Wait for the Lord: why Advent really matters.

Advent brings into sharp focus the gap between the sacred world and the secular world, yet in so doing also highlights the way in which Christian principles and disciplines can have a value in the secular world.

The way in which society appears genuinely unable to wait for the true joy of Christmas is a source of sadness rather than anger to me. 

So…what are the best words for this day, Advent Sunday?

How about Happy New Year?

In the secular world, we are still four weeks away from saying that, but in the sacred world, those are the correct greetings for today. Today marks the start of the Church’s year, although among those who have no church affiliation, this fact probably passes them by entirely.

But that’s the point of what I’d like to share with you today: the glaring gulf between the sacred and the secular, which is perhaps at its most visible during the season of Advent

My theme in a word? Contrasts. My message in a word? Patience.

Bear with me….

You don’t need me to tell you that the secular world thinks it’s already Christmas, and has been for several weeks. Many houses are displaying trees in windows and lights in gardens. I saw Christmas goods in some shops whilst sweltering in that September heatwave. Christmas ads on TV started weeks ago, and I suffered a distressingly early Whamageddon when enjoying a walk in the sunshine along London’s South Bank as long ago as November 17^th: I heard the unmistakeable voice of George Michael and that sleigh bell backing track coming from inside a market stall selling mulled wine. And worse than that, a week later I caught myself singing along with Maria Carey on my car radio. Father, forgive me - I should have changed the station. As a penance, perhaps I should say 20 Maranathas.

The secular world is already bedecked in golds, greens, reds and sparkly tinsel.

But in the sacred world, today we have turned purple, the colour shared with Lent, symbolising restraint and penitence.

Today we enter the beautiful season of Advent - a period in which the church is restrained, dignified and anything but celebratory, jolly and joyful. If we in the church are to be true to ourselves, then for these next four weeks we really are at odds with the secular world in a manner which can be truly challenging. But that shouldn’t stop us addressing that challenge.

Now we have to be pragmatic, and of course in reality, we can’t pretend Christmas isn’t coming. If we are to celebrate and enjoy Christmas, we obviously need to engage in some aspects of it in these weeks leading up to the festival.

Buying and wrapping gifts, sending cards, putting up decorations, planning menus, enjoying concerts, events and parties with our friends and colleagues is all part of Christmas, and clearly that can’t all be done on or after the 25th.

But do we have to completely overlook the notion of a season of preparation, of Advent? The practice of a period of preparation and abstinence in advance of a joyful feast is, after all, common to many other religions, and they are invariably rather better at it than we are - most notably Islam, with Ramadan followed by Eid.

Preparation, abstinence and reflection followed by celebration and indulgence is, surely, good for the soul. Or to put it another way, celebration and indulgence without some measure of restraint and context in advance of it is surely not good for the soul.

As a society, we have become very bad at waiting for anything, at any form of delayed gratification, and I plead as guilty as anyone to this. This sermon risks having a sense of finger pointing, so it’s a good moment to remind myself of that old Sunday School cliché from my childhood - when you point a finger at others, always remember that there are three fingers pointing back at you. I’m as impatient as anyone, and not always very good at waiting. Fast Food, seven-day opening, same-day delivery and Amazon Prime mean that many of us have forgotten what it means to wait for anything.

I grew up in the days of “allow 28 days for delivery”, which these days seems like a joke. Who would wait 28 days for anything?

Yet waiting is, surely, good for us. A bit of imposed patience never did anyone any harm. It’s a given of good parenting not to give in to children’s every “I want”, not to indulge their every wish, for fear of spoiling them, yet we as adults perhaps don’t practise what we preach.

Religion has taught us to believe some pretty daft stuff over the years, and to an extent it still sometimes does. Yet at its heart, Christianity is just love - human decency - laced with a good dose of practical common sense.  Surely we don’t need a government minister to teach us common sense - the Christian faith does it so much better. One of the things which I most appreciate about practising Christianity is the way in which it gives a pattern and a rhythm to our lives which is so in tune with the patterns and rhythms of nature itself, if that doesn’t sound too flaky.

