The passing of Deborah, Dowager Duchess of Devonshire finally broke the magic of an inner circle which provoked just as much social commentary as the Royal Family.
The Mitford sisters were a beguiling mix both politically and socially. While Unity became obsessed with Hitler, Jessica enrolled with the communists during the Spanish civil war. Diana, the socialite par excellence who numbered Evelyn Waugh among her friends, married first to Bryan Guinness (heir to the vast Guinness fortune) and then Oswald Moseley (leader of the British facist party). Nancy drew on the experiences of their unconventional background (they were all home educated on the insistence of parents who would be deemed eccentric even by modern standards) to inspire her very successful series of novels whose waspish social commentary carved out a new literary genre. To complete this remarkable sextet of sisters, Pauline became an expert on poultry keeping while Deborah, the youngest, became a Duchess when her husband succeeded his father as Duke of Devonshire. As far as variety goes, it would be difficult to imagine any group of siblings holding a torch to the Mitford girls.
The story of the Mitfords is, in many ways, a commentary on changing British attitudes to class. Their lives also spanned the decline of the class system as it once was. After the Great War, the days of the class system were numbered. No book explores this truth more honestly and with more poignancy than Brideshead Revisited. It was written by Diana's great chum Evelyn Waugh during the Second World War and he wrote like the devil during times of great national hardship to convey the grim realities of the class system. After the Second World War, the class system was dead and buried. Just after victory had been won, the NHS was born. It still stands as a monument to a classless society aspiring to equity for all. Of the Mitford girls, Jessica alone would have had any sympathy with it's founder, Aneurin Bevan. As with the founding principles of communism, the NHS was built with honourable intentions. But the attitude of the public to their physicians in 1948 was a lot different to today. Sadly, the attitudes of the physicians to the public have arguably changed rather less and there are complex reasons for this. The NHS today is rather different to the 1948 version and I've often wondered whether it is still valued by the public in the same way? Whatever the answer to that question, one thing is now certain; now, more than ever, the public need to accept greater responsibility for their lifestyle decisions and be more aware of their consequences. Research shows that most people are now well aware of the risks to their health of smoking, excess alcohol consumption, lack of exercise and poor diet. Yet paradoxically, the majority choose to just carry on regardless.
Whether Ed Miliband or whoever else gets elected next year spends £2.5 billion extra on the NHS is largely irrelevant. Of greater relevance is that the new leader addresses those health decisions which are exerting the greatest strains on the NHS. If those decisions are avoidable, and most of them are, we need to question as a society why these decisions are being ducked. Education is one factor but motivation is arguably the biggest. What motivates people to make the best choices for their own health outcomes?
But just as the public needs to look hard at their health behaviours in terms of their impact on the NHS, the medical profession has to get down from it's high horse. If the inner circle of the Mitford sisters was legendary, the inner circle of the medical hierarchy is nigh on impregnable. If medicine can find the way to cast off this cloak of paternalism, the existing barrier between the physician and his patient will be eradicated. For once, they will then be able to forge together concordant decisions free of the constraints of superstition.
So, just as we need to understand why so many people continue to make poor health choices, we also need to explore why the medical fraternity at large maintains it's seat at the high table while the poor patient has to dine at a lower level. Until they are all sitting at the same table, the existing cycle of suspicions will remain. If anything, this is the circle in greatest need of destruction. Once parties are finally on the same level, the physician will be able to put all that knowledge to a more productive use. He will be able, through a collaborative approach, to work with the patient more effectively as both parties arrive at achievable, lasting change for the better. The final caveat is that before a physician can motivate a patient to choose the right health options, he must first seek to do so himself.
But all of these circles are there to be broken. As with the vicious circle which dictates addiction, nobody pretends it will be easy to break, but then the things worth achieving seldom are. The big prize worth fighting for is the sustained future of the NHS free at the point of access for every man, woman and child. The rules have changed though and that future can't happen unless we all start to accept that our health is ultimately our responsibility.
