jamescalumcampbell

Scotland’s central belt got a huge dump of snow on Thursday night and Friday morning.  We woke to a world that was very beautiful, muffled, silent, hunkered down.  I put on my boots and walked down to Flanders Mass on the Carse of Stirling.  I only saw one car, and the driver kindly pulled up to offer me a lift, but I said I was out for the walk.  We agreed the winter wonderland was entrancing.  After that, I and the horses and alpaca had the world to ourselves.  A track leaves the road and heads west towards the Moss for about a kilometre.  There were six inches of snow, utterly pristine.  At that time there weren’t even any tracks in the snow from wildlife.  As the rather dreich carol puts it (five verses – best keep the tempo up) “Snow had fallen, snow on snow.”  I think of it as a concrete, or perhaps more accurately a crystalline, poem:

Snow

Snow         snow

Snow

Snow…

Two squadrons of wild geese flew in low and in tight formation, fussing and caterwauling.  They performed a ceremonial fly-past and then landed with precision and consummate airmanship.

Winter’s not gone yet, if the wild-geese fly that way.

So the world holds her breath.  Because, I suppose as a matter of chance, the earth has a declination of 23.45 degrees, we have seasons.  Recently the northern hemisphere has been tilted away from the sun, hence on Dec 21 we had our shortest day.  As the earth’s orbit continues inexorably, the days begin to lengthen, though in somewhat asymmetric fashion.  While daylight expands, dawn remains gloomy.  Still, already we have a sense that we have tilted.  We have crossed un point d’appui.  Perhaps that is why this is the season for reviewing the past, and anticipating the future.  Resolutions?

It’s built into the human condition to strive for improvement.  Next year will be better. Next year I will be better.  Superficially, it may just be a reaction to the excesses of the Christmas season, sloth and gluttony.  So, from the post-prandial perspective of Christmas and New Year, we resolve to have an abstemious January, join a gym, work on the abs and glutes, abjure tobacco, eat 5-a-day (or is it 10?) – you can see how the list gets longer and longer.

Yet, I fancy for most people, resolve goes deeper than this.  In my work, how often did I hear people say, “If I had to do it all over again, I would do it quite differently.”  They are not talking about some minor adjustment, fine-tuning, a little tweak here and there; they are talking about some change so fundamental that the resultant life they would have led would have been unrecognisable.  This idea of fundamental change runs very deep in our culture.  Nicodemus visited our Lord by night and asked what he needed to do.  It turned out that he had to be “born again”.  Imagine that.  Not merely a complete rebranding.  No, more than that, for this has not merely to do with style, but absolutely with substance.

When I was young, I was desperate to metamorphose. It was my ambition to go to bed one night a grub, a caterpillar, and wake up a butterfly.  I would slough off the noxious slimy straitjacketed integument of my life and change, utterly.

But how?

How?

Like Pierre Bezukhov in War and Peace I would explore walks of life in search of answers.  I dallianced with freemasonries.  I would learn to fly.  Literally.  I had a fantasy picture of myself as a kid in jeans and T-shirt sitting on the wing of a Spitfire being interviewed by the BBC.  I was telling the outside broadcaster from Tonight about the occasion that changed my life.  “It was such a small thing,” I said.  “I’m not even sure that I recognised its significance at the time.  And yet it changed my life for ever.  And I never looked back.”

Back to Cliff Michelmore in the studio.  And that’s Tonight for tonight.  The next Tonight will be tomorrow night.  Good night.

I still await my Damascene experience.  Yet oddly enough, by some strange act of grace. I’ve recently been freed from this notion that I am condemned to fall short, that I am always, like Richard Carstone in Bleak House, about “to begin the world”.  I owe a debt of gratitude to Medicine, and its daily practice.  If I had to do it all again – would I do it differently?  Flawed as I was, I did it differently the first time.  And now?

Next year, Jerusalem.

Somebody asked me the other day for an example of an oxymoron, and I suggested, “Safe sex.”

Oxymoron oks-imo’ron, n. a figure of speech by means of which contradictory terms are combined…

Safe sex is, in my opinion, the oxymoron of our time.  I was sharply reminded of this fact on Friday when I saw a letter in The Herald headlined “The decision to allow abortion pill at home must be stoutly defended”.  The letter had 17 signatories, each one acting in a stated official capacity (giving the letter an air of authority), and the signatories’ address was given as Marie Stopes UK, c/o 18 Ashwin Street, London.  The letter was a response to news that the Society for the Protection of the Unborn Child (SPUC) intends to mount a legal challenge to the decision of Scotland’s Chief Medical Officer, Dr Catherine Calderwood, to enable women, for whom it is clinically appropriate, to take Misoprostol – the pill that completes an abortion – at home.  Dr Calderwood’s decision has been supported by Lord Steel who of course was instrumental in introducing the Abortion Bill in 1967.

Misoprostol is taken twice.  At the moment, patients receiving the treatment have to attend hospital twice.  The result of this arrangement is that women may well start to abort while travelling on the bus.  It is legal for women to take misoprostol at home but only if they have suffered a spontaneous miscarriage.  However this does suggest that home administration is medically safe.

I can’t think that SPUC has a case here.  The thing is, once society has concluded that termination of pregnancy is, under certain circumstances, a legitimate medical procedure, surely the issue as to where the procedure is carried out diminishes in importance.  I can only imagine that SPUC take issue with the notion of home administration because it may appear to afford the procedure of termination of pregnancy a certain casualness.  One takes misoprostol as one might take emergency contraception (the morning-after pill) – now available without prescription – and one takes the morning-after pill as one might take the pill.   No doubt SPUC will be aghast at this sentence in the Herald letter: “Abortion is vital, routine healthcare that around one in three women will experience in their lifetime.”

I was very surprised at that statistic.  Given the weight of 17 signatories, I imagine it must have an evidence base.  It does rather suggest that contraception, as a public health initiative, isn’t very successful.

I suppose it is a little perverse of me to be discussing abortifacients on the day of a Nativity.  This is the time of year when the aggressive secularists can be particularly strident – angels, wise men, virgin births – I ask you!  I hadn’t thought to blow the dust off my viola and play at the annual ceremony of lessons and carols, but J is very persuasive and I was there.  What can the idea of a virgin birth mean?  I refer you to Hugh MacDiarmid’s enigmatic poem O Wha’s the Bride?

Wha didna need her maidenheid

Has wrocht his purpose fell.

Every birth is a virgin birth.  Birth, and continuity, in the face of the second law of thermodynamics, is the most extraordinary miracle in all creation.

I think the greatest change in social mores I have seen in my lifetime has been in the attitude towards sex.  Contraception became available in 1960 and termination of pregnancy in 1967.  Of course the 60s is thought of as a time of great sexual liberation. The 60s spawned “the permissive society”.  It was perceived as a time of great freedom because the pill annulled – for those who partook – the possibility of pregnancy, and antibiotics provided a sure-fire treatment for sexually transmitted diseases such as gonorrhoea, syphilis, and chlamydia.  Herpes was not yet recognised to be the nuisance it was, nor human papilloma virus, and HIV was yet to be invented.

