The NHS, as portrayed at the opening of the 2012 London Olympics. Photograph: Julian Simmonds/REX/Shutterstock
Dancing doctors, uniform-clad nurses and children jumping on hospital beds. There are very few countries that would include a celebration of their healthcare system in the opening ceremony of the Olympic Games. But this was the sight that greeted the millions who tuned in at the start of London 2012. After all, as former chancellor Nigel Lawson said: “The NHS is the closest thing the English people have to a religion.”
Now the country will once again celebrate the NHS, as it turns 70. And so we should. Across the globe, 400 million people still don’t have access to essential healthcare services. Thanks to the NHS, no one in the UK faces this injustice. It is there for us all – regardless of race, sexuality, gender or financial means – at our times of greatest need.
But we must also take this opportunity to stop and reflect. How good is the NHS? What do we want for its future? And what do we need to do to make it better?
A new report attempts to answer some of these tricky questions. It shows that, despite the rhetoric, in many ways the NHS is deeply average. In the authors’ words “the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege”. Shockingly, it finds that if you suffer from cancer, a heart attack or a stroke in the UK, you are more likely to die early than in other developed countries.
This reality jars with a national perception of the NHS as world leading. Some will jump on this as an opportunity to call for radical change: perhaps a shift to a social – or even a private – insurance model. This would be a mistake. Fundamentally, the NHS is sound: its “free at the point of need” principle ensures that getting ill doesn’t mean getting poor. Moreover, there is strong evidence that it is more efficient than its marketised equivalents in the US and Switzerland.
Money is part of the answer as to why the NHS underperforms, compared with other systems. We spend less on healthcare than most other countries of a similar size and income level: just 9.7% of GDP compared with around 11% in both Germany and France. It should not come as a surprise that with average levels of funding come average levels of care. Theresa May’s recent “birthday present” – a long-term funding settlement for the NHS worth an additional £20bn a year by 2023 – will start to address this, though many predict that it will not be enough in the context of a growing and ageing population.
But money alone is not the solution: the NHS also suffers from a lack of reform. In places where the NHS has embraced best practice it is undoubtedly world leading. Stroke care is a good example. In 2010, London went from 34 hospitals treating stroke sufferers to just eight new centres of excellence. This has resulted in 400 lives saved per year across the capital. There have been attempts to replicate this nationwide. But in too many areas these changes, which involve consolidating services into fewer, more specialist centres, have been opposed by both the public and politicians.
There are similar debates about moves to embrace new technologies in the NHS. The evidence is clear that artificial intelligence and robotics could fundamentally transform health and care. The government recently announced funding to help save 30,000 lives a year through technology-enabled diagnosis of cancers. But all too often, people see data-sharing as a breach of privacy and the rise of robotics in the NHS as an attempt to cut costs.
In some ways, this reluctance to embrace change is unsurprising. We all have a strong emotional and cultural attachment to the NHS. We are understandably protective of it. And many see the NHS as the last vestige of an endangered postwar consensus. They are fearful that it will go the same way as the rest of the welfare state, becoming watered down, outsourced and underfunded.
But in looking to protect the NHS there is a real risk that we end up “killing it with kindness”. All change is not bad change. As Lord Darzi’s recent review of the NHS has made clear, “high-quality care is a constantly moving target: to stand still is to fall back”. This would not only be a travesty for those who suffer as a result; it would also fuel the arguments its critics. When the great reformer, William Beveridge, proposed the creation of the NHS during the second world war, he was focused not on protecting existing achievements but on embracing the future. On its 70th birthday, it is vital that we do the same again.
What do they know of air pollution who only air pollution know? Kipling didn’t say that, neither did C.L.R. James, nor let’s face it, did former England captain Ted Dexter. But Dexter was the first to connect air pollution in India and international cricket.
After England lost the first Test of the 1992-93 series in Kolkata, Dexter, then chairman of selectors announced grandly that he had “commissioned a report into the impact of air pollution in Indian cities.”
