Is that it for the NHS?
Peter Roderick is right to trace the ills of the NHS to the Thatcher-Clarke ‘reforms’ of 1990 (LRB, 3 December 2015). Having worked as a hospital physician in the NHS between 1968 and 2007, I see the Lansley Act of 2012 as the latest stage in a long process of fragmentation, marketisation and erosion of professionalism. There are two effects of this process that I think should be more widely understood. The first is that before 1990 the NHS ran on goodwill, which has now largely been dissipated. The extra, usually uncounted, unpaid hours that people are willing to put in when they are public servants tend to disappear under a commercial or quasi-commercial regime. I suspect that politicians who thought that commercial pressures and competition would improve efficiency had no idea what they stood to lose, and probably thought that staff were, on average, taking what they could get away with rather than giving more than they were paid for.
Second, when providers are private or, like foundation trusts, quasi-commercial there is an incentive to increase activity. The more patients seen, the more investigations or operations performed, the better the bottom line (as long as the accountants and contract lawyers have done their work well). This makes for overdiagnosis, overinvestigation, overtreatment, iatrogenic disease and quackery. It is almost an invitation to profit from public gullibility.
Among the Sufis
Jenny Diski seems to have had a mixed time with Idries Shah’s ‘Sufis’ (LRB, 17 December 2015). What she disliked ‘more and more’ about them ‘was that sense of belonging to an elite … who thought they had access to a secret that others didn’t’. She also refers to ‘the Sufi who, on hearing of Doris’s death just weeks after [her son] Peter’s, told me that at last they were together for ever.’ No Sufi, by the sound of it; more agony aunt. It sounds as if she encountered only one actual Sufi, Shah himself.
Shah didn’t work with other Sufis at Langton Green, his home in Kent. It would have been pointless. In the Middle East and beyond, people at various times invited to participate in study activity would have been termed ‘dervishes’ or ‘darwishes’ (from the Persian, a seeker, someone at the door, an entrance to something or somewhere). Here, they were called students. He, Teacher – never guru. Gurus were a bane of his life, for the confusion caused, and the source of a good few of his jokes. Unlike the guru, the Sufi’s objective, always, is to get the student to a point where they can go it alone, having developed the necessary mental skills in an ancient, practical form of psychology – and intuition. Sufis say: ‘When the work is completed, the workshop is dismantled.’ The aim of the guru in the flowing robes and preposterous beard, by contrast, is a following of unquestioning disciples for life, if bankably possible.
So, the people Diski disliked were neither Sufis nor an elite in the customary sense. Doris Lessing, whom I met a number of times in the 1960s and early 1970s, had not I think become a Sufi, and referred to Shah as ‘my teacher and my friend’. Shah, as with Sufis throughout history, had students from among society’s most materially unexceptional and often the surprisingly young. What he sought was potential. Given his task of spreading Sufism at all reachable levels of society, he did indeed draw about him groups of men and women of social influence, not all of them as students, to help advance his ‘brief’. That this worked is clear from the international spread of his university lectureships and in the reach of his more than thirty published works, sold in a dozen translations and in their millions.
The Fair Sentimentalist
Steven Shapin writes that in Michael Gordin’s ‘well-founded judgment, there’s no quality intrinsic to the English language that makes it suited to be a global scientific tongue: it’s not “easier” than many other languages’ (LRB, 3 December 2015). Robert Louis Stevenson found it was. Travelling in Polynesia in 1888 he encountered English everywhere. He recalls in his book In the South Seas ‘a Marshall Island boy who spoke excellent English; this he had learned in the German firm in Jaluit, yet did not speak one word of German. I heard from a gendarme who had taught school in Rapa-iti that while the children had the utmost difficulty or reluctance to learn French, they picked up English on the wayside, and as if by accident.’ Most of all, Stevenson was struck by something he ‘heard on the verandah of the Tribunal at Noumea’ where the audience were awaiting the verdict in a case of infanticide against a native woman. ‘An anxious, amiable French lady … was eager for acquittal, and declared she would engage the prisoner to be her children’s nurse. The bystanders exclaimed at the proposal; the woman was a savage, said they, and spoke no language. “Mais, vous savez,” objected the fair sentimentalist; “ils apprennent si vite l’anglais!”’
On Bombing Syria
James Meek makes some very good points about Parliament’s decision to back the bombing of Syria (LRB, 17 December 2015). But he misses the historical context. How any British politician after the events of Suez in 1956 could think that what Britain does on the world stage makes a significant difference for worse or better is puzzling. It suggests a generation in denial about recent British history.
