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Whose care is it anyway?

Health-Literacy

Long before the current financial crisis hit the NHS, Derek Wanless in his ground breaking, and still highly relevant, reports on the future funding of health and social care articulated the impact of public engagement with health and treatment on the likely size of future healthcare costs. Back in 2002 he estimated that between 2002/3 and 2022/3 the gap between a “fully engaged “and a “slow uptake” scenario for the development of the NHS would amount to £30 billion or 16%  difference in the funding requirements for the formal system of care.    Even in times of relative plenty Wanless argued that a very different approach to delivering health care was essential if we were continue to be able to afford a high quality health service in this country.  How much more so in times of austerity when it appears unlikely that we can afford even the most optimistic requirements which Wanless put forward for future funding.

At the heart of public engagement must be a genuine commitment to empower the public to look after their own health and to treat those who become “patients” in the formal care system as genuine partners in and co-producers of their care. In doing so we should aim at a goal of increasing “health literacy” so as to enhance the knowledge and motivation which people have to look after their own health and to maximise the benefits of any treatment they receive.

Just before Easter I was lucky to join a conference organised by Oxford University’s Health Experience Institute considering health literacy. It made me think hard again about this question which has been relevant to many of things I have done in my career, most notably in the time I spent at NHS Direct.  It should be an issue at the very top of debate about health policy making and delivery but in reality, but despite lots of small scale good practice, it has received spasmodic attention and follow through.

There are lots of reasons why this is the case but the most fundamental one, I believe, is a question of structure and beliefs. We call our system the National Health Service but we organise and deliver it as the National Illness Service.  We can talk about self-care but we rarely organise ourselves to support it in any meaningful manner.

If we are to take the issue of health literacy seriously I think there are a number of things we need to do.

First we need to reprioritise spending on public health and self-care. I for one supported the idea of separating public health from the NHS, integrating it in local Government with control of some of the wider determinants of health and making a long term commitment to improving health and health literacy which was separate from the arguments about NHS funding.  It has been sad to see this vision undermined by the level of reductions in public health budgets which I fear will have long term consequences for health outcomes and increased pressure on the NHS.

There is also an argument for investment in the very best of health information and advice, recognising that self-care and self-management need to be supported. Yet, despite the rhetoric, it is always these resources which are the first to be cut when budgets are squeezed. NHS Direct was much more than a means of managing demand for urgent care and represented a world class resource for supporting self-care.  It was a retrograde step when it was closed.

Second we need to move away from the puritan and judgemental rhetoric which has characterised too much of our health promotion activity and shift to a greater focus on individual wellbeing and motivation. Individuals rarely see health as an abstract concept unconnected with the wider circumstances of their lives.  As we know very clearly in mental health, jobs, housing and relationships matter as much as do formal health care interventions in improving health and wellbeing.  The crucial ingredient in successful health promotion is individual agency.  If we just lecture people about their lifestyles we will be doomed to failure. However if we work with people in ways which build trust and tap into their own motivations to change then we have a chance.  From my experience I believe that voluntary sector and peer organisations, with their traditions around more holistic and creative models of working, have much to offer.  I loved hearing about the dance class at risk for older people which aims both to boost wellbeing and reduce the risk of falls.

The third thing is to restructure professional education to put a much greater emphasis on the skills and shared decision making and co-production.   There is clear evidence that shared decision making can improve concordance with treatment (it remains staggering that between 30-50% of prescribed medicines are not taken), improve health outcomes and many cases can lead to the choice of less expensive interventions.  The skills of shared decision making are not necessarily the traditional skills of clinical consultation.  It has been exciting working with the Dartmouth Center for Health Care Delivery Science on the use of measurement and delivery tools to support shared decision making in CAMHS services.  Amongst other things, Dartmouth’s evidence suggests a marked difference between the views of patients in whether they have been involved in decisions about their care from those of the clinicians treating them.

