Sustaining the NHS

Sajid Javid in the introduction to his keynote speech to Policy Exchange on 'Digital transformation in health and social care' said "The truth is that our health and social care system is following an unsustainable path that is too often not delivering for patients". He went on, "At the start of this century health service spending represented some 27% of day-to-day public service spending. By 2024 it is set to account for 44%. ... But can we really say we've seen an equivalent improvement in outcomes?"

Obviously this rhetorical question was meant to be answered in the negative and I would agree. I've said before (eg. see previous post) that overmedicalisation of society has created too much medicine. This situation is ironic as the currently fragmented and dysfunctional NHS has also inflated demand so that it cannot cope. The NHS needs to relearn to concentrate on priorities. There needs to be a shift back towards meeting need rather than demand.

The BMJ has recently called for a reset in its campaign against too much medicine (see editorial). A rushed article of mine 'The limits of psychiatry' was published (with several fairly minor errors eg. picture of Alfred rather than Adolf Meyer) in a BMJ theme issue in 2002 highlighting the dangers of too much medicine. As the recent editorial says. "Evidence for the damaging effect of overdiagnosis and overtreatment continues to grow". And as it concludes, there needs to be a move from "rhetoric and scattered evidence to actionable evidence and measurable impact".

England’s test summer begins

Peter the Great was no saint

Commentary in Politico suggest Vladimir Putin is no Peter the Great because he has failed to stop murder and rape in Ukraine. But this tapestry of Peter shows him looking pretty pleased with the carnage of the Battle of Poltava in Ukraine in the background.

Battle was raging between Russian forces and the army of Charles XII of Sweden, marking the beginning of Russian hegemony in Northern Europe.

The easternmost point in the UK

Along the River Blyth

From Wenhaston to Blythburgh

Death rattle through Buttler hit wicket

Brave fight comes to an end. Day 5 of second Ashes test. Let’s hope England are good enough to come back.

Painful blow at the end but at least there’s a fifth day

Day four of Ashes second test. At least Malan and Root develop their all-round skills with two wickets each.

Worst day of series for England?

Malan and Root did not bat all day unfortunately (day 3 of second Ashes test). Other partnerships are needed. But Warner got confused leading to a runout. So, is this a repeat of 1936-7 in reverse (see previous post). Is there rain predicted?

Australia in command, I admit it, but …

Day 2 of the second Ashes test. Australia got to more than 450 but England have plenty of batting after losing two wickets. And it is first pink ball Ashes test (see article). And it’s hot, watch the lightning.

Dropping a sitter is embarrassing, but so what?

Rubbing in Buttler’s embarrassment is easy game, but he’s playing a real match. Let’s see after day one of second test. (See previous post posted in Australia).

Discover Lowestoft

Lowestoft in olden times (1899 edition by David Price)

The Arnold family of Lowestoft

The Arnold family held a high position in the town of Lowestoft for more than century. The prestige of the family was enhanced by the celebrity of the educational reformer, Dr. Thomas Arnold, Head Master of Rugby School, and his son, Matthew Arnold, one of the most distinguished of the poets and essayists of the Victorian Era.

Fine line between getting out on fourth day of Ashes test and being/becoming best world batter

And I’m not just meaning Joe Root

Australia demolish England by nine wickets in first Ashes Test

Full scorecard

Listen to the oracle for the next matches in the series (see my report of this match in last three days posts)

Rest day on day 5 (that’s definitely true)

Two full days left in first Ashes test (if no rain)

Can Root repeat what Cook did?

Cook’s five double hundreds

Day three summary

Built on day 2 from Robinson

And Stokes knee should be better as he didn’t have to bat today

Ever the optimist after day 2 of Ashes

England tried their absolute best. What more can you ask in the field?

Not wise for Australia to gloat at the end of only day 2 

England could bat out rest of the match on a Gabba pitch or even set a target?

And then Leach would come into his own on day 5?

The Ashes has started

England suffer nightmare start to the Ashes as Rory Burns dismissed first ball

Not since 1936 has this happened at the start of Ashes

English cricket team in Australia in 1936–37

Pat Cummins sets records in first day as captain, bowling figures

Bradman has been the only captain to win a five-match series after losing the first two Tests. But in 2021/2?

Shortest ever county championship match scheduled for 4 days

I saw the whole match of Essex versus Northants, even if it was only 96.3 overs (see article in The Cricketer). There have been shorter matches (see scorecard) scheduled over 3 days (see tweet by @davidaw69).

Cricket as the UK pandemic eases

Glad to return to the Home of Cricket yesterday. I even wore a red jumper (as it was RedforRuth on day 2).

Hartlepool will again vote for British values

The Labour Party's strategy has come into focus with the loss of the Hartlepool by-election (see New Statesman article). The Hartlepools (see Wikipedia entry) first became Labour in 1964. I think Britain's current conflict about its values will again be decided in favour of liberty, responsibility and fairness.

Had my first jab yesterday and the second jab is booked.

Healthcare has corrupted its mission

Victor Montori’s second edition of his book Why we revolt: A patient revolution for careful and kind care talks about how healthcare has stopped caring. Our current industrial healthcare needs to be replaced by a scientific, unhurried and person-centred care. Patient care needs to be reclaimed as the priority of healthcare organisations.

Medicine has tried to correct this imbalance over recent years in its training and practice (see eg. post on my Relational Psychiatry blog). As expressed by George Engel (1977) when proposing his biopsychosocial model, the fundamental problem is the overemphasis on biomedical aspects of illness at the expense of psychosocial factors. Reform may well not be enough, which is why I like the website of The Patient Revolution, a nonprofit organisation. Managers and funders need to be held accountable for creating and fostering systems that allow patient care to happen. As I said in a previous post, medicine needs to be rethought.