Why is the waiting time for A&E the same as a flight to Gothenburg?

The adventures of a broken toe.

When your luck runs out, it runs out all at once. I muse on this as I enter the third hour of my wait in A & E. The day before, I had banged my little toe against the door frame so hard that it is still too sensitive to touch a day later and the configuration of the pain strongly suggests that a bone might have been broken.

I suppose there’s nothing much they can do with a broken little toe, except tell you not to use it, which I think I could work out all by myself, so what I was really after in St Mary’s was information and validation of my own suffering. Which, after the rather painful journey to the hospital – it’s a 15-minute stroll from the Hovel but a rather longer hobble – was fairly acute.

Still, what the hell is this, my waiting here with a possibly broken toe (I did it while rushing to get the clothes out of the machine, which makes me one of the few people in the modern age to have hurt themselves while doing the laundry) when there are people around me visibly suffering? As I write, my friend Leyla Sanai is contemplating the amputation of her leg because of her scleroderma, and is bearing her sufferings with a fortitude that is beyond comprehension. There is a young Spanish man sitting next to me who appears to have something terrible going on with his arm. “Joan,” calls a nurse from a consulting room. He looks up and there is a silence. Of all the people in this room, none is prepared to answer to the name Joan.

“Joan Estevez,” says the nurse. The young Spaniard lifts his head. “Juan,” he says.

“It says ‘Joan’ here,” replies the nurse, in tones which suggest that the name “Juan”, which this young man seems to be claiming as his own, is an imposture and an affectation. Eventually, though, as no one else seems to be claiming the surname “Estevez”, she lets him go into the room.

The quarter hours go by. A nurse had offered me a couple of co-codamol on turning up and I had accepted more out of politeness than need; in rest, the toe was quite docile, but the nurse had charmed me by calling me “sweet pea” and I had a hunch that a couple of these on an empty stomach would have a rather soothing effect. They do but I recognise another pain bubbling up: that of the end of a brief interlude of domestic happiness.

The Beloved, you see, has been offered a job in Gothenburg for something approaching twice the salary she is bringing in here. The offer was made some time ago and she has been putting off making a decision for as long as she can. I have been to Gothenburg and wouldn’t go back there if you paid me, but she is for some reason enamoured of the country and the language; so it’s rather as if someone had offered me a job in Verona.

Is that right? In my campaign to dissuade her from going, I have been doing a spot of research, both on the internet and the internot (ie, books) and have come up with some killer facts about this country, for which I am beginning to nurture a dislike – as you would a rival in love.

“There are 12 people in Sweden,” I tell her, only slightly massaging the facts to suit my purpose. “In the summer, three of them are eaten alive by giant mutant mosquitoes. In the autumn, feral moose, pissed out of their minds on decaying windfalls, account for about four more. Those that remain blow their brains out in winter, which lasts for nine months.

You can only buy alcohol from a small corrugated-iron shed in Malmö, and when you do your name is put on a criminal register, right next to the paedophiles and heroin traffickers. A bottle of beer costs 6,000 kronor and tastes of moose piss, for the very good reason that that is what it is made from.”

I reinforce my point by demonstrating that when you type the words “bad things about Sweden” into Google you get 36,200,000 results (try it). But it’s a jump up in terms of her career and if I was the one to hold her back by having a crying fit, I’d feel guilty for the rest of my life. So, I know that all I can do is try to ignore my own very strong feelings for once and think of what is best for her.

Hence, perhaps, my concentration on my toe. Which, as it turns out, is not broken (but a week later is still painful and impossible to touch). It took four hours to learn that; as long as a return flight to Gothenburg, I reflect.

Turn up with a broken toe at A&E, and be prepared for a wait. Image: Getty

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 06 November 2013 issue of the New Statesman, Are cities getting too big?

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The 2017 Budget will force Philip Hammond to confront the Brexit effect

Rising prices and lost markets are hard to ignore. 

With the Brexit process, Donald Trump and parliamentary by-election aftermath dominating the headlines, you’d be forgiven for missing the speculation we’d normally expect ahead of a Budget next week. Philip Hammond’s demeanour suggests it will be a very low-key affair, living up to his billing as the government’s chief accounting officer. Yet we desperately need a thorough analysis of this government’s economic strategy – and some focused work from those whose job it is to supposedly keep track of government policy.

