Sense of duty: Martin Bromiley founded the Clinical Human Factors Group to bring change to the NHS. Photo: Muir Vidler
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How mistakes can save lives: one man’s mission to revolutionise the NHS

After the death of his wife following a minor operation, airline pilot Martin Bromiley set out to change the way medicine is practised in the UK  – by using his knowledge of plane crashes. 

1.

Martin Bromiley is a modest man with an immodest ambition: to change the way medicine is practised in the UK.

I first met him in a Birmingham hotel, at a meeting of the Clinical Human Factors Group, or CHFG. Hospital chief executives, senior surgeons, experienced nurses and influential medical researchers met, debated and mingled. Keynote speakers included the former chief medical officer for England Sir Liam Donaldson. In the corridors and meeting rooms, rising above the NHS jargon and acronyms and low-level grumbling about government reforms, there floated a tangible sense of purpose and optimism. This was a meeting of believers.

A slow transformation in the way health care works is finally gaining traction. So far, it has gone largely unnoticed by the media or the public because it hasn’t been the result of government edict or executive order. But as Suren Arul, a consultant paediatric surgeon at Birmingham Children’s Hospital put it to me: “We are undergoing a quiet revolution and Martin Bromiley will, one day, be recognised as the man who showed us the way.”

Although I knew whom to look for, Bromiley was hard to spot at first. He wasn’t on stage, and he didn’t address the full conference. He was, I discovered, sitting at a table at the edge of the hall, in the suburbs of the meeting. You would hardly have guessed that the CHFG was a group he’d founded, or that everyone at the meeting that day was there because of him. Bromiley doesn’t fit with our preconceived ideas of a natural leader. He speaks with a soft voice. He doesn’t command your attention, though you find yourself giving it.

Neither is he a doctor, or a health professional of any kind. Bromiley is an airline pilot. He is also a family man, with a terrible story to tell.

 

2.

Early on the morning of 29 March 2005, Martin Bromiley kissed his wife goodbye. Along with their two children, Victoria, then six, and Adam, five, he waved as she was wheeled into the operating theatre and she waved back.

Over Christmas, Elaine had suffered a swelling of her face, connected to sinus problems that had troubled her for years. She was advised by a consultant that the only way to deal with the problem once and for all was to undergo a minor operation to straighten the inside of her nose. Bromiley knew of colleagues who had undergone the operation – the sinuses of pilots take a beating from sharp changes in air pressure – so he didn’t feel overly concerned, that morning, as he drove Victoria and Adam back to the family home in a peaceful Buckinghamshire village.

At about 11 that same morning he received a call from the ear, nose and throat consultant. “Elaine isn’t waking up properly from the anaesthetic,” said the doctor. “Can you come back in?” At the hospital, Bromiley was met by the consultant, who explained that there had been a problem keeping Elaine’s airway open after she had been anaesthetised and her oxygen levels had fallen to dangerously low levels. A decision had been taken to move her to the intensive-care unit.

Grasping for medical knowledge from half-remembered episodes of Casualty, Bromiley asked if the doctors had attempted a tracheotomy – a cut to the throat to allow air in. They explained that the safer option had been to let her wake up naturally. He made his way to the intensive-care unit. When he got there, the first person to approach him was the consultant anaesthetist, who, without saying anything, gave him a hug. Bromiley found himself trying to console him. “I said, ‘I know these things happen.’

He took a seat and waited for news. After ten minutes, two doctors emerged and took seats opposite him. In sombre tones, they told Bromiley that Elaine had been without oxygen for a long period of time and, as a consequence, had suffered severe brain damage. He could hardly process what they were saying. “I just thought, ‘Fuck. What? How?’ I was stunned. My whole world changed.”

An hour later, Bromiley was allowed to see his wife. “She didn’t look any different,” he told me. But she was different. After finally settling her oxygen levels, the doctors had put her into a coma to prevent her brain from swelling to the point where it crushed itself against the top of her spine.

It soon became apparent that it was a coma from which she would never recover. Days later, after a series of discussions with the doctors, he consented to having her life support switched off. The doctors were surprised at the strength of her heart, which continued to beat for another week until, on 11 April 2005, Elaine Bromiley died.

 

3.

How could this have happened? When he surfaced from the shock, that was the question to which Bromiley wanted an answer. At first, he accepted the word of the ENT consultant, who told him that the doctors had made all the right decisions but had simply come up against an emergency for which nobody could have planned: the exceptional difficulty of getting a tube down Elaine’s throat.

Still, he assumed that the next step would be an investigation – standard practice in the airline industry after every accident. “You get an independent team in. You investigate. You learn.” When he asked the head of the intensive-care unit about this, the doctor shook his head. “That’s not how we do things in the health service. Not unless somebody complains or sues.”

This doctor was privately sympathetic to Bromiley’s question, however. Shortly after Elaine’s death, he got in touch with Bromiley to say that he had asked a friend of his, Professor Michael Harmer, an eminent anaesthetist, if he would be prepared to lead an investigation. Harmer had said yes. After Bromiley gained the hospital’s consent, Harmer set to work, interviewing everyone involved, from the consultants to the nursing team.

In July that year, he submitted his report. As Bromiley read it, his mind went back to one of the last nights he had spent in the hospital during his wife’s coma, and to something the duty nurse had said to him: “It’s terrible. I can’t believe that happened.” With hindsight, that was a hint.

Harmer’s minute-by-minute narrative of the operation revealed a different story from the one Bromiley had heard when he spoke with the ENT surgeon. The truth was that Elaine had died at the hands of highly accomplished, technically proficient doctors with 60 years of experience between them, in a fine, well-equipped modern hospital, because of a simple error.

4.

Doctors make mistakes. A woman undergoing surgery for an ectopic pregnancy had the wrong tube removed, rendering her infertile. Another had her Fallopian tube removed instead of her appendix. A cardiac operation was performed on the wrong patient. Some 69 patients left surgery with needles, swabs or, in one case, a glove left inside them. These are just some of the
incidents that occurred in English hospitals in the six months between April and September 2013.

Naturally, we respect and admire doctors. We believe that health care is scientific. We think of hospitals as places of safety. For all these reasons, it comes as something of a shock to realise that errors still play such a significant role in whether we leave a hospital better or worse, alive or dead.

The National Audit Office estimates that there may be 34,000 deaths annually as a result of patient safety incidents. When he was medical director, Liam Donaldson warned that the chances of dying as a result of a clinical error in hospital are 33,000 times higher than dying in an air crash. This isn’t a problem peculiar to our health-care system. In the United States, errors are estimated to be the third most common cause of deaths in health care, after cancer and heart disease. Globally, there is a one-in-ten chance that, owing to preventable mistakes or oversights, a patient will leave a hospital in a worse state than when she entered it.

There are other industries where mistakes carry grave consequences, but the mistakes of doctors carry a particular moral charge because their job is to make us better, and we place infinite trust in the expectation they
will do so. When you think about it, it’s extraordinary we’re prepared to give a virtual stranger permission to cut us open with a knife and rearrange our insides as we sleep.

