Carry on, nurse

In the late 1980s, I spent an awful lot of time at St George’s Hospital in Tooting, South London. I wasn’t ill. I had fallen in with a gang of medical students who were being schooled there, through a mutual art school friend of mine. Though outsiders, the pair of us joined their amateur theatre group, later aggrandised by the name Renaissance Comedy Associates. (One of the students, a driving force behind various dramatic and comedic ventures, was Matthew Hall, who would later adopt the stage name Harry Hill and leave medicine behind.) Because St George’s is a teaching hospital, in that Prelapsarian era of low security, my memory is of having free run of the place: I drank subsidised lager in the Students Union bar, and treated the hospital’s corridors as my own, constantly venturing into the bowels of the place to rehearse with a band, or block out a play, or even curate evenings for the film society. You could even park for free. (It’s £2 an hour these days, I just checked.)

The upshot of this fecund period of my postgraduate life – during which Matthew and I co-wrote a play which we took to the Edinburgh Fringe, and a solo play I wrote about a Woody Allen obsessive was staged at St George’s vast, functioning theatre (not the operating kind) for two nights – is that it shattered my innate fear of hospitals. Having been rushed to A&E twice in my life at that point – both times, in childhood, to get stitched up after an accident in the home – the smell of hospitals still triggered an existential gag response in me, as it does to most people, I would guess. I’d been inside Northampton General plenty of times to visit family members – the worst being when my ailing grandfather was hospitalised, never to come back out – and I would have laughed if you’d told me that in my early 20s I’d voluntarily and regularly hang around in an infirmary with over 7,000 dedicated staff that serves a population of 1.3 million across Southwest London.

In the decades since, I’ve been through the doors of other hospitals, usually for benign tests, or on the occasion of emergencies relating to others, and although they are always potential buildings of death and bad news, I have never slipped back into fearing them since my time as a St George’s groupie. However, the endless recent horror stories about the NHS, which arrive on a daily basis, and range from lethal malpractice and institutional abuse to simple underfunded inefficiency, seem to be doing their best to drive us all away from places designed to make us better and mend us. If the car parking charges haven’t achieved that already.

In January, 15 hospitals in England enacted “emergency measures” in A&E (handily emblemised by an emergency tent erected in the car park of the overloaded Great Western hospital in Swindon). Such symptoms of failure are easy enough to diagnose: we all live with improved life expectancy, with the ever ageing population leading to more ailments and infections; the winter (although it didn’t even get that catastrophic this year); vicious cuts to Council budgets leaving patients without social care and thus blocking hospital beds; the recruitment crisis among GPs, who are hard enough to get an appointment with anyway; the new 111 emergency phoneline driving traffic to A&E algorithmically; just generally more illness as we eat terrible processed food and – who can blame us? – drink and smoke our way out of austerity. None of which ought to be a surprise to those controlling budgets and none of which is suddenly going to go away.

The NHS is sick. It is a suitable case for treatment. It needs TLC and all it got from the last government was PFI, which means nicer-looking hospitals that cost twice as much as they said they would, made tidy profits for the private companies who built them, and inside which every essential service from cleaning to catering has been outsourced to the lowest bidder. But at least Labour wasn’t ideologically against the very idea of what the Americans call “socialised healthcare”; the Tories absolutely are, and would have the NHS fully privatised in a second if they thought they could get reelected afterwards. The dicks.

What’s a national health service to do when the government of the day wants it asset-stripped, and the leader of a currently ascendant golf-club fringe party can think of nothing better than to criticise the English pronunciation of some of its dedicated staff? The majority of us in this country don’t have health insurance. So the majority of us rely on the NHS. It’s ours. But its original cradle-to-grave guarantee is under siege from Tory ideology, which is to say: privatise the shit out of it. (Because free market capitalism states very clearly that the private sector is better equipped to run everything than the public sector.) Perhaps, romantically, you regard emergency medicine and longer-term care as a service that cannot be farmed out to private companies – who, by their very nature, must run things with an eye always on the bottom line. Perhaps you feel that medicine should be available to all, and paid for my our taxes? Like running water, or electricity, or rail transport, or gas. (Spot the irony there.)

