Prof Hugh Montgomery – Written Evidence (LBC0037) 

 

 

Longterm Implications

 

Response to call for evidence

Prof Hugh Montgomery MB BS BSc FRCP MD FRCS FRI FRSB FFICM

Professor of Intensive Care Medicine

Co-Chair, Lancet Countdown on Health and Climate Change

 

 

Positives

Healthcare Transformation

a) The Covid crisis triggered a sudden transformation in use of technology- with e-consultation and telemedicine

b) Whilst many sick people lost their lives through not attending hospitals, the massive scale of overuse of health services for trivial complains was made obvious: hospital emergency departments were largely empty

c) At last, we saw rational decision making about use of Intensive Care beds. Previously, we were forced to accept elderly, demented and bed-bound patients in their 90’s. This ceased.

 

Public Health

The scale of savings which could be made through new public health and social policy were clear.

a) With the lack of heavy drinking in bars, car crashes/ stabbings/ fights/ falling down stairs and escalators whilst drunk all but disappeared, and trauma units saw a >90% fall in attendance.

b) The air was free of pollution. Admissions with chronic obstructive pulmonary disease and asthma plummeted.

c) Smoking rates fell dramatically

d) Reasons to be lean and not obese were augmented by awareness of the Covid risk.

e) Some people engaged in more regular exercise.

f) Lack of use of public transport increased bicycle use.

 

Administrative issues

In health care delivery and research, we have been utterly paralysed for years by massively over-burdensome red tape. ‘Streamlined ethics’ changes a decade ago were a disaster for university research and for industry. Covid accelerated the process.

 

Social Care

For the first time, the public understood the need for social care workers- and just how p[oorly paied they were

Recognition of social care workers

Public Health

 

Awareness of poverty and inequality

This was revealed most starkly cf ‘key workers’

Reduced Carbon Emissions

High-carbon living fuelled Covid, with mass air transport spreading it, and high energy (fossil fuel-dependent) food intakes, and fossil-fuel-powered car transport driving obesity. We need as reduction in emissions of 7.8%/year this year and every year, with no time to waste. With increased public awareness, and acceptance of limitations, now is the time to seize this opportunity.

 

An opportunity to rethink policy

As an example, HS2 will cost >£100bn- the same as the cost of the furlough scheme. But the rationale for building HS2- the neeed to increase capacity for business travel to the midlands- is now gone. Such travel will not return. This is a ‘get out of jail free’ card to stop an environmentally destructive and broadly unpopular investment.

 

Most Worried About

a) That we will revert to business as usual, not driving on with healthcare reform and an emphasis on public health.

b) The Economy. Without a new vision of ‘what Britain is for’, all is lost. We cannot revert to stimulus packages based on ‘what we did before’.

c) The University sector. Erasmus Plus will go, and with it students from the EU. Foreign university students are unlikely to return in numbers. Funding bodies will all have less research money.

 

 

Hopes

We need joined up policy, as all the issues which would be ‘good for us all’ are interlinked and readily explained. We need to embed funding public health in a non-siloed way. Thus:

a) Actively and aggressively restrict private car use. As a stimulus package, build cycle ways and cycle parking. Build walking routes. Make shopping centres readily accessible in this way, and also schools. Support locally grown vegetable production. Thus, road maintenance costs fall. Risks of obesity, diabetes, stroke, heart attack, peripheral vascular disease, falls, dementia and many cancers fall. Road traffic accidents and pedestrian injury fall. Less urban pollution means less lung disease. All of these actions also lower the risks of climate change.

b) Make air travel a ‘luxury’ and hard-bake this. Future disease transmission is better regulated. Climate change risks fall. Monies are retained in the UK holiday sector.

c) Bake in other public health initiatives. Covid has meant that there are 1m fewer UK smokers. Drive up the tax now and restrict access.

d) We have a dangerous drinking culture in the UK. Don’t just revert to driving people to bars.

e) Address inequality. We need social care and other ‘key workers’.

f) Create a new vision of ‘what Britain is for’ in the world. With the expertise in STEM (business and academic), make Britain a ‘special economic zone’ for green-tech development, thus encouraging external investment and retaining our brains, whilst supporting the UK University Sector.

g) In terms of other ‘stimuli’, if we do end up with mass unemployment, create paid work in creating green infrastructure and planting trees (all good for mental and social health, exercise, and inequality).

h) Remove research red tape radically. Convene a quick expert group of those who USE the system (researchers and big pharma) and simplify it.

 

15 July 2020