The last patient I treated was 105 years old. She has lived through two world wars, a depression and at least five pandemics. It’s a real honour to treat centenarians. They teach me much about life: how it is and how it ends. I can also lighten the mood with my 80-year-old patients by telling them that they’re still young. It’s common to hear talk about an ‘ageing society’ being some kind of disaster befalling the country. Yes, people are leading longer, healthier lives now than ever before. Is this really a ‘demographic timebomb’? I’d call it the greatest achievement of our time. When my patient was born in 1915, average life expectancy was about 55. Thanks in large part to vaccination, the postwar years lifted life expectancy at birth from 70 to just over 80. We became better at treating heart disease and other basic killers. To keep pushing progress, we need better medicine and science: to understand what works, and what doesn’t. Which takes me to my day job.
I’m a professor of evidence-based medicine at Oxford University, but work Saturday shifts as an emergency GP. This lets me see healthcare from both sides. Academics can make theoretical arguments for policy changes, but how does this affect patients’ lives? For example, rules on care-home visits were relaxed a few weeks ago. Nurses tell me it has made a huge difference; not just for morale, but for basic health. Patients with dementia can forget to drink, so if they get an infection they can easily die of dehydration. That’s why they need people to sit with them as much as possible to provide basic care.
It’s hard to imagine, let alone measure, the side effects of lockdowns. The risk with the government’s ‘fear’ messaging is that people become so worried about burdening the NHS that they avoid seeking medical help. Or by the time they do so, it can be too late. The big rise in at-home deaths (still ongoing) points to that. You will be familiar with the Covid death toll, updated in the papers every day. But did you know that since the pandemic, we’ve had 28,200 more deaths among diabetics than we’d normally expect? That’s not the kind of figure they show on a graph at No. 10 press conferences. For people with heart disease, it’s 17,100. For dementia and Alzheimer’s, it’s 22,800. As with Covid, people can die with multiple conditions, so they can fall into more than one of these categories. It’s a complicated picture. But that’s the problem in assessing lockdown: you need to do a balance of risks.
Evidence-based medicine might sound like a tautology — what kind of medicine isn’t based on evidence? I’m afraid that you’d be surprised. Massive decisions are often taken on misleading, low-quality evidence. We see this all the time. In the last pandemic, the swine flu outbreak of 2009, I did some work asking why the government spent £500 million on Tamiflu: then hailed as a wonder drug. In fact, it proved to have a very limited effect. The debate then had many of the came cast of characters as today: Jonathan Van-Tam, Neil Ferguson and others. The big difference this time is the influence of social media, whose viciousness is something to behold. It’s easy to see why academics would self-censor and stay away from the debate, especially if it means challenging a consensus. Academics who are tenured, like me, don’t have to worry so much about people pulling strings above us. This is the importance of tenure; it allows academic freedom. In a crisis, when tempers run so high, you need a variety of views more than ever.
I’ve worked every weekend since the pandemic (apart from when I went on holiday, and when I caught the virus) and the GP work is busier now in urgent care than at the peak. Perhaps people are less afraid that the NHS will collapse, so more willing to seek medical help. Sunday is supposed to be my day off, but last weekend I got a text saying: ‘We have a high demand on telephones. We would be grateful for any support.’ These messages are hard to ignore.
Over the last 15 years I’ve been to perhaps every care home in Oxfordshire. The quality of staff I’ve seen — in the big homes and small ones — has been nothing short of amazing. Those who work in our care homes really are the front line. But they rarely get proper credit for the work they do. Something like a third of Covid deaths have been in care homes, but how much of the £400 billion spent on the pandemic has gone into providing better care in these homes? When the pandemic is over, there will be plenty for the government to think about. We’re living longer: that, hopefully, won’t change. But how we care for these people: that has to change.
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