‘Woodstock of the mind’ – healthcare and the NHS at the 2018 Hay Festival

Wales has featured significantly in the milestones of my cancer journey. It was while supporting them in the 2015 Rugby World Cup that my diagnosis was made (see earlier blog), and it was the first port of call for my period of convalescence post treatment (click here).

Nearly three years later, now in remission, I am back there spending a long weekend in the barn at Cwm Bach Farm in the Brecon Beacons National Park (see below). This trip is mostly for pleasure as this is Hay on Wye Literary Festival time, but it also provides a more scenic venue to mark summer exam scripts – sitting in the garden looking up at the Black Mountains.

Hay is a remarkable town, situated by the river Wye on the English/Welsh border it has become the second-hand book capital of the year. Every year at the end of May, tens of thousands of people converge on a series of marquees in a neighbouring field for what the visiting Bill Clinton called ‘Woodstock of the Mind’. We were there just for a day and chose our programme with general interest in mind – attempting to put the predicament of the NHS behind me – yet, strangely, everything seemed to point back to health care and the NHS!

It was an early start with Alistair Campbell at 9am on the Llwyfan Cymru (Wales Set), fresh from his interview with Channel 4’s ‘Today’ programme – they had a studio in the next tent! He was there to promote his latest novel covering football and terrorism, but also demonstrated his passion to stop Brexit (see this week’s BMJ with Martin Mckee and other’s conclusion that Brexit will be disastrous for the NHS) and his equally passionate advocacy for improving mental health services. He exclaimed that he was fed up (the F word was prominent) hearing about how mental health is now a priority when what is needed is implementation of policy!

Over the next few hours we were also introduced to ‘Big History‘ by David Christian, an Australian historian, who has applied his discipline to explaining the whole universe. Perhaps we need ‘Big Health Care’ to identify the best way forward for the NHS, to help prevent it disappearing into its own Black Hole.

At the other extreme was children’s author David Almond (Skellig) who has based his new book on his life and home town in the North of England. Both authors demonstrated the importance of thinking universal and local at the same time – you cannot ignore either if you are to make sense of the world. The same applies to the NHS, will the creation of the new Integrated Care Organisations solve the conundrum of having a locally relevant NHS at the same time as achieving uniform national standards across the whole country? If they do work then the new structure and function will not be unrecognisable from the shape of the NHS in the 1980s, before the advent of managerialism, purchaser provider split and commissioning (so not so much ‘Back to the future’ but ‘Back to the past)!

Our penultimate session was in the Tata Tent to hear Sir Antony Beevor, a war historian, read from his latest book on the disastrous attempt to secure the bridge at Arnhem towards the end of the second world war (immortalised in the film ‘A bridge too far’). A long way from healthcare, I hear you say, but the story is really about leaders (in this case Field Marshal Montgomery) who put their own glory and aspirations above the public good and, unsurprisingly, it was the public that suffered. In this case not only the allied soldiers but the Dutch public were the subject of retaliatory action afterwards. Some of the audience challenged his thesis, saying it could have worked and shortened the war and saved thousands of lives. The author replied that a successful outcome could only have occurred if all the assumptions aligned themselves positively – they did not. A few lessons here for recent NHS policy makers and strategists. For example, how can Jeremy Hunt base his future vision for the NHS on a digital fix when everyone knows that it is the work force that is the biggest challenge (see latest NHS Providers national survey) and that previous IT promises have failed so miserably. Embracing technology and innovation is necessary but not sufficient – there has to be enough people with time to care.

The last session that I attended was actually specifically health focussed (I couldn’t not resist it). Cambridge University, in their annual featured session, had sent radiologist Ferdia Gallagher to tell the story of modern scanning. It was a wonderful demonstration of how to make complex science accessible to the general public. Interestingly though, the questions came from doctors, first from a GP who was concerned over false positives and his anxiety in raising public expectations when the NHS could not afford all this new technology. This theme was continued by a pathologist who was anxious she would be soon out be out of a job. Gallagher reassured them both that value for money (cost-effectiveness) was well assessed in the NHS (his words) and that scanners were better value for money than many new expensive cancer drugs. Interestingly, a recent survey suggests that the public agree and are now getting wary of the promise of these ‘wonder drugs’.

Even health care professionals seem now to be cognisant of the need for ‘value based healthcare’ – who would have thought that NICE would have made the BMA short list (top 12) as one of the most important developments in the 70 years of the NHS… I wonder which one got your vote?

So in the end it was a busman’s holiday – but well worth a visit if you happen to be in Wales on a wet May Bank Holiday.

Please feel free to let us know your thoughts and leave a comment below.

Professor Peter Littlejohns
King’s College London

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