Authors: Jonathan Coe
‘17,000,000 over 5 years 12.3% of GDP 4% more than the EEC 35% up on the USSR 34,000 GPs for every HAS × 19.24 in real terms 9,586 for every FHSA seasonally adjusted 12,900,000 + 54.67 @ 19% incl VAT rising to 47% depending on IPR by the IHSM £4.52p NHS safe in our hands.’
In response to which, Dr Gillam said:
‘I don’t dispute the truth of your figures, but neither do I dispute the truth of what I see every day with my own eyes. And the problem is that these two truths contradict each other. Every day I see staff working longer hours, under greater stress, for less reward, and I see patients waiting a longer time, for worse treatment, under worse conditions. These are facts, I’m afraid. They can’t be argued away.’
And Winshaw’s second answer to Dr Gillam was:
‘16%! 16.5%! Rising to 17.5% under a DMU with 54,000 extra for PAYE and SERPS! 64% PRP as promised in the CIPs and £38,000 = $45,000 + ¥93,000,000 divided by ✓451 to the power of 68.7 recurring! 45% IPR, 73% NUT, 85.999% CFC and 9½ weeks more than under the last Labour government.’
In response to which, Dr Gillam said:
‘My point really is that you can’t make the NHS more efficient by making it more geared to costs. If you do that, you’re effectively trimming its resources, because the NHS runs on goodwill, on the goodwill of its staff, and under the right conditions, this goodwill is potentially infinite. But if you continue to erode it, as you’re doing at the moment, and replace it with a finite range of financial incentives, then eventually you will end up with a more expensive NHS, a less efficient NHS, an NHS which is always going to be a millstone round the government’s neck.’
And Winshaw’s third and final answer to Dr Gillam was:
‘60 CMOs, 47 DHAs, 32 TQMs, 947 NAHATs, 96% over 4 years, 37.2. in 11 months, 78.224 × 295 ÷ 13¼ + 63.5374628374, leaving £89,000,000 for the DTI, the DMU, the DSS, the KLF, the ERM and the AEGWU’s NHSTA. 43% up, 64% down, 23.6% way over the top and 100–1 bar. And that’s all I have to say on the matter.’
After that, he left the studio with the victorious air of a man who has finally conquered the medium. And I suppose, in a way, that he had.
∗
October 6th 1987
At long last, another full meeting of the Review Board – the first since Margaret’s victory in June.
1
The first White Paper
2
is finished and work will be starting on a second and third.
3
The next reforms will be much further-reaching. We’re getting to the heart of the matter, at last. To remind everyone where our priorities lie, I’ve had a large notice pinned to the wall: it says
FREEDOM
COMPETITION
CHOICE
I’ve also decided to take a strong line with the word ‘hospital’. This word is no longer permitted at discussions: from now on, we call them ‘provider units’. This is because their sole purpose, in future, will be to provide services which will be
purchased
from them by Health Authorities and fundholding GPs through
negotiated contracts.
The hospital becomes a shop, the operation becomes a piece of merchandise, and normal business practices prevail: pile ’em high and sell ’em cheap. The beautiful simplicity of this idea astounds me.
Also on the agenda today was income generation. I see no reason at all why provider units shouldn’t impose car-parking charges, for instance, on visitors. Also, they should be encouraged to rent out their premises for retail developments. There’s no point in all those closed wards standing empty when they could be turned into shops selling flowers, or grapes, or all those other things people feel like buying when visiting a sick relative. Hamburgers, and so on. Little knick-knacks and souvenirs.
Towards the end of the meeting somebody brought up the subject of Quality Adjusted Life Years. This is one of my own personal favourites, I must say. The idea is that you take the cost of an operation and then calculate not just how many years’ life it saves, but what the
quality
of the life is. You simply put a figure on it. Then you can work out the cost-effectiveness of each operation: and so something basic like a hip replacement will come out at around £700 per QALY, while a heart transplant is more like £5,000 and a full hospital haemodialysis will cost a cool £14,000 per QALY.
I’ve been arguing it all my life: quality is quantifiable!
