Walking 35km to West Hampstead

This was a variation on a theme but it has never worked so well before!

The simple aim was to get to West Hampstead around 6pm for the monthly BCSA Get to Know You social taking as many steps as possible. And as I had a reason to leave the house around 10:30 I had a lot of time to do that.

The first part of the journey, as far as Southall (north side of Osterley Park), was driven by PokemonGo and the few target gyms that I have in that area.

After that it was a simple (!) matter of finding new ways to walk to West Hampstead in the time available.

My CityStrides LifeMap shows the roads that I have walked previously and all I had to do was avoid those whenever possible. Of course that was not always easy, or possible, as the significant constraints like railways, major roads, rivers and canals, have limited crossing points and so I kept been drawn into familiar territory before crossing the obstruction and then picking a new route from there. 

For example, the little bulge in the top left of the route was me walking to Wembley Central station to cross the railway lines.

As always, one of the great joys of deliberately walking along new roads is you find new things and Alperton was something of a revelation in a couple of ways. The area by the station has become swamped with nondescript high-rise blocks (bad) and around the corner there is Shri Vallabh Nidhi Hindu Temple (good). 

I had walked to West Hampstead via Wembley a few times previously so had walked all the obvious west-east routes before and that forced me to walk north-south a few times to hit new territory. That was expected and it was good to find things like Wembley Brook.

Soon after crossing the North Circular, and setting a new record for the number of pedestrian lights I had to wait for to cross one road, I came across BAPS Shri Swaminarayan Mandir, also known as Neasden Temple.

While walking, I was mostly following my LifeMap to find new roads but I was also checking Apple Maps to see how far away I was on foot from West Hampstead so that I could time my arrival, I walk at 6km/hour which makes the maths very simple. I made one final turn north towards Dollis Hill from where it was almost a straight line to the finish.

I arrived in West Hampstead just a few minutes before 6pm (seven hours after starting out) perfect timing.

I had objectives targets for this walk (steps, PokemonGo, new roads, arrival time) and I achieved every one of them. A perfect walk.

City of London churches and more

Over the years I have got very used to being the one who plans the regular walks that I do with a friend, either I plan absolutely everything or he comes up with a rough idea and I have to turn it in to a route with suitable start and end points and a reasonable walking distance. This was one of the later cases.

While I mostly worked in Central London he was in places like Libya and Angola so he likes walking in London to discover places he does not really know and where I seem to have been to every pub. His idea this time was to visit churches in City of London.

That meant joining the queue of old gits at Richmond Station waiting for the barriers to open at 8:57 to catch the tube. We went all the way to Tower Hill to start our exploration on the east side of the City.

This time I had not done a detailed route and it was just a question of looking for the nearest cluster of churches and heading that way, there being no obvious route between them.

Where possible, we went inside which is something I had never done before so I was discovering something new too.

I forgot to checking on to the first few churches on Swarm but I did do the final nine so I knew that we went to some places with great names, including St. Botolph without Aldersgate, St. Vedast-alias-Foster and St Sepulchre-without-Newgate.

We had a coffee break in the one below, St Mary Aldermary.

This is also one of the several places where either we got lost or the church did. The maps show that Saint Nicholas Moldavian Church is next door but we walked all away around the block and could not find it. The two churches may be sharing one building, as we found elsewhere but there was nothing obvious to show this.

I am nothing like an expert on churches but I was pleasantly surprised at how varied and interesting the interiors were. The stained glasses were my favourites and I also appreciate grand architecture. There were several surprises to, such as the statue by Damian Hirst of St Bartholomew being skinned alive in St Bartholomew the Great (we failed to find St Bartholomew the Less).

The mural below is in St Alban the Martyr, a somewhat hard to find church in Holborn.

Somewhere along the way, St Lawrence Jewry I think, a helpful guide gave us a paper copy of the map at the top, which would have been very helpful a couple of hours earlier!

We saw enough in our haphazard wanderings to tempt us back to look at more churches, we only saw around 15 of over 50.

Our walk took a more usual course after that and we headed more or less due west to Hyde Park and the ever so familiar Serpentine Cafe for lunch.

My friend had to leave at that point and I took the opportunity to tick off some more roads in Kensington and Chelsea.and I surprised myself by completing 40 new roads in under two hours. A great way to end a fun series of walks.

Hawklords at 100 Club (10 Nov 24)

I have absolutely no idea where time goes! I would have sworn blind that I last saw Hawklords in spring 24 but my calendar is pretty convinced that it was in October 23.