I imagine it must be difficult for young people now to imagine life as it was for us in the 60s.  To fall pregnant out of wedlock at that time was a great disgrace.  The options available to people in that situation were limited.  Termination of pregnancy was illegal and, unless one had money and connections and were able to travel abroad, extremely hazardous.  I recall in Glasgow in the mid-60s there was a home for unmarried mothers on the corner of Clevedon Road and Clevedon Drive in the west end of Glasgow.  I know this from two sources, first because for a time my family lived 200 metres from the home, and second because my school pal Billy was the son of the people who ran the place.  I just remember seeing on my daily walk to school heavily pregnant young women standing at the street corner smoking a cigarette, looking as if a truck were about to run them over.

Much of this backdrop came to my mind this week when I met up with a dear friend of mine who has two daughters currently making their way in the south of England.  One of them recently had a date with a young man who, following the assignation, was disposed to ask, by text, for feedback.

Feedback?

Feedback?

Do you suppose the feedback was to be in free text or were a series of highly particular points pursued?

1. Initial greeting.  Was the gentleman warm and welcoming or was he cold and evasive?  Answer 1- 10 – 1: very cold, 10: very warm.
2. Preliminary chat. Did he deftly deal with any unforeseen social awkwardness and did he make you feel at ease as the evening commenced?  Answer 1- 10 – 1: very awkward, 10: at ease.
3. Did he give you free rein to peruse the menu or did he, in the style of a foodie Fascist, tell you what to eat? (Answer 1 – 10 – 1: Fascist, 10: liberal.)
4. Was he polite towards the “wait person” or did he treat them with complete disdain? (1 – 10 – make it up.)
5. During the meal, was he completely absorbed with his own preoccupations or did he show genuine interest in your own passions?
6. If something untoward happened in the vicinity, say somebody at the next table with Tourette’s kept shouting ****! – was he discombobulated?
7. You had an entirely unpredictable reaction to the fish entrée requiring the emergency attendance of paramedics and the administration of epinephrine and steroids. Was he supportive?
8. Did he betray a sense of revulsion when you threw up?
9. Did he try to kiss you?
10. Did he pay?

On the subject of osculation I have some observations.  There can be no doubt that the whole dating scenario has become extremely hazardous for the young man.  Given that a member of parliament might be faced with the accusation, “He put his hand on my knee 25 years ago”, how is a young man to proceed?  I am only reiterating something a very charming young lady in a bikini said to me the other day in the sauna in my local gym.  She was supine on the sauna’s upper tier when I entered, but she quickly sat up.  I said, “Do not derange yourself on my account,” but she insisted, and we went on to have an interesting conversation.  She said, “I’m not sure what the health benefits of sauna might be”, and I, “I’m not sure there is evidence of any, but so long as you don’t stay in too long, it’s very pleasurable.”

“Of course, if we were in France or Germany, we would both be naked.”

Aye aye.

But on the subject of kissing, I seem to recall Jeremy Vine did a piece on his show in which he posed the question of whether it would be appropriate for a chap to ask permission of his date to kiss her.  There seemed to be general agreement that such a strategy would be liable to kill spontaneity stone dead.  This all reminded me of the Merchant Ivory film of E M Forster’s A Room with a View.  Lucy Honeychurch, an upper-middle class English girl played by Helena Bonham Carter, is on holiday in Italy, where she encounters, in the same pension, one George Emerson, played by Julian Sands, whose passion for her she initially abjures.  Lucia is a pianist of some ability and when a parson, played by Simon Callow, hears her play Beethoven’s Appassionata Sonata (or as it the Waldstein?), he says (I paraphrase), “If Lucy lives as she plays, then we may expect fireworks.”  We have the sense that Lucy is repressed by convention.  She has a suitor, Cecil, played by Daniel Day-Lewis, who becomes her fiancé, and who, enraptured by her performance of Schubert, attempts to kiss her and only succeeds in dislodging his glasses.  Contrast this with George who, seeing Lucy on a flower-strewn Italian hillside, is moved to embrace her and unsolicitedly kiss her with great passion.  That this scene should be accompanied by Puccini’s Chi il Bel Sogno di Doretta gave it an emotional power I am incapable of expressing.

Was he right to risk it?  The fact of the matter is this: if it’s welcome, it’s right; if it’s not welcome, it’s awful; and that is the essential dilemma a young man faces, and why the entire enterprise is so filled with dread.  Young men understand instinctively that there is no such thing as safe sex.  People who try to peddle it are just bizarre scout commanders and matrons of an adolescent boot camp introduction to “sex”.

E M Forster wrote a brief epilogue to A Room with a View in which he tried to envisage how the characters would be some years down the track. I think Lucy’s husband George went on to have an affair, but then there was a war on. Beethoven being German got a poor press.  I recall Peter Cook and Dudley Moore doing a sketch about Beethoven.  Dudley Moore was a young pianist playing the Moonlight Sonata.

“That music you are playing, Jeremy, is by Beethoven…

“Beethoven was German…

“That’s something you are going to have to work out…

“Later on.”

Jeremy needn’t have worried.  Lucy’s failed suitor Cecil assures us; Beethoven was Belgian.

 

 

 

 

Got a phone call from my West Highland agent.  “James!  I’ve got a treatment for your next book.”

“Make your pitch.”

“Landfill.”

“Is it a sequel to Skyfall?”

The movie trailer voice-over was rendered in an impossibly deep, gravelly, mid-Western tone.

The ocean depths spawned the kraken;

Transylvania sent us the undead;

Martians visited us from the red planet;

And from beyond our galaxy, our worst nightmare…

But now looms a new threat

Stirs a creature of our own making

Yet, beyond our imagination,

Here with us, now

Beneath our feet…

Landfill.

He dropped the accent.  “What d’you think?”

“It’s a million dollars.  Run with it.  Kerching kerching.  But listen.  It’s your Landfill, not mine.”

“There’s something down there, I know it.”

“Of course there is.”

“Miramax will snap up the film rights.  It’ll be huge.”

“Ace in the hole.  Cash in on it.  You don’t need me.”

“I need you, James.  You can do this.”

“Yes I could do it, but it would become a spoof.  And let’s face it, it’s no laughing matter.”

I’m rather concerned about landfill.  I’m trying to take my recycling more seriously.  We have five rubbish bins – green: paper and cardboard; blue: plastics, cans, and cartons; brown: garden waste and foodstuffs; blue box: glassware; and grey: non-recyclable items, that is, landfill.  Four of the receptacles are each in their own way rather picky and fastidious.  Green: no plastic bags or bubble wrap, polystyrene, wrapping paper, or disposable cups; blue: no hard plastics, batteries, or electrical items; brown: no non-organic material; blue box: no broken glass.  But grey bin: the grey bin has a capacious maw and will seemingly take anything.  Now I don’t think that’s right.  In an ideal world we wouldn’t need a grey bin at all.

I’m actually short of a brown bin at the moment.  Last April it vanished.  I suspected, uncharitably, that somebody in the street had nicked it, but I guess it could just as easily have been swallowed up by the refuse disposal van.  Anyway I phoned the council at the time.  “Rest assured, Dr Campbell.  We will put a new brown bin by your door.”  It hasn’t appeared.  I phone them periodically. “Oh yes we have logged your calls.  This is quite unacceptable.  I’ll get this sorted for you.”  This saga has been running for eight months.  I even offered to drive in and pick a brown bin up but that is, apparently, out of the question.  My trouble is I’m too polite and self-effacing.  “Sorry to bother you.  I’ve been on the phone a couple of times.  Would it be possible to chase up…”  I need to take some lessons from movers and shakers who know how to put a rocket under somebody.  “Aye yes Dr Campbell here.  No no no – you see, you don’t understand – this has gone way beyond a joke.  Your name?  How do you spell that?  Who’s your line manager?”

