I have yet to meet a chief executive who reads regularly.
She means, essentially, reading for pleasure—not reading reports and so forth as part of their role.
Many skip newspapers, and magazines are a stretch. They don’t have time, they say. It’s inefficient; they can get the information they need from those around them.
As well as citing lots of evidence around the benefits of reading, Heffernan observes that reading broadly provides perspective.
Fiction invites you to loiter unseen in the lives of others. We are living through a golden age of translation too, so you can go anywhere in time or place.
The idea that modern complexity is new is swiftly put to rest by the rich brew of voices, perspectives and disciplines that see human history through a spinning kaleidoscope.
Heffernan’s article made me reflect on several things.
Firstly, I disagree a little with her evangelism. I derive considerable benefit from reading, but a large part of that is because I enjoy it. Reading isn’t for everyone. There are other ways of seeking diverse voices and transporting our minds elsewhere.
That said, reading is an enjoyable and effective way to reach those goals. Many people who don’t think they enjoy reading just haven’t yet found their groove, often because they pick up the books they feel they ‘ought to’ read rather than ones they ‘want to’ read. The specifics of what people read are less important than the benefits that come from being swept up and transported to an entirely different view of the world.
Secondly, I’m surprised that so few chief executives read. There’s a surprising overlap between literature and medicine, and it’s common to hear casual book recommendations from senior people in their fields. I’m surprised that this doesn’t extend to the world of business.
Expertise in both medicine and business requires good pattern recognition. Books allow us to live through many more experiences than could be packed into a lifetime and to distil the patterns and lessons from them. I’m surprised to hear that this isn’t recognised in business.
Thirdly, my surprise is tempered by the reflection that the revelation feels true.
In one of the places I’ve worked, a corporate line seemed to catch on about it being a ‘huge organisation’. This wasn’t true: it was smaller than most in its field. I challenged this with executives so often that I ended up with a text file saved on my desktop full of numerically accurate comparisons I could quote whenever necessary.
I’ve worked for organisations whose senior leaders claimed them to be ‘world-beating’, and I’ve wondered which world they lived in.
Wendy and I have come to admire the journalist Sophy Ridge for her pluck, often remarking to political and business interviewees, ‘Come on, you don’t honestly believe that, do you?’
On reflection, all these are about the same thing: a lack of broad perspective. If all executives ever engage in is their tiny sliver of the world, then of course they will believe the unbelievable and of course they will misunderstand their organisation’s place in the world.
Reflecting on what I’ve seen about the lack of perspective many executives possess, I should have intuited that few of them read. Perhaps we ought to hope that things might change.
1: According to a Survation poll, almost a quarter of people who vote Conservative think Boris Johnson is lying when he denies saying that he would rather “bodies pile up in their thousands” than impose a lockdown.
I really struggle with understanding the cognitive dissonance required to simultaneously believe that (a) the Prime Minister is openly lying to the public and Parliament with the support of his ministers and MPs; (b) the Prime Minister thinks that thousands of British citizens dying is the preferred one of any two options in Government; and (c) the Prime Minister and his party are the best people to lead the country.
He must know that this is constitutionally illiterate, yet he’s choosing to say it anyway because—presumably—he values the pursuit of power over truth.
What is the point of public service if not to speak the truth and honestly strive to do what you think is right for the electorate you serve?
I don’t understand politics.
4: On 22 February, the Prime Minister told Parliament “that the contracts [for procurement of PPE] are there on the record for everybody to see.” In fact, many of the contracts had not yet been published: for example, this one wasn’t published until 8 March. It seems that rather than the Prime Minister simply correcting the record, his inability to admit straightforward errors means we now have to debate whether the original—obviously incorrect—statement was misleading.
A party in power for 11 years, a Government mired in scandal, and a set of leaders who have gifted us one of the world’s highest covid-19 death rate, result in a record by-election swing in a constituency which has never previously supported the governing party. It’s an unbelievable achievement for the Conservative party, a miserable failure for the opposition, and further proof (as if any were required) that…
10: In the editor’s letter in the latest Wired, Greg Williams talks about how Apple’s “business model happens to coincide with both governmental and consumer appetites for increased privacy.”
I think he’s wrong: in the UK context, it doesn’t feel to me like there is much governmental appetite for increased privacy. From voter identification, to sharing location history in the covid-19 app, to backdoors in encryption technologies, to calls to prevent anonymous publishing on social media, it feels as though the government is suspicious of the motivations of those who value privacy.
11: I’m on a bit of a Kishi Bashi phase at the moment.
21: I read a bit about how to approach pronouns in the workplace, but it didn’t help me understand the person whose email signature has “she/them” listed in place of the more usual “he/him”, “she/her” or “they/them” combinations.
While the span of a lifetime makes this true in a longitudinal sense, I’m not sure I wholly agree with this as a philosophy: in books, as in life, I think a varied diet is important. Junk food is fine sometimes, and bad books can be fun.
28: Preparing for an appraisal after the most challenging year of my career to date has proven to be a surprisingly emotional process.
At a time when I’m frankly exhausted, it’s making me sit alone in a room while I drag up raw memories of unacceptable interpersonal behaviour, frustration with being left repeatedly in invidious positions, working under enormous pressure to unrealistic expectations, the realisation that I’ve had fewer sets of consecutive weekends off in the last year than I have fingers on one hand, the weird psychological instability caused by people insisting that fiction is fact, and much more unpleasantness besides.
