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....

Everybody Wants to be a Cat - or maybe not

Everybody wants to be a Cat - a Disney favourite from The Aristocats, loved by successive generations, and rightly so. A great song, a classic animated sequence, but is it true? Does everybody want to be a cat? Of course not, but it works well as a title for some thoughts on how those of us with a hidden medical condition portray it, both in the real world and online.

It is often said that cats are good - too good perhaps - at hiding their symptoms. It’s a survival strategy for a solitary species, as opposed to those who live in groups, herds, packs or other groupings. To show weakness is to encourage predators, such that the cat that walks alone prefers to keep its troubles, pains and discomforts private - a poorly cat will often be found hiding somewhere as if hoping nobody will notice. However, those species which live in groups may make more of a fuss, perhaps even looking for sympathy with the proverbial hangdog expression. We human beings, of course, have a choice, and according to our personality type, we may react to illness or disability by quietly withdrawing from interactions with others, or by making it something about which we are loud and proud, a dominant or even defining part of our persona.

So it is with diabetes, and with the growth of social media-based communities such as #GBDoc, a more visible divide has become apparent between those who portray their diabetes as a defining part of their identity, and in many cases a burden to be borne; and on the other side those who portray it as a nuisance alongside many other nuisances in life, but not something which they will allow to dominate their thoughts, words and deeds.

Social media has brought these contrasting attitudes into clearer focus. Some accounts of people living with diabetes flaunt their condition with pride and defiance, detailing their every success or failure, sometimes railing against the curse of T1D, and maybe raging against society's ignorance, or health care professionals' insensitive ignorance. On Twitter, these people are often those who choose a user name featuring a reference to diabetes and have a profile picture or bio that leaves nobody in any doubt that T1D is a big deal for them.

Other social media accounts of people living with diabetes carry little or no clue to their owner's medical condition. The giveaway is often just whom they follow or friend, or maybe just a passing reference in their bio. Their feed may well be about anything but diabetes, or just an occasional reference to it. Their Twitter name is less likely to reference diabetes.

To pursue the animal analogy, the former group are the diabetes pack animals, and are likely to talk frequently about their diabetes, both in real life and online, whereas the latter group are the solitary creatures, the cats if you like, who prefer to keep their condition private and who consequently seldom draw attention to it. Like most divisions, it’s not binary, and most of us have a nuanced attitude, sometimes wanting the world to know that we live with this damn thing and sometimes wanting nobody to know.  And above all, there are no rights and wrongs - just differences. However, my sense is that nearly all people living with diabetes of any type tend towards one type or the other. So which am I? A cat or a dog?

Well I am very much a cat. No surprise there, given my lifelong love of cats, so this post is about being a cat - hiding an already hidden condition.

Today is my diaversary. It was at 5pm on this day in 1997 that I went to see my GP, alarmed by a sudden recurrence of symptoms after I'd recovered from a week in bed with ‘flu. She had asked me to bring a urine sample and I can still picture her concerned and somewhat puzzled face as she told me that it revealed very high sugar levels, and probably diabetes.

I've told the story many times: it actually took several weeks for me to be diagnosed as Type One; back in 1997 it was still widely believed that Type One very rarely came on in adults: we now know very much otherwise.

Twenty Five years. A quarter century. One third of the average male lifetime. Most significantly for me, more than half of my adult life. So it's a day for much reflection, and indeed a blog post. There's much to think over, and whilst in many ways that dark and chilly December evening when I was told that life-changing news remains very clear in my mind, in other ways it seems like a very different life in a very different world.

Over those twenty five years, my attitude to diabetes has varied, and in particular the level of noise that I make about it, has varied due to circumstances as much as anything, but overall I have always tended towards saying less rather than more. As mentioned above, in diabetes as in all else, I want to be a cat.

