Some Words in Praise of the NHS

 – and the Gift of Choice

At time of writing there has been widely reported ‘bad news’ in the British press and broadcast media concerning the NHS (National Health Service). A government adviser has pointed out that there have been 20,000 avoidable deaths in certain poorly performing hospitals over the last decade. Needless to say, this is scandalous. But my intention here is not to condemn the NHS, despite some very serious failings in some areas of the country.

Those who have read some of my previous blog entries will know that I have often touched upon a particular issue that, by implication, incorporates criticism of the NHS. That issue is the historic abuse or inappropriate treatment of people – especially children and young people – within mental healthcare settings (and one setting in particular).

Indeed, as a result of my book Delivered Unto Lions I occasionally hear from people with their own horror stories related to past mental health treatment within the NHS. And I am also aware of one or two horror stories relating to recent or current treatment. It should be emphasised, however, that such things are not confined to the NHS. Bad things happen in the private healthcare sector too. And in any case, I’ve also heard of examples of excellent mental health treatment within the NHS.

Negative attitudes and maltreatment in mental health settings were, of course, deeply entrenched long before the creation of the NHS – if anything, such things have improved (though not nearly enough) since the 1940s when British government minister Aneurin Bevan set in motion the events that led to the creation of this system of healthcare.

One of Bevan’s assumptions was that free healthcare available to all (funded through taxation) would lead to (a) an improvement in the health of the nation, which would in turn lead to (b) the NHS being able to ‘pay for itself’ as better health led to a more efficient economy (healthy workers better contributing to a healthy economy). Needless to say, this didn’t quite happen. The health of the nation certainly improved, but the NHS did not ‘pay for itself’ – as Geoffrey Wheatcroft, a columnist for The Guardian, recently pointed out.

But whatever deficiencies may exist within the NHS, I want to say something positive about my own recent experience of treatment. This experience has included the very welcome opportunity making my own choice with regard to treatment. This isn’t a completely positive story, but it is a substantially positive story.

One of the reasons why I’ve been silent on my blog during the early part of this year is because I was given some unexpected news on the final day of last year.

On 31 December 2012 I had an appointment with a urology consultant at Worthing Hospital in West Sussex. I was expecting some ‘inconvenient’ news, but not anything especially bad. However, the consultant told me that I had cancer. It was prostate cancer. At the time I was surprised rather than shocked – not having yet hit 50 I thought I was a bit too youthful for that sort of thing! The fact that I didn’t react with panic on that occasion may have something to do with the consultant’s rather quaint and reassuring turn of phrase. That’s a good thing!

Over the following weeks I had various scans and tests before learning that my best option was surgery, which in this case meant radical prostatectomy (surgical removal of the prostate).

Less than a month after I was given my cancer diagnosis I met my prospective surgeon. He carefully described the procedure and what I should expect in terms of recovery, and then he patiently answered all my questions.

Since the beginning of this year, every one of the staff members I’ve encountered at Worthing Hospital – consultants, registrar, surgeon, specialist urology nurse, other nurses, counsellor, etc. – has treated me with professionalism and courtesy. I have experienced care of the highest standard.

Unfortunately, the surgery I need is not undertaken at Worthing. I was told I would have to go to another hospital, some 50 miles away, for the actual procedure. I won’t name the hospital where the surgery was to take place because it does not come up to the same high standard I’ve witnessed at Worthing (I’ve already said that this is a substantially positive story, not a completely positive one).

I attended a preoperative assessment at the hospital in question. I won’t go into too many of the unpleasant or off-putting details, but I will just say that I never expected to be sent home with a blank consent form to sign! (That’s the yellow CON 1 form for anyone who’s interested.) Needless to say, I came away determined that I would not sign away my consent on a form which had not been filled in. In fact, I was determined not to be operated on at that particular hospital.

The following day I did a bit of hasty research (clearly this is something that I should have done earlier!) and identified another hospital and surgeon, both with excellent reputations (not that I had any objection to my original surgeon). I then tried to see if my own GP (General Practitioner) would be willing to refer me to the hospital and surgeon of my choice. That referral has now been made with no difficulty whatsoever.

At present this story doesn’t have an end. But it does have a message. The NHS provides free treatment to UK citizens at the point of delivery. In many countries a cancer patient would be reliant on private insurance to pay for a radical prostatectomy. With the best surgeons at the best hospitals charging thousands more than their less experienced and less well-regarded counterparts, it’s easy to see where many insurance providers would steer their policy holders.