But I’m not really irate, more fascinated in a sickly way.  I’d quite like to get to the bottom of the process that is currently going on, or not going on, to understand the cause-effect relationships.  I suspect there is a management protocol at work.  It will be in the form of a digital algorithm, with multiple potential steps to be taken.  Perhaps I’m half way down a cascade shaped like a Christmas tree.

So what have I been doing in the interim?  I’m afraid some of my organic detritus has gone into landfill.  I may well be the route-cause of the next great apocalyptic cataclysm to threaten mankind.  I’ve also manifested cuckoo-like behaviour and furtively added my detritus to the neighbours’ brown bins.  I don’t like to do this because I myself get irritated when people top up my grey landfill bin.  Last week I got home and opened the bin at the kerb to see if it had been emptied, only to find somebody had stuffed in a child’s pram.

My other option is to drive seven miles to my nearest local tip.  That’s fine – visiting the tip does have a recreational side.  I’ve heard it said – doubtless this is fake news – that some east-end Glasgow families regard a visit to the tip as a great day out.  My particular tip is run by a wonderfully helpful if somewhat taciturn wee man.  He is a Dickensian character.  He has an office that he has personalised and turned into a snuggery by decorating it entirely with stuff that was intended for landfill.  Several times he has stopped me on my way to the last skip on the lot and said, “That’s a lovely piece!  Can I have that?”  He is like that character in Our Mutual Friend who is responsible for an enormous mountain of dust.  Our Mutual Friend must be the definitive study of the relationship between money and rubbish.

Of course the other option I have as yet not succumbed to is fly-tipping.  I stop short of that.  I don’t approve of litter.  Yet I come from a city that has a litter culture.  I was standing at a traffic light in Glasgow not so long ago beside a guy who was eating kebabs out of a polystyrene container of the sort that I can’t put into my green or blue bin.  (I could empty the contents into the brown bin, if I had one.)  When the wee green man came on he dropped his entire half-finished dinner on the road and crossed.  I know he was completely oblivious to the idea that this might be a failure of civic responsibility.  If I had taken issue with him he would have been completely gobsmacked.   Oddly enough, I have the notion that if I’d berated him as rudely as possible, he would not particularly have minded.  I might have said, for example, “Oh for ****’s sake Jimmy what the **** d’you think you’re playing at?” and he would probably have taken it as banter, shrugged, and walked on.  On the other hand, if I had taken him to task in an elaborately polite way – “Excuse me sir, I hope you don’t mind my interrupting you, but I think you’ve dropped something.  Would you mind picking it up and depositing it in that receptacle, handily sited for the purpose?” – then I would be in deep trouble and there would be a raucous and potentially violent stand-off in the middle of the road, to the blaring horns of the traffic trying to get by.  Incidentally, I have heard the actor Nigel Havers is on a mission to get people to cut their car engines while sitting in traffic.  Discharging CO2 emissions and diesel particulates is after all another form of littering.  Apparently Mr Havers taps gently on the driver’s door and says, “I’m terribly sorry, but would you mind…”  I would strongly advise Mr Havers not to bring his mission – at least in that form – to Glasgow.  Saying that, if anybody could get away with it, Mr Havers could.  I could even imagine kebab-man looking bewilderedly at him and then stooping to pick the remnants of his dinner.

Litter culture is an index of a lack of self-respect.  And a littered city is like a man who is down on his luck, a professional man who begins to descend the social scale and who loses interest in his personal hygiene, dress, and appearance.  But I daren’t be pompous and sanctimonious about this.  The fact is that homo sapiens is by nature a litter-lout.  Kebab-man merely does in an overt and honest fashion what we all connive to do in secret.  I can’t think that we really take our waste disposal seriously.  We just spill waste into the air or chuck it into the sea or stuff it under the earth and try to forget about it.  I particularly worry about my blue bin – plastics.  Remember The Graduate and the conversations between Benjamin and his parents’ grotesque friends.

“Ben!”

“Mr Maguire.”

“Ben.”

“Mr Maguire.”

… “I’ve got one word to say to you, Ben.”

“Yes sir.”

“Are you listening Ben?”

“Yes I am sir.”

“Plastics.”

A lot of plastics are very non-biodegradable.  They hang around for aeons.  They go everywhere.  You can recover them in the gut of fish.  These small deposits are called nurdles.  Have you ever made yourself a cup of coffee, and a sliver of plastic from the milk carton-top drops into your Americano?  That is a nurdle.

I propose that we take this waste disposal business much more seriously.  We could make it our aim to reduce all waste products to their constituent elemental parts.  That would be a high-tech operation.  It would involve the best brains in physics and chemistry turning their minds to how to detoxify the world.  People who collect and manage waste should be regarded with a degree of deference and respect.

But I’m conscious that there is an element of absurdity attached to the bourgeois habit of hand-wringing at the parlous state of the world.  Last week I chanced to come across Conversations with Menuhin (William Heinemann Ltd 1991).  This is a celebration of the great violinist’s 75^th birthday, and is a protracted conversation between Menuhin and David Dubal, a pianist on the Juilliard School faculty in New York.  It is in two parts: Part 1 on music and musicians (intensely interesting) and Part 2 on music and life (intensely amusing and not in a good way).  Menuhin and Dubal seem in broad agreement that, even in 1991, the world is going to Hell in a hand cart and there is precious little we can do to stop it, that everything is being driven by the carnal instincts of the mob whose insatiable desire for gratification is turning the world into a gigantic rubbish tip.  Popular culture is ghastly.  Interestingly, Donald Trump gets a mention.

Nigel Kennedy does a wonderful impersonation of Menuhin, capturing his horror at Kennedy’s attempt to introduce him to the delights of Heavy Metal.  “Oh Nigel…”

I read Conversations with Menuhin with an inappropriate sense of mirth.  I was reminded of a character in Woody Allan’s film Hannah and her Sisters, Frederick, played by Max von Sydow.  Frederick is an artistic European intellectual living in New York.  He has a Svengali relationship with Lee, a beautiful and much younger woman played by the wonderful Barbara Hershey.  Ms Hershey’s character has benefited much, culturally, from the relationship, but you can tell it is coming towards its end when von Sydow launches into a great diatribe about the state of the plebeian world, and Ms Hershey says, “Lighten up Frederick.”  Frederick gets terribly upset when he realises he is about to lose her, and who could blame him?

It’s a thankless task, being a profit of doom.  It’s almost built into the role, the expectation that nobody will listen to you.  The classical world understood this.  Cassandra was cursed never to be heeded.  People who are pessimistic about the future are dubbed “Jeremiah”.  It doesn’t really matter if you are right; you will always be thought of as an odd ball precisely because you put yourself apart from the relentless onrush of the Gadarene swine.

 

 

 

 

 

 

 

I’ve received a communication from the Electoral Reform Services, containing a letter from the British Medical Association Scotland, a 12 page document entitled “Frequently Asked Questions”, and a ballot paper with the question, “Do you wish to see the proposed new Scottish GMS contract implemented?”  I settled down to read the answers to the frequently asked questions, but I got distracted by pages 11 and 12 which were identical in both bearing a single, deeply mysterious sentence.

This page is intentionally blank.

I’ve come across this sentence before so it is not unfamiliar to me.  I first came across it in RAF standing orders when I was in the University Air Squadron, and I’ve subsequently seen it in Civil Aviation Authority publications.  The aviation world seems a natural home for such a sentence.  The RAF would call it “bumf”.  The question is begged: why?  Why is this page intentionally blank?  I found myself giving this question inordinate attention.

