A Duty Too Far

When I was studying for a Master of Laws degree, a term I became familiar with was that of ‘duty’. In terms of the law it is ‘a legal requirement to carry out or refrain from carrying out any act’. Healthcare professionals are familiar with their ‘duty of care’’; that is, the legal obligation to take reasonable care to avoid causing damage. If we fail, and that failure results in damage, then there has been a breach of duty and we can be found liable. For a professional to fail in his or her duty of care is therefore a powerful charge.

Imagine my surprise, confusion and abject distrust, when I read that the Government, that powerful body of august and learned individuals charged with making the laws of our land, has decided in its wisdom that henceforth a new statutory duty will be included within the NHS Constitution for GPs to ‘make every contact count’. By this, the Department of Health wishes to ensure that we are mandated to ensure that patients are leading healthy lifestyles on each and every occasion we meet.

GPs have been labouring away at this on an opportunistic basis for years without it being made a statutory duty. How many patients have not been nagged to reduce weight, stop smoking, drink less alcohol, eat healthier food, work fewer hours, and take more exercise? I bet the majority of my patients are surprised if I don’t say something about at least one of these issues every time they appear in my consulting room. It is what we do when trying to make people better.

However, making such activity a duty raises it to a whole new level. No longer will it be something we do as caring professionals. From now on, it will be a legal duty and to stray from that path means a breach of duty and the possibility of legal action.

So let us imagine a familiar scenario. Mr X, an office manager in his 50s, who smokes, is overweight, is stressed with running a workforce and meeting targets, has no time in the long working day for exercise, and winds down with an alcoholic drink or three, appears in the surgery for the first time in years, emotionally distraught because he has been made redundant. He is depressed and anxious because his family’s well-being is at stake, the mortgage cannot be paid and the house may be re-possessed. What he needs help with at that moment is coping with his emotional breakdown. What he does not need is a lecture on his errant lifestyle. That can come later. However, if he then goes on to have a heart attack, precipitated by the stress, but no doubt fuelled by his unhealthy habits, the doctor now becomes potentially liable in law for the harm that he has befallen.

Making it a professional standard of care is one thing; making such advice a statutory duty is open to abuse. Let us hope, for our collective sanity, that the courts see it as unreasonable and unenforceable.

(First published in the Scunthorpe Telegraph, Thursday, 28^th February 2013)

Community Needs

A couple of weeks ago I was left pondering the difference between a ‘neighbourhood’ and a ‘community’. It was a question posed during a meeting organised by the local Joint Health and Wellbeing Board (more of which a little later). My immediate response was to say that the term ‘neighbourhood’ invokes the geography of the area, whereas a ‘community’ reflects the people living within a neighbourhood. However, I was left feeling that my response was lacking and shallow, and the question has since been returning to me in the quiet hours of the night.

My discombobulation (such a wonderful word that simply rolls around the mouth) was partially assuaged by recourse to a dictionary. According to the latter, a neighbourhood is ‘a district within a town or city’; whereas a community is ‘a group of people living in one place’. So, I thought, a neighbourhood must contain a least one community (unless deserted), whilst a community could exist either within a neighbourhood, or be a distinct entity living on its own (for example, a small village or hamlet, or a remote tribe, etc.).

But for all the official gravitas of the aforementioned trusted lexicon, there was still some essence missing in that soulless definition of ‘community’. Where, for example, was the spirit of the place? Where was the sense of belonging that bonds people together in something more than the simple fact that they live in the same street or apartment block? Where was that sense of common attitudes and interests?

Ultimately, communities are about living people; people who breath and think; who interact with each other; who may work and play together, who love and fall out with each other, who may worship together; who care for each other in times of crisis, and who also care about the place where they live. That is what the term ‘community’ is really all about for me. A community is not just some sterile, amorphous entity.

So, I can hear you ask, what does the above have to do with Health and Wellbeing Boards, and what are they in the first place?  The simplest answer is to quote the Department of Health. Established by the Health and Social Care Act 2012, Health and Wellbeing Boards act as ‘a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities’. So they consist of people such as public health personnel, social workers, nurses and doctors, who are essentially charged with making life better for local communities.

The problem is we only have a partial idea as to what would make life better, because all communities are different. Ultimately, it is the people living within these communities who can really tell us what would make life better. So please tell us. Tell your local councillor, tell your social worker, tell your GP, write to the council and to this newspaper. Tell us what would really do it for you and your community. We cannot help you win the lottery, but often it is attention to the small matters that makes a big difference to our lives.

(First published in the Scunthorpe Telegraph, Thursday, 21^st February 2013)

The Question of Marriage

Despite the complex issues requiring this Government’s attention in respect to our struggling economy and NHS, our tumultuous relationship in Europe, Afghanistan, Argentina over the Falklands, and the clamour for Independence for Scotland, one matter has particularly exercised me recently. I speak of that ancient institution called marriage.

I thought I had a pretty shrewd concept as to what marriage is all about. Having sung as a chorister at countless weddings, the words of the religious ceremony are etched in perpetuity across my memory. I have even been known to have passed an audition and thus be appointed to one of the leading roles in such a ceremony; the sequel to which, I am pleased to say, is now in its seventeenth year and shows no sign of a diminishing plot. However, despite all of that, the Marriage (Same Sex Couples) Bill, recently put before the House of Commons for its second reading, forced me to analyse my ingrained learning and preconceived ideas as to what marriage means in both legal and philosophical terms.

I already knew the Bible’s standpoint on marriage, so I therefore turned to the Oxford English Dictionary, where I was predictably informed that marriage is ‘the formal union of a man and a woman by which they become husband and wife’. The definitions of the terms ‘husband’ and ‘wife’ were equally predictable and unhelpfully tautologous. A dictionary of law was slightly more helpful, stating that marriage is ‘a ceremony, civil or religious, that creates the legal status of husband and wife and the legal obligations arising from that status’. Nonetheless, many more questions spring from there; not least the problem of whether a man can be a ‘wife’ or a woman a ‘husband’ (the answer to the latter is ‘yes’ if you live in certain Sudanese tribes). The term ‘spouse’ makes life psychologically easier in this respect, being asexual in its implications.

Having got that far, I then considered the concept of marriage in respect to it being a ‘civil ceremony’. We have, of course, become accustomed to the concept of ‘civil unions’ or ‘civil partnerships’ for same-sex couples. So what, I asked myself, is the difference between a ‘civil union’ and a ‘marriage’ if we make the participants asexual by using the term ‘spouse’ to describe them? A Wikipedia article on marriage was particularly illuminating and I formed the opinion that there is little difference apart from certain legal rights; legal rights that should, in a 21^st century society, be available to everyone making a life-time commitment to another person regardless of their sex.

