Wednesday 28 March 2012

Empire Day

In the course of the 20th century, Britain underwent two world wars which decimated its young manhood, devastated its cities and bankrupted its economy.  It lost the most extensive empire the world has ever known, and almost the entire manufacturing base on which its wealth and expansionist zeal was predicated.  Despite this (and its diminutive size) it is still the world’s seventh largest economy by GDP. Extraordinary, when you think about it.  And even more extraordinary that this loss of power and relative wealth was a largely post-war phenomenon: in a few brief decades, the work of two or three centuries was undone; and Britons found themselves being invited to atone for their former global destiny and to get used to being just another country.

Against this background, any attempt to re-appraise the legacy of the British Empire is a risky enterprise.  Children of my mother’s, inter-war, generation were raised to see the Empire as a Jolly Good and Necessary Thing, and the British as a sort of chosen race, destined to bring civilisation, Sung Evensong, and a proper cup of tea to the earth.  While my father (whom she would not meet until 1948) was growing up in 1930s British India, she was at school in east London where, on Empire Day (24 May) they waved union jacks and sang:

Red, white and blue
What does it mean to you?
Surely you're proud
Shout it aloud
Britons awake!
The Empire too
We can depend on you.
Freedom remains
These are the chains
Nothing can break.

Well, they may not have broken, but clearly they do not bind in the same way. This is the theme of Jeremy Paxman's BBC TV series, Empire.  In it, Paxo visits various Commonwealth countries - apparently wearing the same powder-blue linen shirt throughout - in an attempt to re-assess the British Empire's legacy.  The tone and content is one designed to avoid any charge of revisionism on the one hand, and mindless 1970s-style repudiation on the other.  It doesn't quite achieve objectivity, perhaps because that is not really possible, and the series is in any case billed as a personal account.  But there is evidence of an honest determination to get at the facts, combined with Paxman's celebrated "come off it" inquisitorial style designed to get people to spit out what they actually think.

He is, for instance, able to ask an east African man of Asian race (whose forbears were effectively transplanted by the British) if he is not grateful to the British for building the trans-Africa railway which he so admires; and also to ask an Indian if she does not hate the British for their cruelty and snobbery.  The answers are typically nuanced, and can be summarised as "yeah but no but". The conclusion that the viewer is invited to draw is that the British Empire was in some senses a very good thing, and in other senses a rather horrible one.  Not very exciting or ground-breaking; but perhaps in need of being said.

The late, great Bernard Levin coined the term "The Fallacy of the Altered Standpoint", to describe the difficulty of judging something - particularly a historical event or circumstance - free of the insidious prejudices imparted by subsequent events and subtle changes in social mores.  This applies rather sharply to post-war attitudes concerning the British Empire, which have been conditioned by Britain's radically (and, in historical terms, rapidly) changed status.  Perhaps the relatively balanced take espoused by Empire is a small sign that we are beginning to shake off our post-war, post-imperial shroud of self-denigration, and to view our historical selves both more kindly and objectively.

History is neither good not bad. It just is.

Tuesday 13 March 2012

The NHS and Me

There is a poster in the window of the office of the attendants (they would be called concierges in more westerly postal districts) who look after me and the other residents of my City apartment block: "SAVE OUR NHS" it screams in a huge cerise font.

Now, I am a very child of the NHS: born in 1953, I was delivered by said service in east London (I could almost have been a Call the Midwife baby) and enveloped by it from both my and its earliest days.  It tended to my childhood ailments (often involving a GP's home visit), routinely tested my ears and eyes, inspected my feet and drilled my teeth.  It inoculated me against various diseases, the names of some of which - probably partly because of its existence - are rarely heard these days. It gave my mother concentrated orange juice for me to drink and - less welcome - cod-liver oil to swallow.  It even gave me my very own number which - though long since superseded by one with 10 digits - I remember to this day: MMQS 439.  And, notwithstanding the occasional recourse to private treatment, eg for slipped discs (believe me the physiotherapy's no less painful because you're paying for it), it is the NHS on which I continue to rely - quite heavily - to keep me healthy.  I am 58, not rich, and have had lifelong access to free basic healthcare.  My personal experience of a widish variety of hospital and specialist care has been variable but, on balance, positive.  I am, if you like, almost a walking testimonial for the comprehensive, free-at-the-point-of-use, cradle-to-grave care provided by the NHS.  I have as much reason to be sentimental about it as anyone.

