There is no wealth but life

There seemed to be no chance of an ambulance so I phoned for a taxi. If I hadn’t been in so much pain and unable to think clearly I would have caught the train and then a bus. That’s how I usually travel. At the bottom of the street I live in there had been a three car crash. A crowd of people stood and stared. The taxi driver slowed down and we sneaked past hoping not to be caught up in the general incident.

The road out of town slides up across the down. The presence can be felt of the cliff top and then the plunge into the rocks and sea a couple of hundred feet below. A thick fog pressed into the ground. The bright lights of the car seemed to make it worse as if a wall of some immovable object confronted us. A line of large lorries coming towards us. There had been a serious crash earlier on the motorway. Lorries full of manufactured parts for just-in-time assembly processes, boxes of foodstuffs, drums of chemicals, packets of pharmaceuticals. One of the myths of Britain is that it’s a place which ‘no longer makes things’. It is in fact the ninth largest manufacturing state in the world. It is still a major producer of commodities and these late drivers are essential to their distribution.

The drivers stare out into the night, heading for the port, the sea-fog channel crossing, the glaring lights of the motorway from Calais that will take them to Krakow, Budapest, Prague, Graz, Berlin, Milan, Barcelona and a thousand industrial plants scattered in the darkened European countryside. The lorries are in continuous convoy, a conveyor belt of distribution that never ends. The domination of capital and the dynamic of its expansion, the exploitative social relations that make this possible and the creation of a depersonalised alienated state of the workers is all described in the early chapter’s of Marx’s Capital.

‘Blimey’, says the driver, ‘this fog is horrible’. I peer through the claustrophobia of the night. The driver is nervous, I’m nervous, there’s a nervous atmosphere in the confined space of plastic, glass and metal. Out of the gloom the red flashing lights of a police vehicle appears through the lightless, grey-wash world. The diversion takes us from the motorway into a narrow side road that appears to be heading towards a murder scene. The headlights create an obscure snow-white world in front of us. I am experiencing sharp shooting pains in my stomach. I just want to get out of the taxi and lie on the side of the road, in the still, quite and solitude of the night. We drive through one more patch of dense low level cloud and then the lights of the motorway suddenly appear again and we can see the headlights and red tail lights of the midnight traffic and the channel tunnel infrastructure.

Accident & Emergency appears to have been renamed the Urgent Treatment Centre. Or is that something else? I’m not sure if it’s the same place or two different places. The NHS is now surrounded by a toxic cloud of management consultancies, PR firms, marketing campaigns, brand guidelines. Meetings take place with powerpoint presentations and people charging high-cost day rates. There are dozens of management consultancies, thickly embroiled in extracting money from health care. A few days later I read through some of their websites. It is a depressing experience to read jargon laden puff.

‘We are united by the disruptive belief that better public services, reduce inequalities and lead to a stronger society. Our vision is to be the first choice for public service leaders seeking to deliver high impact change’.

‘Making Change Happen – Lasting and sustainable improvements’

‘We co-created a bold new design identity and key message framework’

‘in-depth Target Operating Model workshops’

‘A proactive solution to bed configurations: using simulation to challenge narratives’

All of the management consultancies claim to be ‘making efficiency savings’. The evidence they produce is their own. A independent academic report by Bristol University outlines that taken together these companies cost the NHS more than any ‘savings’ they might make.

In reality these companies are given political power and allowed to create the agendas, organise the meetings, write the minutes and make the decisions in relation to what hospitals and GPs surgeries can do. It is a ‘narrative’ which is funded by the health service to justify the interests of the private, commercial sector. The consultants parachute in, leave with big bags of money and the NHS seems little changed. I don’t notice any of these people being here at 3am while a large man sat in a wheelchair screaming in pain while his elderly parents try to soothe him and get a medial person to come to see him.