Ultimately, a relationship is all about shared values; values such as love, honesty, fidelity, trust, friendship, support and caring. A marriage or civil union gives society’s official recognition to a couple’s pledge to each other in respect to such values. If the values are the same, then the legal rights attached to the relationship should be the same. Let us therefore hope that our parliamentarians continue to consider the issue in depth and with unbiased wisdom.

 (First published in the Scunthorpe Telegraph, Thursday 14^th February 2013)

The Great Divide

I have a confession to make. Throughout my adult life I have voted for the Conservative Party on all but one occasion. That occasion was an episode in my teens in Kent when, in a rebellious streak, I voted for the local Liberal candidate. In retrospect, I suspect that was more because I had a soft spot for an old primary school friend, the Hon. Victoria Lubbock, (daughter of the former Liberal MP for Orpington, Eric Lubbock - now Lord Avebury) than the holding of any real political conviction. However, from thereon I politically turned from yellow to blue, and had seen no convincing reason to rekindle my chameleon activities until the past few years, when I became a sort of bland neutral in response to the growing conviction that nobody in Westminster really seems to know what they are doing with our country.

That was all before Andy Burnham’s speech to the influential King’s Fund last week. For those readers who are too politically fatigued to care anymore (and I don’t blame you), Andy Burnham MP is Labour’s shadow Health Secretary, and The King’s Fund is a renowned, apolitical, high quality ‘think tank’ for debating new ideas in healthcare delivery.

In his speech, delivered to a silent and intently listening audience, Mr Burnham outlined the contents of his Green Paper on how the Labour Party, if elected to Government in 2015, would rescue the remnants of our National Health Service from its current fragmented state on Death Row. What materialised was a breath of fresh air in political thinking in the way we need to tackle the growing crisis of care for an increasingly elderly population, and how to manage the shrinking financial pot with which to tackle that crisis. I say ‘political breath of fresh air’ as many of us outside of national politics but inside local health and social systems have long been convinced of the sensible way forward. That is, the abolition of the artificial divide between ‘health services’ and ‘social services’ in terms of funding, management and provision. The important word here is ‘integration’; an integrated system that can deal with a person’s entire health and social needs without recourse to cross-departmental or cross-organisational politics, policies and funding. Essentially, one organisation would take control of the lot, with specialist advisers (for example, doctors in respect to healthcare) to keep the system balanced. For once, ‘whole-person care’ will be the responsibility of one organisation. Just how sensible is that? 

As I listened to Andy Burnham from my beleaguered bunker as a GP in primary care, I began to sense another colour change materialising. For once, a political agenda was being proposed that I could warm to with heartfelt conviction. It was a policy that was actually saying ‘we understand and genuinely care for the plight of those with health and social needs in our society – and we want to provide a system that can comprehensively help them’. ‘Hallelujah’ was my response, as I psychologically crossed the floor of the House of Commons. Now, I wonder if my constituency Labour party needs an experienced doctor and health manager to stand as their candidate in 2015?

(First published in the Scunthorpe Telegraph, Thursday 7^th February 2013)

Is Anybody Listening?

In 1998, following the referendum in Northern Ireland in respect to the Good Friday Agreement, the politician Gerry Fitt said ‘The people have spoken and the politicians have had to listen.’ Seventeen years later, I wonder whether Whitehall has forgotten that lesson.

That thought commenced with the recent publication of figures from the Office for National Statistics. Evidently, some 3,599,000 people permanently left the UK in 2011. ‘So what?’ you may well ask; ‘aren’t we an overcrowded little island with insufficient housing stock, too few jobs and the incapacity to grow our own food requirement?’ The answer is, of course, in the affirmative. However, the worrying aspect is that two million of those leavers were young people (aged 25-44).

In a country where the older population is growing increasingly dependent on enough young people being around to work in order to provide economic growth, pay the tax to fund our pensions, and care for us in our aged ill-health and infirmity, we need to retain these people in their mother-country. Instead, we are seeing a repetition of the ‘brain drain’ of scientists, academics, doctors and executives seen during the post-war years and the seventies, when talented professionals fled these shores for the USA and Australia. In reality, lured by increased opportunities, better lifestyles and lower taxes, who can blame them? If I was ten-or-so years younger I would be seriously tempted to join them. Instead, I am nearer to joining the band of retired ex-patriots fleeing to warmer climes than throwing my lot in with the bright young things; and if the results of a recent survey of doctors are anything to go by, that departure could be a lot sooner than expected.

Regular readers of this column will know that I occasionally write about the decline of the embattled NHS. Oh, okay, I admit it; I frequently write about it. But it is a subject very close to my heart, and it is something that should be very close to yours as well, as you will miss it when it is no longer with us. Well, the latest news from war-torn General Practice is that, as a profession, we are at breaking point. The increased demands, very long working-days, and reduced investment are pushing many GPs nearer to the edge. In a large study of GPs from the South West of England, 96% responded that the workload had become more intense and complex, and the working day much longer over the past three years. What is more, 84% felt that their present high work load was unsustainable (with 48% saying that the workload was ‘dangerously unsustainable’), 66% have fears that their practices will not survive the contract changes that the Government seems set on imposing, and 50% are considering leaving the profession.

There can be no doubt that the ‘people are speaking’, and our politicians would do well to remember the maxim of the American physician and poet, Oliver Wendell Holmes, who said ‘it is the province of knowledge to speak and it is the privilege of wisdom to listen’. Are you listening in Whitehall?

(First published in the Scunthorpe Telegraph, Thursday 31^st January 2013)

Dying with Dignity

Every so often a piece of investigative journalism hits the national press and causes a storm of sensational outpourings because of its emotive content. Sometimes such reporting has much to commend it, bringing important issues into the open and exposing flaws and wrong-doings in our national systems. However, there are also times when unintended consequences occur, with readers being given an inaccurate picture resulting in confusion and unnecessary concern. Over the past few months we have seen such an occurrence in respect to the topic of the Liverpool Care Pathway.

Whilst it is likely that most readers of this paper will be familiar with the name of the pathway, it is possible that the details are hazy or unknown. I will therefore briefly explain what the pathway is before discussing the current controversy.

As the name implies, the pathway was developed in Liverpool in the late 1990s as a joint activity between the Royal Liverpool University Hospital and the Marie Curie Hospice in Liverpool. It was initially designed to aid the appropriate care of patients who were dying from cancer. However, since its origin, the care value of the pathway has been recognised and as a result, it has become more widely used in the care of many patients dying from other conditions.

