How feminism and the quest for equality made so many nurses too grand to care
By Melanie Phillips
Back in 2001, when Tony Blair was Prime Minister, I was invited to talk to him about the National Health Service. At that time, he was particularly exercised about reforming the NHS. Sitting on the Downing Street sofa, I told him that the experience of my frail and elderly mother had left me shocked and aghast.
My mother, who suffered from multiple sclerosis and Parkinson’s disease, had been hospitalised after a fall had fractured her hip. What appalled me was the lack of nursing care she received.
Not only was she addressed discourteously, there was also precious little attempt to ease her acute discomfort or attend to her basic needs. Despite the fact that she could barely move at all in her bed, she was not helped into more comfortable positions.
Much worse, her food was left inaccessibly out of her reach. Had my father and I not been at hand to retrieve the situation, she would have gone hungry and thirsty. Worse still, she told me she was too frightened to say anything because she was certain the nurses were already punishing her for making ‘too much of a fuss’.
When I complained to the sister in charge, I was astounded to be told this was all nonsense because an hour earlier my mother had been ‘skipping round the ward’. Since she could barely walk even before she broke her hip, and now was patently immobilised, such a comment was a cruel and mocking lie.
When I told Mr Blair all this (and much more in similar vein), he seemed genuinely amazed and horrified. I told him that my family’s experiences had shattered my belief in the NHS — and that a significant part of the problem was that something had gone catastrophically wrong with nursing. In reply, he said I must not lose faith in the NHS, and that he would reform nursing and fix the problems.
Ten years down the line, that promise still has not been kept. Indeed, it would appear that things have got even worse. Last week, a devastating report detailing what can only be described as the widespread collapse of the ethic of nursing was produced by the Care Quality Commission.
This revealed that more than half of all hospitals in England do not meet standards for the dignity and nutrition of elderly people. One in five hospitals were found to be failing the elderly so badly that they were breaking the law.
In hospitals where essential standards were not met, inspectors found that patients’ call bells had been placed out of reach or were not responded to quickly enough, or staff were talking to patients in a condescending or dismissive way.
In one hospital, inspectors witnessed a patient being made to go to the lavatory in full view of the rest of the ward. In another, doctors had to prescribe water to make sure that patients did not become dehydrated.
These horrifying revelations do not signify merely incompetence nor — that perennial excuse — the effect of ‘the cuts’. No, they illustrate instead something infinitely grimmer: the replacement of altruism by indifference, and compassion by cruelty.
We’re looking here at nothing less than the crumbling of a sense of common humanity. And that is because nursing has been all but engulfed by a fundamental moral crisis. Nursing is not a job but a vocation. That means it is governed by a sense of duty to the patient, rather than any self-interest.
Of course, it must be said there are still many dedicated nurses caring magnificently for their patients. But, in general, the presumption of care has been systematically eroded — by modern feminism.
Nursing was effectively created by that 19th-century feminist pioneer, Florence Nightingale. To her, nursing was in essence a moral act. In her book Notes On Nursing, published in 1860, she wrote that ‘the greater part of nursing consists in preserving cleanliness’.
That wasn’t just because hygiene was essential for recovery and health. It was because keeping both hospital and patients clean meant the nurse needed to be motivated by the most high-minded concern for the care and dignity of the patient. Accordingly, lowly functions such as washing, dressing and administering bedpans were functions that were invested with the highest possible significance.
If a nurse declined to perform them because she was concerned about her own status, then nursing was not her calling, wrote Nightingale. That great soul must now be turning in her grave.
For during the Eighties, nursing underwent a revolution. Under the influence of feminist thinking, its leaders decided that ‘caring’ was demeaning because it meant that nurses — who were overwhelmingly women — were treated like skivvies by doctors, who were mostly men.
To achieve equality, therefore, nursing had to gain the same status as medicine. This directly contradicted an explicit warning given by Florence Nightingale that nurses should steer clear of the ‘jargon’ about the ‘rights’ of women ‘which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do’.
That prescient warning has been ignored by the modern nursing establishment. To achieve professional equality with doctors, nurse training was taken away from the hospitals and turned into an academic university subject.
Since caring for patients was demeaning to women, it could no longer be the cardinal principle of nursing. Instead, the primary goal became to realise the potential of the nurse to achieve equality with men. (The great irony is that more women than men are now training to be doctors in British medical schools, thus making this ideology out of date.)
In an important book on the nursing profession, Ann Bradshaw, a specialist in palliative care, described how this agenda removed caring, kindness, compassion and dedication from nurse training. Student nurses now studied sociology, politics, psychology, microbiology and management, and were assessed for their communication, management and analytical skills. ‘Specific clinical nursing skills were not mentioned,’ she wrote.
In short, nursing ditched its core vocation to care. Bedbaths and feeding those who are helpless are tasks vital to the care of patients — but are now considered beneath the dignity of too many nurses. Dame Joan Bakewell, the former government-appointed Voice of Older People, has suggested nurses be given ‘empathy training’. But, of course, you can’t train people in compassion.
