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Nobody’s Perfect



The recent issues at Oxfam are immensely distressing for anyone like me who has worked in the charity sector or who is committed to support its work. Some deeply concerning events have come to light which should have no place in any organisation, let alone in a charity such as Oxfam. In a matter of a fortnight one of the strongest charity brands in the country has been badly damaged with wider consequences, not just for Oxfam, but for the charity sector as a whole. As ever, not just the events themselves but how they have been handled, before and after they have come to public notice, have worsened the problem.

This isn’t the first time, in recent times, that charities have been subjected to public criticism. The sector was badly hurt by the coverage of some of its more aggressive approaches to fundraising. While the laudable British commitment to charitable activity will not undermined overnight it is clear that charities, like any other institution, are no longer immune to criticism.

That may not be a totally bad thing. Charities have to be responsible for their actions and maybe, at times in the past, they have been given too easy a ride by the media and others. I certainly have noticed the different way the media can treat you as a NHS Chief Executive, compared to when I engaged with them as a charity spokesman.

There may be a case too for tightening regulation although my hope is that, in the wake of the Oxfam case, charities will seize themselves the strategic and moral case for tightening up their processes and procedures. Nowhere is that more important than in the area of safeguarding for organisations which, almost by definition, are concerned with working with vulnerable people. Ends do not justify means and the intent to do good, or indeed the previous record of having done good, do not excuse the need for proper process in relation to the selection and management of staff.

The case, however, also raised for me some disturbing issues about the way in which trust in public bodies institutions is continuing to diminish. From the expenses scandal in Parliament, to the exposure of widespread abuse in churches and other religious institutions, to the uncovering of abuse in sport virtually no area of public life seems to be immune from scandal and reproach. Brexit has opened up further lines of attack on the judiciary and the civil service, institutions whose impartiality is central to the quality of democratic life in this country.

In some cases, criticism has been deserved, and, as with what is happening to charities such as Oxfam, is, in part, a product of an undue sense of past defence to institutions. In other cases, criticism seems to be fuelled by intolerance of individuals or bodies which offer a view which is different from a particular political orthodoxy. It is not surprising that some of the criticism of Oxfam has been strongest from those who disagree with the cause of international development.

How do we respond to this? There are messages both for institutions and for the media and the wider public. For institutions, charities included, there needs to be a recognition that we live in an adult world. Everyone has to be accountable for their actions and no institution should feel it has a right to be immune from criticism or exempt from the established standards of probity and good behaviour. If ever you wanted an institutional case study or how quickly you can damage your reputation what has happened to Oxfam in the last fortnight provides it.

For the media, and more importantly, for the public there is a need to avoid blanket judgements and stereotypes. Where bad things have been done, they should be criticised and people should be held to account. At the same time, we need to be wary, in particular in the age of social media, of the risks of descending into witch hunts or of passing summary judgements without a full knowledge of the facts or based on a simplistic assessment of someone’s political views or background. Nobody is perfect and it is possible for good people to do bad things and for bad people to do good things. In an age of anxiety, passing judgement on others can be one way of managing our own fear and concerns.

Importantly we need to reflect again on the character of human nature and the complexity of and contradictions in our motivations and behaviour. History, literature and psychology all give us different insights into these issues. Reform, regulation and outside scrutiny are all correctives which have been necessary over the years to challenge institutions which have become corrupt or separated in, one form or other, from their founding values.

It is right sometimes to give people or organisations a second chance. My wife and I have been longstanding supporters of Oxfam. On this occasion, we have decided to continue our support, concerned that the most likely losers from the withdrawal of resources will be the charity’s beneficiaries and in the hope that an organisation that has a record of doing so much good will take the necessary steps to address concerns and regain public trust.



A little Latin (and Greek) is not a bad thing



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I am aware that Boris Johnson and Jacob Rees-Mogg have recently given Latin a bad name as an elitist pursuit, irrelevant to the 21st century. I would argue, though, that there are many things to be gained from the study of the ancient world and its languages. Certainly, I feel enormously privileged to have had the chance to study Greek and Latin and ancient history at school and University. That experience has provided me, and continues to provide me, with many powerful insights into the modern world and the underlying dilemmas of the human condition. In this blog I would like to set out why.