The final thing is to think through how we structure the delivery of care in ways which put patients and not the system at the centre. The ever increasingly transactional nature of services and greater fragmentation of care works against this.  We need, alongside patients and families, to think through pathways and to understand how we can support patient engagement and health literacy at each stage, not just in the consulting room, but through all of our interactions and communications.  A key point would be the effort, both practical and psychological, we invest at the point of diagnosis.  Given that long term conditions will be at the centre of the demand for healthcare this could be time well spent if our objective is to help patients manage with confidence and skill their own conditions and reduce demand on formal services.

This is an urgent agenda. We are a long away from Derek Wanless’ “full engaged” scenario and the gap between what we need to be and where we are is getting wider.  This theme is not lacking from the Five Year Forward View but needs rapidly to come much closer to the fore.  If it does n’t our chances, as his report 14 years ago highlighted, of delivering a sustainable NHS will be that much harder.

Older and wiser?

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It’s one of those paradigms that age brings wisdom but is it always true?

Since I turned 50 a couple of years back I’ve reflected a lot on what it means to grow older. I have also reflected on what the value is of that half a century of experience.

Experience very clearly does bring benefits in both my professional and personal life. First, and quite straightforwardly, I know a lot more than when I was young.  That gives me a competence in doing things which I might have previously struggled with but just as importantly it lowers the anxiety of handling a wide range of situations.  I am more confident in dealing with people, in meeting deadline and in solving problems.  Experience and practice has helped me refine the psychological skills of managing these situations and has helped me to calibrate my understanding of situations and to distinguish those which are routine and those which are particularly challenging.  Such experience doesn’t always make me wiser or better at doing things but it helps.

Experience also makes me better at understanding the context of situations. There are many more things I have experienced myself or seen other people experience or read about other people experiencing than when I was 20.  As a historian I put a lot of emphasis on the repeating patterns of human history.  Our own age, with its globalised networks, instant communications and rapidly evolving technology, can appear distinctive but it is not unique.  There are historical precedents to the challenges we face today and while history and experience do not necessarily provide the answers to contemporary problems they do help in asking the right questions.  They also provide salutary warnings about the perennial nature of human folly but also about our resilience and adaptability.  At times there is a danger that such experience can make one overly cynical but, in general, it is a salutary feeling.

Age has also made me more of sure my loves in life. Youthful enthusiasms can be powerful but they are not the same as the affections which come with experience.  Whether it is the music of Beethoven and Bach, the novels of Trollope, the sight of the hills or the sea, the poetry of Shakespeare and Homer or a Welsh victory against the old enemy there is something deeper in my sense of satisfaction in the things which I have grown to love over a lifetime.  For a long time I would avoiding rereading anything I had read before on the basis that it might distract me from new discoveries.  Nowadays there is a special pleasure in returning to books or poetry I have read before knowing that they will yield up a new level of pleasure not because they have changed but because I have.  The eyes of an older person see things invisible to their younger self.

The same is true in relationships. However important their roles were in my first decades of life I have got to know my parents and my siblings much better as an adult.  My relationship with my children is richer and closer in many ways now they have grown up and are beginning to make their own way in the world.  The same is true is the closest and most important relationship of my life. Falling in love is a fantastic and intoxicating experience but it does not beat the more profound joy which comes from having shared 26 years or more of life together.

So age brings many consolations but it also brings challenges and previous experience is not necessarily a guarantor of wisdom in dealing with these. Foremost of these challenges is that of accepting loss.

First there can be the loss of health. Here I have been very lucky and many ways feel as fit and healthy as 53 year old as I did at 20 but I can begin to see the first signs of decline, some loss of my hearing, the increasing incidence of frustrating moments when my memory fails in ways it would have never have done in the past. It has been sad to see others, my parents included, struggling with poorer health and diminished physical and mental capability.  Adjustment to weakness and frailty is never easy.

Second there is the question of when to give up activities which one no longer has the capability, in its fullest sense to undertake. For my generation work will no longer be bounded by established norms for retirement set by the state and economic realities will keep many working who might have previously looked to retire.  Work can be good for many older people in keeping them active and engaged with society and their experience, for all the reasons I have described above, is to be valued.  There is a time, though, when it is right to finish and to do so with grace.