The aim of the pathway is to ensure that dying patients are given appropriate treatment to ensure that they die with dignity and in peace, with any potentially distressing symptoms suppressed or controlled. No doubt this is something we would all want for ourselves and for our loved ones when the inevitable outcome to life catches up with us. Sadly, prior to the pathway being formulated, such control was not always the case, and many families no doubt have sad stories to relate about the less than dignified passing of a relative or friend. In recognition of the value of the pathway in terms of patient care, the government introduced a financial incentive to hospital trusts, so that they are rewarded for the use of the pathway. Incentives for good care are not new and are used throughout the health service in order to drive up care standards.

The problems that have recently been uncovered stem from occasions when the Liverpool Care Pathway may have been less than efficiently utilised, resulting in accusations of professional mismanagement, lack of communication with relatives and the patient, and even charges of its inappropriate use for the purpose of financial gain by the hospital trust. Understandably, this has caused outrage in some quarters, and certainly widespread national concern that people are being put on the pathway when more can be done to treat their condition and possibly allow them to live a little longer.

Whether the above is true or not, I cannot judge. However, there is nothing inherently wrong with the Liverpool Care Pathway when used appropriately by experienced professionals. It is also appropriate that tax-payers’ money is used to improve standards of care. As always, the secret is in communication. If a patient is deemed to be dying, and a multidisciplinary team is in agreement that nothing more can sensibly be done to treat their condition, then the patient (whenever possible) and family members need to be included in the conversation, so that everyone understands what is being done and why.

With understanding comes acceptance and freedom from fear, anxiety and anger. With the Liverpool Care Pathway comes a dignified death. Both aspects should be part of the same package.

(First published in the Scunthorpe Telegraph, Thursday, 24^th January 2013)

And the Challenge Continues

Now that 2013 is well and truly here and the partying is over, what can we expect from the NHS? Well, one thing is for sure, there isn’t going to be any new money in a hurry. The economy is failing to bounce back as the Chancellor had hoped, the top earners in the country are being plucked to a state of baldness and thus leaving these shores in droves to escape being skinned into the bargain, and the queues at the Food Banks are becoming longer; as is the waiting list for Tribunals to hear people’s appeals against the withdrawal of their state benefits.

The queue outside my surgery at 7.45am is not much better, either. We still cannot meet the burgeoning demand for appointments; the Department of Health is imposing even greater impossible targets onto us, and patients still book valuable GP appointments and then fail to keep them. GPs, overwhelmed by the aforementioned pressures, coupled with ultimatums from the Care Quality Commission, the requirement for revalidation with the General Medical Council, the expectation that we will balance the failing NHS budget through our work in the Clinical Commissioning Group, and the growing assault on NHS pensions, will continue to retire early or look for alternative employment. In the terms of Charles Dickens, the NHS is indeed a very bleak house.

Some months ago, I mentioned the Nicholson Challenge; essentially the challenge to find the difference between NHS funding and spending. Now, as any self-respecting housewife or businessman (oh, alright, any house-husband or business-woman) will tell you, there are only so many cost-savings that can be made before ‘cutbacks’ and ‘rationing’ come into play. With no extra funding, and costs rising by 4% minimum year-on-year, the problem is more than just a challenge, Nicholson or not; before long it will become impossible without some fundamental changes.

Cue crystal ball and zoom forward to 2015 and beyond. What is happening in the world of NHS General Practice? Well, for a start, I cannot see many small practices around; having either closed under the financial and quality-improvement pressures, or amalgamated with larger practices. There are also fewer older GPs working, having seen the sense of early retirement against ‘early-death-through-exhaustion’. Some practices have been taken over by private companies, staffed by a steady flow of changing faces; young, inexperienced doctors, many of whom are set on bigger goals. In more affluent areas, private GP surgeries are beginning to appear, where for a fee of £50 or so, you can see a GP for half-an hour in state-of-the-art premises. Those patients still dependent on the NHS are still in queues for just about everything; except that now, just like prescription charges, there is a ‘token fee’ for all sorts of things including blood tests, x-ray and scans, contraception, maternity care and A&E attendances. Hospitals still provide care, but families supply the food and bed-linen.

You think I am joking? Well, come and look at the finance books and tell me how it is not going to happen. The golden days of the NHS are fast becoming a memory.

(First published in the Scunthorpe Telegraph, Thursday, 10^th January2013)

Writing for Health

A question I am frequently asked is in respect to how I find time to write as well as run a busy medical practice. Well, I could claim that it is an illness. After all, the Roman satirist, Juvenal, once proclaimed that ‘many suffer from the incurable disease of writing, and it becomes chronic in their sick minds’.

However, the answer is that for me writing is not an illness, but is therapeutic. I am not alone in that sentiment, as many other writers will tell you something similar. Writing is a good way to wake up the brain in the mornings, and is a relaxing way to unwind at the end of a busy day or week. Henri Stendhal, a French novelist, once declared that ‘for those who have tasted the profound activity of writing, reading is no more than a secondary pleasure’; so I apologise to all those readers who are presently not having as much fun reading this column as I had writing it. You are, nonetheless, in good company. Winnie-the-Pooh’s friend, Eeyore, might have agreed with you, stating ‘this writing business – pencils and what-not; over-rated, if you ask me. Silly stuff. Nothing in it.’

There is, however, a serious message behind today’s column. Research has shown that writing can indeed be therapeutic in many different conditions, especially when stress is an underlying cause of the illness. The precise mechanism of action is unknown; though there is a lot to be said for just ‘getting it off your chest’ (my recurrent reflections on the state of the National Health Service spring to mind). However, it is likely that there is a much deeper-seated action, triggered from within the brain, which has a longer lasting positive effect on health. 

That said, the therapeutic effects of writing are not restricted to emotional issues. There is good clinical research to show how writing can improve the symptoms of irritable bowel syndrome, reduce resting blood pressure, improve walking speeds in patients with rheumatoid arthritis, quicken recovery from post-traumatic stress disorder, produce an enhanced sense of mental and physical well-being in patients with bowel, breast or prostate cancer, and reduce the symptoms of some adults with asthma.

Writing is also a useful adjunct to counselling, being a means by which a patient can express concerns, fears and unpleasant memories in a controlled way. Often performed whilst in the comfort and privacy of their own home, the patient can take time to say what they really want to say, without the distress of speaking directly to a stranger. The counsellor can then subsequently use what has been written as a means of conducting the therapeutic session. In many ways, writing therapy can mirror the process of art therapy, the value of which is already well-recognised.

