Transcript Disclaimer – Please note that the following transcript has been machine generated by an AI software and therefore may include errors or omissions.

Robin Daly
Hello and welcome to the last Yes to Life show. I’m Robin Daly, host of the show and founder of the UK charity Yes to Life, that helps people with cancer to find out about and utilise integrated medicine to help their recovery.

Robin Daly
I first spotted my guest today at an event many years ago and thought to myself, who is that guy, as he immediately struck me as unusual. And what was unusual was the sheer amount of energy he was giving out.

Robin Daly
It turned out he was a speaker at the event and so I came to know that he was Dr Sam Everington, now Sir Sam Everington, a hugely creative and dynamic GP with a pioneering practice in East London. I’m speaking to Dr Everington at his home.

Robin Daly
I’m honoured to have you as my guest on the Yes to Life show. So thanks for inviting me. So I first came across to you many years ago in the early days of Yes to Life and I was immediately impressed by your enormous energy and enthusiasm that you brought to everything you were doing.

Robin Daly
It seemed to me like you were managing to get a week’s worth of most people’s output into a day. What do you think the source of all that energy was and is and has it changed over time?

Prof Sir Sam Everington
it’s never changed. So i’m i’m 66 now and still full of energy Enjoying my job feel very privileged to have been a GP all my life. I I think some of it comes from My family i’m one of seven kids.

Prof Sir Sam Everington
my mother had lots of energy. Did a lot of charitable work My father was a barrister quite quite a quiet character, but very very decent and focused on kind of Doing things making changes.

Prof Sir Sam Everington
He was a governor of a of a primary school So it comes a lot from family But I think another key moment in my life was at the age of 17 when I was a welder In a shipbuilding yard in norway on the west coast.

Prof Sir Sam Everington
A colleague of mine who was also a student Died when a crane crashed down on top of him And it’s moments like that because at that sort of age you tend to think you’re immortal But it’s it’s a reminder that actually life is not a rehearsal you have to make the most of every moment, that’s always been my feeling and also Don’t don’t put things off.

Prof Sir Sam Everington
challenge things, try and be brave. It’s difficult at times. Don’t get me wrong But challenge things when you see Really bad behavior or things going badly wrong and you’ll see a lot of the campaigns i’ve done throughout my life Has been about that challenge and Yeah, it’s just Life is short.

Robin Daly
I couldn’t agree more. Anyway, it’s phenomenal the way you go at things. I love it. Interesting. I can imagine it was quite a life-changing episode that you described there. At that age, you’re right.

Robin Daly
You’re just going, afraid everything’s in front of you, and to suddenly see a friend of yours cut off like that must have been quite a shock.

Prof Sir Sam Everington
There’s been moments like that in my life, so I was at BMA House when the bus bomb went off. I was a senior doctor on site. I remember some really strong feelings, so I had to go and do the media that evening.

Prof Sir Sam Everington
You can imagine having managed a lot of people either dead or dying and very severely injured. I mean, the team were fantastic, but the thing that worried me most was there was going to be a backlash against the Muslim community.

Prof Sir Sam Everington
So I did a lot of TV interviews that night and talked a lot about some of the doctors who were helping me were Muslim doctors, giving people a sense that we were all in this together. And that was that was really important.

Prof Sir Sam Everington
there wasn’t a backlash, which was fantastic, which says a lot about our country, doesn’t it?

Robin Daly
Yeah, that was another horrendous incident, so you’ve been highly acknowledged for all the initiatives you’ve developed over the years, and for your dedication to improving the healthcare and the lives of all sorts of people, particularly disadvantaged people, but of course, it wasn’t always so.

Robin Daly
I made out you were some kind of thorn in the side of the establishment for many years, of illuminating their shortcomings, but I wonder if you can talk a little about change, what it takes, and in particular, the key ingredients to success.

Prof Sir Sam Everington
So if I think of all the things I’ve done, so a friend of mine, Professor Anis Ishmael, his family had been thrown out of Uganda, they’d arrived with no money at all. When he was training as a doctor, he described being in the operating theatre, and a doctor saying that when he came to shortlist people, he basically had two piles, and anyone with a foreign name, an Indian name in particular, would just go in the bin.

Prof Sir Sam Everington
he told me this story, and I was absolutely shocked. So what we decided to do, so he was a great researcher and academic, I’ve always been a campaigner and done a lot on the media over the years.

Prof Sir Sam Everington
I said to him, well, why don’t we send fake CVs, applications for jobs, and the only difference with the CVs was going to be the surname. One was traditional Indian surname, one was traditional English surname.

Prof Sir Sam Everington
we found that you were half as likely to get an offer from a job interview, if you had an Indian surname. And what was really interesting was that we got arrested by the police, charged with fraud.

