SACRED COWS (1)

We British have a well-earned reputation for hypocrisy, a claimed freedom to criticise others in an ostensibly high-minded way coupled with an unwillingness to discuss or accept the imperfections of certain aspects of our own society. The British are doubtless not alone in this weakness but I would like to sketch in our peculiar, if protective, attitude to a central institution in Britain, The National Health Service.

William Beveridge

Aneurin (Nye) Bevan

The National Health Service was inaugurated in 1948 acting on the Report of 1942, chaired by Liberal economist William Beveridge, a rather dry old stick. It had recommended the creation of a taxpayer-funded universal healthcare system, from the cradle to the grave, free at the point of distribution.   The necessary legislation was pushed through Parliament by the charismatic Socialist firebrand Nye Bevan; the senior doctors, a powerful lobby bitterly opposed to the NHS, were outmanoeuvred. The Tories voted against the Act, believing that war-weakened Britain could not afford the scheme at that moment, but there was a wide measure of cross-party consensus for the NHS concept. The NHS remains a great blessing for every British citizen and is the corner-stone of the Welfare State.

But the NHS is in crisis. The problems are manifold; demand for healthcare is unlimited; there are constant new and expensive advances in therapies; the UK population is living far longer than Beveridge and his visionaries anticipated and old people need medical help disproportionately. The system works at full capacity, with waiting times for non-emergency GP appointments commonly one month, Accident and Emergency departments become overrun as patients abuse admission criteria. Pressure on hospital beds is intense, operations are routinely postponed, patients often lie awaiting admission on trollies, elderly patients, (“bed-blockers”) cannot be discharged as local authority social services do not have the resources to care for them.

The NHS employs 1.6m people (40% from overseas) and is the largest enterprise in the UK and the 5^th largest in the world. The NHS cost the equivalent of £15bn in 1948 and this has mushroomed uncontrollably to £117bn in 2015/16. Yet Germany and France spend substantially more per head than Britain, not to mention Norway, while Italy and Spain spend a similar amount. The NHS staff is militant, nurses and junior hospital doctors demanding better pay while well-remunerated consultants and GPs fiercely oppose the government’s wish to move to a fully functioning 7-day rather than a 5-day system Sadly the NHS is by no means “the envy of the world” as the systems of about 15 other countries are rated more highly while cancer and cardiac survival rates for NHS patients are unacceptably low.

Politicians have been craven in facing up to these problems. The Left screams constantly for yet more money to be thrown at the problem areas forgetting that resources are finite. The Right puts undue emphasis on “efficiencies”, cutting personnel numbers and bureaucracies which are not truly at the heart of the problem. Together their idiotic reflex action is to “ring-fence” expenditure and not subject it to any profound scrutiny – a sure recipe for yet more failure.  

The NHS cannot be exempted from close examination and some hard choices. The taxpayer contributes the giant’s share of the funding, representing about 8.8% of GNP. It is high time we abandoned the notion that patients should make no contribution to their care. With generous exemptions for the really poor and the very aged (say over 80s), it is surely reasonable to extract a token £5 flat rate for a visit to a GP and say, a £20 flat rate for a night in hospital. The true costs are of course much higher but time-wasters, hypochondriacs and the frivolous need to be deterred from clogging up primary care and hospital patients can usually afford something.

The treatment of the old is a major issue. Over time a network of state-run clinics and hospitals for geriatric illness should be erected, hopefully “centres of excellence”, separating these patients from those in general hospitals and money should be invested in the best geriatric procedures and relief for the helpless, maybe tapping philanthropic donors as well as the taxpayer.

I doubt if the system whereby welfare is notionally funded via National Insurance deductions can politically be changed, but some personal insurance element could be introduced perhaps for unusual therapies. Although the idea of rationing hospital procedures is fraught and emotive there must be limits to what the NHS can provide, humanely applied.

Getting the NHS back to order is partly a managerial challenge, partly a financial one and partly a requirement to think inventively outside the box. The public psychology needs to move away from welfare dependency – the idea that this is a state problem – to an acknowledgement of responsibility by every citizen that the health of every family member, young or old, needs particular understanding, that treatment carries a cost, and health professionals should be cherished.

Thoughts “outside the box” must take due note of the Hippocratic Oath. Save us from the Orwellian nightmare of an Assisted Dying Department (“call ADD to Subtract” its catchy slogan) administering a state blue pill to the inconveniently alive, the blow softened by an illuminated scroll expressing thanks for past services from a grateful monarch! Worse still would be the remedy suggested by arch-satirist Jonathan Swift in 1729, certain to reduce the pressure of numbers, in his A Modest Proposal:

A young healthy child well nursed, is, at a year old, a most delicious nourishing and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricassee, or a ragout.

Are Theresa May and Jeremy Hunt up to this steep challenge?

SMD

23.01.17

Text Copyright © Sidney Donald 2017

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ALAN BENNETT - THE NORTHERN CONTRARIAN

Like, I imagine, a host of others, my favoured Christmas present this year was Alan Bennett’s third volume of diaries, memoirs, criticism and literary extracts entitled Keeping On Keeping On. Bennett’s mordant wit has entertained us for years and his best-selling literary and dramatic output has been highly impressive. He is, although he hates the epithet, clearly “a national treasure”.  Nevertheless he is also infuriating, a woolly-minded Leftie hypnotised by every “progressive” cause and no doubt an ardent admirer of Jeremy Corbyn and his unhinged acolytes.  Mindful of Alan’s proud Yorkshire origins, Bennett’s partner Rupert Thomas neatly summed him up:

Rupert: You’re rather like Heathcliff

Alan, (gratified): Really?

Rupert: Yeah. Difficult, Northern and a c*nt.