Whatever writing may be to you, I personally subscribe to the view of the Japanese diarist, Sei Shonagon, who proclaimed that ‘if writing did not exist, what terrible depressions we should suffer from’. On that thought, perhaps everyone should adopt writing as a resolution. Happy New Year to you all.

(First published in the Scunthorpe Telegraph, Thursday, 27^th December 2012)

Numbering our Days

In 2005, I arrived at the Chamberlain’s Court at the Guildhall in the City of London, where I was greeted by a gentleman dressed in a frock coat and top hat. Introducing himself as the Beadle, he conducted me to the Court Room and announced me to the Clerk of the Court as a ‘Citizen and Apothecary of London’. Having read the Declaration of a Freeman, I was then invited to sign the Freeman’s Declaration Book, and was presented with a parchment copy of ‘The Freedom’, declaring my new found status as a Freeman of the City of London, with the right and privilege to trade within its walls.

The ceremony itself was simple. However, like many matters in life that initially appear to be modest, the Freedom of the City of London is steeped in history and is supported by a wealth of wisdom and expectation.

Dating back to Medieval times, the first Freedom was presented in 1237. The ceremony was once an essential requisite for anyone who wished to conduct business in the City, to own property, and to be unencumbered by subservience to a feudal lord. Today, it is a quaint, symbolic recognition of our rich heritage, and one in which I am a proud participant.

I had cause to reflect on the ceremony when I recently picked up a small, plain red book presented to me at the time of the Freedom Ceremony. With only 43 pages, it is an unpretentious tome apart from the gold embossed title on its front cover, declaring that it contains ‘Rules for the Conduct of Life’. In size, it presents a sharp contrast against another book on my desk that might be said to hold the original ‘rules for life’; I mean the 1,165 pages of the Bible. However, the brevity of the former defies the depth of wisdom contained therein.

Rule I requires the reader to ensure that ‘whatever you intend to do…be sure that it be always really good, or at least innocent.’ Rule II beseeches one to act lawfully; whilst Rule III warns against idle speculation, and exhorts us to put our ideals into practice.

Of the remaining thirty one rules, Rule IV particularly attracted my attention on this occasion. It starts by reflecting on the transitory nature of life; a life ‘short and uncertain’, where ‘the pleasures of it are always intermixt with doubts, fears, and sorrows, of one kind or other’. The rule then requires us to look beyond ‘the joys, pleasures, or prosperity of this transitory world as the ultimate end’. It is indeed a rule of wisdom, and one many of us so easily forget as we travel life’s journey. Yet it is a rule which not only keeps our feet on the ground, but assists us in finding happiness in that which really matters in life.

Psalm 15 says ‘So teach us to number our days, that we may apply our hearts unto wisdom’. Perhaps finding such wisdom brings with it the most significant freedom of all in life.

(First published in the Scunthorpe Telegraph, Thursday 6^th December 2012)

Children in Need

On the 16^th November, the BBC held its 32^nd annual appeal known as ‘BBC Children in Need’. A successful evening was had, as the total raised during the televised event was just short of £27 million. By the time the appeal closes for the year, the amount raised is likely to have been doubled.

However, for me, the success of BBC Children in Need is overshadowed by the very name (and I am not alluding to the bad press the BBC has experienced this year). The words ‘children in need’ are the key issue. The very fact that we, as a so-called civilised society, even need to have a public fund-raising event for children’s well-being, the aim of which is to enable every child to have a childhood that is ‘safe, happy and secure’ and ‘allows children the chance to reach their potential’, is in itself a terrible indictment of our society.

One of my professional roles is as the Named Doctor for Safeguarding Children for NHS North Lincolnshire. It is a role from which I dearly wish I could be made redundant. However, every month or two, I attend a committee which exists purely to perform ‘serious case reviews’; each review being about one or more North Lincolnshire children who have been neglected or abused in various ways. Sadly, it is never necessary to cancel a meeting for the want of agenda items.

Elizabeth Barrett Browning, in her 1844 poem, ‘The Cry of the Children’, wrote ‘Do you hear the children weeping, O my brothers/ere the sorrow comes with years’. That there is ever a need for children to weep is a burden we all share as members of a society which turns a blind eye to abuse when it is to the betterment of other motives. Yet we continue to assuage the guilt of that betrayal by donating large sums of money once per year, as though that makes good our society’s shameful negligence in securing and ensuring every child’s safety. Our aim should not be to raise even more money so as to beat the previous year’s total. Our constant focus should be to eradicate the dangers to children within our society, by everyone adopting a higher level of awareness and a zero-tolerance approach to every type of abuse.

Children, those symbols of the miracle of new human life, are intensely vulnerable. Too many of them are carrying painful burdens, when they should be experiencing the innocence and happiness of childhood. ‘The place is very well and quiet and the children only scream in a low voice’, wrote Lord Byron in 1813, when communicating with Lady Melbourne. In 2012, we should be ashamed to even contemplate the writing of such sentiment, let alone hold the knowledge that there are children doing precisely what Byron described for fear of further abuse if heard. As the Chief Rabbi, Lord Sacks, said in a recent Radio 4 Thought for the Day, ‘Never let us be deaf to the cry of a child.’

(First published in the Scunthorpe Telegraph, Thursday, 29^th November 2012)

Do We Really Value the NHS?

According to one opinion poll after another, one of the things that we British say we value most about living in the United Kingdom is the National Health Service. When defining the word ‘value’, the Oxford English Dictionary speaks of ‘the regard something is held to deserve’, and continues on about an object’s ‘importance’ or ‘worth’. However, therein lays a strange conundrum.

Every year, so many appointments are missed by patients that the cost of the lost time amounts to a staggering £162 million. At the best of times, that is an appalling waste of money; within a harsh economic climate it is nothing short of madness. If a government department was identified as wasting that level of hard-working tax-payers’ money there would be a national outcry, with newspaper headlines baying for blood (think BBC executives’ pay, MPs’ expenses and so on); and yet here we are individually contributing to the monumental wastage of something we steadfastly maintain that we ‘value’.

Separating those appointments out between general practices and hospitals, it is apparent that approximately 1 in 20 GP appointments are lost. In my own practice, around 100 GP appointments are lost every month, and last month an appalling 200 nursing appointments were lost. Like many practices across the country, we are overloaded with work and stretched to the limits in trying to meet the demands thrust upon us. We limit advanced-booking, as it is well known that the more appointments booked in advance, the greater the quantity that is wasted. Yet we are castigated for trying to reduce those wasted appointments by applying such a policy.