Most of the Board, nevertheless, don’t think the public is ready for this concept just yet, and they may be right. But it can’t be long now. We’re all feeling tremendously buoyant after the election result. The sell-offs have been proceeding at an amazing rate – Aerospace, Sealink, Vickers shipyards, British Gas last year, British Airways in May. Surely the day for the NHS can’t be far off.
Such a shame Lawrence never lived to see it happen. But I shall do his memory proud.
We must never forget that we owe it all to Margaret. If ambition turns to reality, it will be thanks to her, and her alone. She is magnificent, unstoppable. I’ve never known such resolution in a woman, such backbone. She cuts her opponents down as if they were so many weeds blocking her path. Knocks them aside with a flick of her finger. She looked so beautiful in victory. How can I ever repay her – how can any of us even begin to repay her – for all that she’s done?
November 18th 1990
The call came through at about 9 p.m. Nothing had been decided yet, but they were starting to canvass opinion among the faithful. I was one of the first to be asked. The poll findings are grim: she gets more and more unpopular. In fact it’s gone beyond unpopularity, now. The plain truth of the matter is that with Margaret as leader, the party is unelectable.
‘Dump the bitch,’ I said. ‘And fast.’
Nothing must be allowed to stop us.
1
October 1990
1
‘The fact is,’ said Fiona, ‘that I don’t really trust my GP. From what I can see, most of his energy these days goes into balancing his budget and trying to keep his costs down. I didn’t get the sense that I was being taken very seriously.’
I did my best to concentrate while she was telling me this, but couldn’t help keeping a watchful eye on the other diners as the restaurant started to fill up. It was beginning to dawn on me that I was underdressed. Hardly any of the men were wearing ties, but everything about their clothes looked expensive, and Fiona herself seemed to have been much more successful in judging the mood: she wore a collarless, herringbone-patterned jacket over a black cotton T-shirt, and cream linen trousers, cut a little bit short to show off her ankles. I hoped she hadn’t noticed the worn patches on my jeans, or the chocolate stains which had been ingrained on my jumper for longer than I cared to remember.
‘I mean, it’s not as if I’m some flappy little thing who comes running into his surgery every time I get a cold,’ she continued. ‘And this has been going on for nearly two months now, this flu or whatever it is. I can’t just keep taking days off work all the time.’
‘Well, Saturday’s probably his busiest day. He was bound to be rushed.’
‘I think I deserved more than just a pat on the head and a few antibiotics, that’s all.’ She bit into a prawn cracker and sipped some wine: an attempt, it seemed, to wash the irritation away. ‘Anyway.’ She looked up and smiled. ‘Anyway, this is very nice of you, Michael. Very nice, and quite unexpected.’
If there was an irony intended, it managed to pass me by. I still couldn’t quite get over my amazement at the thought that I was actually sitting with another person – a woman, no less – at a table for two in a restaurant. I suppose part of me, the most vocal and persuasive part, had simply given up believing that such a thing might happen: and yet it could hardly have been easier to accomplish. I’d spent the previous evening slumped in front of the television, almost mad with boredom even though my intentions had been admirable enough. Over the last few years I’d accumulated a pile of unwatched videos, and it had been my hope that this time I’d find the stamina to get through at least one of them. But it seemed that optimism had got the better of me again. I watched the first half of Cocteau’s
Orphée,
the first thirty minutes of Ray’s
Pather Panchali,
the first ten minutes of Mizoguchi’s
Ugetsu Monogatari,
the opening credits of Tarkovsky’s
Solaris
and the trailers at the beginning of Wenders’
The American Friend.
After that I gave up, and sat in front of a silent screen, steadily making my way down a bottle of supermarket wine. This continued until about two o’clock in the morning. In the old days I would have just poured myself a final glass and gone to bed, but now I realized that this wasn’t good enough. Fiona had called by a couple of hours earlier and I hadn’t even answered when she knocked; she would have seen the light under my door and must have known that I was ignoring her. And now suddenly, sitting by myself with only the television’s dumb flickering to combat the darkness, it seemed ridiculous to me that I should prefer these blank, unresponsive images to the company of an attractive and intelligent woman. It was anger, above all, which drove me to perform an impetuous and selfish act. I went directly on to the landing and rang the bell to Fiona’s flat.