Scandal after hospital scandal has alerted successive ministers to this desperate problem. Yet nothing is ever done. The least that should happen is for those hospitals that have broken the law in this way to be prosecuted.
The reason for this inertia is that the monopoly nature of the NHS turns patients — particularly the old — into helpless captives of the healthcare system. They are unable to exercise the one power that would instantly lever up standards — the power of choice.
Only if healthcare is rethought from first principles will the crisis in nursing finally be addressed — just as I told Tony Blair all those years ago.
Fury after NHS trusts start charging the disabled to use hospital car parks
Hospital bosses are sparking a storm of protest from patient watchdogs by introducing charges on the disabled to use their car parks. As cash-strapped NHS trusts struggle to balance their books, a growing number of hospital car parks have started charging blue badge holders for the first time.
Among the latest to abolish free parking for the disabled is Kidderminster Hospital, Worcestershire, and Southport and Ormskirk Hospital Trust in Merseyside will follow.
Up to now, badge holders normally parked for free while attending hospital appointments and visiting loved ones.
Hospital managers, who raked in more than £100 million in parking charges last year, say the move will raise much-needed extra revenue for patient care.
But patient watchdogs that claim hospitals are exploiting disabled patients and visitors, who now face being forced to pay parking fees of up to £7.50 per visit.
Katherine Murphy, chief executive of the Patients Association, said: ‘Patients and visitors who attend hospital have for a long time been forced to pay heavy car parking charges. ‘But now we are hearing of hospitals who are scrapping free car parking for disabled people. ‘The Blue Badge scheme helps people with the most severe mobility problems and allows them to park close to where they need to go. ‘How can hospitals justify targeting this most vulnerable group? Where will this end?
‘Hospitals should be properly supported by the Government and should not be making ends meet by charging the most vulnerable members of society to park.
‘Car parking charges make a mockery of a service supposed to be free at the point of need and we urge the Department of Health to scrap these charges as they have been in Scotland and Wales and end this charge on being sick.’
At Kidderminster Hospital parking charges will now apply to all outpatients and visitors – £3 for a two hour stay, £4.50 for up to four hours, £6 for up to six, and £7.50 for six to 24 hours.
Southport and Ormskirk Hospital Trust is bringing in its parking charges for the disabled from the start of next month – while increasing short term fees for all drivers by 10 per cent.
David Skelton, of local disability rights group Southport Access for All, said: ‘Many disabled people are attending hospital several times a month. ‘This is going to be an extra tax on illness aimed at disabled people.’
The Department of Health says parking charges are set by individual NHS trusts.
Labour wanted to abolish parking charges in England to bring it into line with Scotland and Wales where it is free. But the plan was ditched by the Coalition after last year’s election.
Lost in administration: Scandal over criminal immigrants hidden among 37,000 files of foreigners appealing to stay in Britain
Last year, 37,300 cases were launched by immigrants appealing to stay in Britain after the Home Office ruled they were not entitled to remain here.
Of course, this figure accounts only for those tracked down by officials — leaving tens of thousands who have avoided detection free to stay.
A significant number of those foreigners fighting to remain in Britain are small-time criminals, terrorists or fraudsters, although the vast majority originally simply slipped into Britain illegally or deliberately overstayed their visas.
Now, for the first time, the sheer scale of this scandal can be revealed because documents have been released on the Ministry of Justice website, giving details of scores of appeal cases.
A typical example is Rhomaine Miyando Mohan, who has appealed five times in 11 years against attempts to kick him out in what Senior Immigration Judge Waumsley described as a ‘contemptuous disregard for British immigration law’.
The Jamaican has fathered three daughters by two British women despite being deported in 2006 for overstaying his one-month visitor’s visa by six years. After slipping back into the UK on a bogus passport, he was jailed twice for a series of crimes, including driving offences and cocaine possession.
This summer saw the latest attempt by the Home Office to boot him out. His appeal against removal from the UK was turned down.
Last year alone, almost 600 Somalis applied for asylum in the UK.
Sue Reid said many foreigners are exploiting our grotesque human rights laws
So where is Mohan now? He remains in Britain as officials struggle with the chaotic immigration system to deport him.
Then there is the case of a woman from Nigeria who came to Britain and overstayed her visa. She took her case to appeal, claiming she would not be safe in her home country.
She explained that when still in Nigeria she had killed a snake ‘by accident’. As a result, she was a hated figure, because her fellow villagers worship snakes as sacred creatures. If she returned home, her safety could not be guaranteed. The files show her appeal failed — but, on previous form, she is likely still to be here.
A similar case also exposes the preposterous nature of many of the appeals. It involved a 28-year-old Albanian woman, now living in Brighton, who fought against being deported by arguing that, as a lesbian, she would be killed if she returned to Albania (despite there being no law there that discriminates against homosexuality).