By hijacking pre-Christian, pagan midwinter celebrations, Christianity taps into our need for some light and cheerfulness, “in the bleak midwinter”. And in the context of Advent, by encouraging us to wait patiently for the fun and festivity, it taps into a bit of useful psychology and self-discipline.

Back to Advent Sunday: I said it was the New Year, and what do we do at New Year? We make resolutions. So the Church’s New Year is surely also a good moment for a resolution, and my suggestion - again, to myself as much as to all of us - is that we get a bit better at separating the sacred from the secular, as Advent can and does teach us.

Separating the sacred from the secular is actually often about learning a bit of restraint, and learning to wait. A bit of self-discipline if you like.

Now of course, in order to remain relevant in today’s world, the church needs to embrace the secular world and in so doing to sacrifice some principles and reach some compromises.

Our great cathedrals here in the UK have proved themselves to be spectacularly good at this compromise, throwing their doors open to concerts, conferences, degree ceremonies, exhibitions and goodness knows what else, as well as staging acts of worship for the faithful. A few years ago, Norwich Cathedral had a helter-skelter in its nave for a whole summer season. Chester Cathedral has staged a fabulous model railway exhibition in its South Chancel these past three summers hosted by none other than music impresario-turned train buff Pete Waterman. A few weeks ago I was at Evensong at Newcastle Cathedral and we the congregation were hustled out with unseemly haste because they were preparing the building for that evening’s concert of - I kid you not - “Meat Loaf by Candlelight”.

That’s right, Meat Loaf performed by a rock band in a cathedral nave. I’m pretty sure some of those deans and bishops buried in that cathedral were spinning in their graves that evening to the strains of Bat out of Hell.

Yet secularisation of churches is a necessary, and often a very good thing. Frankly, it helps pay the bills! Only last week, this very  building was transformed into a bustling market place, and Santa Claus, the Patron Saint of Coca Cola, drew hundreds of children and their families into a holy place whose doors they would seldom if ever darken for the purposes of Christian witness. And I am in many ways personally responsible for the increased secular use of this building, having devised and organised concerts, lectures and exhibitions here since I took leadership of the bicentenary programme in 2022.

Yet I would be the first to urge caution and restraint. If we make greater use of our building for secular purposes, we surely need to be even more careful to distinguish between those purposes and the church’s core function as a sacred space for worship. And yes, this means perhaps being more vigilant about how we conduct ourselves within these walls on a Sunday.

I was raised on a behaviour rightly adhered to by traditional churchgoers, succinctly expressed in these words: “before the service, speak to God; during the service; let God speak to you; after the service, speak to each other”.

Simple, old-fashioned, potentially unfriendly, but I still try to adhere to it in my own conduct. In a church like this, the beauty of the place and the organ voluntary are there to help us to do so. If I could ask for one resolution from the people of churchgoers, it would be that we all agreed to prepare for our worship with a period of silent reflection. 

It's about contrast: the contrast between our often hectic and noisy everyday secular world and the sacred world within these walls. And it's also all about patience: waiting for the Lord. And that, above all, is what Advent teaches us. The value of contrasts, and the importance of waiting.

So instead of joining Noddy Holder in shouting “It’s Christmassss!” from December 1^st, may I suggest that it’s better for us, and actually more fun, to enjoy Advent for what it is? A season of reflection and anticipation, with its own beautiful words and music. The carols can wait.

Then when Christmas finally comes, we can enjoy all 12 days of it, and I shall be saying "Happy Christmas" until January 6th, when much of the secular world will have long since moved on and started eating Creme Eggs.

Today’s gospel told us that the fig tree reminds us that the Lord is near. Near, but not here yet. Let’s learn to Wait for the Lord: our choir can express that better than I can with this familiar Taizé chorus: I invite you to spend these next few minutes in reflection and anticipation while we listen to them.