Perhaps because of the almost superstitious faith we need to place in surgeons, we hate to think of them as fallible; to think that they perform worse when they are tired, or that some are much better at the job than others, or that hands can slip because of nerves, or that bad decisions get taken because of overconfidence, or stress, or poor communication. But all of these things happen, because doctors are human.

 

5.

Within two minutes of Elaine Bromiley’s operation beginning, the anaesthetic consultant realised that the patient’s airway had collapsed, hindering her supply of oxygen. After repeatedly trying and failing to ventilate the airway, he issued a call for help. An ENT surgeon answered it, as did another senior anaesthetist. The three consultants struggled to get a tube down Elaine’s throat, a procedure known as intubation, but encountered a mysterious blockage. So they tried again.

“Can’t ventilate, can’t intubate” is a recognised emergency in anaesthetic practice, for which there are published guidelines. The first instruction in one version of the guidelines is this: “Do not waste time trying to intubate when the priority is oxygenation.” Deprived of oxygen, our brains soon find it hard to function, our hearts to beat: ten minutes is about the longest we can suffer such a shortage before irreversible damage is done. The recommended solution is to carry out a form of tracheotomy, puncturing the windpipe to allow air in. Do not waste time trying to intubate.

Twenty minutes after Elaine’s airway collapsed, the doctors were still trying to get a tube down her throat. The monitors indicated that her brain was starved of oxygen and her heart had slowed to a dangerously low rate. Her face was blue. Her arms periodically shot up to her face, a sign that brain tissue is being irritated. Yet the doctors ploughed on. After 25 minutes, they had finally intubated their patient. But that was too late for Elaine.

If the severity of Elaine’s condition in those crucial minutes wasn’t registered by the doctors, it was noticed by others in the room. The nurses saw Elaine’s erratic breathing; the blueness of her face; the swings in her blood pressure; the lowness of her oxygen levels and the convulsions of her body. They later said that they had been surprised when the doctors didn’t attempt to gain access to the trachea, but felt unable to broach the subject. Not directly, anyway: one nurse located a tracheotomy set and presented it to the doctors, who didn’t even acknowledge her. Another nurse phoned the intensive-care unit and told them to prepare a bed immediately. When she informed the doctors of her action they looked at her, she said later, as if she was overreacting.

Reading this, you may be incredulous and angry that the doctors could have been so stupid, or so careless. But when the person closest to this event, Martin Bromiley, read Harmer’s report, he responded very differently. His main sensation wasn’t shock, or fury. It was recognition.

 

6.

Shortly after 5pm on the clear-skied evening of 28 December 1978, United Airlines Flight 173 began its descent to Portland International Airport. The plane had taken off from New York that morning and, after making a pre-scheduled stop in Denver, it was reaching its final destination with 189 souls on board.

As the landing gear was lowered there was a loud thump and the aircraft yawed slightly to the right. The flight crew noticed that one of the green landing gear indicator lights wasn’t lit. The captain radioed air-traffic control at Portland, telling them, “We’ve got a gear problem.”

Portland’s control agreed that the plane would orbit the airport while the captain, first officer and second officer worked out what to do. The passengers were told that there would be a delay. The cabin crew began to carry out checks. The flight attendants were instructed to check the visual indicators on the wings, which suggested that the landing gear was locked down.

Nearly half an hour after the captain told Portland about the landing gear problem, he contacted the United Airlines maintenance centre, informing the staff there that he intended to continue the holding pattern for another 15 or 20 minutes. He reported 7,000lbs of fuel aboard, down from 13,000 when he had first spoken to Portland.

United’s controller sounded a mild note of concern. “You estimate that you’ll make a landing about five minutes past the hour. Is that OK?” The captain’s response was ostentatiously relaxed: “Yeah, that’s a good ball park. I’m not gonna hurry the girls [the cabin crew].” United 173 had 30 minutes of fuel left.

The captain and his two officers continued to debate the question of whether the landing gear was down. The captain asked his crew how much fuel they would have left after another 15 minutes of flying. The flight engineer responded, “Not enough. Fifteen minutes is gonna – really run us low on fuel here.” At 18.07 one of the plane’s engines lost power. Six minutes later, the flight engineer reported that both engines were gone. The captain, as if waking up to the situation for the first time, said: “They’re all going. We can’t make Troutdale [a small airport on the approach route to Portland].” “We can’t make anything,” said the first officer. At 18.13, the first officer sent the plane’s final message to air-traffic control: “We’re going down. We’re not going to be able to make the airport.”

 

7.

This story of United 173 is known to every airline pilot, because it is studied by every trainee. To the great credit of the aviation industry, it became one of the most influential disasters in history. Galvanised by it and a handful of other crashes from the same era, the industry transformed its training and safety practices, instituting a set of principles and procedures known as CRM: crew resource management.

It worked. Although we usually notice only the high-profile exceptions, crashes are at the lowest level they have ever been, and flying is now one of the safest ways you can spend your time. As they are fond of saying in aviation, these days the most dangerous part of a flight is the journey to the airport.

CRM was born of a realisation that in the late 20th century the most frequent cause of crashes wasn’t technical failure, but human error. Its roots go back to the Second World War, when the US army assigned a psychologist called Alphonse Chapanis to investigate a curious phenomenon. B-17 bombers kept crashing on to the runway on landing, even though there were no apparent mechanical problem with the planes. Rather than blaming the pilots, Chapanis pointed to the instrument panel. The lever to control the landing gear and the lever that operated the flaps were next to each other. Pilots, weary after long flights, were confusing the two, retracting the wheels and causing the crash. Chapanis suggested attaching a wheel to the handle of the landing lever and a triangle to the flaps lever, making each easily distinguishable by touch alone. Problem solved.

Chapanis had recognised that human beings’ propensity to make mistakes when they are tired is much harder to fix than the design of levers. His deeper insight was that people have limits, and many of their mistakes are predictable effects of those limits. That is why the architects of CRM defined its aim as the reduction of human error, rather than pilot error. Rather than trying to hire or train perfect pilots, it is better to design systems that minimise or mitigate inevitable human mistakes.

In the 1990s, a cognitive psychologist called James Reason turned this principle into a theory of how accidents happen in large organisations. When a space shuttle crashes or an oil tanker leaks, our instinct is to look for a single, “root” cause. This often leads us to the operator: the person who triggered the disaster by pulling the wrong lever or entering the wrong line of code. But the operator is at the end of a long chain of decisions, some of them taken that day, some taken long in the past, all contributing to the accident; like achievements, accidents are a team effort. Reason proposed a “Swiss cheese” model: accidents happen when a concatenation of factors occurs in unpredictable ways, like the holes in a block of cheese lining up.

James Reason’s underlying message was that because human beings are fallible and will always make operational mistakes, it is the responsibility of managers to ensure that those mistakes are anticipated, planned for and learned from. Without seeking to do away altogether with the notion of culpability, he shifted the emphasis from the flaws of individuals to flaws in organisation, from the person to the environment, and from blame to learning.

The science of “human factors” now permeates the aviation industry. It includes a sophisticated understanding of the kinds of mistakes that even experts make under stress. So when Martin Bromiley read the Harmer report, an incomprehensible event suddenly made sense to him. “I thought, this is classic human factors stuff. Fixation error, time perception, hierarchy.”