The first thing I gained from a classical education was a better command of my own language. Studying Latin led to a significant development in my skills with English, broadening my vocabulary, improving my spelling, and making me much more aware of the structure and sound of the language. It also helped give me my wider love of languages and facilitated learning romance languages such as French and Italian. As a non-clinician working in healthcare, a knowledge of Greek has been pretty handy in understanding medical terminology.

Making sense of the classical world also brings a particular set of intellectual challenges. Bits of it we know a lot about, bits of it we know very little about. As direct ancestors of our own culture the classical worlds show many things which are very familiar, whether they are stories and dramas, political concepts, forms of art and architecture. At the same time the ancient world can seem very different and distant. It is endlessly fascinating to try to patch together a fuller understanding from partial sources and classical scholarship has been enriched by a widening set of information sources, in particular, the results of archaeological investigation which has cast a much richer light on the lives of the poorer Romans and Greeks.

The study of the ancient world, itself an ancient tradition, has also been enlivened by the interpretation and reinterpretation of the same sources over the centuries in the light of wider developments in scholarship and in ways which reflect the preoccupations of different generations. History, and its interpretation, is never an absolute truth but always carries an image of those who write the history and their concerns. In the age of globalisation, Brexit and its resulting uncertainties there is a plenty of scope to plant our own story on the template of the classical tradition.

A great fascination with so many things in the classical world is that they hold the origins and first examples of some many constructs which are so fundamental to the modern world. Whether it is the democracy or political science, natural science or philosophy, theatre and drama, Rome as the world’s first metropolis, roads or central heating, Greek and Roman civilisations transformed human thought and political organisation in ways which later generations have built on but, not necessarily, fundamentally changed. The intellectual revolution which, in particular, seized the Greek world between the 7th and 4th centuries BC remains one of the most amazing leap forwards in human development. It is humbling that it is still possible for us to appreciate it.

There is also something very significant in studying a world and set of civilisations which came to an end. Views of the end of the Western Roman Empire in the 5th century AD have changed and there is much more emphasis in modern scholarship on those areas of continuity which survived into the early modern era. Nonetheless the end of the ancient world remains one of the most significant and fascinating discontinuities in the whole of our history. Nowhere is that more evident than in the city where I am writing this blog. In the middle of the 4th century London was the thriving capital of Roman Britain, by the middle of the 5th it had been abandoned, not to be properly settled again until the 9th century. As I have argued in a previous blog  the end of the Roman Empire has some lessons for modern Europe and the issues it is facing.

Finally, the classical world casts some brilliant insights into the human condition. Nowhere is this more evident than in Homer’s Iliad and Odyssey, the oldest works of western literature, written down in the 8th century BC but built on an oral tradition which goes back much further. Despite that antiquity, these poems contain a rich and moving understanding of what is like to be human, our battle with mortality and our desire to leave a small mark on the tapestry of life.

Classics will never regain the place it had as the universal basis of western education, but it deserves not to be despised as old fashioned and irrelevant. It needs to adapt to the character of modern world in ways which recognise the significance of a much wider group of ancient civilisations, not just those which have contributed most directly to western Europe. Classics also needs to reach out beyond the bastions of independent schools where it has, to some extent, ended up, to offer programmes and forms of study which can appeal more widely. It needs champions like Mary Beard who can make the ancient world exciting and accessible to modern audiences.

That said, as our greatest poet and playwright, acknowledged, let’s recognise the value of a little Latin and even less Greek.

Some progress, so much more to do


Abandoned Illness

It was good this week to return to the issues affecting people with schizophrenia and psychosis when I joined colleagues at Rethink Mental Illness to mark the 5th anniversary of the publication “The Abandoned Illness” the report of the Schizophrenia Commission. The Commission remains one of the most interesting, and fulfilling, pieces of work I have been involved in, in the course of my career. 5 years is a good perspective from which to judge the impact it has had and how the cause of those affected by severe mental illnesses such as schizophrenia has fared given 5 years of priority for mental health but also 5 years of austerity. Rethink Mental Illness published an assessment of the key developments.

