NHS horror stories, my life as a Twitter fogey, and cricket’s robot generation

Peter Wilby's "First Thoughts" column.

Horror stories about the National Health Service come thick and fast, conveniently for a government that wants to hand it over to private capital. One week, it is chaos in A&E; the next, substandard care at 14 hospital trusts and old folk being ushered to an early grave by the Liverpool Care Pathway (LCP). We should treat these stories with scepticism even when they are apparently validated by official inquiries.

With all the talk of “excess deaths”, you would think that our hospitals had become killers. Yet, as the NHS medical director for England, Bruce Keogh, observes in his report on the 14 “failing” trusts, overall mortality in hospitals has fallen by about 30 per cent over the past decade.

Inquiries, however, rarely conclude that the problems they were set up to address don’t exist and they would be dismissed as whitewashes if they did. Given the emotion and fears surrounding serious illness and particularly death, it’s easy to find allegations of medical neglect. Julia Neuberger’s report on the LCP is replete with phrases such as “some people”, “many people” and “all too often”. There are no references to randomised sample surveys. The inquiry invited submissions from the public (it received 483), talked to 113 people at meetings and looked at hospital complaints. Such evidence should not be ignored but it is naturally biased towards those who suffered bad experiences.

No institution is perfect and anything involving medicine, which is as much an art as a science, will be more imperfect than most. What we don’t know is whether a health service run by private providers would be better.

I offer this snippet: in 2010, the US health department’s inspector general reported that 13.5 per cent of Medicare hospital patients suffered “harm” from “adverse events”, nearly half of them because of care failures. British newspapers love to highlight cases of “wrong-site surgeries”, in which ovaries are taken out instead of the appendix, for example. The United States has 40 of those a week; the UK has about 60 a year. The NHS has failings but they seem relatively few and, by international standards, very cheap.

Guilt by association

What’s in a name? The Neuberger report acknowledges that “many relatives” of patients on the LCP felt their loved ones had had “good deaths”. Yet it recommends dropping the term. “Pathway”, it argues, suggests patients being speeded directly to their coffins. I wonder if “Liverpool” isn’t the greater problem. Thanks partly to the Sun and Boris Johnson, the city has acquired negative associations in the past 25 years. Mention Liverpool and people think of poverty, unemployment, riots, too much drink and a declining football team.

Seen but not heard

The BBC’s director general, Tony Hall, says that he intends to stop actors muttering in the corporation’s dramas. If so, he will be performing a service to theatregoers as well as TV viewers. Actors, it seems, are no longer being taught to articulate their lines clearly and “throw” their voices, largely because the big money is now in TV, where authenticity is thought more important than audibility. Being deaf, I nearly always buy front-row seats at the theatre, but in the West End recently, we sat in the grand circle and my wife, whose hearing is perfect, complained that she couldn’t hear, either. Theatregoers should start a campaign and, at an agreed signal, stand in unison and shout: “Speak up!”

Social outcast

We hear much about how social media companies hold extensive databases on us that could be exploited by governments and corporations. We also hear about their inadequate controls over insulting comments. But I have not noticed discussion of their arbitrary power over users. I returned from holiday to find my Twitter account “suspended”, without warning or explanation. After a polite, emailed inquiry, I was told to look at the rules. I replied I couldn’t see how I had broken them. Two weeks later, someone at Twitter emailed me, saying, “It’s been awhile since we’ve heard from you,” and that “hopefully” the matter had been resolved. It certainly hadn’t, I replied. The account was restored a few days later, still without explanation or apology.

Being an old fogey, I use Twitter spasmodically and was not greatly inconvenienced by its loss. To some users, however, it has become an essential working tool. In a telling example of how technology can restrict rather than widen choice, many feel they must use it because their professional peers do so. We should know more about the Californian geeks who run social media and what redress they offer to those arbitrarily blackballed.

Analyse this

How could Ashton Agar, a 19-year-old cricketer playing his first Test and batting at No 11, make 98, the highest score of Australia’s first innings against England at Trent Bridge? The answer is that, since Agar had played only 16 unremarkable first-class innings, the England coaches, lacking videos of him, could offer bowlers no plans for getting him out. International sides now analyse opponents exhaustively. They produce pie charts, spreadsheets, graphs and other statistical paraphernalia, searching for a batsman’s weakness as assiduously as physicists searched for the Higgs boson. Even the best modern bowlers are robots, programmed by back-room boffins. Without the usual input, they malfunction.