Over the first 16 years or so, through very much the peak of my working career, diabetes was firmly in the background of my life, my concerns and my interactions with others. My diagnosis came at the end of a week off work confined to bed with ‘flu, but that was the last day off for sickness between then (1997) and my retirement 20 years later. (Other than routine appointments). So living with Type 1 had no impact whatsoever on my working life, indeed less than four months after diagnosis I was leading a group of 45 teenaged schoolchildren on a week-long school trip to France, as I had done for years before and continued to do for years afterwards. I remained the same busy person that I had been before T1D came to join me on my journey through life, and I often reacted with wry amusement rather than boiling anger as I watched others - notably work colleagues - moan about how busy and tired they were, or how much they were struggling with whatever short-lived ailment was troubling them. Very occasionally, I would drop the T1D bomb into a conversation or situation, as for example when a colleague was planning a day of interviews in which I was involved, and he said to me “It’s going to be a full-on day, with no time for eating” When I gently suggested that I would have an issue with that, he sheepishly remembered and re-jigged the schedule a little.

Outside work and home life, I also avoided diabetes and anything other than strictly necessary talking about it. I joined the British Diabetic Association on diagnosis (sounds so archaic now, but that’s what Diabetes UK was still called back then), and then ignored a series of letter invitations to local group meetings, not least because the subjects of their meetings were always about low-carb eating and getting more exercise, a clear sign that this was predominantly if not exclusively frequented by people living with Type 2.

However, the world of diabetes care and management was on the threshold of very significant change at the time of my diagnosis, and has come a long, long way in those years - as those whose lives with Type 1 predate mine will readily attest. Whilst by 1997 we had already reached the era of disposable pens and needles and electronic blood glucose meters, we were still two decades from the near universal availability of non-invasive glucose monitoring, and indeed the rapid advance in the availability and use of lightweight insulin pumps and closed loop technology. Yet the Rise of the Machines was already under way by the time I joined the ranks of the pancreatically challenged, and although I am not among those who are desperate to have the benefits of an insulin pump rather than MDI, I have from the very start been convinced that the quantum leap has been the ability to measure blood glucose levels without finger pricking: I was one of the earliest adopters of FreeStyle Libre back in 2015, and with Libre 2 now the norm, I am free from the fear of unforeseen hypos which was a genuine worry for me for the first 20 years or so. I was fortunate enough recently to be given a two week trial of Libre 3*, and whilst I remain unconvinced of whether I need or want a full CGM to remind me every minute of every day what my levels are, I can well see that this latest version is a state of the art which will be welcome by many and will sooner or later end up as the norm.

Equally striking when comparing 1997 and 2022 is the impact of the revolutionary advances in connectivity brought about by the internet. The birth of the World Wide Web is rightly quoted as 1992, but it was not until the late 90s that the internet started to reach ordinary homes on a large scale. We got our first internet connected PC in early 1998, but at first the internet was really just a giant online library. Emails were there from the start, but they were really just instant letters. The notion of real-time “conversations” with friends and family across the world would have seemed fanciful, and for me, any sense that ICT and the web would be of any significant connection to my new condition would have seemed very odd.

Yet for me, like many others, it was online connectivity that brought me out of my diabetes closet and connected me for the first time with fellow Type Ones. It’s a story that I have shared before, for example here and I have no hesitation in saying that connecting with others living with Type 1 was a life-changing move, which has brought me connection with 100s, friendship with dozens and a close and lasting bond with a few.

And yes, online diabetes connections and friendships are all about the sharing, and therefore only really of any value if those involved are prepared to talk about their condition, at least in some small way. From around 2013 onwards, I did indeed start talking about diabetes with others, and as a result became aware of the rapid advances in diabetes care and technology that were at that time starting to proliferate.

And yet……

I remain a cat. I remain a man of relatively few words in any setting, real world or online, and especially in the context of diabetes. My regular social media feeds only occasionally feature diabetes content, and my Facebook is a largely diabetes-free space. I sometimes think I should be more vocal, more of an “awareness raiser” or even a so-called advocate, but my heart just isn’t in it. Others clearly feel more strongly about it, and have more to say, whereas for me, the core of my relationship with this lifelong condition is that it is a nuisance, rather than a burden, that I will not allow to take over my life. To rant and rave about it seems to me to be a largely futile exercise, in which I would either be preaching to the converted or risk becoming a bore.