Prof Sir Sam Everington
It was just extraordinary. And then the GMC kind of wrote a stinking letter admonishing us. And we ended up anyway, we published the research in the BMJ. We got national coverage on the state program on Radio 4 and a whole raft of other coverages.

Prof Sir Sam Everington
I think the policeman who invited us in, the superintendent invited us back in to discuss our misdemeanor, said with a smile on his face, you know, actually, well, we’re not going to take this any further, but, you know, be careful what you do.

Prof Sir Sam Everington
it was extraordinary. And that was probably one of the first pieces of research on race discrimination in the NHS. And because the GMC admonished us, we decided to investigate them. And we found they were three times more likely to discipline ethnic minority doctors.

Prof Sir Sam Everington
the doctors that were disciplined, well, usually were subjected to a higher charge. And so that was really interesting. And then nothing happened to us. But we were so furious that the GMC wrote to us admonishing us, didn’t do anything to tackle, or, or say there was a problem, actually, with the discrimination.

Prof Sir Sam Everington
It was a lovely moment, actually, a few years later, when I applied to be on the board of the GMC. And when I was interviewed, it went fantastically. And I’ve always been very relaxed in interviews. I’ve always had this great sense, and I would recommend it to everybody is, yes, sell yourself.

Prof Sir Sam Everington
But if they don’t want you, you don’t want them. It has to be huge. And if you do that, you can relax a lot more. And so often, I’ll end an interview actually by saying, well, why should I come and work for you?

Prof Sir Sam Everington
it really takes them by surprise that they then have to sell a job with me. And I do politely and diplomatically, but getting a job is a mutual thing. And it’s really, really important that you don’t sell yourself to the point that you seem as desperate and that actually they try and sell the idea that you should apply it for them.

Prof Sir Sam Everington
it’s always worked as a tactic. But at the end of the interview, and you could see the two other senior lay people, I think there was a senior civil servant there, were sort of quite relaxed and chilled.

Prof Sir Sam Everington
then the killer question, is there anything, if it came out, would be embarrassing to the board? Well, I said, well, we’ve been arrested and charged with fraud. We’ve been monitored by the GMC. And I got a caution for criminal damage as a young doctor for gravitating cigarette advertisements.

Prof Sir Sam Everington
You should have seen their faces. But it just sort of sat up. Luckily, actually, the chair of the GMC at the time knew my background. You know what I mean? He knew the story, right? Right. Well, and he was a great supporter.

Prof Sir Sam Everington
It’s really interesting. You often find establishment people, politicians, all sorts of things, people. They can’t say it, but they’re actually secretly great supporters of the sorts of things that you do.

Prof Sir Sam Everington
they gave me the job. There was another lovely moment in 1989 when I ran the Junior Docs Stars campaign. I slept outside the Royal London Hospital over Christmas. I bought a rip because I qualified as a barrister originally.

Prof Sir Sam Everington
I bought a rip from the high court. We sued University College Hospital and one eventually in the House of Lords. So it was a massive campaign for about three years. I was the bétenoir of the government at the time.

Prof Sir Sam Everington
I will never forget the moment when Virginia Bottomley, who was then the Secretary of State Health, came to a junior doctor’s committee at the BMA. And she was quite nervous. That was very obvious.

Prof Sir Sam Everington
she spoke for about 20 minutes about the deal she had delivered on a deal. And then I stood up at the end of her speech and you could just see her face drop. And I looked at her and I thanked her from the bottom of my heart, actually, for what she’d done.

Prof Sir Sam Everington
I could see her well up and I’d bump into her every so often. And she never forgets that moment. But, you know, actually being generous to politicians, there are a lot of politicians who are good people working hard.

Prof Sir Sam Everington
They’re the some that aren’t. And by the way, it’s not party specific across any party. I’ve been on very good terms with Jeremy Hunt for a long time. I even on occasion text him if I think he’s done a good speech.

Prof Sir Sam Everington
Because that’s the other thing people forget. When you’re in leadership positions, everybody is very ready to kind of shoot you down. Of course. And don’t get me wrong, I’m never sick or frantic. But actually, just that occasional message to people is really important.

Prof Sir Sam Everington
Doesn’t matter how senior somebody is in the political life or public life, you’d be amazed how tough it is. And and how rarely they get genuine praise. And it’s that sort of thing that’s really important.

Prof Sir Sam Everington
Going back to the Juno Docks As campaign, why it was successful. We didn’t go on strike. We got a new deal. I decided that the campaign should be to reduce the hours that we worked a week from eighty four on average to seventy two.

Prof Sir Sam Everington
That was on purpose. Because it created massive public sympathy, because what I wanted them to understand was the hours that we were working, the eighty four hours. What I wanted them to feel that I was a bit like Oliver Twist, I was like, can I just have a slightly better life?

Prof Sir Sam Everington
years we got nothing but good publicity and support. It was just extraordinary. And as I say, we got a fantastic deal. So I’ve learned over the years that you campaign, you do tough things, don’t get me wrong, there’s times I’ve been on marches and things, but the relationships, respectful relationships you have with people of influence, people who can actually make the change happen is really important.

