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The war which should have ended all wars

 

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There is something very portentous about the anniversary of the Armistice which ended the Great War at the eleventh hour of the eleventh day of the eleventh month, a hundred years ago  in 1918. Few wars have been as much remembered and it is the First World War which has given us the modern rituals of remembrance: the poppy, the cenotaph, the two minute silence, the war memorial and Remembrance Day itself. There is much to remember and the aim of this blog is to provide some arguments for why.

I have always been interested in the Great War, partly because it is big history, partly because it was a major historical event which, through a number of family members, I had a direct connection.  Over the last couple of years I have been able to extend my reading and gain some fresh insights into the conflict.

There were and still are various narratives about the War and what it achieved. Some see it as a pointless loss of young life, others make a case for the importance of of their issues over which the war was fought and the consequences that might have happened if Britain and other nations hadn’t gone to war.

As ever the reality is more complex but I want to discuss a number of historical lessons which all have significance today.

This starts with the  mass hysteria which carried Europe to war in 1914. Much is made in discussing the start of the War about diplomatic failings and the inflexibility of railway timetables. Those things are important but what strikes me more than anything about the events of 1914 is a sense that the people of Europe and, in particular, its young men wanted to go to war. Accounts and images (including the famous one from Munich which captures the face of the young Adolf Hitler) from all over Europe show almost a sense of relief at the coming of conflict and a nostalgic revelry in the idea of young men leaving the drab reality of industrial or bureaucratic drudgery to return to the heroic world of being a soldier.  It strikes me that with that groundswell of public opinion there was little politicians could do to argue against the idea of going to war.

There has been something of the same sense of hysteria in some contemporary developments here and in the US. Such developments are hard to check but they need brave people to speak up against them and they need politicians prepared to try to contain them rather than stoke them for their own political ends.

The First World War was also characterised by a fundamental shift in the nature of war. Despite the precedents set 50 years earlier in the American Cicil War the nature of the conflict unleashed in 1914 seemed to have taken most generals and politicians by surprise. The adage that it will all be over by Christmas was widespread and, in Britain, Kitchener was a fairly lone voice in seeing the inevitability of a long conflict with the resulting need for a massive military recruitment. Throughout the war despite the reality of the trenches Generals continued to hanker after the use of cavalry.

The mechanisation of warfare was at the heart of this with its resulting massive destructive power and merciless greed for human life. In the Napoleonic Wars 10 lives were lost in every hour of the fighting. This had risen to 230 in the Great War.

Yet despite this it was a war where the behaviour of most generals (there were exceptions such as Petain in France) was marked by optimism bias. While tactics did evolve through the War Generals such as Douglas Haig committed time after time to a belief in the “Great Push” and the ability of human courage to prevail over barbed wire, heavily fortified positions and murderous machine gun fire.

This links to the influence of lived experience. For soldiers such as Siegfried Sassoon there was an unbearable distance between the experiences of soldiers at the Front and the opinions of those driving the War at home. Although the First World War was, at the time, the most photographed conflict in history and pioneered new approaches such as Geoffrey Malins’ filming of the explosion of the mine at Beaumont Hamel on the first day of the Battle of the Somme, this was a different age and news from the Front was still heavily censored.

We now have the graphic accounts of the war poets and hundreds of others who entrusted their experiences of the battlefields to writing. What if some of those accounts had been widely available in real time?

The final reflection rests on the need to win the Peace. We now know, with hindsight, the way in which the humiliation of 1918 and the harshness of the Versailles Treat contributed to the Second World War less than a generation later.  The failure of the League of Nations is also a grim reminder to us of what might happen when nations withdraw from the institutions and spirit of international collaboration.

In many ways World War One should have been the war to end all wars. It wasn’t but it is important we don’t let its remembrance pass without reflecting as deeply as we can on which of its lessons we can most draw on in looking at the challenges of our own age.

On the centenary of Armistice Day we rightly remember the sacrifice of those who gave their lives in conflict. However let’s also remember those things which are most likely to prevent conflict in the future.

 

 

 

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Anthems to doomed youth

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This Sunday (4th November) it is 100 years since the death of Wilfred Owen, perhaps the most brilliant of that group of soldiers who committed to poetry their experiences of the First World War.

Owen died but a week before the ending of hostilities in a brave attack on the Sambre-Oise canal. There are no eye witness accounts of his death and he is buried in the corner of the cemetery at Ors.   In the intervening century he has become the embodiment of First World War poetry and many more British schoolchildren will be familiar with his poem “Dulce et Decorum est” than would be with the Latin quotation from Horace after which the poem is named and which was staple fare for pupils of Owen’s own generation.

