Realise that if they don't invest in primary care they will bankrupt the the health GDP.
So and I think the model, the U.K. model, it's interesting that for a third of my clinical lifetime,
I think the NHS was looking overseas for better models of clinical provision,
but in fact actually quite accidentally we ended up with probably the most
controlled global health system model and one where most general physician general
medical care occurs in the community and a lot of the sort of prevention and
disease follow that occurs in the community and it enables super specialisation,
hospital setting. The other thing especially is to become more specialised.
And that model, I think most health systems and I recognise that that model in the registered list.
Rather than the source of private provision is the most equitable and cost effective.
So there's lots of health systems are trying to orientate more to the way we do things here.
And of course, digital health, which we do a lot of work around as well, is quite an important part of that.
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.
I remember having American friends who were astonished that as a woman who's had two children,
I've never seen either a paediatrician or a gynaecologist.
Yeah, well, they proliferate community care, but that their, according to Jennifer, is actually not exactly the same.
But their family doctor is definitely I mean, they're paid less and generally have a much lower status.
So you tend to at community specialists to your provision as well.
But even the US, the managed care in the US recognises they need a more general population approach to things.
Otherwise, you know, they won't, they won't stop a lot of expense.
They might be doing it for economic reasons, but they're still driving towards a similar model.
Um, and the things we can learn from the US because,
because it's effectively a for profit environment in most cases they are pretty efficient about investing in cost
effective management programmes and we can learn from those is once you've determined that people got problems,
how can you look after them more effectively? They covered this a little bit because you mentioned you went in.
So how did the first lockdown impact on moving now more to your national living, living through the the pandemic?
How did the first lockdown impact on on what you were able to do?
Did it did it change the way you work?
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.
So I was commuting down from Birmingham, so it was a lot easier commute, that's for sure.
It was a bit it was a bit weird. I mean, you felt like it was a Hollywood pandemic film because, you know,
they weren't mowing the grass outside and it stopped and the streets were completely empty.
And, you know, I could across the road here with my eyes closed, I needed to look for traffic.
And I think there were two or three of us in this building,
but I think we didn't actually close this building or the other building we got, which is 100 metres away.
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.
So yeah, that was that was a bit weird. A huge increase in meetings actually early, had a lot of meetings in Madrid,
but far more meetings, most of them online, even though might be taking them here.
I think the other thing that was which I've missed, I have to say, although.
I did not think about my credentials, his travel.
So I think I've had. One flight in the last 20 months.
Where is normally I probably I don't know. I'll probably be twice a month again somewhere.
So that's been bad. Because I think you are often meeting interesting people, different across the world,
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.
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.
But I've stopped attending Congresses. I think online Congress is a.
Not for me anyway, so I don't know what that's going to be like.
And I think it's you know, I think it's been difficult, but domestically as well,
because my wife is in a similar area to me and, you know, we just it just ramped all the time.
Yeah. So you're working hours went out just ridiculous.
Yeah. And I, I've actually taken more space and she has it and she's.
Well, she takes it even more seriously than I do.
But, you know, I'll just miss something if I'm feeling a bit overwhelmed that day or whatever.
And. Yeah. We still publish a lot and still had to bring the grants in for the next stuff
and still cope with more people in the department and all the rest of it.
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.
So that really increased as well the the sort of because obviously the university response was.
From a senior management team is big. So that's been quite time consuming as well.
And do you think the provisions that were brought in across the university to protect people were adequate and well implemented?
He did a good job, really. I mean, and I think, you know, we tried to make.
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.
So virtual coffee mornings and.
We normally have a big fancy dress Christmas party every year.
Last year we didn't, but we did a online pantomime, which was awful for those having to be in the Pentagon.
But I think when you think. Are you in the Pentagon?
Yes. So so do you think the well-being of the people in your department held up fairly well?
I think it probably did.
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.
Yes, it still feels like it cares about stuff.
I think they got that right.
I think it's going to get more difficult there because that length of time has gone on for is just not sustainable, frankly.
And I think I don't know where we're going to end up, really.
So I think the university I mean, we were obviously predicting a big loss over the last financial year and to decisions there.
But as it turned out, you know, the university is actually. Financially done well because it's done so much stuff.
It's obviously increased its grant income. There's been a lot more legacy.
I think it's boosted its international status. As an institution even more than it was already so.
It. It hasn't been bad for the institution. I mean, I think we'll have to wait and see where it settles.
I mean, I think it has been it has made a tangible contribution to the world, actually, in the last 20 months.
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.
But. But that's still the most used vaccine on the planet.
And goodness knows how many lives have been saved through that.
And, you know, it should. It should actually be.
By far the most used vaccine because it's cheap and cheerful and easy to use.
And it's risks, albeit, unfortunately, does have some risks.
In the scheme of things,
and they are no greater than the alternatives and much less than getting the disease and massively less than getting the disease.
And who knows the people? I mean, you can speculate, but the people who get these rare thrombotic effects,
I think you could reasonably surmise that they would be more likely to get those same effects if they had the.
Um, you know, if they could walk over the. Because there's obviously some weird predisposition to a thrombocytopenic reaction.
I mean, there is the disorder is actually it just shows how out science is that because actually
it's a known risk factor with vaccines to get a immunological thrombocytopenia response.
