Month: July 2023

Healing: the future of the NHS

Photo by Daniel Chicchon on Unsplash. The photo is of San Francisco; note that bridge in the background.

I read a short article by Matthew Taylor, Chief Executive of the NHS federation, in the current Wired magazine (July-August 2023). This is an unashamed abridgement of that fine article.

Taylor points out that the human species is better at developing technology than thinking through its consequences. He sees these issue for the NHS:

  1. A revolution in diagnostics. This really good thing– catching disease early– depends a lot on how willing we are continuously to monitor our health. This is not so simple. Already there are harmless incursions in my life. Under my bed is a device that downloads my pacemaker data and sends it to my hospital in London. One time when I was developing symptoms, they asked for a download, then called me in, then re-timed the pacemaker and fixed the problem: really nice. On the other hand, when I was in hospital recently, nurses were taking observations several times a day. My observations are problematic and sometimes set alarms off. At least twice they sent a more senior nurse to redo the observations as they didn’t believe what a junior nurse had recorded. These constant readings do no good whatsoever to how I feel about myself. They are stressful and discouraging. Heaven forbid that I should have a thing on my wrist that did this to me all the time.
  2. The fact that diagnostics are usually probablistic, not black-and-white. In any case, diagnostics don’t help as much you’d like. If you might develop cancer, or might not, but will develop side effects to treatment, whaddya do?
  3. Inequality. Matthew Taylor points out that technology empowers people, but usually it is only some people, and inequality increases given that other people, already disadvantaged, don’t benefit. (This actually is a slightly curious argument when things are on average getting better, but let it pass.)

Finally he talks about care. He makes some fascinating observations: ‘Medicine is technocratic and scientific; care is human and relational‘. Medical expertise is sort-of expected by us patients; care is what makes the difference to how we feel about our treatment. That is very true in my experience.

Medicine is technocratic and scientific; care is human and relational

He points out this issue is especially important in end-of-life care. End of life treatment is usually the most expensive medical phase in a person’s life, but still ‘a lot of people don’t get the end of life care they want. They might receive expensive care, when they would rather have cheaper care that’s more humane, at home, with loved ones.‘ This is fascinating. Having watched friends die both in government hospitals and in our local (charitably run) hospice, I know which of the two I would choose. Give me the lovely hospice every time.

Perhaps a contribution that people of Christian faith can offer in their last days is choosing not to have every possible intervention to keep us hanging on, but to decide our time’s up, go home, or to a hospice, to face the end of life in peace? It is oddly the opposite of euthanasia, realizing our time has come and accepting it. Interesting.

In praise of great courses

What listening to good lectures is really like. Photo by Jonny Gios on Unsplash

This is an unashamed plug for Audible. After a long time protesting that the only way to get audio books at a good price was to join Amazon’s equivalent of a book-of-the-month club, we finally capitulated few years ago and signed up.

One book a month is more than I would like to buy. There are still such things as libraries that give you books for free. But to sweeten the deal Audible also offers free books that are additional to your subscription, and I think these disappear from your personal library if you ever stop paying your £7.99.

Somewhere along the line, Audible appear to have bought a whole catalogue of courses that used to be marketed separately as ‘The Great Courses’ ; and they added some of these to their free offerings. They are lecture sets, from able and obsessive communicators, and like most lectures I’ve ever been to, I enjoy the feeling of dining at a rich person’s table, even if I don’t belong there, and soon forget most of what 1I took in.

They are so good. I tend to listen to them while I work through a keep-fit programme, which, as anyone who does this kind of thing will testify, is among the most boring activities on earth. Unfortunately it’s also a kind of investment in health that you get compelled to make.

So, the Great Courses, to distract from the zombifying act of personal training. Like I said, they are so good. Here’s what I’ve listened to so far:

London: A short history of the greatest city in Western World by Robert Bulchoz. Wonderful story from a lecturer (I think) at Loyola University in Chicago, who in my listening never put a foot wrong in his knowledge of the city, told me huge amounts I didn’t know, and gave me the little warm glow that happens when someone from the outside praises a thing you love from the inside.

Classics of British Literature by John Sutherland. Another survey of the UK by an American lecturer (if I remember right), starting with Beowulf and ending in somewhere in the 21st century. He has evidently read everything and slotted it into its historic context. Absolutely wonderful. Wish I could remember 90% and forget 10% of this rather than the other way around. His only fault was not talking much about Anthony Trollope.

The world of Biblical Israel by Cynthia R Chapman. So nice to hear Biblical studies from a Biblical scholar who isn’t aggressively trying to undo and unpick the Bible, or indeed aggressively defending it, but rather treating it as a thing that is there and explaining it with respect.

Understanding Complexity by Scott E Page. This was somewhat nearer the maths and physics that I failed to understand as an undergraduate. An introduction to the theory of complex systems, with entertaining divertissimos (if that’s the plural of divertissimo) into how complexity theory should be applied to the life we find all around us. Complexity is why economic predictions are always wrong and why (I think) a drug that did me a lot of good when I took it for a season nearly killed me when I went onto a second course. Drugs and human interactions are not simple, they are complex. Doing the same thing a second time can have the reverse effect to what it did the first time. I wish every politician and civil servant who tries to manage a complex entity like the UK, and every physician who tries to solve human body problems would listen to this.

Augustine: Philosopher and Saint by Philip Carey and Books that Matter: The City of God by Charles Mathewes. Two majestic introductions to the life and thinking of the North African saint and ‘Doctor of the Church’. I’m still working through the lectures on Augustine’s great work ‘The City of God.’ I’m used to physics and so I’m aware how Copernicus changed the whole way we think about the solar system, how Newton did the same for physics, and Einstein did it again for cosmology, and the founders of quantum mechanics did for quantum theory. I didn’t realize that Augustine had done much the same for Western theology and perhaps even historiography. This is well beyond me. But even the bits I do understand are revolutionary.

I believe no-one should ever listen to a lecture or read a book because it’s ‘important’. You should only ever tackle anything if it’s fun, a rollercoaster. These were.

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Healing and social justice

One of our local miracle drugs

I’m struck (but then I’m a slow learner; it’s obvious when you think about it) how much health and social justice are linked. For churches, it’s fascinating how important this ‘pre-healing’ ministry is. And any church interested in ‘healing’ ought to be fascinated by the possibilities of pre-healing people before they ever get sick. The good we can do! The changes we can make! Look at this from the current Wired magazine 1, which finds its way to us among articles about virtual wards, remote robotic surgery, and unlocking the NHS’ troves of digital records.

… about one in five people live in poverty in the UK. Poverty has an awful impact on physical and mental health: it is associated with higher infant mortality, lower adult life expectancy, poorer mental health, asthma, diabetes, cardiovascular disease and obesity. It has been estimated that getting your daily calories from healthy foods costs three times more compared to buying poor quality food.

Housing is another big problem. According to the Health Foundation, one in three people reports a problem with the affordability, security, or the quality of their housing. Issues such as mold and damp can lead to respiratory problems and headaches…

Green spaces are another massive issue. There’s a lot of evidence now proving that exercise is like a miracle drug. There is also plenty of evidence that if you provide more open, free, green spaces to people, you end up with higher levels of physical activity in the population, and improved mental health. In 2020, the government itself estimated that if every citizen had access to green spaces, it could save the NHS billions of pounds a year.

… We need to realize that almost all policy has an impact on population health, and think more holistically about what our health priorities are for the longer term.