What redress does Twitter offer to the arbitrarily blackballed? Photograph: Getty Images

Peter Wilby was editor of the Independent on Sunday from 1995 to 1996 and of the New Statesman from 1998 to 2005. He writes the weekly First Thoughts column for the NS.

This article first appeared in the 22 July 2013 issue of the New Statesman, How to make a saint

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Leader: Trump and an age of disorder

Mr Trump’s disregard for domestic and international norms represents an unprecedented challenge to established institutions.

The US presidency has not always been held by men of distinction and honour, but Donald Trump is by some distance its least qualified occupant. The leader of the world’s sole superpower has no record of political or military service and is ignorant of foreign affairs. Throughout his campaign, he repeatedly showed himself to be a racist, a misogynist, a braggart and a narcissist.

The naive hope that Mr Trump’s victory would herald a great moderation was dispelled by his conduct during the transition. He compared his country’s intelligence services to those of Nazi Germany and repeatedly denied Russian interference in the election. He derided Nato as “obsolete” and predicted the demise of the European Union. He reaffirmed his commitment to dismantling Obamacare and to overturning Roe v Wade. He doled out jobs to white nationalists, protectionists and family members. He denounced US citizens for demonstrating against him. Asked whether he regretted any part of his vulgar campaign, he replied: “No, I won.”

Of all his predilections, Mr Trump’s affection for Vladimir Putin is perhaps the most troubling. When the 2012 Republican presidential nominee, Mitt Romney, warned that Russia was the “number one geopolitical foe” of the US, he was mocked by Barack Obama. Yet his remark proved prescient. Rather than regarding Mr Putin as a foe, however, Mr Trump fetes him as a friend. The Russian president aims to use the US president’s goodwill to secure the removal of American sanctions, recognition of Russia’s annexation of Crimea and respect for the murderous reign of the Syrian president, Bashar al-Assad. He has a worryingly high chance of success.

Whether or not Mr Trump has personal motives for his fealty (as a lurid security dossier alleges), he and Mr Putin share a political outlook. Both men desire a world in which “strongmen” are free to abuse their citizens’ human rights without fear of external rebuke. Mr Trump’s refusal to commit to Nato’s principle of collective defence provides Mr Putin with every incentive to pursue his expansionist desires. The historic achievement of peace and stability in eastern Europe is in danger.

As he seeks reconciliation with Russia, Mr Trump is simultaneously pursuing conflict with China. He broke with precedent by speaking on the telephone with the Taiwanese president, Tsai Ing-wen, and used Twitter to berate the Chinese government. Rex Tillerson, Mr Trump’s secretary of state nominee, has threatened an American blockade of the South China Sea islands.

Mr Trump’s disregard for domestic and international norms represents an unprecedented challenge to established institutions. The US constitution, with its separation of powers, was designed to restrain autocrats such as the new president. Yet, in addition to the White House, the Republicans also control Congress and two-thirds of governorships and state houses. Mr Trump’s first Supreme Court appointment will ensure a conservative judicial majority. The decline of established print titles and the growth of “fake news” weaken another source of accountability.

In these circumstances, there is a heightened responsibility on the US’s allies to challenge, rather than to indulge, Mr Trump. Angela Merkel’s warning that co-operation was conditional on his respect for liberal and democratic values was a model of the former. Michael Gove’s obsequious interview with Mr Trump was a dismal example of the latter.

Theresa May has rightly rebuked the president for his treatment of women and has toughened Britain’s stance against Russian revanchism. Yet, although the UK must maintain working relations with the US, she should not allow the prospect of a future trade deal to skew her attitude towards Mr Trump. Any agreement is years away and the president’s protectionist proclivities could yet thwart British hopes of a beneficial outcome.

The diplomatic and political conventions embodied by the “special relationship” have endured for more than seven decades. However, Mr Trump’s election may necessitate their demise. It was the belief that the UK must stand “shoulder to shoulder” with the US that led Tony Blair into the ruinous Iraq War. In this new age of disorder, Western leaders must avoid being willing accomplices to Mr Trump’s agenda. Intense scepticism, rather than sycophancy, should define their response.

This article first appeared in the 19 January 2016 issue of the New Statesman, The Trump era