of sight, out of mind...

Of course, the lay man or woman might be reading all of this and reflecting on the healthy salaries being enjoyed by their doctors. It is true that doctors get paid well but it is also true that they carry huge amounts of responsibility. It is also true that they study for years to get to that position and, in truth, in this post-Harold Shipman world, they never actually stop studying. That is not a moan - that is merely a fact. So if Teresa May is truly serious about healthcare in the UK, I suggest she takes a much closer look at the whole concept of primary care before increasing the workload of weary GPs. Rather than make knee-jerk responses to the current challenges, she would do better to explore why these challenges are there in the first place. 

Double Blow for Scotland

Looking back on the events of the last few weeks and months which culminated in this morning's rejection of independence in Scotland, it is hard not to be impressed on so many levels.

As a resident of Wales, I was consciously aware that a Yes vote would have serious implications for the Principality. To compare Wales to Scotland though would be more than a little optimistic. The last time the Welsh went to the polls over devolution, near half of the population couldn't even be bothered to vote. Last night, a staggering 85% of Scots voted. By any measure, that is an absolutely extraordinary statistic. I sincerely doubt whether I shall ever see anything approaching that again during my lifetime.

Although campaigning on social media did manage to spill over in to acrimony and ill feeling, it was heartening to witness such a passionate debate being fought in such graceful manner by so many people of so many ages. It is also hard to ignore the cynical tactics employed by various factions within the No campaign. There are many ways to win a fight but I don't feel they will necessarily look back on some of their tactics with a great deal of pride.

It is also hard not to feel absolute respect for the outgoing SNP leader, Alex Salmond. There can be little argument that he has been the outstanding politician of his generation. His achievements from a starting point very close to the floor have been incredible - and he very nearly pulled off one of the great political victories of all time.

Imagine if you will a boxing match. In one corner we had Alex Salmond as the sole proponent of independence. In the other corner stood just about every political party you can think of: Tories, Labour, Liberals, UKIP and even elements of Plaid Cymru. Given the inequality of the debate, it is amazing that the Yes vote still garnered nearly 45% of the vote in such a high turnout.

But the debate has been had and the chance has gone. With all of that, Scotland has also lost it's greatest leader. Salmond was the one man who could have made independence a reality. But he should hold his head up. He fought an honourable battle and did so with great dignity and grace. Now the arguments turn to the West Lothian question and the prospect of a profligate Labour government south of the border looms ever closer. If that is to be the real legacy of yesterday's vote, there will be many who rue the day they chose to vote No in Scotland. For certain though, nothing will be the same again after the events of the last few weeks. Rightly or wrongly, Alex Salmond may not have won the battle but he has certainly unleashed the cat among the pigeons at Westminster.

Behind the Painted Smile

Although it has been really sad to learn of the death from suicide of the actor and comedian Robin Williams, the greater sadness is the thousands of suicides which occur with little or no attention. In a reflection of the modern world which we occupy, it often now takes the death of a celebrity to bring a particular health issue in to sharper focus. The problem is that few people want to dwell for too long on negative health outcomes. For a variety of reasons, that is understandable. People still have their lives to lead and rightly so.

One aspect of the Robin Williams story is inescapable. It is arguably more straightforward to consider his alcohol and drug addiction than it is to consider his depression. Successive studies indicate that alcohol consumption continues to rise in Western populations with the spectre of addiction lurking not far away. Although the numbers taking illicit drugs are lower, the concept is still likely to be more palatable to the many. The stigma attached to all mental health remains as strong as ever.

If the passing of Robin Williams impacts even only slightly on the way people think about not just depression but mental health in general, that will be a great achievement. Only when whole societies start to consider it differently will the potential outcomes of people like him be improved. We will never save everyone from this fate but it is certain that whole societies can make a huge difference just through a change in attitude. The media in particular can make a massive difference by reflecting on the language they choose when reporting. We must all remember that negative language is just as powerful as positive language.

I went to fuel in my car recently and happened to glance down at the pump nozzle as the fuel went in. On the nozzle was a really powerful message and I salute whoever thought to put it there. It simply proclaimed the value of a "can do" message when talking about maths with our children. Clearly, the message is aimed at the parents who will be filling their fuel tanks but this is exactly the sort of subliminal education which is needed to effect meaningful change in our society for the better. That same strategy could be used to great effect to suggest to all of us the benefits of being open, honest and respectful when we talk about mental health.

