jamescalumcampbell

On Sunday in Dunblane Cathedral the minister told a story about a boy at school in America, tasked to write an essay on his hopes and dreams for the future.  He had always wanted to create a stud farm, and rear the finest race horses in America.  He drew up an elaborate plan, and submitted his essay.  It received a poor mark.  He approached his teacher and asked what was wrong with his work.  “Well,” said the teacher, “it’s just not very realistic.  Rewrite it, make it more down to earth, and I’ll see if I can award you a better mark.”

The boy went away and thought about this for a while, and then returned to the teacher with the same essay.  He said, “You can keep your mark, and I will keep my dream.”  In due course he went on to found the most successful stud farm in America.  

It’s a nice story.  Who among us has not had a piece of work in which we took pride cast back at us?  And what a great line – “You can keep your mark, I will keep my dream.”  Mind, I wouldn’t have dared say it at school.  That would have been living too dangerously. 

Is it crucial to the story that the boy eventually fulfilled his dream?         

Nowadays, by and large, pupils are encouraged to dream.  Still, there might be a downside to telling people of aspiration that all they need is perseverance, and their dreams will come true.  In the film Dead Poets Society, Mr Keating encouraged and inspired his English scholars to “carpe diem” and discover their potential.  His colleague, the Scottish classics teacher Mr McAllister, warned Keating that his pupils would come to hate him when they realised they were neither Mozart nor Michelangelo.  Perhaps Mr McAllister was the same teacher who told the pupil to rewrite his essay about the stud farm.

During the festive season I played my viola in a ceremony of lessons and carols which happened to take place in a high school for girls in Glasgow, and during a break in rehearsal I took a meander down a school corridor, glancing at the notice boards as I went.  They were full of “rah-rah” calls for increased endeavour.  Realise your potential.  Be all you can be, and more.  Make the difference, be the difference!  I paused to admire the names, embossed in gold on a bronze background, of excelling alumni, “duces” of the past.  And I felt a sense of envy for the pupils who would walk down this corridor, conscious of the propaganda all around them, and entirely impervious to it.  Blessed are the unambitious.  They know, and have always known, at some deep level in their being, that the people who peddle this stuff – well, their heads are full of s***. 

The glossy brochures for the independent schools are full of rah-rah calls, directed in this case at the parents who wish to maximise their children’s potential and, crucially, help them make useful acquaintance.  The freemasonry of the connected.  Sport, especially team sport, is integral.  It encourages esprit de corps.  And IT.  It must be state of the art.  Connectivity is everything.      

Philip Larkin wrote a poem, Born Yesterday, for Sally Amis.  He said to new-born Sally, without any sense of irony, far less misanthropy, or misogyny, May you be dull.  I think Larkin must have walked down the same school corridor as me, and realised that those who are capable of happiness, who have conjured the trick of life because they take life easy, they just don’t need any of that stuff.  They don’t need a dream, because they already know how to live in the present.  Oh yes, they are quite happy to be at school.  They will take from school that which they need.  Learn to read, learn to write, to count, acquire the basic skills that will allow you to navigate the world.  You might find you are interested in something, and good at something, and if these things happen to be one and the same, well, as Larkin would say, you’re a lucky girl. 

Yet all the while, they are living life, these people who have solved the trick of life, quite naturally, and easily, on a different plane.  They have friends.  They are sociable.  They probably like going to gigs.  They have a capacity for fun.  They understand, without even thinking about it, the fundamental importance of having fun.   

I was never like that.  I was always living in the future.  As the school motto had it, Spero meliora.  I hope for better things.  I still make New Year resolutions.  Next year, Jerusalem!  I continue to make black marks on paper and submit my plans for the stud farm to newspapers and publishers.  Perhaps I am like one of these guys on a television singing talent show, convinced of the righteousness of his destiny, whose sense of pitch is excruciating, but who can never be discouraged.  Simon Cowell shakes his head and says, “No. No. No.”  I don’t pay the slightest attention.  But perhaps I should have listened to that girl down by the salley gardens, who bid me take life easy.  

So I envy these people who don’t dream, and who live in and for the here and now.  They have achieved what Larkin called

…a skilled,

Vigilant, flexible,

Unemphasised, enthralled

Catching of happiness.       

It’s Groundhog Day on the apparently dismal “A & E Waiting Times”.  The Herald reported them on Friday, along with the opposition politicians’ calls that the Health Secretary be sacked.  I wrote a letter to The Herald, comme toujours, and was delighted to be published on Hogmanay under the banner headline Time to get clinicians, not politicians, to sort out the NHS.  Here it is:

“We were expecting this week’s A & E figures to be bad, but these are awful” (Analysis, The Herald, December 29^th).  Here we go again.

In the 1990s when I was clinical head of the emergency department (ED) of Middlemore Hospital in Auckland, New Zealand, the then health minister, Bill English, shortly to become Prime Minister, dropped by, not to tell me how to run the department, but to ask me, “What do you need?”  I told him we needed to double the staff, a remark which at the time I didn’t think went down particularly well, yet, in the event, it happened.

Our politicians, throughout these islands, would do well to follow Mr English’s example.  I think the standard of political debate concerning the NHS is, frankly, pitiful.  You have been publishing the same story intermittently for years now, in language you might have used in 1948, concerning “A & E”, or “Casualty”, or “Cas” not “seeing casualties” within four hours.  For the record, this means that emergency departments are not discharging patients within four hours.  This seems to be a surrogate marker for catastrophe.  Opposition parties call for the health secretary to be sacked.  

Political point-scoring is useless in this context.  It would be better if a cross-party committee asked clinicians the Bill English question, “What do you need?”

Better funding and better staffing are obvious requirements.  Yet there are profound systemic problems within the NHS and it must be the clinicians who take a lead in outlining what they are, and how they should be tackled.  One example: few members of the public, least of all politicians, are aware of the turf war that exists between acute medicine and emergency medicine, and that has resulted in an apartheid system of patient care at hospital front doors.  Medical assessment units don’t implement a four hour rule. 