The Mitford sisters were a beguiling mix both politically and socially. While Unity became obsessed with Hitler, Jessica enrolled with the communists during the Spanish civil war. Diana, the socialite par excellence who numbered Evelyn Waugh among her friends, married first to Bryan Guinness (heir to the vast Guinness fortune) and then Oswald Moseley (leader of the British facist party). Nancy drew on the experiences of their unconventional background (they were all home educated on the insistence of parents who would be deemed eccentric even by modern standards) to inspire her very successful series of novels whose waspish social commentary carved out a new literary genre. To complete this remarkable sextet of sisters, Pauline became an expert on poultry keeping while Deborah, the youngest, became a Duchess when her husband succeeded his father as Duke of Devonshire. As far as variety goes, it would be difficult to imagine any group of siblings holding a torch to the Mitford girls.
The story of the Mitfords is, in many ways, a commentary on changing British attitudes to class. Their lives also spanned the decline of the class system as it once was. After the Great War, the days of the class system were numbered. No book explores this truth more honestly and with more poignancy than Brideshead Revisited. It was written by Diana's great chum Evelyn Waugh during the Second World War and he wrote like the devil during times of great national hardship to convey the grim realities of the class system. After the Second World War, the class system was dead and buried. Just after victory had been won, the NHS was born. It still stands as a monument to a classless society aspiring to equity for all. Of the Mitford girls, Jessica alone would have had any sympathy with it's founder, Aneurin Bevan. As with the founding principles of communism, the NHS was built with honourable intentions. But the attitude of the public to their physicians in 1948 was a lot different to today. Sadly, the attitudes of the physicians to the public have arguably changed rather less and there are complex reasons for this. The NHS today is rather different to the 1948 version and I've often wondered whether it is still valued by the public in the same way? Whatever the answer to that question, one thing is now certain; now, more than ever, the public need to accept greater responsibility for their lifestyle decisions and be more aware of their consequences. Research shows that most people are now well aware of the risks to their health of smoking, excess alcohol consumption, lack of exercise and poor diet. Yet paradoxically, the majority choose to just carry on regardless.
Whether Ed Miliband or whoever else gets elected next year spends £2.5 billion extra on the NHS is largely irrelevant. Of greater relevance is that the new leader addresses those health decisions which are exerting the greatest strains on the NHS. If those decisions are avoidable, and most of them are, we need to question as a society why these decisions are being ducked. Education is one factor but motivation is arguably the biggest. What motivates people to make the best choices for their own health outcomes?
But just as the public needs to look hard at their health behaviours in terms of their impact on the NHS, the medical profession has to get down from it's high horse. If the inner circle of the Mitford sisters was legendary, the inner circle of the medical hierarchy is nigh on impregnable. If medicine can find the way to cast off this cloak of paternalism, the existing barrier between the physician and his patient will be eradicated. For once, they will then be able to forge together concordant decisions free of the constraints of superstition.
So, just as we need to understand why so many people continue to make poor health choices, we also need to explore why the medical fraternity at large maintains it's seat at the high table while the poor patient has to dine at a lower level. Until they are all sitting at the same table, the existing cycle of suspicions will remain. If anything, this is the circle in greatest need of destruction. Once parties are finally on the same level, the physician will be able to put all that knowledge to a more productive use. He will be able, through a collaborative approach, to work with the patient more effectively as both parties arrive at achievable, lasting change for the better. The final caveat is that before a physician can motivate a patient to choose the right health options, he must first seek to do so himself.
But all of these circles are there to be broken. As with the vicious circle which dictates addiction, nobody pretends it will be easy to break, but then the things worth achieving seldom are. The big prize worth fighting for is the sustained future of the NHS free at the point of access for every man, woman and child. The rules have changed though and that future can't happen unless we all start to accept that our health is ultimately our responsibility.
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