Private Finance Initiative (PFI)

This little essay is sourced from a book I wrote a few years ago.

A speculative fantasy dreamed up by some British economists in the late twentieth century and elevated to a policy by a succession of right-wing governments.

PFI aims to relieve the state of many of its public service obligations by transferring responsibility for delivering and maintaining them to the private sector. Under PFI public buildings are built with private funds, social care provision for the elderly is delegated to corporations, private clinics replace state hospitals, management firms take over the running of “failing” schools” while successful ones are encouraged to sell off their playing fields before being demolished to make way for private academies. Little by little, government withdraws from its traditional role - indeed from the role for which it was elected. Instead it becomes an intermediary between the people and the private sector - receiving petitions from the former and contracting the latter to resolve them. In a curious reversal of classical economic theory, the state thereby emerges as the largest single source of business profits, and an efficient recycler of funds from taxpayers to the pockets of company directors and shareholders.

Politicians justify PFI on the grounds that because companies are stiffened by market discipline they can build and operate public facilities more cost-effectively than government. Regrettably, no element of this mantra stands up to the mildest scrutiny.

First, most governments can raise capital more cheaply than companies because they tend to have higher credit ratings and at least some control over domestic interest rates. More important, debt is usually less expensive than equity[1]. What this means is that the private sector pays more for its money than the state and will charge the cost back to the taxpayer.

Second, no evidence exists that companies have a genetic capacity to run public services more efficiently than governments. The supposed superior efficiency of the private sector is a favoured fantasy of business executives looking to secure government contracts because they find it peculiarly easy to drill into the mush that passes for the brains of incompetent politicians.

A useful corrective might be to recall from time to time a few items of our collective history that votaries of neo-liberalism are inclined to overlook. Universal access to health and education services, construction and maintenance of most of the world’s road and rail networks, the BBC, the CBC, MOMA[2], Sydney’s Opera House, the Louvre, the Library of Congress, police and fire services, pensions for retirees[3], sewerage and water supplies, the allied victory over Hitler and fascism, the US and Russian space programs, and parliamentary democracy, figure among the numberless initiatives and successes of the now derided public sector - the sector that citizens are told works badly on the infrequent occasions when it works at all.

In a competitive world, companies have to be efficient in order to survive. Those that fail either go under or pass into the hands of their competitors. Public services can’t be allowed to go under, however, because without them neither we nor the country in which we live could keep going. Instead, whenever the companies that run them get into trouble, the State bails them out, rewarding their inefficiencies with subsidies, allowing them to hike prices on a nod and a wink, and turning a blind eye to the inflated salaries of their executives. In place of market discipline, we get sequential rip-offs under government licence while they - the companies - get increasing profits for diminishing levels of service.

[1] Although companies usually borrow funds to finance a project, they still pay dividends on the profits, bonuses to their executives, and interest on the the debt. Dividends are more expensive because they are paid after tax, whereas debt is tax deductible. But, of course, governments don't pay tax or dividends to shareholders.

[2] New York Museum of Modern Art

[3] We have Napoleon to thank for this one.

Parting as friends...?