I am enormously grateful to and hugely respectful of those who define their persona so much by diabetes. In so doing, they are being generous and beneficial to others: we would not be nearly so far down the road to accessible diabetes technology for all according to their needs and wishes, nor would we have anything near the levels of camaraderie and peer support that we enjoy, without the efforts of those for whom diabetes is a big deal.

I certainly have no wish or intention to shy away from the diabetes community, indeed I interact with others living with Type 1 every day, and my best friend is a fellow Type 1. Yet outside the world of the diabetes community, I seldom if ever remind others of what I live with. Sometimes to my cost.

So when it comes to sharing my condition, I am a cat, whilst gladly accepting that not everybody wants to be a cat. I conclude this “Silver Diaversary” piece with a sincere thank you to all the individuals and organisations whom I have encountered as a result of that life-changing diagnosis twenty five years ago: healthcare professionals, diabetes charities, medical tech companies and above all diabuddies. I may be a cat, but as all cat lovers know, our feline friends do actually crave and appreciate company and attention. They're sometimes just too stubborn to admit it....

Illustrations? Well it had to be a throwback to the days when "#OfGBDoc" was a thing. This was a collage of cats belonging to GBDdoc folk which I made back in 2017/18. 

I am aware that some of those kitties are no longer with us, so I hope that the memories are warm and not too sad.

*  #ad #sponsored: I was given a FreeStyle Libre 3 sensor free of charge for evaluation purposes. The opinions in this post are my own and were not influenced or reviewed by Abbott.

Let it be: why we don't need a general election right now.

Politics is a subject supposedly best avoided in polite conversation, and I tend to avoid it on social media. However angry we are about people, events and decisions, it serves little useful purpose to vent about it online, not least as most ordinary people live in social media echo chambers where we mainly see posts by people with whom we agree.

However, although blogging has gone out of fashion, I still enjoy reading others’ thoughts when expressed on the often more considered and restrained platform of a blog, and I also enjoy forming the thoughts that swirl in my head into a coherent whole, so I am committing some strongly-held views which have come to my mind over this week for this new post. As always in matters political, there will be some who agree, and some who don't.

So here we go - on the day that our third Prime Minister in two months takes office - October 25^th, 2022…..Why we don’t need an election right now.

I am not, and never have been, a Conservative voter or supporter. I nevertheless prefer to keep my political opinions and comments for the ears of family and closest friends only, but sometimes there are exceptions, and right now is one of those times.

Like many like-minded people, I have despaired over the past five years at some of the individuals and policies that have been inflicted upon this nation by successive Tory governments which are hostage to right-wing English nationalist factions and which bear no resemblance to the traditions of Conservatives at their best.

It is easy to react to the recent chaos with angry calls for the peoples' voice to be heard, and to elect a Labour Government at this point might seem like an attractive solution. However, it would do the Labour Party no favours were they to gain power thanks to the weakness of their opponents rather than because of their own strengths.  They remain a work in progress after some years of misguided folly, and a strong opposition which is a believable alternative is an essential part of a well-functioning government. Labour may soon be just that, but not right now, not least as they would face exactly the same economic mess that is facing the present government.

In the end, a period in the political wilderness is good for either of the main parties, giving it time for the inevitable recriminations before eventually coming to their senses. The past forty years have seen both major parties spend years in opposition because they have reacted to electoral setbacks by lurching to their own extremes: Labour has done it twice, in the Michael Foot years and then the Jeremy Corbyn years, wasting golden opportunities to shape the country for the better in so doing. Labour’s disastrous spell under Corbyn was a classic case, and is in many ways directly responsible for inflicting this present government upon us. It was patently obvious that Corbyn was unelectable against the background that led to the 2017 and 2019 elections, and a more inclusive Labour Party led by one of its “lost leaders” - (Ed Balls, Yvette Cooper, Alan Johnson, the other Miliband, Andy Burnham, or even Keir Starmer) could have defeated the Tories in either of those elections before the car crash of a hard Brexit became the disastrous long-term consequence of Cameron’s decision in 2016 to try to solve his party's problems by asking the electorate to vote in a referendum on an irreversible policy.

