Skip to content

Weebles wobble but they don’t fall down

weebles

 

Earlier this week I had the immensely sad duty of attending the funeral of Mike Solomon, a very special member of staff at The Tavistock. He had died, far far before his time, after living with a severe form of cancer for a number of years. I joined several hundred of his family, friends and current and former colleagues to pay my respects but also to mark the achievements of someone who had been both a brilliant clinician and educator and an enormously warm person, qualities which he retained all the way the way through his battle with cancer.

You don’t have just to take my word for how special an individual Mike was. Earlier this year he recorded, with his friend and colleagues Fiona Starr a wonderful TED talk on resilience. Sh*t Happens: 8 Lessons in reslience presents a powerful and thoughtful set of insights into how we can cope when the worst happens. Mike’s image to illustrate his message was that of the Weeble”, a 1970s plastic toy with a weighted base which you could push over but which would always stand up again. Not just for nostalgic reasons it was an immensely apposite image.

I do intend to go through each of Mike and Fiona’s points because everyone who reads this blog must also find time to watch the talk itself. Rather, I would like to take it as an opportunity to offer some personal, but I hope complementary, reflections on the issue of resilience. There are three points I want to make.

The first is about the importance of early years and our childhood experiences and how these shape our ability to deal with what happens to us in later life. I am very conscious of how lucky I was as a child and of the decent and loving job my parents did in bringing me up, something I have been even more conscious of in the last year as I have come to terms with the loss of one of my parents. I was also lucky in having influences beyond my immediate family which also helped shape me and which added to my resilience. At the same time, I have also been grateful that not everything in my childhood was straightforward. The impact of having a disabled brother was significant but has undoubtedly made me a better and stronger person.

Like the Weeble the strength we draw from positive childhood experiences adds to our weighted base. Like an oak tree, the depths of our roots allows us to sway in times of strong winds,conscious that our formative instincts will keep us grounded in times of trouble.

A reflection on my fortune in this respect is one of the reasons why in my professional life I feel strongly about the investment we make a society in interventions and services we provide to support those whose early life experiences have not been positive and where childhood trauma or abuse has left a strong mark on development and where, as a result, individuals are less resilient and more at risk of mental health problems.

My second point is about the importance of perspective. This chimes with many of the points which Mike and Fiona make in their talk. Problems look very different depending on where you view them from. Differences of perspective can be those of time, uniqueness and expectation.

It is an often repeated adage that time is a great healer but that message is so hard to remember in the immediacy of loss or misfortune. Similarly, we can often feel that our problems are unique to us. That can add to our distress and sense of isolation but also adding to our own self of self-blame and reproach. The discovery that others have been in the same place or indeed somewhere worse can be very liberating both in a practical sense but also in helping relieve a self-imposed burden of guilt. In the time I have worked in mental health nothing has appeared so powerful as the role of peer support whether amongst those experiencing mental health problems or amongst families.

The last issue of perspective relates to expectation. The impact of misfortune is made greater if we what expect of events or of ourselves is set too high. The concept of “good enough”, identified by the psychoanalyst Donald Winnicott in reference to parenting and included by Mike in the TED talk is a case in point. We add so much to our distress if we expect perfection in world where all things must be finite. I was very struck by the rabbi at Mike’s funeral who refused to accept that Mike had “lost his battle with cancer”, as if anyone can really deny the inevitability of mortality, but instead changed the perspective to highlight the very special way Mike faced up to his fate in a way which was a real victory for him and for the best of human values.

My final point relates to the role of society in respect of resilience.

One of the biggest changes which has happened in my lifetime has been the shift in the balance of focus between collective and individual values. Humans are fundamentally social beings and, in the past, many of systems of resilience have been embedded in collective structures whether of family, communities or religion.

In the modern world some of those collective protections have weakened. There has been an upside to this as it has liberated many who were cruelly affected by the impact of collective stigmas and taboos. However, there are negative consequences who those who are left isolated, in particular in times of misfortune and loneliness has emerged as one of the greatest challenges in our society.

