Among all the noise about the NHS, a little quiet should be a great improvement

There’s been a lot of noise in Britain recently about the failings of the National Health Service.

Popular anger, or at least anger in the media, has focused above all on the Mid Staffordshire NHS Trust. The scandal has its roots in a study by hospital information company Dr Foster Intelligence, which found that 400 more people had died in the hospital over a three year period than might have been expected given how ill they were. A public enquiry revealed a harrowing string of cases of appalling care: patients suffering dehydration because they weren’t given anything to drink, patients left in their own faeces, patients left to suffer in pain as buzzers rang wildly throughout the wards with no nurses answering.

There’s been less talk about the people who sent flowers and chocolates to the hospital, to thank the nurses for the care they or their relatives had received, though some of those making the gifts have been among the most outspoken in their criticism since. Equally, not a lot is said of the encouragement the Trust was given to opt for the much vaunted status of a ‘Foundation Trust’, even at the cost of economies that left too few nurses to ensure adequate coverage. Nor is much said of the findings, again from Dr Foster, which classified the hospital ninth in the country for quality.

Instead, those orchestrating the media noise seem to be intent on directing outrage against nurses, once universally seen as angels, now increasingly portrayed as fiends.

The truth is that in a professional body of 370,000, there are bound to be a few rotten apples. But, overall, the vast majority of nurses are deeply committed to caring for patients, just as nurses always have been: it is after all the overriding motivation for choosing the profession in the first place. But the government chooses to proclaim that nurses have lost their compassion and demands, for example, that in future nurses have more hands-on care of patients – washing them, feeding them – as part of their training, to teach them the compassion it’s alleged they have lost.

This from a government that has just imposed the deepest cuts for a generation in benefits for the poorest people in Britain. But then I suppose we don’t all have the same notion of compassion.

It should also be said, in passing, that the government has launched a programme of reform of the NHS which seems destined to fragment it and undermine its public service commitment. That will encourage the government's friends in the private sector, who want to take over apparently lucrative parts of healthcare, although few of those who’ve tried so far have made any money from it and the scandals about quality from private providers have already begun.

Against this background, I was fascinated to hear of an initiative in my local hospital, the Luton and Dunstable, or ‘L&D’ as we fondly call it. 

Instead of responding to the problem of patients ringing buzzers to no avail by demanding that nurses answer them more quickly, the hospital is planning to do away with buzzers altogether. Rather than giving nurses more non-nursing duties, as the government seems to favour, they’re recruiting more clerical staff to free up qualified staff to concentrate on nursing.

The L&D: quietly improving where others just shout

The hospital has been piloting the idea of a ‘quiet ward’. The approach is widespread in Germany, which is where the L&D came across it. I believe something similar was tried in Gwent, in Wales. In England, however, it’s an innovation.

On a quiet ward, there are no buzzers, phones or faxes. There is a nurse and a healthcare assistant for every ten patients. Nurses are freed of tasks such as cleaning, ordering x-rays, coordinating discharges, answering phones or making beds. Instead, that work is carried out by support staff. 

This means that the nurse and healthcare assistant can devote far more of their time to nursing, including simply walking the ward and checking on patients’ welfare. So patients can expect to see a nurse far more quickly now, without a buzzer, than was ever possible by ringing one before. And without buzzers, phones or faxes the ward is quieter so the patient's experience better.

The pilot at the L&D went so well that the hospital is now rolling out the approach to other wards, and recruiting 105 ward clerks and other staff to support it. 

Without all the recriminations and impassioned debates that surrounded Mid Staffs, the L&D is quietly making radical changes in its approach to nursing, with the profession’s enthusiastic support. The pilot suggests the new arrangements will greatly improve healthcare quality.

It remains to be seen whether our ‘compassionate’ government will support this pioneering initiative by a hospital in the old, public and much-maligned NHS.


