Year of the boar

Editorial timelines and personal travel schedules mean I am writing this article on Remembrance Sunday. It has to be done today or I will miss the copy deadline. It's a difficult day.

I watched on television the Royal Family and dignitaries, pinched with the cold, lay their wreaths at the Cenotaph in London. Then the march past. The swagger of the Guardsmen, the waltzing gait of the Chelsea Pensioners, shoulder to shoulder in their crimson best. The civilians in their anoraks, the boy soldiers and the men and women who march in honour of those who so bravely went into battle in our name.

On the news in the evening came a report that four British marines had been killed in Iraq. We seem to have got nowhere, learned nothing and made not a step of progress. There was a time when the parade in Whitehall got smaller as old soldiers died and wars dried up. Not now. The Falklands, Afghanistan and Iraq have swelled the numbers. Ten thousand marched past the Cenotaph.

Empty tomb
Literally meaning 'Empty Tomb' in Greek, the Cenotaph was initially a wood and plaster construction intended for the first anniversary of the Armistice in 1919.

At its unveiling, the base of the monument was spontaneously covered in wreaths to the dead and missing from The Great War. Such was the extent of public enthusiasm for the construction, it was decided the Cenotaph should become a permanent and lasting memorial.

The current Cenotaph, made from Portland stone, was unveiled in 1920. The inscription reads simply, `The Glorious Dead'. Glorious dead. Surely the real glory is in life. This is a huge sacrifice young soldiers are called upon to make. And even today they do it. God knows why.

It seems that nothing changes. Perhaps it is just a symptom of our time, but 2006 seemed a year when nothing changed. It has been stuck in a groove, repeating itself, determined to recognise no future, reflecting a past we would sooner not see. We have lived this year looking in the rear-view mirror.

Politicians examined for dishonesty, companies going broke, foreign affairs in a mess, resources running out and interest rates on the rise.

What year is this? Don't know. Couldn't tell you.

Even my beloved National Health Service, the focus of my interest, my preoccupation and my inspiration, has contrived to blend into the past. Stuck, marooned and beached.

The rising tide of cash has ebbed away - there is a financial crisis. Staff are being laid off and waiting lists are increasing. Patients have been killed by carelessness. Doctors are angry, nurses are threatening strike action, patients are suing, services are earmarked for closure, managers are being pilloried and there have been more changes of ministers in the Department of Health than in the English football team's back four.

What year is it? Pinch me, tell me. It could be any one of the last 10.

Indeed, in 1997, New Labour abandoned the practice of doctors buying services and dumped regional and local health authorities. Here we are, nearly in 2007, a decade and goodness knows how many millions of pounds later, doctors are commissioning services and the regional and local health authorities are back in all but name.

What year is it? Pinch me. We are stuck in a time warp.

And pharma? Stunning, innovative, leading-edge? Pharma is still not sure which one of the three - doctor, patient or Department of Health - is its customer.

Time warp
Pharma is still not always able to develop drugs the NHS can afford, or even wants. It is stuck in its own time warp: in a loop that takes it back to the lab, to serendipity and a patent lifecycle that tempts some developers to cut corners, finance to think of a big number and triple it and marketing to get more desperate.

This has not been a good year. Roche revealed a side of marketing that no-one can be proud of. Shoving Herceptin under the back door of the NHS has lost it a lot of friends.

I know NHS managers who were almost in tears of frustration when the Health Secretary was bounced into demanding an unlicensed, un-evaluated drug be available at the drop of a hat.

Ten years ago, when so many pharma firms were pointed in the direction of cancer care, they could not have guessed the consequences of their earnest research: the damage that short-term, life-extending, ludicrously priced drugs of little real benefit, could do to staff morale, public expectations and NHS budgets.

But it has always been so. There is a fault line between pharma and the health service. A gulf that is made wider by shareholder expectations and what is in the public interest.

We still speak of NHS and pharma partnerships. We might as well speak of nailing jelly to a mirror.

Promise me this coming year will be better. It has to be. Make the effort. There is a ray of hope for next year. It is, in the Chinese calendar, the Year of the Pig.

Well, it's not really a pig, it's a boar - known for quiet sincerity and purity. The boar is so honest that he feels guilty for the slightest error. He is without artifice or pretence, and dislikes forcing himself on others or being the centre of attention. Chivalrous, gallant, obliging, scrupulous to a fault, the boar is na?ve, innocent, confident, and defenceless. He is sincere, almost to the point of doing himself harm, and always disarmed by the bad faith of others. He is an absolutely straight dealer; it is on a very rare occasion that he will accept compromise. Ironically, though the boar believes unquestioningly whatever anyone tells him, he will always find it necessary to produce proof of what he himself asserts.

Let's hope we have a real Pig of a year in 2007 - good luck!

The author
Roy Lilley is a healthcare author and broadcaster