Sticking up for Natasha
Perhaps we all lead interesting, silly lives, as Andrew O’Hagan suggests the Spenders did (LRB, 17 December 2015). In the 1980s I became involved with the house in St John’s Wood as house-sitter and student – not of Stephen, but of Natasha. Her ‘silly’ life had led her to study psychology at UCL, and to become, for a while, the leading authority on the psychology of music, contributing a magisterial and near-monograph-length subject entry to the 1980 edition of the New Grove Dictionary of Music. I encountered her when she delivered the occasional lecture to my undergraduate year in music at City University, which inspired me to adopt the subject for my PhD and led to something like friendship (which thirty years on and some thirty doctoral students later I now recognise as an integral part of a successful supervisor-graduate student relationship). For two or three years I lived in the Spender house when its inhabitants were abroad, usually at Mas St Jerôme, their house in the south of France. I got to know Natasha better than most, our friendship serving her intellectual needs rather than any other. Stephen was generally a shy and lanky presence tottering in the background, with little evidence of his ‘administrative energy’. Indeed, the only occasion on which I recall him as being foregrounded was when Natasha and he turned up with Isherwood and Don Bachardy late one evening. Natasha had asked me to stay on – I’m not sure why, as I was scarcely the type of conversationalist Isherwood required, other than in my role as audience for a series of anecdotes about Berlin during which Stephen beamed bashfully, shedding half a century in the process. But ‘silly’? Natasha changed my life.
Andrew O’Hagan’s piece reminds me of the one time I met Spender. There was a writing school that met on a Saturday somewhere in Pennsylvania. I was there to discuss science writing, Spender to talk about poetry. I sat in on his class and admired his patience when reading out loud the most terrible poetry one could imagine. Finally I couldn’t stand it and told him that when I was at Harvard T.S. Eliot gave a public lecture and was asked what he thought the most beautiful lines in the English language were. Eliot had replied without hesitation: ‘But, look, the morn, in russet mantle clad,/Walks o’er the dew of yon high eastward hill.’ I asked Spender what his choice would be. He replied with some lines of Auden about the moon. I have looked through Auden’s poems and have never found anything that resembles what I remember. I suppose Spender was earning his living this way.
Memories of the Fog
Four days after the Luftwaffe raid of 16 October 1939 referred to by Harry Watson and Paul Machon, all those who died were buried with military honours (Letters, 19 November 2015 and Letters, 3 December 2015). The coffins of the two Germans were draped with swastikas. A photograph of the funeral procession accompanied a report, headed ‘Britain honours her own and Nazi dead alike,’ in the Daily Mirror the following day. Were such obsequies observed for enemy personnel killed later in the war?
John Lanchester cites two Nobel economists on the apparent irrationality of people paying more for branded than for chemically identical unbranded ibuprofen (LRB, 3 December 2015). There may, however, be a further issue in need of explanation: studies such as Branthwaite and Cooper’s in the British Medical Journal in 1981 show that branded drugs ‘work’ better than unbranded – and, in blind trials, branded placebos work better than unbranded.
In his letter Bill Johnson makes several more or less contentious points about the problems of the Labour Party (Letters, 19 November 2015). He is right to emphasise the extent to which the decay of its institutional and industrial base has undermined it, as such decay has undermined every Western social-democractic party. He underestimates, however, the way in which simultaneous changes in the structure of the media have reinforced that process. When the Labour Party reached its peak in 1951 so did the Daily Mirror. At present Labour has no access to a powerful press and legislation brought in by the last Labour government neutered television as an alternative. Even at the most elementary level the Labour Party has effectively no instrument of mass communication. That was very apparent at the last election.
Johnson says that it does not make ‘a blind bit of difference’ how parties elect their leaders. It makes more than a blind bit when their electoral arrangements elect the wrong leader – as the Labour Party did this year. The election of Corbyn is the long-term result of ill-considered changes which now seem almost irreversible, but unless reversed are likely to continue producing wrong leaders.
On the other hand, Johnson exaggerates the electoral strength of the Conservative Party. Its base, he says, is as ‘healthy as ever’. It isn’t. The social base of the Tory Party began to fragment in the 1980s and 1990s and it remains historically weak. This fragmentation gave New Labour an opportunity which it then almost wilfully threw away. All we can say is that, for the moment, the Tory social base is less insecure than Labour’s.
Johnson is right to suggest that nothing is to be gained by trying to rebuild the old structures of social democracy (though I’m not sure who is doing that); also right to argue that Labour will have to look for new allies – simply because the majority of the population are no longer working class. However, he chooses odd examples – ‘small businessmen, shop-owners, small farmers and so on’. Labour has tried to enrol them for the last hundred years with virtually no success.
St John’s College, Oxford