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Ignoring victims, looking after predators
Positive discrimination exchanges one injustice for another
I have been reading Hard Times again on holiday, at the same time as the daily papers, and it suddenly occurred to me that the 19th century was not brutally absurd enough for Dickens. His Squeerses and Veneerings and McChoakumchilds seem very sedate in comparison with the astonishing characters and follies of the late 20th century. Last week, in an example of ludicrous insensitivity, without parallel in the entire works of Dickens, police in South Yorkshire put a black man (suspected of extorting money from a financial adviser actually called Baden-Powell) in an identity parade with eight white men; to make it "fair", they painted the white men's faces black. In the heat of the line-up lighting, their blackface make-up began to run. Explanations and extenuating circumstances can be of no interest; this was inexcusably stupid. I do not believe that even Dickens could have dreamt up such a farce. Fortunately this nonsense was abandoned when the black man's solicitor objected, and the case was thrown out of court. It is not entirely surprising, perhaps, that in the face of such grotesque obtuseness liberals should have become equally unhinged in their responses. How else can one explain the way they have gone to monstrous, irrational extremes in their support for persecuted groups? How else, for example, can one understand the way in which crude, unthinking homophobia has been met with crude, unthinking homophilia? The persecution of homosexuals has been atoned for, in guilt-ridden liberal circles, with an uncritical adulation of gays. Gays are not just OK, but good, or even possibly better. The loopiest extreme of this has been the sanctification of Aids victims, so that no film star or society hostess can afford to be without her Aids gala and her talented friends dying of Aids. But Aids is a misfortune, not some kind of virtuous apotheosis. People wear their red Aids ribbons with a mindless smugness that makes me want to rip them off their chests. I believe it was the same stupid perversion of good feeling that led to the scandal of child abuse in Hackney, east London, which the Evening Standard has painstakingly exposed - a series of abuses nastier than anything in Dickens. Last week it was reported that Hackney Council, despite repeated warnings from previous employers in Liverpool, employed for 12 years a suspected paedophile and known homosexual to look after children in council care, despite two subsequent complaints of abuse from children in Hackney, and one of violence from his gay lover, now dead of Aids. Keith Trotter himself died of Aids two years ago, but only now, after intense pressure from the Standard and two independent inquiries, is the truth beginning to emerge. Trotter died just two weeks before police arrived to arrest him for abusing five boys during his time as a care worker in Liverpool in 1980. Now, according to an NSPCC report, there is evidence that he abused six children in his care in Hackney. One cannot help wondering how many more than six victims there were, given the difficulty of tracing all the children - 337 former residents of Trowbridge House children's home, and a total of 415. Nor can one feel entirely confident, until all the reports and police investigations are finished, that no children were infected with HIV. Certainly many of them were at grave risk. Poor little Oliver Twist, at his most miserable, was only hungry and unloved; he did not live in fear of rape and fatal infection. The point is not that this wicked man was let loose among vulnerable children who were entirely at his mercy. There is always a risk of evil men preying on children. The point is that those whose job it was to protect these children from such risks appeared to be more interested in protecting the predator. It was the predator they perceived as victim, because he was gay. In 1989, after a police raid, the council accepted Trotter's defence that he was the victim of "homophobia". And in their self-righteous vigilance over one supposed victim, they were blind to the possibility of others. In 1992 the council would not investigate his lover's allegations. In 1995, after Trotter's death, the council was disgracefully slow to look into the case; in the end Hackney's ruling Labour group was split, with 16 rebels walking out among allegations of a cover-up. An independent inquiry will report later this year. The question remains, however: why is it that, for all its good intentions, positive discrimination too often borders on the pathological? In its exaggeration and unreason, positive discrimination simply exchanges one injustice for another and - which is worse - undermines the idea of justice itself.