But of course the statement is false; the page is not blank.  The page would only have been blank if the sentence were not there.  I can’t think that a truly blank page would have caused consternation in any quarter.  Blank pages are quite common at the end of a book; are they not called end-papers?  To check this, I’ve just taken a book at random off my shelves.  It is Nobel Laureate Alice Munro’s New Selected Stories (Chatto and Windus 2011), a beautiful volume.  The last story, Free Radicals from Too Much Happiness (2009) ends on page 434 and is followed by 10 blank pages, 8 in white and 2 in orange.  Neither Ms Munro nor Chatto and Windus felt compelled to offer an explanation.

So Chatto and Windus are quite relaxed about blank pages, but for some reason the RAF, the CAA, the BMA and the ERS are not.  It must have something to do with officialdom.  They might have written, “For your convenience, here are two blank pages for your own notes”.  But maybe that’s the whole point.  They are worried about sabotage; some rogue doctor and/or aviator might decide to invent and insert his own standing orders, so the idea is to endorse the pages in the way a reproduction of a bank cheque might be marked “Specimen only”.  They might have written, “Do not write on this page” but that introduces an absurd element.  It reminds me of a picture somebody sent into the Herald Diary column, of a sign bearing the legend, “Do not throw stones at this notice.” Might it have been better to state, in the interests of accuracy, “The obverse of this page is intentionally blank”, and then, intentionally, left it blank?  That still leaves us with the conundrum, what did the writer or editor intend by blankness?

The fact that there are two sides to the page raises the spectre of the philosopher and mathematician Bertrand Russell.  In his three volume autobiography (George Allen and Unwin, 1967) – a compelling read – Russell describes how he wrote on a piece of paper, “The statement on the other side of this paper is false”.  Then he turned the paper over and wrote, “The statement on the other side of this paper is true”.  Then he sat in silence and stared at the piece of paper for eighteen months.  This is the sort of aberrant behaviour fathers write to their sons about when they see them entering a cul-de-sac in pursuit of some forlorn chimera.  “I beseech you, my son, do not waste your substance on wraiths of gossamer.  Play music as a hobby by all means.  But come into the family business and manufacture ball bearings.”  Russell started out thinking his quirky true/false paradox was just a light-hearted parlour trick, but he never solved the conundrum and he came to believe that the entire edifice of human knowledge was built on sand.

Perhaps in a similar vein of scepticism, I started by thinking that the intentionally blank page was just a trivial manifestation of bureaucratic farce, but its persistence goads me; I keep thinking the blank page has a deeper cultural significance for us.  I’ve been struggling all week to think what it might be.

Then I read of the passing of Christine Keeler and, improbably, the jigsaw began to fall into place.  In 1963, an iconic photograph of Ms Keeler appeared in the newspapers.  She was sitting back-to-front astride a very 60-ish vinyl chair, a very beautiful brunette pouting at the camera.  The only thing she was wearing was the chair.  Just in case you don’t remember, Christine Keeler achieved fame, I will not say notoriety, in 1963 when the then Minister of War, John Profumo, had to resign from the government when it was discovered that his assertion that there was “no impropriety” about his relationship with Ms Keeler was an attempt to provide verisimilitude to an otherwise bald and unconvincing narrative.  If I render this in a Gilbertian way, it is only to accentuate the element of farce.  It was said that Mr Profumo had to resign because he “lied to the House”, but I think everybody knew his sin was not that he had lied, but that he had been found out.  He had to go because his real sin was that he had made the upper classes look ridiculous.  I think that even then, child as I was, I realised this when I saw an interview on the BBC between Robert McKenzie and Quintin Hogg, Lord Hailsham.  McKenzie asked the then potential prime minister if (because Ms Keeler was also thought to be involved with the Russian attaché Yevgeny Ivanov) he thought that Profumo’s affair constituted a threat to British security.  Well!  Lord Hailsham went ballistic.  “OF COURSE IT IS – DON’T BE SILLY!”  Shortly after the whole debacle, the government fell and a successor to Harold MacmIllan had to be found.  The two front runners were Lord Hailsham, who was prepared to give up his peerage, and Rab Butler.  I remember seeing Hailsham at a hustings, being confronted at close quarters by a protester bearing a placard.  I don’t know what the placard said but I just remember footage of Lord Hailsham smashing it to bits with either a walking stick or an umbrella.  Whether that did his electoral chances any good I couldn’t say.  Of course the next Prime Minister was Sir Alec Douglas-Home, a Scottish aristocrat of such high caste that one had the sense he was quite indifferent to the premiership and only acceded to it out of a sense of civic duty.  Lord Hailsham was a colourful character, and Rab Butler had the reputation for being politically astute.  But both were polarising personalities and in the end the Conservative Party opted for an invisible figure for whom it might have been written, “This page is intentionally blank.”

The Profumo scandal ran for weeks.  It ran in tandem with BBC’s greatest satirical show, That Was The Week That Was.  TW3’s legacy was this truth, that a governing class can endure anything through two world wars, but one thing it cannot endure, is ridicule.

I know it’s irrational, but any time I see an official publication bearing the statement “This page is intentionally blank”, I conjure a sense of smoke and mirrors, of official subterfuge, obfuscation, and sleight of hand.  Redact, redact, redact.

Every morning I take (sic) The Herald.  Notice I don’t “get” my newspaper, I take it.  By the bye, I don’t take cream and sugar, I “have” cream and sugar (actually I don’t) and I don’t have a good breakfast, I “make” a good breakfast even if I don’t make it myself.  Then I sit with my coffee and read the Letters Page.  What with Brexit and Indyref 2, politics in Scotland at the moment is somewhat polarised, and in an effort to be impartial, The Herald tends to print letters from Camp A en masse on Monday, and then from Camp B on Tuesday.  Then Camp A ripostes on Wednesday, and so on.  People get exercised, and the tone can become sour, at which point, like Monsieur Manette in Dickens’ A Tale of Two Cities, coping with his post-traumatic stress disorder by returning to his cobbler’s last, I turn to the Puzzles Page.  The puzzles are either literary or numerical.  I usually do the literary ones and if I stray into the numerical I know my PTSD is particularly bad.  It’s a form of addiction really.

This morning’s letters are all about Brexit.  A new word has crept into the Brexit lexicon: Brexodus.  It describes the net fall in the UK immigration figures.  The odd thing about Brexodus is its pejorative connotation.  For years the government has been promising to get the immigration figures down to “the tens of thousands”, and for years the opposition has been lambasting it for failing to do so.  Control of immigration is one of the principal Brexit aspirations.  But now that the trend is swinging in that direction there seems to be general dismay rather than euphoria.  How can this be?  The answer lies in the word “control”.  The government wants to control who comes in and who leaves.  They want to cherry pick.  But the Eastern European cherry pickers have made their own minds up and are voting with their feet.  They will reap a harvest elsewhere.

As the negotiations in Brussels proceed, or stall, I predict we will need a whole thesaurus of neologisms.  We could use the Puzzles Page to generate them.  (You know you’re in a bad way when you start to make puzzles up.)  How many Br-words can you coin?  Less than 5 – brexcruciating; 5- 10 – brexiguous; 10 – 15 – brexcellent; more than 15 – brexcessive.