Another file details how American Jonathan Bartley Stables, 46, originally won leave to stay in Britain on the grounds of having a five-year relationship with his 27-year-old gay partner. However, two years ago he was jailed for five years after admitting five charges of fraud. Described by the trial judge as ‘a persistent, accomplished and practised fraudster’, he was listed for deportation.
But, on appeal, another judge ruled that Stables — under Article 8 of the Human Rights Act (which demands a respect for family life and privacy) — had a right to stay with his partner. According to the judge, the right outweighed the public interest in stopping crime by foreigners in Britain.
Another Ministry of Justice file recounts the story of 50-year-old Pakistani Raja Mohammed Khan, of Rotherham, South Yorkshire, who also used Article 8 to overturn the Home Office’s attempt to deport him after he killed a man in a car crash while high on drugs.
The files show that Khan crashed into the father-of-two while driving an overloaded milk delivery van after smoking heroin. He was jailed for five years for causing death by careless driving.
Yet, because his second child, a son, has a British passport through his mother, Khan won his appeal not to be deported on the grounds of his human rights to a family life.
Then there’s the case of an Afghan man with the mental age of an infant. He complained through his lawyers that during an appeal hearing into his claim to remain in Britain, the judge fell asleep and therefore missed details of his case.
In the Ministry of Justice files, there is another case involving an Afghan who came to Britain several years ago as a youngster to escape war in his homeland and claiming asylum. Asif Abrahimi, now 18, was told by the Home Office in March that he must leave Britain because it was safe to return to Kabul. Predictably, he appealed — but his claim was rejected.
However, within weeks he was back in the appeal court, saying that his new English girlfriend was pregnant with his baby and that he had rights to a ‘family life’ under Article 8 of the Human Rights Act. As a result, he has been allowed to stay in the UK.
A huge number of cases fit a similar pattern. Take 34-year-old Zimbabwean Rudo Ndemera, who arrived at Gatwick airport in 2002 on a six-month visitors’ visa. She overstayed by several years and was eventually found by officials in 2007. She told them that she had a long-term boyfriend who was a British citizen — thus giving her a right to a ‘family life’ in Britain.
However, she failed to produce proof of her relationship with 35-year-old personal trainer Adeniyi Aderinola, despite her lawyer claiming in court that their love could be compared with Romeo and Juliet. In a rare moment of sanity, the court dismissed Ms Ndemera’s fourth request to stay here. Perhaps it is no surprise to discover, though, that today — months after that hearing — she remains in Britain.
But few cases are more shocking than that involving Rohan Cecil William Winfield, 38, a chef from Barbados, who came to Britain 13 years ago as a visitor. He overstayed his visa and went on to marry a British woman with whom he had three children. He then had an affair with a Spanish girl in London who bore him a baby daughter. However, he then raped the Spaniard and was jailed for three years for the attack and ordered to be deported after his release from prison.
But, in July, a judge ruled that Winfield should be allowed to remain in Britain because his removal would ‘violate his human rights and those of his family’ — under Article 8 of the Human Rights Act.
It is just another example of a foreigner who, like so many others, is exploiting our grotesque human rights laws and has turned our immigration system into a shambles.
Ignored for ten years…abandoned wife’s pleas to deport immigrant husband who flouted law
A British woman whose immigrant husband abandoned her weeks after getting into the UK via an arranged marriage revealed yesterday how the authorities spent ten years ignoring her pleas to deport him for flouting the law.
The 32-year-old, who has asked to remain anonymous after threats from her husband’s family, spoke out after learning to her horror that he has been told by the Home Office that he can stay in the UK.
She has spent a decade enduring his taunts about how he has taken the immigration system for a ride. She even took police to the house where the man was hiding – only for him to escape via the back door when bungling officers left it uncovered.
Worse, she says her life is ‘ruined’ because she can never recover from the shame of Sharia law divorce – even though they are still married under British law.
Her protest has been taken up by Deputy Commons Speaker Nigel Evans, who is collecting a dossier of similar cases for Home Secretary Theresa May. He said: ‘It is scandalous that this lady spent ten years telling the police and the Home Office of her husband’s illegal behaviour – yet they did nothing. ‘It makes our immigration system look like a joke.’
The incident came to light after Ministers said two thirds of people who come to the UK on marriage visas have never set foot in the country before. The Government is proposing several new curbs, including encouraging people to report suspected illegal immigrants, outlawing forced marriages and making families of would-be immigrants pay a cash bond.
The woman, who contacted The Mail on Sunday, is a respected member of her community in Blackburn, Lancashire. The daughter of Pakistani immigrants, she was born in the UK, is ‘proud to consider myself English’ and has a full-time professional career.
She said she had been happy to enter an arranged marriage because she considered it ‘part of her culture’. Aged 21, she went to Pakistan to meet her husband, who was her cousin, and they got married. She returned to Britain, where she bought and renovated a house while she waited for her husband to join her.
She said: ‘It wasn’t a love marriage, though I believed love would come after we married. ‘But eight weeks after he arrived, he moved out and moved in with an uncle who lived round the corner. ‘I was very shocked. We phoned his mother back in Pakistan and she said “just give him a visa and throw him out”.