In recent years, I’ve grown to be a bit of a secret fan of appraisals, supporting (as they do) reflection on practice and future plans. But this year, I’ve found the process of preparing for the meeting really quite traumatic. Rather than helping me reflect and learn and spot connections, it’s made me brood and relive events that I could not control and that were bad enough to live through just once, thanks.
For some, this must be the experience every year. And, for all the benefit it brings, I don’t think that’s worth it.
I think we need to do medical appraisals better, in a way that is perhaps more like counselling, and doesn’t involve sitting alone revisiting traumas in an unsupported way.
30: Duncan Stephen has written a great blog post about why content is more important than technology, and I’m simultaneously delighted by his clear explanation and depressed that it is necessary. I’m fed up of having arguments in the public health world where people excitedly say that they give people information X through medium Y, but want to spend more time tinkering with Y than actually making X both technically accurate and practically useful. And that’s before we even get to the question of whether Y is better than long-standing medium Z from the point of view of the end user, even if Y is more cost-efficient (and whizzy) than Z.
31: Eighteen months of daily lessons is enough… for now.
3: The economic generational divide in the UK is something that has played on my mind a lot over the years. It was one of my early pitches for inclusion in the CMO’s annual report, but as the health impacts are mostly in the future, it wasn’t something that was readily visible in surveillance data as yet.
We’re sailing toward an unprecedented crisis, with the burden of paying for the health and social care of the unusually large number of people born from the mid-40s to the early-60s likely to result in an unprecedented liability on those of working age: it’s simple maths.
Yet the same simple maths precludes an easy fix: there isn’t a democratic mandate for rationalising the approach as the median age of voters in the UK is 53.
This Propsect article gives a good overview of recent developments in how this has played out.
During the pandemic, 88 per cent of covid-related job losses affected Britons aged 35 and under, while employment among the more vulnerable over-50s rose.
It takes an average of 19 years to save for the deposit on a first home compared with three years in the 1980s.
“Deaths of despair” (those from suicide and addiction) strike each successive generation at a younger age, and their numbers are increasing. The proportion of young people with diagnosed mental health problems is roughly equivalent to the proportion of over-65s who are millionaires: one in five.
I think it is inevitable that this will lead to social unrest. It is surely impossible to avoid while choices such as triple-locking the basic state pension paid to millionaires while funding cuts mean that student leave university an average of £50,000 in debt. But social unrest only adds to our list of problems.
I have no idea how we can fix any of this. Even if older voters (and politicians) can be persuaded to propose and support politics against their immediate best interests, those very cuts might end up making this generation less healthy and (paradoxically) more costly: four in five aren’t millionaires, and even those who are don’t necessarily have liquid assets.
It’s hard not to imagine that this, along with privacy and climate change, will prove to be one of the dominant long-term societal challenges of the first half of the 21st century.
6: It sometimes feels like we’re in an extremely turbulent political period, but on one measure it is remarkably stable: in my lifetime, there have only been handovers between Prime Ministers from different parties twice (John Major to Tony Blair and Gordon Brown to David Cameron). We haven’t had a similarly stable period in this regard since the 1700s.
11: Jonathan Rothwell’s blog post about the London mayoral election has sent me into a bit of a spiral of thought. “It does rub me the wrong way that there appears to be so little choice—and when there is more than just a binary choice between two ancient political parties, neither of whom appear to have your best interests at heart, the machinery of national politics is willing to snatch even that away.”
It makes me worry that I’m part of the problem. I have no desire at all to get involved in politics: I struggle to imagine anything worse than spending my time having to constantly defend my basic interpretation of reality. It makes me think of heart-sink meetings with anti-vaccine councillors. I completely understand the importance of having those conversations and explaining the science to people who are making local policy decisions, but I it isn’t something I’ve ever enjoyed. The idea of a professional life that involves a lot of that is unappealing. Adding a layer of party politics, in which one has to defend positions one personally finds indefensible simply because it is the ‘party line’, just makes the prospect even grimmer.
And yet: does this not make me part of the problem? If I’m not willing to engage, why should anyone else bother? Are people who enjoy party politics really the people we want making decisions on our behalf? Shouldn’t we all engage more for the good of society? Is “I don’t want to” just a selfish whinge? How can things improve if we leave politics only to those who can be bothered? Aren’t decisions made by those who show up?
12: Work has brought a surprising amount of discussion of stevedores recently, which is a delightful crossword word.
13: It feels like there must be a story behind the placement of this sign.
14: Last week, the MHRA and DCMO used some excellent slides from the Winton Centre for Risk and Evidence Communication (David Spiegelhalter’s stomping ground) to illustrate the risk of serious harm associated with receiving the AstraZencia covid vaccine.
This got me thinking: how does the risk of the vaccine itself compare with the risk of participating in the programme as a whole? In particular—given that most people live “within 10 miles” of a vaccination centre—how does it compare with a 20-mile round trip by car?
After much searching through evidence, my boring conclusion is that they’re focusing on absolutely the right bit of the programme, and the risk of serious harm associated with the journey is orders of magnitude smaller and probably negligible, even at this scale of rollout.
16: From Concretopia, I learned about Cumbernauld town centre, one of Britain’s most hated buildings. I’m amazed I haven’t come across it before.
17: Derwent Reservoir is spectacular in the spring sunshine.
And as though to prove that it’s spring, here are some ducklings.
18: People often talk to me about books, because they know I’m interested in reading and they follow me on places like Goodreads. I find these conversations difficult, never quite knowing what to say or how to say it. I had a moment of stunning clarity this week when talking to a colleague about this: their suggestion was that it’s easier to write about books because books themselves are written-word.
