On the NHS

Thales, according to gossipy Plato, was walking abstractedly, watching the stars, when he fell into a well. I did that a few weeks ago, being preoccupied with the most elevated thoughts when I suddenly found myself lying at the bottom of the well of the NHS. This made me think about several things which no doubt have long been blindingly obvious to fellow citizens who keep their eyes closer to the ground.

In late January I developed a condition called colitis. This is an inflammation of the colon, which shows up as diarrhoea and wind. It can be treated, but since the symptoms could indicate other (and maybe more serious) diseases, the doctors like to get a clear diagnosis before they start. It would be flattering to suppose that it was stress-induced, and the consequences of my selfless labours for peace: all those times I’ve trundled back from Paddington to Worcester station, arriving after midnight having eaten nothing all day but a BR sandwich and an END cup of tea. Unfortunately the boot might have been on a more swollen hoof. For in mid-January I had just flown out as a guest of the Indian Government to an exalted international conference in New Delhi in memory of Indira Gandhi. A little group of us flew out together, Air India, first class: Michael Foot, Jean Floud, William Radice, with Sir Richard Attenborough in pursuit. It was my pleasure to travel with my old friend and newly-minted Dame, Iris Murdoch. I’ve never travelled first before, and well! Cocktails, champagne, caviar, lobster ... Young Dame Iris, by the way, took all as her customary due – no gastronomic problems for her. However fast asleep she seemed to be, she had a preternatural seventh sense to catch the wine waiter passing by.

That was just the start. Imagine the fare in New Delhi for a global conference of amazingly good and wise persons discussing ‘Towards New Beginnings’ at the highest universal level. Generous hospitality, with ministerial banquets night after night. Lunch with the Prime Minister. Exotic foods on every side. And then Air India, first class, back home! Maybe my condition was self-inflicted.

Or it could have been that conference. Colitis can be set off by an allergy. Just think of all those exotic and not always compatible intellectual spices thrown together: Bella Akhmadulina and Chinua Achebe, Régis Debray and Mulk Raj Anand, President Bok of Harvard and Mr Yuri Zhukov, Chairman of the Soviet Peace Committee, Simone Veil and Germaine Greer. Interesting and able people all ... well, some. But thrown together without preparation and in pompous session we did worse than a good graduate seminar. Very large rhetoric about universal human ends tends to leave wind in the bowels.

Why did I go? Partly because I admire India’s non-alignment, and because of my father’s friendship with Jawaharlal Nehru. (According to family tradition, Indira, when at Oxford before the war, was married in a private civil ceremony in a sari borrowed from my mother.) And partly to give the British Council one in the eye.

The Council has always struck my name off invitation lists and refused any help to me, sometimes with gratuitous rudeness. In 1985 my wife and I were invited to teach for a few weeks at the University of Nanjing, whose history faculty specialises in British studies. The Council not only refused any help with our fares (which we had to pay in full ourselves) but saw fit to pass on a message from their adviser, the Cultural Attaché in Beijing, to tell the Thompsons that their visit was unnecessary as enough British historians were already visiting China. When we got to Nanjing we found that this same adviser was writing to the history faculty, urging it to invite a scholar much junior to us in our own field, whose visit (it seems) was necessary.

However, through some extraordinary slip (perhaps mistaken identity), the Council had for the first time invited me, last autumn, to lecture in India. I accepted with pleasure, since I was working on my father’s Tagore papers and needed to consult Bengali scholars and Indian libraries. A few weeks later my invitation was rudely cancelled, in a letter from a clerk saying they had run out of money. A number of distinguished Indian historians were kind enough to make public their protest to the Council. It was a pleasure to fly into New Delhi, just at that moment, without benefit of the British Council’s permission. My offer to help organise a jumble sale for the Council has not yet been taken up.

I contributed my own bit of wind to the conference, which brings me back to my interesting post-Delhi condition, which I didn’t get around to taking to my GP until the end of the first week in February, soon after my 63rd birthday.

The GP had to make tests. A week for that. And when these proved negative, a week for other tests. My not unusual condition (as yet undiagnosed) was confused by the false trail of its onset on return from India, which suggested possible amoeba or tropical disease. After two weeks I was referred to the Worcester Royal Infirmary for an appointment with a consultant surgeon who had patched me up for other things before.

I sat down to wait. And lay down. Work was difficult for more than an hour or two a day. Most foods gave me nausea and I was digesting none. I started vomiting and my GP gave me anti-nausea pills. In just over two weeks (11 March) my appointment came through. I was examined, and referred for a barium meal and X-ray as well as more tests. A further nine days for that, and on 20 March I presented myself for the results.