Postscript. On Mid Staffs, I was amused to see that 40,000 local people – or possibly 50,000, depending on who you believe – turned out to march through Stafford to try to save the hospital, now slated for closure. The difficulties the hospital experienced were always on the front pages, but the support march  received very little coverage. The march is just boring old news; the high death rates, on the other hand, were a story.

Why reading the instructions can be a smart move

Some may feel that 5:00 a.m. isn’t the ideal time to start a Saturday. But if your wife’s a keen birdwatcher, it’s her birthday and that justly exalted institutions, the National Trust, is organising a 6:30 birdwatching walk in that breathtaking place, Ashridge Forest, well, 5:00 is when you get up.

I’d made all the arrangements. I’d planned our departure time based on normal conditions but, of course, there’s no traffic at that time of day, so we arrived dead early. And then we sat in the morning cold watching the minutes tick by, while no-one else showed. I wandered over to the visitor centre, naturally shut, and checked out the posters: there it was, 6:30 on the 27th, beginners birdwatching walk.

The kind of thing we might have seen. But didn’t.

So where was everyone?

Danielle had been checking the web and had the answer.

‘At Steps Hill car park,’ she informed me.

Steps Hill car park? Where on Earth was that?

Ashridge doesn’t do helpful little road signs, marked with useful indications such as ‘Steps Hill car park this way’. In fact, it doesn’t even put names up on the bits of land it’s flattened here and there and designated as car parks. They’re just marked ‘car park’, which isn’t what I think of as uniquely identifying. Be fair, National Trust. I’d call that ambiguity, except that there’s loads of them. Multiguity, perhaps.

Eventually, though, we found a car park with several cars in it plus two National Trust ranger vehicles.

‘This must be it,’ said Danielle. Her tone wasn’t icy, precisely, but had just that kind of non-iciness voices take on when their owners are trying to be kind to the afflicted by not revealing their feelings.

It was 7:00 by then so we went home. Where I checked my e-mails. The one from the National Trust proudly proclaimed that the attachment contained ‘all the information you will need for your visit.’ I looked. And there it was: the meeting point wasn’t the visitor centre but Steps Hill car park. As marked on the attached map. With a grid reference and everything.

If only I’d read it. If only I’d printed it out. If only I’d taken a glance last night.

How did Whittier put it? ‘For of all sad words of tongue or pen, the saddest are these: "It might have been!"’

Ah well. There’s always next year, I suppose. Perhaps by then I’ll have learned to read instructions.

Meanwhile, happy birthday, Danielle.

UK economy: two cheers for the government

‘We are building an economy fit for the future,’ the UK Chancellor of the Exchequer, George Osborne, announced today.

The reason for his satisfaction? The figures for GDP in quarter 1 show we have avoided a triple dip recession: to my heartfelt relief, GDP grew in the quarter and the unrelenting decline seems to have been stemmed. For now.

But how much was the growth? Just 0.3%. If that’s a harbinger of the economy of the future, there isn’t a lot to look forward to. 

On the other hand, looking back isn’t particularly heartening, either, at least for the administration.

The British ConDem government, the so-called coalition between Conservatives who run the show and the Liberal Democrats who rattle along behind, like cans attached to the back of a newlywed couple’s car, doesn’t play the blame game. Of course. No-one does. 

It merely points out that it inherited a miserable economic position from its Labour predecessors.

That’s not blame. That’s recognition of the fact that Labour was in power before them and applied its economic policies. So it’s obviously their fault. Not blame, just a statement of fact.

What they’ve never explained, at least not to my satisfaction, is how the presence of a Labour government in Britain caused so much damage to the economies of the United States, Italy, Ireland, Spain and, indeed, most of the rest of the world. It had always seemed to me that there might have been some kind of global economic crisis, of which Britain, even under Labour, was more a victim than a perpetrator. But, hey, I may just be naïve.