I think there’s something in that. I’ve always been useless at dictating because speaking isn’t the same as writing, and they need different parts of my brain. In the days when I did clinics, I was far faster at typing my own clinic letters than dictating for a secretary.
For the same reason, I got more confident at public speaking when I stopped trying to write presentations out and relied on freely talking around the key points instead. And, probably for the same reason, I find it hard when I phone a company and they ask for a security word (or whatever) that I’m used to typing instead.
So why wouldn’t the same apply to talking about books?
This conversation came back to me this morning as I read Courier Weekly: “One of the best parts about reading a book is getting to talk about it with other people.” Mmm, maybe not.
19: Fran Lebowitz says that “your bad habits will kill you, but your good habits won’t save you.” It’s possibly the most accurate public health aphorism I’ve ever heard.
20: The news that some teams want to play in a new football competition is dominating the papers and bulletins to an extraordinary extent—and no matter how much I read about it, I’m continue to struggle to understand what the problem is, mostly because I’m not really familiar with how football competitions work at the moment (and struggle to care).
For all the hand-wringing about President Trump’s destruction of any form of trust in Government communications, it seems no lessons have been applied to the UK government. When the judgement of the UK media is to disbelieve statements from the Prime Minister’s spokesperson and from his own mouth, we’re in a bit of a sorry (if entirely predictable) state. And, just like Trump, the liar remains popular with the public.
28: Starbucks has on the wall of one of its branches the claim that 99% of its coffee is ‘sourced ethically.’ I’ve been slightly reeling ever since I saw it: Who decided that acting unethically 1% of the time was boast-worthy behaviour? It seems like an active admission of guilt, which obviously doesn’t come as a surprise with that chain, but it still seems amazing that some corporate communications team signed it off. I half expect to see a ‘we’re proud to intentionally overcharge just 1 in every 100 customers’ sign in the next branch I venture into, or perhaps ‘99% of our baristas are paid in full.’ Baffling.
30: I have seen film posters with the line “in virtual cinemas now”—and I’m really not sure what that means. I thought it probably just meant available to stream, but then an ad for Truman & Tennessee said “in virtual cinemas and on demand now – book now” which seemed to rule that out.
I was surprised by the wide tolerance on alcohol labelling, but I really shouldn’t have been.
When I did my ready meals research a decade ago, I was surprised at the wide tolerance on nutritional labelling, which makes anything other than broad-brush calorie counting utterly pointless.
At that time, there was a legal tolerance of +/-20% in calorie labelling, meaning that someone could stick rigidly within their (say) 1500kcal daily target according to the packaging and still be a couple of Mars bars over their target.
Yet even that is an overstatement of accuracy: the tolerance of 20% could in fact be applied to the unprepared ingredients rather than the product as sold, so food could in fact be way more than +/-20% by the time they reached our stomachs.
So it really would be impossible for anyone to count calories accurately, just as it now seems it’s pretty hard for people to monitor their alcohol intake with precision.
11: The British people have “widespread admiration and affection” for Boris Johnson. It’s baffling to me that someone as respected as Allegra Stratton would chose to take a job where she’s having to debase herself with nonsense like that.
12: Airlines have their own trademarked scents: for example, ‘Calm’ for Delta, ‘Landing’ for United and ‘Ocean Citron’ for Alaska Airlines. Verizon has a trademarked ‘flowery musk’.
18: Counting isn’t always helpful. I’ve been frustrated recently by a circular conversation about covid-19 “outbreaks”. I’m often asked to enumerate the current number of “outbreaks”: but defining individual “outbreaks” in the context of widespread community transmission is fairly arbitrary. Cases generally have multiple sites of possible disease acquisition, and may pass on their illness in a number of settings. There isn’t a point source to eliminate, nor is the disease rare enough to identify with a high degree of confidence chains of transmission.
So the only logical response is to ask why someone wants the figure, so that I can help them define the measure that best answers their question: the measure will be different, for example, if one is interested in pressure on the public health response, than it would be if one is interested in a proxy measure of the number of sites of community transmission. The answer, repeatedly, seems to be “the reason for the measure is not your concern, just count them!”
And it feels like the only two possible responses to that are 🤬 or 🤷♂️.
19: Laughter is important. I laugh a lot, especially at work. This is something I never really realised about myself until it was pointed out to me: I am someone whose first reaction to corporate nonsense is most likely to be belly-laughter, with frustration only tending to set in later. I often revel in the absurdity of the world of work, and I know I need a break when I stop seeing the silliness in the world.
20: I was thoroughly depressed today to see adverts up around Newcastle telling men not to ask women for directions and to cross the street to avoid walking near women.
This is such a tangled web of a situation. It is horrific to hear of the violent attacks that people inflict on other people. It’s horrendous that women live in fear every day. It’s awful that many men live with similar fears but are unable to express them. It’s upsetting that people’s level of fear—high or low—is often divorced from the statistical risk they face. It’s hard to explain the lack of focus on male/male violence, which some experience as victim blaming or as men being expendable.
Most of all, it’s regrettable that fear stemming from inhumane violence is allowed to drive a wedge between us and make all of us a little less human as a result.
21: What’s the point of London City Airport? I’ve used it a couple of times and—it seems— liked it more than Jonathan, but it is hard to argue that perhaps it’s an idea whose time has passed.
22: In my experience, most people who work in health—and especially in public health—have a deep-seated passion and drive to do the right thing for patients or populations. Opinions on what “the right thing” is vary, of course, and that can be a source of profound disagreement.
Today I was reminded that some don’t share that passion: some have a natural focus on processes, not people. And those are important people to have around because processes are important, and—from the perspective of the patient-focussed people—robust processes support good outcomes for patients.
Nevertheless, the cognitive load of talking things over with someone who approaches their work from such a different angle is high, and it’s hard not to give into a cognitive bias that nags away suggesting that the other person just doesn’t get it… particularly when they are in a more senior role.
29: Here’s some advice that has become commonplace: don’t sleep with your phone next to your bed. Picking up a screen first thing in the morning it not good for anyone’s mental health, but some people need a phone by the bed for emergencies. There’s no need to use the alarm on it, though.
I started using my phone as my alarm clock when I first got a Blackberry, which required daily charging and even came with a ‘nightstand’ dock which turned it into a bedside clock. I stopped about a decade ago, when I realised how much I valued a couple of minutes of allowing myself to wake up without that sort of input: we got a clock radio instead.
These days, I’m woken by FiP on our Sonos system, because in 2019 the feverish radio chatter about Brexit became too much to handle first thing. At first, the timechecks being an hour ahead made it a little more… alarming! Though we ended up enjoying it so much, we now listen in the kitchen in the morning too. Contrary to common speculation about immersion in other languages, I can confirm that our French hasn’t improved.
1: Lego streets have become worse for pedestrians and cyclists over the years, not least as cars and roads have widened at the expense of footpaths. But things are looking up.
3: It might be time for those who peer review papers for publication to rebel.
4: One of the fundamental principles in outbreak management, and in incident management, is having clear lines of accountability. If I’m managing a multiagency outbreak, I have a little spiel on the topic that I give at the start of each incident management meeting, accountability for decisions is clearly documented in minutes and a section on “legal considerations” appears on every agenda for good measure.
5: I walked past this van and thought: “What on earth is futsal?”
I inevitably ended up perusing the Wikipedia entry, and—having got a few paragraphs down—GCSE Spanish lessons, which often seemed to mention futsal, came flooding back.
6: There’s a line in Shuggie Bain about the smell of static electricity from TV screens, something I haven’t thought about in years. It reminded me of the unique power of olfactory memories.
7: Denis Norden, presenter of It’ll Be Alright on the Night, was the person who came up with the title Auntie’s Bloomers for the rival BBC show.
9: Some people are making their own homemade covid vaccines. I wouldn’t recommend it, but it is a curious reminder of the full range of human responses to the offer of vaccines, from outright refusal to desperate home-brewing.
10: With knowledge of the treacherous frozen slush to come, it’s sometimes difficult to feel positive about snow. Yet there is something particularly beautiful about a fresh fall, and especially about the wintery quality of light it brings.
There are moments when a simple sentence can just tip over into crystallising a bunch of feelings into something more like thoughts, and this Government line has proven to be one of those for me.
By nature, I’m quite libertarian: I don’t really like forcing anyone to do anything. This is quite an unusual proclivity in my specialty of health protection, but one which is shared (to a greater or lesser extent) by most of my immediate colleagues. I think better results are generally achieved through persuasion than through force, though of course a public health emergency like a pandemic is always going to require a multifaceted approach.
A little over a year ago, I was nothing short of astonished when returnees from China were (to all intents and purposes) forced to quarantine at Arrowe Park hospital: I remember suggesting in conversation with colleagues that this would turn out to be a “resignation issue” for the Secretary of State. Of course, I said, we should offer people supported quarantine. Of course, we should ask all returnees to quarantine at home at the very least. But of course we can’t force people. I was wrong.
So much has happened since then, much of it to my mind ethically questionable: do we really have informed consent from all care home residents for routine covid swabbing? If not, is it really in the best interests of each individual? Are we really sure we haven’t slipped into making “best interests” decisions on behalf of populations rather than individuals?—a slippery slope indeed.
We all now live under a level of legal restriction unprecedented in modern times, perhaps concordant with an unprecedented emergency. More than a hundred thousand people have died.
And yet: there is still something which sits discomfortingly about governments using on-the-hoof extreme restrictions as opposed to established ‘emergency’ approaches such as the Civil Contingencies Act. This is even more true in an era of populism and governments who have a history of riding roughshod over constitutional convention and legal limits on executive power.
Will we really find it simple to put the genie back in the bottle?
12: I know I’ve said it already, but would you look at the quality of the light?!
13: Both this podcast episode and this book make, in passing, a very clear argument about emissions being by far the most important ecological consideration of our times, and both, in passing, unflatteringly compare with the impact of most recycling. I’m really pleased to see clear communication on this, instead of a plethora of actions referred to as ‘sustainable this’ or ‘green that’ in a way that treats every action as roughly equal. I was also pleased to see that carbon offsetting, which I do all the time, is more effective than I imagined it to be!
15: There are tens of roads named “Bow Street” in the UK, but it seems that the BBC considers the best way of writing about a Bow Street in Wales is through reference to one of the Bow Streets in London. It’s not hard to see why coverage like this is often judged to be inappropriately London-centric.
23: Spectacularly failing to learn a lesson from promising a Christmas easing of restrictions a month in advance, the Government has chosen to make itself a hostage to fortune once again by promising an easing of restrictionseven more than a month in advance.
8: It’s instructive to look at how Tony Blair, who now pops up from time to time to offer the Government advice on pandemic management, reflected on his own management of a potential pandemic in his ‘risible’autobiography:
During the run up to the election, we nearly had a vast panic over the approaching ‘flu pandemic’. There is a whole PhD thesis to be written about the ‘pandemics’ which never arise. In this case, the WHO had issued a report claiming there would be 500,000-700,000 deaths across the world. The old First World War flu statistics were rolled out, everyone went into general panic and any particular cases drew astonishing headlines of impending doom. Anyone who caught a cold thought they were part of a worldwide disaster.