We couldn’t believe it. They had been planning it all along. I had kept his passport, and he sent people round to get it. I refused.
I knew he would destroy it to remove any evidence of when he had entered the country. ‘Then he started harassing me. He even sent his grandmother to berate me. He pushed his way into my mum and dad’s house and abused them.
I had to call the police to stop him. The Home Office and the UK Borders Agency said they couldn’t do anything until his one-year marriage visa expired. ‘All the time he taunted me over the way he had got into the country.
On one occasion I tracked him down myself. I called the police and they knocked on the front door of the house where he was staying. He got out via the back and has never been seen again. ‘Recently I was informed he has been given leave to remain here for three years. He qualifies for benefits even though he has never paid a penny in tax because he works for cash illegally.
Incredibly, he is now using legal aid to divorce me. He wants to marry someone else to increase his chances of staying here for good.
‘I have been humiliated. I obtained a Sharia divorce on the grounds of desertion, but we are still man and wife under English law. My life is ruined. As a Muslim once you are divorced, no one will marry you. ‘I have been telling the authorities for years that he should be sent back, but they have done nothing.
The people who suffer most are genuine immigrants who come here legally because it makes people hostile to them.’
A spokesman for Immigration Minister Damian Green said: ‘For too long the immigration system was allowed to get out of control, decisions were not taken quickly enough and that meant those who should not have been allowed to stay were able to do so. ‘The Government is toughening the system to prevent abuse.’
Bringing honesty back to the British exam system
Michael Gove, the Education Secretary, was unsparing in his criticism of the status quo, which is seeing Britain sliding down the international league tables.
Thanks to decades of grade inflation, and an all-must-have-prizes mindset in too many of the country’s classrooms, we have a public examination system that is failing badly. Universities and employers find the process of sorting the wheat from the chaff increasingly difficult. Students are cheated because a system designed to sort by ability no longer does that honestly or fairly.
While exam grades have got better and better, our position in international league tables has become worse and worse. According to the OECD, we have “stagnated” while other countries forge ahead: at the age of 15, British pupils are roughly two years behind Shanghai’s. The long-term economic impact of this decline could be immense.
In an important speech yesterday to the exam regulator Ofqual, Michael Gove delivered a welcome blast of common sense. The Education Secretary was unsparing in his criticism of the status quo. He pointed out that an increasing number of universities are being forced to offer remedial courses for students who are unprepared for further study; that the Royal Society of Chemistry had noted a “catastrophic slippage” in school science standards; and that Sir Richard Sykes, the former rector of Imperial College London, has described GCSEs as offering “soundbite science” based on a “dumbed-down syllabus”.
The Secretary of State went on to question the validity of an exam system “that no longer allows us to distinguish the best candidates… we may soon have to invent a Milky Way of A double and triple stars simply to allow the top performers to stand out”.
Fortunately, Mr Gove’s proposals for ending this insidious drift towards mediocrity were equally trenchant. He suggested that the number of A*s awarded each year could be fixed, to set a genuine benchmark of excellence. Tougher marking might mean that some GCSE and A-level results actually dip – something that has not happened for almost 30 years. Yet as he rightly argued, it is better to be honest with our children and with ourselves by having an exam system that has integrity.
Mr Gove also floated an idea that could be truly revolutionary. He admires the system that has been introduced in Burlington Danes Academy in West London, in which every pupil knows where they have come in every subject, whether that is first or 101st. Parents have embraced the scheme, because it gives them information they have hitherto been denied. In turn, it allows teachers to be assessed on the basis of which of them add value, as shown by changes in the rankings. Of course, the teachers’ unions will loathe the idea – which is all the more reason to try it out.
Cheers to a pint of bone builder: Older women could guard against osteoporosis by drinking beer
Older women could guard against osteoporosis in later life by drinking a pint of beer a day. A new study has shown that ale is an ideal source of dietary silicon, which is crucial in the formation of new bone. Bone is continuously being lost and reformed and silicon is vital for helping to renew it.
Although silicon is contained in some plants and beans, one of the richest and most easily absorbed sources is beer, as it is an ingredient of the malt used in the brewing process. Several previous studies have shown that there is a direct correlation between the amount of silicon in a person’s diet and their bone mineral density.
In the new study, Professor Jonathan Powell, head of nutrition research at Cambridge University, studied the effects of beer on bone formation and found that ethanol – which is also present in alcohol – helps to prevent bone loss and silicon encourages the growth of new bone.
‘Silicon combines with the hormone oestrogen to produce a beneficial effect and as women age, their oestrogen levels fall, and so, as they get older, it is important for women to take in a good daily amount of silicon,’ says Prof Powell.
Real ale, which is less refined and processed and so higher in silicon, is preferable to lagers.
‘As a population, we used to get some of our silicon from grain and cereals, but as our food is much more processed today, this is now a lot less. Water also has a certain amount, but the purification process has reduced that as well.
