After The Great Pause

During lockdown our kitchen was at full steam, flour availability permitting, producing cakes, chocolate biscuits and bread. But we ran into a problem. A cupboard door wouldn’t close properly because a spring had broken. The search to find a replacement part discovered weaknesses in UK manufacturing but also created thoughts about its future after the Great Pause.

With some instructions off the web and pressing a few clips I took the broken part out of the cupboard. It was a spring made in Germany. After deciphering a few symbols I headed back onto the web and found a few stockists in the UK. But when I approached them I received the standard get out reply of “we no longer have these in stock.” I eventually contacted the original manufacturer in Germany and ordered a new part that would take four to six weeks to arrive because it had to be made to order. Curiosity took over and I wanted to find out of if there were any UK manufacturers of equivalent springs. I found a few companies that supplied them to the motor and aviation industry but they didn’t appear to have any for a kitchen cupboard. What has happened to the manufacturing capability in the UK?

Manufacturing was once the bedrock of economic activity in the UK but has slowly declined over tens of years. In 1952, it produced a third of the national output, employed 40 per cent of the workforce and made up a quarter of world manufacturing exports. Today, manufacturing in the UK accounts for just 11 per cent of GDP, employs only 8 per cent of the workforce and sells 2 per cent of the world’s manufacturing exports.

The current Covid-19 pandemic has emphasised the weakness in UK manufacturing with our inability to produce medical equipment for frontline workers. However, there are signs of hope as it quickly responded to the pandemic with many companies, large and small, coming together to manufacture ventilators, PPE and hand sanitisers. This flexibility has shown that there is still some life in UK manufacturing and is the basis for building itself a stronger future.

When lockdown starts to ease there is another greater challenge facing us. Climate change, like Covid-19, will affect us all. Lockdown has given an insight into what a green future would look like with reductions in carbon emissions and reduced carbon miles. But for many industries once the pandemic is under control it will not be back to ‘business as usual’ because they will have to rebuild against a background of new demands. Now is the time for UK manufacturing to turn green and rebuild itself to lead the way in combating climate change.

There are many new areas that manufacturing could exploit so that it can rebuild itself. One area that has been highlighted during the pandemic is medical equipment. The UK imports around 40% of its medical equipment and given its strategic importance for future pandemics then there is an opportunity for manufacturers to increase its production in this area. Another area is the development of new medical equipment ranging from robotic surgeons to quick home tests for diseases. Transportation will require a massive switch to electric powered vehicles in all their shapes and sizes. There may be opportunities for new types of vehicles such as unmanned small vans that can deliver goods from local suppliers to doorsteps which would reduce carbon miles down. The UK produces about 60% of its own food. Manufacturing could develop new equipment to plant and harvest vegetables which will be in greater demand as consumption moves away from animals. New technology could be integrated into manufacturing processes to make them more adaptable for changes in demand for example 3D Printing 1. Another example is the future design of equipment could include re-cycling so that old parts are returned to the manufacturer to be used in new equipment.

However, the changes required to rebuild manufacturing will take some time and therefore can not be left to market forces because they are too short-term. Government intervention is required to provide a framework for the regeneration of manufacturing. There are many forms that its policies needs to take. First government policy must have a stronger green element to drive manufacturing towards a green economy. Policies need to reduce cheap imports which ultimately export jobs which has undermined UK manufacturing for many years. If ‘cheap’ goods are demanded then government policy should encourage the development of skills in automation and robot systems to systems that will reduce the production of the goods.

Another change in government policy is education. It needs to be radically overhauled with a stronger emphasis on STEM, biology and the environment. The education system should integrate the arts into the design so that whatever is produced enhances the environment that we live in both physically and emotionally. Their policy must include re-training for people at every stage of their lives so that for those who are interested can stay up to date with the latest manufacturing technology.

Although the manufacturing industry accounts for the majority of R&D expenditure in the UK (65% in 2018), this is down from 84% in 1985. Universities should concentrate on teaching and research and not include spin-offs for new technology which has only been partially successful. If the research shows any promise for new technologies then it can be transferred to something like the government’s Catapult Network where business could get free access to the technology if they meet certain criteria. For example, the business should demonstrate that it is strong enough to sustain a shock in its earnings, as is happening during the Covid-19 pandemic, before they get access to the new technology.

