Ladies and Gentlemen, I have been fascinated to hear from so many of you this evening, before dinner, about your conference on “Healthy Ageing,” a subject to which I find myself paying an increasingly steady degree of attention….
It has, I gather, been an inspiring day. And, as several of you have been pointing out, this is an area which deserves and requires urgent attention, that whole issue of healthy ageing at a time when, as we keep being reminded, demands on systems and resources are becoming ever greater because of our ageing population. I did just want to pay tribute to the Royal College of Obstetricians and Gynaecologists for hosting today’s event, to the College of Medicine for identifying what I think is an inspired choice of subject. I also wanted to thank Alexis St. James, from San Francisco, who I know has helped enormously in creating the success that today’s event has been.
“Healthy Ageing” is, of course, something to which we should all aspire. I suppose I would not necessarily have equated the theme with this Royal College, but the President, Dr. Tony Falconer, informs me that healthy female ageing is very much a key commitment. My family actually has something of a connection, in that my grandmother, Queen Elizabeth The Queen Mother, in 1932, as Duchess of York and I think a remarkable example of how to age healthily, became the College’s first and only Royal Patron… there is, I am told, currently a vacancy. But we won’t go into that now.
I have also been reminded that the R.C.O.G. had rather turbulent beginnings when, in the early decades of the last century, it championed safe birth and an urgent need to reduce maternal mortality in the face of what seemed to many to be a rather complacent medical establishment. I can only urge the Royal College to protect its radical edge in ideas and imagination and its focus on practical, safe and sustainable solutions to high quality women’s healthcare.
Now, I know that, earlier on, you heard from some of the real experts in the field of ageing and I was especially delighted a few minutes ago to meet Professor Elizabeth Blackburn who, as you all know, has achieved so much and in particular through her most eye-catching contribution, the discovery of telomeres, about which I suspect we will be hearing a great deal more in the years ahead. And which before I came here I thought initially may have been part of some complex electronic process in silicone valley! Anyway I understand it’s something else now.
I won’t rehearse it all in detail here as I know this has been a popular discussion point today, but I could not let this moment pass without referring to the fact I found especially riveting - namely, the clear evidence that high levels of stress, according to the research, result in shortened telomeres, and a reduced presence of telomerase, the restorative natural enzyme present in cells.
Equally arresting was the work done a few years ago in which a three month meditation retreat for a study of effects on participants indicated raised levels of telomerase activity, telomere length and therefore greater cell longevity. So, you could say, there we have it – not cast-iron scientific proof, but clear evidence of links between mind and body. Good Lord!
Now as some of you may know, I have been saying for what seems a very long time that until we develop truly integrated systems - not simply treating the symptoms of disease, but actively creating health, putting the patient at the heart of the process by incorporating our core human elements of mind, body and spirit - we shall always struggle, in my view, with an over-emphasis on mechanistic, technological approaches. Please don’t misunderstand me, and I’ve said this over and over again and been systematically misunderstood- the best of science and technology constantly needs to be harnessed and deployed to best effect – but, I would suggest, not at the expense of the human elements which, after all, provide the whole rationale for medicine and healthcare going back to our roots. That is why I was so heartened to learn more of Professor Blackburn’s work and I can only encourage her and her colleagues to persist in deepening our understanding of these issues.
This whole area of work - what I can only describe as “integrated approaches” in the U.K., or “integrative” in the United States, which just shows that American is actually a separate language- takes the best of what we know about appropriate complementary and conventional approaches and applies them to patients. By way of illustration, a good recent example of this “best of both worlds” approach is to be found in the Royal College of Obstetricians and Gynaecologists, whose Scientific Advisory Committee produced a paper earlier this year looking at the effectiveness of acupuncture and Chinese herbal medicine for women in chronic pelvic pain. It then called for better research into the effectiveness of such therapies for this difficult condition.
