From John in Brighton

9 August

Whose sage? Which SAGE?

Well I’ve just had a flashback to my salad days. Flicking thro’ the Observer recently I recognised  a physiognomy from yesteryear – the rugged features unchanged but the black hair now all but grey throughout. Some July that year – the Toxteth riots in Liverpool and Princess Di married Charles. Lest that’s not enough then this should clinch it – cricketing history was made as England became the first team this century to win a test match after following on as soon-to-be-Lord Botham and the late Bob Willis did for the Aussies at Headingley. It speaks for our extraordinary times that Sir Ian gets his upgrade not for the  worthiness of cricketing prowess, his wine label (bit pricey even in Tesco)  or charity walks but for backing Brexit. Does it get rescinded should that all go pear-shaped?
So whose face could be so powerfully redolent of my younger day? Tony Costello my erstwhile SHO (aka dog’s body) colleague at the Childrens’ Hospital in the Hackney Road. Mutual support as the East End children poured into the Casualty (the term A&E was still not widely used) like a tsunami. He was passionate about cricket and our only breaks were very brief test match updates on Tony’s crackly trannie. He was clearly very bright, quite opinionated considering our relatively callow status but with a much-needed sense of humour. SHO’s are like stem cells in the blood – common origins and the potential to develop in multiple different directions. For Tony the stellar heights of Professor of International Child Health at UCL and a Director at the WHO. Meanwhile I was happy to spend 25 rather more prosaic years at the busy coal face on the South coast. Either way we had a perfect training ground for both – . plenty of patient contact and the pre-gentrified Hackney was a melting pot, so perfect for an initial dabble on the international front. We’d occasionally splash out on a curry from Brick Lane, just around the corner, which had yet to become a household name following Monica Ali’s 2003 novel.  
Tony is a member of Independent SAGE, a name which I find confusing and would suggest is ill-advised. It is a self-selected group of experts created with a view to encouraging more open presentation and discussion of the scientific facts around Covid. The group is independent of the Government (unlike the Scientific Advisory Group for Emergencies [SAGE]) and does not answer to it but is chaired by Sir David King, a former Government Chief Scientific Adviser. It shares its work with the Government and the public but whether the former listens may be another matter. They recently wrote to Chris Whitty advising that we pursue a Covid-zero elimination policy before any further easing of lockdown and Whitty publicly then said we’d relaxed as far as we could but will the politicians be of a piece? An effective Test and Trace scheme is key to this – £10 billion for a “world beating” system that misses 25% of cases surely begs some questions. The recent little pockets of escalating cases might be interpreted as a bellwether of a potential second wave and give backing to the harder line. It’s easier to pass judgement and opinion when you have no responsibility for matters fiscal but on the other hand a second wave might well shut the economy down again – surely it’s better to pre-empt that. In his Observer interview Costello was open in some of his criticisms and two comments of note were a suggestion that some of Matt Hancock’s decisions verged on the criminally negligent and  that about 50,000 of our current excess 65,000 deaths were preventable with more competent management .
My reflections move on to how different is the NHS now. Progress in treatment in all specialties has been phenomenal. But it’s not all been rosy. A year after Hackney Roy Griffiths, Deputy Chairman of Sainsburys produced a report and so another-Lord-to-be Ken Clark began the insidious mushrooming of NHS management along with a move towards a more business- based service. It has always been a dilemma in my mind as to how much financial implications should dictate care. Clearly money must be used judiciously but the new world of purchasing and commissioning, business plans, contracts and efficiency savings (euphemism for cutbacks) was one that at times felt like a foreign land to some of us. The Patients Charter gave power to the elbow for patients but some are much better at speaking up and making demands and it encouraged a litigation culture. The introduction of targets seemed to further distort priorities at times and especially in areas which are harder to measure and may explain why mental health really doesn’t have parity with the physical despite repeated governments purportedly making it a priority. The NHS has increasingly become a political football which is detrimental to the service, the staff and the patients.
Notwithstanding all this the septuagenarian NHS remains to my mind one of the jewels in the crown of this country and one which we should respect and cherish if it is to survive.  One thing that undoubtedly hasn’t changed is the enormous commitment of the staff many of whom are seriously underpaid and go well beyond their contracted  hours of employment driven by a sense of duty and desire to do the best for patients. The pandemic has shone a light on this as rainbows have appeared in windows and the Thursday clap became a weekly ritual. The pandemic is going to leave many scars but hopefully there will be the shimmer of a silver lining as well. A weekly clap and supermarket priority slots are welcome but don’t pay the rent or bills and we need to ensure that all public service workers are appropriately rewarded for their skills and commitment. I await with interest whether Boris Johnson does do the right thing and tangibly rewards the service that saved his life.

Oh, it was 1981 by the way.

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