It also told me that the first time I saw them was at 100 Club in November 2014 so this was something of a tenth anniversary. It was also my fifth time of seeing them at 100 Club and the eighth time that I have seen them altogether.

I guess that makes me a fan, certainly enough of one to pay £25 to see them play live again.

Travel worked well and I got to 100 Club just before the 7:30 opening time and joined a couple of dozen of similarly aged people, mostly men.

Getting in early got me the place I wanted at the front next to one of the annoying pillars.

The support band, The Galileo 7, entertained mightily with a distinctly British but hard to categorise sound. They describe themselves as "psych-pop", which works.

This Hawklords was the same lineup as last time with Jerry Richards on guitar and vocals, Mr Dibs on bass and twiddly electronics, and Dave Pearce on percussion. Being a three-piece is not ideal for 100 Club which has an extremely wide stage so they were well spaced out and there was a notable gap in the middle where a front man would have been.

That gap was filled for some songs by Capt Rizz, also a former member of Hawkwind, who made quite a difference with his movement, outfit and singing. 

Hawklords had anew album to promote, Relativity (the appropriate sequel to "Time" and "Space") and I assume that most of the songs that I did not recognise, and there were a lot of them, came from this. I did recognise the occasional Hawkwind classic, e.g. Brainstorm, that made it into the set but these did not differ musically,

I enjoyed their previous gig, at The Forge in Camden, even though it seemed to lack something, perhaps the sound was not quite right or perhaps the venue was too bright, and at 100 Club those niggles were absent and the concert was truly excellent throughout. Even the audience, which can be problematic at times, were on top form.

Hawklords have settled into a nice rhythm with the current line-up and songs and I'll remain a fan for as long as that rhythm continues.

16km from Whitehall to Clapham

I was in London for another National March for Palestine and I combined that with some general walking and some new roads to add to my CityStrides LifeMap.

I love CityStrides but it is built on map data from Open Street Map (which I also love) and, for reasons, that does not distinguish between, say, High Street Kingston and High Street Richmond and so you have to walk every High Street in Greater London for it to count as a completed street. Of course there is no problem when streets have a unique name like Lennox Gardens Mews!

Despite that difficulty in completing roads in London I managed to add 31 roads to my total making it 6,022 London roads completed, which is 15%.

Most roads have several nodes, including the two at each end, and there were another 47 roads that I walked part of, most of which I do not ever expect to complete. But perhaps one day ...

CityStrides also keeps totals for each London Borough (where there are far fewer duplicated roads) and on this walk I pushed my completion rate for Wandsworth to 38% and Lambeth to 15%. I really need to go to those places more often.

The National March for Palestine explains the straight lines at the top of the map and the hunt for new roads explains the wiggles in the middle. For the final section I took a fairly direct route to Clapham Junction Station but still managed to find a couple of new roads.

Of course walking new roads is about far more than just ticking things off on a very long list, it is about discovering new things.

And this new things was a great discovery.

If I was not walking every part of every street in that area then I would never have walked around Carey Gardens Housing Estate and I would not have found this mural by local artist and activist Brian Barnes. Called "A Brief History of Time" it has lots of (mostly) local references, including Stephen Hawking in the top left.

There was other street art and interesting estates, some fine middle-class homes in Clapham Manor, some impressive Victorian schools, and a few green spaces.

It was a good walk.

National March for Palestine (2 Nov 24)

It is depressing that more than a year on it is still necessary to march in large numbers to try and get our government to understand that actively participating in Israel's genocide is a bad idea. I am prepared to keep marching for as long as it takes and I was joined by over 100,000 who think the same way.

The routes vary a little and this time we started in Whitehall crossed The Thames at Vauxhall and finished at the American Embassy at Nine Elms. As a simple walk (ignoring for the moment the purpose of the march) it was a good route with wide roads all the way and only one pinch point (by Vauxhall stations).

That meant passing Houses of Parliament which was good for the politics and also because we were seen by plenty of tourists and visitors too, these are public demonstrations for a reason and I prefer it when we march through busier areas.

The next march is scheduled for Saturday 30 November.

The Crazy World Of Arthur Brown at Dingwall's

I am neglectful and do not always get around to posting about converts that I go to but, even so, this is the fourteenth time that I have done so since this blog started in 2006.

Over those almost twenty (!) years I have seen him at many different venues and with many different musicians and this was the my first time at Dingwalls and the third time seeing him with this band.

Dingwalls is a pretty basic venue and while I am sure that it is fine for your standard no frills guitar band it was not great for a show as visual as this. That said, I soon got used to the heads hiding the lower part of the stage and I could hear the music perfectly.