The management consultancies keep painting pictures of a bright white teeth, smiling patients, a pastel shaded room with fresh floors, but in reality a filth and rust covered cage descends upon England. The politicians who support all this become ever louder mouthpieces of profit making, self-serving interests. A right wing press that lies and lies and lies.

At ground level, covered with a thick ideological gruel, everything in daily life feels as if it declining. Crumbling infrastructure, overpriced and unreliable public transport, the rule on the streets by racing car-thugs, pavements dominated by the uninsured e-bikes of the gig economy, local authorities so battered down by Toryism and fear of the Daily Mail they no longer speak out politically, wrapping union flags around public buildings while libraries and youth centres close. A housing crisis which puts billions of pounds of housing benefit into the hands of private landlords for a low quality supply of housing with child-killing mould. A general social crisis which is ruining the physical and mental health of so many thousands upon thousands of people. Polluted air, polluted airwaves with the free licence of the alt-right on all media channels, raw sewage in the rivers, plastic particles in the sea.

A great contradictions develops. Between the lived-reality and the advertising, branding, websites, social media messages, parliamentary lobbying, pixelated images and language of privatisation which has seeped into all discussion about the civic. The words are louder, more colourful, surrounded by pleasant aromas.

The more grim the reality becomes, the greater the expenditure on amplifying the Spectacle. At some point will the tension force a break? A realisation that a revolution is needed against the image-object-reality that capital itself produces?

It is difficult to get any accurate figure as to how much the NHS spends on external management consultants.

It is known that the rates of ‘a senior consultant’ can exceed £2,000 a day. That’s more than some NHS staff will take home in a month. The strength of these organisations means their costs are hazy. While the amount spent on a cup of tea and biscuit for an elderly patient is calculated to the exact penny no-one in the government can explain how much money management consultancies are given, how that might be spent otherwise on front line health care and what their profits are.

We do know that many commercial organisations made significant profits during the Covid pandemic even when they failed to deliver or delivered faulty products. It is known that the £350 m promised by Alexander Johnson to the NHS was a lie as the promise of an extra 40 hospitals was a lie. More lies and lies and propaganda. All lies repeated by the right wing press. And the same people who vote for the Tories are the same people who read the Daily Mail and they are the same people who moan and gripe because public services don’t work.

Here in the early hours of the morning in the waiting room of A&E – or whatever it’s been rebranded as – everyone needs urgent or semi-urgent medical attention. Here on the front line of life and death and pain and body generated fear the lies don’t wash. Those pixelated images of the efficiency savings don’t make any sense. They have no reality, no content, no weight.

My blood pressure and temperature are taken. Paper bracelets with my name and date of birth are wrapped around each wrist. Time is now suspended. Before I left the house I had the presence of mind to put a book, phone, phone charger, notepad and pen into a bag. I was wary of chancing fate and deliberately did not pack anything for a longer stay.

In the time-less zone of the waiting room I read The Division Bell Mystery by Ellen Wilkinson, the socialist MP who was one of the leaders of the Jarrow March. I am lost in the goings-on inside the House of Commons in the 1930s and political intrigue and the puzzle of whodunnit. I become vaguely aware of my name being called. Yes, that’s me, but where is the voice coming from? It’s the omnipresent nurse-in-charge who is back at her workstation. She is wearing a dark blue uniform and has her black her tied up at the back. On the desk is a half eaten bag of Cheddars and a couple of hard boiled sweets. She goes through all the details with me again. She creates an atmosphere of sitting in a pub having a drink on a Saturday afternoon. It is relaxing, friendly and intimate and if there might be any medical drama to come, she has put me in a good place to deal with it. I explain my real and imagined medical conditions.

‘I get terrible palpitations sometimes’

‘And…’ she says, looking at me with eyes like a tin opener.

‘Well I had an ECG’

She raises an eyebrow which is a sign to continue with the truth, the whole truth and nothing but the truth.

‘Well, I never heard any more about it’

‘And you still get them?’