The medical assessment unit and the emergency department must amalgamate to form a true specialty of emergency medicine.  The entire delivery of hospital acute care would take place around the central hub of the ED, which would no longer function as a first aid outpost, like a dressing station inundated during the Battle of the Somme, but as an integral part of the hospital.  Emergency Department “waiting times” would cease to have any meaning.  

Sincerely…

It’s not the first time I’ve written this letter, or something like it, but I suspect it might be the last.  I’m not in practice any more, and you lose currency in medicine very quickly.  It is said that there is nothing so “ex” as an ex-politician, and the same might be said of a doctor.  It hardly matters what I think.  It is the opinions of the health care workers in harness that matter.  The trouble is, they are so busy that they have no time to think. 

The last time I time I suggested in The Herald that the acute physicians and the emergency physicians merge, somebody wrote in with a gag, that the new college could be called something like the Scottish College Royal for Emergency and Acute Medicine, or SCREAM.  Well, I had to laugh.  Nevertheless, intentional or not, this was a put-down.  And I have no doubt that if, while I was clinical head at Middlemore, I had made this proposal to the elder statesmen of the Royal College of Physicians, it would have gone down like a lead balloon.   

Where did the specialty of Acute Medicine come from?  There used to be a species of consultant encountered in hospital known as the “general physician”.  In fact, most physicianly elder statesmen were general physicians “with a special interest”.  I think for example of a renowned chest physician at Edinburgh Royal Infirmary.  “Never let a patient die of an undiagnosed chest condition, without a trial of antitubercular therapy.”  He was famous the world over, yet he was still on call for his ward’s receiving night, and in the subsequent morning ward round would have to make clinical decisions about patients with all sorts of conditions not relating to the chest. 

But as medicine became more super-specialised, the general physician became an endangered species. In addition, the model of care whereby the acute management of ill patients rested solely with junior, sometimes very junior, doctors, could not be sustained.  So general medicine morphed into acute medicine.  Acute medicine has its own college, its annual conference, its research publications, its own department, the acute assessment unit (AAU), and its own textbook, the Oxford Handbook of Acute Medicine.  I’m holding it in my hand now, along with a companion volume, The Oxford Handbook of Emergency Medicine.  Of course the remit of the emergency physician is far wider than that of the acute physician, yet the acute handbook (third edition) runs to 869 pages, as compared to the emergency handbook’s (fourth edition) 749 pages.  The main topics of the acute handbook all appear in the emergency handbook, though not vice-versa.  If the acute and emergency physicians were to amalgamate, then it might be argued that while the acute physicians would need to increase the breadth of their knowledge, then the emergency physicians would need to increase their depth.  So, a challenge for all. 

It doesn’t make any sense to have two work forces operating in more or less independent silos seeing the same, or at least an overlapping, patient population.  Why not merge?  What is the impediment?  Traditions run deep.  Both disciplines would need to surrender a degree of sovereignty.  No doubt the emergency physicians would be frightened of becoming swallowed up by one of the ancient royal colleges, while the acute physicians would be frightened of opening their portals to a tsunami of undifferentiated humanity.     

There’s more bleak news in The Herald today.  “Patients turn to ‘DIY medicine’” and “Health chief warns 500 could be dying each week due to delays in emergency health care”.  One thing’s sure: the status quo is not an option.         

There’s something very odd about Christmas.

But soft!  That could be a song lyric.  It is after all an iambic pentameter.  It might be crooned, in supermarket aisles, by Michael Bublé.  On the other hand, perhaps it lacks festive cheer.  There is the suggestion that all is not well, a whiff of bah-humbuggery, reminiscent of the setting, for solo violin, by Schnittke, of Stille Nacht.  All proceeds quite sweetly until the violin comes to rest on an excruciatingly dissonant double-stop, and you come to the realisation that something has gone, societally, hideously wrong. 

Christmas, like the fourth movement of Anton Webern’s Six Pieces, is an enormous crescendo leading nowhere, except to a deafening silence.  Tomorrow, the world will be as abandoned and as deserted as the Marie Celeste.  For all of December we have had to endure wall-to-wall Christmas songs on the radio.  It’s not that I object to the songs individually.  I like Christmas pudding, but would I wish to survive on it for a month?  Of course some of the songs are pot-boilers.  I rather like the Chris Rea one about the guy stuck in a traffic jam.  I thought of it the other day when I took my car into a multi-storey carpark to do some last minute shopping in town.  Big mistake.  I returned to the carpark, punched in my car registration at the kiosk and paid by card (“Thank you, and have a nice day”), and then discovered I couldn’t get out.  Total gridlock.  Hundreds of cars in a low-ceilinged Platz, their engines all running.  I just had to sit and listen to Wham.  But then I thought, I am being poisoned by carbon monoxide and all sorts of evil nitrates.  I swung back into a vacant lot, and went back into the mall to find a coffee shop.

When I got back to my car, nothing had changed.  I conducted a piece of sociological research, involving a perambulation around the carpark, trying to figure out where the bottleneck was.  The Checkpoint Charlie-style barriers at the exit seemed to be on a go-slow.  I started to compose in my imagination a stiff letter to the management of the shopping centre, pointing out that traffic congestion in a confined space is a serious health hazard, and they really ought to lift the barriers and get everybody out ASAP.  I never wrote the letter.  Instead, I took another coffee back to the car, re-joined the queue, and listened to Mr Rea.

Top to toe in tail backs, yeah…

Like a run on the bank, Christmas shopping is a collective hysteria.  The crescendo to Christmas seems to have started earlier this year.  Christmas lights of considerable extravagance bedecking our households, inside and out, were switched on earlier.  That is understandable.  It has been a fraught year domestically and internationally, and now in this winter of discontent we need all the cheering up we can get. 