The show, unsurprisingly, followed the format of the Eel Pie show in April bot musically and artistically though there were changes. If I ever took notes and if Setlist was a complete and faultless record then I could be more certain on the extent of the changes but I think that the back projection was more extensive (and the two statues downgraded as a result) and the formerly regular song "I put a spell on you" made a return as the final encore.

I think there was a change to the set order too and I liked the way that (new version) Time Captives ended the main part of the set. Not only is it my favourite Arthur Brown track, originally recorded as Kingdom Come, but the communal singing of the "La Da Da" ending is a perfect ending.

The only disappointment is that I do not have another Arthur Brown concert in my diary yet.

NHS appointments are a mess

There has been much discussion recently about fining people for missing NHS appointments and the consensus seems to be that people have no excuse for missing them and it is only fair that they should pay a fine when they do so. 

My experience suggests that it is quite easy to miss them, because the appointments system is a mess, and my situation is much simpler than many people's.

I am documenting my views here so that I can easily share them as and when required, starting with the hospital's Patient Advise Liaison Service.

My appointments cycle

I have one underlying condition that is being managed by one hospital. I continue to see my GP for other things like the recent flu and Covid booster jabs.

This condition means that I need to see one consultant every three months and another every six weeks with the second visit followed by a treatment session the following day. I also have two scans every other treatment cycle, i.e. once every twelve weeks, which are done at a separate site.

That means that at any one time I have five future appointments booked.

Different appointment systems

The big problem is that there is no consistency in how these are managed:

• For the two consultants appointments I get paper letters and they also appear in the NHS app, which means that I get automated reminders by text
• For the two scans I get paper letters but nothing else
• For the treatment sessions I have an appointment card (!) which gets updated by hand each visit.

The only place all these appointments are consolidated is on my fridge where I store all the letters and appointment card in date order. 

I also put them all in my online calendar manually which is prone to error (more on that later).

Other issues

There are several other niggles in the systems that while are not significant in themselves they all add to the friction in the system and increase the chances that errors will be made. One such niggle has already caused me to get one appointment wrong, luckily I arrived a day early so no really damage was done.

Where electronic communications are used, e.g. NHS app, this just points to a message that is in the form of a PDF file that contains an image of the letter, i.e. it is not possible to simply cut and paste the appointment details in to a personal calendar. 

Many apps that I use, e.g. MeetUp, have an "Add to Calendar" function and NHS app should be able to do this too.

There are inconsistencies in the naming of locations within the hospital, e.g. letters refer to "Oncology & Haematology Outpatients” whereas the signage in the hospital says Haematology & Oncology Outpatients (HOOP)", and the two letters for the scans 

The letters for the scans give the data (dd/mm/yy) but not the day of the week, which is how most people refer to dates most of the time, e.g. it says "31 October 2024" rather then "Thursday 31 October 2024".

The two letters for the scans have slightly different descriptions for the same address. They also use different sized fonts. which may be an attempt to keep all of the main information on the front page.

I sometimes get automated reminders to my landline! I did not know that the hospital even had this number much less intended to use it. I am not sure which appointments these are for as I never listen to the whole message once I know who it is from.

Summary

Three things should happen:

1. The NHS app should be used for all appointments
2.  The app this should link to personal online calendars
3. Appointment letters to patients should be reviewed for consistency and clarity.

Change NHS: A consultation

Introduction

The new Labour Government has said that "Our NHS is broken, but not beaten. Together we can fix it." and has launched a consultation to start the process (I would have gone with money first but that's another story). 

I wanted to respond to that consultation for several reasons, notably because I have worked with business change through IT for most of my career and also I am quite involved with the NHS as a patient at the moment. The NHS matters to me and I think that my views on it are relevant.

I am putting these views in my blog so that I have a record of what I said and I can also share them easily when I want to.

The consultation is online at change.nhs.uk.

The 3 shifts

The consultation covers the 3 shifts, widely trailed before, as"big changes to the way health and care services work – that doctors, nurses, patient charities, academics and politicians from all parties broadly agree are necessary to improve health and care services in England".

These are:

1. moving more care from hospitals to communities
2. making better use of technology in health and care
3. focussing on preventing sickness, not just treating it.

The consultation then asks questions on these. I quote these questions and give my answers.

Q5. In what ways, if any, do you think that delivering more care in the community could improve health and care?

There appears to no rationale behind this idea other than the slim possibility that because more appointments are more local then fewer will be missed. Specialised services are provided through large hospitals for several good reasons from economies of scale to the frequent need to treat patients will multiple conditions.