The Sunday Telegraph | Sunday, July 27, 1997 | Comments (0)
Don't let your heart rule your head
Marriages of convenience have much to recommend them
Cynicism is much underrated, probably because it is so often misdirected. The cynical mutterings about the romances of William Hague and of Gordon Brown, for instance, are entirely misguided. It may be, as people like to suggest, that the engagement of the teenage Tory leader to a pretty and ambitious woman is not entirely the result of an overwhelming romantic passion. And it may be that Gordon Brown's association with another pretty and clever woman is not entirely driven by the spirit of St Valentine. That is no reason for so many people to make disapproving noises, as if there were something squalid about contemplating a marriage of convenience. It is very difficult in these sanctimonious times to reach high office without flaunting clear signs of heterosexuality, uxoriousness and quality parenthood. Hague and Brown would not be the first ambitious politicians of their generation to bite the bullet and reconcile themselves to matrimony as a means to an end. Nor would their girlfriends be the first good-looking and clever women to make a worldly choice about their future. I am not suggesting that I actually know anything of any of their motives. For all I know it is Antony and Cleopatra all over again. What I am suggesting is that marriages of convenience have a great deal to recommend them, and that people who condemn them very often do so out of insincerity and sentimentality. The standard respectable reason for getting married is that a man and a woman have fallen in love, whatever (as Prince Charles so stalwartly said) that means. Being in love is actually middle-class code for being in the throes of a sexual infatuation - not, one might think, the best state in which to make the decision of a lifetime, or an objective character assessment of the beloved. Sexual passion has all too short a life: a puppy is not just for Christmas, so to speak. Any marriage, no matter how romantically it began, will end up as something much less so. People lose their looks and grow old. As my mother-in-law always says, marriage is not a love affair. What remains, for the lucky, is the lasting happiness of shared interest and shared purpose, the intimacy of real companionship and a strong sense of a contractual bond - precisely those things for which people make marriages of convenience, or - to use the gentler expression - marriages of reason. I cannot see what is so shocking about approaching marriage in a spirit of reason. The Anglican prayer book positively recommends it; advisedly and soberly are the words, as far as I remember. Personally I don't think that I could ever quite get myself into an entirely reasonable frame of mind about just anybody; the wildest of political or social ambitions could not reconcile me to a lifetime of Hague or Brown, for instance. And that is my point. Reason does not necessarily exclude feeling. It directs it. As the greatest beauty of my generation at university, much feted by the sons of millionaires and shipowners, once said to me: "Of course I'm not going to marry for money. I'm simply going to make a point of marrying where money is." One might say exactly the same about political power, or upward mobility, or the prospect of a corner shop. Most people marry for something more than disinterested love; most people's motives for getting married do not bear much close inspection. But that is nothing to be cynical about. What ought to make us all feel extremely cynical, yet oddly doesn't seem to, is the way that public figures are now obliged to parade romantic feelings in public. I blame the Prime Minister. It was Tony Blair who started the perfectly ridiculous habit of displaying himself in public clutching the hand of his wife, or with Cherie hanging on his shoulder or neck. In my youth that was considered extremely vulgar. It is an infantile habit he has picked up from the Clintons, whose public hand-holding fills one with the deepest misanthropy. It is one thing to make, or stick to, a marriage of reason. It is quite another for middle-aged public figures to make distasteful public displays of bogus teenage infatuation. Now all the big hitters in British political life - if that is not a contradiction in terms - feel they must be spotted in intimate poses too, snapped exchanging significant glances and generally engaging in awkward mating rituals simply to impress the masses. It is, in its own way, a kind of political sleaze.
The Sunday Telegraph | Sunday, July 06, 1997 | Comments (0)
The doctors' dilemma
It would not be a lamentable necessity at all, but an excellent thing, if patients had to pay directly for medical attention.
There seems to be something infectious in the air about thinking the unthinkable; everyone seems to be doing it. Even doctors are trying it. At the annual general conference of the British Medical Association in Edinburgh on Monday, members agreed in principle to consider new ways of funding the NHS, other than taxes and prescription charges. They have carefully left their options open and avoided being too specific, but what they are really expressing is something remarkable: a clear loss of faith in the possibility of a free, universal national health service. What they are talking about is making people pay individually for treatment, one way or another.
No doubt many of them feel bitter regret at this revolutionary thought. (Many of them appear to be confused as well, because they voted earlier for a motion which appears to be directly contradictory, demanding that the Government should fund the NHS entirely out of public money, "with no assumption of efficiency savings or private money".) No doubt many doctors are only bending, with great reluctance, to the harsh winds of economic necessity.