Prof Sir Sam Everington
Right. And after the June of Dachshas campaign, Robin Cook was a very well known politician who sadly died now, invited me into his advisor. And to in about 92 and 97, I worked part time in the House of Commons for all the shadow health team, which was an amazing experience, actually.

Prof Sir Sam Everington
Can the 97 election when Labour won, I came back to being a GP, I did have an option, you know, I nearly became an MP, actually, I lost by about 30 votes. But you know, I didn’t want to leave the East End.

Prof Sir Sam Everington
I didn’t want to uproot my family. But I love working in the East End. I love living here. And it’s an amazing job as a GP. And one of the things I’ve learned actually, is, is being an MP is not everything it’s cut out to be people think it’s very remote.

Prof Sir Sam Everington
But actually, do you know what, it’s, it’s a very tough and sometimes grueling job, you know, having having to be nice and smile to everyone, whatever type of person they are, you know to me, and that’s, that’s difficult.

Prof Sir Sam Everington
Don’t get me wrong, you do that as a GP on a professional basis. It’s very hard for MPs to get away from some of this stuff. And of course, you know, we’ve seen in the last five years to five or 10 years to the MPs being murdered.

Prof Sir Sam Everington
Yeah, that’s true. Pretty, pretty tough in a modern society with social media. Yeah.

Robin Daly
Right. So tough, but diplomatic. excellent. No, you’re absolutely right. The kind of adversarial approach, attacking other people at times is counterproductive really in the end of the day, in terms of moving forward.

Robin Daly
Yeah. Okay. So you’ve mentioned the barrister bit. So your father was a barrister. You obviously started out down that route. But what made the sudden change? How did you suddenly end up in medicine?

Robin Daly
Well,

Prof Sir Sam Everington
I was a welder in a shipbuilding yard in Norway, and my parents, I’m one of seven children, and they always saw me as quite argumentative. And they thought being a barrister was a good thing. And so I then came back at the age of 18 and went to the Inns of Court School in Law, where you could do a law degree and bar finals in one go.

Prof Sir Sam Everington
So I spent three years doing that, but realized halfway through that I really wanted to do medicine. And I hitchhiked around the country to all the medical schools. And try and get a place. And eventually the Royal Free, which had originally been a North female medical school, and was always a bit more open-minded about taking people with unusual careers and backgrounds.

Prof Sir Sam Everington
They said to me, well, go and get your science A levels, and we’ll consider you. So I did, I spent a year working in a pub, doing physics and chemistry A level in one year, and biology A level, and got grade A’s on all of that, and then got into medical school.

Prof Sir Sam Everington
And very much decided right from the beginning, I wanted to be a GP. I like working with people. You know, not for me, the operating theater or anesthetist, I mean, I love the patient contact. And also just, there’s something about just the satisfaction of sorting people’s problems.

Prof Sir Sam Everington
I often say that I’m a fixer, not in the East End sense of the word, by the way. Right. But just trying to help make their lives a bit better, and focusing on what matters to them. And that’s really, I think very early on, I realized that my medical training wasn’t nearly sufficient to be a good GP.

Prof Sir Sam Everington
And in fact, if you look at, Professor Marmot’s work, he would say something like 80% of health and wellbeing care is nothing to do with biomedicine. And in fact, biomedicine at times can be counterproductive.

Prof Sir Sam Everington
If you take over 65 year olds, 10 to 20% of them are admitted to hospital without adverse drug effects. You know, biomedicine isn’t all safe. And the alternative is really, really important in terms of improving the health of people’s lives and simply gets divided into their connections.

Prof Sir Sam Everington
So that’s about their connections to their family, their community, and to the countryside. It’s about a job, get a good job even better, an education, and then their environment, and the creative or spiritual side of their life.

Prof Sir Sam Everington
That’s the other 80%. And if you can help patients with that or create a team that can deliver support to patients in that area, you will truly be, I think, a holistic doctor and have great fun. And that’s the fund for me.

Prof Sir Sam Everington
You know, when I started as a GP, gosh, 34 years ago, I was single handed in a lockup shop with two outdoor toilets. Within a year, had complimentary therapists working with us. So we were always, People ask me, did you plan all this?

Prof Sir Sam Everington
No, I describe myself sometimes as an accidental leader and just an accident. But there was something I realized on day one, I never wore a tie. Um, I never used my titles to patients. So not the doctor, not sir, not professor.

Prof Sir Sam Everington
It’s always first names. And, uh, I always warn people, by the way, that if I use those titles in an email, you can bet your bottomed up. I’m after some. Um, and, uh, and I gave them their notes and 34 years ago, that was a very unusual.