Amen

For the purposes of this post and its title, here's a Spotify link to that hauntingly appropriate Taizé song:

Come Together: thoughts from the Diabetes UK Professional Conference 2023

I spent two busy but enjoyable days in Liverpool last week attending part of the Diabetes UK Professional Conference, having earlier this year been appointed as Chair of the charity's patient group, the Diabetes Lived Experience Advisory Committee.

I was there as one of three representatives of this group, free to attend any of the lectures and presentations, and to meet and mix with the hundreds of HCPs at all levels who attend this three day event. As its name suggests, the conference is organised first and foremost for healthcare professionals in the field of diabetes care, and over the years it has become very much THE get-together of diabetes HCPs, attended by not only the big names in the field, but also rank and file NHS staff, with places highly valued and sought after. In addition, like any such healthcare gathering, there is the accompanying “trade fair”, at which pharmaceutical and medical technology companies get a chance to display their wares to those whose job is to assess, prescribe, and administer them. It’s an impressive event, administratively and logistically challenging, not to say costly, but my over-riding sense is that it is a hugely worthwhile and successful exercise.

The conference has left two salient points in my mind, and when thoughts such as these get stuck in my mind, it always seems worth sharing them, to see to what extent others feel likewise.

The first is simply the fact that conferences like this are very, very valuable. Sadly, other commitments meant that I could only attend for two days, but my time at Liverpool was more than enough to remind me just how useful and important such events are.

Zoom, Teams and the like were a lifesaver during the pandemic but to experience this flagship conference, happening fully in person for the first time since 2019, was a forceful reminder of the value of face-to-face conferences.

Easily dismissed as "jollies", gatherings of professionals in any field are surely of inestimable value, even if that value is perhaps hard to quantify: As well as the formal content, it was a joy to witness and indeed to be part of the coffee break chats, the lunches, even the after-hours drinks. I always felt that way when I was fortunate enough to attend day or residential conferences and courses during my own working career as a schoolteacher, and I remain as convinced as ever. ”Comparing notes”, even in snatched conversations over a coffee is of immense benefit to anyone in any walk of life, often a precious and reassuring reminder that whatever challenges and difficulties we are facing, someone, somewhere else is also facing it. A problem shared is, indeed, a problem halved.

For me personally, to catch up with so many of the valued friends and acquaintances whom I have been lucky to make among HCPs, diabetes charities and diabetes tech companies was a pleasure.

This brings me neatly to my second point: to what extent should the likes of me, a “patient”, be at an event like this? What, if anything, is the value of lived experience in improving and developing diabetes care?

Over the years, and particularly over the past decade or so, it has become an increasingly accepted wisdom that the voice of lived experience should be front, left and centre at diabetes conferences. A popular hashtag in diabetes social media is #NothingAboutUsWithoutUs, a line borne of frustration from the days when people with diabetes were too often treated like naughty children, their condition described as “poorly controlled” and their attitude as “non-compliant”. In many ways, this goes hand-in-hand with the Language Matters movement, which has done so much to modify stigmatizing terminology used by HCPs and in so doing to also modify attitudes.

So in a sense, it’s the proverbial no-brainer: those living with a condition should indeed have a voice where those who treat it are gathered together. Over the past week, when diabetes social media here in the UK have been full of content about the week’s events in Liverpool, it has been easy to find calls for the lived experience voice to be present at every lecture, discussion or symposium.

Perhaps surprisingly, given my four years of membership of the Diabetes UK Patient group, and my recently adopted position as Chair, I find my enthusiasm for the idea of ubiquitous lived experience participation to be somewhat nuanced, and this worries me. Surely, a strong patient voice is unequivocally a good thing?

Well of course the lived experience voice is a good thing, but I do feel that there is a risk that we overplay the controversy, egged on, perhaps by angry advocates rather than the voice of the majority.

Firstly, because I think there is sometimes a place for humility, for acknowledging that the professionals actually do know best, and that they have a right to meet together and exchange views privately. The loudest voices calling for ubiquitous lived experience involvement are almost by definition those most engaged with and expert in their condition, but few if any have the breadth, depth and variety of experience of HCPs. In my profession - teaching - I was a consistent and sometimes lone voice in advocating student involvement in the teaching and learning process, in the formulation and execution of policies, and especially in assessing and measuring progress. However, to deny altogether that the teacher knows more than the learner is a betrayal of logic: sometimes, teacher does know best.