Like any very large institution, the NHS it has its dark corners. But there is also light. This will be no comfort for those who have not received the best treatment, those who have lost loved ones to poor treatment, and especially to those who have done so without realising there was a possibility of choice (at least in some cases). But for those yet to need treatment, this could well be an encouragement.

While my operation will now be delayed a little – due to my ‘eleventh hour’ exercise of choice – I now know that I will undergo the procedure at a centre of excellence performed by one of the best surgeons. This is a true privilege for which I am very grateful.

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Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Stepping into Rivers

To say that everything changes would hardly be an original comment. The Greek philosopher Heraclitus (circa 535-475 BC) supposedly said, ‘No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.’ He also said much the same thing in another way: ‘Everything flows, nothing stands still.’

One of the biggest concerns and controversies of our time is the issue of climate change. As I understand it, there is an almost universal concensus among scientists (in the relevant fields) that climate change is happening and that it is caused by human activity – the burning of fossel fuels to bring much needed energy to our modern human societies is leading to massive environmental destruction brought about by ‘global warming’.

There are, of course, those who deny this, those who simply do not believe what the majority of climate change scientists tell us. Many of these people are willing to accept that climate change is indeed taking place, but they deny that it has a human cause. After all, some of them say, our planet has a history of climate change dating back long before human beings walked the earth.

I started this piece by quoting a philosopher, and I’m very tempted to carry on in a philosophical vein by talking about a branch of philosophy called ‘epistemology’ (that’s a good word to slip into any conversation!). Epistemology is to do with the theory of knowledge. It asks, How do we know what we know? For those of us who are convinced that climate change is indeed caused by human beings, the obvious question is, How do we know? The same question applies to those of us who are just as convinced that climate change does not have a human cause. How do we know?

If you are a scientist who specialises in climage change, you can make careful observations, compare them, and then try to develop a theory. You can then test that theory by making further observations to see if there’s anything happening that might prove it wrong. But if you continue to observe the same patterns repeatedly with no exceptions (if you establish an ‘empirical regularity’), then you can be pretty sure that your theory is right.

But, there is a problem. Did you do all this work on your own? Did you conduct all the observations yourself? Did you do all the analysis of these observations yourself? Or did you have to rely to some extent on work undertaken by other scientists or technicians, work that you weren’t in a position to supervise personally? If it’s the latter, then you only know what you know because you are convinced by the work of other people. And that is the same for all of us. In most cases, we only know what we know because we are convinced by what other people have told us. We are not always (or even usually) able to test things out for ourselves.

For what it’s worth, I am convinced that the changes currently taking place in the world’s climate are indeed a reality and that human behaviour is responsible. But how do I know? That fact is, I don’t know, I’m just sufficiently persuaded to accept what a particular kind of authoritative figure tells me. (I also think it’s not worth taking a chance over something so potentially catastrophic.) For someone who denies climate change, the situation is pretty much the same. The denier doesn’t actually know that climate change is false, he or she just happens to be persuaded by the arguments of a different kind of authoritative figure.

But, as Hereclitus said, ‘No man ever steps in the same river twice, for it’s not the same river and he’s not the same man.’ Hereclitus knew this (I assume) because he had experienced or observed it (or something similar) for himself. ‘And this I knew experimentally,’ said the seventeenth century figure George Fox. He was speaking of personal religious ‘revelation’ (not the sort of thing you can prove to anyone else), and he knew what he knew ‘experimentally’. Like Hereclitus (so I assume), Fox was convinced by something because he had experienced or observed it for himself; he was not convinced because someone else had told him what to believe.

In fact, we all know about change ‘experimentally’ (or so I’m told!). We may not know very much about climate change – apart from seasonal variations – but we do know about change in general. Change happens. It’s reliable. We know this experimentally.

Given the often difficult subject matter I try to address in my writing, I find it very encouraging that the one thing that we can all rely on is change: some things may deteriorate and get worse, but there are many things that can develop and improve.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Asylums, Antiquarians and Anecdotes - and Arthur C Clarke

It’s no secret that my book Delivered Unto Lions, though presented in the form of a novel, is closely based on events that took place at a former mental institution in Somerset called Merrifield. Merrifield Children’s Unit was, if you like, the partially detached young patients’ arm of Tone Vale Hospital, an old asylum-style institution. Both Merrifield and Tone Vale were closed in the mid-1990s following the rise of ‘Care in the Community’.