We are also beset by seeing economic efficiency and material wellbeing as the only benchmarks by which to judge the way in which organise our workplaces, places of education and many other institutions. We are beginning to recognise that deficit in our society but still too much of the reaction is to focus, solely, on strengthening individual resilience.

So, in saying goodbye to Mike there is much he has taught me over the last three years in how to respond to adversity. No lesson is stronger than that the most important thing in how we cope rests with our own attitude and perspective.  Mike set a wonderful example of how to do that.

Northern Lights

 

DSC_4909

 

Long term readers of this blog will know how important the summer break is to me. It provides a much-needed opportunity to break routine, step away from the day to day cares of my job and spend quality time with my family.

This year we returned to the north, spending a week on the beautiful island of Lindisfarne off the Northumbrian coast.

There is something enchanting about Lindisfarne. At low tide it is connected to the mainland by a causeway but as the tide rises it becomes an island again. This can create some challenges in planning one’s day against the vagaries of both the tide and the weather but, for the most part, it adds to the sense of the attraction of the place.

Lindisfarne has been special for a long time. The site of a famous monastery in the early centuries of Christianity in this country and centre for Anglo-Saxon culture and scholarship it was also made famous in 793AD for being the first target for Viking raids in Britain.

Despite the incursions of the Northmen it has remained a place of pilgrimage ever since and it is not hard to imagine why. The views from the island across the water to the Northumberland coast and the hills beyond are spectacular and there is something about the openness and expansiveness of the sky which is particularly capable of lifting the spirits. When the August sun shines in the afternoon it looks as if it is leaving a series of golden streaks across the sea.

As well as Lindisfarne we enjoyed a number of trips to nearby Berwick on Tweed, for many centuries a border town between England and Scotland, changing hands at least 13 times in between the end of 13th and 15th centuries. It is an elegant town with its splendid location on the estuary of the Tweed, its impressive Elizabethan fortifications and its equally impressive Victorian railway viaduct. It was interesting to learn that it had been a favourite holiday destination for the painter L.S. Lowry, and it was possible to follow a trail around the town showing some of the views he had captured, over the years, on canvas.

Berwick had the feel of a border town with North East and Scottish accents mingling together. It was salutary to think back to when this was contested territory and frightening to think about the current fragility of the Union.

Holidays are also a time for a good read and I usually try to take something a bit more substantial with me. Fitting with the location, this year’s choice was a translation of the Icelandic sagas. Written down, for the most part, at the of the 13th century they describe events several centuries earlier at the height of the Viking dominance of Northern Europe. While much of the action is centred in Iceland the main proponents travel frequently across the Viking world including spending some time in the North of England.

While familiar with the sagas from previous visits to the Orkney Islands, I had never read them before as works of literature. I was blown away by the power of the stories and the characters they contain. Despite portraying a very different age to our own, full of violence and with a much smaller role for the state, their description of human character and behaviour is immensely realistic and powerful. One is drawn, absorbingly, into the issues of honour and small twists of fate on which the fortunes of the main characters depend. As is so often the case in our own world the success of endeavours in the sagas depends not just on strategy and individual capability but on the relationships between characters.

Holidays remain for me a very important time to think about the bigger things in life. Both personally and professionally it has not been the easiest year and it was good to have some space to reflect on things. Immediate troubles can always feel better when you can distance yourself, however briefly, from them. It doesn’t necessarily solve problems, but it does allow you to change your perspective and that, from experience, is so important in the ability to process things and move on.

It is, at such times, that I am most moved to try to express my thoughts in poetry. The beauty of being on Lindisfarne was the ability to look, literally and psychologically, into the distance.

I can see further from here
Beyond the maelstroms of middle life,
Beyond the shadows of fading years,
Beyond all sickness and grief.

Looking beyond the horizon,
Into the distant places of the future,
Into the realms of eternity,
Into the space beyond existence.

I am not the first to search,
Discarding the burden of mortal trouble,
Discarding the pull of earthly concerns,
Discarding the weight of human pride.

I lift my head, the thought is broken,
And to my particular care I return
And continue for now my journey
And know I will return, but then, for ever.