This is blood. Blood clots. Yeah. Sorry. I'm just. It's. Yeah, I know.
In this part of it, you. You drop your platelets, which makes you more likely then to get a bleed associated with the clot.
So it's both a clot and bleed at the same time.
And there are one or two vaccines, which I'm not going to name, which have this associated with them.
And I never knew that. And no, for the disease is not covered.
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.
So it is just one of the potential risks associated with vaccination.
But you're talking about converting a sort of one in a million background risk into two in a million.
Well, if you were that one in a million person. It's obviously tragic and awful and all that, but.
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.
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.
So but that that's been very unfortunate because I think it and it's for some countries have been devastating so.
Because some of the countries have very, very low vaccine uptakes.
Romania, Russia, Japan are going to really get hit badly in this current wave.
So did you personally ever feel threatened by the virus or.
Yeah, I did, actually, because not without going into it. You know, I'm old and have a number of risk factors.
And actually so it was weirdly early on when this had been.
I did actually think that if I get it. Mark Hillman.
And I sort of thought to myself, should I hide away?
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.
And then stop thinking about it other than, you know, sensible precautions.
But yeah, so that's what I did think about it deep down.
But as it turned out, I was infected quite early on, as thick as mine.
Oh, you were? Yeah. So. Oh, right. Was my wife caught in mid-March?
She was teaching on a master's programme in work and quite a few.
The top two exalted old doctors and they've got a few of them have been skiing and,
and two of them and subsequently the whole cohort were infected with COVID in March.
That was before the first lockdown. A week before the first lot. Right.
And and so I know that I was infected at some point because I got I did my antibodies at the end of 2020,
which showed I'd had been infected, and I'm almost certain I was infected then, although I wasn't actually particularly ill.
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.
I didn't lose your sense of taste and smell that I didn't.
I had really given. Well, I'd been thinking in retrospect, stupidly, I got off remarkably mild things with symptoms.
There were another couple of occasions when I was little later in the year where it could have been then.
It's just, I mean, obviously once we realised she got COVID effectively Barry a nurse too at home, but,
but there was at least 24, 36 hours before we knew she was positive when she would have been infectious.
I think the chance of me not having caught it then were negligible and obviously caught it at some point.
So I think it was there. So, so yeah, it you can get it and survive it.
A lot of people do. That's the weird thing about it.
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.
So I need to move to wrap up because I think we have to time.
And so has the work you've done on COVID raised questions that you'd be interested in exploring in the future?
Yeah. I mean, I think the particular area that we'll want to look at as soon as we can actually is long COVID,
and we'll be looking at whether any of the treatments which might not be infected with COVID might be effective.
In terms of long COVID. That's a completely separate and important question,
where you might use treatments not for the initial illness, but because it might alter the illness trajectory.
So that, I think is an important area. I think we're still thinking about how we can integrate all of our digital assets.
We've got quite a number of parallel digital assets and whether we can actually be using those more efficiently,
I think is is quite a big consideration for us and also our relationship with the
software suppliers who actually generate the clinical systems that extract the data.
That's been the relationship with them has been really quite important and much, much stronger over the last year or so.
Yeah. So those are two obvious areas I think trying to resurrect Non-Covid research is also important.
I mean, obviously, you know, we are not going to eradicate this virus and we therefore need to learn to live with it.
And I think that'll become a feature really.
Which is, which is how you can reduce its impact on society and try and return to a more semblance of normality at
the same time as focus on the next or perhaps the overwhelming issue facing society of climate change.
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,
um, where we go with the world, I think is going to be a bit of a.
You know, this is a slightly different question, but related.
Has the experience of COVID changed your attitude or approach to your work?
And how would you like things to change in the future? Well, I really enjoy my job, actually.
I wouldn't necessarily admit that, but I do enjoy its variety.
The amount of control I have over what I spend time doing, etc.
But I do feel a bit wary now.
So I don't know really. It I mean,
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,
you know, generational stuff. So I suppose I, I think more about whether I should be thinking like that.
I don't know whether I will or not, but I think I should think more about that.
And I think quite a lot of people of my generation thinking more like that.
And, you know, worrying about what? Because it's really the next generation and certainly the grandchildren who are really going to.
I've suffered the economic consequences of that.
So once again, I think I've been fortunate enough to live at a time when we never had it so good.
Frankly, as a society, the adults in society, even the ones who.
You know, need support from the state to survive.
They've actually never had it so good either.
Cause I think. I think things are going to get tougher and.
So I don't really know what is going to happen. And clearly, you know, the world's in a terrible state.
When you look at equity and distribution and population and simple stuff, like enough food to eat and.
Whether you populations growing in a sustainable or non-sustainable way.
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.
Mm hmm. That I don't think we would advance beyond where previous civilisations were several thousand years ago.
But actually we have got slavery now. Well, no, we probably we'd have slavery like they had it.
And I think, you know, Greek and Roman and.
Societies like that were probably as advanced as ours and more durable, really.
But yeah. So I don't know. What do you think?
Where do you think we're going to end up? I think we're going to [INAUDIBLE] at that.
And that's. Yeah.
No, it's difficult to feel optimistic. Well, I think that's the point that I'm going to stop.
I think.