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Realise that if they don't invest in primary care they will bankrupt the the health GDP.

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So and I think the model, the U.K. model, it's interesting that for a third of my clinical lifetime,

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I think the NHS was looking overseas for better models of clinical provision,

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but in fact actually quite accidentally we ended up with probably the most

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controlled global health system model and one where most general physician general

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medical care occurs in the community and a lot of the sort of prevention and

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disease follow that occurs in the community and it enables super specialisation,

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hospital setting. The other thing especially is to become more specialised.

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And that model, I think most health systems and I recognise that that model in the registered list.

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Rather than the source of private provision is the most equitable and cost effective.

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So there's lots of health systems are trying to orientate more to the way we do things here.

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And of course, digital health, which we do a lot of work around as well, is quite an important part of that.

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And letting you know where you are in in terms of of the provision of health care and who you need to focus on first and in what order.

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I remember having American friends who were astonished that as a woman who's had two children,

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I've never seen either a paediatrician or a gynaecologist.

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Yeah, well, they proliferate community care, but that their, according to Jennifer, is actually not exactly the same.

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But their family doctor is definitely I mean, they're paid less and generally have a much lower status.

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So you tend to at community specialists to your provision as well.

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But even the US, the managed care in the US recognises they need a more general population approach to things.

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Otherwise, you know, they won't, they won't stop a lot of expense.

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They might be doing it for economic reasons, but they're still driving towards a similar model.

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Um, and the things we can learn from the US because,

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because it's effectively a for profit environment in most cases they are pretty efficient about investing in cost

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effective management programmes and we can learn from those is once you've determined that people got problems,

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how can you look after them more effectively? They covered this a little bit because you mentioned you went in.

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So how did the first lockdown impact on moving now more to your national living, living through the the pandemic?

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How did the first lockdown impact on on what you were able to do?

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Did it did it change the way you work?

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Well, I mean, for me, it impacted rather less because I basically I don't actually live in Oxford, so I live most of the time Birmingham.

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So I was commuting down from Birmingham, so it was a lot easier commute, that's for sure.

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It was a bit it was a bit weird. I mean, you felt like it was a Hollywood pandemic film because, you know,

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they weren't mowing the grass outside and it stopped and the streets were completely empty.

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And, you know, I could across the road here with my eyes closed, I needed to look for traffic.

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And I think there were two or three of us in this building,

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but I think we didn't actually close this building or the other building we got, which is 100 metres away.

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But this building had very few people in it. The other one at about 25 or 30 who normally would have about 100 people in it.

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So yeah, that was that was a bit weird. A huge increase in meetings actually early, had a lot of meetings in Madrid,

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but far more meetings, most of them online, even though might be taking them here.

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I think the other thing that was which I've missed, I have to say, although.

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I did not think about my credentials, his travel.

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So I think I've had. One flight in the last 20 months.

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Where is normally I probably I don't know. I'll probably be twice a month again somewhere.

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So that's been bad. Because I think you are often meeting interesting people, different across the world,

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different perspectives as well as doing whatever you're going to do normally was giving a lecture or examining or something, so that's gone.

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Whether that will ever come back, I'm not quite sure. So more of the conferences I've attended have been you know, I've just been given a video talk.

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But I've stopped attending Congresses. I think online Congress is a.

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Not for me anyway, so I don't know what that's going to be like.

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And I think it's you know, I think it's been difficult, but domestically as well,

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because my wife is in a similar area to me and, you know, we just it just ramped all the time.

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Yeah. So you're working hours went out just ridiculous.

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Yeah. And I, I've actually taken more space and she has it and she's.

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Well, she takes it even more seriously than I do.

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But, you know, I'll just miss something if I'm feeling a bit overwhelmed that day or whatever.

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And. Yeah. We still publish a lot and still had to bring the grants in for the next stuff

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and still cope with more people in the department and all the rest of it.

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I'm quite embedded into the university as well, so I sit on council and sit on quite a few of the council subcommittees and stuff.

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So that really increased as well the the sort of because obviously the university response was.

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From a senior management team is big. So that's been quite time consuming as well.

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And do you think the provisions that were brought in across the university to protect people were adequate and well implemented?

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He did a good job, really. I mean, and I think, you know, we tried to make.