So…

Brexpletive deleted – minutes of the negotiation, redacted.

Brexocet – rebranding of Scud missile.

Brexcalibur – rebranding of Trident.

Brexcrement – exported nuclear waste.

Brex-Cathedra – intervention of Archbishop of Canterbury.

Brexaggeration – £350m weekly to NHS.

Brexorcist – anyone who can get us out of the mess we are in.

Brexterminate – latest Dalek trope or meme

Brexeunt – fall of the government.

You know you’re in a bad way when you start to make puzzles up.  I’ve recently found myself wondering how Sudoku puzzles are generated.  Sudoku is apparently a shortened version of the Japanese suji wa dokushin ni kagiru which means “the digits are limited to one occurrence”.  Even so there are, according to Professor Ian Stewart, 6,670,903,752,021,072,936,960 ways of filling out the typical 9 x 9 Sudoku grid.  I consulted his book Professor Stewart’s Incredible Numbers (Profile Books 2015) hoping to get some hints on how to solve the puzzles, and was somewhat discouraged, though not surprised by his statement, “the methods are too complicated to describe here, and can best be summarised as systematic trial and error.”  That fits in with my experience.  There are usually two Sudokus in the paper, one easy and one difficult.  I find that the easy one can usually be solved by an unbroken series of logical steps; you enter a number into a square confident that no other number will fit.  This added piece of information allows you to enter the next number with the same certainty, and so proceed until the grid is full.  The only potential snag is to make a mistake through carelessness.  You discover it further down the track and then the whole thing becomes difficult to unwind because you can’t identify when and where you made your mistake.  You mutter to yourself in a breathless Japanese whisper, “Shimata!”  Shimata, according to Ian Fleming in his magnificent You Only Live Twice means “I have made a mistake” or, as Mr Bond translates it more pithily, “Freddie Uncle Charlie Katie!”  Ah so desu ka!

The “hard” Sudoku does not seem to offer an unbroken line of reasoning and indeed you seem to need to fall back on Prof Stewart’s trial and error.  Best use pencil and rubber.  But what’s the point?  If the puzzle has a unique solution, there must be a rational way of reaching it.  Well, that’s an axiom.  I sat down with pencil and paper and tried to figure out the anatomy of Sudoku from first principles.

I know what you’re thinking.  Don’t go there.  It’s Mulholland Drive.

Just in case you don’t know the rules:  the Sudoku grid is a grand square of 81 squares, 9 x 9, rather like a chess board with an extra row and an extra column.  The grand square is subdivided into 9 subsets each of 3 x 3 squares.  The digits one to nine occur once, and only once (suji wa dokushin ni kagiru!) in every row, column, and subset, and our task is to fill the boxes with the right digits, the compiler having inserted for our benefit a handful of numbers to get us started.  This immediately begs the question: how does the compiler generate the puzzle, and know the puzzle has a unique solution?

It occurred to me to simplify the problem by reducing the size of the grid.  Instead of having a side of length 9, (3 squared), reduce it to 4 (2 squared) and use only the numbers 1, 2, 3, and 4.  This is now a grand square of 16 squares divided into four subsets each of 4 squares (2 x 2).  I know I’m straying into dangerous territory here.  My readership will have dwindled down to one mathematician (I know who you are) who will see I am making a Terrible Mistake.  What the hell.

Let us now consider the number of ways a 2 x 2 subset can be filled in.  This becomes an algebraic problem in “permutations and combinations” analogous to the following: four people go to the theatre.  They have seats in the back stalls – row X 1 and 2 and, immediately behind, row Y 1 and 2.  How many different ways can the theatre-goers arrange themselves?

Well, X1 can be filled in 4 different ways, and once it is filled, X2 can be filled in 3 different ways, and once it is filled, Y1 can be filled in 2 different ways, and once it is filled, Y2 can only be filled one way.  So there are 24 possible arrangements, that is, factorial 4 or 4!

Put this into the context of the 4 x 4 Sudoku square.  It has four subset quadrants and we now know that there are 4! – or 24 – ways of filling in a given quadrant, say the bottom left.  Once the minisquare is filled, move to the one on its right.  Now there are only two ways of inserting numbers in each row (or column) of the minisquare, so there are a total of 4 ways of filling in the second minisquare.

Now move to the minisquare on the top left of the puzzle.  The situation is exactly the same as with the previous minisquare.  There are four possible solutions.  Move finally to the last minisquare.  Each square, therefore the minisquare as a whole, has a unique solution.

Hence the number of possible solutions for a 4 x 4 sudoku puzzle is 24 x 4 x 4 x 1 or 384.

Clearly we now need to consider the actual 9 x 9 Sudoku puzzle or, better still, create a formula for any n x n puzzle using n digits.  The fact that Prof Stewart tells us the answer for the 9 x 9 grid is 6,670,903,752,021,072,936,960, is daunting.

Think I’ll try Kakuro.

Now that Gavin Williamson has relinquished the post of government Chief Whip to become UK Defence Secretary, I wonder if he will take with him Cronus, his pet tarantula.  Cronus used to occupy a place on the Chief Whip’s desk, and, at least according to the Guardian, Mr Williamson told the Times, “You have to look at all different ways to persuade people to vote with the government, and it’s great to have Cronus as part of the team.”

I’m trying to imagine what effect the tarantula would have had on me if I had been a Conservative MP summoned to the Chief Whip’s office.  Having a tarantula on your desk is the sort of thing a Bond villain might easily have gone in for.  “Ah! Mr Bond…” – stroking one of the eight legs – “An unexpected pleasure…”  It’s that sense of the steel fist inside the velvet glove.

Bullying in the UK is extremely refined.  People often talk about eradicating bullying, in our schools and universities, in the work place, in the armed forces and, most recently, in Parliament.  Yet, it seems to me, bullying is such an integral part of the UK social fabric from top to bottom, that its eradication could only be achieved by an attitudinal change so drastic that I doubt our political masters could take it in.

What is a whip if he (usually he) is not a bully?  The expression whip dates back to the mid eighteenth century and apparently comes from hunting.  (I gleaned this information from the House of Commons Library Standard Note SN/PC02829, 2008.)  The “whipper-in” was a huntsman whose task was to stop the hounds from straying from the pack, literally by whipping them into line.  That the office of whip might be associated with fox hunting may indeed suggest a sense of anachronism.  Yet whipping was never so refined and developed as it is now.

The main function of the government’s Chief Whip is to ensure that the government’s business gets through Parliament.  Some of this task is organizational and relates to the timetabling of parliamentary affairs, but at its heart lies the task of managing MP attendance at votes, and persuading any reluctant MPs to vote with the government.  To this end, the Whip’s Office circulates a weekly document actually known as “the Whip”, which details the coming week’s business and the government’s expectations as to how members will vote.  If the business is important, it is underlined; if very important, it is underlined twice; if crucial, three times – hence the expression “three-line whip”.

It is said, particularly in televised dramas of parliamentary life, that the Whip’s Office gathers dirt on backbenchers which gives the office leverage in influencing how they vote.  It has also been said that the whip is influential in assigning positions in government or on select committees.  Now you may well think so; I couldn’t possibly comment.