The consultant told me, kindly, that I had acute ulcerating colitis and should come into hospital at once. It seems that I was quite ill (a ‘very severe’ case). I had lost three stone and was dehydrated. It had taken six weeks to gain admission to hospital and I felt as if I was going down like the westering sun.

I went into the surgical ward and waited on a drip for 72 hours for an operation. It seems that Nature has provided us with more entrails than we need, and quite a lot can be taken away and the system still be put back together. No doubt the consultant, a very skilful surgeon, would have pulled it off, but in view of my weak condition he might have found things against him. He called in the consultant physician to try a medical remedy. This consultant, highly-regarded for his skill and concern for his patients, with a steep dosage of steroids and watchful monitoring by his team brought me round the corner, and in four days I was transferred from the surgical to the medical ward. I was put into some order in less than a fortnight, and tipped out on my own home lawn on April Fool’s Day, like a rather weak Easter bunny. The prognosis seems good, and I can count myself a most fortunate person and one of the successes of the NHS.

I like the National Health Service. I think it’s a fine organisation and that British medicine is in good shape. Of course there are awful problems, perhaps in Greater London most of all, where the Thatcherite corrosion of societal bonds is worst. But we must do justice to what is still there.

Over the decades my family has passed through the usual hazards and occasions of life by courtesy of the NHS: the death of parents, the ailments and accidents of children and grandchildren, our own problems. My wife has had rougher experiences than I, but, over all, in four decades of living in industrial West Yorkshire and the West Midlands, we’ve found the NHS to be a humane and professional service. GPs have been attentive and sometimes much more; emergencies efficiently handled; resources improved.

Provincial hospitals have been getting better. (They needed to.) Small events have brought me into them from time to time. Gone are the stale airs of discipline and Poor Law that still lurked in the old Halifax General thirty years ago – and the accompanying religiosity which could victimise those who replied on an admission card that their religion was ‘none’. My wife was once admitted in misery with a baby in double pneumonia: the shocked admissions officer thought she had answered ‘nun’. After that the baby’s oxygen-tent was haunted by ghouls demanding that the infant be christened lest he escape this world without an immortal soul.

Hospital doctors are becoming more courteous. This was commented on by fellow patients of my own age: ‘It’s not like the old days – they talk to you now as if you was an equal.’ ‘You know that consultant? He really listens to what you says.’ There were also, in one of my wards, more women doctors than men – a distinct humanisation and a lessening of the oppressive sense of male professional hierarchy of the old days. I can’t talk about medical expertise and technologies. But from the moment that I entered hospital I never felt that I was not getting the best treatment available. One was aware of path labs and microbiology and X-ray and every kind of scanner humming away.

Most of the private health schemes are cons and parasites on the technologies and resources of the NHS. Most of them tip their patients obligatorily into the NHS for their first six or twelve weeks’ treatment. Except for the clinics of the exceedingly rich, the NHS has far greater resources than a private service could compete with.

The National Health Service is a decent way of dealing with health, and an effective one also. It’s a good deal better than my casual experiences of what happens in the United States. Ten years ago I got a bad boil on my bottom in Pittsburgh. I asked my colleagues to recommend a GP but was told that there wasn’t such an animal – I must decide first if I wanted antibiotics or a surgeon. Well, I couldn’t see my own bottom to diagnose it, but I decided it would be quickest to get the boil lanced. The surgeon charged $1500 (a night in a nursing-home and his own attentions) plus an anaesthetist’s fee. The next day he stood over me, trying to persuade me into other unneeded operations. He even complained because he could not make out a medical case for removing my prostate. That is what I mean by an indecent system.

Of course, sick people can be utterly self-absorbed. When I was quite ill I was sometimes infuriated beyond measure by some error in nursing or foible in hospital routine. But these grumps are trivial beside the real exercises in care and skill. Perhaps because I did come through OK, and am back on my own lawn, I am disposed to give the NHS the best possible of references.

There remains, however, that small problem. There was the six weeks’ delay between presenting myself and getting into hospital, and that little blip of crisis when I awaited surgery and lay in the cold air of the well.

In my second week in hospital a retired foundryman a little older than myself was admitted to the next bed. He had a complaint which had been troubling him for two weeks and which the GP could not diagnose. On the previous Saturday he had become concerned that his condition was worsening and he asked his GP to arrange a consultation ‘on the private’. This was done, at the physician’s house in the evening, and, as a result, he was admitted to hospital on Monday morning.

The consultant’s fee was reasonable: £30. ‘No problem,’ the patient said. In effect, this £30 paid for a private latchkey into hospital. If in other respects his history had been similar to mine he would, by the use of this latchkey, have cut out three to four weeks of waiting around and getting weak. But, from the moment of admission, the treatment would be NHS, public, nothing private at all. This puzzles me. I don’t think it’s dreadful that a conscientious consultant should also have some private practice. And why shouldn’t people spend a little extra on their own health?