Preventing Suicide – Everybody’s business

 

logo-with-wording
The week before last, I had the great privilege of chairing a session on the main stage at the NHS Confederation conference on the subject of preventing suicide. I was speaking alongside Steve Gilbert, an expert by experience and recently Vice Chair of the Review of the Mental Health Act, Ruth Sutherland, Chief Executive of the Samaritans and Joe Rafferty, Chief Executive of Merseycare and founder member of the Zero Suicide Alliance.

Our purpose in picking this topic for the main stage reflected both the significance of this issue in its own right but also to highlight the impact which the NHS, with its scale and reach, could have in preventing suicide if it could properly recognise this as a collective priority.

In 2017 in the UK there were 5821 suicides. In recent years rates have been falling after a peak after the 2008 recession and it is possible to take pride in some effective prevention work both in the NHS and, also in sectors such as the railways where the partnership between Network Rail and the Samaritans has made a real difference in reducing the number of suicides involving the railways.

Yet each one of those 5821 deaths is one too many. As Joe Rafferty powerfully pointed out in his presentation, despite some good work we have had nothing like the same impact on suicide as we have on other preventable premature killers such as stroke and AIDS. While advances in treatment have had some place in those successes much of what has been achieved reflects prevention and public health measures. Suicide can also be effectively tackled by such an approach.

As more widely has been the case in mental health, action on suicide has been hampered by stigmas and taboos which have prevented an open conversation about suicide and what can be done to prevent it. Yet most of us, at some time, have had the experience of losing someone we know, whether family member, friend or colleagues to suicide. Many people may also have experienced suicidal ideations and as many as one in fifteen people have reported making an attempt, at one point in the lifetime, to take their own life.

I remember well the experience of losing a number of friends and colleagues through suicide. It has always been one of the hardest things in life to understand. Despite, having, through my work, gained some insight into the depths of mental distress which might lead to some one to think of taking their own life when it happens in reality it is difficult to explain or accept.

Those of us who work in and lead mental health services have a special responsibility to take the measures we can to reduce the risk of someone in our care taking their own life. As Steve Gilbert so powerfully described in his presentation it shames us all to hear when the NHS fails someone who in great distress and thinking of completing suicide can not secure an adequate response.

Yet it is only a quarter of people who complete suicide who have been in touch with mental health services in the last 12 months before their death. The NHS can have a much bigger role both organisationally but also by encouraging its 1.2 million staff to be part of a social movement to help prevent suicide.

The Samaritans have made an enormous contribution since it was founded in 1953 by the Anglican clergyman Chad Varah in using volunteers to provide support, through the phone, and now other channels, to people thinking of taking their own lives. When it started it was the first crisis line in the world. It is amazing to think of how many lives have been saved since then by the fact of someone being there to listen at that moment when someone in despair most needs it.

Such support can exist elsewhere. At the end of my time at Rethink Mental Illness, the charity was involved in the story of “The Stranger on the Bridge”. Jonny Benjamin, a campaigner who has done so much to talk openly about mental illness and suicide has in 2008 been on the verge of taking his own life on Waterloo Bridge. A stranger, known at the time only as Mike, had stopped, engaged Jonny in conversation and helped him to desist from his attempt. 6 year later we tried to “find Mike”. It was a fascinating journey. In the end Jonny did find Mike, who was actually called Neil, but in doing so met many others who had been affected by suicide. Surprisingly a number of people came forward to identify themselves or someone they knew as Mike. This was not, we discovered, a reflection of vain celebrity seeking but more the fact that, quietly, there are many Mikes who spot someone in distress and take the trouble to stop, listen and help.

As part of the work of the Zero Suicide Alliance a 20 minute video has been developed by their training partner Relias, aimed at the general public, which aims to help ordinary people have the confidence and knowledge to engage with someone whom they think may be in distress an at risk of taking their own lives. It is a really powerful way of helping create a wider social movement of suicide first aiders.

It is very positive the commitment, also made last week, that the Government will also encourage the NHS’s 1.2 million to undertake the training. If we can achieve that and extend our ambition to the NHS’s partners in social care and elsewhere it is an intervention which could have such a powerful effect in helping save lives. That’s a goal which is certainly worth 20 minutes of our time.