‘Sometimes. I need to go back to the doctor. In fact, it’s on my to do list’ (this is true, I wrote in my diary on Monday, ‘phone doctor’).

She looks incredulous and slightly shakes her head and mutters something like, ‘with something like your heart’, which has a question mark at the end.

She’s doing a lot of casual but critical observation while she asks the questions. Her manner is confident and assured and I implicitly trust her. I wonder if she has attended a workshop on this or it’s something that she had intuitively developed through practice, experience, her own reading, and thoughtful considerations. It is high quality interaction and for this she certainly does not get paid £2,000 a day. But she damn well should be and all those non-medical so-called experts with their pie-charts and Gantt charts and buzz words and management jargon should be swept out of our hospitals and never allowed back. That would be real disruptive thinking and I bet then we would see their real characters revealed.

I am waved back to my seat and pick up my book again. Some time later, it might be ten minutes or a thousand years in clock time, but in hospital time it’s just another moment of indeterminate length, a young man in a loose green tunic asks for me. I follow him through a labyrinth of corridors and for the first time I notice the shabby state of the building. The walls need painting, wires and things hang from the ceiling, black and yellow tape covers cracks and trip hazards on the floors. A few days ago I was in the reception area of One Cabot Place in Canary Wharf and noticed how smart and clean and well maintained it was.

We reach his workplace, a room full of medical equipment, computers, a bed-trolley, cupboards full of gloves and needles and plastic sample containers. He invites me to take a seat and cleans my arm with disinfectant to prepare for a blood test.

Our conversation is general and light and then I explain the strange car journey through the mist, the nervous driver, the police on the motorway, the diversion into forgotten rural roads and how I’ve just finished reading Green for Danger by Christianna Brand, another British Library Crime Classic. I explain that it was written in 1944 and is set in a hospital in Kent during the Blitz. There are seven members of staff, and one of them is a murderer…

‘You’ll feel a slight scratch’ he says, and puts the needle into my vein.

‘It sounds great’, he says, ‘I’ll look that up’.

‘It’s Green for Danger’ I repeat, ‘you’ll remember it because your uniform is green’.

Everyone should be asleep but instead we are all in the place with no time. Half-asleep, trying to sleep, sitting motionless or shuffling to try and pull together a little comfort. I am part of half a dozen people who are moved to a second waiting room deeper inside the hospital.

I select a seat in a corner which turns out to be a good choice. There is a couple on one side, a woman on her own on the other side and in front, an elderly woman with her daughter. We all slowly get to know each other and conversation begins to bubble up and then fade away. The daughter explains that the elderly woman is 94 and has been here since 5pm the previous day. By the time I leave she is still there, although just about to be released. At one point she was given a bed but a more urgent patient had to be put there and she was decanted, put back in a wheel chair and returned to our small group in the corner.

We exchange intimate life-story details in a way that only strangers can. It is always more comfortable to sit with unknown people when a few words have been spoken because everyone learns something of importance; that the people in close proximity are basically ok. We have some basic camaraderie and solidarity. Not easily captured on project plans and financial spreadsheets. When someone has to go to be seen by a doctor we all look after their things. When the tea trolley comes round we help each other clear up afterwards.

I have a drip attached to my arm and sit and watch the liquid slowly move, drop by drop. Flicking through the news feeds on my phone. There is a picture of medical worker in Gaza. Reports are coming through of medical workers, doctors, nurses being attacked inside hospitals by the Israeli Army. The world has already swallowed a cheap propaganda trick if it believes it as a ‘defence force’. The worker is sitting on rubble in his blue uniform. The badges of his hospital and medical red cross on the sleeve of his tunic. He looks as if he has no more tears to cry. It is not enough to kill the women and children and babies. Those who survive must be duly humiliated. The badges of his profession of care torn of their dignity and pride.