I listened last night to a wonderful programme on the radio in which Sir Ken Robinson was being interviewed about education. The programme started with him revisiting his first school. As a child, like so many others at that time, he had developed polio. He described the primary school class as looking a bit like the bar in the Star Wars films. He was just being candid. The children at that school had a variety of physical problems but his point was that the children themselves only saw each other as people each with their own humour and so on. He went on to describe how he was taken out of the grammar school for which he had passed the 11 plus exam (to the enormous pride of his family) because the teachers felt that it was too much for him to get up five flights of stairs wearing his calipers. Nobody consulted him and he was indeed moved to another school. Had they consulted him (and there is a growing body of opinion that education should be about the child...), he would have reassured them that he was prefectly happy and loved being at that school. The crime is that nobody even bothered to engage with the lad with polio who would go on to become one of the most sought after speakers and thinkers on education in the world!

The subject of suicide is perhaps without parallel in generating very strong opinions. Some consider it selfish and others look upon it in a wider context. When we are blessed with the gift of life, it is up to each of us how we intend to use that gift. That people choose of their own volition to surrender that gift must rank as one of the most extraordinary acts imaginable. It is not about it being right or wrong because it is entirely a matter for the individual.

During his life, the singer and songwriter Nick Drake could barely sell a record. His songs were wistful, plaintiff and plucked at the very soul of those who dared to listen. Since his suicide in 1974, people can't get enough of his music. Although Robin Williams achieved his recognition, achievements and fame before his death, there are still a great many who never do and that is a real tragedy.

Local community: How would you define it?

Since the new year, I have become increasingly drawn to the concept of community with respect to the town of Denbigh where I live and in the wider sense. Many would stop reading at this point because the subject would be a matter of indifference to them.

I recently read an interesting piece written last year in the Guardian. Written by Rosie Niven, the article contrasts the concept of community of yesteryear with the modern day equivalent. Fifty years ago, the word community almost invariably referred to the place where you lived. Since then, the definition has become a little more flexible often alluding to a common area of interest, values, activities, hopes and fears shared by people irrespective of the place where they live. By implication, it thus follows that people living in Britain today can belong to several different communities be they real or virtual. Communities these days are also less static than their predecessors of fifty years ago.

Local activities are cited as promoting cultural integration. The town of Denbigh where I live has been notably active in this regard in the last couple of years. In a short space of time, my home town has re-introduced a town carnival which for many years had faded away. A variety of local communities have also been responsible for the introduction of a car boot sale, a St. David's Day festival and a midsummer festival to name but a few. All these events point strongly to a town which has decided to get back to basics. Enough local people have got together in a variety of separate communities to generate these projects with the shared intention of regenerating the concept of local people coming together to engage in meaningful community activity.

What has really warmed my heart about this is the obvious intention to do so without involvement of local government. This reaffirms the original modus operandi of the local community - people doing it for themselves. All too often in modern Britain, local government has become a bloated organisation too far detached from the real issues facing the people over whom they exert jurisidction. In truth, history informs us that local government had little to do with community activities such as those referred to. One of the factors which has driven the growth of local government is a greater propensity to depend upon it. Obviously there are those occasions where such dependency is justified if only for the sake of the amount we pay in council tax. Equally, our society has tended to become somewhat lazy expecting local government to provide the solutions in instances where we might have done more for ourselves. It is a rare sight where I live to see someone picking up litter in the vicinity of where they live and yet the majority of us are quite capable. It is also rare to see anyone sweeping the mess off a pavement yet most of us are more than capable.

Citing the examples of litter picking and sweeping up, I am really alluding to the sense of civic pride which was ubiquitous when I was growing up in the early 1970s. It is far less obvious now so I wonder whether my local town is on the verge of rediscovering it. Given that they have voluntarily reignited the sorts of event so much beloved of our forebears, does it follow that they will soon start to assume similar levels of civic pride? I certainly hope so and have every reason to remain optimistic. Rural towns such as this are dependent on a sense of community pride to remain vibrant.

Like many similar former market towns, Denbigh has seen it's high street eroded by a combination of factors which continue to impact so negatively the length and breadth of the land. More people now work outside the locality. More people now have access to a car and the greater access which this affords them. More local councils have sanctioned the introduction of supermarkets on the outskirts of the town which have now lured the consumer generation since the 1960s. All too often, the latter has been devastating for the erstwhile high streets.

In purely economic terms, most markets are subject to the whims of cycles in which peaks and troughs are reached with monotonous regularity. While my local high street may well have reached it's nadir in recent times, there are signs afoot to suggest that the ascent to former glories is now on track. Without the involvement of local people in their respective communities with their shared focus, such a change in fortune would have been unimaginable. For a long time, successive generations have looked longingly at the greener grass of the out of town retail centres. Having feasted on that grass now for many years, it seems as though the oldest truism of them all is finally being realised. The grass is becoming more attractive in our own field as indeed it always was.

In our own field, we know more about the local food we eat. We also get to know with forensic detail the people with whom we share that field, warts and all. Ultimately, we exist within a finely balanced ecosystem in which jobs in our local shops are taken by local people often selling the produce of local farmers and artisans. It is difficult to see what can be so unattractive about that particular flavour of grass.