Within two years of the closure of Tone Vale, editors David Hinton and Fred Clarke compiled a slim volume chronicling some of the hospital’s history. The Tone Vale Story: A Century Of Care is the kind of publication you might expect from a local history society, i.e. competently-researched, slightly antiquarian in flavour, and presented with the keen initiative of local history enthusiasts.

Some readers will be familiar, by association, with co-editor Fred Clarke. His brother was the science fiction author Arthur C Clarke. Indeed, The Tone Vale Story is published by the Clarke family’s own organisation, the Rocket Publishing Company. 

The Tone Vale Story covers the opening of the asylum in 1887, various key figures associated with the development and running of the place, and architectural and topographic observations, many of these being illustrated by vintage photographs.

Of particular interest from my point of view are a few paragraphs dedicated to Merrifield:

Tone Vale and the Somerset Educational Authority combined to provide a children’s unit for autistic and other emotionally disturbed children in the grounds of Tone Vale: the Unit served the whole of the South West of England …

Some of the children, although highly disturbed, were extremely well read and educated. A local author, when invited to lecture to them, found that one or two knew nearly as much about his subject, science fiction, as he did!

(Hinton & Clarke, 1997, p. 43)

It is, perhaps, too easy to take issue with parts of this. Firstly, the phrase ‘autistic and other emotionally disturbed children’ is misleading, as autism is a neurological condition, so it gives entirely the wrong impression to then add ‘and other emotionally disturbed children’. Secondly, labelling all Merrifield patients as ‘highly disturbed’ seems to unjustly brand young people who, in reality, were suffering problems of varying severity covering a broad range of emotional, psychological and neurological conditions.

The local author who made these observations, I happen to know, was actually Fred Clarke himself. I know this because I was there! In the Spring of 1979, when I was 15, he came to address a group of patients and staff about the work of his more famous brother.

Putting my criticisms to one side, I remember Fred Clarke’s visit with fondness – he was a genuinely pleasant man. I particularly remember him showing us the handwritten manuscript for Arthur C Clarke’s first novel, The Sands of Mars. My girlfriend of the time (don’t tell anyone I had a girlfriend – it wasn’t allowed at Merrifield!) commented on the neatness of the handwriting. Fred, however, in an entertaining brotherly way, dismissed Arthur’s handwriting as an untidy scrawl!

As a result of that occasion, I was invited by Fred to meet his highly-renowned brother in the August of ’79. It was a slightly bizarre occasion which took place at the Clarke family house (which was very close to Tone Vale and Merrifield).

The well-known author was in the UK (he was based in Sri Lanka) to promote his new television series Arthur C Clarke’s Mysterious World, and a Dutch film crew had been at the house to interview him – and I got to enjoy some of the catering! After the film crew had left, I found myself in the peculiar position of sitting with Arthur C Clarke as he watched an edition of the children’s TV programme Blue Peter (he particularly wanted to see a feature on the Egyptian pyramids). I also took the opportunity to take a photograph of Arthur, and he helpfully pointed out that you should always take more than one shot when photographing something important!

It is, however, the less well-known of the two brothers who made the biggest impact on me. I remember Fred Clarke as a gentle, courteous man who shared his brother’s enthusiasm for both science and science fiction. And when I met Fred again, twenty-two years later, at the 2001 Nexus Convention in Bristol, I was surprised to discover that he remembered me.

Against this background I find myself surveying The Tone Vale Story, which Fred co-edited, from a very particular perspective. I knew Fred Clarke to some extent; I knew Tone Vale to some extent; and I knew Merrifield intimately. So what does The Tone Vale Story mean in relation to unpleasant portrayals of Tone Vale and Merrifield (or their novelised counterparts) in books like Joyce Passmore’s mémoire The Light in My Mind and my own novel Delivered Unto Lions?

The Tone Vale Story is very matter-of-fact in its historical/antiquarian tone. The only controversies it comes close to acknowledging are those associated with past attitudes to mental health, such as those encapsulated in the 1890 Lunacy Act. It tells the story of the institution in terms of developments and innovations, coupled with a few folksy recollections, but it does not tell the story of the institution in terms of patients’ experience.

No doubt there are many former patients, both adult and child, who passed through Tone Vale or Merrifield helped rather than harmed by the experience. But there is enough personal testimony around to know that many individuals – who were already experiencing problematic conditions to one extent or another – were damaged further by their unsavoury experiences of these closely linked institutions.