UK manufacturing response to the pandemic has shown that there are signs that when the Great Pause is over it can have a stronger future in building the green economy. And next time I have a breakdown in our kitchen I can return the part to a UK manufacturer for repair!

 

1. For an in-depth guide about 3D Printing then see: 3D Printing / Additive Manufacturing Using Polymers - Complete Guide

The Future Of The Equation \(R\)

A simple equation has changed the way that we live. It is having a greater impact than any of the ground breaking theories from science. The reproduction number \(R\) is being used to change our behaviours to reduce the spread of the Covid-19 virus and will leave its mark on us well into the future.

Governments around the world are using \(R\) to guide their actions in controlling the spread of the Covid-19 virus. The version of \(R\) that they are using is the “basic” reproduction number, \(R_0\) ( or \(R\) nought) and it is the situation when when no one has been vaccinated, no one has had the disease before and there is no way to control the disease. Calculating \(R\) is a complicated process but comes down to three components: how long a person is infected, how often they come in contact with others and how the disease is spread. A long period of infection will increase the value of \(R\). If a person comes in contact with lots of people then they increase the value of \(R\) as well as how it is transmitted for example airborne diseases will give a higher value.

The value of \(R\) is used to assess the contagiousness of a disease. For example if \(R\) has a value of 2 then one infected person will pass the virus onto another two other people who in turn will each pass it onto another two and so on. If \(R\) is less than 1 then the spread of the virus will decline. Calculating $R$ requires complex mathematical modelling, lots of data and powerful computers which results, at best, in an average for its value. For example $R$ has a value of between 1 - 2 for the common cold, SARS is 2 - 5, and at the early stages of Covid-19 it varied between 1.4 - 5.7. The UK Government’s action plan is aimed at reducing \(R\) by breaking the transmission of the virus with regular messages by washing hands, enforcing social distancing and a lockdown for non-essential workers. Early signs, but unconfirmed, is that \(R\) could be between 1 and 0.5

But it is the impact of reducing \(R\) which is having a dramatic impact on our lives. Health and Social Care systems are having to respond to the virus in ways that were never expected as they fight to save as many lives as possible. Non-essential parts of the UK economy have hit a brick wall while other sectors plummeted to their lowest levels of activity since records began. There is a similar picture around the world which is slowing global trade and will ultimately reduce economic activity in national economies. The response of governments to the pandemic is starting to raise fundamental questions about how we live and work. How will those people who are identified as key workers be valued in the future by society? Will government intervention in the economy during the crisis remain for many years ahead? Is their proposed tracking and tracing app a step too far in monitoring society? How much do we really know about the human body and how it works and how its it translated into medicine Will the growth of the digital economy accelerate through on-line entertainment and delivering more goods to our doorsteps but will it go on to change the type of work? Are the days of commuting over? Will on-line learning become an integral part of education? Will the remote monitoring and support of patients be a few clicks from a doctors desk? Should the length of supply chains be reduced to within our shores and we make more of our own products so that we can respond quickly to future crisis?

If \(R\) had stayed buried in technical papers and and discussed in specialist conferences with the occasional discussion at a government strategic committee then we would never of heard of it. But now it has made its way into everyones lives, through the actions of governments, then lots of questions are bubbling to the surface. The longer that the fight against Covid-19 goes on then the greater the public will require action in answering these questions.

Over a century ago Einstein’s equation \(E=mc^2\) was brought to the publics attention which heralded the start of a revolution in our understanding of how the universe works, from planets down to the quantum level, which created the technology that has shaped our lives. \(R\) has signalled the start of another science revolution but this time it will be in our understanding of how we live together and down to the level cell activity s which will change our future.

The Sustainable Consumer

At a recent meeting of the World Economic Forum in Davos, HRH Prince of Wales delivered a keynote speech about combating climate change. In the speech one statistic caught my attention: “With consumers controlling an estimated 60% of global G.D.P., people around the world have the power to drive the transformation to sustainable markets.” As a consumer do I really have the power to change the world for the better?

