Re-imagining a post-Covid NHS

Editorial from our Autumn Journal of Holistic Healthcare – Beyond COVID

Professor David Peters, Editor in Chief

You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.

Buckminster Fuller

It must be more or less the pandemic’s first anniversary. On its birthday card I see the masks of drama – one face for humans fearful of others and believing in conspiracies, the other showing us caring for all beings and valuing science. Just as ever was, the future is being made today – and the next 10 years will define the future of life on Earth. What we believe now will determine the future we choose.

Though the climate fire alarm has been clanging itself off the wall since the 1990s, fear can be a demotivator. A couple of years ago we were being told to distrust ‘experts’, raise bigger walls on our borders, have faith in ‘the market’ and shrink the state. Now we are desperate for high-tech science to rescue us from a virus which knows no borders, and in many nations governments are pouring money into something very like universal basic income. While we sit at home, masks at the ready, should we wait for more and better medical science to ride to the rescue on a white charger? Maybe, except that science’s many silos have different signs on their doors, and in each one – as with the Sufi parable of the blind men feeling various bits of an elephant – the occupants describe their world in different ways. This is a convenient tactic for carving knowledge up the better to drill down into detail, but where health is concerned these bits of broken jigsaw puzzle tell a false tale. What we need now is a story that brings the parts together, like the underground woodland mycelium through which trees in an ancient woodland communicate.

The stark truth about human wellbeing is no longer the elephant in the room. Politics is no science but nor can it deny the connections between human, animal and planetary health: threads pulled from a tapestry woven of economics and mass travel on one side of the Earth warped the planet-wide weft of health. Expect more of the same as the planet heats up. Covid is really just a curtainraiser for the main show when, as is reliably forecast, the planet gets at least 2 degrees hotter. The Paris agreement aims to limit this to 1.5 degrees. Why? Because the recent IPCC reports with ‘medium confidence’ the terrifying statistic that ‘limiting global warming to 1.5°C, compared with 2°C, could reduce the number of people both exposed to climate-related [ed: health] risks and susceptible to poverty by up to several hundred million by 2050’ (IPCC Summary for Policymakers).

Will the future deeds of industry, politics and agriculture create global wellbeing or foster future plagues? Either way, business as usual is over. What then? Given all the above, and that greed, selfishness and apathy are all too human, climate emergency and social collapse pose far greater health risks than Covid. So now the horizons of public health stretch across a planet-sized canvas and our wellbeing depends not so much on medicine as on everything that supports climate and social justice, and whatever we can do to build social capital and environmental resilience. That’s why this

Beyond COVID edition of JHH presents ideas and actions that are re-imagining healthcare, from activist-authors who, while taking in the big picture, have kept their neighbourhood in view. Adversity a spur to growth? We had better hope so! Burnout spurred London GP Jane Myat to move from ‘what is to what if ’, and re-imagine her London NHS practice as a transition community hub. A similar dark night of the soul led Elizabeth Thompson to found the National Centre for Integrated Medicine in Bristol. We expect doctors to work ‘bio-psycho-socially’, something even harder to do during a pandemic in an NHS already overwhelmed by a fast-rising tide of chronic disease.

Betsan Corkhill offers useful hints to help us all do better. Medical student Lauren Wheeler’s pandemic experiences convinced her that the NHS should be nourishing mental health and healthy lifestyles. GP James Matheson reminds us that poverty and powerlessness undermine them both, and he highlights GPs’ potential for tackling them headon. Medical teacher and GP Louise Younie shares her concerns about helping health workers flourish in the difficult years ahead, a theme that is taken up in an extract from the College of Medicine’s 10-year manifesto. Here we see medical research re-imagined by distinguished Professors Steven Holgate and Debbie Sharpe; William Bird re-imagines human-nature connections, Sir Sam Everington sees ways of narrowing health inequalities, and Simon Mills says the NHS should target and support selfcare where it’s most needed. Post-Covid can we Build Back Better? We have to, so our centre spread features this important campaign. James Hawkins’ fascinating overview of psychedelic research and practice offers a radical vision of psychiatry re-imagined. David Zigmond wraps up this edition’s concerns in his metaphor for the NHS as an over-exploited monoculture, a dustbowl of a system thirsty for ecological renewal. Within this depleted landscape our exhausted NHS frontline will have to find ways for recovering energy and enthusiasm post-Covid. If they and ‘the public’ are to flourish, the next version of the NHS would do well to heed Dr Z’s call for it to localise, de-industrialise, re-humanise, build health and restore personal care.

© Journal of holistic healthcare Volume 17 Issue 3 Autumn 2020