The picture is inevitably mixed. There are some areas of clear progress. Not surprisingly top of the list is the impact of a reducing level of stigma towards mental illness and those affected by it. When we started on the journey with Time to Change and other action to tackle stigma and discrimination there was a fear that, while it might be possible to reduce stigma to more common conditions such as depression, the prejudice towards people with schizophrenia and other more severe mental health problems would be untouchable. This has not turned out to be the case and brings benefit in helping people affected by these conditions to engage, where possible, with work and with other social activities.

It was also good to celebrate the impact of the waiting time standard for early intervention. The model of early intervention remains, for me, one of the most positive developments in mental health care in recent times and it has a clear evidence base both for delivering better outcomes but also for reducing the costs of future care.  At the time of the Commission there seemed to be a threat that early intervention would be diluted under the financial pressure faced by Mental Health Trusts. Norman Lamb, the Minister for Mental Health at the time, deserves an enormous amount of credit for making early intervention one of the first standards for mental health.

There are areas of mixed achievement. The poor physical health of people with severe mental illness is now widely recognised and a lot of effort is being made to build more integrated models of service delivery. There is, however, a long way to go to provide the level of input and support which will make a real difference to such a deep-seated problem. The pressure on primary care services does not help but there is no doubt that further investment here would have a real pay back, not only in terms of years of life for people affected by severe mental illnesses but also in terms of savings for physical health services.

Inpatient care remains a point of concern with levels of occupancy across the system well above the level of 85% recommended by the Royal College of Psychiatrists and too many patients having to be placed out of area to secure a bed. I am pleased that there is a national focus on reducing out of area of placements and I welcome developments, which were called for in the Schizophrenia Commission, to facilitate a transfer of resources from secure care to strengthen community services. However, there is a need to face up to the fact that there in many places there are insufficient resources to create an effective acute care pathway with the right balance of beds and community resources. As this week’s report from the King’s Fund confirmed such a situation is inevitable in world where parity of esteem for mental health still comes second to the pressures in the acute physical care hospitals. A system under strain like this, inevitably, has its impact on the staff working in it and there is a danger we have created a vicious circle where the pressure of the environments we ask staff to work in has a negative impact on recruitment and retention, perhaps most worryingly for new trainees.

The most depressing part of the piece though must be the impact of austerity on areas such as housing, benefits and community services which provide the underpinnings for people with severe mental illness remaining well in the community. There is no doubt for me that this is having an impact in increasing the demand for mental health services and it was sad to hear from carers and others at Rethink Mental Illness the traumatic effect of the work capability assessment amongst other things. This remains the most blatant area of discrimination in society against people affected by mental health problems. While I, of course, welcome the current review of the Mental Health Act, a far more urgent requirement is to make a serious commitment to tackling the injustices which people with mental health problems face in the social security system.

So, 5 years on there are definite areas of progress but still so much to do. However, I was also struck by what Sir Robin Murray who chaired the Schizophrenia Commission had to say at the event this week about hope. For him, one of the biggest learnings from the work of the Commission was the importance of a message of hope in supporting people with a diagnosis of schizophrenia or other severe mental illness. This has a lot of resonance. Hope is not necessarily the same as optimism but hope inspires the will to try and to fight and that for individuals and for society battling with the issue of mental health is what we need more than anything else.


Howards End – not just a pretty period drama


In the end I thought the recent television adaptation Howards End did a pretty good job. Best of all, though, it tempted me to re-read the original novel, reminding me of just how good a writer Forster is and how valid this novel still is in its analysis of human character and psychology.

I have always had a fascination with the Edwardian Age, the period when my grandparents entered adulthood. I read Howards End for the first time at a time when the last of that generation was still alive. Nearly 35 years later it remains just as vibrant as when I first read it and indeed Forster’s reflections on the foibles and anxieties of that age seemed if, anything, more relevant to those we face in 2018 than to that of 1983.