The value of each lost GP appointment in the NHS is worth in the region of £20. Now, if you saw a £20 note on the pavement, would you pick it up and consider yourself lucky, or would you walk by and ignore it? I know what I would do. I cannot ignore 1p or 2p pieces, let alone a £20 note, and I suspect that you would do the exactly the same; at least when it comes to the note. So why are we so dismissive of the issue of lost appointments? Is it that we have been lulled into the false sense that the NHS is ‘free’, when it is anything but free?

Items given away are often seen as holding little value. If we lose them or break them, it doesn’t really matter to us as they were free in the first place. It seems that to value something, many of us need to understand the cost. Even more so, that cost needs to be seen as being paid by us. So, how about the introduction of a fine of £20 for every missed GP appointment? Last month my practice alone would have brought in enough money in fines to pay for another full-time GP or a couple of practice nurses to ease the workload. Perhaps fines would start to make us truly value the NHS and reduce the shameful wastage currently taking place.

(First published in the Scunthorpe Telegraph, Thursday 22^nd November 2012)

Is There a Limit to Our Responsibility?

A few weeks ago, I was walking across the parking area of a motorway service station when I spotted a glass beer-bottle standing upright in the middle of a parking bay. I had two main options. I could walk past, ‘tut-tutting’ about someone’s carelessness and stupidity, or I could picked it up and deposit it in the nearest litter bin. (A third option of seeing how far I could kick it didn’t enter my mind at the time.) Conscious of the perceived danger to someone else’s car tyres, I chose the second of the options, and thus, just possibly, significantly altered the path of some unknown person’s journey later that day. Why did I act in the way that I did? Purely and simply because I felt that, having perceived a risk to someone else, I then had a social responsibility to do something about it. The act was a simple one; but not to have performed it would have been as socially irresponsible as the act of putting the bottle there in the first place.

I would have thought no more about that episode if it hadn’t been for a recent home visit in my capacity as a GP. My patient was an elderly lady who lives on her own. She had been unwell for a few days and a (much younger) female friend had called the surgery. The patient does not have any family living locally, so the friend stayed and tidied the house for her whilst waiting for me. I hadn’t met either of the two ladies before, but was impressed by the care being taken by the friend, who was able to give me a good history and presented me with various hospital paperwork and a list of medication.

Having examined my patient and diagnosed her problem, I wrote a prescription and handed it to her friend on the supposition that she would kindly collect the medicine. It was as I was leaving, feeling sure that the elderly lady was being well cared for, that her friend said something that has had me thinking ever since. ‘I’ll collect the medicine, but of course I’m just a good friend; she’s not really my responsibility’ were her words. It was the bit about ‘not really my responsibility’ which mentally stopped me in my tracks. Just what was the unwitting message behind that phrase? Clearly, she had no legal responsibility for the elderly lady; at least not in the same way as a parent or guardian has over a child, or a carer has over a resident of a residential home. Neither did she have the professional and legal ‘duty of care’ that I had as a doctor. Was the friend expressing the view that her ‘good friendship’ was conditional and only went so far; and when the going got rough, she didn’t really care that much?

Responsibility can be a legally imposed state. However, it is also about being morally accountable for one’s behaviour. In a society such as ours, surely we are all morally accountable for each other? Is there really a time when we can morally turn our back under the cover of the phrase ‘not really my responsibility’? W.B Yeats wrote ‘In dreams begins responsibility’. On humanitarian grounds, that responsibility never leaves us.

(First Published in the Scunthorpe Telegraph, Thursday, 1^st November 2012.)

We Are All In This Mess Together

October 2010 was an auspicious month. Amongst many other happenings, it was the month when I first voiced my concerns over the NHS reforms. One of those concerns was that there was (and still is) insufficient money to run the NHS in a way that pleases most patients and also satisfies the politicians who ultimately have to take account of public spending. Whilst many people lauded the Government’s concept of putting GPs in control of running the local services (whilst at the same time dismissing significant numbers of managerial staff who actually knew how to run the NHS), I voiced the concern that it would all end in tears. The money would continue to be insufficient, services would have to be reduced, hospitals would close, the public would be angry, and GPs, powerless to turn a pig’s ear into a silk purse, would get the blame from both patients and politicians. It was a poisoned chalice from the start.

Two years on, that moment of staring into a murky crystal ball is proving to be prescient. Nobody can doubt that the NHS is falling apart. Every day there are stories from across the country where patients are struggling to obtain an appointment to see their GPs, and clinics, wards and hospitals are closing. Most GP practices are inundated with work to a level where they simply cannot cope. Some have already had to close; others are hanging on whilst the doctors strive to maintain a resemblance of a credible service whilst seeing their personal income plummet. Meanwhile, the Government sits emulating the Emperor Nero, informing us all of how wonderful the reforms are, how necessary they are, and how the politicians are not to blame for the terrible mess they have created.

As an example, let us take one of the craziest tasks currently facing GPs. We must, we are told, reduce the number of A&E attendances. If we do not achieve this, we reduce the money coming into our practices. How, we all ask, are we to manage such a herculean task that is effectively out of our control? We may as well be asked to reduce the number of teenagers visiting the cinema on a Saturday night, for all the power we have over such a situation. People visit A&E for numerous reasons: genuine emergencies, convenience, lack of transport, inaccessible out-of-hours services and over-loaded day-time surgeries are just a few. The solutions for many of these issues do not sit within the grasp of most GPs. It is a multi-facetted, multi-organisational problem. It requires socio-economic changes out of reach of GPs. It also requires more money being spent to address it; not a reduction of finance to general practices.

No one group has the solution. However, you can start by helping us all out by not attending A&E for trivial reasons. The clue is in the title ‘Accident and Emergency’. If it is neither of these, please telephone NHS Direct for advice, visit an NHS walk-in centre, or wait until your local surgery is next open. If you do not, you are contributing to the financial waste and the subsequent decline in GP services. The truth is we are all in this mess together.

(First published in the Scunthorpe Telegraph, Thursday, 26^th October 2012.)

Don't Feel Helpless

Are you a fan of Doctor Who? If, like me, you watch every show with eager anticipation (even if it is from behind the sofa), you will no doubt be very familiar with the front door of the TARDIS. In particular, you will have seen numerous clips showing the distinctive black and white badge of the St John Ambulance on that very door (yes, even the Doctor travels everywhere with a first aid kit).

Well, the latest news is that the St John Ambulance, the country’s leading first aid organisation, has hitched a ride with Downton Abbey (another of my favourites), screening the first viewing of its new, hard-hitting campaign during the first episode of the latest season of Downton Abbey a few weeks ago. If you happened to miss it (the campaign, not Downton), do not worry as I will give you a web-link a little later.