One of the most absurd pieces of so-called wisdom that gained popularity in some quarters during the run-up to the Brexit vote in 2016 was Michael Gove's “I think the people in this country have had enough of experts”. An example of the damaging populism that drove the political process during that era, Gove's soundbite was both arrogant and delusional. Advanced human society is built upon expertise at every level: “to each according to their need, from each according to their ability” is how a civilised society ensures that we benefit collectively from the specialist skills of others, not least when it comes to healthcare. Far from having had enough of experts, I am deeply grateful for them, and in terms of my own diabetes, I am grateful not only for the pioneering expertise that brought us injectable insulin just over a century ago, but also for the technical expertise of those who have driven such spectacular advances in diabetes technology over the past decade or so. Listening to some of the content in lectures at DUKPC, I was left not so much with a burning desire to be represented, but rather a feeling of humble gratitude that there are people as clever as that working on better ways to treat and care for me.

Now of course there are areas when the patient voice is not just valuable, but crucial, and indeed still under-represented. The emerging area of diabetes psychology springs most readily to mind, where there is surely a vast amount to be learned by professionals listening to the voice of lived experience rather than trying to apply theory to practice. Walk a mile in our shoes before telling us how it feels to  walk in our shoes is surely how diabetes psychology should be applied, and I have heard alarming tales from a friend who lives with a diabetes-related eating disorder of the mis-application of theory in a manner which is counter-productive at best, harmful at worst. So yes, the voice of lived experience can be crucial in advancing the work of experts, but should always be offered and accepted collaboratively, rather than confrontationally.

Indeed I can’t help wondering whether here in the UK at least, we are actually pushing at an open door. In personal terms, what struck me most as I travelled home from Liverpool and reflected on my experience there was how a conference like this one is in fact a wonderful coming together of ALL stakeholders in the world of diabetes. When I had the chance to address the Diabetes UK HCP Council on the eve of the conference about the value of peer support, I was keen to make the point that in the UK, we are uniquely blessed with a diabetes community in which the overwhelming majority of HCPs are already respectful of and receptive to the expertise of their patients. Moreover, the very fact that it is a diabetes charity, not a professional association, which organises this event, is significant: we are exceptionally well served in the UK by our NHS and by our diabetes charities. Who needs angry advocates when we are blessed with the passionate, driven healthcare professionals who have brought about such spectacular advances in technology access for people living with Type One, or charities like Diabetes UK and JDRF who are driven by a passion for improving care and pursuing the elusive cure?

Together at conference: Partha Kar, Diabetes Lead for NHS England
with Karen Addington & Chris Askew,
CEOs of JDRF & Diabetes UK respectively. And me.

DUKPC is, above all else, a collaborative event, a chance for the community to Come Together (there's the customary song title if you click on the link, with a deliberate Beatles/Liverpool slant). A chance for the experts to do their thing, a chance for the companies to sell their wares, a chance for the professionals to hear from their patients where appropriate, and a chance for the charities and support groups to care and share.

Nothing about us without us? Of course the voice of lived experience should be at the centre of diabetes care, but I’m not actually sure that we need to sound quite so angry about it. Maybe, just maybe, diabetes care is an area in which we British are actually quite well served on a global scale, thanks in no small part to the voice of lived experience. The remarkable reach of Flash or CGM - 90% of people living with Type One - has been achieved by passion and determination on the part of HCPs (led by Partha Kar) informed, encouraged and supported by the patient community with which many HCPs have so willingly engaged over the past decade or so.

We in the UK have had much reason to feel rather ashamed and second rate over recent years, and the air of crisis which accompanies the NHS remains a severe and very real cause for concern. But this should not blind us to what has been achieved in the world of diabetes care, especially Type One care, and the fact that this has come about by such a collaborative effort. It was achieved not by shouting at each other and demanding better representation, but rather by a mutual realisation that collaboration and cooperation are almost always how progress is achieved.