Some nationalist comments on Scottish independence come laced with a good dose of venom directed not just against Westminster but against the English who have been variously described as, torpid, bovine, smug, complacent, nasty (add your own epithet) toffs. Plenty more examples have appeared recently in the media, so I won’t trouble the reader with additional references. These barbs - largely from Scottish nationalists - seem to me like the painful cries of an anxious lover, for they come accompanied by entreaties more often than not for the English to listen to what the Scots are saying. They are in other words, calls for attention, for evidence that the English care about keeping the union together.
We can, I think, dismiss the possibility that nationalists want the rUK Brits to persuade them not to leave. More likely their aim, perhaps subconscious, is to draw expressions of affection from the English (in particular) as a prolegomenon to inflicting on them the maximum of discomfort - hurt feelings - when, as they hope, Scotland chooses to go its own way. In short, they want the separation to matter to the abandoned partner. Anyone who has been involved in a conflictive divorce will be familiar with the complex emotions at work.
One or two recent polls suggest that at least as many English as Scots want the separation to take place. A much larger proportion of English, however, appear not to care. My own casual inquiries over the last year - mainly though not exclusively - in London and the South West (notably Devon and Cornwall where I work) have yielded very little beyond a sense that Scottish independence appears to be a very long way down anyone’s list of priorities. The most widespread opinion I have heard voiced - and this only after I had insisted on hearing one - is that “..it won’t make any difference…”
It would be easy - and false - to dismiss this response as evidence that the English deserve to be speared for their intellectual laziness and smugness. For behind this apparent indifference to Scotland lies a much more profound aspect of the character of the English which I would summarise as an unthinking confidence in their own identity.
Robertson Davies, the great Canadian writer, was once quoted as saying that to understand the English you needed to know that they don’t give a damn what anyone thinks of them. Like most exaggerations this one harbours a kernel of truth. Rarely outside the confines of a football stadium (and adjacent pubs) do the English proclaim their national identity. The barmy army, whose members seem to have enough cash and leisure to follow the England cricket team round the world, acquired its name because, to most of their compatriots they are - literally - barmy. Often against the evidence, the English (drunks excepted) naturally assume that they are on good terms with everyone. Moreover, they seldom if ever compare themselves with other nations, not because they think themselves superior, but because they do not consider that the qualities of other nations diminish them. This is notably true of the “home” countries. If England gets knocked out of the World rugby cup, the English will cheer Wales, or Scotland, or Ireland. They can be horribly chastened by the kind of ashes thrashing recently administered by the Australian cricket team; but they will think no less of the Australians for the beating. They treat it as a game and to a large extent treat life itself in much the same way. They are genuinely perplexed by the ABE (Anybody but England) t-shirts enthusiastically sold in Scotland on international sporting occasions; but, despite the occasional efforts of the tabloid press to whip up a furious reaction south of the border, they are only too happy to ignore the intended slight, and to cheer Andy Murray, Chris Hoy and other Scottish champions as their own.
Contempt and distrust are not alien to the English temper but they tend to direct such sentiments not at the people of other nations, but at faceless bureaucrats and city bankers, and especially at politicians. They know that the country has been grotesquely ill-served by successive governments; they are only too conscious of the litany of ills so forcefully described in Robin McAlpine’s recent piece for Open Democracy; the majority who live outside the self-indulgent, myopic bubble of Westminster and Canary Wharf feel both utterly marginalised and, ever since the New Labour betrayal, bereft of political choice. Many are furious about the damage inflicted on the social fabric of this country by neoliberalism and its acolytes, among whom are numbered all the political leaders who have been in charge since Thatcher. But anger and indignation are expressions of love; and they can be and one day surely will be catalysts for action and change. England has been through such periods before - as anyone will know who has studied earlier periods of our history. Disaffection with the status quo, however, is not the same as self-doubt. The English - and I include all those who were born in England or live there by right of citizenship - do not define their identity with reference to their neighbours. In fact they rarely bother to define themselves at all; they take what they are as a given. My sense - a purely personal view - is that they feel generally closer to the Welsh than to the Scots (in literary terms closer to Dylan Thomas than to Robert Burns) and are rather mystified by the tribal hostilities in Northern Ireland; but they are entirely comfortable with the larger identity of Britishness which I believe they view as a kind of brother/sisterhood
From whence does this English self-confidence arise? Part undoubtedly stems from territorial integrity, the long history - almost a thousand years - of borders that no foreign army has crossed except by invitation. No one has better expressed the English sense of geographical security than Shakespeare when he wrote the famous “sceptred isle” speech for John of Gaunt:
“This precious stone set in the silver sea,
Which serves it in the office of a wall,
Or as a moat defensive to a house,
Against the envy of less happier lands.”
Though in the same speech old John rails against the corruption of politicians in their willingness to sell out the country in return for power:
”…this dear dear land,
Dear for her reputation through the world,
Is now leased out…
Like to a tenement or pelting farm:”
It could have been written yesterday.
Another portion of self-confidence without doubt arises from the depth and richness of the culture: in literature from Chaucer and Shakespeare to Harold Pinter and Doris Lessing; in painting from the Wilton Diptych to Constable, Turner, Bacon and Lucien Freud; In so-called classical music from Tallis and Purcell to Walton, Vaughan Williams, Britten; in popular music, from Dowland to the Beatles, the Rolling Stones, David Bowie…..In science from Newton to Stephen Hawking and Peter Higgs (of boson fame), in technology and engineering from Brunel, to Frank Whittle (turbo jet engine), Charles Babbage….Alan Turing (computers), Clive Sinclair (electronic pocket calculator), Tim Berners-Lee (WWW) etc. etc. These are mere examples drawn from a seemingly endless list of contributors not just to the nation but to the world. For whatever reasons - good and bad - English has become the lingua franca of international discourse and the most widely spoken and taught on the planet.
In short, England’s cultural bags are heavy with achievement, and though most of us have had no part in filling them, we carry them subconsciously in the language we speak and the way we think.
David Bowie is currently under attack in cyberspace for having politely asked the Scots to “stay” in the Union, a backlash that would seem to reflect more on the attackers than on their target. Snarling at those with whom you disagree in an attempt to silence them has about it a sulphurous whiff. It reminds me of a personal experience that occurred during the lead-up to the Quebec independence referendum in 1995. I found myself sharing a meal with a group of writers and intellectuals in a Toronto restaurant. Several Quebecers were present, one of whom sat next to me, a young university professor. Inevitably the subject of conversation turned to Quebec and someone made a disobliging remark about the people of anglophone Canada. I said softly, in reply, that the opinion just expressed was not very charitable. The professor turned to me, eyes blazing.
“You can stuff your effing charity up your arse.” I recall this incident as way of suggesting that there is no need to be nasty. Regardless of what the largely right-wing London-centric press may claim, the English people will not think less of the Scots for separating. If independence induces the Scottish people to cease blaming their discontents on the English there will likely be polite applause from south of the border.
What the Scots should not expect is lamentation for their departure. Politicians and their friends in the media may bleat for a while but they’ll soon get used to the new dispensation, which will, of course, include Scottish entry into the EU as an independent nation. If Scots do vote for independence, the English will wish them well and hope that they too will gain sufficient confidence in their identity that they no longer feel a need to proclaim it or to compare themselves with others.
As Gandhi is said to have remarked as India moved towards independence from Great Britain, “we have come a long way together; so we must part as friends.”