The St John Ambulance film is called ‘Helpless’. It is a highly emotive drama, depicting the story of a young man who is diagnosed with cancer, is treated and survives; only to die of choking at a celebratory barbecue with his family. Why did he die? He died because nobody knew how to save him with simple first aid.

It is a worrying fact that so many people have not taken a first aid course because they do not see the point of doing so, or think it will take up too much time. However, there is a very good chance that everyone will get called upon to act as a first aider at some time in their lives. The tragedy is that some 140,000 people die needlessly each year, when simple first aid could have saved their lives. 140,000 deaths is equivalent to the number of people who die from cancer each year. Yet, despite these terrible statistics, 41% of people recently surveyed said that it would take something as severe as the death of a loved one to make them learn first aid. The obvious question is, why wait until then? Why not learn first aid now and be in a position to save your loved one from dying?

Fewer than 1 in 5 of our population knows first aid. If you are one of those four people who doesn’t, please take a moment to watch the new St John Ambulance film ‘Helpless’ (http://www.sja.org.uk/sja/support-us/the-difference/helpless.aspx) and then ask yourself whether you would have known what to do. If the answer is ‘no’, then enrol now for a first aid course (http://www.sja.org.uk/sja/training-courses.aspx) or at least download a free first aid app for your mobile phone (http://www.sja.org.uk/sja/support-us/the-difference/helpless/mobile-phone-app.aspx) or request a free pocket-sized guide (https://www.sja.org.uk/sja/support-us/the-difference/get-a-free-first-aid-guide.aspx or text HELP to 80039). There is even an on-line game for the children (http://www.sja.org.uk/sja/support-us/the-difference/helpless/rescue-run.aspx); after all, it is often children who help the adults in times of emergencies.

Don’t feel helpless. Don’t wait for a loved one to die before you act. Learn first aid now and be the difference – the difference between a life lost and a life saved.

(First published in the Scunthorpe Telegraph, Thursday, 11^th October 2012.)

            

The Remembrance Day Parade

As he walked up to the rostrum

silence round him fell;

and, whilst he gazed upon the steadfast ranks,

emotive lines began to tell.

Too many lives were lost before today:

young men and women – yesterday’s youth.

They were the cheques we drew to pay

for the blinded search for fallacious truth.

You are the inspired; the fortunate few

who have lived through to this day;

the ones who now must tell the world

to find a better way.

It is the charge of those who live,

beyond vanquished dreams of many men,

to find the strength to forgive;

to learn and love as best you can.

And in so doing, let us ensure

a sense of remembrance, not of rage;

may this quietude beyond the war

turn pugnacious soldier into reflective sage.

Thus, he stood upon the rostrum as

the silence round him fell,

and gazed upon the steadfast ranks

of those returned from hell.

© Copyright Robert M Jaggs-Fowler 2008

Spirituality, Religion and Health

I wonder how many readers would find it strange if their GP was to ask them about the role of faith in their lives, or whether they consider themselves to be spiritual or practised a particular religion?

At the present time in the UK, the General Medical Council (GMC) may take a dim view of such a line of questioning. However, there is growing evidence to show how spirituality and religion can, and does, have a positive effect on many aspects of our health and longevity.

In a society that is becoming increasingly secular, those of us who profess a faith, pray, meditate, or attend a place of worship (regardless of whether it be the parish church, mosque or synagogue) are often, at best, misunderstood. Yet there are studies to show that we are most likely to make a successful recovery from illness, have lower incidence of some illnesses, and may live longer than those who are not spiritual or religious.

This column does not allow for a detailed analysis of the definitions of spirituality and religion. However, if we place to one side for the moment the precise meanings, and simply accept that the terms often overlap and encompass a wide range of beliefs and rituals, scientific studies indicate that people following such practices have lower suicide rates, less anxiety and depression, recover faster from depression, are less likely to abuse drugs and alcohol, have a greater sense of optimism and general well-being, consider their lives hold greater purpose and meaning, have higher levels of social support, and greater marital stability. They also have better immunity to infections, lower blood pressure and cholesterol levels, less heart disease, better recovery rates from heart disease, less sleep problems, lower death rates from cancer, are less likely to smoke and more likely to take regular exercise. Furthermore, regular religious attendance can add an extra seven years to one’s life; equivalent to the gain in longevity seen by non-smokers.

Armed with such important information, the question is how should health professionals make use of it? Being prepared to take a spiritual history may well be the first step. This is not as strange as it sounds, especially if we consider the role of doctors is to become familiar with any issues that may be affecting a person’s health, or may affect their acceptance of certain forms of treatment. The doctor does not have to be personally spiritual or religious, or be of a particular faith to understand the impact of such issues; just as a doctor is not expected to have heart disease to understand and assist someone with heart disease. The important factor is for the doctor to be in a position to assemble the resources required to assist a patient’s recovery; and that may involve calling upon the services of a chaplain, rabbi, imam or other members of a particular faith community. Furthermore, the evidence suggests that the positive role of spirituality and religion in people’s lives should even become an issue for Public Health services.

In 1869, when Charles Darwin wrote about the ‘survival of the fittest’, many thought he was blasphemous and anti-religion. The irony for Darwin and his followers (including contemporary writers such as Richard Dawkins) is that it is now known that the fittest are likely to be those who are religious.

(First published in the Scunthorpe Telegraph, Thursday 4^th October 2012.)

The Hard Game of Life

 ‘Hope springs eternal in the human breast.’

If only the 18^th century words of Alexander Pope were true for every person. Hope, that powerful emotion that, when present, so readily dispels its antithesis despair, is sadly lacking from many people’s lives. The result is a never ending spiral into an increasingly black hole at the bottom of which resides suicide; the thought of which curiously acted as a ‘great source of comfort’ to the German philosopher, Friedrich Nietzsche. Yet our true source of comfort ought not to be found in death, but in an optimistic outlook on life, fuelled by a game plan to bring our great expectations into fruition.

The statistics for suicide are a cause for great concern. The World Health Organisation calculates that every year some one million people worldwide die by suicide, corresponding to one death every 40 seconds. This is more than the annual loss through murder and war combined. Yet, the situation could be far worse as up to twenty times this number of people fail in their attempt at suicide. It is calculated that 5% of people attempt suicide at least once.

Often hidden by other events (such as road traffic accidents and cases of drowning), suicide is the leading cause of death amongst young people (100,000 adolescents per year). Those overwhelmed by stressful life events and emotional distress, in chronic pain, or suffering from a psychiatric disorder, alcoholism or drug addiction are most at risk. Overall, more men die by suicide, whilst more women attempt suicide. In terms of age, the suicide rate is high amongst middle aged men and highest in people over 75 years.