Of course the Chief Whip has a Shadow Chief Whip, fulfilling similar tasks for Her Majesty’s Loyal Opposition.  The orderly dispensation of parliamentary business requires that the Chief Whip and his shadow to some extent co-operate.  This co-operation constitutes “the usual channels”.  Much of this work can be undertaken by the Civil Service, and in this the Private Secretary to the Government Chief Whip has an important role.  The Chief Whip has a Deputy Chief Whip and a team of junior whips.  They each in turn have their shadows.  Deputies and juniors are assigned regional or departmental areas of interest.  One of the government whips, the Vice-Chamberlain of the Household, is held hostage in Buckingham Palace during the Queen’s Speech at the State Opening of Parliament, as surety against Her Majesty’s safe return to the palace.  The House of Lords, (“the other place”) also has whips, although the influence they exert tends to be a little less zealous.

I find it fascinating that MPs’ questionable peccadilloes are – allegedly – recorded in a “little black book”, but that if an MP really fouls up, the whip is not lashed; on the contrary, it is withdrawn.  The offending MP is no longer subject to discipline because he has been expelled from the party.  He is like a concentration camp inmate who starts to smoke his own cigarettes rather than bartering them for scraps of food.  Or like a hypothermic mountaineer who stops shivering violently and starts to hallucinate he is in a sunlit meadow, meandering towards the sound of children’s laughter.  He stops suffering, because he is finished.

What do you think of all this whipping stuff?  Is it the sum total of priceless tradition that has evolved over centuries in the Mother of Parliaments, there for a purpose and to be cherished and venerated?  Or is it a load of tosh?

I’m rather fond of tradition (albeit viewed from a distance of 400 miles).  I think the Palace of Westminster is a very beautiful building.  Precisely because it is falling to bits, I think it should be evacuated and restored ASAP.  I rather like the tradition of referring to “My honourable friend the member for Biggleswick” rather than Joe Bloggs, and the insistence that to call Mr Bloggs a liar – even if he be guilty of terminological inexactitude – is unparliamentary.   I don’t mind the MPs parading through lobbies rather than pressing an electronic gadget in order to vote; at least they get to stretch their legs.  I quite like Mr Speaker to announce, “The ayes to the right… the nays to the left… the ayes have it!  Unlock!”  If I were a sitting member I might even be tempted to take a snort of snuff apparently provided at the entrance to the Chamber, in a wooden box with a silver lid, made from the old chamber door the Luftwaffe managed to blow to bits in 1941.

But I think they should dump the whips.  Get over it, I say.  I realise this is an extremely radical point of view to take.  If you dump the idea of a whip, you really dump the idea of a political party, because you are removing the party’s disciplinary machinery and saying to the members, “Vote according to your conscience.”

Now I hear you say, that’s an impossibly jejune and naïve idea.  It is the most natural thing in the world for people of like mind and with a common end in view to organize.  You can’t achieve anything unless you can get a body of men and women to act as one.  That is perfectly true, but is not the purpose of a parliamentary debate to explore an issue such that men and women of good will can indeed take a vote, establish the majority, and then act as one?  The trouble with the whip is that parliamentary debate is reduced to number crunching.  You count the number of votes the government and the opposition can rely on, and you push forward the debate when you already know what the outcome is going to be.  People may be compelled by the three-line whip to vote for something they don’t believe in.  They might even be called upon to go on camera and defend the indefensible on the BBC and before the nations.  Big hitters traditionally take on this role, particularly if the interview is going to be rocky, because big hitters are big bruisers.  They are well versed at maintaining a straight face and giving expression to some specimen of cognitive dissonance or, more colloquially, talking b*******.  They justify the outcome of the debate, but the outcome of the debate was already established through techniques of backstairs jobbery.  The debate becomes a show-debate.  If your debate is a show-debate, it is meaningless.  All you really have left is flummery in the surround of ornate architecture, ancient modes of polite address, the tinkling cymbal of the division bell, and snuff.

In the magnificent setting of Glasgow’s Park Circus, astride his steed, looking out across Kelvin Grove towards the tower of Glasgow University, sits Field Marshall Earl Roberts of Kandahar, Pretoria, and Waterford VC, KG, KP, GCB, OM, GCSI, GCIE, born India on the 30th September, 1832, died France on the 14^th November 1914, while visiting British troops.  Beneath the statue on its east side are listed the Field Marshall’s campaigns – the Indian Mutiny, Umbeyla, Abyssinia, Lushei, Afghanistan, Burmah, South Africa.  And there is a quotation from a speech he gave in Glasgow on the 6^th May, 1913: “I seem to see the gleam in the near distance of the weapons and accoutrements of this Army of the future, this Citizen Army, the warder of these islands, and the pledge of the peace and of the continued greatness of this Empire.”

That quotation reminds me of a short story by Kipling, The Army of a Dream.  It’s one of these rather eccentric, Kiplingesque extended flights of fancy perhaps describing Roberts’ Citizen Army on manoeuvres, on a yomp or, as Kipling calls it, a “heef” – beef on the hoof.  It’s good natured and jolly.  But it is a dream.  And its abrupt end is shocking.  It’s a tricky business, foretelling the future.  Within a single generation following Earl Roberts’ Glasgow speech, Britain was exhausted and bankrupt, and the British Empire was to all intents and purposes no more.

Churchill had a go at foretelling the future in his collection Thoughts and Adventures published in 1932.  Some of what he said was remarkably prescient.  In Shall we all commit suicide? (written in 1925) he predicted that a bomb “no bigger than an orange” would contain the force of a kiloton of cordite that could obliterate a town.  In Fifty Years Hence he predicted, inter alia, the mobile phone, Skype, and (still unattained) cold fusion.  (I think you can tell he had been picking the brains of his scientific advisor Prof Lindemann.)  He admired Lord Tennyson’s effort at prophecy in Locksley Hall.  The poet laureate, in foreseeing modern aviation, both civil and military:

Saw the heavens fill with commerce, argosies of magic sails,

Pilots of the purple twilight, dropping down with costly bales;

Heard the heavens fill with shouting, and there rain’d a ghastly dew

From the nation’s airy navies grappling in the central blue;

But Churchill’s glance into the future is essentially dystopian.  He bemoans the fact that scientific progress has outstripped our capacity for living in harmony.  And in 1940 he famously foretold the possibility of a new Dark Age rendered more sinister and perhaps more protracted by “the lights of perverted science”.

If one were to write a Fifty Years Hence now, what might it contain?  Robots? Radio 4’s PM programme recently talked up robots every day for a week.  Eddie Mair encouraged the artificial intelligence boffins with humour and a light touch, but I got the sense he wasn’t really engaged.  I’m on Prof Stephen Hawking’s side.  We should watch these robots in case they take over the world. Have you read Robert Harris’ The Fear Index?  Maybe there’s something to be said for being Luddite.  I’m with Sir Henry Campbell-Bannerman.  His hackney carriage drew up outside No 10 and his aide asked him if he was thinking of acquiring one of these new horseless vehicles powered by the internal combustion engine.  He said no.  Why ever not?  He went round to the front of his conveyance and allowed the horses to nuzzle in.  “This is why.”  Bartok was walking along Fifth Avenue New York when he stopped and sniffed the air.  Horses!  He crossed the road and found the stable and communed with the beasts.  Ah, Bartok Bela!