I’m afraid I tried to do the minimum we could we the minimum expenditure. I understood the risk, but it just didn’t seem to me that the ‘pan-panic’ was quite justified. And in those situations, everyone is so risk-averse that, unless you take care, you end up spending a fortune to thwart a crisis that never actually materialises.
However, the reaction of the system is perfectly understandable. The first time you don’t bother is the time when the wolf is actually in the village, so you have to steer a path, taking precautions and be ready to ramp it up if it looks like this time it’s really happening. But oh, the endless meetings and hype of it all!
Is doing the bare minimum really that different to the current Government’s initial approach? Isn’t the lesson of history that we should hit potential pandemics hard and early? Or, has been quipped, is the real lesson from history that we never learn from history?
9: Publishers often tell readers that ebooks are the future; but when they want they books reviewed in the hallowed pages of The TLS, they still send hardbacks.
10: More than a month on, I’ve still not seen a better briefing on covid vaccines than Rupert Beale’s.
13: 2021 is a census year: with most students working online, it strikes me that University towns might be about to discover that they have smaller than expected official populations, which could cause trouble for the next decade.
14: In professional work, I’m a stickler for keeping writing concise. Only yesterday, I moaned to colleagues that a draft internal guideline had more than doubled in length with very little additional useful content, but a whole lot more waffle. We all know the Mark Twain quip that “I didn’t have time to write a short letter, so I wrote a long one instead”, but it wasn’t until I read this article by former Court of Appeal judge Robin Jacob that I considered that work pressures might result in baggier writing. I’m sure this is true for my own work too; I’d just never connected the two before.
15: One of the challenges with trying to use the law to control an outbreak is that the law often comes to define the limits of the response. For example, laws requiring self-isolation will necessarily tightly define those who are required to self-isolate (say, people with known identified contact with an infectious person). However, there may be very good reasons for asking people outside of that group to self-isolate (say, people likely to have had contact with an infectious person, but without certainty). If systems are then built solely around requiring isolation, with the necessary barriers around it to prevent those who should not be required to isolate from being contacted, then it can become very practically difficult to ask people to isolate, even though this may be a key control measure in a given outbreak.
For example, if an app were to be built to allow people to ‘check in’ to venues, it would be difficult to conclusively prove that any two people in that venue had been in close contact, and it may therefore be legally challenging to require them to self-isolate. However, if ten people have been in the same venue at the same time and nine of them were infectious, it would be perfectly reasonable to ask the tenth to self-isolate on the basis that they may well be at high risk of contracting the disease.
If the app is built only to meet the needs only of the legislation and not of broader public health management of complex situations, it may turn out to be considerably less good than just keeping a written log of customer details to which judgement can be applied.
17: The Aston Villa football team is based in Aaron, near Birmingham. I have spent the last 35 years thinking it was a London-based team. My knowledge of football (and English geography) really is woeful.
19: Matt Hancock, proponent of the Government’s “act like you’ve got covid” guidance—an act which includes playing rugby in a park—is self-isolating now that he’s a contact of someone who had covid. It’s an odd state of affairs when “acting like you’ve got covid” includes being out in public and in close contact with others, while acting like you are a contact of a covid case means self-isolating.
23: “One morning in 2002, while walking his daughter to school, forensic psychiatrist Dr Richard Taylor ran into an ex-patient, who waved to him cheerily. Years earlier, the man, a talented musician, had beaten his father to death during a psychotic episode, then set fire to his body before sticking a meat thermometer into his stomach (‘To see if he was done’). Taylor had assessed him in custody. He was ‘incredibly disturbed and violent’, he says. But having undergone years of treatment, the man had been freed under close supervision. ‘Who was that, Daddy?’ asked Taylor’s five-year-old daughter, as they walked on. ‘Oh, just someone I used to work with,’ he told her.” (from The Week magazine)
24: The commonest cause of fire in UK hospitals is arson, at least according to the fire safety mandatory training which has been frustrating Wendy this afternoon.
27: Sometimes, something I read makes me feel regretful through association with and on behalf of medical colleagues who I’ve never met. It’s a strange feeling. This is one of those times:
Every medical staff member we met along the way has asked my wife how she’s doing, not just once but on every occasion they’ve crossed paths with her. She’s spent a lot of time telling them she’s fine. None of them ever did get around to asking me the same question.
I am being OK; I want to make that clear. I think that, by now, I’m getting it down pat. But am I OK?
29: It’s a year since we set up our Incident Co-ordination Centre for ‘Wuhan novel coronavirus’ response at work, and I’ve learned that—as in life—some years in health protection can be substantially more challenging than others.
31: Many of the organisations involved in the covid response are corporate members of the Plain English Campaign. Avoiding jargon is a key part of good communication in incident response. Yet my inbox is now full of emails talking about “two-week sprints”, “playbooks”, “taskforces”, “canvases” and more besides. Management-speak seems to have taken over to an alarming extent. I despair.
1: The national lockdown unlocks tomorrow, so the time feels right for another deeply ill-advised prediction with potential to make me look like an idiot when you read this next year.
Here in Tier 3 country, the “great unlock” means that non-essential retail is to re-open. That is, people are going to be able to take public transport into their nearest city centre or shopping centre, and spend spend spend in poorly ventilated indoor spaces where the main control measures are stickers on floors. Indeed, Councils are planning to string up their regular Christmas lights to really draw in the crowds. This seems to be because it is assumed that the transmission risk associated with retail remains consistent even during winter weather and with Christmas crowds, which seems deeply unlikely to me.