The Tories have, since 2015, done serious and in some cases irreparable damage to the country which I love, and part of me wants to see the Tories out of office until, like all parties eventually do, they come to their senses and return to the centre ground which is where the overwhelming majority of Britons stand.

However, I do NOT want a General Election right now.

Firstly, because, like millions of others, I just want some political and financial calm and stability. I want some peace and quiet. After the chaos of recent times, with the lazy amoral leadership of Johnson followed by the astonishingly inept non-leadership of Truss, we now have as Prime Minister a young British Asian man who has the look and sound of a serious, capable and hard-working leader. His speech on taking office today was characteristically measured and serious: realistic yet reassuring.

Whether we admit it or not, we already owe Mr Sunak a debt of gratitude for instigating the long overdue departure of Johnson, not to mention for his shrewd management of government finances through most of the pandemic. I have no idea whether he will make a good PM, but at the very least he appears to behave like a grown-up leader, not an opportunistic clown (Johnson) or an incompetent zealot promoted way beyond her ability by the votes of a few thousand deluded party members (Truss). I really don’t care that Mr Sunak is a millionaire, or that his wife is, as long as he can steer the country clear of its present financial perils. Being a millionaire does not necessarily make you uncaring about those less fortunate than you are.

Secondly, because to demand an election now is futile. The Tories have a large majority - a mandate for a party and a set of policies, not an individual, and their MPs would not in the near future dream of voting down their leader in a confidence vote. Turkeys don’t vote for Christmas.

Thirdly, and in many ways most importantly, because to demand an election represents a fundamental misunderstanding of our parliamentary democracy. At a General Election, we vote in constituencies for representative delegates, most of whom belong to a party, and the party which achieves a majority of seats wins the election. We do not vote for the party’s leader, even though of course our choice is heavily influenced by the personality and policies of the leaders, but the Prime Minister is not a President. He or she is the person whom the majority party chooses as its leader, by its own choice of system, be it right or wrong. And the party with a parliamentary majority can change leader as often as it wishes to, as has been the case more times than many would care to admit.

Believe it or not, no British Prime Minister has arrived and left office through a General Election since Ted Heath (1970 - 74). That’s a remarkable statistic. Of the subsequent PMs, seven have resigned whilst still in office (Wilson, Thatcher, Blair, Cameron, May, Johnson, Truss) and seven have taken up office without an initial public electoral mandate (Callaghan, Major, Brown, May, Johnson, Truss, Sunak).

The gradual elevation of the position of Prime Minister to a quasi-Presidential status is, in my opinion, one of the most regrettable features of British politics in recent years, and is a process undoubtedly fanned by mass media and by both opponents and supporters of incumbent PMs. Of course we cannot and must not deny the primacy of the office and the importance of a good leader, and in the mass media age it is inevitable that TV debates have replaced local hustings and soapbox speeches as the main source of our views on potential leaders.

However, to assign every government decision to an individual is just plain wrong, and risks giving the individual more importance than the office deserves. Johnson played up to this, and people lapped it up in a manner that I found cringe worthy. Those who love him and those who loathe him constantly refer to him as “Boris”, thereby creating a personality cult which plays into the hands of a man who relies for his appeal on a carefully crafted persona of some kind of lovable buffoon, when in fact he is a lazy, amoral opportunist with no sense of duty. I have always pointedly referred to him as Johnson, because he doesn’t even deserve the respect of a title like “Mr”. The new PM is Mr Sunak, not “Rishi”. Politics is, as he himself has said, a serious and professional business. Surnames, please.