Just for the sake of argument, though, let’s say that what happened back in 2008 really was the worst financial crisis since 1929. Wouldn’t you say that to get us back out of recession after just five quarters, and then take growth to 7% as part of five consecutive quarters of growth, was quite impressive?

Alistair Darling: a comparison that doesn't flatter Osborne

Well, so would I. Quite an achievement by Osborne’s predecessor, Labour Chancellor Alistair Darling. 

Particularly if ten ConDem quarters later, as the graph shows, we’ve had only five quarters of growth. One was impressive at 0.9%, but the rest were pretty anaemic. And the latest, as we were saying, was just 0.3%.

An economy fit for the future? Osborne’s not really very ambitious, is he? Or maybe he prefers to keep us looking forwards rather than back. Because he’s way behind the performance achieved under Labour just before he took office. 

No mileage for Osborne in drawing attention to that comparison...

Slaying dragons, or perhaps dinosaurs

It took a message from Catalan friends to remind that today is the Feast of St George, the pretext for a huge party out there. And it’s the day of our patron saint, too, back here in England (not Britain – England).

Barcelona's going to be having fun tonight

At first sight, it’s a curious coincidence that Catalonia and England share a patron saint, but a lot other places share him too, including Greece (and they really need a patron saint right now) and, naturally, Georgia.

St George has become a bit of a thing in England over the last couple of decades. The flag, red cross on a white ground, has begun to rival the Union Jack, that mish-mash that’s supposed to represent the whole of the United Kingdom: it’s made up of bits from the flags of England, Scotland, which is in the throes of an independence campaign, Ireland, most of which has long since gone, but not poor old loyal Wales. 

More about Wales later.

You see the flag of St George flown quite a bit these days, above all from church steeples. Church of England steeples, I suppose.

Flag of England on a Church steeple

The flag’s growth in popularity seems to be a reaction to the increasing nationalism of the Welsh and the Scots, which is a bit of a cheek, when you think that Welsh and Scots nationalism has grown in reaction to English nationalists lording it over them for centuries.

In any case, the most attractive aspect of St George is nothing to do with nationalism, but with his legendary exploits in slaying dragons. Now that’s something that we badly need again today. Or if not dragons, at least a few dinosaurs.

• The dinosaurs that inhabit the clubs of London, including the big one that meets in Parliament, and runs the Tory Party on the basis that the measure of a man is his wealth, and the greater his wealth, the better qualified he is to run the show.

• The dinosaurs in the US senate who’ve decided to react to the killing of twenty kids in Newtown by doing precisely nothing, even blocking the most limited control on guns, though they’ll doubtless react to the three deaths in Boston by clamouring for a war somewhere.

• The dinosaurs on both sides of the Atlantic who feel that the rights of an embryonic collection of cells in a uterus trump those of the grown, sentient, suffering woman to whom it belongs.

• The dinosaurs everywhere who think there’s a lot too much love in the world, so that any that occurs in couples of the same sex really ought to be locked away in the dark somewhere or, better still, banned.

• The dinosaurs who think that the best thing the poor can do is suffer a bit more to make sure that the fine people who run the place, can add a bit to their wealth. Maybe that’s just restating the first entry in this list but, hey, sometimes I feel it can’t be said loud enough or often enough.

So, come on St George! Show us what you’re made of and slay a dinosaur or two.

Which brings me back to Wales. That’s the country that’s not even significant enough to warrant inclusion on the Union Jack, but just when England, proud bearers of the flag of St George, were about to clinch the triumph of a Grand Slam in the Six Nations rugby championship – victory over every one of the other nations – who stepped up to deprive them? Wales, of course.

In the words of an Irish friend of mine, who adds insult to injury by living in Wales, they didn’t just beat England, they trashed England. I phoned to check whether he’d perhaps misspelled ‘thrashed’, but no, ‘trash’ was what he meant. And a trashing was what it was.

So, St George. If you don’t fancy taking on a dinosaur for us, let me point you towards Cardiff. There’s a dragon there on whom you might like to wreak revenge.