 

8.

It’s a miracle that only ten people were killed after Flight 173 crashed into an area of woodland in suburban Portland; but the crash needn’t have happened at all. Had the captain attempted to land, the plane would have touched down safely: the subsequent investigation found that the landing gear had been down the whole time. But the captain and officers of Flight 173 became so engrossed in one puzzle that they became blind to the more urgent problem: fuel shortage. This is called “fixation error”. In a crisis, the brain’s perceptual field narrows and shortens. We become seized by a tremendous compulsion to fix on the problem we think we can solve, and quickly lose awareness of almost everything else. It’s an affliction to which even the most skilled and
experienced professionals are prone.

Imagine a stalled car, stuck on a level crossing as a distant train bears down on it. Panic rising, the driver starts and restarts the engine rather than getting out of the car and running. The three doctors bent over Elaine Bromiley’s throat were intent on finding a way to intubate, just as the three pilots in the cockpit of United 173 were determined to establish the status of the landing gear. In neither case did these seasoned professionals look up and register the oncoming train: in the case of Elaine, her oxygen levels, and in the case of United 173, its fuel levels.

When people are fixating, their perception of time becomes highly erratic; minutes stretch and elongate. One of the most striking aspects of the transcript of United 173’s last minutes is the way the captain seems to be under the impression that he has plenty of time, right up until the moment the engines cut out. It’s not that he didn’t have the correct information; it’s that his brain was running to a different clock. Similarly, it’s not that the doctors weren’t aware that Elaine Bromiley’s oxygen supply was a problem; it’s that their sense of how long she had been without it was distorted. When Harmer interviewed him, the anaesthetic consultant confessed that he had no idea how much time had passed.

Imagine, for a moment, being one of those doctors. You have a patient who has stopped breathing. The clock is ticking. The standard procedure isn’t working, but you have employed it dozens of times before and you know it works. Each of the senior colleagues around you is experiencing the same difficulty, which reassures you. You cling to the belief that, between the three of you, you will solve the problem, if it is soluble at all. You vaguely register nurses coming into the room and saying things but you don’t really hear what they say. Perhaps it occurs to you to step back from the patient and demand a rethink, but you don’t want your peers to see you as panicky or naive. So you focus on the one thing you can control: the procedure. You repeat it over and over, hoping for a different result. It is madness, but it is comprehensible madness.

Team trauma: British Midland Flight 92 came down near the M1 at Kegworth after a breakdown in communication among the crew

 

9.

In the months after Elaine’s death, as Bromiley tried to rebuild his family life, he couldn’t stop wondering about the difference between the way people in health care treated accidents and the way his industry dealt with them. So he would phone people in and around the National Health Service and ask them about it.

He discovered that many others – an anaesthetist in Scotland, a medical researcher in London – had been wondering the same thing. Eventually, he accumulated a long list of like-minded people, none of whom was talking to any of the others. So he booked a room in a hotel, called a meeting and invited them all, along with experts from other industries and academics, including James Reason. Everyone agreed that when it came to safety, health care was languishing in the Dark Ages. Hospitals more or less pretended that mistakes didn’t happen, failed to learn from them and, as a result, repeated them. If we don’t like to think that doctors make mistakes, doctors like to think about it even less.

One of the biggest problems identified was the unwritten but entrenched hierarchy of hospitals. Bromiley, who has worked with experts from various “safety-critical” industries, including the military, told me that the hospital is by far the most hierarchical workplace he has come across. At the top of the tree are consultant surgeons, the rock stars of the hospital corridors: highly driven, competitive, mostly male and not the kind who enjoy confessing to uncertainty. Then come anaesthetists, often quieter of disposition and warier of risk. Further down are nurses, valued for their hard work but not for their brains.

A key principle of human factors is that it is the unspoken rules of who can say what and when that often lead to crucial things going unsaid. The most painful part of the transcript of Flight 173’s final hour is the flight engineer’s interjections. You can sense his concern about the fuel situation, and his hesitancy about expressing it. Fifteen minutes is gonna – really run us low on fuel here. Perhaps he’s assuming the captain and his officers know the urgency of their predicament. Perhaps he’s worried about being seen to speak out of turn. Whatever it is, he doesn’t say what he feels: This is an emergency. We need to get this plane on the ground – NOW. Similarly, the nurses who could see the urgency of Elaine Bromiley’s condition didn’t feel able to tell the doctors that they were on the verge of committing a grave error. So they made tentative suggestions that were easy to ignore.

John Pickles, an ENT surgeon and former medical director of Luton and Dunstable Hospital NHS Foundation Trust, told me that usually when an operation is carried out on the wrong part of the body (a class of error known as “wrong-site surgery”), there is at least one person in the room who knows or suspects a mistake is being made. He recalled the case of a patient in South Wales who had the wrong kidney removed. A (female) medical student had pointed out the impending error but the two (male) surgeons ignored her and carried on. The patient, who was 70 years old, was left with one diseased kidney, and died six weeks later. In other cases nobody spoke up at all.

The pioneers of crew resource management knew that merely warning pilots about fixation error was not sufficient. It is too powerful an instinct to be repressed entirely even when you know about it. The answer lay with the crew. Because even the most experienced captains are prone to human error, the entire aircraft crew needed to act as a collective intelligence, vigilant for problems and responsible for solutions. “It’s the people at the edge of the room, standing back from the situation, who can often see it best,” Bromiley said to me.

He recalled the case of British Midland Flight 92, which had just taken off for its flight from London to Belfast on 8 January 1989 when the pilots discovered one of the engines was on fire. Following procedure, they shut it down. Over the PA, the captain explained that because of a problem with the right engine he was making an emergency landing. The cabin staff, who – like the passengers, but unlike the cockpit crew – could see smoke and flames coming from the left engine, didn’t pass this information on to the cockpit. After the pilots shut down the only functioning engine, British Midland 92 crashed into the embankment of the M1 motorway near Kegworth in Leicestershire. Forty-seven of the 126 people on board died; 74 sustained serious injuries.

The airline industry pinpointed a major block to communication among members of the cockpit crew: the captain. The rank of captain retained the aura of imperial command it inherited from the military and from the early days of flying, when pilots such as Chuck Yeager, immortalised in Tom Wolfe’s book The Right Stuff, were celebrated as audacious mavericks. The pioneers of CRM realised that, in the age of mass air travel, charismatic heroism was precisely the wrong stuff. The industry needed team players. The captain’s aura was a force field, stopping other crew members from speaking their mind at critical moments. It wasn’t just the instrument panel that had to change: it was the culture of the cockpit.

Long before they started doing more good than harm, surgeons were revered as men of genius. In the 18th and 19th centuries, surgical superstars performed operations in packed amphitheatres before hushed, admiring audiences. A great surgeon was a virtuoso performer with the hands of a god. His nurses and assistants were present merely to follow the great man’s commands, much as the planets in an orrery revolve around the sun. The advent of medical science gave this myth a grounding in reality: at least we can be confident that doctors today make people better, most of the time. But it reinforced a mystique that makes doctors, and especially surgeons (who, of course, still perform in operating theatres), hard to question, by either patients or staff.