The Big Issue

Lignite-Fired Power Station
It’s been encouraging, to see the re-emergence of climate change as a leading political issue. Whether in terms of the coverage attracted by teenage climate change campaigner, Greta Thunberg or by the noticeable growth in political support for environmental parties in last week’s, elections for the European Elections, it does seem that this issue is more prominent in public debate than it has been for some time.

It strikes me that it shouldn’t be otherwise given the level of peril we and the planet face whether as a result of global warming, declining biodiversity or other challenges. However other issues, starting with the 2008 economic crash, and more recently with Brexit have crowded it out. In some quarters, notably in the US, there has been the strengthening of the voices of those denying man made climate change.

The environment has been a longstanding personal cause which I have tried to ensure is central, not just to my political choices but also key decisions about my personal lifestyle. For most of my adult life I haven’t owned a car, I have tried to avoid flying when I can, I have been committed to recycling and to environmentally friendly products, to buying locally and to supporting renewable energy suppliers. Some of those choices have been straightforward, others have required some sacrifice from myself and, from my family.

Recent coverage has made me think again, in particular as I see the leadership of environmentalism moving from my generation to that of my children. It has made me want to stop and reconsider whether I need to refresh the positions I have held, probably in most cases for at least 30 years, on the challenge of global warming and what should be done about it.

One of the challenges of the issue is how to frame the debate. I am not a scientist, but I have followed the debate about global warming for some time. To me it is absolutely clear that temperatures are rising at an alarming rate and that human actions are largely to blame. How close we are to a tipping point can sometimes, however, be a distraction to debate. As with other issues a catastrophic narrative which allows people to bury their head in the sand or accuse those making the claim of crying wolf, is not always helpful. Climate change is already impacting on the world in terms of a greater incidence of severe weather events and heightening tensions over scarce resources such as water. The risk of such an impact increasing, possibly severely is high. There is no doubt we need to act and with some urgency.

There are three areas for focus.

First is creating the necessary political will for change. There has been progress compared to when I first took an interest in these issues, but not sufficient. It will need a further injection of public concern if there is to be a step change in action. There are a number of conditions in achieving that. This starts with the need to build a very broad-based coalition in support of change. The challenge of climate change is too significant for its ownership to sit, uniquely, with anyone part of the political spectrum. It was encouraging to read recently about figures on the Christian Right in the USA, so often hostile to this agenda, who have championed action on climate change drawing from their own perspectives.

Political action on this issue must also be international in character. In particular the major economies of the developing world such as China and India have a crucial role to play and environmental principles need to be embedded as a fundamental part of the working out of international relations and international trade.  It is one of the reasons for me why we should remain involved in Europe.

Finally, this is an issue on which older generations need to give way to the views and priorities of young people. It is younger generations with whom the greatest risks of climate change sit. Those of us who already have had a significant part of our lives need to be willing to give greater space to this agenda compared to others which are the specific preserve of older people. That said the future of the planet should be a priority for all of us.

The second area of focus is technology. While we should not totally rely on technological fixes I am much more confident about the scope to impact positively on reducing global emissions. Whether that is in the form of improvements in the technology around renewable energy, more energy efficient forms of transport or the impact of digital applications in reducing the need for travel there are promising developments. Just as importantly capitalism itself has begun to align itself more closely with the green agenda, recognising not only the science but also the shifting priorities of consumers. The debate around nuclear energy remains an interesting part of the debate. I remain unconvinced, at present, but also open to arguments about whether it has a place in the measures to secure a sufficiently rapid reduction in emissions.

The third focus must that sphere of individual and collective action. Climate change is not just a question of beliefs but also of action. It is easy enough probably to sustain those actions which have become habits but there are other things which warrant some thought such as the balance of my diet, the amount of travel I undertake and my use of plastics. There are also things to think about in my role as a leader in the NHS. There has been some interest in the development of a green agenda in healthcare, but progress has been slow, crowded out by other issues. However, one cannot escape the challenge when the NHS accounts for more emissions than the sum total of all the planes leaving Heathrow.