Take a look at the driver next to me…

I raised my coffee cup in his direction and pulled a face to empathise with him over our shared plight.  He pulled one right back.  An hour later, I reached the barrier.  Of course the barrier took one glance at my number plate and stayed resolutely in situ.  An attendant came over.  “It took so long to get out,” I explained.  I didn’t tell him about the two cups of coffee, and the sociological survey.  If the attendant decided to make life difficult for me, I could only imagine the drivers behind me getting more and more irate.  Fortunately he lifted the barrier, and I got out.

But now I had a headache.  Headache is a symptom of carbon monoxide poisoning, as is mental confusion.  There can be long-term sequelae to such an insult, including decline in cognitive function.  Hyperbaric oxygen is an effective treatment.  I imagined myself dialling 111.  “I’ve got CO poisoning.  You need to dive me.”

“Pardon me?”

“I need to be put into a high pressure oxygen chamber, you know, like, for the bends.”

“Are you saying you’ve got the bends?”  The call-handler would have difficulty locating the appropriate algorithm.  She would be endlessly patient with this latest fruitcake on the line.  The Health Secretary has warned us all not to indulge in risky activity while the NHS is under stress, and here am I, deep-sea diving in the bleak midwinter.

In the bleak midwinter…

Not my favourite carol.  Tends to drag.  Too much snow. 

That’s enough carping for one day.  If I listen to Carols from Kings this afternoon, I might just be able to calm down.

Ich wünsche euch allen ein entspanntes Weihnachtsfest und einen guten Rutsch ins Neue Jahr 2023!

JCC                 

Canterbury remarked to Ms Kuenssberg on Sunday morning that we live in a very unforgiving age.  You make a mistake, he said, and you are absolutely…  I could see him searching for a word.  I consulted the thesaurus of the imagination and addressed the television screen.  Vilified? Demolished?  Cancelled?

…crucified.

Ms K remarked that it was a good joke, and Canterbury, with a trace of a smile, said that it probably wasn’t very funny at the time.  It crossed my mind that the brief exchange, making somewhat light of Golgotha, might come back to haunt him.  It is ironic that he might become an exemplar of the very point he was trying to make.  The Pharisees might take umbrage and crucify him.

But he’s right.  We live in a pharisaic age.  One strike and you’re out.  You make a mistake – actually you don’t even need to err, you just need to voice an opinion at odds with the zeitgeist – and the Pharisees will trap you.  They might not do it to your face.  The generation of vipers has moved on line, trolls trawling the surf, surfing the net, vigilantes on the lookout for misdemeanour, much like the Morality Police. 

There’s a simple solution: switch off the computer, and live your life off-line.  Of course the irony of this statement is that I am making it, sitting at a computer composing a piece which I will shortly post on-line.  It is a truth universally acknowledged that there is nothing intrinsically good or evil about the digital world; it’s what you do with it that counts.  All technical innovations in the field of communications have suffered a reactionary response, from the printing press to the telegraph, the telephone, radio, television, mass media, the movies, the world wide web, and now… Facebook, Instagram, TikTok…

In West Stirlingshire on Friday morning we woke to six inches of snow.  I wrapped up, took a flask of coffee, braved the blizzards, and walked down to Flanders Moss where the blanket of white was completely pristine, save for the prints of deer and rabbit.  The world was left to nature and to me.  There is a beautiful sentence in Thomas Hardy’s The Return of the Native…

The time seems near, if it has not actually arrived, when the chastened sublimity of a moor, a sea, or a mountain will be all of nature that is absolutely in keeping with the moods of the more thinking among mankind. 

Who needs a digital “platform”?

Luddite?  Well, the critical thing is that you remain in control of the on/off switch.  Recall that in 1984, Winston Smith could turn the volume on the telescreen down, but he could not turn it off.  The evil thing about social media is that people, especially young people, feel compelled to stay connected.  They are addicted, much as they might be addicted to cigarettes, or opiates.  Addiction is not an accidental phenomenon.  The entrepreneurs in any business enterprise that thrives on addiction will purify and refine the agent of addiction such that the lag time to the state of dependence is quicker, the “high” headier, the time lapse to need for a booster dose quicker.  The movers and shakers understand what sort of material will grab your attention, and hold it, keeping you glued to a smartphone screen. 

I’m very fortunate that I’m not vulnerable to such enticements.  It is as incomprehensible to me as gambling addiction.  But I mustn’t be a prig.  I’m as prone to addictive ruin as anybody.  I’m partial to an Islay single malt, and fond of the occasional Cuban cigar.  It’s as well both commodities are hellishly expensive.  Incidentally, I was perturbed that the New Zealand government are outlawing tobacco for everybody born after January 1^st. 2009.  Every time you think you are about to attain the age of responsibility, the Beehive in Wellington moves the goalposts.  Terrible idea.  They’ve just created a new black market.  I digress.    

So I’m not convinced by this truism that the digital world is morally neutral.  You have to assess any human activity, not by what it could be, but by what it actually is.  The fact is that the promise of connectivity is a lie.  With each new digital technical innovation we dig ourselves deeper into our entrenched individual silos, content to listen to nothing but the voices in our own echo chamber.  Steven Spielberg remarked the other day on Desert Island Discs that he much preferred the experience of seeing a movie on the big screen in a film theatre, to watching it on a smartphone.  Why?  Because you shared the experience with a community whose individuals might hold views quite different from your own; yet a shared experience offered a possibility of connection, within that community.   

With this in mind I braved the icy conditions yesterday and went into Glasgow to play my viola in a ceremony of lessons and carols.  I’ve been taking part in this particular gig for years, thanks to the kind and generous invitation of my hosts.  With the pandemic, the last time we met up we had to be on-line.  Such a relief this year to be back in the real world.  The church in the west end is unusual in all sorts of ways, not least that, certainly for the lessons and carols, the audience was large and unusually heterogeneous, particularly in age range.  You seldom see such variety in churches or concert halls, in which the grey-haired audience is fast becoming white-haired.  Who will be attending such events a decade from now?  Where is the next generation?  Are they all wired up to their devices? 