Most importantly in growing older there is the need to reconcile oneself to the ultimate loss. Mortality is a condition we all share.  It can be postponed but never avoided.  The greatest wisdom is how we can adapt ourselves to accepting that inevitable fate.  For once I do not agree with Dylan Thomas: we should go gently into that good night.

In all things the most important knowledge in growing older is the knowledge of ourselves. Without that our greater experience of life can become meaningless, making us prone to making the same mistakes we have always made and leaving us unprepared to deal with the ultimate challenges of life.

Older and wiser? We’ll have to see.

 

Learning from the past

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History does not repeat itself. However certain ages can have a resemblance to each other in a way which encourages thinking about what the experiences of the past can teach us about the challenges of the present.

The 1930s have always been a salient period of history for me as it is the decade of my parent’s childhood, a decade which in many ways was in such contrast to my own comfortable upbringing in the 1970s. In particular my father’s experience of growing up in the Rhondda Valley in the height of the Depression has made a profound impact on me.  Many contemporary visitors to the South Welsh coalfields were also moved. As the future Edward VIII commented when seeing, at first hand in South Wales the level of poverty induced by industrial decline and mass unemployment “Something must be done.” Little was done at the time but the images of the Depression did much to inspire the political determination, after World War II, to create a fairer and more prosperous society.   The current issues around the future of the steel industry at Port Talbot show how deeply entrenched such experiences are in the folk memory of the Welsh.

Other narratives describe the economic traumas of the decade in other parts of the country. George Orwell’s “The Road to Wigan Pier” and “Down and Out in London and Paris” are uncompromising in their descriptions of the life of the poor and unemployed and Winifred’s Holtby’s brilliant novel “South Riding”  captures the oppressiveness of the hard times of that decade.  In America the impact of the Depression, if anything even more profound there than in Britain, is captured in the writing of John Steinbeck and in particular in the “The Grapes of Wrath”.

The economic experience of the last 8 years has not been that of the 1930s but it shares some characteristics. The depth of economic distress has not been as great (for instance it took until the 1940s for British GDP to return to pre-1929 levels) and the burden has fallen more on living standards than unemployment.  There are similarities, however, in the sense of sustained period of economic stagnation and uncertainty mirrored across much of the western world and reflected as well in the policies of austerity in respect of public spending.  This has had its impact on society and on politics with the rise of extremist politicians and parties across Europe.

That of course was the other shadow of the 1930s, the decline of democracy and the rise of fascism across Europe. In the 1920s the large majority of European countries were democracies but by 1939 democracy survived in only a handful.  This is a phenomenon which, at 80 years remove, is still hard to understand but any understanding has to include the acceptance that significant numbers of ordinary people opened the path to the rise of extremist parties and that those parties, when in Government, were sustained not only by force and the fear of force but a good measure of public support. Again we are not in the 1930s but current political history shows worrying signs of the politics of anger and anxiety on which extremism thrives.

The final similarity is the weakening of international institutions and a growing tendency towards isolationism. The League of Nations, a well-intentioned attempt to prevent the horrors of the First World War ever happening again, was perhaps never fit for purpose, especially once America retreated into isolationism.  However in the 1920s there were some successes in resolving international tensions, in particular in helping Germany reintegrate into the international community.  By the 1930s however all semblance of authority in international institutions had disappeared and until the very end of the decade there was no counter to the rise and increasing aggression of the Nazis.  Europe again staggered towards a conflict in which millions died and much of its cultural identity was torn apart.  For much of the decade a dark cloud lay of the continent which its inhabitants were powerless to counter.  This sense of gathering gloom is captured so powerfully in Patrick Leigh Fermor’s accounts (“Between the Woods and the Water” and “A Time of Gifts”) of the journey he made from the Hook of Holland to Istanbul in the early 1930s. There is a scene where he visits a Jewish community in the Carpathian Mountains proudly maintaining the beliefs and rituals of their ancestors which has such a rich poignancy in the light of the events which were shortly to follow.