Climate change has previously had a significant impact on the history of life on this Island. The Ice Ages made Britain virtually uninhabitable. The melting of the ice led to cutting off Britain form mainland Europe. Agricultural production and the sustainability of population has been regularly affected by changes in temperature and precipitation.
Today we face a challenge, despite our technological know how and skill, beyond those which we have faced before. Whatever else preoccupies us as individuals and a nation, the environment and the climate change must have the prominent place in our politics. If we need a Swedish schoolgirl to remind us of that so be it.

The Shoe on the other Foot

IMG_0692 (002)

 

Yesterday I got the good news that, after two and a half months, I could take off the orthopaedic boot I have been wearing since I broke my foot. So, crutches handed in and back on my bike I can resume my normal life. I am very grateful and once again amazed at the natural healing powers of the body.

However, my temporary period of disability was a good opportunity to see life from a different perspective. Literally the shoe was on the other foot. This blog is an attempt to share some of my reflections of that experience and the wider importance of trying to see life from the perspective of others.

Until I broke my foot, I had not quite realised how delicate and important feet are. Initially, at least, my mobility was quite considerably constrained, and I was in a lot of discomfort. Similarly, I hadn’t worked out that, just as I am righthanded, I am right footed and that, in its own right, that made the accident more disabling. Luckily, my injury has healed in quite a straightforward manner but others (and, for obvious reasons, I have had a lot of conversations in the last couple of months about broken feet) are not so fortunate.

It was very insightful to have negotiate London in a different way, and at a different speed, than I am used to. As far as I could judge London transport has made good progress in making its network accessible although the configuration of lifts in some of the bigger stations is confusing to say the least. The importance of accessibility for wheelchair users and those with mobility difficulties is something I have always supported but do so now with a much greater realisation of its significance, both in terms of being able to get around, but also in terms of what it does to support the psychological value of independence.

I was also pleasantly struck by the courtesy and kindness of others. It easy to form a stereotype of Londoners as selfish and self-absorbed but almost without fail people would stand up for me on the tube or on the bus. Many times, this was done very graciously, occasionally I had to be a bit more forceful but that was often not a function of a lack of willingness but rather of people being too focused on what was on their phones.

It is true a crutch and orthopaedic boot are a pretty visible form of disability. Other types of distress are more easily ignored but, nonetheless, the last couple of months has reinforced again for me the value of small acts of kindnesses from strangers. It’s made me reflect that life is never too short or business too pressing not to give them.

The perspective of seeing life from a different point of vantage has a wider resonance, particularly in our divided times. My Welsh heritage and working-class roots have always been important to me in trying to form my view of the world although my life circumstances now are very different from those in which my parents grew up. In my professional life the stories of lived experience have been of profound value in helping make some understanding of what it means to live with a mental illness and what needs to change if, as a society, we are to respond adequately to the needs of those affected by mental distress. It has been the opening up of stories of lived experience which has done so much to change the narrative about mental illness and raise its profile in our society. The lifting of stigma, like the lifting of a cloud, has made it clear that mental illness is an issue that effects every part of society. On the back of that attitudes have changed for the better.

There are other things where we are in desperate need of better understanding the experiences and views of others. The 2016 referendum highlighted, amongst many things, a big gap between the perspectives of places like London which had remained prosperous and parts of the country which had been left behind by the decline of traditional industries and the shrinking of opportunities, places which still had their sense of identity and pride which they saw as being treated with little respect by metropolitan elites. Judging by the last couple of weeks that division in our society has worsened rather than healed.

We need to find ways of better connecting our fractured country and to better understand the lived experience of those whose lives run in different currents. It’s interesting to note how much the post-world settlement created institutions such as the NHS, and indeed the European Union, drew from the shared experiences which were created by two world wars. On another front I am always struck by how different the attitudes of individuals can be towards the role of imprisonment in our society depending on how much direct experience they have had of that system.

Travel is one means of opening minds, although we need to be beware of our modern packaged tourism where we can too easily go to places and absorb nothing of the real lives which are lived there. Books, similarly, are crucial. Writers such as George Orwell had an immense impact in reshaping the narrative about poverty in the 1930s with accounts such as the Road to Wigan Pier. It is something which charities such as the Joseph Rowntree Foundation are trying to revive in making the case to tackle poverty in the early 21st century. Social media has its place although it can also lock us in our own prejudices.