Isn’t it funny – I can remember when I was a child thinking how wonderful it would be if you could have a device that could record television programmes in the same way that radio programmes could be taped; I supposed such a device would be called a videotape.  Then if I missed an episode of Doctor Who I would be able to catch it later.  Pie in the sky.  Nobody then predicted that you could make your own movie on a device the size of a pack of cards, watch it instantly, and send it instantly to somebody on the other wide of the world.  It is amazing, but I confess deep down I’m indifferent.  What do you do when you see the world progress along a path you do not wish to take?  You write your own Fifty Years Hence.  Like, the kingdom of heaven is like…

Like a museum.  The world will become a vast museum.  Everything will be managed.  The check-list manifesto of the museum’s employees will be indistinguishable from the bucket-lists of the visitors, therefore it will be impossible to know whether you are a tourist or you work in the tourist industry.  Enga Province will be the Kew Gardens of Papua New Guinea.

Because you inhabit a museum, everything you experience will be at a remove.  Music will be in inverted commas.  You can relive “The Battle of Agincourt”.  Sex will be “sex”.  The museum will have an Executive Board in the old United Nations building in New York, itself a museum.  The Non-Executive Board will be in Beijing’s Forbidden City.  The identity of the museum’s curator will be unknown.

Yet still there will be rumours of an area outwith the museum, a Steppe in Central Asia, wild and anarchic, where men and women are expert on horseback and species still devour one another.  You may try to find this region, but you can never be sure that the peasants with grinning faces, beckoning you on, are not museum stooges, their log cabin still within the perimeter, waiting to send you to a Gulag in “Siberia”.  The worst thing that can happen to you is not that you will be cast into outer darkness, but that you cease to be a museum employee, or a visitor, and become an exhibit.

I’m travelling with the Bakhtiari, a nomad in Persia.  We’ve reached the water’s edge of the Bazuft River.  The migrating flocks are about to plunge into the swollen melt water and make the crossing.  My people need to follow the herd to survive.  I bid them farewell.  I’m not making the crossing.  Not this year.

To The Lion & Unicorn on Saturday night with my ex-colleagues, to celebrate L’s 50^th.  (She looks about 17.)  One of the practice receptionists, S, has the gift of laughter.  I don’t mean a smile or a smirk or a chuckle, but uncontrollable mirth that brings tears to the eyes.  For this reason I relayed to her an anecdote I’d heard two nights previously in the same L & U (home from home) from my friend J who is a great tennis fan.  She went to the Murray-Federer exhibition match at the Hydro in Glasgow.  “Hey Roger,” called someone from the crowd, “are you going to wear a kilt?”  A young lady came on court, took off her kilt and gave it to Federer who obligingly put it on before playing on.  “Hey Roger,” cried another young lady in the crowd, “Show us your Toblerone!”

Only in Glasgow.  Sir Billy Connelly used to do a running gag about Toblerone; something about eating a bar and getting an Alp stuck up your nostril.

Hughie, one of the park dog walkers, has been to Amsterdam for the weekend.  He took the obligatory tour of the red light district, where young ladies in various stages of undress advertise themselves in shop windows.  He said – and you have to say this in a characteristic urban central belt nasal whine – “I felt no desire.”

S was moved to remind me of a consultation she once had with me.  Actually that is not quite right. She told me of the consultation, for I have no recollection of it, m’lud.  She’d phoned me mid-surgery to ask if she could see me.  I said add your name to the list and come in at the end.  She showed me a mole on her neck.  Apparently I examined it and said, “Don’t worry about it, it’s benign.”  She said, “I’m so relieved.  I thought I might have to take my clothes off.”  I said, “Well, you can take your clothes off if you like, but it’s still benign.”  She said, “Oh, I only take my clothes off for Dr P!”

Dr P is the model of rectitude.

Talking of stripping off, I went into my local gym to find they’d swapped round the ladies and gents changing rooms, I guess so that a guy could carry out some repairs in the ladies.  I duly went in, changed, crammed my stuff into a locker, and went to the gym.  Nothing too strenuous: I ran 5k on the treadmill and then went for a sauna and a spa and a swim.  That blew a few cobwebs away!  Then back to the changing room.  Stripped off, had a shower… I was padding from the shower back round to the lockers, stark naked, and walked smack into a young woman.  To tell you the truth I can’t quite remember her own state of dress.  I said, rather redundantly, “I’ve come into the wrong dressing room, haven’t I?”

“Hmm.”

I put my togs back on and retreated.  “Apologies ladies!”

There was no reply.

The person next to me in Dunblane Cathedral for the Service of Remembrance on Sunday was completely tone deaf, and very loud.  I noticed it as soon as we started to sing Paraphrase 18, Behold! The mountain of the Lord to the tune Glasgow.  It has seven verses, which allows time for the flags and military regalia to process the length of the cathedral.  My neighbour might have been Horatio Hornblower.  It wasn’t so much singing as sprechgesang.  I didn’t mind.  There is a convention in church that extraneous noise should be tolerated.  If babes in arms heckle Church of Scotland ministers they tend just to soldier on.  I have to say I am less tolerant of noisy audiences in the concert hall.  At the Usher Hall Edinburgh on Friday night, despite a plea from the CEO that everybody turn their mobile off, a phone rang during a particularly contemplative passage of the Rachmaninoff third piano concerto.  The concerto was played by a young South Korean pianist, Yekwon Sunwoo, who won the 2017 Van Cliburn International Piano Competition in Fort Worth Texas.  In this, said to be technically the most difficult concerto in the whole piano repertoire, Mr Sunwoo was both virtuosic and expressive.  It was a tour de force.  He played an encore which I could not place.  Chopin?  Rachmaninoff?  It dissolved into a deep and intense silence, punctuated by the clatter of somebody’s elbow crutch falling and ricocheting off the floor.

Dined in Bologna, Bridge of Allan, with Tim Peake’s grandmother-in-law, another great tennis fan and a very remarkable woman who shares S’s capacity for uncontrollable laughter.  She told me she got a phone call from the International Space Station, the only time I can ever remember her say she was rendered speechless.

I heard on the BBC news last week that the emergency department of a hospital in Nottingham saw over 700 patients in one day.  Now, in peacetime, and unless plague is sweeping across the land, that ought not to happen.  What can it mean?  The collapse of General Practice?

Right now, in British General Practice, professional morale is at rock bottom.  GP training positions can’t be filled.  GP partnerships are advertised and nobody applies.  GP surgeries are either being placed into special measures or closed altogether.  Medical School lecturers are hostile to general practice and put the students off.  Junior doctors are heading for Australasia in droves.  When you consider that most young people who enter medical school do so with a high sense of vocation and a genuine wish to serve the community and make the world a better place, this is bizarre.  What task could be more rewarding than that of entering people’s lives in a unique way, using one’s knowledge and expertise to help and to be of use?

In my opinion, British General Practice has lost its way.  It did so circa 2004-5, when a contract was negotiated whereby the responsibility for out-of-hours patient care was handed over from practices to trusts or health boards.  That was a fatal error.  The opportunity to stop being on call, to shut the surgery door at 6 pm and not look back, looked like a priceless gift but in fact it turned out to be a poisoned chalice.  We should have known.  After all, with power comes responsibility.  If you abrogate the responsibility, you lose the power.  Thereafter, it hardly mattered how well a GP was paid or how much free time he was given.  He would be at somebody else’s beck and call, powerless, and miserable.

The new contract came into being at a time when information technology was taking off and paper records were being scanned into electronic systems.  Sophisticated and expensive software packages were adopted by NHS Direct in England and Wales and NHS 24 in Scotland.  There were frequent system crashes.