On top of that, the Government is lifting lockdown at a point where the country is still seeing more than 14,000 new covid cases per day, which means we have a large pool of people ready to act as sources of infection: the 14,000 only counts confirmed infection, there will be many additional people each day with undetected infection because they are asymptomatic or choose not to be tested.
It’s hard to see any outcome other than case numbers bouncing up rapidly over the next three weeks: and with case numbers getting towards / as high as / even higher than the numbers immediately before the latest lockdown, it’s hard to see how the planned lifting of restrictions over Christmas can possibly go ahead… but it’s also impossible to see how, politically, this is something on which the Government can reverse ferret.
Even without the lockdown and tiering decisions, the Government boxing themselves into a decision a month ahead of time looks crazy to me: it may have been more prudent to announce conditional principles backed up by work with retailers and the travel sector to guarantee refunds for cancelled travel plans if the relaxation can’t proceed.
Though, perhaps with a larger dose of optimism than realism, Wendy’s Christmas flights to Northern Ireland are already booked.
2: From this book, I learned that it was only in 1938 that an Act of Parliament required every local authority to provide a fire service. If you’d asked me to guess, I’d probably have said it became a requirement after the Great Fire of London, putting me about three centuries out
11: The Prime Minister who, a year ago, offered the electorate an “absolute guarantee” of securing a trade deal with the European Union by the end of 2020 says it is “very, very likely” that he will break his promise. Even if we ignore the bluster and accept that it’s pretty likely that a deal will be done in the end, it’s hard not to see this posturing as deeply damaging to trust in politics.
15: I’ve never before clocked the (obvious) fact that bone china isn’t vegan or vegetarian friendly. I wonder if there’s a vegan crockery alternative to William Edwards for First Class passengers on British Airways?
16: On my rainy walk to work this morning, a group of 12- or 13-year-old boys ran past me with their teachers (or perhaps coaches) riding bikes alongside. As the stragglers slowed to a walk, one of the faster kids aggressively shouted, “Come on you lazy bastards, get moving!” Something about this scene jarred with me, but I couldn’t quite put my finger on what.
I think it may be something to do with rarely hearing this sort of hectoring in everyday life. Had I been one of the stragglers at that age—quite likely, if I hadn’t found an excuse to get out of running in the first place—this would have been the least effective strategy to get me moving faster, and perhaps the most likely to make me roll my eyes and snigger.
It also made me wonder whose behaviour the shouty child was modelling. Perhaps it’s a sports thing. I’ve chaired three outbreak control team meetings for elite sports teams in the past week, and I don’t think I’ve felt as culturally out of my depth since working at the Department of Health around Glyndebourne time.
17: If you asked me to name words that typically follow “agile” then “lighthouse” would not previously have featured among my answers. Yet the phrase “agile lighthouse” has been crowbarred into my vocabulary by people involved in the covid response who seem to speak a different version of English to me, and searching online reveals that it is genuine management speak.
Cummings is possibly the only man in Britain who needed to spend time in Government to appreciate that people who dedicated their lives to winning regular public popularity contests are people who dislike being disliked—and Alexander “Boris” de Pfeffel Johnson dislikes it more than most. It’s hard to conceive a more fundamental misjudgement of character than assuming this Prime Minister to be one who wouldn’t worry about short-term unpopularity in pursuit of more noble goals.
19: With the number of new confirmed covid-19 cases in the UK each day now similar to that at the introduction of the November lockdown, the planned lifting of restrictions over Christmas is cancelled. But, please guv’, it’s nothing to do with the Government’s decision-making, it’s all to do with a new variant of the virus.
20: In quite possibly the most bizarre bit of Government messaging to date, the Secretary of State for Health is urging everyone to “act like they have the virus” while imploring them to continue attending school, workplaces (if they can’t work remotely), take outdoor exercise in public spaces, visit essential retailers, and more besides—all of which are not allowed nor remotely sensible for people who have covid. Marr really ought to have asked, “Would you be sitting here in my studio if you had the virus?”
24: “In the 1960s, NASA went to huge expense to contain possible pathogens from the Moon” but the measures were so disastrously poor that the effort would have had little effect. This is a great story: particular highlights are the choice to base control measures on spread of Yersinia pestis and that “NASA’s plans stipulated that quarantine at the LRL could be broken in the event of a medical emergency. Ironically, if a lunar microbe made an astronaut really sick, that astronaut would be removed from quarantine.”
26: I’m currently really enjoying The Heart’s Invisible Furies. The novel (at least as far as I’ve read) has vignettes from Cyril Avery’s life aged 7, 14, 21 and so on, every seven years. This has made Wendy and me reflect on how this structure would reflect our own lives: both of us have collected five vignettes so far; each vignette would see us living in a different house, each at a different school or workplace. We’d both have few recurring characters outside family—though we’ve been together for the most recent three vignettes of each other’s stories.
28: There’s a direct line of succession from the Acorn processor in the BBC Micro which sat in the corner at school to the ARM (Acorn RISC Machine) processor in the iPhone I’m typing this on.
29: The iOS Reminders app has got much more fully featured since I last used it (around iOS 5).
30: A Government which claims to be keen on parliamentary sovereignty is ramming legislation through without time for proper parliamentary scrutiny and then shutting the doors on the House of Commons for an extra week. Her Majesty’s Most Loyal Opposition is supporting the Government in implementing legislation it disagrees with, because it is unable to figure out a better approach. And in the world of 2020, all of this feels like par for the (lamentable) course.