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Quite a few departments did. We certainly tried to make people still feel they were part of a department, even if they were working from home.

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So virtual coffee mornings and.

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We normally have a big fancy dress Christmas party every year.

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Last year we didn't, but we did a online pantomime, which was awful for those having to be in the Pentagon.

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But I think when you think. Are you in the Pentagon?

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Yes. So so do you think the well-being of the people in your department held up fairly well?

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I think it probably did.

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We've got a fantastic team here who are, you know, really dedicated and took the responsibility to try and keep the eye of a big department.

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Yes, it still feels like it cares about stuff.

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I think they got that right.

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I think it's going to get more difficult there because that length of time has gone on for is just not sustainable, frankly.

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And I think I don't know where we're going to end up, really.

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So I think the university I mean, we were obviously predicting a big loss over the last financial year and to decisions there.

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But as it turned out, you know, the university is actually. Financially done well because it's done so much stuff.

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It's obviously increased its grant income. There's been a lot more legacy.

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I think it's boosted its international status. As an institution even more than it was already so.

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It. It hasn't been bad for the institution. I mean, I think we'll have to wait and see where it settles.

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I mean, I think it has been it has made a tangible contribution to the world, actually, in the last 20 months.

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Way above its station. Not least of which was the vaccine, which is a tragedy that it's been as blighted as it has been latterly.

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But. But that's still the most used vaccine on the planet.

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And goodness knows how many lives have been saved through that.

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And, you know, it should. It should actually be.

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By far the most used vaccine because it's cheap and cheerful and easy to use.

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And it's risks, albeit, unfortunately, does have some risks.

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In the scheme of things,

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and they are no greater than the alternatives and much less than getting the disease and massively less than getting the disease.

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And who knows the people? I mean, you can speculate, but the people who get these rare thrombotic effects,

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I think you could reasonably surmise that they would be more likely to get those same effects if they had the.

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Um, you know, if they could walk over the. Because there's obviously some weird predisposition to a thrombocytopenic reaction.

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I mean, there is the disorder is actually it just shows how out science is that because actually

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it's a known risk factor with vaccines to get a immunological thrombocytopenia response.

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This is blood. Blood clots. Yeah. Sorry. I'm just. It's. Yeah, I know.

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In this part of it, you. You drop your platelets, which makes you more likely then to get a bleed associated with the clot.

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So it's both a clot and bleed at the same time.

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And there are one or two vaccines, which I'm not going to name, which have this associated with them.

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And I never knew that. And no, for the disease is not covered.

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Yeah, yeah, yeah. I it is a known rare effect of immunisation and has actually happened with the marinades as well, but in lower numbers.

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So it is just one of the potential risks associated with vaccination.

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But you're talking about converting a sort of one in a million background risk into two in a million.

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Well, if you were that one in a million person. It's obviously tragic and awful and all that, but.

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If you're going to get 12, 15 in a million, if you get COVID and you've got all the other risks on top, then it seems like a no brainer.

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Really? Yeah. And no, COVID vaccination does not sterilise you and it doesn't introduce a microbe bot that then allows you to be tracked.

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So but that that's been very unfortunate because I think it and it's for some countries have been devastating so.

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Because some of the countries have very, very low vaccine uptakes.

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Romania, Russia, Japan are going to really get hit badly in this current wave.

106
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So did you personally ever feel threatened by the virus or.

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Yeah, I did, actually, because not without going into it. You know, I'm old and have a number of risk factors.

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And actually so it was weirdly early on when this had been.

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I did actually think that if I get it. Mark Hillman.

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And I sort of thought to myself, should I hide away?

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And because I could just work from home, just decided that I wasn't going to let it dictate how I lived my life, really.

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And then stop thinking about it other than, you know, sensible precautions.

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But yeah, so that's what I did think about it deep down.

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But as it turned out, I was infected quite early on, as thick as mine.

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Oh, you were? Yeah. So. Oh, right. Was my wife caught in mid-March?

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She was teaching on a master's programme in work and quite a few.

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The top two exalted old doctors and they've got a few of them have been skiing and,

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and two of them and subsequently the whole cohort were infected with COVID in March.

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That was before the first lockdown. A week before the first lot. Right.

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And and so I know that I was infected at some point because I got I did my antibodies at the end of 2020,

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which showed I'd had been infected, and I'm almost certain I was infected then, although I wasn't actually particularly ill.