Better safety involves bringing doctors off their pedestal or, rather, inviting them to step down from it. Modern medicine is more reliant than ever on teamwork. As operations become more complex, more people and procedures are involved. Operating rooms swarm with people; various specialists pronounce judgement or perform procedures, and then leave. Surgical teams are often comprised of individuals who know each other only vaguely, if at all. It is a simple but unavoidable truth that the more people are involved in something, and the less well they know each other, the more likely it is that someone will make an error.

The most significant human factors innovation in health care in recent years is surprisingly prosaic: the checklist. Borrowed from the airline industry, the checklist is a standardised list of procedures to follow for every operation, and for every eventuality. Checklists compensate for the inbuilt tendency of human beings under stress to forget or ignore what is important, including the most basic things (the first item on one aviation checklist is FLY THE AIRPLANE). They also empower the people at the edges of the room: before the operation and at key moments during it, the whole team goes through each point in turn, including emergencies, which gives a cue to more reserved members of the team to speak up.

Checklists are most effective in an atmos­phere of informality and openness: it has been shown that simply using the first name of the other team members improves communication, and that giving people a chance to say something at the beginning of a case makes them more likely to speak up during the operation itself.

Naturally, this spirit of openness entails a diminishment of the surgeon’s power – or a dispersal of that power around the team. Some doctors don’t mind this – indeed, they welcome it, because they realise that their team can save them from career-ruining mistakes. Others are more resistant, particularly those who treasure their independence; mavericks don’t do checklists. Even those who see themselves as evolved team players may overestimate their openness. J Bryan Sexton, a psychologist at Johns Hopkins University in the US, has conducted global surveys of operating-room staff. He found that while 64 per cent of surgeons rated their operations as having high levels of teamwork, only 28 per cent of nurses agreed.

The lessons of human factors go far beyond the status of surgeons. From his earliest conversations with insiders, Bromiley realised that the NHS needed to undergo a profound cultural change if it was to reach the level of the aviation industry in terms of safety. Hospitals gave little or no thought to how their teams functioned. Doctors underestimated the effects of tiredness on their own performance. Medical schools taught doctors that technical excellence trumped everything else and spent little or no time teaching communication or team management skills. Specialists saw their job as fixing parts of the body, rather than helping a person (at this year’s Clinical Human Factors Group conference, Peter Jaye, a consultant surgeon at Guy’s Hospital in London, remarked: “At medical school I was trained to think of a patient as a pair of kidneys”). There was little or no data on which hospitals and doctors were making mistakes, and therefore which required the most urgent improvement.

Safety risks were routinely misperceived. The “can’t ventilate/can’t intubate” emergency happens about one in every 20,000 times, which anaesthetists consider a remote possibility. Yet as Bromiley told me: “In aviation, when we find out there’s a one-in-a-million chance of an engine failing, we worry. To me, one in 20,000 means a regular occurrence.”

As James Reason showed, mistakes arise out of coincidence. Suren Arul, the consultant paediatrician in Birmingham, told me that “when mistakes happen, it’s almost never one person’s fault. It’s usually a whole series of things, some of them tiny.” Bromiley asks hospital boards to consider their procurement of marker pens, used to mark the part of the body about to be operated on (best practice is for the surgeon to make the mark and to sign it with his initials). “I tell them, ‘I understand your need to cut budgets. But do you realise that because you didn’t buy those marker pens you’ve just trebled your likelihood of having a wrong-site surgery case?’

There is now greater awareness of the complexity of safety than ever. The body that Bromiley founded, the Clinical Human Factors Group, has no official status within the NHS, but its influence has been felt right across that sprawling and multifarious institution. At the meeting I attended, everyone to whom I spoke seemed to believe that things are moving, albeit too slowly, in the right direction.

10.

It was a trauma situation: an 18-month-old baby boy had fallen down the steps at Euston Square station, smashing his head and injuring his leg. Through a one-way mirror, I watched as a young doctor entered the operating room and was greeted by the baby’s distressed mother. The woman sitting next to me turned to her team. “Why don’t you play the orthopaedic surgeon this time, Dave?” she said. “Clare, can you be the anaesthetic consultant?”

In recent years, simulations have started to become part of the training of doctors. Sarah Chieveley-Williams, the consultant anaesthetist who is director of clinical simulation at University College London Hospitals (UCLH), had invited me to watch junior paediatricians being put through their paces. The room before us was a near-perfect replica of an operating theatre, with an anaesthesia machine, various equipment, monitors and a stock of medication. The dummy baby had pupils that dilate, a heartbeat and a noisy cry.

Chieveley-Williams and her team were interested in the doctor’s ability to identify the right priorities: first, stabilise the baby’s condition by anaesthetising it; second, get a neurological consultant to look at its head injuries, in order to prevent or minimise brain damage. On our side of the glass, one of the team sat by a computer from where she could manipulate the baby’s vital signs. She slowed down its heart rate, ratcheting up the urgency of the situation.

Chieveley-Williams turned to another colleague: “Dave, see if you can get her fixated on the leg.” Dave left us and a moment later reappeared in the operating room wearing a white coat. After examining the patient, he proposed, with the air of someone used to being agreed with, that an X-ray be taken of the injured leg. Chieveley-Williams watched intently. In a quiet but firm voice, the young doctor said, “Right now, the priority is his head injury. The leg will have to wait.”

Chieveley-Williams turned to me with a grin. “That told him,” she said.

Over the next 20 minutes, a succession of people entered and left the room. Specialists were summoned, medications ordered and procedures arranged. At times the impression was one of near-chaos. A trauma incident, Chieveley-Williams explained to me, presents an acute management challenge, as well as a medical one. Because it often involves injuries to different parts of the body, many specialists come into the treatment room, each with his or her own agenda. “The doctor needs to establish leadership and keep everyone focused on the big picture – the patient’s health.”

In the case of Elaine Bromiley, there was too much hierarchy and too little. On the one hand, the nurses didn’t assert themselves. On the other hand, nobody was taking ultimate responsibility for the patient’s safety. As John Pickles remarks, “You had three very senior people in the room and no one in charge.”

Hierarchy, in the sense of clear leadership, is a good thing, as long as the leaders are confident enough to confess uncertainty. A common problem, Chieveley-Williams said, is young doctors being reluctant to say they don’t know what the answer is because they are so eager to project competence. A member of her team told me, “We tell them that when you’re stuck, ask everyone in the team for their view. One of them probably has the answer, but until you speak up they’ll assume you have it, too.”

These sorts of lessons weren’t being given ten years ago. Like UCLH, Great Ormond Street children’s hospital in London is at the forefront of the new thinking about patient safety, and is absorbing lessons from other industries. The transfer of patients from surgery to the intensive-care unit is a complex process that has to be accomplished at speed, and involves several people. Unsurprisingly, it is a well-known danger zone: things get dropped, tubes are left unattached, and patients suffer. In collaboration with the human factors researcher Ken Catchpole, the hospital studied the process of pit-stop changes in Formula 1, learning the importance of every individual on the team being allocated a precisely defined task. Mistakes fell.