It’s bitterly cold out there.  Wrap up!  I remarked to a lady outside Dunblane Cathedral yesterday that conditions were very treacherous underfoot.  She agreed.  She advised me not to have a fall, because there would be nobody to pick me up.  I would die of hypothermia waiting for an ambulance, or even if one turned up, I’d languish in it for sixteen hours outside “A & E” (to use an expression as anachronistic as squills, bleeding or cupping).  She was voicing a concern that has become very widespread in the community: don’t, whatever you do, fall ill, or fall over, because the health service is in dire straits.

During the 1990s I was Clinical Head of the Department of Emergency Medicine in Middlemore Hospital, South Auckland, New Zealand.  The then Health Minister, Bill English, who went on to become New Zealand Prime Minister, visited the department one day, and sat down in my office, not to tell me how to do my job, but to ask me a question.  What do you need?

There’s the difference.

I always suspected that the Thursday 8 pm two minutes’ clap held for the NHS during the pandemic was a load of tosh.  It might just as well have been George Orwell’s “two minutes’ hate”.  The doctors and nurses on the front line were compared to “the few”, who ensured the survival of Great Britain in 1940 during the Battle of Britain.  We were encouraged to clap, while members of the government were partying, flagrantly breaking all the Covid rules.  They were spending millions giving out PPE contracts to cronies who didn’t know what they were doing.  The NHS might have borrowed a line from President Zelenskyy, when Russia invaded Ukraine last February.  The Americans offered him a flight to safety, but he said no, I don’t need a ride, I need weapons.  The NHS might have said, we don’t need applause, we need resources. 

And now that the nurses in England have asked for a pay rise, the government has distanced itself.  The nurses’ union has never called for a strike throughout its long history.  They clearly don’t want to go on strike now.  On the Kuenssberg Show on Sunday their leader Pat Cullen asked to meet with Steve Barclay the Health Secretary in England to work out a deal.  If Mr Barclay did not wish to meet Ms Cullen face to face, then the nurses were willing to negotiate with him through ACAS.  But Foreign Secretary James Cleverly distanced the government from the row, which is apparently only between the nurses and the NHS.  Keep the politics out of health, he said.  Nothing to do with us, gov. 

But the government in England has never previously been shy of telling health care professionals how to do their job.  Five health secretaries ago, Mr Hunt got offside with the junior doctors by telling them how and when they were going to work.  Four health secretaries ago, Mr Hancock, of celebrity fame, got offside with the GPs by insisting they go more or less permanently on line.  Three health secretaries ago, Sajid Javid got offside with the public when they told them to get vaccinated and not “cower” under Covid.  Two health secretaries ago, Thérèse Coffey drew up a masterplan, bullet-pointed “ABCD”, which never got off the back of a fag packet because she was only in post for six weeks.  And now, bizarrely Steve Barclay says his door is open, as is Pat Cullen’s, but he doesn’t want to talk about money.  There is no sign of a meeting getting scheduled.   

Professor Sir Stephen Powis, National Medical Director NHS England, also appeared on the Kuenssberg Show.  Ms Kuenssberg asked him if a strike by nurses could cause patients harm, serious harm, could, ultimately, result in fatalities.  Sir Stephen gave a politician’s answer.  “We are doing all in our power…”  I had rather he had said, “Yes.”  After all, if the nursing profession withdraws its labour and the health of the nation does not suffer, then what’s the point of nursing?  But people who spell out unpalatable truths without qualification tend to get removed from office.  Ms Kuenssberg informed us Professor Powis receives his knighthood this week.  Once you are the recipient of a gong, it becomes very difficult to voice unpalatable truths. 

If the government is not going to sort this problem out, and if the Medical Director is going to restrict his remit to operational matters, then who remains to solve this problem?  It raises the issue, what, precisely, is a Health Secretary for?  If the Foreign Secretary says his cabinet colleague is not there to micromanage the NHS, then surely he is there to resource it.  It cannot have escaped the government’s attention that the NHS is on the brink of collapse.  In England, they are trying to reduce waiting times for out-patient appointments from two years to eighteen months.  There are huge numbers of job vacancies, partly because there is nobody to recruit, and partly because doctors and nurses are leaving in droves.  The hospitals are bursting at the seams.  The focus of the log-jam has moved sequentially backwards from the discharge suite, to the ward, “A & E”, the ambulance bay, and now the community, where the elderly lady lies on the kitchen floor all night with a fractured femur.  Surely in that context, the Minister of Health needs to sit down with the health care professionals and ask them, what do you need?                   

English nurses are the lowest paid in Europe. If the nurses can’t survive without recourse to food banks, then there is a problem.  The government’s solution to the problem seems to be to introduce new legislation banning the right of members of some professions to go on strike.  It doesn’t seem to have occurred to the government that they might not be the solution, they might be the problem.          

About twenty five years ago in Middlemore Hospital emergency department, Auckland, New Zealand, I said to a doctor who I thought might be Chinese, “Where are you from?”  He coloured slightly, and said, “Auckland.”  That was the first time I realised that my question, even if well-intentioned, was fraught with difficulty.  At least I didn’t follow it up with, “Yes, but where are you really from?”

In New Zealand, people enquired of my provenance all the time.  “Do I detect an accent?”  (Actually they said, “Do ah duteect un uk-seent?”)  I would reply, “I don’t have an accent; you have an accent.”  Thus we would josh one another and that was okay.  Context is everything.  It seems that Lady Hussey compounded a problem last week by her persistence; an enquiry became an interrogation.  And I dare say there would be an issue of tone.  I remember seeing a fly-on-the-wall documentary on TV some years ago, when during a palace reception a lady from an African country asked her hostess, a lady of extremely high caste, whether she had visited her homeland.  “Visited it?  I gave you your independence!”  The whole purpose of the documentary was to pick up such nuggets as this, and to broadcast them without comment.  The aristocrats were so tin-eared that they might have watched the programme later and not realised they were being ridiculed.    