And on this theme, I am often struck by the clarity and relative simplicity of the core commitments at the heart of the College of Medicine’s mission - service, science and healing. They were identified by Dr. Michael Dixon, Sir Graeme Catto, Dr. Harry Brunjes and others as representing the practical, evidence-based building blocks, which not only recognize the need to retain mind, body and spirit at the heart of any good system of healthcare, but also actively promote and encourage these aspects amongst a range of individual health professionals and groups of practitioners.
I cannot help thinking that, in reflecting on the nature of the healthcare systems needed around the world, it is essential that we retain, foster and enhance the age-old qualities of human kindness and compassion. All too often, we hear of instances where these have been palpably lacking and some commentators and observers have spoken of the need to restore urgently a climate of care and compassion at the heart of our health services.
I find it quite extraordinary that there appears to some at least to be a gap here, especially when we are told that these so called “soft skills” of caring can have a significant impact on the quality and pace of recovery amongst patients. Surely though we all know this is the case instinctively. So it therefore seems not unreasonable to pose the question – are we doing enough to ensure there is sufficient empathy and compassion instilled throughout training at medical schools and for the duration of hospital training? And should we not be doing more to enhance the amount of contact time and continuity of relationships between professionals and patients? In short, it appears to many inside and outside the healthcare professions that our capacity for providing “the human touch” has steadily decreased as science and technology have improved. Surely, it should not be a case of “either/or”? It seems to me that good medicine should not be purely about what science and technology demand, but about what patients need?
One senior professional said to me the other day that what seems to go missing all too easily is the art of thoroughly understanding the patient’s narrative. In fact I hear this all the time from all sorts of people who haven’t exactly been asked the right questions about their entire history. We need to equip our health professionals with the skills (and desire) to listen and honour what is being said, and - importantly - what is not said to them - so they can develop a thorough understanding of the story. In this way, they can develop healing empathy and help the patient find their particular path towards better health. This, I might add, not only helps the patient, but also nourishes the health professional as they can connect and engage in a much more meaningful and professionally satisfying way.
One of the ambitions of the College of Medicine is to help realize greater alignment of the ambitions of health service organisations, health service leaders and frontline clinicians. Good care, I believe, depends on all three. To that end, I was delighted to hear that the College of Medicine is proposing to introduce three “Extra Care Awards,” from next year. These will be for the most caring frontline clinician, the most caring health organization and the most influential N.H.S. leader in creating a culture of caring within his or her organization. I am equally delighted that the Royal College of Obstetricians and Gynaecologists and the College of Medicine are discussing other ideas of valuing and rewarding this culture of caring which is so important to women’s health.
Good personal care is, of course, very important. But I wonder if there might not be potential for us all to become more concerned and caring of each other outside the professional encounter? In Burnley, for instance, in Lancashire, where health inequalities have lowered life expectancy to among the worst levels in this country, up to a dozen of my Charities are working in partnership with local organizations, over the last four years or so, trying to make a difference for the better in the fields of health, the built and natural environment, the Arts, education and business. Why? Because, we know alienated and uncaring communities can only reduce the health and wellbeing of those living in them. Conversely, all the evidence shows that, if you try to tackle some of these admittedly deep-seated problems, not only do you begin to witness improvements in health and other inequalities, but you begin to see improvements in the overall cost-efficiency and effectiveness of local services.
So, Ladies and Gentlemen, if I may be so bold, it seems very clear to me, at least, that we know enough about what causes unhappiness and poor health; we know enough about the impact of the patient/professional relationship and we also appreciate that there is a strengthening case for greater research effort where we know, or suspect, that health improvements are being realized through a range of integrated interventions and programmes. You are the ones, ladies and gentlemen, who must take all these things forward but, in closing, I would strongly suggest – indeed, would implore you to accept - that now is surely the time to concentrate real effort in these areas and to do so by deploying approaches which, at their heart, retain the crucial bedrock elements of traditional and modern civilized healthcare - of empathy, compassion and the enduring values of the caring professions.