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How long will it take the health service to clean up its act?
Wearied by events, readers may by now have forgotten the first fine frenzy of the New Labour imperium. How exciting it all was. New, cool ways of doing things in new, Cool Britannia burst upon us, day after new young day.
For instance, in the early June of 1997, only a few weeks after Tony Blair's tremendous triumph, the new minister for public health, Tessa Jowell, and the new minister for food safety, Jeff Rooker, in a dazzlingly new sort of initiative, took themselves off to the young, happening area of Covent Garden in London, the fashionable haunt of clowns, hucksters and mountebanks.
There they proceeded to communicate with the people, in a very thoughtful and inclusive piece of performance art. Their theme was the need for improvement in standards of personal hygiene; what they did, carefully rolling up their sleeves for the purpose, was to act out, and thereby to demonstrate, the most effective way of washing one's hands.
At the time I was duly amazed. It had not occurred to me that any government could ever be so shamelessly, flamboyantly patronising, though Virginia Bottomley, in the previous one, had gone a surprisingly long way in that direction.
I wondered then, and I wonder now, why it has never struck any of the bossy brigade that their attempts to bully us are almost always counter-productive. Years of state sex education have produced nothing but an increase in pre-teen sex, schoolgirl pregnancies, single mothers and an exponential leap in sexually transmitted diseases. Years of trying to impose equality on education have resulted in much greater educational inequality. Years of nagging health education initiatives have coincided with an enormous growth of food poisoning, eating disorders, obesity and affluent malnutrition.
In just the same way, despite the sterling buffoonery of Ms Jowell and Mr Rooker, and all the apparatchiks who put them up to it, the handwashing situation has not improved. On the contrary: we don't do enough of it. Or, to be more precise, our doctors and nurses don't do enough of it. Hospital hygiene in this country is all too often abysmal. Deadly new superbugs stalk the wards; they kill about 5,000 patients a year, they make at least 100,000 others needlessly, miserably sick; and all this costs the NHS pounds 1 billion a year in wasted effort.
And one of the most important reasons is that all too many doctors and nurses don't wash their hands often enough; they don't observe the most elementary rules of hygiene and cross-infection. This week, the Commons Public Accounts Committee made the usual shocked and horrified noises, but there is nothing new about all this. It is merely getting worse.
"Hospital-acquired infection endangers patients' lives and is a major drain on NHS resources," the committee's conclusions were reported. How true. I have several times made the same point, with much the same figures, on this very page. "We find it inexcusable that compliance with guidance on handwashing is so poor."
Well, yes. It is particularly inexcusable because it is so easy to put right. As well as being absolutely essential at certain times, it is very cheap, quick and easy to wash your hands. One can ask only why so many doctors and nurses don't do it. This problem, and its solution, have almost nothing to do with money. Like most of the really intractable problems of the NHS, it has to do with culture, or, in this case, perhaps, with a lack of culture.
I am often tempted to hold forth about the culture, or lack of culture, among NHS nurses. I can hardly believe my eyes when I see them out in the street in their working uniforms, trailing germs and the filth from the pavements into and out of the wards, and from the hospital into and out of home, no doubt. I am astonished by determinedly untidy hair, falling forward on to patients, and their revolting food, not to mention their wounds. However, as far as handwashing goes, it is doctors who are more to blame, according to the parliamentary committee.
I have heard horror stories from nurses about doctors. One is the poison pen routine. Doctor with clean hands examines patient, takes pen from breast pocket, makes note, puts now contaminated pen back in pocket, washes hands and proceeds to next patient. Takes out contaminated pen. Touches patient. Finally takes pen home and uses it there.
Nurses often dare not speak out; very often, doctors won't be told. Nurses dare not criticise one another either. One who regularly cleans equipment sloppily will not be reported by another, more vigilant nurse; the entire culture is against it.
Part of this may be due to a general decline of standards in most things, from personal hygiene to grammar to manners. More specifically, one must conclude that the NHS hospital culture, all too often now, devalues the patient. For where anything is really felt to be of value, as (say) in the food industry, where bad hygiene means bad business, there is an excellent culture of hygiene: successful food factories insist on hairnets, hats, sterile clothing and footwear and superstrict discipline.
The average supermarket ham sandwich has more tender loving hygiene lavished on it, with scrupulously washed hands, than the average hospital patient. Twenty-four hours to save the NHS? It takes more than a few empty promises, and a couple of prancing politicos in the piazza, to change a decadent culture.
The Daily Telegraph | Saturday, November 25, 2000 | Comments (0)
Is this woman the very worst mother in Britain?
Here is a cautionary tale for our times; it has many morals. Peter and Patricia Thompson of Thrybergh, South Yorkshire, longed for a baby. After five years of marriage, no baby had appeared, so they went to a private fertility clinic and paid pounds 1,600 for in-vitro fertilisation treatment.
As a result, Mrs Thompson gave birth to three babies in 1997. As everyone knows, fertility treatment is extremely tricky, and so are multiple pregnancies, but there are many people who feel that the grave risks are worth the great rewards.
Fortunately, all three of Mrs Thompson's babies were born healthy. Lucky woman. She recovered very well. In fact, she recovered so well that she became pregnant in short order, by the conventional method as far as I know, and gave birth to another healthy baby the following year, in 1998. What a happy ending, you may think.
The strange truth is, however, that Mr and Mrs Thompson say they are not happy at all. They felt unhappy enough to sue the fertility clinic for compensation, and on Thursday, at a High Court hearing in Sheffield, they won their case and were awarded damages. These are yet to be decided; they are asking for pounds 100,000.
You might well wonder what their problem was, or is. What did they need to be compensated for? It is simply this: they got too many babies. "I wouldn't have wanted three children," Mrs Thompson told the court. "I just wanted two babies or one baby."
She claims that the clinic did not gain her consent for implanting three embryos, and therefore that it must cough up for all the fuss, bother and expense of having triplets, not to mention that strange legal thing, the "loss of amenity".
According to my dictionary, amenity means, among other things, "the quality of being pleasant or agreeable, pleasant ways or manners". Mrs Thompson appears to have lost a lot of all that. It is very disagreeable, to put it mildly, to go to court and say you want compensation for having one baby too many - one day they will find out.
Furthermore, it is both disagreeable and odd to say so, when you went on very quickly to have a fourth baby. The Thompsons now say, in public, what I suppose is the only explanation in the circumstances, that the fourth child was a mistake. One day that child will find this out, too.
So three of the children will know that their arrival was so dreadfully inconvenient that their parents felt driven to sue for damages. And all four will know that two of them were not wanted. I found myself horribly reminded of the suicide and murder note of the child in Jude the Obscure to his impoverished parents: "Done because we are too menny".
Meanwhile, childless couples across the country who long for babies but are unable to have them, or unable to pay for private treatment, will stare at the Thompsons with astonishment and resentment. And taxpayers of all kinds will resent the fact that the Thompsons brought this distasteful suit at our expense, on legal aid.
I am quite prepared to believe Mrs Thompson's claim that she did not agree to the implantation of three embryos. I am quite prepared to believe the clinic blundered, if only in good faith. I can also imagine how very hard it must be to carry triplets, and how much harder to look after them. Incidentally, I am glad to think that the Thompsons had enough "amenity" left to make the "mistake" that led to their fourth child; from their accounts of their dreadful exhaustion, you might have wondered.
Of course, their life must have become much harder. But surely the point is that having a baby is not like going to the supermarket or thumbing through the mail order catalogue. You cannot just order what you want. There are no shoppers' guarantees or consumers' statutory rights of any kind.
Whether you have your baby naturally or with the help of technology, it is quite extraordinarily risky; with technology, the risks are even greater. Your entire life may be turned upside down, and in unimaginable ways; everyone who wants a child must accept that.
When you have a baby, you get what you get. For some people, that proves to be a tragedy; I insist on saying tragedy, whatever the commissars of the disability lobby may say. A badly damaged child means a badly damaged family, for life.
Mrs Thompson might have produced only one baby, but it might have been very damaged. She might have had only two implanted, but one might have developed into a twin, and a very damaged twin at that.
Instead, she has had four healthy babies. She and her husband should consider themselves quite exceptionally lucky. And yet they feel hard done by; they feel that someone else must take responsibility, that someone else must pay.
Legally, they may have a case: morally, there is something very distasteful about their attitude. It combines existential arrogance with irresponsibility. It shows an unfeeling lack of humility in the face of imponderable things; inter alia, I mean a lack of humility in the face of one's own good fortune and other people's bad fortune, a failure of fellow feeling. As I said, there is a veritable surfeit of morals in this tale.