  

Maybe the last time?

I have just one more day to attend at the medical school in Keele before I can drive away from ten years' study. Although I return on July 14th for my graduation ceremony, it is now that I can begin to reflect on the enormity of the last decade of my life.

It started with the death of my first wife from breast cancer. Having unexpectedly met my second wife later that year, I made the risky decision to pursue the long road to a career in medicine. I embarked on a first degree in Medical Biochemistry before being thwarted after just one semester due to kidney failure. Nine months on dialysis were rewarded with a successful kidney transplant. The birth of my daughter just after my original kidney failure shone a bright light on our lives but then the light went out when she succumbed to meningococcal septicaemia at just 15 months of age.

It was a hard decision to carry on with medicine after that but tomorrow will be the last day of my quest. Barring miracles, I will start the process of giving something back at the Wrexham Maelor hospital in early August. I have nothing but admiration for the students at my medical school all of whom have far more maturity than I ever did at their age. They are also infinitely more intelligent than I could ever hope to be. It is hard to adequately convey the extent of their dedication and focus. It has kept me on my my toes being surrounded by so many bright minds and taught me far more than I could ever teach them. They are an inspiring bunch with the world at their feet - and deservedly so.

When we begin our posts as junior doctors five weeks hence, I'm sure we will often look back on our time at medical school and the friends we made and the lessons we learned. Many of my colleagues are not yet 25 with the biggest hurdle safely negotiated. At the age of 45, I can only say that learning becomes more challenging with the passage of the years. I wish them all luck in their careers and look forward to my own. This has been a long journey which I could not hope to have achieved without the love and support of my amazing wife and family. I wish Dad could have been around to know that I had definitely made it but remain grateful for his enthusiasm and guidance.

When I was working in the coca cola factory in Wakefield in 1994, days like tomorrow seemed to belong to other people. I have stretched myself to the limits of my capacity and have savoured every moment. We really are never too old even though it sometimes might feel like it.

British Values

In recent weeks, a clearer picture has started to emerge of what current British values really are. As the politicians seek to take the moral high ground in their endless quests for power at all costs, I take the opportunity to reflect on what values we have in Britain.

We are obsessed by our relationship with Europe and are about to be dumped by the Scots as the Union begins it's inevitable demise. We have just returned to the economic levels we enjoyed before the financial crash even though the resurgence has largely been achieved by the same route which got us here in the first place. Levels of personal debt are being promoted by another cynical Government more concerned with it's own chances of re-election next May.

We have a worryingly high rate of teenage pregnancy. We have a bigger public sector than France. We have a health time bomb ticking underneath the very foundations of our allegedly beloved NHS in the form of booze, obesity, diabetes, smoking, lack of exercise and diets dripping in the high glycaemic index sugar procured from supermarkets who could scarcely do more to destroy whatever community spirit we might once have had. We obsessed with moaning about the quality of our free health service while the majority seem oblivious of their role in it's downfall.

We bemoan immigrants having their faith having long since discarded our own. As church congregations dwindle, mosques and temples continue their relentless spread. Where we do little to promote the benefits of faith to our young, immigrant families have the good sense to retain their faith. Go to the Law schools and Medical schools and see the students. Every picture tells a story.

British people have new Gods. We have gambled a fortune in recent days on England winning the football world cup. Football and money continue to attract the British although both remain bereft of real value. As I write, the England footballers who are paid morally indefensible sums of money for reasons I will never understand are being urged to try and sing the national anthem at the beginning of their forthcoming matches. Being urged to try?

At the recent European elections, an outcry was heard when it became obvious that the anti-European UKIP had won the day. British values dictate that in the centenary of the beginning of the Great War in which our forebears laid down their lives so that we could enjoy our freedom, only a third of us can even be bothered to exercise our right to vote.

A recent school trip to Barcelona made the headlines because of another set of British values. The teachers were so drunk, they started to fight with each other and thus the example was set for another generation. Where I live, the local council wants to close two of the last remaining faith schools in a cynical attempt to finish the secular job off.

The modern British value is to borrow as much we can in the vain hope we will ever be able to repay it thus guaranteeing a return to the previous recessions for the same reasons.  

A British value which has come to the fore in recent times is our ability to eat mountains of food of dubious nutritional content as food banks continue to prosper. We throw away as much food as we eat and the greedy supermarkets are equally culpable. And still the waste goes on less than fifty years after the end of the rationing which guaranteed such a good start in life for our grandparents. We still have the same number of legs as our grandparents but prefer the car even for short journeys.

We pertain to love and cherish our NHS and yet there is little evidence to support that view in the lifestyle choices of the many.

Our prisons are full at a time when our churches have never been so empty.

The British values to which Michael Gove refer are not clear to me but if he intends to teach the values to which I have referred, God help us all.