The new contract was target-driven and GPs were remunerated according to their attainment of set targets as delineated by the Quality Outcomes Framework (QOF).  GPs, doctors generally, have been training to hit targets since long before they ever entered medical school, and it should have come as no surprise that most GPs would fulfil the requirements of the QOF and gain maximum points nearly 100% of the time.  The QOF therefore evolved and became more complex, more IT-driven, and more time consuming.  Computer systems were programmed to drive the QOF, so that GPs would be prompted by a series of alerts on the computer screen to ensure the QOF was adhered to.

The new contract also brought in a system of annual GP appraisal, whereby an appraiser, usually a GP colleague from a neighbouring practice, would spend a couple of hours with the appraisee reviewing his educational activities and monitoring his continuing professional development.  Appraisal was developed shortly after the trial and conviction of a single-handed GP in the north of England who was found guilty of murdering fifteen of his patients, and who it was thought over his lifetime might well have murdered in excess of 300 people, making him the most prolific serial killer in the UK’s history.  By a strange non-sequitur, this was depicted by the media as the event that kick-started appraisal.  Read any newspaper article of the time about GP appraisal, and you could be sure the name Harold Shipman would appear in it.  The purpose of appraisal therefore was to stop GPs from murdering their patients.  Actually GPs knew perfectly well, and said often enough, that “appraisal won’t stop another Shipman.”  I suspect Dr Shipman’s appraisal paperwork would have been quite up to the mark.  As it turned out, appraisal wasn’t even that good at detecting GPs who were incompetent.

Meanwhile the ever exuberant, nay promiscuous QOF sired progeny such as “QIP” and “Whole Systems Working” by which GP practices were required to undertake ever more arcane and time-consuming pieces of paperwork (or electronic work).  It was around this time that I myself decided to get out.  I remember I attended a GP locality meeting at which GPs were being asked to undertake a particularly pointless piece of work.  I stood up and made a short speech, subsequently referred to by my colleagues as “the speech”, rubbishing the whole enterprise.  For a flavour of the occasion, I refer you to Chapter 17 of my novel Click, Double-Click.  ACS’ rant was, essentially, my rant.

The QOF has been abolished, at least in Scotland.  It is being replaced by another contract, to be “rolled out” (as they say) in 2018.  Will it be better?  I was about to write “I’m not holding my breath” but actually that’s not good enough.  GPs need to take back control of the nature of the profession.  The motto of the Royal College of General Practice is “Cum Scientia, Caritas.”  It seems to me that science has been replaced by pseudo-science and care or compassion is in danger of being lost altogether.  We need to come up with a plan.

Let’s draw up a model of care for a population of, say, 7000 people.  I’m going to envisage it as being located in a Health Centre in a small town serving the population of the town itself, and a surrounding rural community, but it could as easily, with some modification, be an inner-city practice.

The practice needs seven GPs.  If a GP has a “flock” of around 1000, he will seldom see more than 100 patients per week.  That’s 20 patients a day, 25 if the GP wishes to devote one day a week to research, education, administration, or a special interest.  Offer fifteen minute appointments.  Patients will be able to be seen on the day they phone for the appointment.  Believe me.  I’ve done it.

The practice does its own out-of-hours work.  This means being “on call” between 6 pm and 8 am once a week.  Depending on the work load, consideration could be given to sharing “on call” with neighbouring practices so that the frequency is lessened.  Schedule your night on call to be on the eve of your “off the floor” non-clinical day.

Next, the Health Centre has an in-patient unit.  This is not as innovative as it sounds.  Think of the traditional “cottage hospital”.  There is much talk at the moment of “hospital in the home” particularly with regard to care of the elderly.  But “hospital in the home” is very expensive.  “Hospital in the GP surgery” is viable and still constitutes care in the community.  Many elderly patients need to be admitted to hospital not because they need sophisticated tests or therapies, but simply because they need nursing care.  This is the sort of patient who should be admitted to the GP unit.

GPs running such a unit would be required to cultivate and maintain skills that are chiefly learned in hospital emergency departments and in-patient units.  They would have access to near-patient testing such as routine biochemical and haematological testing to allow for monitoring of intravenous therapy.  There is no reason why there shouldn’t be on site plain radiography.  Other lab facilities could be developed depending on the extent to which GPs were comfortable managing more serious conditions.  The unit would be run by GPs and practice nurses.  Allied health professionals such as physio, and OT would have input.  The on-call doctor would be on site.  Evening and overnight consultations would also be on site.  Home visits might take place but the default position would be to consult on site.  Transport, and a driver, would be available for both doctor and patient.

That strikes me as an attractive proposition for both patient and doctor.  It’s real.  It’s caring.  It can’t be belittled.  It’s pure medicine.

The colours of the trees round the Milngavie Reservoir yesterday were bedazzling.  It’s a beautiful time of year.  I am determined to relish it and in particular to ignore my two least favourite festivals of the year, Halloween and Guy Fawkes.  When I was wee me and my pals, we would dress up on Oct 31 and go round the tenements of Glasgow G11 trawling for swag.  We knocked on the door of a second floor flat on Randolph Road.  A grumpy man said, “What do you want?”  I recognised him.  He was the newsagent at Broomhill Cross.

“Please can we have wur Halloween?”  (We’d never heard of “trick or treat”.)

“Can you sing a song?”

“Aye.”

“Well don’t bother.  Here’s threepence.”

I have turned into that man.  The clock jiggery-pokery on Sunday morning has put me into a mood.

So I intend to ignore all these foul fiends and flibbertigibbets.  I will spare a thought for Martin Luther on the eve of All Saints Day.  It will be 500 years to the day since he pinned his 95 theses to the door of All Saints Church, Wittenberg.  95!  That’s a lot of bullet points.  It rather reminds me of these inquiries that take place following the uncovering of poor standards in an NHS hospital that needs to be placed into “special measures”.  Some retired judge comes out with a fantastic number of recommendations like three hundred and fifty seven or so, and you get the sense that, whatever the problem was, he has missed the wood for the trees.

Hard on Halloween, the whizz-bangs start to go off. Why on earth would you celebrate a plot to blow up the Houses of Parliament?  Is it in truth a celebration of the fact that Mr Fawkes came to a sticky end, hence a celebration again of Luther’s 95 theses and the dawn of the Reformation?  It wouldn’t be so bad if the racket was confined to the evening of November 5th, but it starts early and goes on and on seemingly only to be silenced by Armistice Day.  Now I’m all for Remembrance Sunday.  I cherish two minutes of blessed silence.  But two minutes is quite enough.  The people on the BBC have already been wearing poppies for days and it’s still October.  Is this what is meant by “virtue signalling”?

Then, just when you think it’s all over, the shops start banging on about Christmas, and we’re off into the six weeks’ hysteria of the advent to Saturnalia.  Count me out.

But I mustn’t make my alternative universe sound so wintry.  It is, in fact, autumnal, and autumn is the most poignant season.  It is the season of Rachmaninoff’s last piano concerto, his fourth.  I heard Peter Donohoe play it in Perth on Thursday night, with the St Petersburg Symphony Orchestra.  The orchestra’s timbre seemed to me to be of a bygone era.  They might have been accompanying Rachmaninoff himself.  As an encore, Mr Donohoe played the Prelude in D, Opus 23 No 4.  There is a secret that those of us who are in the autumn of our lives should really impart to the young.  It is that, when you realise that every day is a bonus, everything becomes infinitely more precious, the colours brighter, literature more profound, music more deeply moving, the natural world more awe-inspiring, ideas more intriguing, women – am I allowed to say this in the current climate? – incomparably more beautiful.