 

11.

Martin Bromiley has rebuilt his life. Happily remarried, he is stepdad to his second wife’s two children, as well as still dad to Victoria and Adam. He is not haunted by the tragedy of Elaine’s death but driven by it. Between flying commitments, he talks to doctors, nurses, researchers and NHS boards, connecting the like-minded; telling his story to those, whether managers or medical students, who most need to hear it. It is a heavy workload. I wondered if he was ever tempted to leave it behind, now that the CHFG has its own momentum. He shook his head. “This is a duty.”

Improving the safety of patients in health care doesn’t necessarily require spending on expensive new technologies, or complex structural reorganisation. It requires forethought, empathy, humility and a willingness to learn from mistakes. Which, after all, is a duty to those who have suffered from them. Bromiley insisted that the Harmer report be made public as happens with air accident reports, and he chose for it an epigraph borrowed from aviation: “So that others may learn, and even more may live.” All of the medical staff involved in Elaine’s operation are back at work. That, says Bromiley, is exactly what he wanted, because they will be better clinicians for their experience, and advocates for the cause.

There are two approaches to reforming a large institution. You can impose change from outside by invoking the will, or the wrath, of the public – or you can persuade those inside to let you in and to listen to your message. Both can work. When Julie Bailey exposed the gross malpractices of staff at Stafford Hospital, she shook the health service from top to bottom. Bromiley greatly admires what Bailey has achieved, but he has taken a different path. Rather than using his story as a club – and nobody would have blamed him for doing that – he has deployed it as you would wish a surgeon to apply the knife to someone you love: with skill, subtlety and precision.

“From the moment something went wrong with Elaine, it was different, because they knew my profession,” he says. Responding to his calmness and extraordinary ability to empathise with their situation, the team rose to their best. As Elaine lay in a coma, they involved him in every decision they took, right up until the last one. It was proper teamwork, and a model for the long campaign that followed. “I’m an outsider who is also an insider,” he says.

Martin Bromiley has reminded clinicians that not everything is or should be clinical. His legacy, says Professor Jane Reid, a researcher in nursing at Queen Mary’s Hospital in south London, is “a new safety culture” in the NHS. He has no desire to take up any official position. “I’m not an expert on medical practice,” he told me. “I’m just a guy who flies planes.” 

Ian Leslie is the author of Curious: The Desire to Know and Why Your Future Depends on It (Quercus, £10.99)

Ian Leslie is a writer, author of CURIOUS: The Desire to Know and Why Your Future Depends On It, and writer/presenter of BBC R4's Before They Were Famous.

This article first appeared in the 28 May 2014 issue of the New Statesman, The elites vs the people

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Jeremy Corbyn has attracted "socialism fans", not Labour voters

The leader's project is to transform the Labour party, not win elections. 

Jeremy Corbyn was elected leader of the Labour Party in September 2015, and (following a vote of no confidence and a leadership challenge) re-elected to the same post in September 2016. In February this year, many of those who had re-elected him expressed disappointment at his effectively unconditional support for Theresa May’s invocation of the Article 50 process to leave the European Union; perhaps to placate them, Corbyn subsequently called for a demonstration in support of those who would suffer the most from EU withdrawal, but then failed to turn up.

Part of the public rationale for Corbyn’s three-line whip on the Brexit vote was that if the party opposed it, then that might lead to a loss of support in predominantly working class constituencies in the North and the Midlands that had voted Leave by large margins: constituencies such as Copeland and Stoke-on-Trent Central, where the party nevertheless went on to lose vote share in by-elections later the same month.

But despite all this — despite Brexit, which Labour Party members and voters had overwhelmingly voted against, and despite what was arguably the worst by-election performance for an opposition party since the late 19th century — Corbyn’s supporters in the Labour Party are still for the most part Corbyn’s supporters in the Labour Party, and they’re not going anywhere — and neither, therefore, is the man himself.

Asked whether Corbyn’s continued leadership of the party was a good thing, the answer from sidelined deputy leader of the Labour Party, Tom Watson, was pragmatic: "It doesn’t matter; that is the situation." This impasse will not endure forever: Prime Minister Theresa May has called for an early General Election, and Corbyn (who has been asking for one since December last year) has given his support. But in the six weeks that we have left until the Labour Party is overwhelmingly (and perhaps irreparably) crushed, it may perhaps be worth reflecting on how it got into this appalling mess.

1. A hostile takeover

The best way to find out what a particular group thinks is to survey a random sample of about a thousand of its members — and this is exactly what Ian Warren of Election Data has done, by commissioning a YouGov opinion poll of the Labour Party. Warren’s poll found striking differences between party members who joined before Corbyn became leader and party members who joined afterwards. Among the former group, 28% approve and 62% disapprove of his leadership, but among the latter, 69% approve and 20% disapprove. The poll also found Corbyn’s leadership to have the approval of only 47% of those members who voted Labour in 2015, but of 73% of those who voted for other parties at that time. Both of these findings support the view of Corbynism as a hostile takeover  of the Labour Party.

The party has long been attractive to such takeovers because, since the early 20th century collapse of the Liberal Party, it has consistently been one of the two most dominant parties in the British parliament. However, it was recently made more vulnerable to takeover by rules changes that gave anyone who joined the party or registered as a supporter an equally weighted vote in its internal elections.

Corbynism is the exploitation of that vulnerability in order to increase the influence of a particular faction within the Labour Party. This faction is sometimes referred to as Labour’s "hard left" wing, to distinguish it both from the party’s "centrist" wing (think Tony Blair or Harold Wilson) and the "soft left" that lies between the two (think Ed Miliband or Neil Kinnock). However, it is perhaps more useful to refer to it as the party’s "Bennite" faction. This emphasises its long-term leadership by Tony Benn, father of Melissa Benn, the author; Hilary Benn, the decidedly non-Bennite MP whose sacking from the shadow cabinet prompted the 2016 leadership challenge against Corbyn; and Stephen Benn, the 3rd Viscount Stansgate.

Although originally a centrist, Benn converted to Marxism in the 1970s, acquiring a devoted following among the more radical elements that were by then flowing into the party membership. He was never successful in his attempts to become party leader or deputy leader, but Benn was responsible for the party’s adoption of its most radical manifesto ever: a programme of industrial nationalisation, unilateral nuclear disarmament, and withdrawal from the EU’s predecessor organisation, the European Community. When Michael Foot, a representative of the party’s "old left" (think Aneurin Bevan or Richard Crossman) led Labour into the 1983 general election on this manifesto, it received its worst defeat since before the Second World War. Foot resigned as leader of the Labour Party and was replaced by Neil Kinnock, a left winger who had not supported Benn.