There is a well known saying that you can not understand a person until you have walked a mile in their shoes. I have had a very small taste of that in the last couple of months. It’s something which we could all do with a lot more of.

Nurturing Children – the value of long-term work with young people

Nurturing Children

One of the difficult things in making the case for the value of long-term psychotherapy is the difficult of getting inside the consulting room. Nurturing Children, the latest book by Graham Music one of the Tavistock and Portman’s senior child psychotherapists manages to do this with great insight and humanity.

The book describes a number of long-term clinical encounters which Graham has had over the years and which illustrate a range of the issues and challenges which arise in working with young people presenting with complex emotional and mental health issues. The accounts are tinged with refreshing honesty, setting out the difficulties of the work as well as its successes.

There are four things I took out of the book which I feel have a wider relevance for the development of services for children and young people.

The first is quite how much this work matters. Disturbed emotional development and in particular the more severe presentations which can follow childhood abuse, neglect or other trauma create considerable distress and can often have a major impact on life chances, in some cases fuelling an inter-generational cycle of disadvantage. When looking at wider problems in society such knife crime, school exclusions or addictions, to name but a few unresolved issues of childhood trauma are often key background factors for many of those involved. As Graham states very clearly, he has never met a violent or psychopathic person in the course of his work who has had a normal childhood.

In describing the range of his work Graham makes a crucial point in highlighting the significance of emotional neglect and the levels of distress and difficulties that this can leave. This is particularly important for young people whose experience makes seeking and engaging with help particularly difficult and who, as a result, can be “doubly or triply neglected by professionals.”

The second is the clear message that for some young people there needs to be a commitment to long term work if real progress is to be made. At a time when there is a massive gap of unmet need there are clearly real tensions about how, within the resources available, it will be possible to provide enough care to fill the gap. As in work with adults, there are real benefits in providing well designed and scalable short-term interventions such as IAPT for those with more straightforward presentations. In some cases, and as know from the work which the Tavistock and Portman teams do with schools in Camden, there is a value in keeping some young people out of a clinical pathway altogether and meeting their needs through educational adjustments and other forms of support.

There are others, however, who need a longer term and more specialist response. Graham’s book brings out very clearly why this is the case whether because of the challenges of engagement with therapy, the level of distress, the difficulties in establishing the nature of the problem or the simple fact that in some cases progress is not easy.

In addressing the needs of the many we must crucial keep our eyes on the needs of those with more complex needs and the role which specialist practitioners such as child psychotherapists play in either treating those young people or supporting other practitioners do so.

In defining our vision for the expansion of children and young people’s mental health services we must not just focus on access and the quantum of treatment delivered. We must also, crucially, focus on needs and the outcomes we are achieving. For me this means we must retain a priority around young people with complex interventions.

The third fascinating part of the story which Graham tells of his work is an ongoing curiosity he has maintained for exploring different approaches to unlocking the distress of the young people he is working with. He is rightly proud of his roots in psychoanalytical training which he identifies as the strongest basis for “bearing the harshest of realities”. On top of this he has built other approaches such understanding the significance of body states, the use of mindfulness and Compassion Focused Therapy.

The final and, for me, most significant message is around the significance of the therapeutic relationship and the central value of empathy, a quality I have written about in another blog as the most important quality in any caring work. Graham sees the therapeutic relationship as “perhaps more important than modality at driving outcomes.” I am inclined to agree.

A good practitioner needs the right professional training and skills, but they also need a broader depth of human understanding which reflects quoting George Eliot” people from a life vivid and intense enough to have created a wide fellow feeling with all that is human.”

Graham brings out a strong message on the need for professionals to avoid taking a judgemental position and in the case of those who have done bad things to “be able to understand the victim and perpetrator.”

At the heart of working with those with difficult life experiences is the ability to build a new sense of hope and to reconnect traumatised young people with the “lifegiver” from which positive feelings and developments can flow.