This article was first published in Open Democracy.

Art as Politics

Anyone who has visited the Royal Academy’s Daumier exhibition Visions of Paris expecting to see views of fine buildings and picturesque plazas will have been sorely disappointed. The title is misleading because the focus of Daumier’s penetrating gaze was not urban landscape but people, and the social and political milieu of his time. Paris barely appears at all. Instead, what arrests the attention from the very first works on display is the force of the artist’s political commitment: on one hand his mockery of the rich and powerful, at its best in the caricature of King Louis-Philippe as Gargantua and his grotesque maquettes of monarchist politicians; and on the other his sensitive depictions of the poor and working classes. Daumier was an uncompromising republican, a quiet but acerbic revolutionary conscious at once of the extremes of inequality prevalent in nineteenth century France, and of the humanity of the common people. He belonged to and in many ways exemplified the Romantic revolution, one of whose characteristics was a recognition that “ordinary” individuals were as worthy of study and respect as the aristocrats and idealised religious figures that had largely dominated pictorial art of previous periods.

What struck me at the Daumier exhibition as forcefully as the creative and intellectual vigour of this remarkable artist was the applicability of much of his social and political satire to the UK’s present circumstances. Just as in the France of Louis-Philippe, we too have:
• an upper class with a heredity monarch at its head support by obsequious politicians and a servile, gossip-driven media; • extremes of inequality that have not ceased to grow since Thatcher and her successors enthusiastically chose to deliver the country to the international market.

Daumier was not alone, of course, in using his art for social and political purposes. Artists and thinkers at the barricades were a familiar sight in the nineteenth century: Shelley’s writings were considered seditious; Victor Hugo’s Les Miserables evoked the life of the underprivileged as did Zola’s L’Assommoir and Germinal; Marx gave his name to revolution with pamphlets and newspaper articles as well his longer works; Proudhon in What is Property? answered his own question by concluding that “property is theft”; Dickens honed in on numerous contemporary ills including England’s sclerotic legal system, widespread social deprivation, capitalist corruption and so on; a little later Kropotkin was working on an anarchist proposal for the administration of economic life. Daumier himself earned a spell in jail for pillorying the monarchy. All these were or became opinion shapers who, by their very choice of subject matter, succeeded in engaging their contemporaries and steering them into an uncomfortable contemplation of injustice and poverty.