So yes, in two years’ time, the people can, and will pass judgement on this Conservative government, and they may well decide that after what will by then be 14 years in power, their time is up. But in the meantime, the opposition would be well advised to get on with fine-tuning their policies and making themselves look like a government-in-waiting, and the government should be left to attempt to clear up the mess left by a pandemic, a war and its own idiotic decisions, under what I truly hope will be Mr Sunak’s shrewd, assiduous and serious-minded leadership. Give the man a chance.

So no election yet, please. Let's leave things as they stand, give King Charles time to get to know his second Prime Minister and let Mr Sunak have a chance to prove that he can indeed unite the country by deeds as well as words. And give the rest of us a break from politics, politicians and political correspondents.

Those who know my blog posts will be aware that I always give them a title from a song, so I leave this one with a title from the words of wisdom of the Beatles, or rather of Paul McCartney’s mother Mary: Let it Be. 

We Don't Need No Education? I think we do, and we also need exams.

 

After a gap of three years, I have in recent weeks been back doing my post-retirement job as an invigilator of GCSEs and A-Levels at the school where I taught for my entire working career.

It's nice to be back: a taste of the teaching vibe which I loved so much, but it's a strange and in many ways deadly boring way to spend a working day - pacing up and down a hall full of young people, trying to strike a balance between ensuring that they are actively supervised yet not disturbed. No squeaky shoes, no phone notifications, only whispered and strictly functional conversations with fellow invigilators, and nothing to do except watch the clock ticking along. For the candidates, a two hour exam flies by, whereas for the invigilators time crawls. However, it's been nice to see this (admittedly less than fun) piece of normality returning to school life.

Almost everyone is familiar with the strange and stressful routines of school exams, but if you haven't been directly or indirectly involved with them for a few years, you might well be startled by how much more complex and regulated they have become than was the case a generation or two ago.

Exam security and fairness of access have made the organisation and execution of exams into an incredibly demanding logistical exercise for all involved, and I thought it worth drawing attention to what goes on in schools of every type and size during these five weeks or so – as well as, on a more limited scale, at other times of the year. I hope that in doing so I can help to foster added respect and understanding for all involved in the process.

Let's start with the students. Well nearly all of us have been there and done that. We all have memories of sitting in those rows of desks, 1.5 metres apart, with the sun shining outside and hay fever season peaking such that everyone is either sneezing, being disturbed by others sneezing, or both. We remember the invigilators pacing up and down like prison guards – in the past they were familiar teachers, but these days they are more likely to be outsiders recruited just for this role. We remember the ticking clock, the aching hand, the annoying desk that wobbles, held steady by a folded piece of paper, the distant sound of a playground as exams cut across the school day and its breaks, the occasional disturbance caused by a delivery van or  a teacher outside the room forgetting it's exam time and shouting to a colleague.

And above all, we remember the panic as we leaf through the question paper and see the topic we were hoping wouldn't come up and did – or the silent “yesss” as the one we revised only yesterday pops up. And we remember the uniquely focussed chatter as we were released from the gloomy hall into the sunshine outside, all comparing reactions and hoping that even the bright kids would agree that “Number 7 was impossible”.

It's all so familiar to everyone over school age. However if you're over about 40 and not involved in a school you'd be amazed at what now has to be monitored and what is and isn't allowed. A photo id card must be displayed on each desk. All writing must be black. Pencil cases must be transparent. Mobile phones are banned from the room, as are watches of any kind. Drink bottles must be transparent  and have the label removed. Walls must be free of any written material which might help in any way. Toilet breaks are discouraged, but if taken must be accompanied by an invigilator as far as outside the toilet. A prolonged stay in the loo would render the candidate under suspicion of malpractice. All this in the name of fair play.

Secondly, spare a thought for the invigilators. As already mentioned, these days they are an army of people, often with an oblique connection to the school: my invigilator colleagues at present are a delightful crew: retirees like me from this and other schools; part-time non-teaching staff redeployed from their usual roles; off-duty school nurses; a semi-retired doctor; the adult son of a teacher earning a few extra pounds to supplement his student loan; or just friends of the exam officer who were persuaded to help out. All of us have had to undergo DBS checks and take online training for the invigilator role, and are required to follow all the rules listed above, whilst also presenting to the stressed out students an air of supportive, empathetic yet suitably strict supervision. Not an easy balance to strike!