With the party under Kinnock’s leadership, Benn and his associates — such as Ken Livingstone, who had become leader of the Greater London Council in 1981, and Jeremy Corbyn, who was elected to parliament for the first time in that fateful 1983 election — were unable to prevent the expulsion of their allies in Marxist-Leninist groups such as Militant (originally known as the Revolutionary Socialist League), and were increasingly sidelined from the late 1980s onwards. Their defeat seemed cemented in 1995 when Tony Blair amended Clause IV of the Labour Party constitution to replace its commitment to public ownership of industry with a commitment to unspecified "democratic socialist" ideals, subsequently rebranding the party as "New Labour" and (together with his then-ally, Gordon Brown) leading it to an unprecedented run of three general election victories in 1997, 2001, and 2005.

However, the balance of power shifted with the party’s demoralising 2015 defeat under its "soft left" leader, Ed Miliband. Following Miliband’s resignation, Corbyn — at the time, a largely forgotten Bennite — secured sufficient nominations from fellow MPs to gain a place on the leadership ballot. In accordance with rules changes agreed under Miliband, the ballot was put to members, registered supporters, and affiliate members of the party, whose ranks were swelled by large numbers of people joining specifically in order to vote for Corbyn. Corbyn’s victory was convincing, although it is noteworthy that – despite the influx of new members – he was not the first choice of 50.4 per cent of party members.

After winning this internal election, Corbyn swiftly moved to install his allies at the top of the party. His long-term friend, John McDonnell — another Bennite, who once described Karl Marx, Vladimir Lenin, and Leon Trotsky as his "most significant" influences — was appointed to the most senior shadow cabinet position, and a number of Marxist-Leninists from outside Parliament were given important posts within the party. Labour centrists often refer to Communists as "Trots", i.e. Trotskyists (that is, supporters of revolutionary proletarian internationalism as represented by the Fourth International). However, the prevailing ideological climate of Corbyn’s circle tends more towards the other primary stream of European Marxism-Leninism, i.e. Stalinism (that is, support for the totalitarian Soviet state as well as — for unclear reasons — its gangster capitalist successor state, the Russian Federation).

The antifascist blogger, Bob from Brockley, explains as follows:

Corbyn has had a weekly column in… the Communist Party of Britain’s Morning Star, and he has used that column to promote a basically Cold War second camp worldview, most recently in promoting Kremlin lies about Ukraine…After leaving Oxford, Seumas Milne [whom Corbyn appointed as the Labour Party’s Executive Director of Strategy and Communications] cut his political teeth in a group called Straight Left, whose USP in the small but crowded market of the far left was that it thought most other Communist groups were insufficiently appreciative of Stalin’s achievements. 

Let’s not get carried away, though: whatever the political background of the Labour leader and his circle, there is no need to assume that all those who voted for him are current members of revolutionary Communist organisations. Some sort of Communist influx has undoubtedly occurred, especially within Momentum (the "grassroots" pro-Corbyn organisation founded and owned by Corbyn’s old friend, Jon Lansman, and now riven by conflict between its Trotskyist and Bennite wings. As Colin Talbot has argued, there are very large numbers of aging ex-Communists who may have "turned to Corbyn as the political equivalent of going out and buying a Harley".

But Corbynism appeals to a wider (but not that much wider) group of mostly middle class people whose primary cultural identification is with "the Left". Such people are keen to support Corbyn because they see him as one of their own: a vegetarian pacifist who has never been interested in the tedious work of winning elections and scrutinising legislation but who has (as he told Nigel Nelson in the middle of his first leadership election campaign) "always [been] passionate about justice, the environment, and war and peace", and who, in his youth, "got arrested in most countries [he] visited for demonstrating".

Although Corbyn was originally elected with broad support from existing members of the party, his power base within it now primarily consists of people who joined it in order to re-shape it in his image and their own. These people might best be thought of as "socialism fans", and are quite different from traditional Labour Party members and voters. They are people who joined the party not because they agreed with its goals and wanted to help it achieve them, but because they identified with the culture of Leftism and sought an active form of cultural participation — much as theatre buffs might join an amateur dramatics club, or history enthusiasts might join a medieval re-enactment society.

The difference between those who joined the party in order to help its representatives get elected to local and national government and those who joined the party in order to place and keep Corbyn at its helm is as stark as (and in many ways parallels) that which George Orwell's The Road to Wigan Pier describes between, on the one hand, "the warm-hearted, unthinking Socialist… who only wants to abolish poverty", and, on the other hand, "the foaming denouncers of the bourgeoisie, and the more-water-in-your-beer reformers… and the astute young social-literary climbers… and all that dreary tribe of… sandal-wearers and bearded fruit-juice drinkers" who flock to "Socialist" organisations and drive away ordinary working class people who might otherwise be inclined to join or vote.

It is not just that members who voted for Corbyn in 2016 (i.e. after and despite the bad opinion polls, the dreadful showing in the May elections, the loss of the referendum, and the vote of no confidence from those it was Corbyn’s job to lead) are — as Warren’s YouGov poll shows — far more likely than those who voted against him to engage in low-investment forms of political activity, such as sharing campaign messages on social media, and far less likely to engage in high-investment forms of political activity, such as delivering leaflets or knocking on doors.

It is that they have a very different idea of what the Labour Party is for. They view it not as a party of parliamentary government or opposition but as an opportunity to engage in demonstrations, protests, marches, and rallies — as well as thrilling social media battles against insufficiently radical Labour MPs (and their supporters). These are the people for whom Corbyn was speaking when he said: "We’re all in power. We just don’t realise it. We have the power to speak, to influence, to demonstrate, to demand."

Engagement with the business of parliament is irrelevant — perhaps even an impediment — to the socialism fan’s enjoyment of such "power". Thus it seems unsurprising that, of those who voted for Corbyn in the 2016 election, only 11 per cent consider "understanding what it takes to win an election" to be among the two or three qualities most necessary for a Labour leader (compared to 55 per cent of those who voted against them), while 30 per cent and 31 per cent respectively consider "mov[ing] the party to the left" and "tak[ing] on powerful interests" to be among them (compared to 2 per cent and 6 per cent of those who voted against him).

The conflict between socialism fans and people with a more direct interest in electoral politics plays out again and again in social media. For example, when Owen Jones last month asked Corbyn supporters on Twitter what they thought of the prospect of an early election, he was told that "transforming the Labour Party" was "never a short-term project". The Corbyn supporter who supplied this answer seemed indifferent to Jones’s objection that the "decimation of Labour" would be the result.

A few days after I observed the above exchange, a Labour Party who had once held the post of Political Education Officer within his CLP used the relatively less public platform of a Facebook group to inform me that it did not matter whether the party lost votes as it turned towards socialism, because votes for a party that was (on his view) insufficiently socialist were no different from votes for the Conservative Party or the Liberal Democrats. As he continued: "I want Labour to be firmly socialist", "I think New Labour must be permanently exterminated", and "the important thing is having Labour as a socialist party and eradicating New Labour for good".

One might wonder what end could be achieved by transforming Labour if it could not then be elected to government? But that is the wrong question: the eradication of Blair’s legacy is an end in itself. This is recognisably the same politics advocated by Corbyn-supporting journalist Paul Mason in conversation with the more sceptical Carole Cadwalladr:

"In America, he says, ‘what the Occupy generation chose to do was to occupy the Democratic party and that’s effectively what [we] have chosen to do here: to occupy the Labour party. … We, on the left of the party, didn’t want this fight. But it’s like what General Sherman said in the American civil war: “You’ve chosen war. We’re going to give you all the war you can take" …I want to lay waste to the whole neoliberal hierarchical tradition that Blairism and Brownism represented’."