Indeed, if it came to the push, I suppose I could have bought a latchkey myself. I was browsing in a bookshop the other day and came across a book by one Roger Scruton about Thinkers of the New Left. It included biographical notes on these Thinkers, of whom I turned out to be one. To my excitement, I found myself described as a man of ‘considerable wealth’.

This was welcome news, and I must write to this Scruton to find out where this wealth is and how I can get hold of it. Perhaps he knows of some fortune about to come to me? Because all that I know is that my net income from all sources – that is, literary and some lecture fees (and I have no other sources) – in 1985-6 was £8,653.62 before tax. That is not poverty, but it is not, I think, what is normally regarded as ‘considerable wealth’ by characteristic figures in Mrs Thatcher’s Britain, such as directors of Guinness and the like. Perhaps even Mr Scruton does a little better? But I find on scanning the dust-jacket that this Scruton is a philosopher, who need not pay regard to inconvenient things like facts. He is engaged in loftier heuristic exercises.

In fact, I know why some in the academic community have for years been telling each other that I am stinking rich. It has this much to it: fifteen years ago a legacy enabled us to buy a large old house in Worcestershire, with room for two studies, all our books and papers, and mortgage-free. We are lucky and we know it.

But the other part is this: the fury of certain academics, including some historians at the venomously ideological history faculty of my old university, Cambridge, that I should be able to go on writing history without a job and without their permission. They thought that when I found that I must leave Warwick that would shut me up. Even friendly academics resent anyone who drops out of the profession to become a writer. Again and again I’ve been told, in envious tones: ‘I’d love to write full-time like you, but ... ’ The ‘but’ implies that they are both more deserving and less fortunate than I. They do not have my ‘considerable wealth’. Some of them may have an odd notion of what being a working writer involves. They imagine it as being one continuous sabbatical, with all expenses paid from some inexhaustible source and with leisure to research and write all the books one had ever imagined – while, of course, drawing the equivalent of a professional salary as reward.

In fact, they could be writers like me if they were ready to risk it. What it required in my case was a good start – a house and an earning book (The Making of the English Working Class); the cashing of my superannuation; my wife’s salary as a university lecturer – and her contribution to our income has been larger than mine; and, every three or four years, generously-paid and rewarding spells teaching at different American universities. In those years our income has shot up and we have dug ourselves out of the red.

I do not know that writing is harder work than university teaching. Both can be hard, but they run according to different rhythms. One is only irritated when one’s acquaintance show that they suppose that a writer’s life is a soft option, a sort of half-employ, by busting in at any time of day, supposing one can always lay work aside. And the world more widely assumes one is a kind of public service, to be granted expenses at the most, and to be turned on on demand like a water-faucet in the public street.

I do not know that the trade of writers is soft. It is a nervously taut, self-driven kind of life. How often, in these past fifteen years, have I looked up and seen the dawn against my study windows?

                                                  If it could fight
Or dream or mate, what other creature would
Sit making marks on paper through the night?

Writing is not spacy sabbaticals strung end to end but cobbling a patchwork livelihood from reviews, articles, royalties, lectures. It can mean lying at the bottom of a well, with no sick-pay and with no superannuation to come, and wondering if Karl Miller would take a piece on all that?

I’m not moaning, just repelling envious scrutoneers. But even if I can’t lay hands on that ‘considerable wealth’ I dare say I could scrape together £30 for a consultant’s fee. Of course I could. The trouble is that, in honour and in principle, I couldn’t and I can’t.

It is something to do with my generation’s cultural formation. My age-cohort went through some kind of hardening in World War Two, and some of us are still stuck like that. We have these weird inflexible principles which must sound silly to the young, such as ‘Thou shalt not queue-jump’ or ‘Thou shalt wait in line and not make a personal fuss.’

The notion that Edward Thompson is dedicated to avoiding fuss will surprise my old acquaintance, not least any survivors of the leadership of the British Communist Party of 1956 or Lord (‘Flash Harry’) Butterworth, late of Warwick University. I have made one or two public fusses in my day. But a fuss about one’s private convenience – a claim to privilege – is different. There entered here a taboo. And any claim to priority in matters affecting the chances of life was taboo most of all. It was not just the discipline of war, whether active service or being bombed and rationed, when the young, above all, gave priority to the injured, the sick, the children and the old. It was far wider than that. In that almost-democratic, half-anti-Fascist time, the chances of life were shared; in 1941-45 this island was fanned by strange airs of égalité, when the pursuit of private privilege seemed contemptible. And this most of all for the socialist young, who went to the polls in 1945 to vote Labour, Commonwealth, Communist, ILP.