Prof Sir Sam Everington
And, um, but I believed in working in partnership with patients. Um, yes, I might have, and I did have a lot of knowledge about health and, um, but actually you were going to achieve the best with patients if you do it in partnership with them.

Prof Sir Sam Everington
Yes. There are moments where what a patient really needs is, is clarity. Actually doctors as patients are often the worst. Sometimes they’re so terrified actually about what’s happening to them, but they have this very professional face.

Prof Sir Sam Everington
And sometimes you just need to say to them, look, just sit down. I’ve got, I’m going to get this sorted for you. Do you know what I mean? And this is what you need to do, but, but you need to work out with every patient.

Prof Sir Sam Everington
What’s the right tactic for them? What’s going to work for them? And, and then most importantly, I think I learned very early on that it wasn’t what the matter was with somebody. So we’d been taught at medical school.

Prof Sir Sam Everington
It was all about you’re a diabetic or an epileptic or have schizophrenia. It was what matters to them. And so you’re using the same word, but once you start thinking in those sorts of terms, I think you have a very different relationship with patients and you are much more likely to focus on things that are really important to them and their quality of life, because as I said to a patient the other day,

Prof Sir Sam Everington
you’re going to die. He looked at me horrified. And so, and then, then I started laughing and of course he started laughing and I said, the question I’ve got for you is what do you want to do with the rest of your time, you know, how, how can we improve your life, the life that you got left?

Prof Sir Sam Everington
I think that’s, that’s really important. Yes, there are moments where what you do in medicine is truly about saving lives, but actually most of what we do is actually improving people’s quality, ensuring that they have the happiest and healthiest life possible.

Prof Sir Sam Everington
when you look at the difference between rich and poor, where I live, those life expectancies, you’re looking at least 10, 15 years. And in my community, you know, particularly some of the women, interestingly, in the East End of London, the women, some of the women are living shorter lives than men.

Prof Sir Sam Everington
that’s extraordinary. That’s right. It’s the wrong way around. And it’s not unusual for them in their 50s and 60s to look 10 years old, to be depressed, overweight, poor teeth, housebound, you know what I mean?

Prof Sir Sam Everington
It’s a, it’s a dreadful spiral down. And so it’s really, really important to get people to focus on their health at a very early stage. And mental, physical and social are so connected and people don’t understand that.

Prof Sir Sam Everington
People often say to me, well, how many of my consultations are actually about mental health? And I say every single one of them. Right.

Robin Daly
But it’s just interesting to me, you’re talking about a medicine as though 80% of it is this other side of things that they like. And that’s, I completely agree with you. And unfortunately, of course, medicine as a whole doesn’t see it like that.

Robin Daly
The screen is filled with diagnostics and biochemistry. But it’s so refreshing to hear you talk that way. It’s clear that you’ve always thought that way as well. And I actually visited your practice in Bromley by Bow, somewhere about halfway through the journey you discussed there about 15 years ago, I guess.

Robin Daly
It was a very inspiring experience. I’d seen you talk at an event. I thought I must go and see what this guy’s up to. And so I came over to have a look. And I mean, what a place. It was just humming, basically, quite the opposite of that quiet waiting room at the surgery.

Robin Daly
So we’ve been there to expect. And so it was absolutely clear that you’ve been implementing what you’ve been talking about for years. And yeah, way ahead of the curve, you may have been accidental as a leader.

Robin Daly
But no doubt about it, you’re leading the field in thinking in that way that medicine is a lot more than just pharmaceuticals. So you were a radical at that time. What you’ve done, what you’ve achieved there is extraordinary.

Robin Daly
But I know you’re a bit of an idealist. You’re always working on something. And I expect it falls far short of what you’d like to see as well. So how does it look to you now at this point? I mean, obviously, you’ve had an effect on the whole health service.

Robin Daly
But let’s just talk about you and your practice and what you’ve managed to achieve with your patients. What do you feel is absolutely great is just exactly what you wanted. And what do you feel is like, oh, if only I could manage to find a way to do this.

Prof Sir Sam Everington
I think what’s great is to be working within a team. And and, you know, actually, Bromley by Bow is all about people and relationships. You know, we’ve got about a hundred different projects that run amazing.

Prof Sir Sam Everington
I feel intensely lucky. I never and that’s why I couldn’t be a barrister. I didn’t want to work on my own, right? Lonely life as a barrister, I think. And and so it’s the team that’s really, really important.

Prof Sir Sam Everington
The patients and the partnership with patients really important. So quite a lot of those projects will be run by patients. And there’s something quite wonderful. I’ve got five children. And if you’ve got children, it’s I can describe it in a well, and it’s like your two year old when they do a painting.

Prof Sir Sam Everington
Clearly it’s a van Gogh. And that’s what you tell. Right. That’s amazing. And there’s a parent, what you want to do, what what gives you the greatest joy in life is to see them take off. Actually, it’s what gives me the greatest joy as a leader.