She answered after a minute or two, wearing a light, Japanese-style dressing-gown. An expanse of freckled breastbone was exposed, sheened thinly with sweat although I for one thought the temperature had dropped quite sharply this evening.
‘Michael?’ she said.
‘I’ve been really unfriendly these last few weeks,’ I blurted out. ‘I came to apologize.’
She looked puzzled, of course, but managed to take it in her stride.
‘That’s not necessary.’
‘There are some things – possibly there are some things you ought to know about me,’ I said. ‘Things I’d like to tell you.’
‘Well, that’s wonderful, Michael. I certainly look forward to that.’ She was humouring me, I could tell. ‘But it is the middle of the night.’
‘I didn’t mean now. I thought maybe … over dinner.’
That seemed to surprise her more than anything. ‘Are you asking me out?’
‘I suppose I am.’
‘When?’
‘Tomorrow night?’
‘OK. Where?’
This put me in a corner, because I only knew one local restaurant and didn’t want to go back there. But there wasn’t much choice.
‘The Mandarin? Nine o’clock?’
‘I look forward to it.’
‘Fine: well, we could either get a taxi from here, say ten minutes beforehand, or actually it’s not very far to walk, and then we could maybe stop on the way …’
I realized that I was talking to a closed door, and went back to my flat.
Now Fiona was spreading plum sauce over a pancake with the back of her spoon, and filling it with thin strips of duck and cucumber. Her fingers worked neatly.
‘So, Michael, what are these revelations about yourself that you’ve been bursting to tell me? I’m agog.’
I smiled. I had been nervous all day, thinking how peculiar it would be to share a meal with someone again, but now I was beginning to feel quietly euphoric. ‘There are no revelations,’ I said.
‘So last night – that was just a subtle way of getting to see me in my dressing-gown, was it?’
‘It was just an impulse, that’s all. It had only just occurred to me how strange my behaviour must seem. You know – the way I keep myself to myself, how I barely answer you sometimes, all the time I spend watching things on the television: you must wonder what on earth’s going on.’
‘Not really,’ said Fiona, biting into her folded pancake. ‘You’re hiding from the world because it frightens you. I frighten you. You’ve probably never learned to form real relationships with people. Did you think I wouldn’t be able to see that?’
Wrongfooted, I tried to bite into my pancake, but I hadn’t folded it properly and the contents spilled out just as I was about to put it into my mouth.
‘You have to work at these things, that’s the point,’ said Fiona. ‘If it’s depression we’re talking about then let me tell you, I’ve been there. But, you know … Take that bike ride I went on the other week. Agony, it was. Complete bloody agony. But at least I met some people, went for a drink afterwards, got a couple of dinner invitations out of it. It may not sound like very much, but after a while you realize … there’s nothing worse than being on your own. Nothing.’ She sat back and wiped her fingers on her napkin. ‘Well, it’s just a thought. Perhaps we shouldn’t get heavy this early in the evening.’
I wiped my fingers too. Huge amounts of plum sauce seemed to come off and smudge the napkin with great brown patches.
‘You made a good choice here,’ said Fiona, glancing around the restaurant. It had a comfortable atmosphere, somehow intimate and convivial at the same time. ‘Have you been here before?’
‘No, no. I just read about it somewhere.’
But this, of course, was a lie, since we were in the very place where my mother and I had had the last, explosive argument from which our relationship was yet to recover. I had vowed never to come back here, fearing that someone on the staff might recognize me and make some embarrassing reference – for we had created quite a scene at the time – but now, finding myself both calmed and exhilarated by Fiona’s company, this anxiety seemed preposterous. It was after all one of the most popular restaurants in the area, and when I thought of all the thousands of customers who must have come and gone during the last two or three years … Really, I was flattering myself to suppose that anybody might have found the incident at all memorable.
A waiter came to clear our plates. ‘Good evening, sir,’ he said with a slight bow. ‘How nice that you come back again after all this time. Your mother is well?’
I sat speechless for a while after he had gone, unable to meet Fiona’s eyes which were laughing even as her mouth remained politely quizzical. Then I admitted: ‘Well, yes, I did come here with my mother once. We had a terrible row and … well, it’s not something I really wanted to talk about.’