The 1930s were not a period of unmitigated hopelessness. There were idealists such as the young men who went off to fight Franco in the Spanish Civil War, a story described In George Orwell’s “Homage to  Catalonia” or Laurie Lee’s “As I Walked out One Midsummer’s Morning”.  Brave men such as Nicholas Winton put themselves at risk to save hundreds of Jewish children at risk as the Germans seized control of Czechoslovakia.

It was also a time of solidarity.  My father’s memories of the Rhondda in the 1930s were of economic hardship tempered by a phenomenal sense of community.  Despite the widespread poverty subscriptions from those miners in work provided access to a network of libraries and healthcare.  In the USA FDR’s New Deal managed to create a sense of hope to a country traumatised by the Depression even if it took the War to restore fully economic prosperity.

It is a good thing to reflect on the past. From the 1930s there are powerful lessons about the insidious strains which times of economic hardship can place on the bonds within and between societies. It is easy, at such times, to resort to anger and to find scapegoats for what has happened.  However such responses are not the solution to our difficulties.  They lie in values of hope and respect for common and shared interest.  The bigger the threat the more we need to stick together.

The wonderful Anthony Trollope

BXD7PG Anthony Trollope (1815-1882) English Novelist. Portrait Albumen Print c1880. Image shot 1880. Exact date unknown.

If you asked the question who was the greatest Victorian novelist the standard answer would probably be Charles Dickens or George Elliott. I would rest a case, however, that the prize should go to Anthony Trollope, a literary favourite of mine since, following some excellent television adaptations in the 1970s, I first read one of his novels. This year I decided to return to his work and, once again, have not been disappointed.

Trollope writes about two subjects: Love and Politics (with both a large and small P).  He sees both subjects through the lenses of class and wealth which were so fundamental to Victorian lives including his own.  This is middle class literature.  Trollope does not have the interest in wider social issues in the way in which Dickens does.  That may, in part, account for why he has somewhat faded from view in modern times.  Nonetheless, Trollope is writer of deep psychological insight who has much to tell us about universal aspects of the human condition as well illuminating in detail the anxieties and foibles of his own age.

Trollope was a prolific writer but is probably best known for two series of novels he wrote across the 1860s and 1870s: the Barchester Chronicles, at the centre of which are the clerical intrigues of the Barchester diocese(inspired by Salisbury), its weak Bishop and his authoritarian and scheming wife Mrs Proudie, and the Palliser novels which are acted out on the stage of national politics and in particular of Whig and Liberal politicians including the eponymous Plantagenet Palliser and the young Irish hero of two of the novels Phineas Finn. Both series cover a network of stories and characters which appear and reappear across different novels.

Trollope’s own life is an interesting one and he wrote an accessible and entertaining autobiography which is still available today. He was born to a privileged family but his father made a total hash of his career and the family’s finances.  The young Trollope suffered from the family’s lack of resources, was very unhappy at the schools he attended, thought about taking his own life and consoled himself by living in imaginary worlds of his own creation.  His mother Fanny, was a larger than life figure who herself became a writer.  The family had to live abroad for a period in the 1830s to escape their debts.

Trollope, in the end, became an official at the Post Office. For a while that was n’t successful but a stint of a duty in Ireland made his name and in time he rose to a fairly senior position.  Amongst his achievements at the Post Office is reputedly the invention of the pillar box.

In Ireland Trollope started to write. His autobiography describes his routine, rising very early to pen several thousand words each day before attending to his day job.  The Barchester novels established his reputation and by 1867 he had made enough money from his writing to be able to resign from the Post Office.

Trollope’s writing is liked a well baked Victoria Sponge, well-formed and delicious but also light and easy to digest and peppered with humour. His characters, even those, such as Mr Quintus Slide the unscrupulous editor of the People’s Banner, who are written with a touch a stereotype and caricature, are plausible and compelling.  Trollope’s heroes and heroines are attractive and likeable but never perfect, their very human faults, adding to the psychological realism of his stories.  In the same way we are usually left with some sympathy for the bad guys.

Trollope’s writing focuses on people and conversations and these are the drivers of his plots. While he uses many different locations for his stories they are not drawn into his narratives in the same was as in Dickens novels where place as well as people shape the flow and impact of the stories.