Let's not forget the teachers! These days, they are not allowed anywhere near their own subject exam until it's finished, yet most are nearly as nervous as their pupils: “did I get it right when I suggested there would be a question about topic ‘x'?” “Was that twilight revision session last week helpful?” “Will the clever but lazy ones have crammed it all in at the last minute?” “Will the hard working ones who really struggle get the breaks they deserve with the questions we've practised?” Some confident and conscientious teachers want to see their pupils after the exam, but others may understandably hide in the staffroom.

And what about the markers? Only those who have done it know what a tough and poorly paid gig that is. Again, it's changed beyond recognition in the past decade or so. Markers are a hidden and highly qualified army of current and former teachers, stay-at-home parents, retirees, or ambitious newcomers to teaching seeking added insight into the assessment process. These days, virtually all exam papers are scanned (hence the compulsory black pen), digitised and marked using an online platform which helps markers to add up totals and, in many subjects, ensures that different questions are marked by different people. Markers' work can be, and is, remotely and anonymously sampled and standardised by team leaders and senior examiners. The proverbial “rogue examiner”, a mythical ogre created in peoples' minds to explain away a poor grade, does not in practice exist any more, even if s/he did ever exist. Marking requires sustained attention to the task in hand over many days and weeks. And it does not pay well: nobody is in it for the money alone.

I leave the best until last: examination officers:  in many ways the most put-upon, under-appreciated supermen and women in the whole process. Every school or college has them, sometimes combined with another role, sometimes not.

Back in the day, EO was a job often done by a teacher, either a senior figure as part of a managerial/leadership post or a junior as a deserving incremental point on the pay scale. These days, it's almost always a non-teaching post, one for which there is no formal qualification but which requires a list of qualities and competences only found in a few individuals. S/he must have strong admin and ICT skills, limitless patience, physical stamina, kindness, tact, firmness, adaptability, creativity, problem-solving skills, and anything else I've forgotten.

The challenges faced by EOs are many, varied and unpredictable. During exam season, they are often the first to arrive on site and the last to leave. Having already ahead of each day arranged rooming, invigilation, seating plans, secure storage and recording of the arrival of papers, they then have to fetch all that day's papers (often well into double figures  on any given day if a school does both GCSEs and A-Levels) and check, count and assign them to the correct room. All this must take place within a secure room, with the papers kept in double-locked filing cabinets protected by keys held in a separate safe. Papers must be checked off by a second pair of eyes, who must countersign for all papers, and once out of the safe, they must stay in the hands of the EO or an invigilator at all times until they get to the exam room. Only then can they be opened.

And it's not just a matter of sitting a whole cohort in one big hall, as was once the case. If you haven't recently been involved with school exams, you would perhaps be startled, reassured or even slightly jealous of the concessions and arrangements made to ensure a fair chance is given to all. Students with a variety of reasons for such a concession will be given the chance to sit their papers separately in a smaller room, including some who are granted 25% extra time (if they have a formally diagnosed SEN need such as dyslexia), and some who are allowed to work on a laptop (again with a formally diagnosed need). Any laptop used must be supplied by the school and have access blocked to anything other than basic offline word-processing.

Likewise students with certain medical or mental health conditions may also be allowed to take the exams in a smaller group or an individual room, and may be allowed rest breaks. This applies, for example, to students with Type One Diabetes who are permitted rest breaks to test their blood sugar and administer correction injections or pump dosages when required. The current (June 2022) Coronation Street storyline of a girl with Type One taking and cheating in her A-Levels failed to recognise this reality in order to make a good story.

All such concessions require exam officers to facilitate separate, quiet, secure rooms in already crowded school campuses, and to find separate invigilators. Packs of exam papers have to be opened under secure conditions then resealed in separate envelopes. And at any time, with no notice, exam boards can and do send inspectors to spot check that all such conditions are being fully met.