England lost all the Tests of that series, and the excuses varied from pollution to the players’ facial hair to prawn curry in a Chennai restaurant. But Dexter’s attempt at studying pollution is the best remembered a quarter century later.
In The Guardian, David Hopps wrote then: “Dexter will deservedly face accusations today that he is hiding behind a smogscreen, that the only air about last night was hot air, and that anybody seen choking was most likely choking with laughter.”
What innocent days those were!
No laughing matter
Pollution is no longer a laughing matter. It is real, measurable, and, in the case of Delhi, 12 to 15 times beyond safety limits.
To say that Indians handle pollution better than Sri Lankans is a foolish boast, and quite meaningless. To attach nationalism and patriotism to the manner in which Indian players don’t cough or vomit while their opponents do is ridiculous in the extreme.
The fact of the matter is, Sri Lankan players suffered, they deserve our sympathy and even an apology. Two First Class matches were called off in Delhi last year owing to the pollution; there is good reason for the Board of Control for Cricket in India to drop Delhi from its schedule during winter, especially when the pollution levels go from the merely dangerous to the hazardous.
The BCCI has been quoted as saying that next time they will check the pollution levels before giving Delhi a match. We’ll see.
Players selected for a Delhi Test in future might have to acclimatise themselves by revving a car engine in a locked garage. This is a terrible thing to say, but Delhi has been an embarrassment. Images of fielders in masks must rate as the most mortifying to emerge from an Indian sports field.
Such high levels of air pollution are dangerous; players and spectators who already have respiratory problems are badly hit. R. Ashwin, for example, suffered from asthma as a child. Bowling and fielding in these conditions could not have been ideal for him.
Yet, he carried on heroically. No Indian was likely to wear a mask on the field — they wore one off it, though — since that would have sent out a message no Indian wanted to hear. Patriotism before health is the safer option.
If Sri Lanka wore masks, that was a health statement; if the Indians had worn them, it would have been a political statement. That is not a burden cricket needs to carry.
Sri Lanka had every right to complain. The umpires and the match referee had to deal with a unique situation. The guiding principle in all such cases is simple: the health and safety of the players is paramount. Yet there were political considerations here too. Relationship between the countries, future tours, the financial implications of rubbing India the wrong way.
The BCCI president’s aggressive response was disingenuous — but then the governing body has not been known to use tact when belligerence is an alternative.
Not unintelligent
Players are grown men who are not unintelligent. Sri Lanka could not have been unaware of the strategic advantages of disrupting a game where they were being so thoroughly dominated. But we cannot assume that was their primary motivation. If Kohli missed a triple century, blame the politicians of Delhi or the farmers of Punjab. Further proof that no sport exists in isolation.
It has been argued that India play in extreme conditions in Dunedin or Manchester, so why can’t visiting teams play in polluted Delhi?
But climate is a natural phenomenon, pollution is manmade. Playing in England or New Zealand is not injurious to health.
It is true that international sportsmen must be prepared to play in all conditions — weather, pitch, outfield, audience — but you do not travel equipped to deal with pollution.
Pollution affects the Indian team too, brave front or not. If a players’ association existed (as mandated by the Supreme Court), here’s another area it might have made a difference. By definition, such an association would be focused on the players’ welfare (players, history has shown us, are not the top priority of the BCCI).
Perhaps the players and administrators lack specific knowledge of the long-term damage that air pollution can cause. That gap can be filled by a players’ association which focuses on educating the stakeholders in the game.
Sri Lankans will return to their country, the cricketing caravan will move on.
But what of those who continue to live in Delhi? Not for the first time, cricket has shone a light on man’s inhumanity to man.
Just off to a meeting? Stop right now. Turn back. You will be stuck in an overheated room, chained to a table for an absurd length of time and stopped from proper work. Worse, we are now told that just sitting there is a killer. It shortens life. You will die.
