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Compared to many, my health problems are minor; osteo-arthritis which has led to hip problems and which has aggravated spinal stenosis. Both required surgery four years ago. Continuing symptoms are virtually all in my feet and legs: changes in sensation, involuntary muscle spasms, and, increasingly if not frequently, sudden loss of muscle power in my joints, most often my knees.

Putting aside the failure of a locum at my then GP practice to diagnose early neurological symptoms, two things stand out about the treatment and management of my conditions. The first is that, in the early diagnostic situation where it was difficult to know what was attributable to what, my neurological and orthopaedic teams never met. The second is that neither team gave me information that enabled me to calibrate my experience against other patients who had presented with similar symptoms or who had undergone the same procedures. A corollary of this second limitation is that only after surgery did I learn that over a hundred different hip prostheses were available under the National Health Service. It appeared I was being offered only two.

The alternative is patient-centred healthcare. Since I am aware that this term is used in a variety of ways, let me explain the three changes I advocate.

First, patients should be treated on a holistic basis, including cross-disciplinary diagnosis and treatment by specialists whenever necessary. The emphasis on medical disciplines and sub-specialisms has served well the development of new skills and new procedures, and has distributed career rewards accordingly. However, it seems to impede the sort of collaboration across disciplines that the strategic treatment of real patients requires. I am conscious that many medical specialists will not recognise the interdisciplinary nature of the challenges of patients who present to them. In some cases this will be a case of the person with the hammer seeing every problem as a nail. In others a referral for specialist treatment may be the result of a failure to look in a holistic way at a patient’s healthcare needs before they reached a critical stage.

The second change arises directly from the first. GPs need the time and capacity to act not just as referrers to specialists and reporters back from them, but as initiators, integrators and as necessary interrogators of all their patients’ services. The reference point in this process would be to provide each patient with a long-term health plan including advice on diet and exercise. The considerable extra resources this would require would be offset by the savings which the more integrated and preventative perspective should deliver.

The ultimate responsibility in this approach would fall on the patient themselves, the beneficiaries of a major shift of power. In the third major change, with the informed consent of participants, patient experiences would become a key resource in helping each patient to understand their condition, select treatments, and calibrate their progress.

None of these are entirely new as separate elements; together they would constitute a major change of focus and power within our health system.

Pirates roamed the Aegean when Alexander the Great (356-323 B.C.) ruled over Greece. In 331 B.C. he ordered them to be cleared from the seas.

The great warrior king reputedly asked a captured pirate what reason he had for making the seas unsafe. The pirate replied: “The same reason you have for troubling the whole world. But since I do it in a small ship, I am called a pirate. Because you do it with a great fleet, you are called an emperor.”

From the (highly recommended) Alonnisos Museum, Patatiri, Alonnisos, Greece.

This last weekend looting and burning developed amongst groups of predominantly young people in London and then spread throughout other UK cities, before massive police presence on the streets led to an uneasy peace. The ability of the looters to stay ahead of the police during the disturbances has been attributed to their use of the encrypted Blackberry Messaging Service, hitherto thought of as a business device.

The government initially concentrated on the individual criminality of the participants and eschewed wider social explanations. More recently they have ventured into explanation. The generally ‘broken’ society which the government inherited, we are told, has sick pockets of individuals who act entirely selfishly, with no sense of the consequences for others.

It is true that those on the street have acted criminally with apparently selfish motives. Faced with cuts that have hit the poor disproportionally they have not shouted for social justice in front of government buildings or put them to the torch. Instead, operating between greed and fear, they have taken what they saw to be due to to them, randomly redistributing wealth, and destroying assets and livelihoods in the process. They will rightly face the consequences of their actions.

There are many ironies in this situation and more hypocrisies in the government’s position. The cuts are not only threatening some of the services and support for the poor but also reducing the size of the police force. Police morale is also low because of their perceived inaction (at best) or bribetaking (at worse) in the NewsCorp phone-hacking scandal. The NewsCorp press and their tabloid competitors have helped to resurrect the Victorian notion of the feckless and undeserving poor which have had such political utility as social and economic inequality grew, and grew more evident, in our big cities.