A long article about the housing crisis by James Meek in the London Review of Books (9 January 2014) suggests why we could do with a few such figures now. Meek opens his piece by introducing the reader to a sixty-year-old retired woman who, having lived for forty years in the same two-bedroom council flat where her husband died is now being forced to contemplate self-eviction because of the government’s notorious “bedroom tax”. Scheduled to lose part of her housing benefit, she must choose between eating and moving to an affordable one-bedroom. She lives in Tower Hamlets where “ten thousand are waiting for a one-bedroom flat….five hundred of whom have been waiting for 12 years or more.” Although such a person cannot be said to own her two-bedroom in the capitalistic sense, by almost every other definition she has surely acquired possession of it. The walls will be decorated to her colours, the shelves and cupboards stocked with what is hers, the furniture and rugs and curtains, moulded to her taste and that of her late partner; from the window the view will be familiar to her; those who live nearby are her neighbours; local shopkeepers know her by name. Her emotions, her memories, her sense of self are invested in the modest apartment from which George Osborne now desires to evict her. John Ruskin - another nineteenth century free-thinker - described the process:
“Whether we force a man’s property from him by pinching his stomach, or pinching his fingers, makes some difference anatomically; - morally none whatsoever: we use a form of torture of some sort in order to make him give up his property; we use, indeed, the man’s own anxieties, instead of the rack; and his immediate peril of starvation, instead of the pistol at his head.” [1]

In the same issue of the LRB, playwright Alan Bennett finds similarities between George Osborne’s rhetoric about the poor and statements “…voiced in the 17th century and thereafter.” . Perhaps Bennett was thinking of that great enlightenment theoretician John Locke who asserted “ ‘Tis not to be expected, that a Man, who drudges on, all his life, in a Laborious Trade, should be more knowing...than a pack horse….” [2]; or maybe that icon of illiberal Tory fundamentalism Edmund Burke who thought it was at once “mad” and “blasphemous” to believe that the “competencies of government” included “supplying to the poor those necessaries which it has pleased the Divine Providence for a while to withhold from them”.[3]

During my visit to the Daumier exhibition, I remarked to a companion that at a time when we seem to me mired in the same kind of inequities of which Daumier was so obviously conscious it was a pity we did not have artists like him - true republicans prepared to challenge both the monarchy and our tired political system. To my surprise I heard around me several murmurs of agreement and none of dissent. Later, I wondered if my off-the-cuff criticism stood up to scrutiny. Certainly we have artists of the other kind - those admired (and handsomely paid) for putting tiny birds on sticks, encrusting skulls with diamonds, and exhibiting nothing - a phenomenon on which I wrote a spoof years before the none event at the Hayward Gallery in London.

But do we have political rebels amongst our artistic luminaries? Any who find in the lives of our people - of the world’s peoples - the lifeblood of their art?

Sculptor Anthony Gormley figures on the 2014 list of those receiving a high-level gong - an accolade of which he apparently approves because gongs ”now … also go to people that have opened people’s minds…” . Well perhaps some folk have had their minds opened by Sir Anthony though I find it hard to imagine to what purpose.

Of one thing we can be sure, given Daumier’s jaundiced representations of royalty, there wouldn’t have been much enthusiasm in Louis-Philippe’s palace for giving him a gong of any kind. Whoever has stood before Daumier’s piquant caricatures, his stark evocations of Don Quixote and Sancho Panza, his poignant depictions of the Parisian “lower” classes might, however, conclude that the greatest artists don’t need them. Some of us might also wonder if a decoration conferred on a creative artist by an unelected head of state on the recommendation of a politician might even be considered a bit demeaning, less a mark of honour than one of failure. Lucien Freud, Francis Bacon, Aldous Huxley, Graham Greene, JB Priestley - artists who one might consider to be at least as important as Gormley - figure among those who turned down their gongs. Perhaps they didn’t want to belong to a club that included people exalted for their allegiance to political parties or for their dedication to personal enrichment, or who pay a lower tax rate than their cleaners, or who have earned a spell in one of her majesty’s hostelries for criminals. Or did they simply recoil from the embrace of an establishment that many in this country learn by dint of experience to despise?

Doubtless all the names on the News Years Honours list are worthy people; but the list itself, especially at the most elevated levels, is dishonoured by those who have found their way onto it less by the nobleness of their deeds than by the size of their wallet and the quality of their address book For every of one those before whom commoners are expected to genuflect, there will be thousands - tens of thousands - whose service to others and to their nation goes unremarked: the toilers who pass under the radar of the better-off but on whose labours we and the city depend, the brick-layers and carpenters, street-cleaners, shop-assistants, bin men, plumbers, electricians, nurses, fire-fighters, social workers, small entrepreneurs... As George Eliot memorably reminds us in the concluding lines of Middlemarch: ” ... the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.”