It seems to me there are four key dynamics the Budget must address:

1. British spending power

The spending power of British consumers is about to be squeezed further. Consumers have propped up the economy since 2015, but higher taxes, suppressed earnings and price inflation are all likely to weigh heavily on this driver for growth from now on. Relatively higher commodity prices and the sterling effect is starting to filter into the high street – which means that the pound in the pocket doesn’t go as far as it used to. The dwindling level of household savings is a casualty of this situation. Real incomes are softer, with poorer returns on assets, and households are substituting with loans and overdrafts. The switch away from consumer-driven growth feels well and truly underway. How will the Chancellor counteract to this?

2. Lagging productivity

Productivity remains a stubborn challenge that government policy is failing to address. Since the 2008 financial crisis, the UK’s productivity performance has lagged Germany, France and the USA, whose employees now produce in an average four days as much as British workers take to produce in five. Perhaps years of uncertainty have seen companies choose to sit on cash rather than invest in new production process technology. Perhaps the dominance of services in our economy, a sector notorious hard in which to drive new efficiencies, explains the productivity lag. But ministers have singularly failed to assess and prioritise investment in those aspects of public services which can boost productivity. These could include easing congestion and aiding commuters; boosting mobile connectivity; targeting high skills; blasting away administrative bureaucracy; helping workers back to work if they’re ill.

3. Lost markets

The Prime Minister’s decision to give up trying to salvage single market membership means we enter the "Great Unknown" trade era unsure how long (if any) our transition will be. We must also remain uncertain whether new Free Trade Agreements (FTAs) are going to go anyway to make up for those lost markets.

New FTAs may get rid of tariffs. But historically they’ve never been much good at knocking down the other barriers for services exports – which explains why the analysis by the National Institute for Economic and Social Research recently projected a 61 per cent fall in services trade with the EU. Brexit will radically transform the likely composition of economic growth in the medium term. It’s true that in the near term, sterling depreciation is likely to bring trade back into balance as exports enjoy an adrenal currency competitive stimulus. But over the medium term, "balance" is likely to come not from new export market volume, but from a withering away of consumer spending power to buy imported goods. Beyond that, the structural imbalance will probably set in again.

4. Empty public wallets

There is a looming disaster facing Britain’s public finances. It’s bad enough that the financial crisis is now pushing the level of public sector debt beyond 90 per cent of our gross domestic product (GDP).  But a quick glance at the Office for Budget Responsibility’s January Fiscal Sustainability Report is enough to make your jaw drop. The debt mountain is projected to grow for the next 50 years. All else being equal, we could end up with an incredible 234 per cent of debt/GDP by 2066 – chiefly because of the ageing population and rising healthcare costs. This isn’t a viable or serviceable level of debt and we shouldn’t take any comfort from the fact that many other economies (Japan, USA) are facing a similar fate. The interest payable on that debt mountain would severely crowd out resources for vital public services. So while some many dream of splashing public spending around on nationalising this or that, of a "universal basic income" or social security giveaways, the cold truth is that we are going to be forced to make more hard decisions on spending now, find new revenues if we want to maintain service standards, and prioritise growth-inducing policies wherever possible.

We do need to foster a new economic model that promotes social mobility, environmental and fiscal sustainability, with long-termism at its heart. But we should be wary of those on the fringes of politics pretending they have either a magic money tree, or a have-cake-and-eat-it trading model once we leap into the tariff-infested waters of WTO rules.

We shouldn’t have to smash up a common sense, balanced approach in order for our country to succeed. A credible, centre-left economic model should combine sound stewardship of taxpayer resources with a fairness agenda that ensures the wealthiest contribute most and the polluter pays. A realistic stimulus should be prioritised in productivity-oriented infrastructure investment. And Britain should reach out and gather new trading alliances in Europe and beyond as a matter of urgency.

In short, the March Budget ought to provide an economic strategy for the long-term. Instead it feels like it will be a staging-post Budget from a distracted Government, going through the motions with an accountancy exercise to get through the 12 months ahead.

Chris Leslie MP was Shadow Chancellor in 2015 and chairs Labour’s PLP Treasury Committee

 

 

 

Chris Leslie is chair of Labour’s backbench Treasury Committee and was shadow Chancellor in 2015.