Prof Sir Sam Everington
When I see somebody take off, you support them actually to do something fantastic, and they really do something amazing. That is the joy and pleasure of that is quite enormous. So thinking about where it’s gone is amazing.

Prof Sir Sam Everington
So we now had our third international conference. We’re, I think, leading the world in many ways on social prescribing. Persuaded government. Well, as CCG chair, I put it in every practice entire Hamlets about 10 years ago.

Prof Sir Sam Everington
then about four or five years ago, we persuaded government to put it in every practice in the country. That was fantastic. And that was what a what a win. Yeah, real breakthrough. Yeah, it was was amazing.

Prof Sir Sam Everington
that was years of ministers, the king, all sorts of people coming to Bromley by Bow and understanding what it was from their personal perspective and didn’t matter what their politics were, whether they rich or poor, they got it.

Prof Sir Sam Everington
that way, that was a thing that we learned in the very early years. You used to get people saying, well, write us a document or a business case. There’s nothing better than actually tasting, smelling, feeling it.

Prof Sir Sam Everington
Do you know what I mean? It’s I sometimes say, if you’re used to drinking plonk and you’ve never tasted champagne, how would you know the difference? And so actually the experience of going there and hearing some of the stories, meeting some of the people.

Prof Sir Sam Everington
then actually we don’t tell people to go and do what we we we’re doing. We say, what is it you’re passionate about? What’s your community needs? What’s what’s the resources in your community? Go and do something that you want to do.

Prof Sir Sam Everington
A friend of mine in Leicester put a police station in her waiting room as a GP, reduced the crime rate on the local housing state to 20 percent of what it was before. And the policeman who worked with her, completely new experience.

Prof Sir Sam Everington
Their bosses, of course, loved them because they delivered on the crime. Right. But actually for them personally, they were liked by the community. This was a new experience for them. Right. So it’s all over the place.

Prof Sir Sam Everington
people often say, well, we haven’t seen other Bromley by Bow’s. And I’m saying, you know, it’s all over the country. You know, it’s in a small way, much bigger way. I mean, there’s a GP in St. Allstel who works very closely with the Eden Project, who’s doing amazing things in his town of 30000 patients.

Prof Sir Sam Everington
So, yes, it’s incredible. What next? Well. To me, the big gap is there’s something around the parity of stream between hospitals and primary care. There’s a major issue about the lack of investment in primary care.

Prof Sir Sam Everington
It has gone down from about 11 to 7 percent of the budget, NHS budget in the last last 10 years. And that’s catastrophic because if you think about it, the number of people we’re seeing every day, it’s a massive part of the population and good primary care always, always saves.

Prof Sir Sam Everington
I mean, you’re intervening early on in people’s illness. You’re doing prevention and you’re acting as a massive support to the hospital. And a lot of the things I did as a CGG chair was to support the hospital in all sorts of I mean, we did we’re doing something called advice and guidance where we encourage all our doctors and we resource them to send a note to the consultant saying, here’s the problem, help. And the consultant then in probably about sixty five percent of the occasion will just send us a note within a week. So no wait of months to be seen in our patients for a patient. And we get on and we sort the problem.

Prof Sir Sam Everington
You know, there’s there’s some very simple solutions to some of the problems at this moment in time. And social prescribing was a very big part of that. It gets patients. to use their resource, their family’s resource, and the community resource actually to help them.

Prof Sir Sam Everington
It’s very important because there’s quite an addictive behavior that goes on in traditional biomedicine, which is, I often describe it as, look, you come into me and your cholesterol is raised, and I could just prescribe you a cholesterol tablet, and you and I will be happy on the surface.

Prof Sir Sam Everington
You’re thinking to yourself, thank God for that. I’ve got a pill that will sort out all my problems, and I can carry on eating junk food, not exercise and all those things. I can carry on as I am, and I can superficially be quite satisfied and happy because you’re happy, and I’ve solved your cholesterol problem.

Prof Sir Sam Everington
But that’s quite addictive behavior, and it doesn’t get you anywhere in the long run. In fact, actually, if you think of all the people who are on statins, you may be talking just about 1 in 100 patients who are truly going to benefit in terms of producing risks of stroke.

Prof Sir Sam Everington
When you put that in those terms, you realize there’s a massive gap. Actually, if I can get people to swim three times a week like I do, or just go for a good long walk every day, and eat healthy food, this will substantially prolong their life and improve the quality of their life.

Prof Sir Sam Everington
I talk all the time with patients about Mediterranean diet. I shop in my local supermarket, and you’d be horrified at the number of trolleys that have virtually no fruit and veg in them, but fizzy drinks, all sorts of prepared foods.

Prof Sir Sam Everington
It’s not all about the money. I mean, don’t get me wrong, there’s a poverty issue in all of this. But actually, you can do a lot to help people make healthier choices. That’s really important. The next stage at Bromley-Bye Bowe is the teaching issue.