[1] The Work of Iron, 1858

[2] Essay Concerning Human Understanding

[3] Quoted in Domenico Losurdo, Liberalism - A Counter-History, London 2011, p. 37

The Meaning of PISA

OECD’s Programme for International Student Assessment (PISA) tests 15-year-olds on their knowledge of reading, maths and science. Publication of the latest test results has raised much alarm in the UK - and in other countries that we think of as “advanced” - because our students seem to be flat-lining  in a world apparently being overtaken by the likes of China and  the Asian Tigers. Some of the dismayed rhetoric emanating from the Education Secretary has sounded eerily like an updated version of a terror known in the late nineteenth and a good part of the twentieth centuries as the “yellow peril”, namely that the West was about to be overrun by hoards of ill-intentioned folk from the Far East.  Ghengis Khan, thirteenth century founder of the fearsome Mongol Empire, provides the proto-type.
“Do PISA scores matter?” was  the introductory topic  on  BBC’s December 5th edition of Question Time.  All three politicians on the panel concurred that they do, along with that self-important purveyor of prejudice Nick Ferrari (formerly of Fox News,  deviser of  Topless Darts  and the News Bunny - you get the picture).  Professor Mary Beard, sole educator on the panel, found herself alone in questioning the validity of PISA scores; but though she was clearly the most knowledgeable of those present, she was also the least articulate, possibly because she was less accustomed than her fellow-panelists to the soundbite world of instant opinion. Even though her intervention may have lacked impact, however, its thoughtfulness  provoked me to dig a little deeper into international educational comparisons.
Finding PISA sceptics proved easier than I expected.  A  Huffington Post article by Diane Ravitch, professor of education at New York University dismisses international test scores as worthless. While the US  has never been first in the world, nor even near the top, on international tests, Ravitch claims, it has done pretty well economically, and in terms of scientific invention and business creativity - in fact better on many measures than any other nation. She bases these assertions partly on her own observations but more on a paper by Keith Baker, a retired researcher at the US Department of Education, entitled Are International Tests Worth Anything?.
Baker’s  paper begins with his main conclusion: “...for the top dozen or so most-advanced nations in the world, standings in the league tables of international tests are worthless.”  He then goes onto analyse how well the First International Comparison Study (FIMS) - administered in 1964 to 12-year-olds in 11 countries - predicted national success in the first decade of the 21st century. [1] That he focuses his analysis on the US should not concern us unduly since of the eleven country participants in the 1964 FIMS, US students came second last, just ahead of Sweden.
Politicans wringing their hands (or gloating) over their nation’s PISA performance tend to think in simple terms of economic growth. Baker goes both deeper and wider. His measurements cover Wealth Creation, GDP growth, Productivity, Quality of Life, Democracy, and Creativity; and his results do not simply cast doubt on the validity of international comparisons of student performance, they are in some cases, starkly counterintuitive. He demonstrates convincingly, for example, that “the higher a nation’s test score 40 years ago, the worse its subsequent economic performance”.
In an analysis of a more recent PISA exercise incorporating 27 countries,  Bakers reaches similar conclusions :”...the nations that scored at the PISA average generally outperformed those scoring above or below average….   Mediocre test scores correlate with better, more successful countries than do top scores (or lower scores)”.
Rather than worrying about PISA, Baker argues, policy-makers would to better to concern themselves with issues that UK readers might recognise:  “run-down schools in the nation’s inner cites, misdirected parental interference in schools, …. the lack of parental and administrative support for teachers.” ...and assisting students to pursue the dreams and ambitions that really matter: life, liberty and the pursuit of happiness.[2]
Cambridge economist Ha-Joon Chang comes to a remarkably similar conclusion about education in his entertaining “23 things they don’t tell you about capitalism”.  In Thing 17,  subtitled “More education in itself is not going to make a country richer,”  Chang provides a plethora of examples to illustrate the point. Education is valuable, he maintains, not for raising productivity or GDP, but  for helping us to “...develop our potentials for living a fulfilling and independent life.”
The table below offers a comparison of selected countries by PISA score,  Nobel prizes (as a simple proxy for intellectual creativity) and GDP per capita. In the first of the two Nobel columns, I have counted solely Nobel prizes awarded since the beginning of the century so as to allow for the recent developmental advances that have occurred in the Far East.  The second column accounts for all Nobel prizes as a proportion of each country’s population. Israel and Finland are included on account of their reputation for educational quality.