We see more of the same in the following, by the influential left-wing author, Richard Seymour, who laid out his vision on Twitter:

1. Regarding "pessimism", a few points of order. The most plausible outcome of Corbyn's leadership has never been socialist triumph.

2. The party apparatus and the wider terrain (media etc) was always going to be set against him.

3. The electoralist goals of Labour would always conflict with the goals of regrowing the grassroots, winning socialist arguments.

4. Because the latter work on a long timeline, whereas elections are short-term, responsive to news cycles, parliamentary squabbles, etc.

5. Even winning an election wouldn't be triumph, because it's a question of what kind of country you govern -- political economy, etc.

6. The best hope for Corbynism was/is that it would transform Labour, democratise it, make it a mass campaigning party.

7. A party capable of organising social power beyond electoral arena -- but that means taking short-term losses, esp middle class votes.

Winning elections is not an objective; losing votes is not a problem; the goal is to transform Labour: to take it out of electoral politics, to refocus it on the exercise of "social power", and above all, to democratise it, i.e. to put it under the control of anyone who wants to join it, rather than those of its representatives who have been elected to parliament or to local and regional government by the general public and who do the day-to-day work that this involves. If that goal is ever achieved, it is hard to imagine what the party would do next. Those who share a desire to take it over do not necessarily share much else in common, besides a hatred of Tony Blair. In fact, the most likely outcome would be a series of splits, for example between those who wish to abolish private property and those who only want to nationalise the railways.

Corbyn’s leadership can be advocated by liberal environmentalists and revolutionary Communists, as well as by mutually opposed sub-groups of the latter, because his own ideology is impossible to pin down beyond a commitment to a "socialism" that he defines only in the vaguest possible terms. "You care for each other, you care for everybody, and everybody cares for everybody else", (another gem from Nelson’s interview) is his clearest statement yet of what the word means when he uses it.

What manner of policies for the governing of a country could one derive from such a position statement? Almost any — which means that all those who wish to, can imagine that Corbyn would govern in accordance with their own preferences. But the defining feature of Corbynism is that it is only incidentally concerned with the outside world. It is primarily a politics of coalition between members of the self-identified "Left", who will be able to work together only as long as there is no goal beyond the defeat of Labour’s centrist and soft left factions.

For example, the Stop the War Coalition, whose president was Tony Benn until 2014, whose chair was Corbyn until 2015, and which retains Corbyn’s full support, is felt by many people to be a front for Britain’s largest Trotskyist organisation, the Socialist Workers’ Party or SWP (of which the above-quoted Richard Seymour used to be a member). It seems oddly unbothered by the savagery of Daesh/Islamic State. Meanwhile, the Morning Star is unbothered by the equally barbaric Kremlin-backed Assad regime and likewise retains Corbyn’s support.

What rational sense can this make? It’s not just that these are groups that no reasonable and humane person would want anything to do with. It’s that Trotskyists and Stalinists were at each other’s throats even before Stalin had Trotsky murdered — and that Daesh and the Assad regime are at war. Similarly, Corbyn can insist that "women deserve… unflinching support in the face of violence and abuse", yet ignore his own feminist supporters when they demand that he distance himself from Stand up to Racism over the well-documented willingness of the SWP (for which it is, of course, yet another front organisation) to cover up allegations of sexual violence by its own senior members. Because all the associated speaking and demonstrating and demanding (to return to Corbyn’s above characterisation of the kind of "power" that he and his followers appear to understand themselves to wield) is covered by the umbrella of an amorphous Leftism with no need for ideological coherence, relatively substantial numbers of socialism fans can be recruited to the support of often rather nasty groups even as the majority of the population is repulsed.

Corbyn, with his vague passion for "justice, the environment, and war and peace", is the ideal figurehead for this cultural or aesthetic Leftism and its cynically tactical coalitions - an apparently blank canvas onto which socialism fans can project their fantasies. Since 2015, his own saintly figure has been the focus of perhaps the largest coalition of all, devoted to the single issue of getting the Labour Party out of the government business by installing him as its leader and keeping him there. As the rest of this article will argue, it scarcely matters how particular Corbyn supporters might choose to define their politics, because they all speak the same language in support of this shared goal.

2. The commonplaces of Corbynism

Here is a quote amalgamated (note the ellipses) from three comments that a single individual made on a mutual friend’s Facebook post on 27 February 2017. Between his posting of the second and third comments, I commented that the Labour Party is not primarily a socialist party but has "always had room for socialists — provided that they can reconcile themselves to electoral reality".This comment of mine is referenced in the third of his:

"A centrist-Labour would now be what was once considered right wing. Corbyn is hardly hard left, but mainstream politics has lurched so far to the right it’s normalised the right doctrine and neoliberalism. As Raymond Williams scarily predicted, the values and ideas are of neoliberal capitalism are so normalised it appears to be the only way, the way it’s ‘always been’. … If the only viable choice is a right leaning Labour party, or an extreme right Tory party, dictated mostly by the right wing and corporate owned media, then really democracy and decency are already lost. …‘Electoral reality’ is exactly what Raymond Williams warns about. This is the way it is, there’s no room for change. Corbyn represents a genuine difference. If the choice is between Extreme Tory and Tory-Lite, then what is even the point? Corbyn has repeatedly been on the right side of history, and his policies have genuine popular appeal and yet it’s increasingly clear the media control what people see and hear."

There’s nothing special about the above, but that’s the point: the most striking thing about it is its sheer predictability. Although not all attempt to understand contemporary politics by reference to the work of Marxist literary critics who died three decades ago, Corbynites say more-or-less the same thing on a daily basis, both on social media and off it. For example, the day after the above Facebook comments were made, the aforementioned Morning Star bluntly asserted that "people understand Jeremy’s message to be true" in an editorial published under the headline "The only political leader offering radical change". An article published later the same week in Socialist Worker — the official newspaper of the aforementioned SWP — argued that "Corbyn’s 'hard left' policies seemed normal inside the Labour party when he first became an MP in 1983" but "n]ow they are regarded as very left wing", and, as a result, "most of the media have waged a vicious campaign to undermine Corbyn".

Like those articles, the Facebook comments above are assemblages of what rhetoricians call topoi or "commonplaces": ideas or themes that are — within a particular culture — frequently revisited and rarely challenged. Within particular groups, people adopt the same ways of speaking, which imply the same ways of thinking. The following are clearly recognisable as the kinds of things that Corbynites say:

Jeremy Corbyn’s policies are what the public really wants.

Jeremy Corbyn only seems to be "hard left" because the Labour Party has moved to the right, leaving him behind.

Without Jeremy Corbyn, the Labour Party would be virtually indistinguishable from the Conservative Party and there would be no point voting for it.

Jeremy Corbyn is different from other politicians.

Jeremy Corbyn brings change that powerful forces seek to prevent.