The television version stayed very true to the original plot and the dialogue was often based on that of the novel. In re-reading the novel I was struck that the screen adaptation missed one very powerful ingredient, Forster’s own authorial voice through which he delivers much of the interpretation of the characters he is portraying as well as a fascinating commentary on the times in which the novel is set.

The novel takes place just before the First World War, the most catastrophic event in European history and the growing political tension which led to it is part of its background. This is played out in the relationships between two families: the Schlegels, half-German, intellectual, cosmopolitan and edging to socialist and the Wilcoxes, classically English, insular in attitudes, immensely practical in outlook and conservative in politics. Translated to today one family would be staunchly Remainers, the other, hard line Brexiters (Of Mr Wilcox “My husband has very little faith in the continent, and our childrten have taken after him”).Foster brilliantly brings out the mutual incomprehensibility of outlook between the two families. At the extreme they “had nothing in common but the English language.”

And yet Forster’s novel forces those two very different families together for better or for worse. Margaret, the older of the Schlegel sisters, becomes Henry Wilcox’s second wife (to the disgust of most members of both families). Forster brings out wonderfully the psychology of the attraction of opposites, how people can be drawn, unconsciously, to what, consciously, they could never admit to liking and the compromises that people inevitably make in the cauldron of real life and real relationships.  This is expressed beautifully by Margaret as she chides the rest of her family for their reaction to her relationship with Henry Wilcox, “How dare Schlegels despise Wilcoxes when it takes all sorts to make a world.”

Gender is a key theme of the novel, written, as it is, during the Suffragette campaign for votes for women. While some of the attitudes captured in the novel are historical Foster’s description of gender battles have a contemporary ring to them. In this, as in all things, Forster is most judgemental of hypocrisy and of men who assert that different standards apply to women than to their own conduct.

As is appropriate for an English novel the biggest issue is that of class. In the midst of the dance between the Schlegels and the Wilcoxes comes Leonard Bast, a working-class autodidact, who wishes to better himself through books and music whom the Schlegels attempt, somewhat ineptly, to support and help. They are enchanted by him and his authentic love of culture but cannot bridge the division of class and wealth that stands between them. Forster, affectionately but nonetheless ruthlessly, dissects the conundrums of Bloomsbury socialists and middle-class do-gooders. Again, such issues feel vividly relevant to current times.

Later in the novel the plot thickens as it emerges that Leonard’s wife was formerly Henry Wilcox’s mistress. The younger Schlegel sister, Helen, is drawn, almost in an act of revenge against the Wilcoxes, into a liaison with Leonard which leaves her pregnant. In an act of cruel double standards Charles Wilcox the son sets out to beat Leonard to an inch of his life and in fact kills him. Charles has to serve a term in prison for manslaughter but the rest of the Wilcoxes and Schlegel manage, in an uneasy way, to come together in the wake of the terrible event.

The final captivating aspect of the novel is Forster’s eye for place. This is central to the  novel in the form of the eponymous Howard’s End, based on Forsters childhood home Rooksnest (pictured at the top of the blog) which was then just outside Stevenage. The house, which acts almost as a character in the novel, casts a powerful beam of nostalgia for the values of an English past fading under the strains of technological change and political and social uncertainty.

By contrast Forster comments on the constant change of London in terms which are fully comprehensible to a modern resident of the city “It was the kind of scene that may be observed all over London whatever the locality, bricks and mortar rising and falling with the restlessness of the water in a fountain.” He also has a telling eye for the mores of London life commenting on Margaret “with a Londoner’s impatience she wanted everything to be settled immediately.”

Next to Shakespeare, Forster is one of the writers who, in my view, most captures the conscious and unconscious movements of the human soul and who brings a deep psychological insight into the portrayal of his characters, none of whom are perfect but all of whom are eminently believable.

Howards End is set more than a hundred years ago but is scarcely a dry period drama. It speaks of some of the dilemmas of Britain’s place in the world, of gender, class and human relationships in ways which are just as relevant in 2018 as they were 110 years ago and were just as vivid for me as when I first read the novel as a twenty year old.