I keep seeing ambulances which proudly announce that they are run by G4S. (I wouldn’t announce my presence if I were G4S, but such private companies know little of hubris.) This is how old-fashioned I am: the very sight of a private, or partly-private, or public-private, ambulance make me feel sick. The NHS works “in partnership with” G4S, a company that has been criticised for using “non-approved techniques” at a detention centre, the “breach of human rights” of a prisoner being treated at Royal Liverpool University Hospital (who was handcuffed to a security guard for eight days), and using immigrant detainees as cheap labour, and is currently accused of torture at one of its South African prisons, and the unlawful killing of an Angolan deportee after “unreasonable force” on a British Airways flight. The company also paid a settlement of £109 million to the government after a Serious Fraud Office investigation into tagging, incorporating a refund for “disputed services”, but still it enjoys government contracts. Who wouldn’t want these people turning up to take you to the hospital – what could possibly go wrong?

So it is no surprise to find out that St George’s – my adopted alma mater! – relies on G4S to “provide flexible healthcare logistics solutions that meet its customers’ evolving requirements.” It’s all rotten, right down to the weasel words used to dress up its job description. At least, as the election looms, the party that used to be Labour is using the NHS as one of its big platforms. Who can blame them, when the Conservatives have made their feelings about the old warhorse pretty plain? I’m stirred that it’s still considered an issue, even by Labour strategists, with the ghost of PFI still sitting at the banquet table. The Green Party bemoans “botched privatisation schemes” and “hospitals and surgeries treated like profit-driven businesses rather than public services” and promise to oppose cuts, closures and privatisation , and to “maintain the principle of a free NHS”.

It’s not over yet. But it’s worth bearing in mind when you choose who to vote for if you wish NHS doctors and nurses to carry on treating you.

Advertisement

Health, and safety

I have been co-writing a script which is now going into production. You know how I roll well enough by now, so I won’t name or describe the project. But I will tell you this: while writing the script, my co-writer and I enthusiastically set one scene in a park lake, and I mean in it. Two characters are in a rowing boat, and one of them has to walk through the shallow water to the shore. This is fine when it’s just words on a MacBook screen, but becomes an “issue” when the words have to be turned into action in front of a camera. We discovered – and we should have guessed – that filming in a lake is a Health & Safety nightmare.

Apparently, even in a shallow pond, once you put an actor into it up to their knees, tests have to be made on the water for specific diseases that may be present, inoculations are required, and a safety boat and a diver must be present. It’s not a problem. We changed the location of the scene. Not really a nightmare at all. But it made me think about the way that the concepts of health and safety have taken on negative connotations since being joined by ampersand in holy non-departmental matrimony. If, for instance, you glance at the Daily Mail, you will see Health & Safety constantly cited as a folk devil for our times; proof that the “nanny state” is out to ruin our lives with its focus on maintaining the rights of employees to work in safety, and without endangering their health. (Richard Littlejohn, the famous wit, likes to write it out as “Elf’n’Safety”, and although I’m not entirely sure why, you get his drift: the very idea is comical to him.)

The Healthy & Safety At Work Act was enshrined as long ago as 1974. It’s not a new concept. It’s not “New Labour”. The Health & Safety Executive, merged with the Health & Safety Commission, is responsible for “the encouragement, regulation and enforcement of workplace health, safety and welfare.” Some might say that its reach extends too far, and into farce, so that the simple act of going about one’s work is often a minefield of regulation and administration. But there is common sense at its heart.

In today’s Guardian, journalist David Conn has written a long and vigilant assessment of the safety failings that contributed to the death of 96 Liverpool fans at Hillsborough on 15 April 1989. It’s worth reading in full although I’ll precis it here. What struck me about this deadly litany of fudging and finger-crossing and hoping for the best is that the evil spectre of Health & Safety was nowhere to be seen, and look what happened. The Hillsborough Independent Panel, chaired by James Jones, the Bishop of Liverpool and charged with combing through all the evidence two years ago by Labour’s Alan Johnson, presented its findings last week, since which all manner of bodies have queued up to issue full, frank and unreserved apologies to the families of the dead, including South Yorkshire Police, the FA, the Sun (not that one more blot on News International’s copybook is going to make much difference this year) and a sniveling Boris Johnson, on behalf of The Spectator. But Conn’s report looks past the appalling mishandling of the situation by the police, and the disgraceful misreporting of the tragedy by the tabloid media, and points the spotlight at Sheffield Wednesday, whose application to host the ill-fated FA Cup semi-final between Liverpool and Forest in 1989 was made despite its ground’s safety certificate not having been updated since 1979.

It was, in modern parlance, a Health & Safety nightmare. According to the report, helpfully and clearly disseminated by the Guardian, “the risks were known and the fatal crush … was foreseeable.” Counsel on behalf of the Hillsborough Family Support Group is calling on the director of public prosecutions to charge Sheffield Wednesday for corporate manslaughter. This is an interesting development, but not one that should come as a surprise. News International have been punished, in Liverpool at least, ever since the egregious Sun headline of April 19, 1989 (“THE TRUTH”). It seems likely that those officers at fault within South Yorkshire Police will at least be investigated by the IPCC. But what of the owners of the stadium itself?