‘Our research shows that the absorption rate of silicon from beer is the highest of any foodstuff. ‘A pint of beer contains around 8mg of silicon – around a third of our daily recommended intake.
‘Pre-menopausal women would benefit from drinking a half-pint a day as a means of absorbing silicon, and post-menopausal women would benefit from a pint of beer a day.’
Approximately three million people in the UK are thought to have osteoporosis, and there are more than 230,000 fractures every year as a result. Sufferers include Camilla, The Duchess of Cornwall, who is known to be partial to a glass of real ale.
Dr Clare Gerada, chair of the Royal College of General Practitioners, says: ‘Studies such as this are interesting, but they should be viewed with caution and not taken as an excuse for increasing the amount you drink or for drinking certain types of alcohol excessively.’
“Green” home-heating boilers breaking down and costing Brits a packet
Millions of homeowners who were forced by John Prescott to buy expensive energy-saving boilers are now facing bills of £150 to stop them from breaking down in the cold this winter. The £4,000 water heaters – known as condensing boilers – were hailed by Mr Prescott, when deputy leader of the Labour Party, as a green alternative to traditional ‘dirty’ boilers.
A law was passed in 2005 stating that when an old boiler is replaced, it must be with a condensing boiler.
However, last year’s freezing weather caused hundreds of thousands to break down because a pipe that carries waste water from the boilers to the house drain froze up.
More than eight million have been installed, and British Gas – which has sold almost a million of them – is now urging its customers to fit a new cold-resistant pipe. In a letter to 46,000 customers who suffered boiler breakdowns last year, the energy giant is saying it will fit the new pipe for £149.
But their offer has been criticised by MPs and consumer groups as another instance of ‘profiteering’. They said British Gas should fit the pipes for free as the problem is a design fault and nothing to do with the customers.
Labour MP Barry Gardiner, who is a member of the Energy and Climate Committee, said: ‘This is outrageous. It is clear that British Gas has installed the product which is not working properly. ‘This is like a product recall – they must put right the defect with the product for free. You have to assume responsibility for the product.’
Charlie Mullins, managing director of Pimlico Plumbers, Britain’s largest independent plumbing company, said: ‘This is a total rip-off. It is a manufacturing fault and it should be fixed for free. British Gas have people over a barrel.’
Pensioner Ellen McGhie, 85, from Boughton, near Faversham, Kent, who received the letter from British Gas, said: ‘This is a cheek. I spent nearly £4,000 on a new boiler and it should work, even when it gets cold. It is obviously a design fault. ‘Why should I pay for a faulty product? This would not happen if I bought a new car. The last time it packed up they told me to pour boiling water over the pipes. But as they are in the loft, and I find it difficult to walk, that was impossible.’
The company is already being criticised for profiteering from its customers by hiking fuel tariffs. Last week, watchdog Ofgem said that the ‘big six’ energy suppliers – including British Gas – had increased their profit margin per customer per year from £15 in June to £125.
British Gas says it sells 130,000 condensing boilers a year, which means it would have installed almost 800,000 since the law was changed. Based on this, British Gas will charge £119 million if all its customers install the pipe, called a condensulate.
Around 1.2million Britons are fitting condensing boilers each year as they replace their old boilers. Mr Prescott made them compulsory as a way of getting Britain to reach its CO2 targets under the Kyoto Protocol. New Labour even introduced a ‘boiler scrappage’ scheme with homeowners offered £400 towards the cost of a new boiler.
In traditional boilers, a quarter of the heat generated vents out of the exhaust pipe in the form of hot steam and gas.
In the new boilers, a condenser claws back much of the heat, condensing the steam back into water. This increases heat efficiency to as much as 93 per cent.
One by-product of the process is waste condensed water, which escapes through a pipe into the house’s external drains. But in severe cold, the pipe freezes and blocks the flow of the waste water, which shuts down the boiler. Thousands of customers have complained about the problem.
Even despite the freezing pipe problem, it often does not make much economic sense to replace old boilers with the condensing type. It is estimated that replacing an old, inefficient model with the best condensing boiler will save about £200 a year in gas bills. But with condensing boilers costing £4,000 to buy and install, it will take 20 years to pay for itself. However condensing boilers do not last anywhere near as long as 20 years. Experts say they do not even last ten years.
A spokeswoman for British Gas said they had faced no problems with the boilers until the extreme cold of last winter. She said: ‘We carefully followed manufacturers’ instructions when we installed them. The problem was caused by the exceptional weather.’ She said British Gas had no plans to fix the problem for free. The Department of Energy and Climate Change declined to comment on the issue. A spokesman said: ‘Customers should take this up with British Gas.’
All British homes are expected to have condensing boilers by the end of the decade.
What is Poverty?
What do we mean by poverty? Not what Dickens or Blake or Mayhew meant. Today, no one seriously expects to go hungry in England or to live without running water or medical care or even TV. Poverty has been redefined in industrial countries, so that anyone at the lower end of the income distribution is poor ex officio, as it were—poor by virtue of having less than the rich. And of course by this logic, the only way of eliminating poverty is by an egalitarian redistribution of wealth—even if the society as a whole were to become poorer as a result.
