Owls and Larks; there’s no time for sleeping, we have a job to do!

This past week, I have been really feeling my age. My long weekend trip to Vancouver to see The Rolling Stones, whilst very enjoyable, left me with the worst jet lag I have experienced in many a year. The 4,522-mile return journey home saw me flying East to West, which added to the problems of my body clock adjusting to the time differences. I’ve been tired and exhausted and found it difficult at times to concentrate. As I write this, I’m beginning to feel more like my normal self and when all is said and done, the concert was simply brilliant and well worth the effort. Thankfully, my body clock appears to have reset itself.

I have been an early bird for many a year. I don’t have an alarm clock and it doesn’t matter what time I go to bed, I always wake up ready to start the day before 4.30am. I do so every day. I was amused to read yet another story, last week, that looked at whether night owls or early birds have ‘superior cognitive function’. There is no definitive evidence one way or the other. The research looked at peoples’ reasoning, reaction time and memory function, and they found that night owls did better across all these areas than early birds. However, it was folk’s sleep patterns that really made a difference. The quality and duration of someone’s sleep are the factors that affect our brain performance. Research suggests that we need between seven to nine hours of sleep each night for our brains to remain healthy and functioning effectively.

There are exceptions to the rule. Famously, Margaret Thatcher, Winston Churchill and Barack Obama thrived on very little sleep. I have thrived all my adult life on five to six hours sleep a night. On the other hand, J does just as well when she enjoys seven to eight hours sleep. We are both active, do jobs that require us to use our brains more than our hands and we both write, play music and enjoy trying to beat each other at University Challenge. Clearly, the amount of sleep we require is a very individual thing.

Now I don’t know if our new Prime Minister is a night owl or an early bird. He will have, like me, I’m sure, had to deal with some jet lag given his transatlantic travels last week. What I do admire is his steadfast decision to try and avoid any work-related activity after 6pm on Fridays. I understand this is partly to do with his family’s faith, partly to do with being present for his family and partly to ensure a healthy work-life balance. I’m not being political when I say that for someone in such a high public office, he is setting a great example for the rest of us to follow.

Amanda Pritchard, the current NHS England Chief Executive, reminded us all last week that in the 76-year history of the NHS there have been 18 Prime Ministers, 34 Secretaries of State for Health and yet only nine changes of government since 1948. However, every change of government has at some stage, tried to ‘reform’ and in so doing, improve the NHS. Those of us who have been around the NHS for many years have become adept at navigating the various changes that have been introduced.

I vividly remember the elections resulting in the change of government in 1997. I had just completed the first data collection of my PhD. My participants were GPs and other primary care colleagues who were working in what were known at the time as GP Fundholding Practices. These operated in a so called internal quasi-market made up of purchasers and providers of health care services. Frank (Father Christmas) Dobson, one of the jolliest Secretaries of State for Health we have ever had, declared an end to the internal market. Considering the whole set up formed the basis of my PhD, I was pretty devasted. But I carried on. Whilst the internal market was disbanded, and GP Fundholders abolished, the subsequent establishment of Primary Care Groups (PCG) happened over the following two years. By this time, I had been able to modify my study and was able to complete my doctorate in 2000.

In 2001, PCGs were replaced by a fewer number of Primary Care Trusts, later to become Clinical Commissioning Groups in 2013. These too disappeared in 2022, being replaced by Integrated Care Systems that bring together health and social care services. Interestingly, there were two main protagonists who started this change process back in 1999. These were Frank Dobson’s successor, Alan Milburn, and the political strategist and advisor, Paul Corrigan. I don’t think I have knowingly met Paul Corrigan but I did once meet Alan Milburn in a first-class train waiting room, but that was over 20 years ago. I say interestingly, as Wes Streeting, the new Secretary of State for Health and Care has brought both of these folk in as advisors to help him tackle the issues facing the NHS. I never like to use the R word when it comes to the NHS, but I’m sure there will be changes to come yet again. They did it once and I’m sure they will do it again.

Indeed, some of these have already been signalled: moving care out of hospitals and into primary and community care; better use of technology and data; and boosting prevention and reducing health inequalities. Thankfully the discussions have put children’s health care, and mental health care front and centre in these plans. Like my jet lag recovery period, only time will tell how quickly the NHS can move forward in tackling the challenges and once again better meet the needs of our communities and the folk who live in them.