The Daily Telegraph | Saturday, November 18, 2000 | Comments (0)
The BBC might take 'The Archers' seriously, but we addicts don't
I have a shameful secret. I listen to The Archers. What is more, I am coming close to addiction. Like all addictions, mine grew on me slowly. At first, I wasn't interested at all. When I was young, I would laugh contemptuously if ever the first few detestably folksy bars of The Archers' theme tune intruded on my ears, and turn it off.
Somehow, though, as the years went by, I formed the habit of listening to Radio 4 when doing household chores, and I found that The Archers always seemed to coincide with vegetable peeling time, and I became a passive listener. Now, many, many vegetables later, I actually feel the lack of The Archers when I miss more than a few episodes.
This is despite the fact that for years, I despised it heartily and am surrounded by people who still do; I have to disguise my Archers' habit from my husband and children, and tune in furtively. They cannot understand why I listen to it, and nor can I, because I know it is dreadful. Such is the way of addiction.
We are not alone in our mystification, it seems. Trying to cash in on the enormous popularity of The Archers - it has an audience of two million, twice a day - the BBC recently tried to introduce some new listeners to the programme. Alas, they couldn't make head or tail of it. The head of Radio 4 confessed last week that it wasn't just that they disliked it, or found it boring; they simply couldn't understand it at all.
Apparently, they even thought that the country noises of horses and other animals sounded suspiciously like a man banging coconut shells together. Perhaps it was. It used to be the pride and glory of old-style BBC Radio that the most ambitious and amazing sound effects could be produced with little more than a rubber glove, a bent spoon and a piece of sandpaper. Those were the days. Alternatively, perhaps, newer listeners are so culturally deprived that they genuinely can't recognise a moo from a whinny, and would be disturbed by the suggestive squelching of a modern milking machine.
In any case, it failed to convince, failed to entice. The world seems to divide into those who are susceptible to The Archers and those who aren't, and they are separated by a deep cultural chasm. It is partly historical; it takes at least 10 years to get to grips with the plot. It is partly age, too; younger people's fix is televisual. But this does not explain why so many people of perfectly good intelligence are addicted to a programme of such awesome banality. Even serious intellectuals such as Iris Murdoch and John Bayley were said to love it; I am sure there are plenty more high-brow and would-be high-brow Archers' addicts lurking in the closet.
The obvious answer is that intelligence is no respecter of the craving for moral uplift. The most brilliant schoolchildren cannot get to grips with their quantum mechanics homework until they have had their daily shot of Home and Away or Neighbours. Others of perfectly adequate intelligence feel deprived without regular access to Coronation Street or EastEnders.
What these programmes have in common is their high moral tone. The moral idiom may not be high, but the tone is always one of determined niceness, goodness and tolerance. It is oppressively optimistic. No one is quite irredeemable. People do bad things and talk dirty, but everyone is after goodness in the end. These are all sermons in soaps, not least The Archers; these sagas are latter-day people's pulpits, without church or clergy. It is comfort viewing and listening.
The Archers is also heritage listening, being an extended fantasy of a lost world, one of those unobtainable rustic idylls. Contemporary shocks intrude: the vicar is now a ghastly woman; Usha the Indian lawyer was racially harassed a few years ago; the appalling Linda Snell has gone alternative and become a feng-shui bully; and the asinine Tommy destroyed some GM crops.
But this is a celebration of continuity, something that does not alter in the change and decay all around - or not much. It has, however, become quite astonishingly politically correct; it is very difficult to see why we addicts put up with that.
My suspicion is that it is an extended post-modern joke. The didacticism and worthiness of the programme is so extreme that it is actually subversive. The highly sophisticated scriptwriters are playing with us, and occasionally leave little clues. On one level it is a public information service; it began long ago, in a paternalistic Reithian spirit, to offer practical advice to farmers and continues with the most right-on advice posing as info-drama about practically everything - agricultural depression, breast cancer, parenting, grandparenting, divorce law, infertility, mental illness, folklore and much much more.
It is one long therapy session, with people compulsively sharing and caring. The overkill is so startling, and the cliches so dazzlingly predictable, that it hovers on the edge of comedy. Who can forget the episode that opened with the half-crazed Joe Grundy tenderly muttering endearments to his son's prize ferrets, as he smashed their brains out with a hammer?
My son roared with laughter and admitted that he could, at last, see why The Archers might be addictive. It has all the appeal of a post-modern, high-kitsch cult.