According to Public Health England, we are so addicted to meetings that we don’t realise the threat they pose to ourselves and our organisations. Its chief executive, Duncan Selbie, told this week’s annual meeting that sitting in meetings “haemorrhages productivity”. It slows metabolism and affects the body’s capacity to regulate its sugar and thus blood pressure. This leads to obesity, diabetes, cancer … and death. So don’t do it. Don’t go.
The Get Britain Standing campaign agrees. It says that sedentary office activity is now as dangerous to health as smoking. It takes an hour of exercise to eliminate the toxins built up in one round-table session. Meanwhile, the Columbia University Medical Center this week produced a no less alarming statistic. After tracking 8,000 individuals in all walks of life, it concluded that inactivity for 13 hours a day (including sleep) makes “risk of death” 2.6 times more likely than it is for inactivity of less than 11 hours.
The best meeting is spent walking, like in The West Wing. (The fact that all West Wingers seem on the verge of a heart attack is apparently irrelevant.) Mike Loosemore of the Institute of Sport, Exercise and Health rather desperately advises regularly standing up and getting a glass of water. Neanderthals must be laughing themselves sick at what Homo sapiens has to do just to survive.
While we can take that with a pinch of salt, it feeds a wider meetings malaise. All the revolutions of the internet – Skype, Facebook, Twitter – have not diminished humankind’s craving to gather in tedious conclave. Executives ruthless towards workplace productivity are careless of their own offices. Meetings are the cocaine rush of the corporation. I am told there are scores of executives at the BBC, an institution famously addicted to the meetings culture, who are so high on the stuff that they spend the entire day in meetings, and return home with no one any the wiser, except those who pay their salaries. It is half a century since C Northcote Parkinson first addressed the meeting as social anthropology, yielding his celebrated “coefficient of inefficiency”. It calculated that a meeting of just five people was “most likely to act with competence, secrecy and speed”. Few such bodies exist because five swiftly expands to nine: and two of the nine tend to be “merely ornamental”, people whom no one has the heart to exclude.
Above nine, said Parkinson, “the organism begins to perish”. Once the meeting reaches 20 people, it may as well go on to 100, since by then most of those present are not contributing. They are spectating, talking to each other, squabbling or forming lobbies. Nowadays many are peering at their phones or tablets – pretending to take notes, or frantic not to fall asleep. All are praying for “any other business”.
Management research on meetings is uniformly hostile, yet like most research it has not the slightest practical effect. A recent study by Microsoft, America Online and Salary.com found that the average person works only three days a week. The rest of working time was regarded as wasted, with “unproductive meetings” heading the list. Workers on average regard a third of any meeting as pointless.
Minnesota University’s “decisions” guru, the psychologist Kathleen Vohs, has shown that most executives have a limited stock of “cognitive resource”. It depletes over time, like physical energy. People get impatient, they tire and take worse decisions. Curiously, they leave feeling exhausted, despite hours spent doing nothing at all. Four-hour board or “strategy” meetings are probably disastrous to the firm, inducing torpor, claustrophobia and misjudgment.
Yet still recruits arrive from management schools and consultancies, brilliant zombies doped to the eyeballs in presentations “delivering strategic solutions going forward by thinking out of the box”. They are like chateau generals, kept well away from the front line, versed in the parlour games of the articulate classes. They are for coffee and biscuits, not the watercooler.
Nothing is likely to cut this flab. The meeting has become the ceremony of executive importance: who calls it, who chairs it, who presents to it, who is invited and who is not. Its status is a classic cause of office “fomo” – fear of missing out. It soon develops its Harlequinade, the bad jokesmith, the unstoppable talker, the maddening interrupter, the toadies, bad-mouthers, extroverts and those who just sit in silent despair. None is producing goods or services. In short the meeting is the office as religion. Its sacraments, creeds and acolytes are found in agendas, minutes and note-takers. Its liturgy is the canticle of the PowerPoint. The modern office even has its ritual sanctuary, the “meeting room”: 11.00 for matins, 2.30 for vespers.