Owen, while the most familiar name, was one of many outstanding poets from this generation of doomed youth. Some like Owen, Siegfried Sassoon and Robert Graves knew each other and encouraged each others’ work.    They came from many different backgrounds but lived in an era where poetry had an acknowledged currency as a mode of expression.  Few, perhaps with the exception of Rupert Brooks, author of the famous line “That there’s a corner of some foreign field which is forever England” acquired fame at the time but they now define our understanding of the Great War.

I’ver been familiar with First World War poetry since my own schooldays but in recent years have had the chance to broaden my reading. When I toured the Western Front on my bike in 2016, I included a volume of First World War poetry in my luggage as a psychological guide to the landscape I was about to visit.

So what is the essence of First World War poetry and why is it so special? I wanted to share in this blog a few thoughts.

The first objective of many of the poems is to give expression to some of the intense experiences and feelings which the poets were going or had gone through.  While there is some wonderful prose writing from the period, it takes the intensity of poetry and its language and imagery to do justice to some of what soldiers in the trenchs were going through.

Take Owen’s own description of a gas attack in “Dulce et Decorum est”:

Gas! GAS! Quick, boys! – an ecstasy of fumbling

Fitting the clumsy helmets just in time,

But someone still was yelling out and stumbling

And flound’ring like a man in fire or lime

Some of the urge to write is also an attempt to process unbearable feelings and it is striking that a number of  War Poets, including Owen, were treated for shell shock. In one case, that of the Gloucestershire poet, Ivor Gurney, the war left a lifelong history of mental illness.

The second feature of War Poetry is to portray a realistic view of the war, in contrast to that portrayed through the newspapers or official communications. It is that spirit in the poems which has often most captured the imagination of readers. For the most part the soldier poets were not pacificists. They fought as bravely as anyone and many such as Owen, Edward Thomas and the Welsh poet Hedd Wyn were killed in the fighting, often avoiding the opportunity for the chance  to escape the front line by taking on, for instance, a training assignment. This perspective is summed up by Edward Thomas’ poem “This is no case of petty right or wrong” which, while rejecting jingoism, is filled with a deep sense of patriotism, grounded in Thomas’ love of the English (and Welsh) countryside and life.

By contrast there is hardly a word, in any of the poetry I have read, of hatred for the enemy. Indeed in a number of poems there is a recognition that the horrific experience of the War is something which soldiers on both sides are experiencing.  There is lovely poem by Ivor Gurney “Serenade” which captures the moment when the sound of Schubert on a gramophone in the German trenches connects the two sides for a minute. More hauntingly, Owen’s poem “Strange Meeting” describes the tormenting image of a German soldier whose life he, himself, has taken.

Some of the most moving poems are those which mark the intense bonds between fellow soldiers, including the feelings which officers will have for the men under their charge.  Nowhere is this captured more intensely than “In Memoriam Private D Sutherland” by EA Mackintosh which so poignantly marks the deaths of the young men in his command as if the poet was a second father to them.

You were only David’s father

But I had fifty sons

When we went up in the evening

Under the arch of the guns

And we came back at twilight –

O God! I heard them call

To me for help and pity

That could not help at all.

It was Horace again who pointed to his poetry as his everlasting monument.  Little could be more true of the poetry of the First World War and the amazing descriptions they have left of one of the most horrific conflicts in human history.

 

 

 

 

 

 

 

What’s in a plan?

 

 

 

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As a historian working in the NHS I always think we don’t spend enough time looking at the past in deciding how best to develop our plans for the future. I was therefore delighted to read, last week, the Nuffield Trust’s excellent publication Doomed to repeat? Lessons from the history of NHS reform which set out the stark lessons of what we have consistently failed to address in the last 30 years of NHS plans and reforms. As well as the disturbing experience of seeing my working life suddenly pass before my eyes in the two-page summary of previous reforms, I was struck by a familiar litany of issues: not enough public engagement, forgetting about workforce until too late, putting too much trust in reorganisation, optimism bias, misreading the unintended consequences of financial incentives. There are many ways in which the NHS is better than it was 30 years ago, but I couldn’t help being left with a sense of how little that had to do with many of the top down initiatives.