Prof Sir Sam Everington
Medical students spend very little time in general practice, and yet probably 40% of doctors will end up as GPs. That’s when you train GPs. If you think about it, being a GP is probably the most complicated job in medicine, because actually, you have to know a lot about a lot of illnesses.

Prof Sir Sam Everington
Whereas actually increasingly over the last few years, doctors in hospital become highly specialized. You get orthopedic surgeons who just do knees. If you train to be an orthopedic surgeon, it takes 13 years from entering medical school.

Prof Sir Sam Everington
If you try to be a GP, it takes 10 years. And of those five years you train after being a doctor, three of them will be spent in hospital. Now, I look at that and I think that’s mad. So we’re pushing, and we’ve done a four-year course so far, we’re pushing to take doctors straight out of qualification and put them in general practice for five years to train them as GP.

Prof Sir Sam Everington
we think that will be, they’ll learn a hell of a lot more, and they’ll have a fantastic experience because they’ll be part of a team, a family, for five years. They won’t have to move every six months to a year.

Prof Sir Sam Everington
They won’t be doing hospital jobs where they’re doing day shifts, night shifts. It’s really interesting. So I work those 84 hours a week. But in my day, you worked on a ward, the same ward for the same nursing team, for the same consultant for six months.

Prof Sir Sam Everington
it was a wonderful experience. We called other firms in those days, and people cared about you. Yes, it was long hours, but actually people really looked out for you. That’s gone. And one of the reasons why the junior doctors are so unhappy, it’s not just about the money.

Prof Sir Sam Everington
A big part of it is the circumstances of their life. So they’re doing a lot less hours. But actually, nobody really cares about them. And so actually, my idea of completely changing the training, and I’m a professor at Queen Mary University, so I’ve been brought in to completely rethink the training of medical students and GPs.

Prof Sir Sam Everington
at the heart of it is the concept of continuity of training. So we understand from Norway, interestingly, where I’m partly from, we understand how important continuity of care is. There’s a study done about three years ago in Norway, which shows absolutely clearly that you’ll get much earlier and better diagnosis of cancer, heart disease and other life-threatening conditions with continuity of care.

Prof Sir Sam Everington
I would argue the same applies when you’re a teacher. actually watching. And of course, you know this. I mean, if you ask anyone to talk about somebody who had a big influence in their life, they’ll often tell you about that teacher.

Prof Sir Sam Everington
They had continuity teaching from all those years ago that had a massive impact in their life. But we’ve forgotten that with mentoring in that teaching world.

Robin Daly
Absolutely. I mean, it’s in the common sense territory that one, you know, you can, you get that feeling like as a patient, if you’re a, you never see the same GP twice in some vast practice, you never see the same nurse twice if you’re in the hospital, you know, this kind of thing, you know, that it’s, it’s bad news, actually, you’re not getting to know anybody, there’s no relationship.

Robin Daly
so they’re not even able to care about you particularly well, even if they’re wonderful people. So yeah, continuity, very important indeed. So this programme is all about integrative cancer care, we haven’t exactly been talking about cancer here, you did mention cancer, well, that’s good.

Robin Daly
But I’m going to say we’ve been talking about many of the key factors that do play into integrative cancer care. Factors that the NHS has been kind of lacking in, but you’ve been working extremely hard to change to name some of the big ones, I’d say like, you know, empathy and compassion, patient engagement, patient choice, and autonomy, and lifestyle medicine, those are the kind of things which we’re seriously interested in and pushing for.

Robin Daly
they’re what I call vital ingredients of integrative cancer care. Social prescribing is going in just the right direction is helping people with cancer just like everybody else. So I’m extremely happy to see it arriving as part of our healthcare.

Robin Daly
But I mean, my view from where I see it is that cancers are particularly tough nut to crack when it comes to change. It seems to be one of the most intransigent areas of healthcare. I don’t know what you think. Do you have any thoughts on that and what it might take to bring change into cancer care?

Prof Sir Sam Everington
I think there’s two areas to look at one is living with cancer. What is dying with cancer? You know relation to living with cancer. We’ve already talked about the importance of continuity of care you know and You’re quite right.

Prof Sir Sam Everington
The social prescribing is really really important because yes, we’ve got great advances in surgery radiotherapy Chemotherapy great advances in all of those snot spares and there will be more to come The key to the treatment is is the the biomedical side at least is early pickup The treatment regimes and all of that in a sense is very possible And we know how to solve that problem The other the big area is and here is a pretty shocking statistic It’s about 47 percent of people were terminal illness dying hospital then now that needn’t be and And and when I talk at conferences I I always get people to put their hand up if they want to die in hospital the term illness or die at home or In their community surrounded by their loved ones.