The speech was aimed at governments, businesses and other organisations and was strategic in nature but what is needed is a translation from the high level ideas into to what it means for how we spend our money. The first question that I asked was do I really control 60% of my income? A quick back-of-the-envelop calculation using some average numbers: the UK’s Gross Domestic Product for 2019 was £2.21 trillion pounds and the total tax receipts including VAT was £821 billion pounds which gives around 63% which was left for us to spend as I wish. However, there are certain things that we have to purchase by law for example car insurance and TV licence, and other requirements e.g. house insurance, therefore very roughly it is correct that we control how we spend 60% of our income.

The next question is what exactly is a sustainable market? After all isn’t growing food not sustainable? The farmer grows a crop and holds back some seed to grow the crop the following year. Is that not a form of sustainability? However, with increasing mechanisation and automation in agriculture, with its subsequent increase in the Carbon footprint along with overworking of the soil ( which the experts claim that we only have around 60 years of harvesting left ) it is not as sustainable as I thought. A quick web search produced the following description for sustainable markets: “can be loosely defined as those that contribute to stronger livelihoods and more sustainable environments. In linking with the pursuit of ‘sustainable development’, such markets have a multiple focus on social, environmental and economic outcomes. Sustainable markets aim to reflect the true costs (or externalities) of natural resource degradation, environmental pollution, and promote just and safe labour practices.”

But how do I know that the goods and services that I purchase are sustainable? There are two aspects for any goods or services: how the item is produced and how we consume it. For example buying a DVD: how sustainable is the method of manufacturing, sales, playing it and its final disposal? The same question can be asked about each item that we purchase which can cover hundreds of products and services) ranging from a cup of coffee to holidays. The operation of national and local governments and organisations such as charities can fall under this question. The Prince of Wales emphasis this point in his speech “ … we cannot expect consumers to make sustainable choices if these choices are not clearly laid before them. As consumers increasingly demand sustainable products, they deserve to be told more about product lifecycles, supply chains and production methods. For a transition to take place, being socially and environmentally conscious cannot only be for those who can afford it. If all the true costs are taken into account, being socially and environmentally responsible should be the least expensive option because it leaves the smallest footprint behind. We must communicate better with consumers about the sustainability of the goods, services and investments we offer.”

The Prince of Wales’ keynote speech outlines a ten point plan to achieve sustainable markets which I believe will be a start to combatting climate change and I hope that governments, business and other organisations start to implement ASAP. In the meantime I shall be taking my spending power and asking questions about the sustainability of the products and services that I buy - I will keep you up to date with what I find.

Men Hooked On Health

A TV fishing series has opened up a conversation about men’s health. But is it all talk?

The TV series Mortimer & Whitehouse: Gone Fishing shows the comedians Bob Mortimer and Paul Whitehouse try, with mixed success, to catch a particular species of fish for example the beautiful coloured brown trout or the mighty carp. Each episode takes them to a scenic river or lake in the UK where they spend most of the day fishing. During the long periods of sitting waiting for a fish to bite they crack jokes, mess about and discuss life’s great problems. The TV series has had an impact on men. I have lost count of the times when I mention that I am an angler there is a reply: “have you seen Gone Fishing?” which is an opener for a discussion about fishing and men’s health. But is there any science to back up the claim that fishing can improve men’s health?

The statistics for men’s health in the UK makes grim reading: 68% of men are overweight and 14% of men have untreated high blood pressure. The statistics for men’s mental health has worsened with 37% admitting to regularly feeling worried or low in 2009 to 43% today.

Although on the surface, fishing doesn’t seem to be as active as cycling, swimming or football, there is more going on than meets the eye. Studies have shown that there are many benefits from standing in the fresh air: boosting the immune system and increasing levels of energy. Fishing also includes the challenges of how to reach the river bank with rods, nets, bait etc. and trying not to fall in! Carrying equipment strengthens muscles and improves heart health. Walking over the rough surfaces of a river bank or around a lake has been shown to improve balance and coordination.

Apart from the physical benefits there are mental health benefits to be gained from fishing. Scientific reports have shown that fishing provides a perfect stopgap measure for dealing with short-term stress. Also, in a recent study, a team of researchers found that combat veterans had significant reductions in stress and post-traumatic stress disorder symptoms along with improvements in sleep quality after participating in fly fishing. Also, studies have shown that connecting with fellow fishers and belonging to a club, and [learning new skills]((https://www.nhs.uk/conditions/stress-anxiety-depression/learn-for-mental-wellbeing/) can boost self confidence and improve mental health.