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She was much older than me, but she was like you. I mean, you know, I fell off colour and had horrendous headaches, which I don't normally get at.

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I didn't lose your sense of taste and smell that I didn't.

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I had really given. Well, I'd been thinking in retrospect, stupidly, I got off remarkably mild things with symptoms.

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There were another couple of occasions when I was little later in the year where it could have been then.

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It's just, I mean, obviously once we realised she got COVID effectively Barry a nurse too at home, but,

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but there was at least 24, 36 hours before we knew she was positive when she would have been infectious.

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I think the chance of me not having caught it then were negligible and obviously caught it at some point.

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So I think it was there. So, so yeah, it you can get it and survive it.

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A lot of people do. That's the weird thing about it.

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It, it's, it's so unpredictable even amongst people with risk factors, the majority don't want to get seriously ill, but some will.

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So I need to move to wrap up because I think we have to time.

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And so has the work you've done on COVID raised questions that you'd be interested in exploring in the future?

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Yeah. I mean, I think the particular area that we'll want to look at as soon as we can actually is long COVID,

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and we'll be looking at whether any of the treatments which might not be infected with COVID might be effective.

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In terms of long COVID. That's a completely separate and important question,

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where you might use treatments not for the initial illness, but because it might alter the illness trajectory.

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So that, I think is an important area. I think we're still thinking about how we can integrate all of our digital assets.

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We've got quite a number of parallel digital assets and whether we can actually be using those more efficiently,

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I think is is quite a big consideration for us and also our relationship with the

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software suppliers who actually generate the clinical systems that extract the data.

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That's been the relationship with them has been really quite important and much, much stronger over the last year or so.

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Yeah. So those are two obvious areas I think trying to resurrect Non-Covid research is also important.

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I mean, obviously, you know, we are not going to eradicate this virus and we therefore need to learn to live with it.

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And I think that'll become a feature really.

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Which is, which is how you can reduce its impact on society and try and return to a more semblance of normality at

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the same time as focus on the next or perhaps the overwhelming issue facing society of climate change.

148
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Mm hmm. But I think everybody is a bit knackered, really, and how you can bring everybody round from that and make them feel more positive about the,

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um, where we go with the world, I think is going to be a bit of a.

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You know, this is a slightly different question, but related.

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Has the experience of COVID changed your attitude or approach to your work?

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And how would you like things to change in the future? Well, I really enjoy my job, actually.

153
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I wouldn't necessarily admit that, but I do enjoy its variety.

154
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The amount of control I have over what I spend time doing, etc.

155
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But I do feel a bit wary now.

156
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So I don't know really. It I mean,

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what it's done for a lot of my colleagues is get them to decide to retire early and focus on other important things like grandchildren and the,

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you know, generational stuff. So I suppose I, I think more about whether I should be thinking like that.

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I don't know whether I will or not, but I think I should think more about that.

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And I think quite a lot of people of my generation thinking more like that.

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And, you know, worrying about what? Because it's really the next generation and certainly the grandchildren who are really going to.

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I've suffered the economic consequences of that.

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So once again, I think I've been fortunate enough to live at a time when we never had it so good.

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Frankly, as a society, the adults in society, even the ones who.

165
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You know, need support from the state to survive.

166
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They've actually never had it so good either.

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Cause I think. I think things are going to get tougher and.

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So I don't really know what is going to happen. And clearly, you know, the world's in a terrible state.

169
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When you look at equity and distribution and population and simple stuff, like enough food to eat and.

170
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Whether you populations growing in a sustainable or non-sustainable way.

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It's yeah we're a bit we may not be very advanced technologically, but we're not very advanced in terms of our governance structures or anything.

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Mm hmm. That I don't think we would advance beyond where previous civilisations were several thousand years ago.

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But actually we have got slavery now. Well, no, we probably we'd have slavery like they had it.

174
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And I think, you know, Greek and Roman and.

175
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Societies like that were probably as advanced as ours and more durable, really.

176
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But yeah. So I don't know. What do you think?

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Where do you think we're going to end up? I think we're going to [INAUDIBLE] at that.

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And that's. Yeah.

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No, it's difficult to feel optimistic. Well, I think that's the point that I'm going to stop.

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I think.