There is an imperceptible change from night to day which as it happens I don’t really notice. It’s only when a Filipino woman starts to sweep and mop the floor that I realise the day shift has replaced the night workers. There is more energy, more movement, the new staff, despite their early starts are fresher and more alert. A Sikh doctor comes to see me. My blood pressure and temperature are taken again. A sample has been lost so it must be re-taken. The Sikh doctor comes to see me again and invites me to follow him. He asks me to lie on a trolley bed and he pushes hard on my abdomen and generally prods me. He sends me off for a scan.

It’s too tiring to read now and I sit in the chair and make lists of towns and cities in my head to force me into sleep. First from England….Arundel, Aylesbury, Aylsham….Ashford…and once that’s done, I go through towns and cities in France, ….Dinan, Dinard, Dieppe, Dijon…..and then Germany….Köln, Koblenz, Kiel, Karlsruhe…it sends me off into a hallucinogenic sleep where it’s not clear what is the waking reality and what is the uncontrolled stream of fantasy images.

The doctor returns and I follow him to the consulting area. He has an authoritative, calming presence and explains the results of the scan and what the problem might possibly be. He gives me his time and attention and listens patiently to my questions. And we conclude with some radical statements about how the world might be changed for the better. Once I have collected a prescription medicine I can go.

The pharmacist is in the basement of the hospital and here I meet for the final time the daughter of the elderly woman. She has had a much greater ordeal than I have. But as with just about everyone I’ve spoken to there is no criticism of the staff but of the visible underfunding, the lack of resources, the state of the building. My prescription is ready, it’s time to leave.

I walk back up the stairs and through the neonatal area. A young woman wearing a headscarf comes bouncing through some double doors that are marked no entry to the public. She calls to a colleague who comes running over.

‘Xxxxx’ has just had her baby! And I delivered it!’

The two women hug and there is immense elation. The mid-wife cannot stop smiling.

And that’s infectious too, of the most welcome kind. I leave the hospital with a sense of something grand and great and life-affirming, and with the memory of some people-solidarity and the kindness and caring of the medical staff.

None of this is captured on the websites of the management consultants. And yet the £2,000 a day lot, for all there blather about disruption, lack the self-awareness to realise that far from them being the answer, they are part of an enormous problem. The primary reasons they exist is to act as agents to increase the exploitation of the workforce and to privatise what should be public. Along the way they help with union busting, wage suppression, increased work intensity and the creation of a great layer of meaningless, pointless and expensive bureaucracy of which they are a big part. Into what world do they draw into in their drunken hours? That welfare does nothing but corrupt the poor, that profit seeking is the main ambition?

You don’t need to be paid £2,000 a day to understand this. Just a heart in the right place, a sense of people before profit and that someone who does a good day’s work deserves to be well paid for that.

David Widgery describes all this and more in his book The National Health: A Radical Perspective. With great insight, suppressed fury and a call to arms it is as relevant today as it was when it was first published nearly 40 years.

All of the processes he describes have continued to worsen: privatisation, running down of health care, stupid government interference, demoralisation of health staff, attacks on trade unions, increasing relative poverty, a decline in a great many people’s health.

Once upon a time I sold Socialist Worker with Dave Widgery every Friday morning outside Old Street tube station in Hackney. Those were memorable times with the sort of free-thinking conversations that makes you aware of being alive. He always had a great vibrancy of ideas and infectious enthusiasm, optimism and curiosity. We need that today and a new type of socialist organisation that creates the conditions for the likes of Widgery and independent thinking socialists, oppositionists, radicals and Marxists to thrive.

In those early mornings we talked a lot about London history and dock workers and the health service and what all those office workers might do all day as they streamed past us on their way to the City. We sometimes sold a surprising number of papers. But we never managed to get to know those buyers. We were pushing at something and perhaps with better organisation and more lively content, laced with the ideas of everyday life, we might have pushed with more effect.

I can’t remember if we ever talked about John Ruskin but if we had, I think it’s fair to say we would have both agreed with this:

‘There is no wealth but life’.