I see no health and care benefits in doing this.

Q6. What, if anything, concerns you about the idea of delivering more care in the community in the future?

Healthcare provisions is already fragmented, e.g. dentistry and optometry, and having separate centres for other services risks further fragmentation with the need to visit several centres for one condition.

Small units are likely to be inefficient, e.g. a surgery facility at a GP surgery will either be over staffed to ensure that it meets all demand or under staffed at some times leading to more waits.

People often have multiple needs and being co-located means it is easier to address them at the same time, for example, to get an unplanned x-ray for a patient. When working on Business Transformation we called this "one and done", i.e. fix everything on one visit.

Small specialist units will focus on the one thing that they do and will lack the patient's full context to provide the best service. This happened to me when a private surgery unit missed the possibility of skin cancer and this went undiagnosed for a few years. This fragmentation may kill me.

Q7. In what ways, if any, do you think that technology could be used to improve health and care?

Again, the described benefits of this are weak at best and they are all claims made about other large IT projects that spectacularly failed to deliver. I have worked on some of these and the example of Horizon at the Post Office is fresh in our memories.

The idea that patients need only tell their story once misses two very important points, each specialist needs to hear and questions a different part of that story and that story will change over time (do you smoke, what medications are you taking, how active are you, how stable is your weight etc. etc.) and so it must be retold for accuracy.

Using AI to review scans is an obvious thing to do but it is hardly transformational. The only way that this could help significantly would be if we took lots more scans but that would be an additional cost on the NHS.

Technology is too often portrayed as a magic wand, it is not.

Q8. What, if anything, concerns you about the idea of increased use of technology in the future?

I am concerned that the benefits are overstated and could not be delivered without substantial additional investment (beyond the basic hardware, software and networks) in things like data cleaning and ID cards.

The basic technology, e.g. exchanging packets of data between systems, is easy but does not help because the data quality is pretty low and inconsistent and so sharing it will only make things worse.

I have worked on large IT systems with simpler data, e.g. spare parts held in stockrooms, and every project had to start with a large data cleaning exercise and even that does not solve all of the problems as some of the answers are unknown, e.g. a supplier code does not match any code used by any supplier. Similarly in systems involving people you will often find several dates of birth of something like 01/01/1900 where people have made up data just to get past that screen. Or, even worse, used a special data as a code for something else that has been long forgotten but which is useful.

There will be significant inconsistencies in the data between systems. To pick another example I have direct experience of, there is not a standard list of Nationality codes so things like the Census and Schools (both part of UK Government!) use different lists. These lists also change over time so while a younger person may be identified as, say, Bangladeshi their parents may be just Asian. I picked this as a simple, easy to understand example, other parts of health data are far more complex and far more prone to inconsistency. Agreeing standard lists will help but will take time and will make the data cleaning longer.

And one key part of the data is missing, a unique identifier for each person. Who remember's their NHS number or carries a card with it on? A national ID card system could help (after a lot of time and money) but there will always be gaps, e.g. recent arrivals.

I would be very surprised if you could get the data at sufficient quality to share in less than eight years and employing thousands of people for that long is expensive.

Q9. In what ways, if any, could an increased focus on prevention help people stay healthy and independent for longer?

This is where the focus should be, though not necessarily for the reasons given. We should enable people to be healthier so that they can live more fulfilling lives, not just to save the NHS money. People play sports for fun not to keep out of hospital.

The consultation gives no idea of the scale or ambition of "tackling the causes of ill health" but these need to be bold to first address recent declines in population health (e.g. obesity) and then to significantly improve them.

That means being brutal with manufacturers and retailers over things like smoking, processed foods, alcohol, etc. We know many of the major causes of ill health and should address these seriously.

Going back to school lunches for all school pupils and breakfasts too for primary pupils would be a major boost to wellness and is probably the easiest and quickest option the Government can implement.

In 2023, there were 132,977 casualties on UK roads. We must do a lot more to address this, including stricter enforcement with harsher penalties and redesigning roads to manage out traffic.

Managing out traffic is a win-win as it reduces traffic accidents and also encourages people to use other and healthier means of travel. In the early 70s I went to an edge of town secondary school and hardly anyone went there by car, we need to get back to those days.

Q10. What, if anything, concerns you about the idea of an increased focus on prevention in the future?

My concern is that the Government will back away from the big necessary changes under pressure from lobby groups claiming that it is trying to implement a "nanny state". If these measures are to work then they must be bold.