But this reality is not acknowledged in The Tone Vale Story. No doubt this is because the source materials used by the book’s compilers make no reference to such matters. Instead we find in the book an almost celebratory appreciation of achievements and milestones:

• Dr Henry Aveline, the first Medical Superintendent of the asylum, is revered for his multi-lingual ability
• Dr Kenneth Bailey, a later Medical Superintendent, is almost canonised for developing more humane approaches to mental illness
• Ernest George Stephens, Head Gardener, is highly commended for his ‘adventurous’ development of the hospital grounds

This is all well and good; achievements should be celebrated. But what of the darker side? Were editors David Hinton and Fred Clarke even aware that there was a darker side?

Fred Clarke certainly had some interaction with the on-site authorities at Merrifield and with some of the patients (including myself), but it seems to me to be entirely likely that, despite his close proximity to disturbing events, he knew nothing of these things. I wonder how many other visitors to Merrifield – NHS and local government officials, chaplains and other supportive individuals, etc. – remained unaware of some of the damaging things that happened from time-to-time in an institution they knew relatively well.

I’ve always maintained that the phenomenon of Merrifield was one kept hidden from public knowledge. Tone Vale Hospital was less well concealed, but still there was much that was kept hidden. Even for those who might have thought they knew these places – because at some point they had stepped foot inside – the full truth still remained hidden.

This leads me to wonder how many other local histories and modern antiquarian writings unwittingly keep their readers out of the hidden recesses. Perhaps the unpleasant anecdote (as well as the pleasant one) deserves some space alongside the historical or antiquarian record.

____________

The Tone Vale Story: A Century Of Care, edited by David Hinton & Fred Clarke, is published by the Rocket Publishing Co.

ISBN 978-1-899995-05-9

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

When Childhood Ends

The rain on the pavements

From a crack in the sky

The watery remnants

Of how you once cried

It drains through your being

Like the death of a friend

And I think you’ll find your childhood must end

I wrote those words more than twenty-five years ago. I was a young man then, still in my early twenties. To be honest, I’ve slightly changed one line as I decided my original attempt wasn’t good enough. I’m not sure that any of it’s particularly good anyway – including the melody I wrote for it (it’s a song) – but this is it, for what it’s worth.

There was a particular incident that prompted me to write those words. A work colleague of mine (a little older than me, but still a young man) had recently left our employer and taken up another position – his dream job! – elsewhere in the country. A few weeks after he left, the message came back that he had suffered a severe head injury in a road accident. I can’t remember for certain, but I think he may have been a pedestrian rather than a car-driver or passenger.

Over the coming days and weeks reports continued to filter back about his condition. Eventually the news came that he had died.

I’m sorry to say I can’t remember his name – this wasn’t quite the ‘death of a friend’ that I wrote about in my song. The truth is, this man hadn’t been an especially close friend of mine, but he had been a friendly, likeable colleague. Other colleagues of mine who had known him better and for longer were, of course, devastated.

This left me with the luxury – if you can call it a luxury – of being able to step back and reflect on what had happened in a way that the more deeply bereaved couldn’t. And so I thought about how a man of a similar age to myself had moved away to follow the career he wanted. This was a very positive thing, something to be celebrated. But in what seemed like no time at all, it was all over. He only got to experience his dream for a short time before his life came to a tragic end, his last few weeks lived in unconsciousness.

While pondering all this, I also thought of another young man I knew who had died a few years earlier (he had been slightly younger than me). His name was Chris. He was still in his teens when he lost his life to meningitis. Again, he wasn’t an especially close friend of mine, but he was a friend nonetheless (we went to the same youth club). Chris had been on my mind when I wrote some earlier verses –

Frozen water

Iced out, glassed out

Has melted, washed away

– but he was still on my mind when I wrote the words about ‘rain on the pavements’ and ‘a crack in the sky’.

Is there a point to all this gloomy recollection? Well, yes. I think the point is that, one way or another, childhood and youth come to an end.  Innocence of endings comes to an end.  Such things can come to an end in sudden tragedy or they can just slip away gradually, almost unnoticed. Adulthood, if it is achieved, also comes to an end.

But a legacy remains from anything that comes to an end. For those of us who still live, legacies remain a part of our personal existence; for those of us who no longer live, legacies remain for others.

Given that endings cannot be avoided, maybe we should work harder to make those legacies good ones – challenging though that may be. Perhaps we can work towards discovering the childhood happiness that wasn’t known in life, while also celebrating and maintaining something of the childhood happiness that was.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu