LOOKING BACK IN ANGER AND GRATITUDE

Looking Back in Anger and Gratitude 

Cyril Taylor 1921-2000

This was written on June 1st 2019. During the previous week a number of news  items caught my attention. 

First of all there was a BBC Panorama programme waiting on my IPlayer  “watch list”. It was entitled GPs: Why Can’t I Get an Appointment? The programme was filmed in a health centre where staff were battling against closure, overwork, privatisation; in short the wholesale devaluation of  entire neighbourhood and its the health care needs. The BBC explained

The NHS is seeing the first sustained fall in GP numbers in the UK for 50 years, the BBC can reveal.The number of GPs per 100,000 people has fallen from nearly 65 in 2014 to 60 last year, analysis by the Nuffield Trust for the BBC shows.The last time numbers fell like this was in the late 1960s and it comes at a time when the population is ageing and demands on GPs are rising. Patient groups said it was causing real difficulties in making appointments.

“Real difficulties” is a massive understatement “real distress” is far more appropriate to characterize the sufferings of children, elderly, parents, workers -as they encounter a chronically underfunded, dysfunctional, system -even to get an urgent appointment. Distress also best describes the strain on all staff -receptionists, nurses, doctors- as they battle to provide a service despite the odds. Conditions are so demanding in such places, medical professionals so exhausted, secondary referrals so exasperatingly delayed that recruiting younger staff to work such decaying, compromised, institutions is becoming untenable. Fearing for health and sanity, younger health workers of all sorts prefer to work under less toxic conditions. 

in-sourcing liverpool

 A second item of news in the Guardian was, by contrast, more up beat. A recent report from The Association for Public Service Excellence had noted how many councils (including Liverpool, pictured above) are increasingly providing their own services, rather than relying on an increasingly outmoded, dangerous, and cranky model of tendering and outsourcing. This optimistic recipe promising excellence in service, economy in cost, has -apparantly- proved to be an illusion. Paradoxically it was the enforcement of this relentless austerity culture, that gave impetus to the reversal. As the chair of the report said:

In an age of austerity, councils can no longer afford outsourcing failures. Most can deliver quality services at a better price and without sacrificing the workforce on the altar of the lowest bidder

Now councils in Islington, Stoke, and Liverpool -to name but a few- have discovered that in-sourcing improves services, brings economic benefits, as well as producing more fulfilled -and less stressed- workers. The people of Liverpool -where I live- recently witnessed failures of outsourcing and privatisation on a massive scale. The new city-centre hospital was due to be opened some time ago. Thanks to the abysmal collapse of the outsourcing firm Carillion, its opening was delayed -despite the building  being 80 percent ready for immediate use. 

the not-yet-opened new hospital Liverpool city centre

Previous delays -one could say outsourcing disasters- in its construction (involving asbestos, creaky foundations, cracks in concrete, failures in weather proofing, inadequate and improper cladding) were being rectified. But then Carillon failed and the project halted. The British Broadcasting Association announced additional structural flaws in its news services of June 10th 2019. Apparently three of the original eleven floors were proven dangerous and not strong enough to cope with machines, patients, staff, or visitors. This "highly complex" structural deficit now requires more than 220 cubic metres of new concrete and a further 165 tonnes of new fabricated steelwork. A recent freedom of information request by the Liverpool Echo related to costs incurred by the empty hospital.  Between July and December 2018 taxpayers paid over three million pounds for the grotesque structure.  During January 2019 a further £523,000.00p had to be paid to keep it closed for that month alone with a recurring monthly electricity bill at over £100,00.00p. The Echo wryly noted that £523,000 would pay for  an extra163 fully qualified nurses per annum.

The legal, financial, and architectural messes caused by this abysmal failure of public finance initiatives is still being sorted out. Meanwhile patients and staff have to endure a dilapidated building with corridors that flood, surgical rooms that leak, equipment which malfunctions due to failures in wiring and plumbing. The merseyside MP Frank Field gave a pithy comment on the fiasco by labelling the public initiative project that financed the New Royal Hospital  as a monument to greed. Thank goodness for the new insourcing culture!

A final -and distressing news item- concerns allegations of anti-semitism in the UK Labour Party that have been accumulating in recent years. Like drips in the old royal hospital they are reaching flood proportions. Today, June 1st 2019, the UK Times reports

A member of Labour’s ruling body has been suspended after saying that Israel was to blame for the party’s antisemitism crisis. Peter Willsman, who was re-elected to Labour’s national executive committee (NEC) by party members last summer, said that the rows over antisemitism were “all lies”. 

He claimed that rabbis who had criticised the party were “obviously organised” by Israel and that party staff worked for the Israeli embassy. These remarks were allegedly made in America earlier this year to a man planning to write a history of Britain. The interview was recorded and is now the property of LBC. According to the Times newspaper article, Mr Willsman is also claimed to have said something equally outrageous last year …… namely that Jewish Trump fanatics were manufacturing claims of antisemitism. All this, following in the wake of more recent incidents, involving both groups and individuals, forced the deputy leader of Labour to admit "how serious the problem of antisemitism is in our party`".

Game, Set, and Match to Cyril Taylor

Dr Cyril Taylor was born in the merseyside town of New Brigthon which for many decades of the twentieth century was the holiday alternative to Blackpool for those families who could not afford the more expensive Flyde resort. His family was Orthodox surnamed Zadesky. Taylor was used later in order to make life easier for his dad’s clients who was, in fact, a taylor.
The  future doctor was educated at a local grammar school, then at Liverpool University where he studied medicine. During the war of 1940-1945, as an army medic he eventually became an officer in charge of a hospital in Khartoum. He enjoyed playing rugby and did so until he was forty. Later tennis became his passion

Though certainly an officer, it would be misleading to use the traditional epithet “and a gentleman”. Cyril was certainly a highly social being, kind, generous, and fun, but he was always something of a radical, fighter for justice, and interrogator of hierarchies. His earliest political involvements were with the Federation of Zionist Youth and later the Communist Party. A keen member of the  Socialist Medical Association, Taylor became active in promoting health service unions and  became a city councillor in 1966. 

One of his great contributions to the United Kingdom was his spearheading the notion of primary care health centres staffed by interdisciplinary teams. General practitioners, particularly in inner-city areas- were more often than not single-male businesses with sadly limited resources in knowledge, technology, pharmacology. Once a young doctor started work in such inner-city areas, he was often there until death. An amazing commitment, alas- more often than not marred by weariness, alcoholism, and condescension. None of this was acceptable to Taylor. 

The Labour Prime Minster, Harold WIlson, represented the Merseyside constituency of Huyton. When in 1975 Wilson established a Royal Commission on the National Health Service, Cyril Taylor was one of the members whose job it was to discover the best use and management of the financial and manpower resources of the NHS.  Cyril’s invention of the modern health centre spread quickly throughout the United Kingdom. His own vision, ideals, and commitment was incarnated in the great love of his life Princes Park Health Centre in Toxteth, Liverpool 8. There he established not just a medical centre, but a dedicated community of health workers devoted to their neighbourhood and the best possible medical practice. 

When I went to work at Princes Park some thirty years ago, Cyril had just retired but made regular appearances as a locum. As well as doctors and nurses, the health centre had clinics for men, women, post and ante-natal care facilities. There were health visitors, physiotherapists,  social workers, and advice clinics to deal with housing, benefits, legal rights. The local psychiatrist had a weekly clinic too -supported by a variety of counsellors, psychotherapists, and psychologists. This was an incredible achievement and its documentary history is now being collated, stored, and commemorated. Hopefully some source of funding can be mustered to record oral histories before former staff and patients die.

The question I ask myself is this: why did Princes Park Health Centre not continue to flourish after such auspicious beginnings and celebrated achievements?  There are many factors which come to mind; but I can only select those which seem important to me.

First of all the beginnings of privatisation -and along with that the correlative demands required for an internal market: tendering, bids, and outsourcings of the sort mentioned above. This trend began with a conservative government, but intensified under Labour. Health care provision was becoming not so much a lottery -as an auction. It was near impossible for just one local institution -albeit a feisty one- to withstand this massive thrust to “marketization”  with the consequent pressures for large-scale purchasing and rationing. It was my impression that the health centre was at times run on deficit financing;  that would become increasingly censured by a new health market as highly irresponsible. Though entrepreneurs eventually bought the centre, it was never going to be a profitable undertaking and services there became highly compromised for a time. Now they have greatly improved again.

Secondly, Princes Park Health centre depended upon massive commitment  from all its staff. Cyril, his colleagues, and immediate successors were driven by a vision. The present buildings were on the sight of a redundant Anglican Church in Bentley Road, closed for worship in 1972. Neither Princes Park Health Centre nor Cyril had much time for religion, but  running it demanded dedication, commitment, hard work, and a sort of faith. This faith -and perhaps hope- could sustain and encourage workers in a friendly environment. It could not survive the pressures of the market nor easily attract a new generation of workers who increasingly did not share such values.

A final thought is this. Taylor’s pioneer health centre was a very local undertaking. Cyril himself had been a city counsellor and the health centre had massive political support from the neighbouring community, city council, and health authorities. It was not just a place for dispensing treatments. Rather it was a socio-political hub fully involved with the hopes, fears, longings, and anger of its community. A historical paradox for me is that it was a socialist government that began relentless attacks localism -albeit under the auspices of some noble-sounding economic and social progrom. National minimal standards are indeed important and necessary;  but not when they impose a boring managerial minimalism on all. 

Some deeds of Blair years still make me angry. As far as mental health is concerned a new objective was dictated by central government eventually enforced by a swelling number of health bureaucrats and apparatchiks insisting on minimal care -and that only- everywhere. That objective was happiness. 

No longer was it acceptable for counsellors, nurses, psychologists, help ease and give voice to distress whenever possible. Now they had to promote happiness. This depression project was a sinister manipulation geared to masking real distress caused by the quickening pace of “liberal capitalism”  and privatisation in all areas of social and civic life including health. The absurdity -and delusion- of the project became ever more apparent as this current age of austerity relentlessly  pulverised all services including heath. Now austerity has become normalized. This was confirmed in a United Nations report claiming UK poverty to be both systematic and tragic. In a unbelievable BBC Newsnight interview, Mr Hammond, finance minister of the dying Teresea May government, was keen to  proclaim his legacy. He completely rejected the view that millions of UK citizens lived in poverty despite food banks, rough sleeping, increased child poverty, and so forth

CBT does not make happy workers or happy, grateful patients. Even more so in an era of enforced austerity. Threatening sick and distressed people, already living on basic benefits, with a magic and moralistic mantra- employment and compulsory therapy OR cessation of benefits- is a cruel manipulation reminiscent of the tortures of the inquisition. Equally abhorrent to me is the suggestion that depression, anxiety, or strain in workplaces can easily be remedied by a simple cognitive techniques that will automatically promote both individual and mass happiness. Even Marie Antoinette could not have dreamt that one up.

Marx once claimed religion was opium for the masses. Now it is becoming psychological therapy along the frightening amount of “pain killers” being consumed whether dispensed by the NHS or purchased directly from China on the web.

Dr. Taylor and his achievements engender a deep sense gratitude for a very special period of medical and social history. There is also hope. The project of marketisation has utterly failed. Already are the beginnings of new forms for financing and providing essential services that are sensitive to the needs of communties.  It would be naively stupid to suggest insourcing is the big answer to ensure equitable balances between need, provision, finance, and accountability. There is probably no one big answer, but maybe many small ones. As well as insourcing,  another new trend is the growth of buyers-coops to lobby for -and obtain- medicines which national rationing refuses to support. Another part answer might be to extend policies that actually work such as the Healthy Start scheme. Honesty about  mental health gaols, outcomes, state of knowledge, provisions, and treatments would also inject some honesty and realism into national debates. It is to be doubted, though, whether opening the entire NHS market to Trump grab and spin tactics will work. More likely it will utterly kill-off what remains of the steeply declining respect UK citizens have for their politics, which has been undermining of their heritage for decades. 

Cyril accomplished all his terrific deeds in a Labour Party at a time when having Jewish origins was no obstacle to achievement or membership.

 This too can happen once more.

 Dare to dream.

 Dare to act. 

Dare to change.

NOTES

Mr Hammond Chancellor denies dire poverty in UK https://www.bbc.co.uk/news/uk-politics-48503170

Costs of running a substandard empty hospital in Liverpool 2019 Liverpool Echo

https://www.liverpoolecho.co.uk/news/liverpool-news/revealed-unbelievable-cost-keeping-liverpools-16249133

Mark Fisher 2012 Why mental health is a political issue  https://www.theguardian.com/commentisfree/2012/jul/16/mental-health-political-issue

A remarkable topography of English pain was published in The Sunday Times on 24th February 2019 as OPIOID DEATHS BY REGION

C Simon Fisher 2019