The “Where are you from?” question is common in language classes.  An introductory spiel round the table is almost de rigueur.  “Ich komme aus Glasgow und ich wohne in Stirling.”  So far so good.  In Gaelic, people might say, “Who are your people?  Ah yes, I know them.”  Again, context is everything.  But even here, difficulties can arise when one’s resumé continues to unfold.  Marital status – Married/single/divorced/separated/widowed/it’s complicated/no comment!…  Children/ no children…  Student/employed/retired/unemployed…  It can be quite intrusive.  Some textbooks actually remind you that you’re simply practising language and there is no need to tell the truth.  But this I think can backfire.  Rather than saying, “Single, retired, no children, I am a sad old git…” you might be tempted to construct a phantasy world that will spill over into other areas of your life.  At this time of year, for example, you might be tempted to send out a Round Robin circular with the Christmas cards: “Jack loves Gonville and Caius as much as Ophelia does Brasenose.  Letitia had time to scale Everest during her Nepal gap year…”    

The trouble with “Where are you from?” is that it can be code for “You are not one of us, are you?”  I remember when I was a medical student in Edinburgh a consultant physician asked me, “What does your father do?”  I had no idea at the time that he was trying to place me, socially.  I guess he chose a reasonable surrogate for potential social mobility, or immobility.  According to Sir Paul Collier, Professor of Economics and Public Policy at the Blavatnik School of Government, and Fellow of St Antony’s College, Oxford, who gave the annual Bowman Lecture at Glasgow University last week, the two most powerful indicators of life chances are where you live, and what your parents did.  In the UK, to have any chance at all, your parents had better have gone to University, and you had better live in the South East of England, or the East of Scotland.  I don’t think he was referring to Hastings, or Thurso; rather London and the Home Counties, and Edinburgh, the centres of power. 

Sir Paul’s special area of interest is in regions of extreme poverty across the world.  (He included his own home town, Sheffield.)  Why can’t they escape the cycle of poverty?  Incidentally, Sir Paul’s own life chances may not have looked particularly rosy when he were a lad.  Not only did he come from Sheffield, both his parents left school aged twelve.  Now he is an academic in Oxford, advising such august bodies as the IMF, the World Bank, and the Minister for Levelling-Up.  He attributed his own success to the post-war Prime Minister Clement Attlee, a modest man, according to Churchill, “with much to be modest about.”  I have a notion Churchill also described him as “a sheep in sheep’s clothing.”  Yet Attlee’s government founded the welfare state, despite the fact that post-war Britain was bankrupt. 

Sir Paul’s graphs depicting the gap twixt rich and poor in the UK were startling.  It occurs to me that in our society, that question, “Where are you from?” is being asked all the time.  This is what an interview for a place in medical school is all about.  They want to know if the candidate is “doctor material”.  In other words, is he, or she, one of us?  Did they go to the right school, have they prepared a faultless “personal statement”, were they groomed to pass the UK-CAT test, have they got umpteen A* A-levels, did they find a cure for cancer during their gap year, above all, do they, at interview, sound like a doctor?  Yet the end product of this exhaustive and exhausting process is a health service on the edge of collapse, with burnt-out professionals leaving the sinking ship in droves. 

Talking of sinking ships, Sir Paul compared the UK to a sailing dinghy.  A sailing dinghy has two conditions of equilibrium – one when it is sailing, and one when it is capsized and upside down.  Sir Paul considers the UK to be in the latter state.  He did not mince his words. 

Yet he was not without hope.  Even if the antiquated institutions of the UK are no longer fit for purpose, if they ever were, people needed to be empowered to solve problems at a local level.  I thought of this when I heard a lady on Friday’s Any Questions, a nurse of 40 years’ experience, ask the members of the panel, given the dire state of the NHS, what they would do about nurse recruitment and retention.  After the panel had had their say, the chairperson returned to the questioner and asked what she would recommend.  Answer: a £500 bonus, bursaries, a pay deal in line with inflation, on-site nursery facilities, subsidised meals, and subsidised car parking.  As a doctor, nine times out of ten, all you need to do is sit and listen, and the patient will hand you the diagnosis on a plate.  I hope the government was listening.       

In my German conversation class at the Goethe Institut we have a weekly slot in which a member of the class gives a Vortrag or lecture on a subject of their own choosing.  It is generally a light-hearted and interactive affair.  The element that differentiates a conversation class from a more traditional language class with its accent on grammar and syntax, is that the conversation can go off at a tangent into unknown and unpredictable regions, for which you can’t prepare.  For „Jims Vortrag“, for example, we each had to bring along a paperback book, any book.  “In English or in German?” we asked.  “Any paperback book!” said Jim, with an expression of mock exasperation.

I picked off my shelf, more or at less at random, an ancient and dog-eared paperback of Ian Fleming’s You Only Live Twice.  Now, I mused, would I be required, in the language of managerial break-out groups, to “talk to it”?  Better prepare a few stock phrases.  The title, for example.  I settled for, Nur zweimal lebst du.  Same number of syllables as in the English.  That, after all, is quite important, because the title is the first line of a haiku, or poem of seventeen syllables, which James Bond composes after the fashion of the Japanese poet Basho.

You only live twice:

Once when you are born,

And once when you look death in the face.

Bond’s Japanese mentor in all things cultural, head of the Japanese secret service Tiger Tanaka, enchanted, claps his hands softly.  He scribbles a few ideograms in Kanji to see if the haiku will work in Japanese, but no, too many syllables.  The haiku form is quite strict – three lines of five, seven, and five syllables respectively.  It occurred to me to see if, with a little poetic licence, I could get it to work in German.  I came up with

Nur zweimal lebst du:

Einmal geboren, einmal

Vor Todes Gesicht.