Welsh Dragon.
A target for St George if dinosaurs aren't his cup of tea

And, in the meantime, have a great party, my friends in Catalonia. And you Georgians too. As for the Greeks – see if you can at least drown your sorrows for one night.

And everyone else – happy St George’s, even if you don’t celebrate it.

Let them live, however vile

Nearly two thousand years ago, a group of aristocrats decided to defend the privileges that they and their ancestors had enjoyed for centuries, by striking down the military leader who seemed intent on putting an end to them.

On 15 March 44 BC, they mobbed Julius Caesar in the Roman forum and stabbed him to death. The assassination sealed their own destruction in the civil war that followed, along with the end of the republic they had been so keen to defend. For self-fulfilling prophecy, to say nothing of own-goals, the assassination of Julius Caesar is right up there with the all-time greats.

Just under a century and a half ago, a mediocre actor achieved far greater fame than he ever could on stage, by bursting into Abraham Lincoln’s box at Ford’s Theatre and shooting him in the head. To crown his act, John Wilkes Booth shouted ‘sic semper tyrannis’, the words Brutus is said to have proclaimed after killing Caesar, to signal that all tyrants would die. 

John Wilkes Booth.
May not have been much of an actor, but I wish he'd stuck to it.

As it happens, anyone less like a tyrant than Lincoln would be hard to imagine: his consummate skill was in persuading, cajoling or indeed buying (as the recent film Lincoln showed) enough support to compromise his way to success.

How might things have been, in the counter-factual hypothesis that Lincoln had survived? We can’t know, of course, but I guess that we might not have had to wait until Franklin Roosevelt to see a president re-elected to a third or fourth term of office. What effect that might have had on Lincoln and his commitment to good government and democratic principle it’s hard to say.

More significant would have been the effect on post-civil war reconstruction. My suspicion is that the reintegration of the southern States would have been quicker and more complete, and on the basis of a more rigorous equality among races. The fourteenth amendment freeing slaves was passed in 1865; a century later, their descendants were still battling – in many cases literally – for their civil rights. A lot of bloodshed might have been avoided.

So those were two successful assassinations that were wholly unsuccessful in achieving any useful aim.

On the other hand, there have been assassinations successfully avoided. For instance, late in the Second World War, the British Special Operations Executive launched a plan to murder Hitler. Who opposed these action men, the blowers-up of bridges, the killers of officials in occupied territory? The more established agents of conventional intelligence with their cooler heads. Why? They believed any replacement would run German military power more effectively than Hitler, lengthening the war and making victory less sure.

SOE: Bravest of the brave, but a little misguided over Hitler?

Why am I dealing with such morbid issues? Blame my youngest son Nicky who criticised me for talking too much about the natural death of Maggie Thatcher, having promised to stay silent on the subject. He insisted that I spend some time on violent political deaths, to make up for my inconsistency. 

As an inhabitant of Madrid, he’s particularly well placed to make that demand. I first got to know Spain well in the early nineties. Already then, I had trouble remembering that the country had been under the thumb of a thoroughly vile dictator, though he had died less than twenty years earlier. Indeed, in between, there had been the 1981 attempt by Antonio Tejero, latter-day John Wilkes Booth, to seize power by an armed attack on parliament. Friends in Barcelona described that terrible night in 1981, as they drove about the city to track each other down and try to decide what to do: to wait, to fight, to fly? But then in the small hours, the King finally broke his silence, and called out the army to put down the few rebel units, which it duly did, and the coup was over.

Antonio Tejero: misguided, wrong and thankfully a complete failure

So Spain was a strong enough democracy to resist even an armed attack.

Now would it have been the same had Franco been assassinated? That’s another counter-factual, but again I have little doubt over the broad outlines: Franco would have become a martyr, the far right would have been revived,  crushing repression would have been imposed and many opposition figures murdered or worse. I’m not at all sure that Spain would have been a democracy even today.