The costs to society from suicide are enormous, estimated to be equivalent to billions of US dollars per year. The psychological and social impact on families and communities is even greater. Yet, despite its frequency, suicide is often under-reported for fear of family stigma, religious concerns and negative social attitudes.

The good news is that suicide can be prevented. It was with this simple fact in mind that September 10^th marked the 10^th anniversary of the World Suicide Prevention Day. The latter exists to raise public awareness of risk factors, improve efforts to strengthen society’s protection of the vulnerable, and to teach people where they can seek help. The focus is on public awareness campaigns, increasing supportive networks for young people, increasing training for healthcare professionals, improving mental health resources and reducing the barriers to accessing these.

That said, even at present, there are various readily accessible support groups outside of the normal health services. For example, the Samaritans, founded by the Reverend Chad Varah (who was born in Barton upon Humber), provides a 24 hour support line on 08457 90 90 90 (www.samaritans.org). There is also Nightline; a student-focused support line, whose Hull number is 01482 466272 (www.nightline.ac.uk).

Life was never promised to us as something that is easy; but neither, contrary to the lyrics of the theme song to the television programme MASH, is suicide painless. Somebody, somewhere, always gets hurt to an unfathomable extent. Working together, society can reduce that pain.

(First published in the Scunthorpe Telegraph, Thursday, 20^th September 2012)

Thought for the Day

'I believe in Christianity as I believe that the Sun has risen - not only because I see it, but by it, I see everything else.'

C. S. Lewis (1898 - 1963)

Out of the Frying Pan into the Fire

Stagecoaches were the main means of long-distance travel before the advent of the railways. Drawn by horses, each journey required regular stops to change the tired horses for fresh ones. Travelling at slow speeds (4-7 mph), a lot of effort was involved just to cover short distances. Indeed, it could take an entire day’s journey to travel from Barton upon Humber to Boston; a long, arduous journey without any meaningful change of scenery.

Last week saw the Prime Minister change many of his horses in a mid-term re-shuffle of the Cabinet. Amongst the ministers put out to grass was the former Secretary of State for Health, the Rt Hon Andrew Lansley. Vaunted as the architect of the Health & Social Care Act 2012, many would prefer to see him cast as a demolition man rather than a designer; in this case, the destruction of the National Health Service. Having spent almost nine years holding a health portfolio (the first six in Opposition), it is astonishing that he so spectacularly failed to understand that the National Health Service works better as a functioning whole rather than as fragmented bits. After all, who in their right mind buys a jig-saw puzzle ready made up, dismantles it into 1,000 pieces, and then stands back to admire the result?

That, however, is what Andrew Lansley has managed to bring about after nine years of studying the NHS. Albeit rickety and demanding high-maintenance, what was once a functioning and coherent service is now lying in broken chunks scattered over the landscape. The irony is that Aristotle understood the principle as far back as the 3^rd century BC, commenting that ‘The whole is better than the sum of its parts’. Integrated health care is something clinicians have desired for many years. Yet, the concept of co-ordinated, comprehensive and seamless care has been laid to waste by a Secretary of State who was deluded into thinking he understood the complexities of life at the forefront of health care. For someone who holds a degree in politics, it is astonishing that he was unable to assimilate the lessons of the past, and in particular the Porritt Report of 1962 which stated ‘We have concluded that in future one administrative unit should become the focal point for all the medical services of an appropriate area’. That was what the now terminally-ill Primary Care Trusts were for.

The Prime Minister’s change of horses has produced Jeremy Hunt as the new Secretary of State for Health. Hunt is on record as holding controversial views on health care, which do not exactly encompass Aneurin Bevan’s vision of free-at-the-point-of-use medical care for everyone. A failed exporter of marmalade, Hunt is clearly the right person to pull the NHS on to its final stage of destruction.

The only real hope of rescue is a change of government with the next election when, as one senior NHS executive said to me recently, another major reform will be needed to stitch the NHS back together again. Perhaps the French novelist, Jean-Baptiste Karr had it right when he wrote ‘Plus ça change, plus c'est la même chose’; the more it changes, the more it is the same thing. After all, even after a long arduous journey, the Wash still looks a bit like the Humber.

(First published in the Scunthorpe Telegraph, Thursday 13^th September 2012)

Thought for the Day

'Faith need not be unacceptable to contemporary culture, and contemporary culture need not be unacceptable to faith'

Paul Tillich (1886-1965)

Thought for the Day

'To study theology is to set out on a voyage of discovery that is at times enriching, at times challenging, but always profoundly interesting.'

Alister E McGrath (2011)
From the Preface to Christian Theology - An Introduction

In a Motivational Mood

Continuing with my theme of the Olympics and Paralympics serving as motivators to those who for some reason psychologically feel unable to achieve something with their lives, I watched with interest as Professor Stephen Hawking opened the Paralympics with an opening ceremony designed to ‘celebrate the possibilities that lie within us all’, as the brief for the artistic directors was phrased. 

Tapping those inner possibilities is not something we are always good at; either as individuals or as adults with a responsibility to do precisely that in respect to our younger members of society. I still remember the moment my headmaster informed me that, in his opinion, I would never become a doctor. I could so easily have been discouraged at that first hurdle, spent my time at university reading the Classics and be running a bookshop by now. I could also have been dissuaded of my heart’s desire when, in the 4^th year at medical school, a general surgeon pompously informed me that I was wasting my time by wanting to enter General Practice. Fortunately, my well-polished rebellious streak came to the fore on both occasions and I ploughed my own furrow with a focused determination.

However, not everyone can be so self-motivated. It is then that such reservations need to be overcome by those who recognise the untapped potential. It was with those thoughts in mind that I recently listened to BBC Radio 4’s programme ‘Lewis’s Return Home’. Based on the life of the writer Ted Lewis (author of the book behind the famous film, Get Carter), it told the story of how, when a pupil at the Grammar School in Barton upon Humber, Lewis was taken under the wing of his schoolmaster, Henry Treece. Treece, in his own right a celebrated poet and author, recognised the artistic talent within Lewis and persuaded both him and his parents that the Hull Art College was the place for Ted to go. From there, Ted Lewis began a writing career and, as the saying goes, the rest is history.

The story was far different for Nicholas McCarthy. McCarthy only has one hand; he was born without his right hand. At school, his head teacher told him that ‘having one hand would always hold him back and it was better not to waste his and other people's time’. The comment was made in respect to McCarthy’s desire to learn the piano. Not to be daunted, McCarthy taught himself to play the keyboard. Last month he graduated from London’s prestigious Royal College of Music. Last week, he played as part of the paraorchestra, Britain’s first disabled orchestra. Next month he embarks on a tour as a concert pianist, starting with the Fairfield Halls in Croydon. (McCarthy’s remarkable story and the opportunity to watch and listen to him play can be found at www.bbc.co.uk/news/uk-england-surrey-19179499).