I’m very fond of You Only Live Twice.  It is late Bond, psychologically damaged, bruised and battered Bond who has somehow retained his humanity, and a sense of humour.  It is as much a travelogue, ein Reiseführer, as a thriller.  What else might I be able to tell the class about it?  It is really part three in a trilogy, concerning Bond’s arch-Nemesis, Ernst Stavro Blofeld, the head of SPECTRE.  Blofeld is, naturally, a megalomaniac.  How do you say that in German?  Ein Größenenwahnsinniger, apparently.  SPECTRE is the Special Executive for Counterintelligence, Terrorism, Revenge, and Extortion. 

Der besondere Vorstand für Gegenspionage, Terrorismus, Rache, und Erpressung.

Pithy.

So there we are.  I attended the class, armed to the teeth.  And of course, true to form, the conversation went off completely at a tangent.  I should have known.  Jim did say, bring a paperback, any paperback.  So the content didn’t matter.  His Vortrag was, timeously, a lesson on how to wrap up a book in Christmas paper.  We were issued with paper and sellotape, and directed with close instructions in German.  I really ought to have paid more attention, because I am the world’s worst wrapper of Christmas presents.  Captain Maladroit.  I have this notion that the constituents of parcelling conspire against me.  First, I allow the end of the sellotape on its roll to adhere to itself, and completely disappear.  I can’t find the end, and when I do, I can’t figure out which direction on the roll to direct my gouging fingernail.  If I can get past this hurdle, I generally attempt to cut three generous lengths of tape, and adhere their ends to the edge of my worktop, for subsequent use.  The lengths of tape generally curl underneath the table there to adhere.  Meanwhile I align my book on its sheet of wrapping paper, cut more or less to size, and fold two opposing ends across the front of the book along its long axis.  I pinion this first fold with my left hand, and must now, with my right, extricate the first length of sellotape from the clutches of the table’s underside, and secure the first fold of paper with the tape.  This is of necessity a one-handed manoeuvre, and it has to be my right hand, because I am an incredibly right-handed person.  Truth to tell, my entire universe is right-handed.  I won’t say I suffer from spatial neglect.  I wouldn’t go that far.  I know the left-hand side of my world is there.  I just don’t pay it too much attention. 

There are various things that can, and do, go wrong, in the transfer of sellotape from table to book.  Generally the sellotape attempts to adhere to itself.  The adhesive is so strong that this is a terminal event, requiring a fresh start.  If I can get the sellotape to the paper in an uncurled state, the next challenge is to affix the first fold, one-handedly, with the sellotape running parallel to the paper edges.  This I achieve rarely.  But at least, at this stage, the paper’s fixation is serviceable. 

I turn my attention now to the short axis of the top of the book.  This is a complex piece of origami requiring me to infold the two ends of the paper in two triangular shapes, then to fold the rest of the length over the top of the book, then to repeat the pernickety task of transferring sellotape to paper.  It becomes clear at this stage that I am using too much paper; there are redundant wrinkles and creases, and the inner aspect of the paper is visible, like the underwear of somebody who has dressed too hurriedly. 

Repeat stage two, at the bottom end of the book. 

An absolute pig’s breakfast.  Jim told me as much.  I handed the wrapped book on to the class teacher, who double-wrapped it, perfekt. 

I can’t say I’m too phased.  Maybe I’m just not that interested in Xmas wrapping.  I do as little DIY as possible and I hope never to assemble another flat pack.  I was complaining to somebody the other day about my clumsy ineptitude, railing about the sullen recalcitrance of things, and they replied, “What are you talking about?  You play the viola, you can stitch people up!”  True enough.  This profession of incompetence, it’s really an affectation, like women who say they can’t do mathematics.  I said to another friend on another, other day, “D’you know, I’ve never done a jigsaw in my life.” 

She said, “Do I sense a certain pride in that assertion?”

“Ah!” said I.  “You see through me.”                                       

COP27 ended, two days late and at dead of night, not with a bang, but a whimper.  The gavel was thumped, and there was a smattering of uncertain and disconsolate applause.  The remaining delegates looked utterly exhausted.  Alok Sharma had been emotional in Glasgow at the end of COP26; now he was beside himself with rage and frustration.  “Emissions peaking before 2025, as the science tells us is necessary.  Not in this text!  Clear follow-through on the phase down of coal.  Not in this text!  A clear commitment to phase out all fossil fuels.  Not in this text!  And the energy text, weakened, in the final minutes.  Friends, I said in Glasgow that the pulse of 1.5 degrees was weak.  Unfortunately, it remains on life support.”  Well, Greta said it would be a greenwash. 

I wonder about the way our politicians negotiate.  Well-known clichés are iterated, and reiterated, at international summits.  “This is going down to the wire.”  “Nothing is decided, until everything is decided.”  “We can walk away!”  “No deal is better than a bad deal.”  It’s brinkmanship, waiting for the other guy to blink first.  Such tactics are based on the received wisdom of entrepreneurs who have struck it rich through “the art of the deal”.  In business, you make sure your own interests are protected, and if the other guy goes to the wall, well, too bad.

But the Conference of Parties is, or ought to be, different.  I’m always suspicious of another frequently reiterated cliché, “We are all in this together” – that’s what George Osborne said before Austerity Marque 1 – but this time it’s true.  We might have said in Glasgow, “Hi’ wan, ye hi’ us aw!”  The trouble is that we are trying to tackle a global emergency using the sorts of negotiating tactics that would have been favoured by Bismarck and Disraeli. 

I can understand the frustration of the climate activists, though I can’t see that daubing a Monet with mashed potato, or pouring tomato soup over a Van Gogh, or gluing yourself to a train, or stopping a woman in labour from going to the maternity unit, contributes much to the debate.  Indeed, it is counterproductive, because it only makes the average man in the street conclude that the activists are weird, and to be avoided at all costs.  Still, I don’t think the government should be rushing through legislation further to curtail the activities of demonstrators.  If somebody is inflicting criminal damage, or committing a breach of the peace, they are already breaking the law. 