A typically lugubrious Alan Bennett

      

Born in 1934, so now 82, Alan Bennett was brought up in the bleak Armley district of Leeds in West Yorkshire. He was the elder of 2 sons of Walter Bennett, a Co-op butcher, and his “Mam” Lillian Peel. He later was to paint a loving picture of his painfully shy parents (a friendly clergyman married them at 8am so that Walter could return to the shop by 8.30 am and avoid any “plother”).  Alan’s working class background deeply defined him; the dependence on the public library, the constant family visiting, the Sunday get-togethers to sing while an aunt played the piano, Walter’s accompanying violin, played by ear, the wartime hardships alleviated by pilfered coal nuts, the rattling Leeds trams.

Alan was however an exceptionally bright pupil from the unglamorous, but free, state schools of Leeds. He won a place at Cambridge but first did his National Service learning Russian at the Joint Services School for Linguists, principally based at Cambridge. On demob, he switched horses and secured a scholarship to Exeter College, Oxford, winning a first class honours degree in history before doing post-graduate work on medieval studies. He enjoyed university acting, but would have settled into the life of a second-rank Oxbridge don, had he not been invited to join the Oxford Revue/Cambridge Footlights production of Beyond the Fringe at the Edinburgh Festival in 1960. This satirical show, debunking the public attitudes of the day, was an immense success in London and New York with Bennett supplementing the more extrovert efforts of Peter Cook, Dudley Moore and Jonathan Miller.

The show opened up many wider horizons for Alan; he gave up academia and decided to become a professional writer.

AB, atop a piano, in Beyond the Fringe 

Bennett in the 1970s

In many ways, Bennett had the world at his feet but he had inherited a diffident streak from his parents and felt he did not easily fit into even his chosen milieu; he was also of a religious cast of mind. All this was compounded by the fact he was a covert gay, not “coming out” until the 1990s. This sense of otherness and of frustrated detachment was only very slowly overcome; he developed a parsonical air, high-minded, aesthetically aware, uncarnal, seeking to look and admire but not to touch. He knew and regretted he was missing out on many aspects of life. 

He wrote a variety of plays for radio and TV. He enjoyed a considerable West End theatre success in 1968 with Forty Years On, a rather heavily allegorical drama/review about a school called Albion House led by its headmaster John Gielgud, easily identified as 1960s England. Amusing in its time, it would be found too preachy for contemporary tastes.

Bennett had found his voice, gently mocking and challenging conventional attitudes. He took this further in his 1983 TV play An Englishman Abroad, depicting the Cambridge spy Guy Burgess in a sympathetic way. This tolerance of traitors was developed in A Question of Attribution (1988) centred around dialogues between MI5, the Queen and Anthony Blunt, the unmasked spy who was the Keeper of her Pictures. Interesting as both pieces may be, it seems that patriotism, treachery and institutional loyalty sadly do not feature in the Bennett vocabulary.

So fruitful has Bennett’s muse been that it is impossible to cover everything. He has written penetrating criticism of Auden, Kafka and Larkin, screenplays on Orton and many others, readings for children including Winnie the Pooh, fine plays in The Madness of King George (1991), The History Boys (2004) and The Habit of Art (2009), a play within a play imagining conversations between Auden and Britten. Several have been filmed or otherwise adapted. His TV monologue series Talking Heads (1988 and 1998) featuring Patricia Routledge, Thora Hird and Julie Walters is considered by many to be the apex of his achievement.  It all represents a very solid body of work, even if there is no obvious master-piece to rival those of Rattigan or Osborne.  

I guess his autobiographical works and diaries will live longest, collected in Writing Home (1994), Untold Stories (2005) and Keeping On Keeping On (2016). They paint a picture of a very civilised man. He has a very wide acquaintance in the theatre but is by no means a green-room luvvie. He loves to gossip reminiscently and regrets the passing of old friends. He lived in Camden Town for years but his London base is now in leafy Primrose Hill. While in Camden Town he was the reluctant but generous host to the eccentric Miss Shepherd who parked her dilapidated van in his drive and lived there for 15 years – the subject of his The Lady in the Van starring Maggie Smith.

Alan also inherited his parents’ house in the Yorkshire village of Clapham and he adores walks there amid the becks of the Dales. He does everything with his civil partner, aesthete Rupert Thomas, with whom he has been in a relationship since 1992, legally since 2006. Together they enthusiastically visit churches, buy antiques and bric-a-brac, visit galleries (Alan has been a Trustee of the National Gallery and gets privileged access) go on trips abroad to New York, Rome and a villa in Provence.

Rupert Thomas with Alan Bennett

He gives a candid and moving picture of his late parents, Walter and Lill, and their families. Lillian’s father committed suicide by jumping into a canal in the early 1920s, a shameful episode in those days, never discussed. Lillian herself became mentally ill, suffering depression and was intermittently institutionalised. Walter died of the strain of constant caring and visiting. Alan was a dutiful son, regularly visiting as she descended from depression to dementia, and she lived out her life pathetically in a care home in Weston. Bennett describes this situation with delicacy, wit and tenderness; his campaigning for improved mental healthcare has been hard earned.

Alan is what I call contrarian: he refused a proffered knighthood and even an honorary doctorate from his own university of Oxford on the tenuous grounds that it had accepted the endowment of a Chair in Communications from his bête noire Rupert Murdoch. He dislikes the work of Leonardo and Cézanne, and until recently flew around London talking to himself on his bike. He overdoes the eebygummery of his Yorkshire origins and his political views are best classed as “Rococo”.

Yet his Northern tones are ultimately irresistible: he is our best-recognised and most cherished literary intellectual. May he continue to amuse and educate us for many more years!

SMD

8.01.17

Text Copyright ©Sidney Donald 2017