Clearly the countries with the worst PISA scores are those with the most impressive  Nobel record. Equally significant, the correlation between PISA performance and GDP per capita is, as both Baker and Chang suggest, rather weak (less than 0.5).  Admittedly, the GDP comparison does not allow for a dynamic element of growth; but it does suggest the enormous distance China still has to travel in order to achieve a GDP per capita level similar to that of the “developed” world. Rather than fearing China’s progress we should be urging her on as well as applauding the achievements of countries like Korea and Taiwan that, in economic terms at least, have already reached the promised land.
Education Secretary Michael Gove has given no sign that he might be aware of the ambiguities inherent in PISA comparisons. What he has evidenced repeatedly - as Seamus Milne outlines in a corruscating critique - is a remarkable degree of political incompetence allied to an uncritical belief in his own genius, characteristics that would make him a figure of fun were his role in public life less important. On hearing him speak, I find myself irresistibly drawn to the thought that he might be an incarnation of Thomas Gradgrind, Dickens’ teeth-grinding, flint-hearted headmaster, for whom all that matters in life are “facts and calculations.”  Gove’s own words suggest he would probably welcome the likeness. Were he alive, would Dickens despair at this re-emergence in the flesh of what he had satirised on the page?
We should not be surprised then that Gove interprets the PISA results as indicating national failure. Rather, he gives the impression of relishing what he considers to be evidence of our scholarly mediocrity because it provides ammunition for his assault on two of his pet hatreds: state education and the Labour Party. Naturally, in the Education Secretary’s smug universe, the excellence of teachers, which he is ever quick to note for fear of an unwelcome riposte from the profession, is entirely a consequence of Tory (meaning his) policies, whereas our PISA results are a product of Labour ineptitude.
Among the current crop of parliamentarians, Gove is far from alone in preferring facile opinion to critical thinking. Today’s politicians would doubtless all claim to be well educated. Yet  in the matter of PISA, as in so many other matters, most display a remarkable lack of curiosity about the data they are fed. What might cause us to doubt the quality of our educational system  is their apparent inability to apply their minds to anything not addressed in their Party instructional manual. If at some stage they were trained to think for themselves, they seem to have deposited that faculty at the door of Party Central Office - hoping perhaps to pick it up when they retire and not realising that brainpower left in storage tends to atrophy for lack of exercise.
“In science,” Einstein once remarked, “Imagination is more important than knowledge.” [3] Gove and many of his fellow parliamentarians appear to believe the opposite. Readers may judge which of the two is more likely to be right.

[1] He justifies the choice of decade  on the grounds that  “Today’s world is largely a world created and operated by the now 55-year-old FIMS generation”
[2] It is worth emphasizing that Baker does not claim (and nor do I) that educational standards and scores within nations are not valid and useful.
[3] Interview with George Sylvester Viereck, Saturday Evening Post, October 26, 1929