Trollope does politics well. He understands politicians and the mixture of personal gain and public service which then, and still to this day, motivates them to seek to enter Parliament and gain office.  This was an ambition which Trollope himself shared.  When he comments on one of his character “It is the highest and most legitimate pride of an Englishman to have the letters MP written after his name” the author is reflecting his own view.  Trollope stood, as a Liberal for the seat of Beverley but lost in an election bedevilled with corruption.

Then there is hunting. Trollope was an inveterate fox hunter and cannot resist including a number of fox hunting scenes in his novels.  Despite my modern day disapproval of fox hunting I cannot fail to be drawn, by Trollope’s compelling descriptions, into a genuine sense of the excitement of a good run.

The last thing about Trollope’s writing is a warm and engaging sense of optimism. He is an author, who despite some of the unhappiness in his own life, strains to see the best in life, in love and in his fellow mankind. With some of the gloominess in the world at present that’s not a bad world to escape to.

 

 

America

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Last month we visited New York, where our son is studying this year, and made a return trip to Boston, where 18 years ago we lived for a couple of months when I too had the chance to study in the US. Apart from the temperature (which at one time reached minus 22), it was a very enjoyable trip.  It made me think again, however, about America, its current position in the world and the influence it has in shaping modern western culture.

I have always liked America more when I have visited and lived there than I do back home where I have always been resentful of its hegemony and the undue control it has appeared to have over increasingly large domains of our own lives and thinking. That difference of view is fuelled by an appreciation of how more diverse the real America is than the pastiche of the country we see through Hollywood, of how beautiful its landscapes are and of how engaging many of its inhabitants are.

That contrast between the real county and our of image of that country is probably true for many other places but it is inevitably more marked for America because we are so exposed to images and messages from that country in our media and in other aspects of daily life. We have absorbed vast amounts of American idiom into our language, we have adopted American festivals (or at least American ways of celebrating our own festivals), and we eat cookies and muffins, drink American drinks and even have started importing America’s idiosyncratic sporting traditions.

And yet, despite this, when we go there it can still feel strange. Despite the amount of American media we consume, Winston Churchill’s dictum “Two countries divided by a common language” still remains true.  So we caught a train on “track 3”, we took our coats to the “coatroom”, we travelled on the “subway”.  Nothing incomprehensible but clear signs that, despite much familiarity, America is still a different place.

As you walk around New York, visit the Met and other wonderful Museums, admire the skyline (there is still nowhere else on earth for the density and style of its high rise buildings) it is not difficult to be impressed by America. Nor is it hard to be impressed by the sense of self-reliance of its inhabitants and the belief that each person holds their own destiny in their own hands.  It is not hard to be impressed by the role which charity plays in American life and the commitment which many Americans (rich and poor) are prepared to make, in the absence of state support, to ensure the success of communal activities.  And while it is not possible to overgeneralise about any nation, this is, on the whole a friendly and welcoming country.

There are, of course, things to be less impressed about America. More than on previous trips I was very visibly struck by the run down nature of much American public infrastructure.  Compared to London and many other British cities, public facilities in the US such as trains, stations, airports look much shabbier , a hall mark of years of underinvestment, not, I suppose, because that investment can’t be afforded but because the deep distrust of Government makes it the wrong thing to do.

Then there are the things about America which someone from a liberal European background such as mine finds impossible to understand. How a country can suffer a level of gun inflicted violence on the scale which has been the case in the US and not find in itself the collective will to introduce a measure of gun control?  How a country as rich as America cannot introduce a measure of universal access to healthcare?  I can remember for the 3 months we lived in the US having only basic health insurance and imagining, for the one and only time in my life, what it would be like if I or my family needed major healthcare and how we would pay for it.

As the current Presidential election campaign demonstrates, America is in a major period of flux, its position as the leading power of the world challenged by the emergence of China and India as leading economic powers and by the nature (post 9/11) of external threats which are not in its power to control as it has controlled other events in the past. Donald Trump’s slogan “Make America great again” appears to chime with a fear in many sections of American society that America may no longer be the self-assured and prosperous country it once was.  That is probably true of many places, Europe included, but there is something about the immediate past in America which makes that angst all the more stark.