Teachers such as the headmasters both I and Nicholas McCarthy were exposed to have no place in the lives of children. Demotivation is the last thing young people need. Every child should have a Henry Treece at their elbow, seeing the hidden potential and driving them forward to achieve what is in their hearts and minds, regardless of the hurdles they might face along the way. ‘Celebrating the possibilities that lie within us all’ is what the London Paralympics was focused upon. It should become everyone’s mantra for life.

(First published in the Scunthorpe Telegraph, Thursday, 6^th September 2012)

The Frustrating Field of Human Endeavour

As a doctor, I have realised that people broadly fall into three categories when it comes to illness and disability. The first consists of those who are so severely ill or disabled that they require assistance with all activities of daily living. They are unable to perform even the most minor task. They need and deserve all the assistance that medicine, social services and society as a whole can provide to ease their misfortune.

Then there are those who, regardless of how severe their diagnosis is, shoulder the burden and carry it with aplomb, determined that they will continue to live as actively as they possibly can. They overcome psychological and physical burdens, as well as social prejudices and discrimination, to make their lives fulfilling. They are largely uncomplaining, being appreciative of everything done to lighten their load. They strive to meet everyday challenges, including working for as many hours or days they can manage. They do not expect to be totally kept by the nation on benefits, and instead earn money and pay their tax as well as any able-bodied person. They are a credit to themselves and to humankind.

Finally, there is the opposite group to the aforementioned. They usually have some genuine illness or disability (although some do fabricate their condition), but they magnify their symptoms and wear their suffering like a badge for all to see. Regardless of how capable they remain, they consider themselves to be totally incapable of work for even a reduced number of hours per week.  These are people who are quick to blame others, including the medical profession, for their misfortune in life. They also believe that society owes them something and that it is their right to live on state benefits. The fact that they still have a functioning brain, or the use of their arms, or can sit even if they cannot stand for long (and so on) is immaterial to how they see themselves and their ability. In their eyes they are totally disabled and incapable of contributing to their own care or to society as a whole.

It is this third group that I admit to professionally finding the most frustrating. With such people, there is a part of me that wants to confiscate their unnecessary walking stick or crutches, shake them by the shoulders and tell them to get a life. As a reader, you will know someone like that. You may even recognise yourself as one of this group.  To such people let me say that I know you are often in pain, or have difficulty with your heart, lungs, bowel, bladder, or a limb or two, and that life is not always easy; but it is not impossible. Life is also precious; a once-only gift and you are wasting yours.

Dr Ludwig Guttmann shared the same professional exasperation when he was put in charge of a spinal unit at Stoke Mandeville Hospital in 1943. Refusing to allow his colleagues or his patients to see people with disability as totally incapable, he strove to make patients focus on what they could do rather than what they could not. As a result, the Paralympics was born. This week we will watch with awe, pride and fascination as men and women show how they have overcome enormous difficulties and suffering to excel and make something of their lives. As you watch, ask yourself one question. If they can do it, what is stopping you from achieving more than you currently imagine you are capable of doing? 

(First published in the Scunthorpe Telegraph, Thursday, 30^th August 2012)

Thought for the Day

'We must...resist the doctrines of progress and emancipation that undervalue the task of helping one another to live well and truthfully with situations when, frequently, there are no cues or answers. This is the task of the pastor which early Christians termed 'sustaining'...'

Elaine Graham (1999), 'Pastoral Theology: therapy, mission and liberation?'
Scottish Journal of Theology, p. 448.

Thought for the Day

'In nothing do men more nearly approach the gods than in giving health to men.'

Cicero.

The Dawn of a New Renaissance

Within the past week an avid reader of this column kindly let it be known that her husband calls me ‘Renaissance Man’. For someone whose internet blog describes himself as ‘an aspirant polymath’, such an accolade was very flattering indeed. For a few hours I basked in the delusion that I had finally joined the ranks of Leonardo da Vinci, Frances Bacon, Galileo and other erstwhile figures, until my wife recognised the danger symptoms and rescued me by the simple reminder that I still hadn’t accomplished the task of getting the flat battery out of her MG, and had yet to remove a radiator from the wall without the need to call an emergency plumber.

With my feet firmly back on the ground and putting my practical failings to one side, I attribute my interest in so many areas of life to my time spent at one of the country’s foremost grammar schools (St Olave’s in Kent). An Ofsted inspector recently described the school as having ‘a focus on scholarship and cultural enrichment with a vibrant approach to intellectual curiosity’; another said ‘it is a school which aims at success and succeeds’.

A major aspect of life at St Olave’s was the sense of competition. Competition ran through every activity of the school as much as ‘Brighton’ runs through Brighton Rock. If you were not competing to ensure that your ‘House’ won the most points in that academic year, you were striving to be in the 1^st rugby team, squash team, tennis or fives team. In between the omnipresent sports fixtures, you polished up your musical scales in order to secure your place in the school orchestra, brass band, wind ensemble, jazz band, barbershop quartet, choir or whichever musical group was performing in the near future; and amidst all of that, you aimed to ensure that your academic grades would secure you a place at one or other of the country’s top universities. Quite simply, you aimed to be the best…at everything. What is more, it was always understood that you had either ‘succeeded’ or you ‘hadn’t succeeded yet’. Failure was not recognised. Everything was possible.

The 2012 London Olympics has profoundly demonstrated the sense of endeavour portrayed by an enormous number of people; men and women who, day in and day out, have pushed themselves to the limit to excel at their sport; to be the best. Often, during the long hours of training, the only driving competition has come from the inner strength and desire to beat their personal best; to excel for the shear unadulterated joy of achieving something worthwhile.

If we think we have already witnessed drive and enthusiasm, the London Paralympics is sure to make us think again. I have no doubt that in one week’s time we will witness human endeavour beyond the personal comprehension of many. If the Olympics have been inspiring, let the drive and enthusiasm of the Paralympics teach or remind each one of us that success is all about competing with, and overcoming, our own personal limitations; whatever they may be.

As one commentator reflected, the Olympic Games have shown that there is nothing we (the British) cannot do well if we set our hearts and minds to it. The re-introduction of a sense of competition to school life is an important component of future adult success; whether it is on a national or international level, or simply for personal satisfaction. Ultimately, we can all be 21^st century Renaissance people if we wish to. Now, wouldn’t that tell the world a thing or two about the British?

(First published in the Scunthorpe Telegraph, Thursday 23^rd August 2012)