My impression is that the Westminster Government does not really believe we are in a pickle.  Doubtless, collectively, the members of the cabinet believe in Climate Change, but it does not appear that they believe in Climate Catastrophe.  That Mr Sharma was demoted from the cabinet just before COP27, and that Mr Sunak was originally minded not to go to Sharm El-Sheikh – the autumn statement at home was more important – would suggest as much.  Yet Mr Guterres has told us not only that we are going to hell in a handcart, but that our progress thereto is accelerating.  That would suggest that the human species, collectively, is committing suicide.  Lemminglike?  Another cliché, which does the lemmings an injustice.

But why should we knowingly and willingly hurl ourselves over a precipice?   The answer must be that our gut instinct is that we are not in danger, because – putting isolated incidents around the globe to one side – the danger is not immediately apparent.  A similar phenomenon is observed in human pathophysiology, when the organism adapts to a recurring insult, in order to preserve le milieu intérieur.  Let’s say the patient is bleeding.  A whole host of physiological mechanisms will kick in to maintain the pulse and blood pressure.  You adapt, adapt, adapt… and then quite suddenly you can no longer adapt.  You “decompensate”.  The blood pressure drops, catastrophically.  You only believe it is happening, when it happens.  And by then it is too late.

You can well understand how difficult it is for the affluent to perceive how far along this curve they may have travelled.  There is, after all, something self-justifyingly reassuring about a condition of prosperity.  It feels right, to be comfortable.  This is why it is more difficult for a camel to pass through the eye of a needle, than for a rich man to enter the kingdom of heaven.  The rich man thinks he has already arrived.  All that is left for him is to flaunt his wealth, in a demonstration of conspicuous consumption.  As Ben Jonson puts it in Volpone –

…and, could we get the phoenix

Though nature lost her kind, she were our dish.

Musically, a punishing schedule last week, with rehearsals of the Dunblane Chamber Orchestra on Monday, Wednesday, and Friday, for a concert on Remembrance Sunday.  We played Handel’s Music for the Royal Fireworks, Mozart’s Haffner Symphony, and, a first for me, a concerto for accordion and orchestra, “In Liquid”, by the contemporary Danish composer Martin Lohse.  It became apparent on Wednesday evening that the soloist, BBC Radio 3 New Generation Artist Ryan Corbett, is an extraordinary talent.  In the atmospheric last movement of the Lohse, music perhaps reminiscent of Arvo Pärt, the soloist appeared to enter a kind of trance.  You could have heard a pin drop.

Then on Thursday after my German conversation class in the Goethe Institut in Glasgow I popped into the Kelvingrove Art Gallery in time for the organ recital.  Lots of lollipops – the adagio from Bruch’s G minor violin concerto, Dvořák’s Humoresque, the Grand March from Verdi’s Aida, and the Toccata from Leon Boëllmann’s Gothic Suite.  You can play anything on the organ and, in the right hands, it will sound great.  It occurred to me that the same could be said of the accordion, a kind of portable organ. 

At some stage on Thursday, I think I must have eaten a piece of dodgy crumpet.

To the baths in Stirling for a sauna and a swim.  I glanced at myself in the changing room mirror.  “You’re a wee bit peely-wally!”  The symptoms of staphylococcal food poisoning can come on very quickly.  I became unwell on the drive home.  I focussed on the job in hand and got to within three miles of my destination.

Road closed.  Sod’s Law.  I pulled over.  Now what?  I had no alternative but to take the long route home.  I took a deep breath and got going.  Concentrate!  In the commercial aviation world, there is a rule that pilot and co-pilot must never eat the same item on the lunch menu.  Nausea is debilitating for a whole variety of reasons, not least that it interferes with perception.  I had the odd feeling that in the gathering darkness the milestones of my alternative route came around much quicker than usual; even so I didn’t make it.  A further stop was required.  Eventually I limped home, went to bed, and slept for twelve hours.

On Friday I was washed out, but I really wanted to hear the accordion again.  I struggled along to rehearsal.  “Wie geht’s?” asked a viola colleague.  “Nicht gut.”  I explained the situation.  “Schwach, wie ein Kätzchen.”  Weak as a kitten.  She said, “Always avoid dodgy crumpet!”  Incidentally, I’ve just finished reading Ian McEwan’s latest, Lessons, a biography of someone who happens to be contemporary with McEwan, and who leads a rather chaotic and perhaps even aimless life against the backdrop of cataclysmal world events – the Cuban missile crisis, Chernobyl, the fall of the Berlin wall, Covid, climate change…  The protagonist’s first wife is German, a writer, so there is a smattering of German throughout the book.  Each utterance is followed by an English translation.  I would hazard a guess that that was an editorial decision.  We whose mother tongue happens to be English are not encouraged to gain fluency in foreign languages.  At school, we were taught foreign grammar fastidiously, but never learned how to order a cup of coffee in Paris or Berlin.  At the Institut, nobody seems to mind that my genders and cases are all wrong, so long as I get the meaning across, and get the gist of what is coming back, by recognising a few phrases and filling in the gaps in my imagination.

In my spaced-out, convalescent world, I decided it was better to keep going than to sit and moulder at home.  On Saturday, to the Glasgow Royal Concert Hall, and the Sir Alexander and Lady Gibson Memorial Concert, a performance of Benjamin Britten’s War Requiem.  I’ve known the War Requiem for a long time, because at school I wrote my Sixth Year Studies English dissertation on it.  The connection with Eng Lit was of course the settings of Wilfred Owen poetry.  The culmination of the War Requiem is the setting of Strange Meeting.  Owen’s poem has a couplet:

I would go up and wash them from sweet wells,

Even with truths that lie too deep for taint.

For reasons best known to the composer, he changed this latter line to:

Even the sweetest wells that ever were.

I remember pointing this discrepancy out to my English teacher, who read the line aloud and said, “Yuck.” 

I was always a bit ambivalent about the music, like the curate’s egg, I thought, good in parts.  I’m more inclined now to admire it as it is.  And conductor Thomas Søndergȧrd was ever musical.  His interpretation had a chamber music feel throughout.  And the RSNO Youth Choruses were magnificent. 