Killing an individual leader, however evil or incompetent, seems seldom to produce the desired result. Sometimes, as in the case of Hitler or Franco, it’s best to learn some patience and wait: the effect seems far more profound and longer-lasting.

That’s a lesson the West would do well to learn. There was such celebration over the execution of Saddam Hussein, but might he not have been dead by now anyway? Would things have been much worse? Or rather, when we look around the bloody, Iranian-dominated state Iraq has become, might they not have been a great deal better?

Getting over that death and getting a life

It’s sad that the very qualities that win Brits grudging admiration abroad, alongside the usual derision, are the ones that tend to go fastest when some major event occurs.

The qualities are a sense of humour and a certain civility. You know, the good manners that mean we check with our hapless victim that the electrodes are comfortably attached to his genitals, sir, before turning on the current.

The major event was the death of an old age pensioner last week. She’d played a significant role in politics a generation ago, had been stitched up by her closest friends, and had left the stage in some disarray.

That’s her in disarray, but also the stage. Her immediate legacy was decline, into a corruption without even the redeeming feature of grandeur – you know, the larger-than-life drama that goes with a Richard Daley in the States, a John Profumo in the UK, a Mohammed Karzi in Afghanistan – and marked instead by the sleaze that merely provokes ridicule. 

One remembers, for instance, a fine tabloid paper set up a Conservative MP, Piers Merchant, by getting a young woman to kiss him in a park – oh, and he kissed her back too, naturally – while their photographer was lurking in the shrubbery snapping the whole scene.

Cue one career-challenged MP and the Beckenham constituency needing a new representative.

However, twice as much time has passed since Maggie left office than she spent in it. When she died, it seemed to me to be a moment for historians, politicians and journalists to make a few appropriate comments, maybe publish a paper or two, but for the public to do no more than any other historical footnote merited.

But of course the Conservatives are back in power now, and not doing well in the polls. Whatever they could do in the way of riding a Maggie wave back into some popularity was worth trying.

And that’s when the sense of humour and civility failures click in.

First the civility. There were a number of parties celebrating Maggie’s death. Odd, really. In dying, Thatcher became the equal of all of us, who will in turn also have to face that same dreary exit some day, in a way she hadn’t been for years. Surely that was a moment for some restraint; the time for parties was at the time of her political assassination by her supposed allies back in ’90.

Much funnier than the parties was the campaign to get people to download the 1939 Wizard of Oz song, Ding, dong! The witch is dead. I refused to take part, for the same reason I wouldn’t have gone to a party: I’m against celebrating death. But the controversy was great to follow. Why, the other side decided to get in of the act too, and set out a little late to persuade people to buy I’m in love with Margaret Thatcher. In the end, Ding dong didn’t quite make it to number 1, falling one place short. I’m in love only got to 35.

What amazed me is how few people can make that much difference to a song’s place in the charts: Ding dong sold just 52,605 copies. In a nation of nearly 60 million. That’s what it takes to get to number 2.

Even more amusing were the reactions. Tory grandees were lining up to suggest that, despite their total and unshakable commitment to democratic principle, and all that free speech stuff, doncha know, they really rather felt that the BBC should do the decent thing and not play the song on its Chart Show. A new entry. Straight in at number 2. But the BBC caved and another victory was notched up for the humourless, over the adherents of the good old phlegmatic British inclination to say, ‘boys (and girls) will be boys (and girls); let them have their fun.’

Then protesters travelled down to her funeral to turn their backs on the procession as it went past. Strikes me if you want to reduce the event to its real insignificance, the best thing is not to go at all. By turning up in person, you surely give the moment substance – as though protesting against Thatcher hadn’t become irrelevant two decades ago.