After all it was, as one of them said, "putting a stake through the heart of the welfare state"; and Dr Sandy Macara, chairman of the BMA, urged members to vote against the proposal, saying the NHS could perfectly well be paid for by the taxpayer, with only "a miserable pounds 17" more from each person. (It is also worth noting that a doctor arguing in favour of payment for doctors' visits claimed that it would raise half a billion pounds a year.) But this is the voice of the boy with his finger in the collapsing dyke.
The time has come not only to think the unthinkable, but also to believe it, and to start to think differently. Actually it would not be a lamentable necessity at all but an excellent thing if patients had to pay directly for medical attention. The fact that people have not had to pay all these years, but have regarded doctors' and nurses' time as free, has actually been a disaster for the NHS. The illusion of a free service has been wasteful, demoralising and counter-productive from the point of view of doctor, patient and taxpayer, and even, arguably, from the viewpoint of health administrators.
Anyone who pays for private treatment will know that the relationship between doctor and patient is radically altered for the better by the existence of a fee; parting with money tends to concentrate the mind. It sets up a powerful sense of personal obligation on both sides. Doctors have to provide a service patients think worth paying for, or they will go out of business. Equally no one with any sense will spend hard-earned money on a visit to the doctor unless he or she feels genuinely ill, and unless the excellent advice now available from pharmacists, and the passing of time, have not solved the problem, as they often do. People who pay the enormous fees of private GPs think long and hard before making an appointment, and find it quite astonishing how effective self help can be.
The other side of the picture is the frivolous abuse of the NHS, which is a direct result of people perceiving it as free. All doctors have outrageous stories of patients wasting their time, demanding visits even for sore throats or shampoo in the eye. Dr James Le Fanu tells of a middle-aged woman with asthma who called her GP for treatment at midnight; as he left she thanked him for coming, saying "my drugs are in my daughter's bedroom, but, I did not want to disturb her as she was fast asleep".
Night calls have risen fivefold in the past 25 years, and doubled in the last three, not because people are sicker, but because they are much less respectful of the doctor's time, which of course costs them not a penny. Not surprisingly GPs have become seriously demoralised.
The same goes for the ambulance service, which can offer equally outrageous tales of waste. In one station alone in one month emergency ambulances were sent to a young man who did not know how to remove his new contact lenses, a man who had been bitten by a stag beetle, a man who had stubbed his toe and broken a nail and a woman who had lost the string of her tampon.
What is more, highly equipped ambulances are regularly wasted by police, hospitals and local authorities as sources of "free" transport or of "free" low level community care, such as putting old people into bed. Not surprisingly, you cannot now count on an ambulance in a real emergency; only 66 per cent of calls are answered within 14 minutes.
So casual have many people become about the value of treatment, that many patients do not bother to turn up for hospital outpatients and consultants' appointments, and do not even bother to cancel. Considering that it takes many months to get one of these appointments, this is not only wasteful and disruptive, it is also unfair to sick people further back in the queue, and very demoralising to administrators. Frivolous patients might feel entirely differently if they were to lose a significant sum of money for wasting the hospital's valuable time, as private patients do when they fail to turn up.
It is not only patients' attitudes that can be damaging to the NHS. Doctors and nurses and other medical staff may find their attitudes subtly undermined by the knowledge that treatment is apparently "free". It is only human nature to treat with greater deference a customer who pays; a customer who had not paid, except in the remote sense of being (perhaps) a taxpayer, will sometimes be seen as lucky to get anything at all. Some patients seem to share this view, and feel unduly grateful for inferior service and oddly uncritical.
Certainly that is my experience of prevailing attitudes in the NHS, and certainly NHS patients are often treated in a casual way that would drive private practitioners straight into bankruptcy. All too often they are made to wait about ceaselessly; they see a constant stream of different doctors and their operations are frequently and brutally cancelled. This is not new, and not necessarily anything to do with the supposed cuts. It has to do with a prevailing culture that has horrified me all my adult life.
There cannot be a sense of value without a direct sense of cost. Equally there can be no personal sense of waste, without a personal sense of cost. So, far from the betrayal of an ideal, the single most effective reform of the NHS, the simplest way to cut back waste, queues, abuse and hypochondria, and to make way for those in real need, would be to make people pay, directly, part of the cost of each appointment. Of course there are many vulnerable people, who cannot and should not have to pay. But the rest of us might find we were buying, at low cost, a much more efficient service for everybody.
The Daily Telegraph | Wednesday, July 02, 1997 | Comments (0)