Remembrance Sunday.  To Dunblane Cathedral.  I managed the two minute silence without keeling over.  On to the concert.  I shared a desk with a professional violist.  It doesn’t half lift your game.  She used to play violin but at some stage crossed the floor.  As she put it, “A mid-clef crisis.”  The concert went well.  The soloist played two encores – Mendelssohn and Bach.  Quite magnificent.  I have a bad habit of saying after each DCO concert, “I really must keep practising!”  Then the viola, well, she lies dormant in her case (nota bene she – die Bratsche – feminine) until the next time.  But this time I’m inspired by an accordionist who makes his own arrangements of great classical music.  Time to get out the Bach cello suites and fiddle partitas, transposed to the alto clef.                     

Greta was on the Vine Show last week on BBC Radio 2.  As one of the world’s most influential women she is easily identifiable by first name only.  So used to the obfuscations of government ministers as we are, her directness was a breath of fresh air.  Jeremy was asking about the early days, of sitting outside the Swedish Parliament with the home-made “school strike for climate” placard.  Didn’t her school friends urge her to lighten up?  She laughed.  “I didn’t have any friends. I was a geek.”  What about her teachers?  Were they worried about her?  “They just ignored me.  I was invisible.”  At what point did she realise she had become a celebrity?  “We don’t have a celebrity culture in Sweden.”  When she said that, I was reminded of a certain high court judge from New Zealand who was drafted in by Westminster to lead an enquiry into historic sex abuse in high places.  How would she cope with the Establishment?  She didn’t understand the question.  “We don’t have an Establishment in New Zealand.”  For whatever reason, the judge changed her mind about the enquiry and went home.

Matt Hancock, who, at least according to the title of the TV programme he has joined, thinks he is a celebrity, has jetted off to Australia apparently to devour the reproductive organs of kangaroos live on air.  It was really the Japanese who inaugurated this particularly gruesome form of reality TV.  The late Clive James used to show clips of the citizens of Tokyo being suspended in a tub of maggots and, just as there was an ironic remove in having Margarita Pracatan close his show, the predilections of the Japanese were viewed through a prism, and at a distance.  How can these people be so bizarre?  Now we’ve caught up.  Some people are angry with Mr Hancock because he has gone off on a media junket while an enquiry into the Westminster government’s management, or mismanagement, of the pandemic has started.  People died as a result of government policy, and the erstwhile Minister of Health has disappeared into the jungle.  Personally I got angry with Mr Hancock quite some time ago, when he instructed the GPs in England to use Zoom as the default mode for GP – patient interaction.  Consultations would remain remote.  “No more going back to your bad old ways,” he said.  This was before he resigned, having broken Covid rules.                 

Jeremy asked Greta about Cop 27, in Sharm El Sheikh.  Should King Charles have gone?  Should Rishi go?  She made diplomatic noises about conflicting priorities.  Should Boris go?  She giggled.  There was quite a lot of giggling. I think she has lightened up, without compromising her position.  In fact she has “created” a book – The Climate Book (allen lane 2022), a comprehensive compilation of short essays by climate scientists and other interested parties, about the state of the planet.  I popped out to Waterstones and bought a copy.  It is a sobering read.

I don’t think Greta is going to Egypt.  I think she’s given up on big movers and shakers.  Bla bla bla.  My guess is she is with George Orwell – If there is hope, it lies with the proles.  So her “creation” is, I think, an attempt to galvanise popular opinion in order to drive the politicians to act.  A kind of trickle-up effect, if you like.  I was relieved to hear she still holds a stake in the game.  There was a time when we didn’t hear much from Greta.  I didn’t know whether she had fallen silent, or whether the media moguls had chosen to cancel her.  Frankly I was worried that her silence implied we had crossed a tipping point, or, as they might have called it following the Paris Accord, “un point d’appui”.  Greta had given up because there was no longer any point.  But no.  Limitation to an increase in global temperatures of 1.5 degrees may be a missed opportunity, but every 0.1 degree rise is worth resisting.  In other words, we are no longer staving off disaster, but striving to mitigate it.

Do you remember the spring of 2020?  The world closed down and everything came to a grinding halt.  Life became very simple.  You held yourself aloof, stayed at home, and occasionally went out to exercise or get provisions.  That was it.  It sounded very miserable but in fact we all began to notice certain benisons.  The absence of industrial noise.  Little traffic on the roads, and none overhead.  Birdsong.  Profound silence.  And a breathtakingly beautiful spring.  We all said, “Let’s not forget this.  We mustn’t go back to our bad old ways.”   

At noon, Jeremy Vine has taken to summarising his show in four words, reflecting the four topics to be covered over the next two hours.  “Chancellor Drug Nose Badger”.  Or “Energy Racers Strike King”.  I jot them down, thinking they contain some arcane secret message, of the sort that London might have broadcast to the Resistance in Nazi-occupied France.  “This is a message for Pierre in Dieppe.  Greta Hancock Celebrity Kangaroo”.  Perhaps they are crossword clues.   

Is it just that I am entering my dotage of disgruntlement, or has the BBC, aged 100, become utterly puerile?  I gather that Radio 4’s Today programme has lost 600,000 listeners in the blink of an eye.  They appear to have defected to Radio 2 and the Zoe Ball Breakfast Show.  I used to quite like Zoe on telly’s Strictly – It Takes Two.  But I confess I can’t listen to the Breakfast Show.  How can anybody be this relentlessly upbeat?  Particularly at that time in the morning.  The BBC has dumbed down.  It has opted for the amusing over the serious, and as a result is neither amusing nor serious.  The funniest thing to me about Have I got news for you is that I can sit through it with a stony face.  Lord Reith must be turning in his grave.  But I don’t think the controllers will much care.  They will echo the words of Winston, when Reith once left a meeting in high dudgeon.  “There goes the Wuthering Height.”