The Health Service, even more than the nationalisation of the pits, expressed the spirit of that time and extended it forward into the future in institutional form. It was designed by the ablest and most socialist minister in Labour’s post-war government. And it expresses in transparent form the first of socialist egalitarian principles: to each according to his or her needs. Of course things are never as simple as that. But the lay person supposes that, in the chances of health and life, medical science is able to determine priorities according to criteria of need, and that no other consideration need enter. In this way the NHS replaced the vocabulary of class with that of citizenship.

I’ve sometimes been surprised to find out how much I care about this. A few years ago I was at a small Manhattan party. It was a time when everyone was being some sort of ‘Marxist’, and most of them were also into ethnic health and food fads and shrinks. Somehow their conversation got around to the British Health Service, which they were running down. They supposed I would join in.

Horror stories were exchanged – one young woman knew this man whose uncle had had to wait EIGHT MONTHS for a simple operation to remove a really painful bunyon and ... I suddenly found myself to be shaking with anger. Wasn’t it right, I asked incoherently, that this uncle should wait in a queue if resources wouldn’t go round and if his need was less than other needs? They looked at me aghast. For them the criterion for judging a service could only be its capacity to satisfy the demands of the consumer. They could scarcely understand that there could be other criteria. Between the assertion of the individual’s right to ego-fulfilment and the notion of the pursuit of the common good, American and British ‘radicalism’ derive from very different sources.

The NHS is also, in a different professional tradition, a service. You go in, you get the best treatment they can give, and at the end of it there is no bill! Of course, your NI contributions and taxes have paid for that. But it is really nice that it is free. No one makes you feel guilty if your share of the service has been greater than others.

One might think up much grander socialist structures, although one might be advised to find out if they worked before exchanging them for what we have. Two or three years ago a friend of mine, a lifelong socialist, slipped and broke her ankle in socialist Budapest. To get it X-rayed and excellently set, as an out-patient in a leading hospital, required influence at a High Party Level. Even odder, the translator who accompanied her through the corridors took her through a series of imposts: the tip was so much at admissions, so much to the nurse, so much to the porter who wheeled her chair. Can one imagine tipping a nurse or a porter in our NHS?

One is not supposed to say anything good about British things these days, and writing all this down makes me feel old. I have to say that I find the NHS to be both decent and humanely socialist, but I dare say it won’t last much longer. Every tree we planted in those almost-democratic years is coming under the axe.

What makes me feel old, also, is the realisation that what I had thought to be widely-held principles are now little more than quaint survivals among the least flexible of my generation. We had supposed, quite fiercely, that one didn’t try to bend the rules. If people wanted to pay for convenience or for extras – good spectacles or special dentures or nursing-home deliveries or convalescent comfort – we could go along with that. But access to the essential resources of the service must be ruled by égalité. And we believed that professional people (those who were socialists) should be loyal to this most of all. For if they started buying private latchkeys, then the whole system would start to get fouled up with the double standards and hierarchies of class.

Times and manners have changed. The generation which fought for the NHS, and which now has come to that stage of life where they need it most, must jostle with the assertive anti-moralistic young. Everyone is into latchkeys, technicians and skilled workers as well. If my wife and I and a few friends want to hold out for old ‘principles’ no one is going to stop us. But I have to recognise now that such a stiff-backed sense of honour could cost even risk to one’s life. And if we still choose to be like that, can one possibly make the same choice for another – a child or a grandchild? And by what right?

One is left with a ‘principle’ that the young can’t even understand, which is ineffectual (unless self-damaging), and which is really a private notion of honour. Or a stuffy habit of the old. And I suddenly can see the survivors of that socialist age-cohort as historical reliques, like the old Covenanter in The Heart of Midlothian. Those of us who stay loyal to the old imperatives and taboos – the oaths of égalité – are a goldmine for the oral historian, and Raphael Samuel will collect us as specimens in a nostalgic book.

Not many did stay loyal, though, to the oaths of 1942 or 1945. Most proved adaptable. We’ve all adapted a bit. Which reminds me that I neglected to congratulate the young Dame on the new handle added to her name. The neglect was studied. One had supposed, in those old Covenanting days, that serious writers did not accept that kind of handle from the state – and least of all from a mean and malevolently philistine government like this. How could Iris Murdoch have forgotten the oaths of yesteryear? I would be glad to see her honoured by the public or by her peers. But is it an honour to carry a warrant of approval from Mrs Thatcher?

Oh well, never mind, Dame Iris. I’ve blurted it out because no one else would dare. Or perhaps no one else notices these metamorphoses of cultures and moralities any more? The times I was remembering have long been wrapped up. Today they snigger at égalité and the whole business of state is to conspire against the common good. But for a few more years, since my generation needs it for its terminal episodes, let the National Health Service survive.