That’s where the sense of humour failure showed through too. Nigel Lawson, Lord Lawson, told the BBC that the protesters were exercising a right Maggie had done everything she could to protect. On the other hand – oh, wasn’t it obvious there was another hand coming along? – it would be a terrible pity to show the world an image of Britain as a place that couldn’t show respect to that fine, fine woman.

This from the man whose resignation from Maggie’s cabinet triggered her eventual fall.

Hey, lighten up a bit

It’s pretty significant that he mentioned that point about the image of Britain abroad. Many eulogies to Maggie have pointed out that she converted ‘basket-case’ Britain of 1979 into a nation that won the respect of others.

Well, basket-case Britain had one child in ten living in poverty. Eighteen years of Tory rule later, internationally respected Britain had taken that ratio to one child in three.

International respect paid for by little children? You can keep it. The kind of respect I’d appreciate – and show myself – would be for those who did what they could to alleviate the suffering of little children, not to increase it.

And I might also feel more respect for the country if it learned to take itself less seriously again. To see the funny side. So that instead of working up outrage in response to a little tasteless protest, people just shrugged, walked off and got a life.

In memory of an outstanding woman

Today’s a particularly good day to salute the achievements of an outstanding figure of the twentieth century. She was a woman who opened doors in ways that are being felt as strongly today as they were in her time. 

And she wasn’t Margaret Thatcher.

A single photograph is the key to the significance of her years of careful work. Of course, as a complete layman, I have to admit that when I first saw it, I was inclined to ask, ‘err... yes... but just what are we looking at?’

The justly celebrated Photo 51.
'Yes, dear, very nice. But what is it?' is not the right response.

However, for those in the know, it provides powerful evidence that DNA is not only a spiral, but a double helix, with the ‘bases’ – the bits that code the genetic message – on the inside. In other words, it was the key to understanding the structure of what has come to be known as the language of life.

It was taken by a crystallographer at King’s College London who, as well as being a skilful and painstaking experimentalist, was also, apparently, a little abrasive, a quality that cost her a few friendships. So it was without her knowledge or permission that her colleague Maurice Wilkins showed the picture to two scientists from the Cavendish Laboratory in Cambridge, James Watson and Francis Crick, giving them the decisive push to build their successful model of the DNA molecule.

James Watson wrote up the story of the discovery in his book The Golden Helix. I heard Watson speak at a conference in 1970, at which he claimed that the US government could save a great deal of money and achieve precisely the same progress, by shutting down all cancer research programmes other than his own. It didn’t seem to me that he was joking, and I was left with the impression that no-one could surpass him in enthusiasm or sincerity of admiration for James Watson.

The book is less than flattering about Rosalind Franklin, who took the key photo 51. Later, Watson admitted that he had been unnecessarily dismissive of both her personality and her skill. But by then he’d shared the 1962 Nobel prize for Physiology or Medicine with Crick and Wilkins, in recognition of their work on nucleic acids, including DNA. Franklin didn’t get a look in. But then she’d died, at the pitifully young age of 37, in 1958. 

On 16 April, as it happens, which is what makes today so suitable for commemorating her life.

The Nobel Prize isn’t awarded posthumously. But it’s also never shared between more than three laureates. Had she been alive in 1962, would Franklin have been the also-ran? The fourth scientist, the one whose work wasn’t recognised? Perhaps it’s just as well that we’ll never know for sure.

And congratulations to the American National Cancer Institute for establishing the Rosalind E. Franklin Award for Women in Science, to the Royal Society in London for setting up the Rosalind Franklin Award for outstanding contributions for any area of natural science, engineering or technology and to the Finch University of Health Sciences/Chicago Medical School for changing its name to the Rosalind Franklin University of Medicine and Science (which, to be honest, trips slightly more easily off the tongue, too).

And what a joy, one day before all the pomp and circumstance of Maggie Thatcher’s funeral, to remember another woman of that time, whose contribution may actually prove more lasting – and certainly a lot less controversial.

Rosalind Franklin at work