Prof Sir Sam Everington
In fact, the only time anyone ever said they want to die in hospital was a chief exec of a hospital trust and I don’t know whether that was The hospital or or she didn’t have any loved ones. I

Robin Daly
It’s a bad picture either way.

Prof Sir Sam Everington
But it’s, so what we’ve developed in Tamhamlets is a local contract, which creates a multidisciplinary team that meets at least monthly. And you’ll have the palliative, so it’s done virtually now, which is very effective.

Prof Sir Sam Everington
You’ll have the geriatrician, the psychiatrist, you’ll have the palliative care nurse, the district nurse, the social scriber, the GP, the practice nurse, the whole team actually then going through this top 5% of patients that are complex care, housebound and terminally ill.

Prof Sir Sam Everington
that’s proactively managing them. And that’s a very novel idea in general practice, because most of the time what you’re doing is responding to requests from a patient. And so just to give you a taste of what that means, and by the way, you can, one of the great projects I led for Simon Stevens, now Lord Stevens, the NHS, was the Vanguard project.

Prof Sir Sam Everington
we had 50 vanguards across the country, and one of them run by a group of nurses reduced deaths in hospital from 47 to 14%. Wow. So they cut it a third. So how are we doing that? How are we giving that choice to patients?

Prof Sir Sam Everington
Firstly, it’s really important to have that constitutive care relationship with them. You know, for relations, people don’t see death these days. I do, because I’m a doctor, but most people don’t. And the idea of somebody dying at home, your m or your dad or whatever, is really frightening.

Prof Sir Sam Everington
if you can hold their hand virtually throughout that process, A, it becomes, well, I often say that actually the greatest gift you can give your m or dad is a good death. And if you support that son or daughter to do that, the sense of achievement they will have, and the reduction in bereavement, of course, they’ll be incredibly sad when the person dies.

Prof Sir Sam Everington
But they won’t be filled with that guilt of not having supported them through that journey. Or that, you know, yes, we’ve all had testy moments with our families. But that falls into the background because of what they’ve done in the process.

Prof Sir Sam Everington
you have to take people through that process. I, for example, give my mobile phone number and email address to all my terminally ill patients and they can ring or text me anytime they like. And I’ll give you an example of what that means.

Prof Sir Sam Everington
I remember getting a text in surgery one day from a woman who just said, Oh, my mum’s just passed away. Could you pop round at some point? Now, what a calm message. This was somebody who’d been terrified of doing it.

Prof Sir Sam Everington
So I went round, it was a Bangladeshi family. As usual, there was lots of people in the house and you have to kind of do the last rites in front of everybody. And then I sat down with her and did the test certificate.

Prof Sir Sam Everington
It’s very important to our Muslim and Jewish patients that they’re able to bury their loved ones within 24 hours. And then I looked at her and I said, you know, if your mother was still alive, she would be so grateful and thanking you about what you’ve done.

Prof Sir Sam Everington
it’s it’s saying things like that it’s having described to her what death looks like so they don’t just dial a blue light and then you end up with some ambulance team trying to resuscitate somebody who’s clearly you know it’s just but that just the fact that they know they can just ring or text me you know what I mean there’s help at the end as someone who knows them yeah is really really important and is that is that it’s just kind of that personal touch which is really really key and you asked about what the next steps is well that should be across the country this is a madness that all these people are dying of term illness I mean financially insane you know actually nobody wants it a thousand to two thousand a night in hospital and nobody wants it and you know to be on an acute ward where the nurses are overwhelmed with work you know and can’t pay decent attention to somebody who’s terminally ill I mean this is crazy and it’s very possible to manage it at home you know managing terminal this is on the on the vast majority of time is not difficult once you do it it’s it’s emotional yeah you know and there are very sad moments do you know what I mean and somebody said to me the other day you know well aren’t you just professional and don’t get sad no I mean there’s moments you know I walk into the house and somebody’s died and I’m hugging somebody and I’m I feel myself welling up you know and that’s okay I say I say to my students and trainee doctors it’s okay yeah a lot of time you don’t feel that way you know you’ve not been close to somebody but it’s okay to feel like that and and I have to say if you have helped somebody die at home like that it’s it’s a fantastic sense of pride professionally actually that you’ve given there was a lovely patient of mine actually is a lovely 80 year old at stalwart east ender he wanted to die in the in the uh in the hospice because his his wife was very frail but he was like that old-fashioned man who didn’t want to cause any trouble you know and didn’t want to be a burden to his wife or anything and uh so anyway after a month of his term illness I am uh he so we got him into the hospice but about two weeks later they rang me and said look he’s not dying we’ll have to just right so I virtually begged them and I said look please please trust trust me I think he’s going to go soon and and this is a very odd thing to say but luckily he died within a week odd thing to say but actually he got he got his wish by the way the other thing that is really worrying about hospitals so he had he had liver cancer and I’d suspected it and I’d referred him up to hospital and they’d done a CT scan which showing up yeah spread all over his body but they’d gone ahead and biopsied him there is a real problem with some of the ethos in hospital right which is not recognizing death and there is I think one of my colleagues call called uh oncologists and living in balmas a cheeky moment which but actually there is a problem and I think some of the hospital doctors find it difficult to have that discussion with patients about you’re going to die you know that 80 year old man I I sat down and he was in his chair I got down on my knees and looked him straight in the face and I told him in the kindest way that I could exactly what was going to happen to him and he was amazingly grateful for that it enabled him actually to prepare I will never forget that he is one wish he was a train spotter and his one wish was one last time a platform mate strapped with his a train spotting mates you know and we got a wheelchair for him and he and he managed that you know actually bring them but often you know I I don’t know about other people but the people that matter most to me in my life are my family okay and I don’t want to leave a mess behind you know what I mean and so I want to leave everything tidy for them I’ve done the will I’ve done everything else and and I think other people who are dying deserve that obviously but so often they’re not good with it. Yeah.