Describing meetings as “secret killers of productivity”, Forbes magazine recently suggested they be simply banned, or held “only on Wednesdays” – all other decisions to be taken in absentia. Anyone who needs to be consulted – the “coordination” role of meetings – will find out soon enough. If not they don’t really need to know. The few brave organisations that have experimented with this drastic step report phenomenal improvements in workrate. One worker who said that if he missed a meeting, “my boss would probably kill me”, was told: “In that case he probably should.”
The number, length and size of meetings must be a sound Parkinsonian indicator of an organisation’s productivity or decay. The FTSE or the government should publish an annual league table of meetings per employee per week. It would illustrate the thesis by economist Joseph Schumpeter that all organisations have a natural lifecycle: they grow, they fatten, they ossify into meetings, and they die – unless funded by the state.
I bet Apple had few meetings in the early Steve Jobs days, but I bet it has thousands now. If so, as Parkinson warned of all who broke his laws, sell the shares. As for that meeting, skip it – and live.
For years successive governments have built what they call a bonfire of regulations. They have argued that “red tape” impedes our freedom and damages productivity. Britain, they have assured us, would be a better place with fewer forms to fill in, fewer inspections and less enforcement. But what they call red tape often consists of essential public protections that defend our lives, our futures and the rest of the living world. The freedom they celebrate is highly selective: in many cases it means the freedom of the rich to exploit the poor, of corporations to exploit their workers, landlords to exploit their tenants and industry of all kinds to use the planet as its dustbin. As RH Tawney remarked, “Freedom for the pike is death for the minnows.”
It will be a long time before we know exactly what caused the horrific fire in the Grenfell Tower, and why it was able to rage so freely, with such devastating loss of life. But it seems at this stage likely that the rapidity with which the fire spread was either caused or exacerbated by the cladding with which the tower was refurbished.
There have been plenty of warnings that cladding can present a severe fire risk. To give just one example, in 1999 the House of Commons select committee on environment, transport and rural affairs published a report entitled Potential Risk of Fire Spread in Buildings Via External Cladding Systems.
But both Conservative and New Labour governments have been highly reluctant to introduce new public protections, even when the need is pressing. They have been highly amenable to tearing down existing protections at the behest of trade associations and corporate lobbyists. Deregulation of this kind is a central theme of the neoliberal ideology to which both the Conservatives and Labour under Tony Blair succumbed.
In 2014, the then housing minister (who is now the immigration minister), Brandon Lewis, rejected calls to force construction companies to fit sprinklers in the homes they built on the following grounds:
Conservative MPs see Brexit as an excellent opportunity to strip back regulations
“In our commitment to be the first Government to reduce regulation, we have introduced the one in, two out rule for regulation … Under that rule, when the Government introduce a regulation, we will identify two existing ones to be removed. The Department for Communities and Local Government has gone further and removed an even higher proportion of regulations. In that context, Members will understand why we want to exhaust all non-regulatory options before we introduce any new regulations.”
In other words, though he accepted that sprinklers “are an effective way of controlling fires and of protecting lives and property”, to oblige builders to introduce them would conflict with the government’s deregulatory agenda.Instead, it would be left to the owners of buildings to decide how best to address the fire risk: “Those with responsibility for ensuring fire safety in their businesses, in their homes or as landlords, should and must make informed decisions on how best to manage the risks in their own properties,” Lewis said.
This calls to mind the Financial Times journalist Willem Buiter’s famous remark that “self-regulation stands in relation to regulation the way self-importance stands in relation to importance”. Case after case, across all sectors, demonstrates that self-regulation is no substitute for consistent rules laid down, monitored and enforced by government.
Crucial public protections have long been derided in the billionaire press as “elf ’n’ safety gone mad”. It’s not hard to see how ruthless businesses can cut costs by cutting corners, and how this gives them an advantage over their more scrupulous competitors.