The cuts in government spending are of course in large part a consequence of the financial crisis, and the financial crisis is largely a consequence of banker behaviour. Operating between greed and fear, they have taken what they saw to be due to to them, randomly redistributing wealth, and destroying assets and livelihoods in the process. In contrast to those caught on the streets, banker behaviour has been seen to evade responsibility, and systems in place allow its repetition.

It is naive to think that all this went through the minds of the London looters before they took to the streets. It is also fair to mention that the start of their unrest, in Tottenham, was caused by a police shooting in murky circumstances, in a part of London with a history of bad police-community relations. Yet if we are preaching ethics and the need for social change we should look honestly at the whole social balance sheet, and embrace much more radical change.

Forest occupies about 30% of the land surface of the earth.  It is assumed that even in historic times it declined from about 50%.

I met someone who heard a presentation from a speaker at a recent environmental conference in Abu Dhabi who claimed that our use of fossil fuels had been fine; that had we not used them then the pressure on the forest would have been much worse, that much more would have been lost.

Given the proportion of total biodiversity locked up in the forest, perhaps we would have reached a critical environmental tipping even earlier than we are now at risk of doing.


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S. came to London from New Jersey at the end of the swinging sixties believing that the Beatles would provide the music for dancing in the streets and that she would meet one of them.  Instead she met me, lived with me, and travelled with me.  She was short, with a glowing lure of of blond hair and sculpted thighs in which the scuba diving knife of her street fighting days would have nestled.  On her fingers were a setting of a Roman intaglio which had been given us by our friend Bruce, and one or more puzzle rings.

In London, she went to film school, I was a junior public servant, and we played at film and photography in our space time, and ate the first kebabs and tandoori chicken to hit the London streets.  It was with S. that I first visited the Greek islands.  I can remember that first trip to the islands over whatever huge span of years almost viscerally.  Me and my American girlfriend Sheila were travelling with two other Americans, Mike and the delectable Janie, who, she said, would do anything for icecream.  Those were more modest days before Janice Joplin raised the odds in terms of Mercedes Benz, Colour TV etc…  En route they described arriving by night in an enchanted land of cubiform houses lit like soap bubbles.

On one of our September trips to the Greek islands, S. just kept on going, on the well-worn hippie trail.  She found, not her private Indian ashram, but something more sinister in the back streets of Kabul.  She dyed her hair black – perhaps she was tired of its challenges – and changed the spelling of her name.

Although we had some good times, we were not good together.  I was naive and found it hard to compete with the frequently recurring ghosts of her past.  When we were parted by this trip I dropped her but not in a clean good way.  I still have some vinyl and some books.

This spring I learned that she was dead at the age of 59.  A mutual friend who brought me the news told me that her obituaries indicated a full life, a ‘happy ending’, which my friend appreciated. I was glad of it too, and had never wanted to see her again, but the impossibility of her death still gnawed at me.

Perhaps part of us  always expects to be able to revisit lost loves and lost islands, whereas in truth both are always inaccessible second time round.

In London this has been an extraordinary week in which the successive waves of retreating defence of wrongdoing in the News of the World have collapsed, the paper has closed, and the cautious taunting of the bogeyman Rupert Murdoch has changed to open season. It is if the politicians have liberated themselves from their craven fear, and learned that if they transform themselves from the few whispering suspicions into the many shouting accusations then, as in Tunisia and Egypt, it is the emperor rather than they who suffers.

Yet there is something a little desperate about politicians’ responses, and about their attempt to focus attention on a corrupt conspiracy between media and the police against the interests of the public. From a longer perspective what has been going on is a much more corrosive set of relationships between media and politics. Successive waves of retreating defence are no doubt in preparation but won’t be needed to be deployed whilst political parties can keep the attention elsewhere.

Therefore whilst it is vital that the forthcoming enquiry probes relations between NewsCorp and the police, it is equally important that its terms of reference and powers are wide enough to allow it to probe NewsCorp’s relations with the last and current governments. It is these sets of relations which have established NewsCorps exceptionalism in British life and which have given rise to deeper public suspicions that democratic accountability has been sacrificed in the process.