The real challenge, and one in which I hope I can play a small part over the coming two years, is to spread this success into care for people living with all types of diabetes. 

Radio Gaga

It often seems that there are plenty of things for people to get annoyed and upset about these days, and I sense that we're getting too good at getting annoyed. In reality that probably isn't true: it's just that the internet has given us somewhere to express our annoyance, and some people have accepted that gift with tiresome glee.

Some of the things that cause annoyance really do matter - our own wellbeing or that that of our loved ones; questions regarding the morality and integrity of those in positions of power and influence; political policies and decisions; issues specific to our own lives, our families, our workplaces, or our neighbourhood. Other things arouse passions and strong opinions but actually don’t matter at all: most obviously sport and entertainment. The passions and anger that sport generates, if kept proportionate and in check, provide a valuable safety valve for anger and emotions that might otherwise become destructive.

A lot of our anger and frustration is these days termed “First World problems” - things that annoy and frustrate us which are in reality little or no cause for real suffering, and stem from the fact that many of us are spoilt by the relative luxury in which we live compared to previous generations, and to many people in other parts of the world. We should all try to remain aware that a sense of proportion is important regarding whatever is annoying us. 

So with that preamble out of the way, I'm going to write about something that has annoyed me, and by all accounts many others, in recent times and especially in recent weeks: radio, and in particular some changes over recent months to BBC Radio 2, the soundtrack to the lives of so many, and in particular to older adults like me.

The on-air announcement by 71-year-old Ken Bruce that he had chosen to step down from his long-running mid-morning slot on Radio 2 created a surprising amount of response and reaction, and has fed into a narrative which many feel is a pattern since the appointment of a new controller, Helen Thomas. Following soon after the enforced departure of another veteran presenter from a long-held slot, Steve Wright, it is hard to resist the conclusion that Ms Thomas is seeking to lower the average age of presenters, to “update” the prevailing style of music played and hence to target a younger audience.

Ken Bruce

The simplistic reaction is to smile knowlingly and say “that's life, change happens etc”, to leave the baby boomers to whinge about it until they find another radio station playing “their” music and something else to complain about from the comfort of their index-linked pension fuelled lifestyle.

We have, after all, been here before, thirty years ago, when Matthew Bannister took over as controller of Radio One and purged that station of the “Smashy and Nicey” generation which was, like the typical listener of the time, growing older. Then, as now, many listeners reacted with dismay, accused the BBC of ageism and in many cases defected to other, commercial, stations. Nothing lasts forever.

Matthew Bannister's changes came at the start of what proved to be a pivotal time in the history of rock and pop, when the decline of the “hit single”, of “the charts” and later of the purchase of physical music recordings was just starting to be felt. A generation which had grown up with “pop” music, very much their music as opposed to that of their parents and grandparents, was growing older and refusing to grow out of what was thought to be a phenomenon of rebellious youth. Back in the day, older people were like your proverbial granny in Slade's Merry Christmas, Everybody, telling you that “the old songs are the best”, meaning gentle, melodic tunes.

But as we aged, we, the baby boomer generation were, like Noddy Holder's granny, “up and rock and rolling with the rest”. We not only carried on listening to rock and roll, sixties pop, seventies glam rock, punk and new wave, but we also embraced the music being enjoyed by the next generations. This phenomenon was already apparent at the time of Bannister's infamous purge of Radio One, with the Britpop explosion of the mid nineties proving to be the last hurrah of hit singles and physical music recordings, and artists like Oasis, Blur, Pulp, Suede, the Lightning Seeds and many others, not to mention teen idols like The Spice Girls, Take That and Boyzone producing songs which owed everything to the sixties and seventies, and appealed to kids, parents and grandparents alike.