I didn’t know this, but there was a “serious crush” at the Leppings Lane terrace in 1981, at which 38 people were injured. The club’s then-chairman Bert McGee, reacting to the police’s claim that they had averted “a real chance of fatalities” in a post-match meeting, replied, “Bollocks – no-one would have been killed.” This cavalier attitude to health and safety masks a much deeper contempt for the fans. The club erected those metal fences which created “pens”, something the report said made “a demonstrably unsafe terrace dangerous.” A supporter wrote to the FA after another crush at the “old, inadequate” turnstiles in 1988, calling the Leppings Lane terrace “a death trap.” What a chillingly prescient prediction; what a shame it was from a fan. Fans appear not to have mattered much to the FA, or Sheffield Wednesday, in 1988.

The FA asked Wednesday no questions about safety when it awarded them the FA Cup semi in 1989. Lord Justice Taylor, who delivered the first report four months after the disaster, listed all of the club’s “safety deficiencies and breaches of the Home Office Guide to Safety in Sports Grounds (or Green Guide)”, and described Leppings Lane – whose name is now etched on the minds of all who remembers that horrible day – as “unsatisfactory and ill-suited to admit the numbers invited.” The new report merely underlines these findings.

There was a disconnect between the club’s eagerness to host a glamour tie and count the ticket money of the 54,000 people who attended, and the reality of safely siphoning those fans into the stands. 10,100 fans came from Liverpool, and yet the turnstiles at Leppings Lane were “too few to admit so many supporters.” The tunnel into the pens had a gradient of one in six, much steeper than the Green Guide maximum; 40% of the fans were too far from the prescribed distance to an exit; the crush barriers were the wrong height and too far apart; and liaison between the club and the police – as we know – “failed.”

Good heavens, it really is a nightmare, and yet most of this stuff we’re only officially treating as gospel  now. (I think most ordinary people knew what went wrong at the time. Certainly Jimmy McGovern’s powerful Hillsborough made it plain in 1996.) But Sheffield Wednesday never admitted liability and not a single director or employee of the club resigned at the time. They didn’t even put up a memorial until 1999. As you know, I’m not a dedicated follower of league football. I come at this story from a pretty casual stratum of devotion to the sport, so if it sounds like I have it in for Wednesday, I clearly don’t; my reaction is based on what I’m reading – and, more viscerally, what I remember so vividly from the heartbreaking news pictures on the day. Trevor Hicks, chairman of the HFSG, speaks of the club’s “contempt” for those fans that died, or their families.

Sheffield Wednesday only made an official apology last Wednesday, on the morning of the report. Dave Richards, who took over from McGee as chairman in March 1990 – apparently prompted to join the board by what he saw on the day at Hillsborough – presided over the dead-air period when the club refused to memorialise the tragedy. He left in 2000, since which he’s been a well-rewarded chairman at the Premier League (his salary last year was £347,000). Under his chairmanship at Sheffield, the ground became all-seated. But the Guardian says that he now admits he didn’t put a memorial up to the 96 who died after legal advice; he was advised that if they put up a plaque it would compromise the club’s denial of liability. This is pretty rum. The families’ lawyer – who happens to be Charlie Falconer, former Blair flatmate and then Lord Chancellor, but wipe those old prejudices aside – says, “The idea that Sheffield Wednesday putting up a memorial would amount to admitting liability is utter rubbish … they wanted to reduce their association with the disaster as much as possible.”

Yes, that Health & Safety disaster.

It’s all too easy to fall in line with lazy, Daily Mail orthodoxy and regard Health & Safety with sneering disdain. But if Hillsborough’s safety certificate had been renewed at any time between 1979 and 1989, maybe 96 people wouldn’t be dead (41 of those deaths are currently adjudged to have been avoidable). It might be slightly irritating to have to wear a high-viz tabard, or a safety helmet, or protective gloves, in the workplace, but the same paranoia behind such measures might have reduced the chances of Leppings Lane becoming a “death trap”, into which fans were herded, down an inappropriate gradient, with many different sorts of contempt and neglect.

When representatives of official bodies give a “full and unreserved apology”, as the FA did, you have to check the wording. Are they really apologising fully? Or are they actually apologising partially, in order to avoid admitting liability?

I have been able to rewrite a comedy script to that an actor doesn’t have to be inoculated and stand in a pond, by relocating the scene to a children’s playground. Not so easy to rewrite – or relocate – Hillsborough.