I had not long finished reading David Runciman’s cautionary article on the commercialisation of the NHS (LRB, 21 April) when I happened on a few lines in the newspaper to the effect that a man of ninety who was a patient in a hospital somewhere in the North of England had been left lying on a mattress on the floor because the lease had run out on his bed. This seemed to be taking commercialism rather beyond any acceptable limit, even for those of us who are not fanatically opposed to the Private Finance Initiative as a way of raising ready money to pay for new hospital buildings. If local hospital trusts find it good practice to rent beds from outside rather than buy and own them, it can only be because it works out cheaper in the long run, the long run being the prime consideration if laying out more money in the short term involves you in having to raise it from somewhere or somebody who is unwilling to pay up. The only reason we have the PFI in the first place, as Runciman indicates, is that we are presumed by New Labour to be so unwilling to pay more taxes to fund new hospital building from public sources that we might decide to vote for the other lot when the day comes, as it’s just about to. It may of course be the case that the story about the floored nonagenarian up north isn’t true, but was offered to the press as one of those ‘hateful’ – Runciman’s word, and how right he is – individual cases of which so much is made at election time. The fact that the Tory Party seems not to have picked up on it makes me wonder whether even they were suspicious of its authenticity. They have instead, at least where I live, put out an election poster claiming that since New Labour took charge of the NHS, we’ve had three times as many MRSA bugs in our hospitals as when the Conservatives had charge of them – these nasty little foreign bacteria are presumably the medical equivalent of illegal immigrants. The long-term answer to the problems of the NHS may in any case not lie with governments of either colour. If commercialisation is held to be the solution why not hand it over to what is patently the most successful commercial organisation currently in our midst? ‘This does not mean that schools and hospitals should try to be more like supermarkets,’ Runciman writes. But why not? Given that Tesco appears to be able to make £2 billion honest profit in a single trading year, it’s surely time they were invited to start building a Tesco wing for the local hospital rather than opening yet more of their awful convenience stores.
Horsham, West Sussex
David Runciman’s account of the injection of choice into the NHS doesn’t mention ‘Choose and Book’, a project intended to transform the process of allocating outpatient appointments. Instead of being put on a waiting list and subsequently given a date for an appointment, patients will be able to book appointments with the help of their GP, through a call centre or via the web. Not only will they be able to pick a date that suits them, they will be offered a choice of hospitals, including private ones. The project made the headlines when the National Audit Office reported that although it had been hoped that 205,000 patients would have taken advantage of the new system by December 2004, only 63 patients had used it.
Some of the rhetoric that surrounds this initiative is illustrative of the institutional hypocrisy Runciman describes. The Choose and Book website boasts that you will get your appointment faster. But getting your appointment faster doesn’t mean that you will be seen sooner. Under the present system a patient seeing their GP in, say, April might be told in June that their appointment will be in July. With Choose and Book the patient will be told the appointment date in April, but it’s actually less likely to be as soon as July. The project is mentioned in a section of the Labour Party manifesto called ‘Choosing Not Waiting’, but as a result of the constraints involved in offering choice and guaranteeing availability patients will in fact have to wait even longer to be seen.
University College London
It is true that the subsidy system which has been used to allow the construction of foundation hospitals leaves much to be desired, but the principle that patients, former patients and staff should elect the boards of governors of foundation hospitals is an excellent one and should be extended to all NHS hospitals. David Runciman is wrong to allege that these boards of governors have no power. They are able to appoint or remove non-executive directors, and to decide their pay, allowances and other terms and conditions.
Hugh Pennington notes that ‘the Soviets were not alone in considering the military use of Yersinia pestis,’ and mentions Geoffrey Bacon’s death from plague at Porton Down in 1962 (LRB, 21 April). Ten years before that, plague was among the organisms tested in Operation Cauldron, part of the British government’s programme of biological warfare sea trials. On 15 September 1952, a trawler from Hull, the Carella, sailed through the test area near the Isle of Lewis while plague germs were released; the crew were clandestinely monitored for three weeks in case any sign of infection appeared.
Matt Cavanagh says that the number of applications for asylum in the UK has been reduced as a result of the government’s asylum policies (Letters, 31 March). The UNHCR, however, reports that the number of asylum seekers has fallen by 40 per cent since 2001 in fifty industrialised countries, and that the movement of refugees is in decline everywhere. While the number of asylum applicants entering the UK has fallen, the proportion granted refugee status has stayed more or less constant, showing that stricter border controls keep out those who are in need of protection as much as those who are not.
