For the first time in my life I had to call an ambulance, because my mother was suffering from chest pains. It was a fascinating episode: so much so that my mother, when she was feeling a little better, accused me of actually enjoying it. The reality of Monday morning in a south London A&E department — within 25 minutes of the 999 call she was in the recovery room at St George’s, Tooting — may lack the intensity of ER and offer no hint of the tangle of doomed doctor-nurse-paramedic relationships that afflicts Holby City, but it gives you plenty to think about.
Stories this week have suggested that NHS blunders cause 2,000 needless deaths annually, and that the service is heading for crisis over its new £6 billion computer system (one of the suppliers, iSoft, is in deep trouble) to add to a continuing crisis of funding; St George’s itself was £24 million in the red last year. But at ground level — to the observer hanging around A&E for a day — it is reassuringly robust. It is also surprisingly homely: the 999 operator addressed me as ‘my love’ and the big, brisk Afro-Caribbean woman driving the ambulance called me ‘sweetheart’. A nurse took the trouble to move a couple of male patients out of an alcove of the medical assessment ward because, she said, ‘My mum wouldn’t like being surrounded by blokes in here either.’ The only features that deserved criticism were the baffling pay-as-you-go bedside phone and television provided by Patientline plc of Slough — in which I shall not rush to buy shares — and the stewed food. ‘Vile,’ my mother declared, feeling a little better still and dispatching me to a nearby kiosk for fresh fruit and sandwiches.
But if it felt homely, it also felt foreign. At a time when there is so much debate about the influx of half a million Polish workers into Britain, we forget how heavily the health service relies for its workforce on previous waves of immigration and temporary visitors. In the course of my mother’s brief emergency, she encountered doctors from (I’m guessing, since it seemed impolite to interrupt and ask) South Africa, India, Hong Kong and Egypt; nurses and paramedics from Singapore, the Philippines, Barbados and Cyprus. We should be glad that they all want to train and work in the NHS, because without them it could not function; just as we should be gratified that so many Poles see Britain as a land of opportunity. And if there’s a concern about overcrowding — I mused, watching a multi-ethnic throng at the main entrance of St George’s, which when you think about it is nicely symbolic — let’s remember that migration works both ways. One in five Britons wants to leave the country because they consider themselves overtaxed, according to a survey this week — and half a million have already moved to France, many in the hope of finding a better health service. On this experience, I’d say they were misguided.
I learnt a neat trick for actors from the paramedics. Watching hospital dramas on television, I’m always unconvinced by the part when the ambulance crew shout out the vital signs and medical history of the incoming patient as they wheel the trolley into the treatment room. How come they’re always so seamlessly word-perfect, without a piece of paper in sight and with all those doomed relationships preying on their minds? The answer is that they write it in biro on their surgical gloves.
Along with thousands of other regular travellers on the north-east main line, I am horrified at the prospect that GNER may hand back its franchise. The King’s-Cross-to-Scotland service is imperilled by a combination of rising power costs, disappointing passenger growth, a debt crisis in Sea Containers, GNER’s parent company, and a decision to license new competitors on the same route. It is apparent that GNER’s £1.3 billion bid last year to secure the franchise for another decade was far higher than it needed to be, and the bullish chief executive who made the bid, Christopher Garnett, has walked the plank, shortly to be followed by several other senior managers. There seems little hope of clawing back any cash from the government. Dr Mike Mitchell, director general of railways at the Department for Transport, has declared flatly that he does not renegotiate franchise agreements — and since he recently suffered the embarrassment of appearing at Peterborough magistrates’ court on a charge of assaulting a GNER dining-car steward, of which he was acquitted, he may be even less inclined to compromise.
I moaned here recently about the rate at which GNER’s fares have increased to pay for the new franchise deal. Garnett and his team have only themselves to blame for that, and deserve rather less passenger loyalty as a result. But in all other respects, GNER is Britain’s model railway. It is courteous, comfortable, well-catered and as reliable as it can be given its dependence on Network Rail to service the tracks and signals — four out of five GNER delays are not its own fault. Its staff give every impression of being genuinely interested in customer service. It has consistently outpointed other long-distance operators for passenger satisfaction, and the prospect that it might now be replaced by Virgin Cross Country, or something worse, fills us regulars with gloom. Of all the unintended consequences of the complete lash-up that was the Major government’s rail privatisation scheme, the demise of GNER would be the most bizarre.
With Allister Heath’s sermon last week about debt and personal responsibility ringing in my ears, I tuned in to Radio 4’s Inside Money report on the charges imposed by banks on unauthorised overdrafts — and found myself in a looking-glass world where the banks are cynical villains and profligate spenders are their innocent victims. It’s not the unauthorised borrower who is committing theft by helping himself to the bank’s money, apparently, but the bank that is committing theft by charging a penalty higher than the cost of sending a warning letter. The only interviewee who said he tried to live within his means and that the banks were right to discourage irresponsibility was treated as a quaint eccentric. Allister had better shout a bit louder.