Carry on, nurse

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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.

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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.

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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.)

Carry on Doctor 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”.

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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.

A second opinion

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There are bigger, more globally grave stories in the news, but this one has gnawed away at me over all of them for the past four days: that of Ashya King, the five-year-old with an aggressive brain tumour whose parents, Brett and Naghmeh King, are currently under arrest in Spain after removing him from the Southampton hospital where he was being treated. I’ve attempted to engage in a dialogue about the heartbreaking story as it unfolded via social media, but keep encountering people who I’ll generously describe as fence-sitters.

My reaction to the facts as they keep emerging has generally been a visceral one: that of disbelief, empathy and anger. Anger that when the seemingly well-informed, well-prepared and determined parents of a sick boy remove him from hospital care in order to seek an alternative, less scattershot radiation treatment which is not freely available on the NHS except in very rare circumstances – a treatment they were willing to pay around £100,000 for – are criminalised for taking this step. The parents, and the most tech-savvy of Ashya’s six elder siblings, Naveed, seem entirely fluent in the power of social media, and have been posting regular YouTube videos explaining their position.

Although it’s ten minutes long – and what’s ten minutes compared to the life expectancy of a five-year-old with a tumour on his brain stem? – I have been urging people to view father Brett King’s key testimony, in which Ashya appears, apparently relaxed and well cared for in a hotel in Vélez-Málaga. (They’d taken him to Málaga – not “snatched” him, in the alarmist words of the first media reports – in order to sell a holiday apartment to raise the money to pay for “proton beam” treatment in the Czech Republic.)

Although, as the fence-sitters have been quick to point out, we cannot know the full, transcribed conversations that have taken place between the Kings and the oncologists at University Hospital Southampton, Brett makes a clear and non-hysterical case for why he and Ashya’s mother took the unusual step of removing him from hospital care. They used the Internet to research alternatives and the one they chose was not one based on crystals or cabbage soup but on conventional radiotherapy, which goes against what would have been the media’s preferred narrative: that the Kings were complementary medicine nutters.

That they are Jehovah’s Witnesses – a breakaway millenarian Christian branch that, by strict doctrine, refuses blood transfusion, or so I’ve read – was seized upon initially before the facts were known. It was during this cloudy period of speculation and kneejerk conclusion-jumping – a vacuum into which rolling 24-hours expands to fill – that the facts got away from us. But it seemed to me that reason was to some extent restored and hysteria averted by the first YouTube video.

Naveed subsequently posted this, to reassure those who would condemn his family’s decision that they did not make it lightly or without investing time, effort and money into ensuring Ashya’s normal feeding routine would not be interrupted.

In Madrid, which is 322 miles away from Málaga, where Ashya remains under armed police guard in a foreign hospital, Judge Ismeal Moreno ordered that his parents be held in custody for up to 72 hours while he studied medical reports and documents from the couple’s defence lawyer. Those who insist on blaming the parents will experience a weird sort of melancholic schadenfreude here – if they hadn’t “snatched” Ashya, they’d have been at his bedside in Southampton, instead of staring at the walls of separate cells in Madrid.

Again, although we can only know what we know, the family’s lawyer gave a statement denying that Ashya’s life had been at risk, and that he had been admitted to the hospital in Málaga “in a perfect state of health”. (Ashya’s brother Daniel, 23, was with him in hospital – thank heavens for small mercies in a case where very little has been shown, in my emotionally crazed and ill-informed opinion.)

There is still a chance that common sense will prevail and the family will be reunited after days of stress that none of them asked for. There was no “snatching”, there was “abandonment” (quite the opposite) and there has been no “neglect”, the flimsy basis of the arrest warrant and the threat of extradition. I asked aloud on Twitter when David Cameron would step in: he’s quick to get on the phone to Obama when the US needs our “military prowess” – why not a quick call to Spanish Prime Minister Mariano Rajoy? Nick Clegg has weighed in today, coincidentally after the Daily Mail made it a campaigning issue, although I fear one needs political and/or moral weight to make “weighing in” count. Cleggs boasts neither.

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I hold no torch for the Mail‘s dirty tricks and grubby Victorian hypocrisy, but when it gets involved, politicians tend to be roused from their slumber. I’m no expert on the law, but isn’t extradition – an outcome that is on the table – basically about co-operation of governments? Though the Kings have refused extradition, surely some co-operation could resolve the matter before – and let’s not be coy – things deteriorate?

Unless Brett King is lying through his teeth, he was “threatened” with a “protection order” by the boy’s oncologist if he continued to push for the proton beam option and thus defy the child’s doctor – which would have meant (ironically) that he and Ashya’s mother would have been denied access to their son’s ward. That prospect seems to have driven them to act. They’d contacted the Prague clinic, but when the clinic contacted Southampton for the requisite X-rays and paperwork, the request was ignored. (Unless, again, Mr King is lying, or dressing up the facts. The fence-sitters will cling to this grey area until the story has been the subject of an independent review, I guess.)

Is it so wrong to air a gut reaction to a news story as it unfolds? I felt so sick about how quickly a child’s parents can be painted as neglectful, irresponsible criminals in a supposedly free society. Even if the hospital felt it was acting in the best interests of Ashya King, did it really have to call in Hampshire police so soon after discovering he had been removed? The first “breaking” media reports were of a “missing boy” who had been “snatched”. He was not missing. He had not been snatched. Assistant chief constable Chris Shead said in the police’s first statement on Friday: “It is vital that we find Ashya today. His health will deteriorate rapidly. Ashya is in a wheelchair and is fed through a tube. The feeding system is battery operated and that battery will run out today.” Clearly, at this stage, the police had no idea how well equipped the King family was, but no wonder the world acted with alarm.

I can totally understand Hampshire’s “damned if we did, damned if we didn’t” defence, but what I personally regard as a heavy-handed, panic-button reaction did not help matters, or contribute to the boy’s health. A European arrest warrant? Could they not have called the family to ascertain how much danger Ashya was in?

I’m not a parent. I will never be in the Kings’ position, thank God. But this didn’t stop me from feeling for them. Commentators have been saying, “It’s what any parent would do if they felt it was the best for their child.” I suspect the unconditional love for a son or daughter would trump all nuanced options, but I think the Kings should be applauded for taking such careful preparation before removing Ashya from care. (Naveed said that their mother was “by Ashya’s side for the whole month that he was in hospital.”)

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I don’t pretend to have all the answers. But since we all hope that Ashya’s health will improve, by whichever treatment his guardians decree and pay for, at least there is some common ground. Without the Internet (and some of us can remember a prehistoric time before it), patients were in thrall to doctors for advice, and took it, without question. The dissemination of information, while wildly unpoliced across a once-super highway full of potholes, means access for all, even we plebs who do not have the luxury of a medical degree.

But a little knowledge can be a dangerous thing, and that works in both directions.