And that's where it started to get complicated: Bannister's purge of the DLTs, the Tony Blackburns, the Simon Bates, the Steve Wrights of this world sent them to Radio 2 or to commercial radio, and there they might have stayed, endlessly recycling their fab and groovy hits to an ageing audience, were it not for the for the fact that the older generation was still liking the new stuff, and the younger generation was liking the old stuff.

My own children grew up listening to my 60s, 70s and 80s CD collection, and rather than thinking of it as “old people's music”, they loved it just as I had done at their age. Music by The Beatles, The Stones, The Eagles, Queen, Fleetwood Mac, The Bee Gees, Abba, Motown, 80s power ballads - all from before their time - became as much a soundtrack to their lives as it had been to mine. And meanwhile, I was embracing artists like all the above mentioned Britpop, Coldplay, Kaiser Chiefs, Keane, Amy Winehouse, Adele, The Killers and many more, whilst artists from my younger years were in many cases still releasing new material which appealed to all ages. Moreover, anthemic songs like We are the Champions, Hi Ho Silver Lining, Is this the way to Amarillo, Rockin' all over the World, Hey Jude and above all Sweet Caroline have acquired a ubiquity which few would have foreseen at the time of their original release. Known and sung, word perfectly, by people aged 5 to 95, at weddings, football matches and other joyous gatherings.

Musical tastes, which had in my youth created a very real divide between me and my parents, was now a powerful bond between me and my kids.

And so to 2023, and the fate of BBC Radio 2. Helen Thomas may think that she is refreshing Radio 2 and reaching out to a younger demographic. Maybe she is, but to base decision-making on what seems increasingly like a laughably outdated understanding of musical tastes and sociological behaviours seems to me and to many people of ALL ages to be a very short-sighted, simplistic and potentially deeply harmful way of proceeding, especially given the BBCs historic remit as a kind of embodiment of British values and culture.

Yes, Steve Wright and Ken Bruce are getting on in years, but their fans stretch back into a far younger demographic. Wright may be old, he may have the look of a recluse, but his youthful voice, his mastery of the zoo format radio that he pioneered and his catholic taste in music provided a perfect soundtrack to the working week for millions, of all ages. His sidekicks Tim Smith and Janey Lee Grace were also intuitively real, and provided a wonderful antidote to Wright's persona. Wright himself was not only a very good interviewer of celebrity guests, but also had enough self-awareness to send himself up with the whole “DJ Silly boi” and  no ‘g' thing which heralded the end of the working week in such joyful style. His somewhat predictable humour, his catchphrases and idiosyncracies had the air of the embarrassing uncle - a bit weird, sometimes a bit cringe worthy, possibly even a bit creepy, but nevertheless much loved and somehow very reassuring.

Ken Bruce may be a portly bald-headed septuagenarian, but he has his finger on the pulse of how middle England in its broadest sense thinks and feels. Through the difficult and isolating days of Covid lockdowns, he, like many, was “working from home” with the perfect blend of awareness of collective suffering yet also of the need to chivvy us all along. And his musical tastes are absolutely not stuck in the past: he has embraced and promoted good music from every era, valuing and cherishing the best of the past alongside all the good stuff which is still emerging in the fields of pop and rock.

The BBC hasn't yet admitted it, but it is abundantly clear that Scott Mills has been a disaster in Steve Wright's former slot. An ageing DJ with no intuitive feel for his audience's taste, he comes across like a man embarrassingly refusing to admit he's past it. His show feels like an awkward warm up set in Magaluf done by a superannuated mobile DJ hoping nobody will notice his paunch and his wrinkles. When I hear Scott Mills, I always have a mental picture of a man wearing a backwards baseball cap in a desperate attempt to look down with the kids.

Steve Wright and his successor Scott Mills

Sadly, Radio 2 is collectively heading down the same road. Zoe Ball comes across as far too matey with her guests and co-presenters, leaving the listener feeling left out rather than included. Her predecessor Chris Evans, despite his millionnaire lifestyle and hell raiser past, felt more like “one of us”. Sara Cox, too, has started to sound a little desperate, putting on silly voices in the hope that it will sound cool in an ironic post-modern way, but unfortunately she just sounds - well, silly.