I am not trying to wash my hands entirely of having any part of this state of affairs. I have spent a considerable amount of my career in, or working with, central Government and have contributed, in my time, to the writing of many top down plans and reforms. One always produces them with the best of intentions and sometimes central actions do achieve some good. However, while it is sometimes quite possible to see the problems from the centre, it is much harder to design and ensure the delivery of effective action to address them.

So, what are my hopes of the forthcoming 10 Year Plan? I have four.

First for a message of continuity in where we are trying to get to. The underlying “sense of direction” of the 5 Year Forward view towards a more integrated and population focused system of care still strikes me as the right one. We have a long way still to go to realise that vision, but we have done a lot to bring our organisations, services and staff round to that way of thinking. While, inevitably, there will be some changes in tactics and terminology we need to continue in the same direction.

Second is for a sense of realism about how quickly we can move and what will be possible within the resources which have been made available. While I am grateful for the size of the settlement the NHS received there needs to be a sense of honesty that the figures being made available are at the lower end of what expert commentators thought was necessary. There is limited scope for doing new stuff and while everyone must remain committed to the need for efficiency we must accept that heroic assumptions about what can be achieved in terms of efficiency gains, even if we are successful in developing more integrated care, are unhelpful. As part of this I think there needs to be some public realism, which politicians must support, about what will be possible and a recognition that some areas of care will not be able to develop or expand.  As society I think, we need to have, for instance, a much more open debate about what should be provided at the end of life.

My third point and the corollary of realism is a clear sense of priorities. There are three which stand out for me: the long term commitment to addressing parity of esteem for mental health (for which yesterday’s report by the IPPR Fair Funding for Mental Health set out the implications); the systematic strengthening community, primary and care services and investment, of focus and resources, on prevention. These for me are all 10-year priorities but as with the closure of the long stay hospitals a systematic focus on these areas will deliver the transformation in our health and care system we desire.

Finally, my hope is that the plan will recognise the crucial role of NHS staff in delivering change and that it will put their welfare at the centre, in a genuine way, in the centre of things. This is see workforce not just in terms of numbers but crucially in terms of the values and commitment of staff which sit at the centre of good quality, empathetic care. Despite technological change the NHS in 2030 needs to be more rather than less of a human institution than it is now.

We will have to see if those hopes are realised. My sense is that the political nature of the NHS will inevitably mean that we will have another plan or set of reforms before the next 10 years are out. However, let’s hope that this one learns some of the lessons of the past.

 

 

 

 

 

Universal Credit a wakeup call to take poverty seriously

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I am both frustrated and pleased to see the issues around Universal Credit as headline news.

Frustrated that we have to go so far before significant issues of this kind which affect some of the most vulnerable individuals and families in the land get taken seriously. Pleased because it offers a chance to mobilise opinion in favour of action and to initiate a wider debate about poverty in the UK.

I have now been a Trustee of the Joseph Rowntree Foundation (JRF) for over a year and have been excited to be involved in the work of the organisation in making the case for reducing poverty. The need for a strong voice on these issues has never been greater as the data suggests that after years of austerity the incidence of poverty in the UK, in particular, amongst working age families with children is growing again. Certain groups, especially lone parents and disabled people and families including a disabled person, are most affected. As an illustration 30% of families with a disabled member are in poverty compared to an average of 19% of families.

The issues around Universal Credit go to the heart of the argument of what needs to change if we are to reverse these trends and hinge around two keep planks of JRF’s approach: the need for people to find a way out of poverty through work and the need for a social security system which helps and keeps people out of poverty.

For someone entering work in the 1980s, and brought up hearing the experience of my father growing up in South Wales in the 1930s, the natural instinct is to see unemployment as the great driver of poverty. Yet today with record levels of employment we have a major issue of growing levels of poverty amongst working adults with an increase in the three years to 2016/7 of more than a million in the number of people living in poverty in working families.

Some of this is a function of expenditure pressures and, in particular housing costs, but it also reflects the hollowing out of the labour market and the lack of opportunity, especially for workers with limited skills and for those, such as lone parents, carers and disabled people, with the least flexibility in the labour market.

There are no easy answers to this problem which is far from unique to the UK. Properly resourced system of skills-based education which is properly owned by employers would seem to be one essential ingredient. The NHS, as the largest and one of the most evenly distributed employer in the land, would be one place to start where investment in developing a broader based clinical workforce with less artificial barriers for advancement might offer real benefits.