So where do we go for the future? America, even if in decline, will remain a major shaper of the world we live in and our relationship with it will be crucial. There is much to learn from America and the American experience but we also must be aware of and proud of our differences and confident in values and institutions such as the BBC and the NHS which do not find favour in all parts of American thinking.  Our relationship with America is also an important part of our relationship with Europe.  Strong relationships with both are in our interests.

The American story was the dominant narrative of the second half of the 20thcentury.  We are all realising we need something different to navigate the complexity and challenges of the 21st.

 

The Taskforce report is a great start but this time we have got to be serious about change

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The recent Mental Health Taskforce report presents a clear and compelling picture of what we still need to do to deliver the right support for the one in four people in this country who, in their lifetime, will be affected by mental health problems. While there wasn’t much in the analysis which was particularly new, it powerfully made the case for change backed up by the voice of 20,000 people with lived experience of mental health problems who contributed to its work.  Paul Farmer and colleagues on the Taskforce deserve a big of vote of thanks for what they have achieved, in particular in helping to secure a commitment of an additional £1 billion of funding over the next 5 years.

But where do we go next and how confident can we be that this will be genuinely be the start of a new dawn for mental health care in this country. Those are slightly harder questions to answer.  As I have often said over the last couple of years these are is both the best and worst of times for mental health.  There is a genuine sea change taking place in public attitudes, encouraged in part by programmes such as Time for Change.  Senior politicians have been falling over themselves to stake some ownership of an issue which matters to so many people.  At the same, as the Taskforce rightly highlight, demand for services is increasing and resources in many key services are being cut back.  So far, in the round, we have scarcely scratched the surface in addressing the historic underfunding of mental health care and delivering a genuine parity of esteem between mental and physical health.

There are a number of things which have got to happen if, this time, we are to be really serious about change. The first is the money.  Let’s be clear to start with, £1 billion, however welcome as a start, is not the sum total of what is required to put mental and physical health on an equal footing.  In what is still the most authoritative statement on the issue, the LSE’s 2012 report on “How Mental Health Loses out in the NHS” made the case that, while representing 23% of the demand, mental health services received only 13% of the funding.  To close that gap we are talking about £10 billion additional funding.  However long it takes it must be the explicit objective to reach a genuine parity of funding.

Behind the financial numbers lie literally millions of individuals for who, we as the NHS, are currently unable to provide any help. The same LSE report highlighted 6 million people with depression and anxiety and 700,000 young people who are unable to access to treatment.  No similar treatment gap exists for any major physical condition.

This said, the £1 billion additional funding is welcome, and it is particularly welcome when the overall pressures on NHS and other public resources are so great. However it is to be the catalyst for change there has got to be clear transparency about how the additional funding reaches the front line.  There has been a difficult recent history of the mismatch between national funding promises and decisions by local funding bodies.  One of the most shocking statistics highlighted by the Taskforce is the variation in local funding and it is crucial that the Taskforce’s recommendation on establishing clear reporting of mental health investment is followed through.

Clearly the backdrop to the debate about mental health investment will be the current crisis in the finances of the acute sector which has attracted some much attention in the last couple of weeks. There is already evidence of the needs of stabilising hospital finances being prioritised ahead of much needed investment in mental health, primary and community services.   There is a real tragedy here.  We all want good quality and financially stable hospitals but the route to managing the pressures on hospitals fundamentally lies in strengthening out of hospital services.  While we fail to invest in those services any efforts to stabilise the acute sector will inevitably have the nature of a sticking plaster. There is a particular point about mental health with estimates of at least £8 billion and may be as high as £13 billion additional annual costs linked to untreated co-morbid mental health conditions.  This was an area which secured a helpful focus in the Taskforce report and it highlights that fair funding for mental health is not just a matter for mental health services.  It is fundamental to the future sustainability of the whole NHS.