The NHS at 70 – time for an honest debate about the future



5th July 2018 will mark the 70th anniversary of the establishment of the NHS. It remains the most enduring testament of the collective will of the people of this country to tackle the need and suffering of their fellow citizens. As such it will be an occasion which deserves celebration, but I hope it is also an anniversary which provides a focal point for some critical debate about its future.

By this I do not mean challenging the basic principles of the NHS. Britain is not unique in providing universal access to healthcare but it’s system is distinctive and, on the whole, is relatively efficient and fit for purpose. However, the last 8 years of austerity have highlighted weaknesses which, if not addressed, will undermine the sustainability of what is able to be offered for future generations given an inevitable increase in demand with an ageing population and advances in medical technology.

I would highlight five priorities for the New Year.

The first is workforce where we have now woken up to the scale of the short and long-term challenges we face. In the short term the big pressure is numbers, for instance, in mental health, we need 19,000 extra members of staff by 2020/1 to replace staff we are losing and to meet the extra demands of the Five Year Forward View for Mental Health. In the long term there are bigger challenges about reenvisaging the health and care workforce and rethinking career pathways along the more flexible lines which will appeal to a younger workforce less likely to buy the old paradigm of a profession for life.

We also need to be much smarter at looking after the workforce we have got. The recent Farmer/Stevenson report on mental health at work positioned the NHS as one of the sectors of the economy with the highest annual costs of poor mental health at work (estimated at between £2,028 and £2,174 per head). We need more than a sticking plaster approach to addressing this, taking account of the fundamentally traumatic nature of working in healthcare and any remedy must be a fundamental part of the calculations make about efficiency and productivity in the NHS.

The second priority is to be honest about the money. All I have seen in the last couple of years is of a system, which despite some heroic efforts from providers and commissioners, is seriously struggling to keep up with the demand it is facing within the resources available, let alone being able to address key priorities for development and transformation such as those for mental health. I am, of course, not alone in that view with similar opinions being voiced by the Kings Fund and most of the leading health think tanks. While I accept that there are no easy answers to the pressures on public finances there are major consequences of the current position. First there is stress of dealing with the fallout on the frontline staff and who can often feel held personally responsible for the failings of the system. Second a constant focus on short term efficiency distorts priorities, making it harder to make investments in new models of care which often require some element of double running but which, in the long term, are central to the delivery of a sustainable system of care.

These dilemmas have made me a supporter of proposals to take decisions about the long-term funding of the NHS and social care out of day to day political decision making with funding pegged to an agreed proportion of GDP. There would still be difficult choices to be made but, at least, the basis for those choices would be less arbitrary.

My third priority is prevention in its wider sense. It is the most obvious economics that intervening early is less expensive than waiting to deal with issues when they have reached crisis point. However again and again in the years of austerity we have cut those services which prevent demand or help to seriously reduce its impact. Some of this recognises the limited role which health services play, on their own, in improving health outcomes. It also reflects the distortion caused by the short-term nature of funding which can lead to the exclusion of initiatives which deliver a very robust return on investment but where payback will be over years if not in some cases, decades. From my perspective there would be very powerful case for treating elements of public health spending as capital investment with upfront investment justified in terms of its longer-term impact on health outcomes and utilisation.

Linked to this is the need for a much greater sense of urgency in tackling health inequalities which needs to be a much greater focus of national policy making and local commissioning decision. In an era where what we can do is being rationed, either explicitly or implicitly, the impact on health inequalities should be a key criterion for any assessment made by NICE of new treatments.

My fourth point is the need to continue to resist the temptation to default to organisational change as a kind of “magic thinking” to address the problems of funding. I think STPs have, in general, been helpful and the principles of Accountable Care provides opportunity to take a paradigm of integrated care further. But let’s not again make the old mistake of putting form before function. From my experience organisational development is best as a means of supporting and extending those areas which are already well on a journey towards more integrated working and any wider roll out must be justified in terms of clear evidence of benefit in a UK setting. We must also be bold in constructing approaches which go beyond the traditional boundaries of the NHS and ensure social care, housing and the voluntary a key seat at the table.