One of the other things I have learnt in my time with JRF is that the social security system rather than being seen as a bottomless drag on the public finances can be used in a very proactive way to tackle poverty. During the years of the last Labour Government there are clear examples of how key areas of poverty, for instance amongst pensioners and children, reduced as a result of specific targeting of resources on particular groups. It could be argued that this was easier to do at a time when resources were more plentiful but by the same token the impact of austerity has been unduly felt by those of working age benefits and disabled people. It is no surprise therefore to see this play out in the statistics on poverty.

These issues need political will if they are to be addressed. That will require a recognition from voters that the costs of tackling poverty will need to come ahead of middle class benefits such as tax cuts or the abolition of student loans. It will also require a genuine identification with the experience of people in poverty, not just as numbers on a chart, but as lives which are blighted by the practical, physical and psychological consequences of poverty. When, rightly, we are becoming more concerned about poor mental health in our society, especially amongst young people, then we need to acknowledge the greater incidence of mental health problems amongst people in poverty and the corrosive impact which poverty and the anxiety it induces has on producing poor mental health.

All of this takes me back to Universal Credit. Given the issues above I do not, personally, have a major issue with designing a system which creates the best incentives for individuals to move from benefits into work. The lack of flexibility in the current system was certainly a major problem for many people with mental illness I worked with at Rethink Mental Illness who wanted to start work as part of their recovery but who were often penalised, financially, if they did so.

However, what does matter is how things are done and the level of investment which is made to make sure the system works in the way in which it was intended. There is no doubt that Universal Credit has been stripped back in the interests of making savings which, when combined with other factors, will put thousands of families of risk of falling into or further into poverty. The restoration of the Work Allowance which helps families maximise the additional income they secure when they move into work is crucial.

With Brexit, there is so much to distract us this is the kind of issue on which it is crucial there is a clear message about where our priorities as a society lie. We need to have a social security system which supports people to move out of and stay out of poverty. That is all of our business.

Upon a peak in Darien – discovering afresh the wonder of Homer’s Iliad

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I have written before in this blog about Homer’s Iliad. I’ve been familiar with the story since I was at primary school and have been lucky enough to have had the chance to read it in the original Greek. I am of the opinion that it is not only one of the earliest works of literature but also one of, if not, the greatest. However, despite that I hadn’t come across the translation by George Chapman, published in 1611. I read it when on holiday in the summer and it was if I had come across Homer for the first time, seeing it with a new brightness and insight which I hadn’t seen before.

I shared this experience with John Keats who wrote a beautiful poem to celebrate his discovery of Chapman’s translation.

“Oft of one wide expanse had I been told
That deep-browed Homer ruled as his demesne;
Yet did I never breathe its pure serene
Till I heard Chapman speak out loud and bold:
Then felt I like some watcher of the skies
When a new planet swims into his ken;
Or like stout Cortez when with eagle eyes
He star’d at the Pacific — and all his men
Look’d at each other with a wild surmise —
Silent, upon a peak in Darien.”

Keats’ images of a unique discovery, such as that of a new planet or the explorer Cortez and his men seeing the Pacific Ocean for the first time are rather bold but I did not think overstated, a tribute both to the power of the original but also to Chapman’s dramatic translation of the poem into the compelling and resonant English of Shakespeare and the King James’ Bible.

Homer’s story gets to the very heart of the human condition. How do we face up to our own mortality and what meaning do we give to our lives as a result? These are the dilemmas faced by the Greek and Trojan heroes who are the centre of the Iliad, and, in particular, the Greek Achilles whose bitter anger starts the story and the Trojan Hector whose funeral finishes it.

Chapman’s translation is respectful of Homer’s original but is not totally bound by it. What he does achieve is to bring out in stark clarity the tragic drama of the story and its principal protagonists.

It also heightens Homer’s realistic and horrific description of war and conflict. It has struck me, over the last four years, as we have been marking the centenary of the First World War, how much the Trojan War, so familiar to many who fought in the Great War, seems to the battles of the Western Front. There is the same air of fatality combined with moments of boldness and death-defying bravery, the same brutality in the scenes of death and destruction, the same loyalty to comrades and wild instinctive commitment to protect or revenge. While the key characters in the Iliad are princes there are also many descriptions of more ordinary soldiers meeting their ends such as Axylus, renowned at home for his hospitality but whose generosity was of no use in warding off his death.

Chapman’s translation also brings out well the role of the Gods in determining the outcomes of the conflict. It is possible to see this in a too literal sense but, for me, it captures the very real sense in all human activities of what is in our direct control and the impact of chance and luck on what turns out. It is a reminder of the need, understood by Homer’s characters and all too readily forgotten by or own generation, for humility in our thinking and actions.