Another complication is where a student has clashing exam papers in the same session. When this happens, one paper must be taken out of the published time slot, and the candidate kept under constant supervision between the papers, to avoid him or her either hearing or divulging the content of a paper sat out of sequence. Again, a significant logistical challenge for the EO.

And the EO fields all the problems or hitches: if a student gets upset or disturbed during an exam, then the EO will deal with it. If a parent complains about any aspect of the exam, the EO gets the email or the call. And when results get published in August, s/he will oversee the logistics of distribution of those, and deal with the huge and growing burden of requests for re-marks.

And nobody thanks them, gives them cards, boxes of chocolates or bottles of wine, as happens for teachers at the end of term.

So yes, exams are back after Covid. Students are stressed, especially the hugely unfortunate Year 13 cohort of 2022, who are taking A-Levels having never had the practice of GCSEs. For all their weaknesses, exams do, by and large, deliver fair results, develop valuable transferrable life-skills and form an integral part of most advanced education systems. But I hope that this brief and personal insight has given those whose lives are only fleetingly touched by exams a sense of the many challenges that they pose, in addition to the burden on those who sit them.

“We don't need no education” sang Pink Floyd's choir of North London schoolchildren in their iconic anti-school song, Another Brick in the Wall (Part Two) from 1979. Well actually they did need some education if they didn't recognise a double negative when they saw one. A glorious song nevertheless which will serve, suitably modified, as a good title to this post. We do indeed need an education, and exams are a necessary evil. Please, however, spare a thought for ALL involved in this colossal annual enterprise.

 

You'll Never Walk Alone - the forgotten pleasures of a collective experience

I see no value to me or to others of writing for writing's sake, so my blog posts, like those of anyone else who cares more about quality rather than quantity, have become fewer in number over the years. On many topics I have penned my thoughts and see no point in saying the same thing again in a different way, or in saying what others can say more effectively than I can.

So whilst I never think “What shall I write for my next post?”, every so often a set of thoughts forms so strongly in my head that I feel that I must commit them to the written word while they are so strongly held in my mind, and having committed them to writing, it seems silly in the age of online connectivity not to share them, even if only a few ever read them.

So here we go...with a post inspired by a football match but actually more about the joys of collectivism, and the inestimable harm that the Covid 19 Pandemic threatened to do to us as a species. If that sounds like a contrived and pretentious leap of reasoning, I apologise. However I hope that some will identify with what follows….

Yesterday evening, Saturday 7^th May 2022, I had the good fortune to be present at one of the true cathedrals of the beautiful game, Anfield, the home of Liverpool FC, for a crucial fixture as the English Premier League approaches its seasonal climax. A generous friend of mine, who has hospitality seats at Anfield, had two spare places for a pre-match meal in the Centenary Suite followed by a crunch match against Tottenham Hotspur, and he texted me a couple of days ahead of the game to ask if I and one of my family fancied joining him. For my son Nick and me, this was a gift horse not to be looked in the mouth.

I'm a lifelong active football fan, with memories stretching back to crumbling windswept terraces of Burnden Park, the home of my hometown team, Bolton Wanderers, where as a schoolboy I would pay my 15p admission and cheer on my heroes in white, then as now plying their trade in the lower tiers of English football. Supporting Bolton has brought many highs and lows, and in the not-too-distant past there were real highs, when in the first decade of this century Nick and I never missed a game as our team established itself as a Premier League force and evolved into a highly successful outfit, with Sam Allardyce attracting mavericks and misfits from world football like Jay Jay Okocha, Ivan Campo, Youri Djorkaeff, El-Hadji Diouf, Fernando Hierro, Bruno N’Gotty and Nicholas Anelka. Such superstars all bought into Big Sam's style and values such that for several years the team punched well above its weight in the League, and during the early 2000s, we saw most of the world game’s superstars at the Reebok. Moreover, the big teams were quite often sent home humiliated and outclassed by a Wanderers team that at its best in 2004-2005 mixed sublime artistry with bruising pragmatism.