And yet sentimental about it I am not. Someone has said that the NHS is the nearest thing we have to a national religion and, depressing as that is, it does perhaps help to explain the reaction to the Health Bill currently going through Parliament.  Some of this borders on the hysterical, and can be readily disregarded. Some is fairly crude political opportunism, and can be received accordingly.  Other criticism is more measured and/or more independent; and it makes sense to heed the reservations of those who actually work in the NHS, and on whom people like me depend for our care.  But there's no doubting the emotion involved.  I wonder if the proposed dismantling of the Church of England (which is our actual national religion) would provoke such passion?

I use the word "dismantling" because that is the word used repeatedly by its critics to summarise the present Government's intention with regard to the NHS; and it is that fear which is undoubtedly exciting much of the reaction.  I do not claim to have more than a layman's insight into it, but it seems to me that nothing like "dismantling" is actually on the cards.  Of the two main provisions, one (the extension of competition) is not on the face of it very controversial.  Competition within the NHS was introduced under Thatcherism and significantly extended under New Labour.  Some are and have been, perfectly rationally, opposed to it all along; but it is now, in one form or another, a reality of at least some aspects of almost of all public services. It's reasonable to question the extent of its influence, but a bit anachronistic to recoil in horror from the very idea.

The second of the two main provisions - the concentration of power and money in the hands of GPs - is a big change.  Who knows - it may well not work.  But does it constitute the dismantling of the entire structure?  I doubt it.  In fact the more you look at the Bill, the less radical it all seems; and I'm beginning to wonder if that's the real issue.

You see, if you treat the NHS less like a religion and more like any other taxpayer-funded service; if you can appreciate its strengths but admit its shortcomings; if you can be honest about your experience within it it while being realistic about what it can deliver in its present form, you may begin to think that nobody is being radical enough.  In the last 15 years, overall spending on the NHS has more than trebled - and even now, is continuing to rise slightly.  It's true that the rate of increase is now falling well behind increasing costs (which is why "net" cuts are necessary). But I cannot be the only NHS user on whom it has dawned that the recent massive increase in spending has still not given us the health service we want (ie one free of horror stories of the kind that pre-occupy the early evening news bulletins).  I cannot be the only NHS user who has observed that, satisfactory though my overall health care is, there are some things badly amiss with the NHS that do not seem to be susceptible to increased funding. Have you ever spent a night in an A&E unit? Have you ever been with a loved one during a serious health emergency and extended hospital stay? Have you tried to co-ordinate post-operative care when the hospital and the community health service don't appear able to talk to one another, and you are exhausted?  And, if so, are you still of the opinion that what is needed is simply increased funding?

I don't pretend to know what the answer is.  But I have a growing conviction that what is wrong is with the NHS is embedded in its very culture, which no amount of mere reform (or money) can hope to change.  This culture is one which bears little resemblance to that which existed when I was a child, and which instinct leads me to associate with the gradual disappearance of a certain sort of health professional driven primarily by vocation - this itself perhaps the result of wider social change.  I don't think the re-introduction of Hattie Jacques-style matrons - which some prescribe - would work.  Such people, and those whom they managed and mothered, simply do not exist any more.

This leads me to suspect that what we need is a completely new health service for a new society.  This means actually dismantling the NHS and replacing it with something else - perhaps something closer to the universally admired French system.  Now that would take political courage.