The Iliad has many brilliant moments but there are two that stand out, both brought relayed powerfully through Chapman’s translation.

The first is the description of the death of Hector, the Trojan prince. If there is a good guy in the Iliad, it is Hector, something which Chapman’s translation recognises perhaps even more than Homer himself. Strong and courageous, and intrinsically decent, he represents the main hope of survival of the city of Troy. He has led the Trojans to some measure of success while Achilles is absent form the battle and has killed Patroclus, Achilles’ companion. In the end, despite the love which both men and gods bear him, he has to face his death. Strong though he is, he is not strong enough to beat Achilles. As his parents and others watch he is chased three times round the walls of the city. Finally, knowing his fate but showing the ultimate bravery in facing it, he stops.

But when they reacht the fourth time the two founts
Then Jove his golden skiles with’d up and tooke the last accounts
Of Fate for Hector

His consolation is that, while Achilles can take his life, he can not take away his reputation which will resound through the generations.

But Fate now conquers; I am hers. And yet not she shall share
In my renowne; that life is left to every noble spirit

The second is in the last book of the Iliad when Priam, Hector’s father is guided in disguise to the tent of Achilles to beg back the body of his son for burial. In a scene of the most profound poignancy Achilles’s anger melts and he takes pity on his foe. In doing so he recognises the universality of human suffering saying to Priam.

Sit and settle we our woes, though huge, for nothing profits it.
Cold mourning wastes but our lives heates. The gods have destinate
That wretched mortals must live sad.

Priam returns with Hector’s corpse to the city and with his funeral the story finishes, a story of the human condition relevant in 2018, as it was in the dark days of the First World War, as it was when it was first told nearly 3000 years ago.

Technology – can it be the magic bullet for the NHS?

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It seems clear that Matt Hancock has chosen technology as the big idea to mark his tenure as Secretary of State for Health and Social Care. There are good reasons for doing so. There is no doubt about the transformatory nature of modern technology and the health and care sector has been slow in adopting its potential.

Twenty years ago, I was very privileged to have a job leading the implementation of NHS Direct, a service which was a genuine exemplar in the use of technology in the delivery of healthcare. While technology has developed enormously since then, many of the fundamental challenges around the effective use of technology, remain, in my book, the same. I wanted to use this blog to reflect on some of those issues.

Technology can have enormous benefits in improving the quality and cost effectiveness of healthcare. Four things stand out.

First good technology can improve the safety of healthcare by providing clinicians with point of contact information about a patient’s individual history and condition and the best evidence on how to treat it. In addition, when things do go wrong, it can provide a much stronger basis for determining what happened.

Second technology can promote access and facilitate the best use of clinical time, in particular of specialist clinical staff, by reducing the need for travel time and of, some groups of patients, reducing some of the barriers to accessing care.

Third digital applications open the potential to involve patients proactively in their care by supporting self-monitoring and self-care and facilitating peer support. As various approaches in mental health have demonstrated intelligent remote monitoring can help make the best use of clinical capacity, targeting resources on those in immediate need rather than tying up time in routine appointments.

Finally, there is enormous potential in the data generated through the use of technology to help improve care, better target resources and support research into future treatments.

While developments in Artificial Intelligence have perhaps extended the range of possibilities the basic parameters of what technology can offer are very familiar from what I encountered when working on NHS Direct. The bigger question is not what is on offer but what are the challenges in realising those benefits and where are the potential risks in how this is done.

There are again four key questions.

To start with how we are sure that technology is addressing the current need for healthcare rather than just stimulating an additional level of demand? This was always a dilemma for NHS Direct and the challenge is all the more acute in times of more straitened resource. Technology can make it easy to improve access but that will be counterproductive if it generates additional downstream demand which the system is not resourced to deliver. An exception might be if we can target interventions on areas where late identification of symptoms has a negative impact on patient outcomes or costs.

The second question relates to the implications for staff of technologically driven change to their working practices and lives. As anyone who has been engaged in a technology project knows, the technology is the easy part, it’s the people bits where all the real challenges rest. If we are serious about technology driven change we need to invest heavily in staff training and in the effective redesign of care pathways in ways which seamlessly incorporate technology. In doing so we need to be open the very real anxieties which staff have about the impact of technology on their jobs, in particular in relation to issues of control, and, just as importantly, their professional worth. I was always struck by the extent to which GPs felt threatened by the introduction of a nurse led service in NHS Direct.