Heady days indeed, but Wanderers' decline into the lower leagues, plus other commitments in my life and that of my family, have led to a decline in the number of matches that we attend, then the pandemic has meant that I hadn't been to a live match in over three years. So to be thrust back into the experience with a surprise trip to a top-of-the-table clash between two of the legendary teams of English football represented a quite stunning return to a forgotten pleasure.

The pre-match buzz is better at Anfield than almost anywhere because the modernised and expanded stadium still rises like a temple from the midst of the terraced housing of the city whose name it bears. However wonderful the newly built stadia such as the Emirates, the Tottenham Hotspur Stadium or even Bolton's still futuristic Unibol, there is something special about Anfield, approached along residential streets with street corner pubs crowded with raucous fans. I'd forgotten how good that pre-match buzz is, as it assaults the senses with sounds (distant chanting) sights (pilgrim like fans dressed in club shirts or colours) and smells (burgers, onions and beer)

But nothing prepared me for the emotional impact of the moment we emerged to take our place high in the Sir Kenny Dalglish Stand. I've been to hundreds of matches over a period of over fifty years, at many of the great venues of football: Maine Road, Highbury, Old Trafford, Wembley old and new, even Marseille’s Velodrome, as well as Burnden Park and the Reebok/Unibol, and many times to Anfield. But not for a few years, and not since Liverpool’s current team has reached such excellence under Jürgen Klopp's charismatic leadership. I was unprepared for the impact of hearing “You'll Never Walk Alone” sung on a perfect spring evening beneath the lights, and even though I was there as a neutral, it was impossible not to join in with those truly inspirational words set to that soaring melody. What must it feel like as a player to hear that choir of 45000 singing with such gusto?

The game was a 1-1 draw, not a classic, not a goal fest, but a chance to be reminded of the stratospheric standards of the players now gracing the EPL. The likes of Kane, Son, Van Dyke, Salah, Henderson, Alexander-Arnold, Thiago and all the rest make even the premier league stars whom I watched a decade or so ago look slow and pedestrian. The modern game, played at bewildering speed on a pitch that looks and plays like snooker baize, is light years away from that which I watched on the rutted sandy mud heaps of the seventies. Live TV does a great job, but comes nowhere near to conveying the grace, pace, speed of thought and lightness of touch of the modern game. These men ARE worthy of their eye-watering wages, because people show up in their thousands to watch them, just as others pay to watch film stars and musicians. Exceptional talent is box office. And when a team of mercurial talents like this Liverpool side is led by Klopp, a man of such manifest human qualities, including a sense of proportion, the result is compelling. I genuinely believe that Klopp is one of the most impressive human beings in the public eye at present, and if I could meet one person from the world of sport I would wish it to be him.

But above all, what I took home from last night's game was a renewed belief in the value and power of a collective experience - the pleasure of being part of a crowd. I'm glad I am triple jabbed and have recently had a bout of Covid, because I was able to relish the joy of a crowd, free for now of any worry of what I might catch: the collective elation caused by a goal going in or by the frustration of a misplaced pass or an unlucky miss; even the shuffling along in a queue for the bar and the toilets, with unknown strangers breathing down ones neck, felt somehow like a forgotten pleasure recaptured.

Lockdown and isolation suited some, and brought its own benefits - a chance to slow down, even to stop, listen and reflect, and we must not forget that. But we homo sapiens are social animals, and even those like me who prefer quiet places and one to one chats rather than noisy parties, can find joy in the collectivity which affirms a common identity, be it at a concert, a sports match, or even a religious act of worship. And as is often pointed out, there is in fact very little difference between an act of religious worship and a football match - not least the singing of songs of praise to those whom we worship.

You'll Never Walk Alone? Well yes, I will often walk alone, and I'll enjoy it enormously, but to walk and to rejoice among a crowd of others is also a true joy.