The last point I want to comment on is leadership. If the vision set out by the Taskforce is to become a reality it will need determined leadership at all levels of the system.   NHS England and other Arm Length Bodies will need to give more priority to this issue in how they allocate their own resources and effort.  It will need priority to be given by Commissioners, however many other pressures they face.  It will need leadership, creativity and determination from providers.  The success of this endeavour must not be up for negotiation or just a nice to have if we’ve sorted all the other issues.  The stakes in terms of broken lives, lost opportunities and the very future of the NHS are too high.

It is been good to see engagement from the very highest levels on this issue and, for the first time, seeing the Prime Minister making a speech on mental health. He has rightly commented on the need to end the stigma relating to mental health.  However it also must be the time where we stop stigmatising people with mental health problems, not just with our words, but also with our actions and the decisions we make about spending the nation’s resources.

 

 

In praise of the Six Nations

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With the start of the 6 Nations this has got to be one of my favourite weekends of the year.

The first of 5 weekends during which all other social and professional responsibilities take second place to the duty of watching the rugby, the time when, each year, the dreams of a Triple Crown or even a Grand Slam can be safely nurtured. The tournament starts in the depth of winter but by its end we have reached spring.  The sense of anticipation of future pleasure is immense.

While the World Cup has yet again proved that our cousins in the Southern Hemisphere remain top of the rugby pile there is still something special about the 6 Nations. It is so much more than just a sporting contest, epitomising, as it does, the ancient rivalries in this land and with its immediate neighbours. However in allowing us to indulge those rivalries, the 6 Nations championship also expresses what unites us a community of nations.  A good game and a few beers cement friendships across national boundaries.

I first watched the then 5 Nations in 1971, a good year for a budding Welsh rugby fan as the team of Gareth Edwards, Barry John et al won the first of 3 Grand Slams in the 1970s.  In those days the only Welsh games one could watch in England were those against England (and as England didn’t have a game that day) Scotland.  For the other games it was necessary to wait for the highlights, a formulaic presentation I’ve never liked that much.  Rugby, I always feel doesn’t lend itself to highlights, you need to see the whole match to really get a sense of the struggle.  In any case if we had won they were too short and if we had lost they were far too long and painful.

Watching the tournament was, and still is, a great shared interest between my father and his three sons (even my mother has now become a supporter). Unable in those days to get any real tickets we relied on the “magic chairs” in our lounge to take us into the midst of the crowd at Cardiff, Twickenham or Murrayfield.   For 80 minutes, in an early experience of male bonding, we might as well have been there in the flesh for the level of intensity there was in the room.

In later years we have had the chance to see the games live and to make our visits to the various rugby temples in Edinburgh, Paris, Dublin and latterly Rome. These trips have always been very special occasions.  There is something about spotting the first red shirt at the airport or train station, about joining the sea of supporters emptying out of bars on their way to the stadium, the anthems, the Paris bar erupting into Calon Lan, the cultural activities planned for the Sunday despite the scale of the hangover one was nursing, the buying of the present to secure permission for the following year’s trip.

Pilgrimage is probably the word I would use to best describe the experience. While rivalries are great and passion for your team ever present, the tournament also represents a lovely culture of mutual respect between nations and between supporters.  The 6 Nations is a community of interest, something we all share and something which, without any of its participants, even the English, would be seriously lessened.  There is always a welcome for travelling supporters who, unlike the case of football, mingle freely in the stadium and in bars before and after the game.   In the smaller cities such as Edinburgh, Dublin and Cardiff, 6 Nations’ games take over the city for the day and even in the bigger cities their impact is noticeable.

After the golden years of the 1970s Welsh rugby fortunes dipped and we spent nearly 30 years in the wilderness. For a while we continued to be able to beat England but, after a while, we couldn’t even do that.  It didn’t stop each year, however, a sense of awakened optimism on the first weekend of the tournament and a belief that this might be the year where Welsh fortunes would be restored.  Usually the end of the first game had put pay to those ambitions but hope never died and in 2005, probably my favourite of all the 6 Nations I have watched, was eventually vindicated.

So let’s raise a glass to the one of the world’s best sporting events and to the community of nations who make up the 6 Nations. It may not always be the best rugby in the world but it is certainly a very legitimate cause for excitement and optimism on a grey and windy February morning.

 

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