A third consideration must be the issue of digital inequalities. This can, at times, be overplayed and for some groups, for instance young people, digital applications can offer better ways of connecting with populations the NHS struggles to reach through old fashioned means. (It staggers me, for instance, in 2018 that the NHS still uses snail mail as its predominant means of communication with its younger patients). The trap to be avoided is to take a one size fits all to digital development which sees the world sole through the lens of the middle aged, middle class smart phone user. As a universal service the NHS also needs to keep open a variety of channels and approach based on “clicks and mortar” must be on offer.

The final question relates to where to ownership of digital developments best sits. As with all structural issues the NHS has oscillated between centralism and localism. The National Programme for IT has cast a long shadow and while to drive a certain measure of progress in digitising the NHS did so at the expense of disempowering local organisations, and front-line clinicians. Perhaps there is never a totally right answer but perhaps STPs or ICSs provide a level where, for some issues, you can get the best balance between ownership which is so crucial to service transformation and economies of scale in relation both to cost, but just as importantly the management of resources and contracts.

It is one of those adages that we always overestimate how different the world might look in two years’ time but consistently underestimate the level of change ten years might bring. The current Secretary of State might not be around in ten years’ time but sure as anything technology should be central to the development of health and care.

In praise of Uncles

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This is a more personal blog than usual, prompted as it is by the fact that today, 23rd August, marks the 20th anniversary of the death my favourite Uncle, a lovely man who made a profound impact on my interests and development. As well as a personal tribute to one Uncle it is a chance to celebrate, more generally, the contribution of those significant individuals who, whether family members or others, can make such a difference to how we turn out.

My Uncle John, my mother’s older brother, was a very special man. He was the first member of our family to go to University, he was a war hero who survived being blown up in tank in Italy, he was cultured and well-travelled and a wonderful raconteur and conversationalist, a talented artist and amateur actor. He had that gift of brightening up any room he walked in and making fun and adventure out of the most mundane of situations. He was a man of principle who encouraged me to take an interest in public affairs. Despite all of that I remember him most as man who always had the time to take in an interest in what I and my brothers were doing.

We were lucky that I and my brothers were quite a lot younger than his children and that, as result, he and my aunt had the time to see us quite regularly. I have a special memory of when they joined us at Christmas time. He would contrive to create a wonderful set of Christmas party games, well beyond our own, somewhat Puritan traditions, which transformed the occasion. He is a man whom I have missed deeply ever since his death.

I have much to thank other significant individuals in my life. My grandparents, especially my grandmother, who I was able to spend so much time with as a child. My Welsh aunt who opened her home, each summer, to give our family a holiday and who helped cement my lifelong love of the land of my fathers; a number of teachers who took a special interest in my development and who encouraged me to expand my interests and to explore horizons beyond what was common place in my family; early bosses who backed my ability and gave me the chance to progress and to take opportunities which have been crucial to the success of my career.

While nothing can take away from the role of parents in my upbringing I have been immensely lucky to have access to that wider network of adults who have been able to offer me perspectives and opportunities which it was not in my parents’ gift to provide.

This story has a number of wider lessons. First it stresses for me the value of intergenerational relations and how much we, as individuals, can always learn and benefit from those with different life experiences than our own. We need to guard against the divisions in society which seem, increasingly, to be isolating us from those who are different from us or who hold different views. Some of this can play out across the generations and we need to guard against that. I have a number of good Indian friends and I have always liked the way they address as “uncle” individuals of an older generation with whom they have a close connection.

My second point relates to those without access to the same opportunities as I had. For those who have lost parents through death or separation or who in other ways have had traumatic childhoods, special individuals can be particularly important in helping someone overcome their difficulties. Some people have scarcely ever felt the benefit of someone taking an interest in their story or their development. I see every day in my work in mental health the crucial value of sustained therapeutic relationships in supporting recovery and the roles of peer workers and mentors are also enormously important in supporting individuals who have experienced difficulty. We need to think about this carefully in the way we design and invest in public services.

My third point relates to our own behaviour and what we do, beyond our formal responsibilities, to take an interest in the affairs of others. It can, of course, be very easy to be too busy to take the time to do so but the difference that is made by learning someone’s name and story and spending time, formally or informally, supporting and encouraging them on their journey is incalculable. After nearly 12 years as a Chief Executive I have realised that it is the most significant thing I do.

Twenty years ago, I raised a glass, with others, to the memory of a very special man. I do so again tonight, grateful for the contribution he made to my life and mindful of the example he set about in taking an interest in the lives of others.