My final point relates to culture. The NHS has many strengths and it is full of many very committed and inspiring individuals. The way it works together as a system can, sometimes, leave something to be desired.  Part of the problem is the public and political nature of the service and to the way in which it is portrayed in parts of the media, some of it relates to the way in which different constituencies, especially when under external pressure, react to each other.  We need a culture which is tough on problems and supportive of individuals and when things go wrong does not automatically try to find someone to blame.  We need to call time on aspects of the persecution and bullying of staff which sadly remain all too visible in the way the NHS, at times, goes about its business.

So, 2018 will be the time to celebrate the 70th birthday of a remarkable British institution. Its remarkableness, however, will be even more reason for an honest debate about its future.



Just like the ones we used to have – the two sides of nostalgia



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Whether we’re dreaming of a white Christmas or a blue passport, nostalgia is a widespread feeling at this time of year. First coined in the 17th century by a Swiss medical student to describe the distress of mercenary soldiers fighting away from home the word has come to mean, more generally, a sentimental longing or wistful affection for a period in the past.

Nostalgia often has a benign connotation. It is a feeling which allows us to capture and reflect on beautiful and pleasurable moments of the past, stripped of their contemporary difficulties. Such moments of nostalgia can bring us much pleasure and comfort, but it is worth reflecting on the darker and more disturbing side of this emotion.

The origins of the word relate to issues of distress, for individuals, who as mercenaries, were dislocated from the surroundings of home, of their fellow countrymen, of familiar customs and the like. This distress could affect wellbeing, harmed individuals’ ability to recover from their wounds and, sometimes, be a cause of suicide. We know from more modern science that that the cultural dislocation experienced by some immigrants can be a trigger for severe mental health problems. Like most psychological issues nostalgia sits on a spectrum, for many of us, a manageable set of symptoms but for some a source of distress.

I am no stranger to nostalgia myself. The Welsh have their own word for this phenomenon “hiraeth” and as the son of a welsh exile I was surrounded, as a child, by a lot of nostalgic affection for the country of my ancestors, its language and the values and sense of community of the Valleys. I built on that with my own sense of nostalgia for the beautiful countryside which I visited each summer, so different from the suburban drabness which I grew up in. Such feelings are easily aroused when I return now to Wales and provide a well of comfort from which to draw in facing some of the challenges I face in life.

There is a wealth too of nostalgic writing, often at least semi-autobiographical, which I have always enjoyed. How Green was my Valley by Richard Llewelyn, captured for me as a teenager a romantic and inspiring view of the South Welsh Valleys. Books such as Lark Rise to Candleford and Cider with Rosie described evocatively the English countryside before the modern world fully intruded on century old patterns of living.

As yesterday’s debate about the post Brexit colour of our passports demonstrates, questions of nostalgia are playing an increasingly large role in public discourse in our country. These are not trivial or superficial issues but rather relate to a deeper reaction to the scale and pace of change which is happening in the modern world. This is most acute for those groups most left behind by economic and social change and technological development and for those places and communities whose sense of identity and purpose have been marginalised in a more globalised world.

For Britain there is an added narrative of national decline, related to unresolved issues about the loss of empire and related sense of our own importance. Nostalgic yearnings whether for blue passports, the heroism of the Dunkirk evacuation, evensong and afternoon tea, brass bands and old-fashioned football teams are all part of a national narrative, however false at times, which demonstrates a nation, at least in part, not comfortable with its position in the world.

Inevitably nostalgia is a bigger issue for the older generations. One of the saddest features of the Brexit referendum was how it emphasised a division of outlook between young and old. Such a division has many historical precedents but in our own time it is further exaggerated by the scale of demographic change and the shifting balance between the generations.

So, what we should think of nostalgia, comfort or curse? As with many things it is probably both.

The first point I would make is that while nostalgia can provide moments of comforting reflection the reality is that history, like a river, flows in one direction. While there are always echoes of the past in future events, it is not possible to “turn the clocks back”. When we try to do so we do not recreate the past, only a different version, and not necessarily better, version of the future.  Furthermore if we are to apply the past in our consideration of the future we have to face up to the reality of past events and not just our rosy tinted recollection of them.