Robin Daly
that’s very fair. Yeah. Man, lovely stories. Shane, the NHS hasn’t done much on clothing. We could do a few more like you.

Prof Sir Sam Everington
There’s lots more out there, there’s lots more outlets.

Robin Daly
No, there are, but they need to be in the forefront, that’s what I say, particularly in cancer care, because it’s a hard place. People go there, it’s so tough in cancer care. People dread their oncology appointment.

Robin Daly
They don’t go there thinking they’re going to get support. They feel they’re going to be disempowered and they’re going to come out feeling much worse than when they went in. That’s terrible from somebody who’s supposed to be healthcare, you know, looking after you.

Robin Daly
So, yeah, I mean, your approach, right on, bring it on. Yeah, anything you can do in the oncology wards, we’ll have it, please.

Prof Sir Sam Everington
Well, I would be very happy to talk to an oncologist. I remember an inspiring oncologist I met years ago at Arts. He was a child, a pediatric oncologist, and

Prof Sir Sam Everington
he was teaching people laugh to therapy. How inspiring is that? The biggest area in life not to laugh is about dying children. I remember quite a few years ago, I had a young child with Wilms tumor, which normally is curable, but was dying.

Prof Sir Sam Everington
It was a struggle for the hospital doctors to accept it. They kept trying to want to bring the child back in. And I kept on saying, look, the parents have recognized the child is terminally or they were very religious.

Prof Sir Sam Everington
Actually, they just, they want the child to die at home. And I had to, I had to push back at them consistently. I also was very cognizant of the fact that actually, the child and the parents was the key.

Prof Sir Sam Everington
And they didn’t need a lot of professionals running around. And so when I did home visits, I often didn’t go in and see the child.

Prof Sir Sam Everington
Quite often you don’t need to, do you know what I mean? Because I didn’t want to interfere with that absolutely important relationship, unless it was essential, don’t get me wrong. If I needed to examine or talk to the child and it was really vital, then fair enough.

Prof Sir Sam Everington
But actually, most of the time, what I was there to do was actually help them manage the situation, whether it was pain relief or anything else. And actually, that relationship with the parents, I think, was really, really important.

Robin Daly
absolutely right. Well, thanks so much. It’s been a great talk. I’ve absolutely loved it, Sam. Thank you so much, and we’re out of time. But I get very hardened when I find people like you have actually managed to get to a place where people are listening to what you say.

Robin Daly
You know, you’ve got some influence there. You’ve got the ear of a lot of people who make decisions, and you can help things to go in a much better direction. Very heartening and very inspiring, and yeah, a personal thanks to you for being an inspiration to me.

Prof Sir Sam Everington
Well, it’s I mean, I just feel very lucky. I you know, I feel like I landed on Mars by accident and It’s just very lucky great team great people we work with I’ve also learned that actually Don’t ever feel that you can’t ring or talk to somebody, you know, it doesn’t matter how Hyvee might be up in the hierarchies or status Everyone’s a human being I always love Jimmy cars quip When he says to people look if you’re really worried and notice about somebody just imagine them naked It’s a great lie

Robin Daly
I do hope you enjoyed meeting Dr. Everington, he’s the best face of our NHS and the changes he’s driven are inspirational. 2023 has been a great year for progress in interpretive cancer care, but is still way too slow.

Robin Daly
Hence, we at Yes to Life will be pushing even harder in 2024 and are lining up many great initiatives to this end. I hope you’ll continue to join me here for the show, but also if you haven’t already, please do sign up for our email newsletters, which you can do in the foot of every page of our website, yestolife.org.uk, and or follow us on social media to keep in touch with developments throughout the year.

Robin Daly
Wishing you every happiness in the coming year and the very best for your health and health care, and if you think Yes to Life could play any part in that, please don’t hesitate to contact us. I look forward to bringing you to the next Yes to Life show in 2024. Bye. Bye.