Such redistribution was the goal of the welfare state. But it has not eliminated poverty, despite the vast sums expended, and despite the fact that the poor are now substantially richer—indeed are not, by traditional standards, poor at all. As long as the rich exist, so must the poor, as we now define them.
Certainly they are in squalor—a far more accurate description of their condition than poverty—despite a threefold increase in per-capita income, including that of the poor, since the end of the last war. Why they should be in this condition requires an explanation—and to call that condition poverty, using a word more appropriate to Mayhew’s London than to today’s reality, prevents us from grasping how fundamentally the lot of “the poor” has changed since then. The poor we shall always have with us, no doubt: but today they are not poor in the traditional way.
The English poor live shorter and less healthy lives than their more prosperous compatriots. Even if you didn’t know the statistics, their comparative ill health would be obvious on the most casual observation of rich and slum areas, just as Victorian observers noted that the poor were on average a head shorter than the rich, due to generations of inferior nourishment and hard living conditions. But the reasons for today’s difference in health are not economic. It is by no means the case that the poor can’t afford medicine or a nourishing diet; nor do they live in overcrowded houses lacking proper sanitation, as in Mayhew’s time, or work 14 backbreaking hours a day in the foul air of mines or mills. Epidemiologists estimate that the higher rate of cigarette consumption among the poor accounts for half the difference in life expectancy between the richest and poorest classes in England—and to smoke that much takes money.
Notoriously, too, the infant mortality rate is twice as high in the lowest social class as in the highest. But the infant mortality rate of illegitimate births is twice that of legitimate ones, and the illegitimacy rate rises steeply as you descend the social scale: so the decline of marriage almost to the vanishing point in the lowest social class might well be responsible for most of its excess infant mortality. It is a way of life, not poverty per se, that kills. The commonest cause of death between the ages of 15 and 44 is now suicide, which has increased most precipitously precisely among those who live in the underclass world of temporary step-parenthood and of conduct unrestrained either by law or convention.
Just as it is easier to recognize ill health in someone you haven’t seen for some time rather than in someone you meet daily, so a visitor coming into a society from elsewhere often can see its character more clearly than those who live in it. Every few months, doctors from countries like the Philippines and India arrive fresh from the airport to work for a year’s stint at my hospital. It is fascinating to observe their evolving response to British squalor.
At the start, they are uniformly enthusiastic about the care that we unsparingly and unhesitatingly give to everyone, regardless of economic status. They themselves come from cities—Manila, Bombay, Madras—where many of the cases we see in our hospital would simply be left to die, often without succor of any kind. And they are impressed that our care extends beyond the merely medical: that no one goes without food or clothing or shelter, or even entertainment. There seems to be a public agency to deal with every conceivable problem. For a couple of weeks, they think this all represents the acme of civilization, especially when they recall the horrors at home. Poverty—as they know it— has been abolished.
Before very long, though, they start to feel a vague unease. A Filipina doctor, for example, asked me why so few people seemed grateful for what was done for them. What prompted her question was an addict who, having collapsed from an accidental overdose of heroin, was brought to our hospital. He required intensive care to revive him, with doctors and nurses tending him all night. His first words to the doctor when he suddenly regained consciousness were, “Get me a fucking roll-up” (a hand-rolled cigarette). His imperious rudeness didn’t arise from mere confusion: he continued to treat the staff as if they had kidnapped him and held him in the hospital against his will to perform experiments upon him. “Get me the fuck out of here!” There was no acknowledgment of what had been done for him, let alone gratitude for it. If he considered that he had received any benefit from his stay at all, well, it was simply his due.
My doctors from Bombay, Madras, or Manila observe this kind of conduct open- mouthed. At first they assume that the cases they see are a statistical quirk, a kind of sampling error, and that given time they will encounter a better, more representative cross section of the population. Gradually, however, it dawns upon them that what they have seen is representative. When every benefit received is a right, there is no place for good manners, let alone for gratitude.
Case after case causes them to revise their initial favorable opinion. Before long, they have had experience of hundreds, and their view has changed entirely. Last week, for example, to the amazement of a doctor recently arrived from Madras, a woman in her late twenties entered our hospital with the most common condition that brings patients to us: a deliberate overdose. At first she would say nothing more than that she wanted to depart this world, that she had had enough of it.
I inquired further. Just before she took the overdose, her ex-boyfriend, the father of her eight-month-old youngest child (now staying with her ex-boyfriend’s mother), had broken into her apartment by smashing down the front door. He wrecked the apartment’s contents, broke every window, stole $110 in cash, and ripped out her telephone.
“He’s very violent, doctor.” She told me that he had broken her thumb, her ribs, and her jaw during the four years she was with him, and her face had needed stitching many times. “Last year I had to have the police out to him.”
“I dropped the charges. His mother said he would change.”
Another of her problems was that she was now five weeks pregnant and she didn’t want the baby.