Moorfield and the NHS

A year ago I developed an unsightly lump on my left eyelid. At first, I thought it was a stye but when, after a month, it was still in place I consulted my doctor. He told me it was a chalazion cyst caused by a blocked tear gland, could last as long as six months but required no treatment. It lasted seven. Two months later it re-emerged in the same place, larger than ever and this time with a slight but discomforting addition of pain and blurred vision.
Further back in time, when I was living in Mexico, I was a regular dinner guest at my girlfriend’s family home. Other guests would often be present, one of whom, an elderly uncle, had a habit of launching on one of a seemingly infinite store of anecdotes with the phrase “Cuando yo mataba a la gente…” which roughly translates as “In the days when I used to kill people…” It took me a few dinners to inquire - nervously and in the uncle’s absence - whether I had correctly understood the meaning of such an alarming prolegomenon. When the initial burst of laughter had given way to appropriate sobriety, I received an explanation.  Uncle Luis had been a doctor but had ceased to practice while still a young man because his beloved wife had fallen seriously ill and he had been unable to save her. He had thereby concluded that doctors do more harm than good and people should stay away from them - a view that Moliere the great satirist of the medical profession might well have approved.
It is perhaps under these twin influences - the one literary the other experiential - that I have tried to steer clear of serious engagement with doctors, and though  my efforts have not always been successful, I am only too happy to find reasons for ignoring their counsel or simply not seeking it. Armed thus with my doctor’s original advice, namely to wait it out, I opted this time not even to bother him with a visit. I would simply do nothing.
So matters would have remained had an old friend who had suffered a similar problem not advised me to pay a visit to London’s Moorfield Eye Hospital.
“They cured me in no time, “ she said, adding by way of reassurance for my pocket that Moorfield is NHS and I wouldn’t have to pay.
At first I demurred on the grounds that I would have to get a referral from my doctor and then wait for months for an appointment.
“No, you just walk in.”
“?”
“You might have to wait, but they’ll see you for sure.”
My partner  plus a couple of other friends were listening to this conversation and now, with one voice, they urged me to seek treatment. What after all had I got to lose?
My reluctant answer: nothing very much.
So I followed the advice and, one Friday morning last September, walked into Moorfield Eye Hospital unannounced. To my surprise, the receptionist treated my sudden appearance as perfectly normal and directed me to the out-patient’s department where, after a ten-minute delay, my details and the purpose of my visit were noted and I was directed to an adjacent waiting area where some twenty others were already seated. I had brought the Penguin edition of Boethius to console me during what I was sure would be a near eternity of enforced faineancy, but had barely had time to read through the opening verses  of Book 1 before being interrupted by a nurse who bore me away for a preliminary assessment of my state of health. Then came a second period of waiting in a different area, before I was once again led away, this time, for an eye test. Third and fourth episodes of waiting and examination followed - each in a different location of the out-patients’ department whose layout is sufficiently bewildering to dispel any confidence the uninitiated might entertain about their navigational skills. This first visit lasted for about four hours, long enough for my sense of direction to abandon me entirely so that, despite a respectable amount of signage, I had to ask for directions to the exit. Nevertheless,  when I finally made my way out, I carried with me, in addition to  the news that I would need minor surgery, a brace of appointments, the first for a preliminary medical check-up, and the second for the main event.
The last of these took place a few hours ago and I am now  seated before the computer, minus an unpleasant cyst and with a very large patch over one eye, held in place by numerous lengths of white tape which I am instructed not to remove until the morrow. En route home, I felt like the very incarnation of Dickens infamous headmaster of Dotheboys Hall  because,  in addition to having only one (visible) eye, the blank side of my face was much wrinkled and patched up, which gave me a very sinister appearance, especially when I smiled.
None of that matters, of course.
What does matter is that the manner in which all the staff of Moorfield Eye Hospital dealt with me could not, in my view, be bettered. The organization works not so much like a well-oiled machine - for machines are impersonal  and can offer no tenderness or humour, still less awareness of pain - as the epitome of what one imagines a hospital should be: a place where skill, compassion and efficiency combine in the service of the people. This is the same, magnificent NHS that is odiously hounded by the right-wing gutter-press and repeatedly traduced by Tories bent on breaking it up and delivering the pieces to private profiteers. Both have seized with delight on the problems at Stafford Hospital, thereby fostering the patently false idea that it represents the NHS as a whole. By contrast, when it comes to awarding fat contracts to the private sector, our coalition government studiously avoids drawing a generally adverse conclusion about  the likes of G4S and Serco, companies under scrutiny for over-charging the government and false accounting.
Before embarking on my recent brief experience of the NHS at Moorfield, I harboured no small degree of scepticism, if not about the level of expertise, then certainly about the waiting times, bureaucracy and quality of patient-care I would encounter. Instead,  I have come away proud and grateful to live in a country capable of offering such exemplary service to someone who, literally, walks in off the street. In a world that continues to be driven by crass neo-liberal values, NHS is something rare and precious. We must do all we can to keep it; and if, by the next election, it has been largely sold off, then we must fight to take it back.

First published by Open Democracy.

A Foreign Tongue?