But of course  these days, I seldom listen to any of them. Like many others, I have moved to Greatest Hits Radio, where I await the triumphant arrival of Ken Bruce in a few weeks' time. Their advertising department must be rubbing its hands with glee as ratings and hence revenues soar.

On Greatest Hits, I have rediscovered Simon Mayo, himself lost to Radio 2 some years ago, but still relaxed and effortlessly on trend, in touch with the zeitgeist and the lives of ordinary people in a way that Scott Mills simply isn't. Mayo comes across as a cool ageing man at ease with, but not obsessed by, his age. Ken Bruce and Steve Wright share that trait of character, which was in many ways the essence of Radio 2 in recent decades .

So there I am, a disgruntled older man, moaning about change. I offer two points in mitigation before I shut up:

The first is this: the knowledge that my “disgruntledness” (a good word if it doesn't exist) is shared by millions, including many much younger than me. My thirtysomething, gay, Labour-voting, Brexit-hating daughter agrees with everything that I say on this topic. She's millennial to the core, yet resents Scott Mills and all that he represents with a passion. And I know many of her generation and even younger who feel the same way.

The second is this: that I do NOT want to hear just music of the 60s/70s/80s. I love plenty of music from the past 30 years. Radio 2 in the 21^st century had become a place where “music of the future and music of the past” were played and promoted in equal measure. My one gripe with Greatest Hits Radio, if it is to be my new home, is the obsession with the musical past. Perhaps Ken Bruce could fix this when he joins.

And do you know what? My daughter even agrees with me on that last point

So please, can someone at the BBC see sense before they alienate and lose several generations all at once? National, commercial-free radio is our friend, a medium of unique value, and used wisely is a wonderfully unifying glue to an increasingly fragmented society. Divisive ageism is not the way forward, indeed it is - irony of ironies - hopelessly outdated.

Let's leave the last word about all this Radio Gaga to Freddie Mercury, who, had he not been taken from us too soon, would now be an old man of 76. Old peoples' music? I don't think so...

Let's hope you never leave, old friend

Like all good things, on you we depend

So stick around, 'cause we might miss you

When we grow tired of all this visual

You had your time, you had the power

You've yet to have your finest hour

You can't always get what you want

When I first started posting my thoughts as a blog, back in 2015, I started using song titles - or occasionally lines from song lyrics - as the title for each post. It happened almost by accident when I was writing my very first post, about the then new and very rare FreeStyle Libre blood glucose monitoring device: the words of a song came into my head, and I thought it would make a good title. That post - entitled What's Going On? - is still there, now of course very outdated, but in a very good way.

These days, it's often the other way round: a title or line comes into my brain as a result of something that's happening in the world, and thoughts start to swirl around in such a way that I end up expressing them in writing and usually publishing them on my little corner of the internet. Read on to find out how this title - You can't always get what you want - became a post.

My blog has always been about more than just diabetes, but the condition with which I live, and which has brought me so many friends, opportunities and experiences, remains a recurring theme, not least because the world of diabetes care and treatment has moved on so much over those six years. There's always much to talk about.

This week brought the announcement by NICE of proposed guidelines and a consultation on the future availability of closed loop systems for people living with Type One diabetes in England. It stimulated a frenzy of comment and opinion, ranging from excitement and gratitude to anger and resentment and all stops in between. Once again, I found myself somewhere between amused and dismayed by the speed with which people felt it necessary to broadcast their views to the online world. Not least when the announcement was of proposals, not policy, with an invitation to comment. An invitation to comment: online, privately, and thoughtfully, having read and considered the proposals.

We live in an age of instant and therefore necessarily less than reflective opinion, driven by the platform of social media where so many strive to be heard. By the time I'd read just a few of the torrent of responses, I had already started to feel that I must be a freakish loner in wanting to give the proposals some thought. Until I remembered that those expressing the most strident and immediate views are almost by definition a minority, and that tens of thousands of others are probably unaware of the announcement or too busy living their lives to be able to join the chorus of opinion. 