“I want to get rid of it, doctor.”
“Who’s the father?”
It was her violent ex-boyfriend, of course.
“Did he rape you, then?”
“So you agreed to have sex with him?”
“I was drunk; there was no love in it. This baby is like a bolt out of the blue: I don’t know how it happened.”
I asked her if she thought it was a good idea to have sex with a man who had repeatedly beaten her up, and from whom she said she wished to separate.
“It’s complicated, doctor. That’s the way life goes sometimes.”
What had she known of this man before she took up with him? She met him in a club; he moved in at once, because he had nowhere else to stay. He had a child by another woman, neither of whom he supported. He had been in prison for burglary. He took drugs. He had never worked, except for cash on the side. Of course he never gave her any of his money, instead running up her telephone bills vertiginously.
She had never married, but had two other children. The first, a daughter aged eight, still lived with her. The father was a man whom she left because she found he was having sex with 12-year-old girls. Her second child was a son, whose father was “an idiot” with whom she had slept one night. That child, now six, lived with the “idiot,” and she never saw him.
What had her experience taught her?
“I don’t want to think about it. The Housing’ll charge me for the damage, and I ain’t got the money. I’m depressed, doctor; I’m not happy. I want to move away, to get away from him.”
Later in the day, feeling a little lonely, she telephoned her ex-boyfriend, and he visited her.
I discussed the case with the doctor who had recently arrived from Madras, and who felt he had entered an insane world. Not in his wildest dreams had he imagined it could be like this. There was nothing to compare with it in Madras. He asked me what would happen next to the happy couple.
“They’ll find her a new flat. They’ll buy her new furniture, television, and refrigerator, because it’s unacceptable poverty in this day and age to live without them. They’ll charge her nothing for the damage to her old flat, because she can’t pay anyway, and it wasn’t she who did it. He will get away scot-free. Once she’s installed in her new flat to escape from him, she’ll invite him there, he’ll smash it up again, and then they’ll find her somewhere else to live. There is, in fact, nothing she can do that will deprive her of the state’s obligation to house, feed, and entertain her.”
I asked the doctor from Madras if poverty was the word he would use to describe this woman’s situation. He said it was not: that her problem was that she accepted no limits to her own behavior, that she did not fear the possibility of hunger, the condemnation of her own parents or neighbors, or God. In other words, the squalor of England was not economic but spiritual, moral, and cultural.
I often take my doctors from the Third World on the short walk from the hospital to the prison nearby. It is a most instructive 800 yards. On a good day—good for didactic purposes, that is—there are seven or eight puddles of glass shattered into fragments lying in the gutter en route (there are never none, except during the most inclement weather, when even those most addicted to car theft control their impulses).
“Each of these little piles of smashed glass represents a car that has been broken into,” I tell them. “There will be more tomorrow, weather permitting.” The houses along the way are, as public housing goes, quite decent. The local authorities have at last accepted that herding people into giant, featureless, Le Corbusian concrete blocks was a mistake, and they have switched to the construction of individual houses. Only a few of their windows are boarded up. Certainly by comparison with housing for the poor in Bombay, Madras, or Manila they are spacious and luxurious indeed. Each has a little front yard of grass, surrounded by a hedge, and a much larger back yard; about half have satellite dishes. Unfortunately, the yards are almost as full of litter as municipal garbage dumps.
I tell my doctors that in nearly nine years of taking this walk four times a week, I have never seen a single instance of anyone attempting to clean his yard. But I have seen much litter dropped; on a good day, I can even watch someone standing at the bus stop dropping something on the ground no farther than two feet from the bin.
“Why don’t they tidy up their gardens?” asks a doctor from Bombay.
A good question: after all, most of the houses contain at least one person with time on his or her hands. Whenever I have been able to ask the question, however, the answer has always been the same: I’ve told the council [the local government] about it, but they haven’t come. As tenants, they feel it is the landlord’s responsibility to keep their yards clean, and they are not prepared to do the council’s work for it, even if it means wading through garbage—as it quite literally does. On the one hand, authority cannot tell them what to do; on the other, it has an infinitude of responsibilities towards them.
I ask my Third World doctors to examine the litter closely. It gives them the impression that no Briton is able to walk farther than ten yards or so without consuming junk food. Every bush, every lawn, even every tree, is festooned with chocolate wrappers or fast- food packaging. Empty cans of beer and soft drinks lie in the gutter, on the flower beds, or on top of the hedges. Again, on a good day we actually see someone toss aside the can whose contents he has just consumed, as a Russian vodka drinker throws down his glass.
Apart from the antisocial disregard of the common good that each little such act of littering implies (hundreds a week in the space of 800 yards alone), the vast quantity of food consumed in the street has deeper implications. I tell the doctors that in all my visits to the white households in the area, of which I’ve made hundreds, never—not once—have I seen any evidence of cooking. The nearest to this activity that I have witnessed is the reheating of prepared and packaged food, usually in a microwave. And by the same token, I have never seen any evidence of meals taken in common as a social activity—unless two people eating hamburgers together in the street as they walk along be counted as social.