Cavanagh implies that I question whether ‘the current laws should be enforced’ at all. But my concern is rather with the proliferation of new laws that inflict arbitrary sanctions on asylum seekers, regardless of the status of their claim. I don’t think, for example, that officials are being ‘overzealous’ in their application of the new law which penalises asylum seekers who don’t have any travel documents when they’re first interviewed by the Immigration Service. I was criticising the law itself (rather than the way it is applied) because it designates as criminal something that is legitimate according to international refugee law.
It is worrying that Cavanagh, a former government adviser, accepts that the case studies I cite ‘remind us of the individual cost of changes in policy or its application’, yet continues to defend those policy changes. I suppose the man who was made homeless by a law that contravened the European Convention on Human Rights, or the survivor of torture who was locked up without adequate explanation by the Immigration Service and whose asylum claim was rejected twice in the face of compelling evidence to support it, are instances of Cavanagh’s ‘trade-off’ between protecting human rights and ‘eliminating abuse of the system’.
According to Cavanagh, ‘the government is ensuring taxpayers’ money is going to the people who are entitled to it.’ But last month a Refugee Survival Trust report, funded by Oxfam, found that ‘administrative errors and procedural delays within the National Asylum Support Service’ are a major cause of destitution among asylum seekers. If Cavanagh was really worried about taxpayers’ money, he wouldn’t support the arbitrary detention of increasing numbers of asylum seekers, a policy which is both expensive and unnecessary. Unjustly punitive policies and incompetent government agencies are the real waste of public resources.
Sean Wilsey (LRB, 17 March) and Alan Bernheimer (Letters, 21 April) tell a number of entertaining horror stories about streetwise city rats. But their country cousins are just as smart, and just as brutal. There used to be a farm across the road from my house, but a few years ago the farmer sold up and the farmyard was acquired by a property developer. The barns and outhouses have been gradually converted into desirable semi-rural homes for commuters. The resident rat colony beat a steady retreat as each building was lost to the developers, until they were cornered in the last shed. When that fell, rather than stand and fight they fled across the road, under our gate, and into the relative safety of the space beneath my garden shed (at least, I assume that’s what happened: that’s where they are currently camping out). I occasionally spot them scurrying industriously to and from the compost heap, though none of them has as yet acquired a wheelbarrow, like the eponymous anti-hero of Beatrix Potter’s Tale of Samuel Whiskers. The cat’s keeping well clear. A mother duck and her ducklings, less canny than the cat, recently waddled into the garden. I shooed them away, but one duckling got separated from the others and scuttled off under the shed. It never came out.
Frank Kermode says of Kazuo Ishiguro’s novel The Unconsoled that ‘Ryder hears from nearby the sound of the conductor Brodsky digging a grave for his favourite cat’ (LRB, 21 April). Brodsky is in fact burying his only dog, Bruno. Cats figure prominently in another of Ishiguro’s novels, A Pale View of Hills, and in a recent appearance at the South Bank Ishiguro mentioned his discussions with Angela Carter on the ‘serious’ issue of whether dead cats float.
Ana María Sánchez-Arce
John Lanchester shouldn’t be surprised that David Blunkett turned out to be so authoritarian in office (LRB, 31 March). Harold Laski, an old Labour politician mentioned in passing by Lanchester, advocated wartime detention under the infamous Regulation 18B, which allowed the home secretary to detain people without charge or trial. His position exemplified an ideology which continues to thrive under New Labour: trust government and distrust judges; pass legislation granting the executive wide powers, and describe whatever the executive does as ‘democratic’.
John Lanchester makes a connection between the Home Office’s illiberal record and its being ‘the home … of our thickest civil servants’. Does he really know the Home Office is full of ‘dimwits’, or is this just a fashionable thing to say? Are those who work at other government departments – the Foreign Office, say – much brainier? Or is it simply that the FO retains some outmoded macho glamour?
Frank Kermode says that Harold Nicolson’s ‘homosexual excursions’ were ‘presumably more democratic’ than his appalling opinions about the lower classes might lead one to imagine (LRB, 17 March). They were. An Australian with a working-class background (thereby twice ‘bedint’), I attended Harold Nicolson’s all-male soirées in his Albany rooms half a century ago. Social inferiors were allowed if they were attractive, wore neat suits and never used the definite article when referring to his Piccadilly apartment.
Leura, New South Wales