Grenfell Tower fire is corporate manslaughter, says Labour MP
The “pollution paradox” (those corporations whose practices are most offensive to voters have to spend the most money on politics, with the result that their demands come to dominate political life) ensures that our protections are progressively dismantled by governments courting big donors.
Conservative MPs see Brexit as an excellent opportunity to strip back regulations. The speed with which the “great repeal bill” will have to pass through parliament (assuming that any of Theresa May’s programme can now be implemented) provides unprecedented scope to destroy the protections guaranteed by European regulations. The bill will rely heavily on statutory instruments, which permit far less parliamentary scrutiny than primary legislation. Unnoticed and undebated, crucial elements of public health and safety, workers’ rights and environmental protection could be made to disappear.
Too many times we have seen what the bonfire of regulations, which might sound like common sense when issuing from the mouths of ministers, looks like in the real world. The public protections that governments describe as red tape are what make the difference between a good society and barbarism. It is time to bring the disastrous deregulatory agenda to an end, and put public safety and other basic decencies ahead of corner-cutting and greed.
Drinking even moderate amounts of alcohol can damage the brain and impair cognitive function over time, researchers have claimed.
While heavy drinking has previously been linked to memory problems and dementia, previous studies have suggested low levels of drinking could help protect the brain. But the new study pushes back against the notion of such benefits.
“We knew that drinking heavily for long periods of time was bad for brain health, but we didn’t know at these levels,” said Anya Topiwala, a clinical lecturer in old age psychiatry at the University of Oxford and co-author of the research.
Alcohol is a direct cause of seven forms of cancer, finds study
Writing in the British Medical Journal, researchers from the University of Oxford and University College London, describe how they followed the alcohol intake and cognitive performance of 550 men and women over 30 years from 1985. At the end of the study the team took MRI scans of the participants’ brains.
None of the participants were deemed to have an alcohol dependence, but levels of drinking varied. After excluding 23 participants due to gaps in data or other issues, the team looked at participants’ alcohol intake as well as their performance on various cognitive tasks, as measured at six points over the 30 year period.
The team also looked at the structure of the participants’ brains, as shown by the MRI scan, including the structure of the white matter and the state of the hippocampus – a seahorse-shaped area of the brain associated with memory.
After taking into account a host of other factors including age, sex, social activity and education, the team found that those who reported higher levels of drinking were more often found to have a shrunken hippocampus, with the effect greater for the right side of the brain.
While 35% of those who didn’t drink were found to have shrinkage on the right side of the hippocampus, the figure was 65% for those who drank on average between 14 and 21 units a week, and 77% for those who drank 30 or more units a week.
The structure of white matter was also linked to how much individuals drank. “The big fibre tracts in the brain are cabled like electrical wire and the insulation, if you like, on those wires was of a poorer quality in people who were drinking more,” said Topiwala.
In addition, those who drank more were found to fare worse on a test of lexical fluency. “[That] is where you ask somebody to name as many words as they can within a minute beginning with a certain letter,” said Topiwala. People who drank between seven and 14 units a week were found to have 14% greater reduction in their performance on the task over 30 years, compared to those who drank just one or fewer units a week.
By contrast, no effects were found for other tasks such as word recall or those in which participants were asked to come up with words in a particular category, such as ‘animals.’
Expert reaction to the the study was mixed. While Elizabeth Coulthard, consultant senior lecturer in dementia neurology at the University of Bristol, described the research as robust, she cautioned that as the study was observational, it does not prove that alcohol was causing the damage to the brain.
Even small amounts of alcohol increase a woman's risk of cancer
In addition, the majority of the study’s participants were men, while reports of alcohol consumption are often inaccurate with people underestimating how much they drink – an effect that could have exaggerated the apparent impact of moderate amounts of alcohol.
Dr Doug Brown, director of research and development at Alzheimer’s Society said that the new research did not imply that individuals should necessarily turn teetotal, instead stressing that it was important to stick to recommended guidelines.
In 2016, the Department of Health introduced new alcohol guidelines in the UK, recommending that both men and women drink no more than 14 units of alcohol each week – the equivalent of about six pints of beer or seven 175ml glasses of wine.