http://www.opendemocracy.net/jeremy-fox/human-compassion-in-foreign-lingo

Imperialism without clothes

David Cameron “gets it”. He respects the will of parliament and the views of the public at large. There will, therefore be no UK involvement in military action against the Syrian regime.
On the other hand, word from Downing Street has it that Ed Milliband is a “copper–bottomed shit”; and from Michael Gove that the Tory and Lib-Dem rebels are “ a disgrace” Evidently, the will of parliament is not so worthy of respect as the prime minister pretends. As usual, the nastiest and loudest vitriol comes from the Right.
Such childish tantrums are, perhaps, what we must expect from the callow young people who rule over us, most of whom have long since grown accustomed to getting their own way. So accustomed, in fact, that on recalling parliament a couple of days early the prime minister took it for granted that the governing Coalition - and possibly Labour too - would give him the licence he sought to pursue the course of war.
When Tony Blair got to his feet in parliament for a similar purpose ten years ago, he at least felt it necessary to offer a compelling case. His speech, however deceiving in content, was nonetheless a tour-de-force of rhetorical virtuosity. Cameron’s, by contrast was numbingly pedestrian, loud and clear-voiced to be sure but strong on bombast and sonorous outrage, flimsy of content and devoid of any genuine direction by moral compass. Milliband’s response, though less fluent (he has a distressing tendency to repeat words and even whole phrases as if he is not sure whether anyone is listening) at least offered a semblance of coherent thought as well as political awareness of the desirability of learning from the UN weapons inspectors. He was, of course, correct in saying that the recall of parliament could only have been to obtain immediate approval for military action.
The interplay between the Coalition and Labour offered a depressing reminder of the bovine partisanship of our parliamentarians.  Commentators have noted that the government motion and the opposition amendment  were not so different in purpose and content as to be irreconcilable.  Gripped by mutual antagonism, however, nothing - least of all the “national interest” -  would have induced either to vote for the other. As a consequence, both motions flopped. But it is worth noting that had the Tories held their collective nose and approved the Labour amendment, we would now be holding hands with Obama and Hollande and readying ourselves for another perillous Middle-East adventure.
Much hand-wringing has followed the negative vote.  Are we no longer prepared to intervene wherever wrong-doing occurs?  Are we retreating into isolationism? Is the “special relationship” at an end? What if the master casts his unprofitable servant into outer darkness? Well, a mere decade ago, the French were “cheese-eating surrender monkeys”, “French fries” had become “freedom fries”, and France formed part of the “axis of weasles”. Now "les grenouilles" are America's oldest ally. Redemption can come swiftly if nations make the right squeaks.
Following hard on the UK parliamentary negative,  John Kerry claimed that a large volume of material existed all pointing to the Assad regime as the perpetrator of the chemical weapons atrocity in Damascus.  Why didn’t Cameron offer up this evidence? Possibly because the State Department didn’t have any until Mr Kerry decided that it was needed. Who can forget Colin Powell’s embarrassing submission to the UN on Iraq’s WMD - his assembly of unverified accusations and grainy photographs that revealed nothing in particular? That, too, was incontrovertible evidence. In a BBC radio interview, one Tory spokesman offered an alternative explanation: that after the Iraq debacle, the British public no longer trust evidence provided by the government; although why he felt that we should have greater trust in the word of government ministers is a question similar to the one posed by the Carpenter to the Oysters after he and his pal the Walrus had consumed them: “...answer came there none -”.
The US President - no doubt with half an eye on what happened in the UK - opts to ask Congress whether to attack the Assad regime. He has power to act already but is understandably insecure both about the objective of military action, and whether he can carry public opinion.  The second is, of course, dependent on the first.  We know US intervention will not involve “boots on the ground”. Talk is of “punishment”, a “surgical strike” and lately of  “infrastructure degrading”. What would be the consequences? No one can say given this rather complex version of prisoner’s dilemma. The region is a notorious powder-keg with major powers like Russian, Iran and Israel in the mix.  For good reasons, no one articulates the aim in terms more definite than a handful of foggy abstractions.
Regime change, ruled out here as so often in the past, nevertheless has to be the only game worth playing. So it was in Iraq and in Libya. In the long run, Assad is doomed regardless of the outcome because, even in the unlikely event he were to win the civil war outright, he will become an international pariah. With the possible exception of Russia under Putin, the world community will not engage with him; and even Russia may tire of an association with someone so tainted by crime, so sullied by pursuit of an appalling civil war, and who sooner or later is bound to be replaced by a regime that will steer clear of involvement with an overt supporter of its predecessor. In other words, Putin’s support for Assad could, in the medium term, ensure that Russia loses its best ally in the region.
What of the imperialist fantasies of UK politicians? They appear still not to have caught up with the fact that we are now a medium-sized power with no money. The public understands this; understands that the government is savagely cutting public services, selling off whatever remains of publicly-owned assets, and making the poor pay for the greed and fecklessness of bankers. It is also slicing away at our military capability and making a wholesale mess of defence spending. Yet the inexperienced people who govern the country still think they can strut the world stage like 19th century  commanders of the empire, summoning gunboats to bend ignorant natives to the imperial will. With apologies to Shakespeare, we may picture Assad in the role of Barnadine on the day of his intended execution:
Assad:...I will not consent to die this day, that’s certain.
Coalition: Oh you must; and therefore we beseech you, Look forward on the journey you shall go.
Assad: I swear I will not die today for any man’s persuasion.
Coalition: But hear you…
Assad: Not  a word. If you have anything to say to me, come to my ward; for thence I will not today.
(Measure for Measure IV:iii)
What should we do? Provide aid to the refugees and support for the countries that harbour them. Leave the rest to the UN.