The Daily Telegraph | Saturday, November 11, 2000 | Comments (0)
Rustic idyll that destroys both town and country
Noah's Flood was sent by God as a punishment and a warning; so, too, the dramatic floods now stretching across Britain come as a terrible warning, from nature, if not from God. Nature is not mocked; man may propose, but nature in the end disposes, especially of unsuitable suburban executive housing on concreted-over, low-lying greenfield sites.
Though the floods are very startling, however, they are not the only warning of recent months. There was a sudden brief vision of empty motorways and empty streets during the fuel strike, a startling reminder (through its sudden absence) of our ceaseless, agitated hypermobility and the entrenchment in the national psyche of commuter culture.
Then there have been recent reports of the loss of songbirds in Britain, and the virtual disappearance of the common sparrow. Last week's discussions about the early life of James Bulger's child murderers was a reminder of the shameful squalor and demoralisation of Britain's inner-city wastelands.
All these different things have been caused, in large part, by the same mistake - our headlong rush out of the cities, in pursuit of a romantic rustic idyll, or, failing that, a pseudo-rustic suburban idyll. Our national obsession with this idyll is destroying not only what's left of the countryside, but much of our cities, too. If we want to preserve the country and save the city, we will have to abandon these dreams of blue remembered hills. The floods force us not just to accept, but confront, the obvious truth that our well-established pattern of flight from the city brings blight both to city and to country.
This case, surely, hardly needs arguing. If it does, it has been made exceptionally well by Richard Rogers and Anne Power, in their radical and informative book, Cities for a Small Country, published last month (Faber & Faber, pounds 14.99). Lord Rogers is the chairman of the Government's Urban Task Force; how the heart sinks at the words "task force", and "urban renewal" is nearly as bad. However, urban renewal is what we need, and for this we require a new urban idyll; our cities must be made lovely places to live in, and lovely places to imagine living in.
And if four million or more new homes are needed, in short order, as the Government says (which incidentally I doubt), then surely they must all be built on brownfield sites. Why should any more greenfield land be released at all, when 40 per cent of greenfield development, incredible and shocking to relate, goes under Tarmac? Bluebell woods and meadows give way to car ports and cars. Mass flooding is hardly punishment enough.
Rogers and Power suggest stopping the release of greenfield land until all available brownfield sites have been used. They recommend that green belts be created around all built-up areas. That sounds excellent: there is so much that can be done to bring life back to cities. The trouble is that it is very hard to persuade people to believe it. People who dream of the country tend to have nightmares of the city; and even in the least worst cities there is little community, little sense of belonging, no sense of safety, or calm, or green.
To those whose dreams incline to the rustic, there are very few appealing city models. Town planning rightly has a shameful name in this country; local authorities are not exactly arbiters of taste. And even many of the much admired international models in the book looked unsympathetic and faceless to me.
However, I do know of one wonderful model for inner-city life. It is the Victorian terrace street where I live in Notting Hill, and the streets around it. The urban terrace is a peculiarly English achievement; our terraces are all arranged, in a wonderful experiment of 19th-century town planning, around communal gardens. Instead of having a square across the street, what would have been our gardens at the back have been united into one very large garden - or small park. A couple of hundred people or so live on ours, perhaps more, but the garden is never crowded.
We all look after each other's children; we find company easily when we need it; and we come together in running our garden, with communal fireworks and summer parties. We have far more mature trees and lawns than most suburbanites and country dwellers; my children have many more friends of all ages, in and out of each others' houses, than I had as a child in the country; and we, too, have made close friends. This garden helps me stop dreaming of Dorset. We are only minutes on foot from all kinds of shops, excellent public transport and the Portobello street market. This is one of the most racially mixed area in London, and there is subsidised housing on our communal gardens.
I hate to sound sentimental, and I am not used to enthusing, but it is a very beautiful, large, safe communal space, and it creates a powerful sense of community. It has all the advantages both of a large city and of a safe small village. And this is very high density housing, and therefore suitable for central city sites.
At the moment, there are few examples in Britain of such communal garden development, but I think it is one of the best models for real community housing in inner cities. I notice Lord Rogers included an aerial photograph of the area in his book. The White Paper on urban renewal is due out at any moment; let's hope the Government will actually, at last, do as Lord Rogers says - starting with lifting VAT on rebuilding and refurbishment, and imposing it on new building.
The Daily Telegraph | Saturday, November 04, 2000 | Comments (0)