So, I recommend this book for anyone interested in the mental and emotional health of young people. It is the kind of thoughtful story from the front line of care which both inspires but also some important questions about how we create the conditions for helping those with the greatest distress and most challenging presentations.

End of Empire

 

amritsar

I very much enjoyed, recently, watching Sathnam Sanghera’s brave and thoughtful documentary on Channel 4 on the 1919 Amritsar Massacre. Broadcast a hundred years to the day on which at least 379, and probably many more, Indians were killed by British troops under the command of General Reginald Dyer it provided an important opportunity to reflect on the consequences of this event and more broadly on the wider legacy of the British Empire.

The massacre fiercely divided opinion at the time. Defended by conservative opinion, it was strongly criticised by, amongst others, Winston Churchill, then the Liberal Secretary of State for War in Lloyd George’s Coalition Government. An inquiry was established to investigate the events which condemned Dyer’s actions. However, perhaps more than any other single event, it marked the point where Britain lost the moral authority to rule India. While both the Queen and David Cameron, when Prime Minister, have paid their respects at the site of the massacre Britain has never issued a formal apology for the massacre.

The programme made a stronger claim that the massacre and the subsequent acts of repression against the local population were not a one-off act of misjudgement but rather indicative of a wider pattern of institutional racism in the Raj. It highlighted the difficult and, often, unexplored issues which are wrapped up in Britain’s imperial past.

I had some awareness of these issues having had a great Uncle who was brought up in India at the start of the 20th century. His father and older brothers were involved in the administration of British India, in his father’s case as the Chief Engineer for West Bengal. He had, himself, left home in 1914 to sign up to fight in the First World War, married my Great Aunt and never returned. Nonetheless he talked a lot about his childhood in Calcutta and his insights into that world were fascinating although not always comfortable.

I am strongly of the view that we need to revisit more regularly the history of the Empire, not necessarily to judge it but, certainly to better understand it and to make sure we properly appreciate its consequences for how we set our path in the modern world.

From my great uncle’s testimony, I definitely heard of a regime which was based on a clear sense of the superiority of the white population and which supported all sorts of explicit, and probably more often, implicit acts of racism. At the same time, it also seemed to be a regime with some intent to do good, whether in the provision of security and justice or the provision of infrastructure. In India, perhaps more so than in other parts of the Empire, there was also some interest in native history and culture. My great uncle spoke Hindi and, while his attitudes towards Indians were those of a member of the ruling class, they were not without genuine affection.

So, what does all of this mean today?

First, we have to acknowledge more explicitly that we had an Empire and that Empires by definition, even if they also do some good, are about exploitation of other peoples and that the European Empires, of which ours was one, were also based on beliefs of racial superiority. We should not over judge our past, but neither should we ignore or deny it and we should, in particular, avoid a view that British imperial rule was necessarily better than that of others. Events such as the Amritsar massacre bring such a challenge into focus.

Second some of the lessons of the past should make us more sensitive to the need to prioritise issues of equality and diversity in our contemporary society. That means a total repudiation of the re-emergence of politicians and others who look to stoke up racial hatred and fear of others. It also means redoubling our commitment to deliver genuine quality of opportunity for those who have come to Britain form other parts of the world. As my own world of the NHS shows there is still a lot more to do.

Finally, there are implications for the debate about how Britain tries to position itself in the modern world. For me one of the most disturbing features of the Brexit debate has been the re-emergence of a sense of nostalgia for the Empire and the status in world affairs which the Empire gave Britain in world affairs. Talk of sending gunships to the South China Sea as our Secretary of State for Defence has recently suggested is very much in this vein.

For Britain, joining the EEC in 1973 was a recognition of the passing of our imperial past with our interests and identity now more closely aligned with our geographical neighbours. In this context Europe has provided a means of resolving our most difficult imperial legacy in Ireland.

If we do leave the EU and have to rethink our position in the world, we must at all costs avoid the paradigm of thinking this will, in any way, be a return to the days of the Empire. While there are many reasons to want to develop close economic and other links with the countries such as India which were part of the Empire, we have to recognise that the terms of doing so are now very different. Reflecting on difficult moments in our imperial past such as the Amritsar Massacre are a good place to start.