31: At the stroke of 11pm, the Government’s actions stripped me of more freedoms and opportunities than at any other moment in my life so far.
Instead of having free pick of the job market across 28 countries, I’m limited to one. Instead of having the automatic right to live in any of 28 countries, I’m limited to one. No longer can I travel at will or whim across Europe; and no longer will I be guaranteed a lack of roaming charges.
Brexit is regrettable for much bigger reasons than those that affect me directly—not least friends born in other EU countries who have dedicated their lives to the NHS now being made to feel like second-class citizens (if even ‘citizens’ at all)—but when Government rhetoric is all about victory and celebration, it feels like tonight’s a night for self-indulgent melancholy.
1: I’ve managed to keep a series of posts on my blog running for a year rather than giving up after about a month.
2: William Barr is someone we may be hearing more about in the coming days.
3: I recently read Lawrence Douglas’s Will He Go? and the first 24 hours after the polls closed in the US presidential election have been just as mad as he predicted. But I wasn’t convinced by Douglas’s arguments on the abolition of the Electoral College, and Ian Frazier’s piece in the New York Review which I read this morning strengthened my view. (I also realised this morning how mad the dating of New York Review issues is: it’s more than two weeks before the cover date and I’m reading a printed copy in Newcastle!)
6: Channel 4 is seizing on US electoral chaos to advertise the availability of The West Wing on their streaming service, and even just seeing the trailers makes me feel a bit warm and fuzzy.
Disastrous data management, and a critically poor understanding of the relationship between population level data and individual clinical care, is one of the as-yet untold stories of the failure of covid-19 control in England. I hope we learn from that, and build upon those lessons to do everything Goldacre and co suggest.
12: There was a time, not that long ago, when politicians disagreed civilly, and leaders clarified misconceptions about their opponents and worked to raise the tone of public discourse.
13: Paul Flynn’s interview with Sarah Jessica Parker in the latest Happy Reader made me reflect on the differences in our responses to Tony Soprano and Carrie Bradshaw, and contemplate the everyday sexism those responses perhaps reveal. As Parker and Flynn point out, why are Soprano’s murders downplayed and yet Bradshaw’s profligate spending on fashion overplayed in popular notions of those characters?
17: In an order confirmation email, fashion and homeware retailer Next says “we are working incredibly hard to get your items to you.” They apparently underestimate my credulousness.
18: This book taught me that the Olympic torch relay is an entirely modern creation, a Nazi idea introduced for the 1936 Olympics in Berlin.
21: While pondering whether I should send an email at work today, I caught myself reflecting on Marcus Aurelius and Meditations. This is completely ridiculous, embarrassingly knobbish, surprisingly frequent and really quite helpful, all at the same time.
22: Some big wotsits were towed out of the Port of Tyne this afternoon. I assume they were bits of oil rigs, but don’t really know.
23: This book taught me the depressing word hemoclysm (coined by an American, so no ‘a’ or ‘æ’).
24: For a few years, while I was contributing to some guidelines, NICE used to invite me to their annual conference as a guest. One of the most memorable presentations in the years I attended was one on the extraordinary results of getting GPs to opportunistically remind older people not to sleep with their bedroom windows open: something that was commonly advised decades ago but which led to many older people sleeping in rooms which were unhealthily cold. A simple clarification in this DHSC campaign could have saved lives; I worry that the lack of one may do the opposite.
30: Some people feel so strongly that face masks are unsafe that they scrawl messages on walls. I’m not sure what specific harms concern the author(s).
2: Donald Trump, who only allows people who have tested negative for covid-19 to be in close proximity, has tested positive for covid-19, underlining the fallacy of relying on other people’s negative test results as the sole protective measure against infection. Meanwhile, Boris Johnson presses on with his moonshot project to provide mass testing so that we can all rely on other people’s negative test results as the sole protective measure against infection. A negative test is only as good as the testing technology—and even if the technology were magically perfect, it still only reflects the moment the test was taken.
3: I’m no fan of spiders (to say the least), but even I found this short article about the venom of funnel web spiders surprising and interesting. The thesis is that the venom is only deadly because it’s not had enough time not to be.
The combination of extreme pressure and tiredness which characterises the experience of most people in public health at the moment means that warranted frustration—and perhaps grief—is often expressed in a manner that looks a lot like anger. This article helped me to reflect on and unpick some of the true underlying emotions, which aren’t really anger at all… in most cases.
The plan which the Government has announced is scientifically illiterate. Tiers appear to be allocated mostly on the basis of the number of cases in a given area, yet the speed of spread is far more important. An area which has only 10 cases today will have nearly 500 cases within six weeks if the case numbers are growing by 10% per day. An area which has 100 cases today will have only fewer than 250 cases within six weeks if case numbers are growing by only 2% per day.
Restricting only areas with high case numbers is folly. The oft-repeated argument that it’s “unfair” to impose restrictions on areas with low proportions of the population infected is based on a misunderstanding of mathematics.
The fact that the measures at each tier are only aimed at slowing the spread, and won’t be introduced until an area has a high number of cases—regardless of the speed of spread—means that I’m certain we’ll end up with an England-wide lockdown within weeks. It’ll be “stay at home” again, but with schools allowed to remain open this time. I think the Government will be slow to admit the error of the Tier system, so we may well see a new Tier 4 (local “stay at home”) unveiled before then.
And while I’m on a roll… basing restrictions on incident cases is acting far too late. The impact of restrictions takes at least an incubation period to come into effect. Introducing restrictions only when the case numbers are causing the NHS to reach breaking point is damning services to fail. I think Nightingale Hospitals will be taking patients within the month. Probably not covid patients, because that never made much sense as a strategy, but non-covid patients will be admitted to free up beds for the covid surge.