This is not to say that I haven’t seen people eating at home; on the contrary, they are often eating when I arrive. They eat alone, even if other members of the household are present, and never at table; they slump on a sofa in front of the television. Everyone in the household eats according to his own whim and timetable. Even in so elementary a matter as eating, therefore, there is no self-discipline but rather an imperative obedience to impulse. Needless to say, the opportunity for conversation or sociality that a meal taken together provides is lost. English meals are thus solitary, poor, nasty, brutish, and short.
I ask the doctors to compare the shops in areas inhabited by poor whites and those where poor Indian immigrants live. It is an instructive comparison. The shops the Indians frequent are piled high with all kinds of attractive fresh produce that, by supermarket standards, is astonishingly cheap. The women take immense trouble over their purchases and make subtle discriminations. There are no pre-cooked meals for them. By contrast, a shop that poor whites patronize offers a restricted choice, largely of relatively expensive prepared foods that at most require only the addition of hot water.
The difference between the two groups cannot be explained by differences in income, for they are insignificant. Poverty isn’t the issue. And the willingness of Indians to take trouble over what they eat and to treat meals as important social occasions that impose obligations and at times require the subordination of personal desire is indicative of an entire attitude to life that often permits them, despite their current low incomes, to advance up the social scale. Alarmingly, though, the natural urge of the children of immigrants to belong to the predominant local culture is beginning to create an Indian underclass (at least among young males): and the taste for fast food and all that such a taste implies is swiftly developing among them.
When such slovenliness about food extends to all other spheres of life, when people satisfy every appetite with the same minimal effort and commitment, no wonder they trap themselves in squalor. I have little trouble showing my doctors from India and the Philippines that most of our patients take a fast-food approach to all their pleasures, obtaining them no less fleetingly and unstrenuously. They have no cultural activity they can call their own, and their lives seem, even to them, empty of purpose. In the welfare state, mere survival is not the achievement that it is, say, in the cities of Africa, and therefore it cannot confer the self-respect that is the precondition of self-improvement.
By the end of three months my doctors have, without exception, reversed their original opinion that the welfare state, as exemplified by England, represents the acme of civilization. On the contrary, they see it now as creating a miasma of subsidized apathy that blights the lives of its supposed beneficiaries. They come to realize that a system of welfare that makes no moral judgments in allocating economic rewards promotes antisocial egotism. The spiritual impoverishment of the population seems to them worse than anything they have ever known in their own countries. And what they see is all the worse, of course, because it should be so much better. The wealth that enables everyone effortlessly to have enough food should be liberating, not imprisoning. Instead, it has created a large caste of people for whom life is, in effect, a limbo in which they have nothing to hope for and nothing to fear, nothing to gain and nothing to lose. It is a life emptied of meaning.
“On the whole,” said one Filipino doctor to me, “life is preferable in the slums of Manila.” He said it without any illusions as to the quality of life in Manila.
These doctors have made the same journey as I, but in the reverse direction. Arriving as a young doctor in Africa 25 years ago, I was horrified at first by the physical conditions, the like of which I had never experienced before. Patients with heart failure walked 50 miles in the broiling sun, with panting breath and swollen legs, to obtain treatment—and then walked home again. Ulcerating and suppurating cancers were common. Barefoot men contracted tetanus from the wounds inflicted by a sand flea that laid its eggs between their toes. Tuberculosis reduced people to animated skeletons. Children were bitten by puff adders and adults mauled by leopards. I saw lepers with noses that had rotted away and madmen who wandered naked in the torrential rains.
Even the accidents were spectacular. I treated the survivors of one in Tanzania in which a truck—having no brakes, as was perfectly normal and expected in the circumstances— began to slide backward down a hill it had been climbing. It was laden with bags of corn, upon which 20 passengers, including many children, were riding. As the truck slid backward, first the passengers, then the corn, fell off. By the time I arrived, ten dead children were lined up by the side of the road, arranged in ascending order as neatly as organ pipes. They had been crushed or suffocated by the bags of corn that fell on top of them: a grimly ironic death in a country chronically short of food.
Moreover, political authority in the countries in which I worked was arbitrary, capricious, and corrupt. In Tanzania, for example, you could tell the representative of the sole and omnipotent political party, the Party of the Revolution, by his girth alone. Tanzanians were thin, but party men were fat. The party representative in my village sent a man to prison because the man’s wife refused to sleep with him. In Nigeria the police hired out their guns by night to the armed robbers.
Yet nothing I saw—neither the poverty nor the overt oppression—ever had the same devastating effect on the human personality as the undiscriminating welfare state. I never saw the loss of dignity, the self-centeredness, the spiritual and emotional vacuity, or the sheer ignorance of how to live, that I see daily in England. In a kind of pincer movement, therefore, I and the doctors from India and the Philippines have come to the same terrible conclusion: that the worst poverty is in England—and it is not material poverty but poverty of soul.