The second point is to recognise that shared ideas and symbols of historical identity do matter, and matter, in particular, in times of stress and disruption. In a more globalised world we need to celebrate and cultivate more local customs and sources of identity, whether geographical or representing other expressions of shared identity. This needs to be done in an open and tolerant way not to provide another source of repression and control.

Finally and to echo the theme of my last blog there is a need to find ways, at a time of a worrying lurch to the extremes, to find ways of creating a dialogue which connects, rather than divides, the majority of opinion.

So, in dreaming of white Christmases or green Valleys we can find comfort and common cause with our fellow citizens. Let’s celebrate nostalgia as long as we remember we must live in the present and not the past.


Holding the Middle of the Road



Confucius’ famous curse feels a bit superfluous these days. There is little to doubt that we do live in “interesting times”. Whether it be Brexit, Donald Trump and the rise of populism, austerity, terrorism, the impact of automation or climate change the last decade has seen a convergence of challenges to the established order of things in the Western World which, in my life time, feel unprecedented. Disturbingly we face these issues in a political and social environment which has become increasingly extreme and polarised. Social media, which doesn’t always lend itself to subtly, has epitomised this phenomenon.

These trends are disturbing and don’t, I feel, bode well for the health of our democracy and for the social cohesiveness which is so central to our sense of collective wellbeing. For many the term “middle of the road” is off putting, symbolising, perhaps, unsatisfactory compromises and the abandonment of more comforting oppositional positions. However, for me, the middle of the road is the place where we need, more than ever, to be if we are to make genuine progress in resolving the challenges which face us as individuals and as a society.

There are four aspects to this.

The first is the willingness to listen, with respect, to a range of opinions and views beyond one’s own. It is one of the real problems of our current times that the polarisation of opinion has limited our ability to have a constructive dialogue with those who don’t share our views. It has been one of the things I have always valued about mental health that it has been an issue which has united so many people from different backgrounds and social and political perspectives. By contrast it was one of the tragedies of the Brexit referendum that it exposed the extent to which we had become two nations, impervious to each other’s’ experiences and concerns.

The second principle is the ability to respect evidence and to change one’s mind as a consequence. Truth is rarely black and white, and we need to be able to tolerate the nuances of intelligent debate and the possibility that the evidence will not always support the position which we are taking. Some of this relates to our respect for experts although, in my opinion, experts can also be blinkered in their outlook, especially when they have a lot staked, as individuals, on a particular position. It is more to do with an openness of mind and sense of humility which allows us to admit that we have been mistaken in our views and are able to move on.

The third attribute is perseverance. Vision and a clear sense of direction are important in any endeavour, but I would rather have ten small changes which make a practical difference to peoples’ lives than a grandiose promise of change which has little chance of success or can only come at an enormous cost. With perseverance must come patience and a trust that small actions can lead to real change and that long-term commitments are necessary if we desire to transform society. Short termism is a particular British curse, nowhere more evident than in the planning of the NHS where, too often, there is a desire to promise enormous change in the short term while we remain unable to resolve the problems that have been with us for thirty years or more.

The final point is that how things are done matters as much as what is done. The quality and tolerability of life is a function of how we behave with each other. Courtesy, tolerance and respect are essential requirements of civilised life which need to be championed. Where people are held to account for their actions due process must be paramount and everyone, wherever they sit on the political spectrum, is innocent until proven guilty. Justice and good administration need to be nurtured and ends do not always justify means. As every conflict in my lifetime tells me one of the biggest dangers of extremism is that it somehow justifies an equal and opposite reaction. When terrorism triumphs over civilised values it really has won.

At a time of such existential threats it is easy to understand why some people have rejected the politics of compromise and consensus. All through history there have been politicians who have been prepared to “trim” their positions to further their own personal advantage. However, it is in the middle that real movement and progress is possible. I am not advocating a world without values and principles which are strongly held, they after all define the terms of what is possible to achieve through compromise with others. I am advocating that we are willing to reach out from where we are comfortable to engage with others and to put the common good above all.

When the traffic is speeding rapidly in both directions it takes some courage to hold the middle of the road.