18: I recently finished reading Ali Smith’s Summer, the extraordinary finale to her seasonal quartet. This article in the London Review of Books made me realise how much more there is to the whole series than I derived on my casual read. Maybe a series to revisit at some point.
24: Less than half of the population knows the three cardinal symptoms of covid-19 infection, and fewer than a fifth of those advised to self-isolate actually follow the rules according to the Covid-19 Rapid Survey of Adherence to Interventions and Responses study. I’m surprised more by the former than the latter: for many, a lack of support makes full self-isolation a unviable, and “best efforts” are worthwhile anyway.
One of the dominant narratives about the UK Government response to covid-19 is that the UK was well prepared, but for the “wrong kind of pandemic”.
A command and control structure is required for any pandemic: indeed, it’s probably the keystone. The plan wasn’t for “spaghetti”. The plan wasn’t for the Government to set up a Joint Biosecurity Centre nor a Covid Task Force nor to abolish the single national organisation providing health protection expertise.
Spaghetti doesn’t just appear. It doesn’t grow on trees. Ignoring the long-standing plan, outsourcing to countless private companies, creating public organisations on the fly, abolishing established players half way through, and sprinkling people with no relevant qualifications or expertise at the top; it all adds up to a Government spaghetti recipe of which even Nigella would be proud.
27: HM Government’s top-line advice for people who are in a large indoor shopping centre and feel that they have symptoms of covid-19 appears to be to whip out one’s mobile and book a test—not to immediately self-isolate. This is a surprising approach to controlling spread of a respiratory virus.
1: “We’re not repeating history, just the parts that sucked.”
2: Reminded of Ogden Nash’s observation that “Candy / Is dandy / But liquor / Is quicker,” and his later regretful postscript that “Nothing makes me sicker / Than liquor / And candy / Is too expandy.”
3: Artificial banana flavours are usually based on a type of banana which is no longer commonly sold, which is why banana flavour generally doesn’t taste like banana. It’s all the same to me, as I don’t really enjoy either.
4: The Economist says Donald Trump is very likely to challenge the result of the US presidential election. By the time this blog post is published, you’ll have the benefit of hindsight in knowing whether that prediction comes true. As I write this on a bright and windy September morning in Bangor, it feels depressingly hard not to assume—despite the statistical modelling—that Trump won’t somehow win the election without any legal challenge. It’s noticeable how much tighter the odds are at the bookies than in the press: William Hill is offering the same 10/11 odds for both Trump and Biden wins, while The Economist’s tracker has Biden on an 85% chance of winning.
12: London’s bridges really are falling down. “Hammersmith Bridge is an apt metaphor for all the ways the country has changed after a decade of economic austerity, years of political wars over Brexit, and months of lockdown to combat the pandemic, the last of which has decimated already-stressed public finances.”
16: I’m reading Lorna Arnold’s account of the accident at Windscale in 1957 at the moment. The opening chapter portrays a small localised part of a national organisation that is undergoing a massive politically driven restructure, which cannot recruit enough professional expert staff to replace those it is losing, let alone to support the enforced expansion. Arnold says, “Windscale was over-worked and under-manned with inadequate research support, but it was a well-run site with hard-working and dedicated staff. They tackled their problems tenaciously, overcame formidable difficulties and met the demands made on them.” The whole section feels like it could be lifted from the inevitable covid-19 inquiry.
19: Ruth Bader Ginsburg has died. She was inspirational in so many ways. Her career-long elucidation of how the whole of society is harmed by discrimination on the basis of sex is a message which is feels still hasn’t been fully absorbed across US and UK society even in 2020.
20: A month ago, I was very sceptical… but Streaks has proven remarkably at convincing me to remember to do important but mundane everyday tasks that I otherwise frequently forget (like flossing).
22: Everyone was in the office, then out, then in, then out. Just one more cycle left before we get to shake it all about, do the hokey-cokey and turn around.
24: It’s not so long ago that Wendy first came across (and was appalled by) Fanny Craddock, thanks to a repeat of her Christmas series, so I read this profile with amusement. (“Her appearance got more striking each year, and by the time of that Christmas series—presented without Johnnie—she resembled a psychedelic Cruella de Vil, her face heavily powdered, her eyebrows plucked and redrawn an inch above her eyes, her hair decorated with large pink ribbons. She was—and still is—magnificently watchable, partly because she’s so elusive; she switches from ingratiating smiles to impatient scowls so quickly that one can’t tell what she’s thinking or feeling, whether she wants to embrace her viewers or rap their knuckles.”)
25: Subscription shoes are (almost) a thing now: when this post goes live in twelve months’ time, they should have launched.
27: Since Pret launched takeaway coffees by subscription, their shops have been rammed and I’ve had to join a long queue to buy my lunch. The staff in my local shop have been not-so-quietly grumbling about the amount of money the store is losing as a result. It’s hard to know whether a reverse ferret might be coming, or whether this is a “first month” effect (given that the first month is free).
The content of this site is copyright protected by a Creative Commons License, with some rights reserved. All trademarks, images and logos remain the property of their respective owners. The accuracy of information on this site is in no way guaranteed. Opinions expressed are solely those of the author. No responsibility can be accepted for any loss or damage caused by reliance on the information provided by this site. Information about cookies and the handling of emails submitted for the 'new posts by email' service can be found in the privacy policy. This site uses affiliate links: if you buy something via a link on this site, I might get a small percentage in commission. Here's hoping.