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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Banishing safe seats, and other proposals to bridge the democratic divide

How to improve key areas of democracy.

Labour’s election train is finally pulling into the station, with its new leader announced in just over a fortnight. However, a summer absorbed in the party’s internal democracy has obscured a deeper truth confronting the country: the general election confirmed that unequal political participation rates in the UK – by age, class, ethnicity and region– have become increasingly hardwired into how our democracy operates.

IPPR’s new report underscores the scale of the democratic divide.  For example, less than half of 18-24 year olds voted, compared to nearly four-fifths of the over-65s, while three-quarters of "AB" individuals cast a ballot, against just over half of "DE" registered voters. Critically, this marks a sharp rise in turnout inequality over time. In 1987, for example, turnout rates by class were almost identical but have steadily diverged since.

Similarly, age-based differences have got significantly worse over time. In 1964 turnout for 18-24 year olds was 76.4 per cent, almost matching the 76.7 per cent turnout rate of those aged 65 or over. By 2005 only 38.2 per cent of 18-24 year olds voted against 74.3 per cent of 65+ year olds, with only a very slight improvement this year.

Underlying growing disparities of electoral voice are striking divergences in perceptions of the fairness and effectiveness of our democracy. For example, IPPR/YouGov polling suggests a striking 63 per cent of "DE" individuals think that our democratic system serves their interests badly, while "AB" voters are evenly split.

Given these signs of democratic distress, there remains a strong case for establishing a wide-ranging constitutional convention to reset how our democracy operates. Yet Westminster shows no appetite for such constitutional reformation, and there would only be so much a civil society-led convention could achieve in terms of practical change.

In our report we therefore propose a series of achievable reforms that could update the civic, institutional and technological architecture of our democracy in the here and now, with the explicit goal of ensuring that all voices are better heard in the political process.

On electoral reform, while we reiterate our support for proportional representation for national elections, we know this simply isn’t going to happen this Parliament. We had a referendum on change in 2011 and it was heavily lost. The energies of electoral reformers should therefore focus on extending PR in local government, where it is more obviously in the self-interest of the major parties, as a means of extending their geographical reach.

In addition, the reduction in the number of MPs provides an opportunity to chip away at the number of safe seats. More than half of seats are "safe", a number that has grown over time, even allowing for the electoral earthquake in Scotland. Safe seats typically have lower levels of participation, lower turnout rates, and less electorally powerful voters. While safe seats will always be with us in a first-past-the-post system, too many can be damaging to democracy.

Given this, we have recommended that the various Boundary Commissions of the UK be given a new duty to consider the electoral competitiveness of seats – ie. to tilt against the creation of safe seats – when boundaries are redrawn. The priority would be to meet their current duties of ensuring the geographic coherence of a seat and roughly equal electorates.

However, where these duties can be met we suggest that the Commissions should consider revising boundaries to reduce the number of safe seats, as a step to increasing participation and the voting power of the average elector. Of course, this will clearly not "abolish" all safe seats – nor should it  but it could help re-empower millions of voters currently with little meaningful say over the outcome of elections and force political parties to up their game in safe seats.

At the same time, the transition to the individual electoral registration process risks excluding millions from the franchise, people who are disproportionately younger, poorer or from an ethnic minority. For example, there are clear inequalities by age and ethnicity in terms of who is registered to vote: in the 2010 general election, for which figures are most accurate, 90 per cent of people aged 55-64 were registered, compared to 55 per cent of those aged 18-24, while nearly 20 per cent of BME individuals were not registered to vote, compared to only 7 per cent of the "white British" population.

There are simple steps the government could take to ensure all who are eligible are able to vote: extending the registration deadline to December 2016, and making support available to local authorities to assist registration efforts, weighted towards authorities with higher levels of under-registration, could help reduce inequalities.  In the longer term, electoral registration officers should be given new duties, and the Electoral Commission more powers, to drive up registration rates, with a particular focus on presently under-registered demographics. 

Finally, we recommend introducing a Democracy Commission. At present, the Electoral Commission effectively regulates elections and party funding. Democracy, however, is far richer and broader than electoral processes. It is about formal representation, but also about participation and deliberation, in what Marc Stears has called "everyday democracy".

A statutorily independent Democracy Commission could give institutional ballast to the latter and help reinvigorate democratic life by providing research, resources and capacity-building to facilitate local, civil society-led initiatives that aim to increase broad-based levels of powerful democratic participation or deliberation in collective decision-making processes.

For example, a Democracy Commission could work with the GLA to introduce participatory budgeting in London, assist the Greater Manchester Combined Authority in instituting a public deliberative body with real teeth over how to integrate health and social care in the area, help the Scottish government conduct citizens’ juries on the future constitutional shape of the country, or support civil-society experiments to bring people closer to collective political decision-making processes in their locality.

We are living in a paradoxical political era, where growing political inequality is accompanied by ongoing social and technological change that has the capacity to collapse unnecessary political and economic hierarchies and build a more inclusive, participatory and responsive democracy. However, there is no guarantee that the age of the network will necessarily lead to democratic revival. The institutions and technologies of our political system, products of the 19th century, are struggling in the fluidity and fracture of the 21st century, inhibiting democratic renewal.

With our economy post-industrial, our ways of communicating increasingly digital and more networked, our identities and relationships ever more variegated and complex, it is therefore critical public policy seeks to update the democratic infrastructure of the UK, and, in so doing, help reverse entrenched political inequality.

Such an agenda is vital. If we simply accept the current institutional arrangements of our political system as the limits of our ambition, we must also content ourselves to live in a divided – and therefore inherently partial – democracy. Yet our democracy is not immutable but malleable, and capable of being reformed for the better; reform today can make democratic life more equal. After all, the story of British democracy’s evolution is one of yesterday’s impossible becoming today’s ordinary.

Mathew Lawrence is a research fellow at IPPR and the co-author of "The Democracy Commission: Reforming democracy to combat political inequality". He tweets at @dantonshead.