In summary there are lots of scientific support for the physical and mental health benefits from fishing for men. Therefore my call to the medical professionals dealing with men’s health is that instead of reaching for a programme of drugs, or activities with strange sounding names, why not prescribe some fishing?

Bob and Paul may not catch many fish during their TV series but they have caught the attention of the wider public and men in particular. Let’s hope that the discussion continues and develops into concrete action to improve men’s health.

A Tale Of Two Consultants

I have reached an age where urinary infections are impacting on my quality of life. But my recent experiences with managing the problem has highlighted inconsistency in the urology expertise of the NHS.

I have been troubled for many years with Urinary Track Infections ( UTI ) because of an enlarged prostate. After a particularly bad infection which developed into Prostatitis I was put on a bag catheter and then eventually moved onto Intermittent Self Catheterisation ( ISC ) to reduce the risk of any further UTIs.

My story starts with two consultants at different hospitals. Let me label them consultant A from the Urology Department in one hospital and consultant B from the other hospital. After recovering from Prostatitis an appointment was made with consultant A for further tests and to discuss the best way to manage my health problem. When I met with consultant A he advised me to stop using the catheters. Life settled into making sure that I was drinking enough water and carefully marking out the location of public toilets! The situation was tolerable and I was beginning to feel that this was the new normal. When I left the consultant I made an appointment to review the situation in six months time however the hospital cancelled it closer to the date. When I hadn’t received a date for an appointment I contacted the hospital’s help line to be told that they hadn’t forgotten about me and I was still on the waiting list. After about 18 months and with no signs of an appointment with consultant A I discussed the situation with my GP and asked to see another consultant who had helped me in the past and I was switched to consultant B. I received an appointment within a week and if I hadn’t been travelling abroad I would have seen him before the month was out. Two long haul flights later and I came down with a bad UTI which required 3 weeks on antibiotics by which time I was on my way see consultant B. In consultant B’s Urology department I we went through a series of tests and a questionnaire about how the medical problem was affecting the quality of my life. During the consultation I explained what had happened over the last few months and then consultant B explained that I had been sitting too long and should have used my catheters. He then went on to explain why I needed to use the catheters for the rest of my life and how they ensured that my bladder was emptying. When I was leaving I asked if he wanted to see me on a regular basis for example annually he replied that that would not be necessary because he felt that I was competent enough to manage the situation.

Under the new catheter regime looking back I realise that I probably had a low level urinary infection since I saw consultant A. I now feel a lot better and the inconvenience of using the catheters is insignificant when compared to the improvement in my quality of life.

Looking back over my experience with both consultants I realise that I had assumed that the level of expertise of urology consultants across the NHS would have been approximately the same. I say ‘approximately’ because I realise that due to the complexity of the human body and we all have different medical histories. However, I felt that my condition was not uncommon in older men and therefore the diagnosis and medical support should have been the same.

So what could have contributed to the difference in advice? Lack of resources between the two hospitals could have contributed to the difference in advice with consultant A not having enough time to analyse the test results and have an in-depth discussion. There could be a wider issue of the organisation of Urology departments which are under increasing pressure from changing employment contracts, a challenging on-call system, changing training requirements as well as the increasing threat of litigation. All of these factors could have contributed to the difference in advice. However, I think that the difference comes down to the approach. Consultant A viewed my medical problem as a problem where he prescribed the appropriate solution a bit like a mechanic fixing a problem on a car. Consultant B looked at the problem from the patient perspective and by increasing my knowledge of the underlying problems and taking the time to explain why the course of action would improve the situation. Consultant B took a patient centric approach where I was seen as part of the solution.

I remember listening to a surgeon on the radio where he said that curing medical problems boils down to two approaches: medicine or surgery. We automatically think that medicine comes in a bottle or a tablet, but it could come in the shape of knowledge, and it is how it is applied that makes the difference.

Big thanks to the Nurse who helped me overcome my fear of inserting a catheter as well showing me a few ‘tricks of the trade’, both urology consultants and their staff and my GPs for their on-going support.