“Although this research gives useful insight into the long-term effects that drinking alcohol may have on the brain, it does not show that moderate alcohol intake causes cognitive decline. However, the findings do contradict a common belief that a glass of red wine or champagne a day can protect against damage to the brain,” said Brown.
Who says exercise is always good for you? Cycling to work in certain highly polluted cities could be more dangerous to your health than not doing it at all, according to researchers.
In cities such as Allahabad in India, or Zabol in Iran, the long-term damage from inhaling fine particulates could outweigh the usual health gains of cycling after just 30 minutes. In Riyadh, Saudi Arabia, this tipping point happens after just 45 minutes a day cycling along busy roads. In Delhi or the Chinese city of Xingtai, meanwhile, residents pass what the researchers call the “breakeven point” after an hour. Other exercise with the same intensity as cycling – such as slow jogging – would have the same effect.
“If you are beyond the breakeven point, you may be doing yourself more harm than good,” said Audrey de Nazelle, a lecturer in air pollution management at Imperial College’s Centre for Environmental Policy, and one of the authors of the report.
The study, originally published in the journal Preventive Medicine before the World Health Organization’s latest global estimates, modelled the health effects of active travel and of air pollution. They measured air quality through average annual levels of PM2.5s, the tiny pollutant particles that can embed themselves deep in the lungs. This type of air pollution can occur naturally – from dust storms or forest fires, for example – but is mainly created by motor vehicles and manufacturing.
Breathing polluted air has been linked to infections including pneumonia, ischemic heart disease, stroke and some cancers. The Institute for Health Metrics and Evaluation’s Global Burden of Disease study ranks it among the top risk factors for loss of health.
The report in Preventive Medicine assumed cyclists moved at speeds of 12/14kph, with health benefits calculated in a similar way to the WHO’s Heat assessment tool. It also assumed cyclists used roads with double the background levels of air pollution, which may underestimate how poor air quality is in many developing world cities: for example, a study in Lagos found five out of eight sites exceeded Delhi’s annual PM2.5 concentration.
People commuting to work along busy roads in a city with average annual background PM2.5 levels of 160 micrograms per cubic metre (μg/m3) or above will pass the breakeven point at just 30 minutes a day, the study found. Using the WHO’s latest global estimates, published in May, those levels are only reached in Zabor, and in Allahabad and Gwalior in India – although many large cities in the developing world do not accurately measure air pollution so were not included in the WHO database.
Fifteen cities (see map above and table below) have annual mean PM2.5 levels of 115μg/m3 or above, according to the WHO data, so the breakeven point is reached after an hour of active travel. Fine particulate levels above 80μg/m3 were found in 62 cities, making cycling more harmful than beneficial after two hours.
The study found people in western cities such as London, Paris or New York would never reach the point where PM2.5 air pollution’s negatives outweigh exercise’s positives in the long term.
“The benefits of active travel outweighed the harm from air pollution in all but the most extreme air pollution concentrations,” said Nazelle. “It is not currently an issue for healthy adults in Europe in general.”
London’s annual average PM2.5 pollution was estimated at 15μg/m3 by the WHO – above the WHO’s guideline of 10, but still at a level at which the study estimated active travel would always be beneficial. Paris had ambient PM2.5 levels of 18μg/m3, while New York had 9μg/m3.
However, the study did not consider the health impacts of short-term spikes in PM2.5 pollution, or take into account the effect of exercising in air containing larger PM10 particulates, ozone, or toxic nitrogen oxides (NOx) from diesel cars.
“This is the highest level of alert and everyone – from the most vulnerable to the physically fit – may need to take precautions to protect themselves from the filthy air,” Khan warned.
The point at which air pollution becomes so bad that the harm from cycling to work outweighs the health benefits
City
Country
PM2.5 annual mean, micrograms/m3, from WHO 2016
Minutes spent cycling per day for harm to outweigh benefits
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