It’s the negativity that really gets me down. We've been here before, of course: 

I remember a taxi ride back into Central London in September 2017, after being interviewed live on Sky News on the day that FreeStyle Libre was added to the NHS tariff, and reading through dozens of negative comments about that decision, spiced with suggestions that the likes of me or indeed Partha Kar were paid by Abbott to promote this product. Most comments boiled down to “Yes, but what about...”, overlooking the universal truth that all progress, all change for the better, comes in stages, not overnight. Partha repeatedly used the “tip of the spear” analogy to restate his point that this was a marathon not a sprint, and that progress and evidence would generate further change, price reductions and hence wider benefit.

Then this time last year, we had a similar furore over the news that FreeStyle Libre 3 would not be as readily prescribed as Libre 2. Again, the misplaced sense of entitlement, and the consequent rage, was baffling.

After all, we're only 7 years on from the arrival of Libre, and progress has indeed been remarkable. Flash or CGM is now, with one or two shameful exceptions, the norm for people living with T1D in the UK. It has taken just five years from a fortunate few paying £100 a month for Libre 1 to everyone with T1D getting at least Libre 2 or other devices like Dexcom or Libre 3 according to need and at no cost at all to the patient.

So the other day, these wise words, from the Rolling Stones, came into my head:-

You can't always get what you want

You can't always get what you want

You can't always get what you want

But if you try sometime you'll find

You get what you need

Check out the song here - it was actually the B-side of their iconic 1969 hit Honky Tonk Women, but has achieved far greater fame and acclaim over the subsequent half century.

Why these words? Because we now have the prospect of pump with closed loop connection to CGM - a de facto artificial pancreas - for those who need and want it. Do we all want it? Possibly, but not necessarily. Do we all need it? Arguably, but at what cost relative to other demands on diabetes care and the NHS in general? Another huge step forward in diabetes care and treatment, but one that comes with a cost, and therefore with decisions to be made regarding who gets it and who doesn't. Hence the frenzy of excitement this week, but also a disappointing amount of negativity.

Surely, before we all start with the “What abouts” we should pause to reflect, and to keep a sense of proportion, fairness and context to this news. Loop and CGM for more than a favoured few is wonderful news, to be welcomed, celebrated and shared, not least by those who have lived through years of far more primitive methods of insulin delivery and blood glucose monitoring. But we must, now more than ever, remember that this massive improvement to care has a cost, a cost to us all as taxpayers, and that this cost must compete with other growing demands on NHS funds. Assessments of need and decisions, sometimes hard decisions, will have to be made, both theoretically and then in practice: there will be winners and losers. We must surely place need before want, not the other way round.

Take me: I have an Hba1c well below the proposed threshold of 8. I am doing fine on MDI, not least because I have the luxury of being retired and therefore having the time and headspace to devote to keeping my levels in reasonable range.  So whilst I might want management of my diabetes to be easier and more automated, do I need it? Right now, no, I don't, and I'd happily see my £6k of closed loop funding go into the pot to improve diabetes education courses, to increase HCP pay or to speed up cancer diagnosis.

 

I can think of many others living with diabetes whose need is greater than mine. Busy working people with no time to constantly check levels and correct; pregnant women and nursing mothers with 1001 other stresses and strains on mind and body; children and teenagers with raging hormones and lives to live, fun to be had and worries to be addressed; older people with additional mental or physical disabilities or challenges on top of diabetes. The list goes on. I even happen to think that the need of basic flash monitoring for many living with Type Two is greater than my need for a pump and a loop. If we think hard and selflessly, and with due regard to financial realities, the need of others may well be greater than our own want. 

So before I start sabotaging my own blood sugar levels in order to raise my Hba1c to above 8, so as to qualify for a pump, I shall gladly stand back, rejoice in the progress of recent years, thank those who have driven it, and remember that as so often in life, what we need is often considerably less than what we want.

Jagger and Richards wrote some very wise words as well as some of the greatest ever riffs....