Jeremy Corbyn has always been "on the right side of history".

If members of the public think they don’t want Jeremy Corbyn, that’s only because of the malign influence of the media.

The only thing missing from the above list is the assertion that Jeremy Corbyn is actually very popular with the British public. If you haven’t heard such lines before, then you haven’t yet met the people who joined the Labour Party in order to get Corbyn into the leader’s office and keep him there — the people for whom Corbyn’s leadership is the only good thing about the Labour Party — the people for whom supporting Corbyn is the very point of being in the Labour Party.

Taken literally, these ideas are a mixed bag. There is never any clarity as to what Corbyn’s "difference" from other politicians consists in, nor as to why it should be considered a good thing. The nature of the "change" he is said to bring is similarly nebulous. The grand-sounding claim about "the right side of history" only means that he voted against the invasion of Iraq. And while some of Corbyn’s policy positions are potentially popular with voters, those are positions that are shared across the Parliamentary Labour Party, including by centrist MPs. As for the idea that Corbyn originally represented the mainstream of the Labour Party, that is true only in the limited sense that his entrance into Parliament was via the disastrous 1983 election, which the party fought on a manifesto that was largely the handiwork of one of its most left-wing MPs. 

But the power of commonplaces arises from repetition, not from rational consideration in relation to empirical evidence. Indeed, their very point is that they are never subjected to critique, serving instead as accepted starting points for trains of thought that reliably loop back to the point of departure. For Corbyn’s supporters, a good argument is an argument both founded upon and re-affirming Corbynite commonplaces, while a deceptive or mistaken or otherwise Blairite argument is an argument that does not.

3. The culture of the Left

One of the most interesting aspects of these commonplaces is their ability to circulate between groups that might otherwise appear to have fairly fundamental disagreements, including supporters and opponents of Britain’s membership of the European Union, as well as both Stalinists and Trotskyists. This is because they have their roots in the culture of the 21st century British Left — which is shared across multiple left wing groups and left-identified individuals unaffiliated with any specific group — rather than in any particular political analysis — which is the sort of thing that socialists and Communists will feud over until the end of time (hence the virtually microscopic size of all British parties to the left of Labour).

Here, for example, is an editorial published nearly two years before the above social media comments in Solidarity, the official newspaper of the Alliance for Workers’ Liberty or AWL, a Trotskyist organisation formerly known as Socialist Organiser, membership of which is proscribed for Labour Party members:

"The huge support for Jeremy Corbyn’s campaign for Labour leader is a reminder that what seems like an overwhelmingly dominant right-wing ‘consensus’ in bourgeois politics can be limited and unstable. It shows that large numbers of people, including working class and young people, still want a politics that is different to, and to the left of, the consensus of neo-liberalism."

We can read this and the more recent quotations we have already seen almost as a single text. Left politics, identified with Corbyn, are positioned as "different to", "offering radical change" from, or "represent[ing] a genuine difference" with regard to a "normalised" or "consensus" position described as "neoliberal" or "bourgeois" and identified not only with the Conservative Party ("Extreme Tory") but also with all Labour MPs not overtly affiliated with their party’s left wing ("Tory-Lite"). This politics is not really "hard left"; rather, it is "popular", "understood to be true" by "people", and supported by "large numbers of… working class and young people", such that any apparent lack of enthusiasm from the general public must be explained, whether explicitly or otherwise, by conspiracy theories — for example, involving "a vicious campaign" waged by "the media", which has "control [over] what people see and hear".

The latter is particularly important because it functions as an alibi for the failure of the rest. For example, while I was writing this, a message was posted to a popular Labour Party Facebook group using a reference to Edward Herman and Noam Chomsky’s Manufacturing Consent to support the argument that it is not the Labour leadership but the media that need to change. "Labour politics is fine," the poster concluded, and if "a political party that clearly represents the interests of the vast majority of the population cannot obtain the commensurate backing", this can only be explained through media bias.

To accept this line of reasoning is to accept then the Labour Party will never again win elections because it cannot change the media, but to assert that its future defeats won’t matter, because they won’t be the party leader’s fault. If indeed one regards elections in which the general public participates as in any way important – which many enthusiasts of party democracy apparently do not.

Such thinking goes all the way to the top of the current party, with Corbyn’s closest parliamentary ally, McDonnell, informing two journalists at the Guardian — a newspaper that was intensely critical of Blair (especially over the war in Iraq) and that publishes numerous pro-Corbyn commentators — that because their employer "became part of the New Labour [i.e. Blairite] establishment… you feel dispossessed because your people are no longer in power" and therefore collude in the media’s attempt "to destroy a socialist who is trying to transfer power from the establishment to the people". Corbynite commonplaces all the way.

4. "Working class politics"

But what is "the establishment" and who are "the people"? In practice, the former simply means whoever held positions of influence in the Labour Party before Corbyn’s election as its leader, and the latter simply means the Bennite faction of the Labour Party and its allies in various left-wing organisations, some of whose members are banned from joining Labour.

On the subject of organisations proscribed for Labour members, I turn now to an editorial published just after Corbyn’s re-election as Labour leader in The Socialist, the official newspaper of the Socialist Party or SP: another Trotskyist organisation that formerly practised entryism under the name of Militant but subsequently shifted to competing against the Labour Party in local and parliamentary elections, latterly in partnership with the SWP as part of the Trade Unionist and Socialist Coalition or TUSC (from which the SWP recently withdrew in order to focus its efforts on supporting Corbyn). The editorial, which also writes of ‘huge enthusiasm for Corbyn’s pro-worker platform’ argues as follows:

"The battle against Labour’s right is not simply a battle between two wings of a party. Behind them are the class interests of the different participants. The right ultimately represents the capitalist elite, which was delighted with the Blairite transformation of Labour into a party that could be relied on to act on their behalf, and is fighting to turn the wheel of history back to that situation."

It’s worth thinking about this carefully. Its scope is the Labour Party itself (from which ex-members of Militant are banned), and its concern is with whether the party shall remain in the state to which it was transformed by Blairite Labour MPs for the benefit of the "capitalist elite" or shall be re-transformed by Bennite Labour MPs for the benefit of… well, who, exactly? The idea appears to be that Corbyn’s leadership will deprive the "capitalist elite" of the tool that the Labour Party supposedly became under Blair. The Labour Party does not have to win elections for that goal to be achieved. Indeed, it could simply vanish – or fragment into micro-parties indistinguishable from the rest of the British far left.

The image of heroic struggle within the Labour Party is given graphic form in a drawing on the cover of the issue of Solidarity from which I quoted previously, which shows workers (standing on the left, of course!) cheering Corbyn on while senior Labour Party figures (including Blair himself with a badge that reads "Tony Tory") and obese, drunken journalists (naturally standing or sprawled on the right) hysterically condemn him as an "extremist" or a "disaster". The drawing is captioned "The Socialist who stood in a Labour leadership election", and accompanying front page headlines are "Back Corbyn’s campaign" and "Fight for working class politics", while the article quoted above carried the slightly different headline, "Back Corbyn, fight for working-class politics!" From Corbyn’s mouth come vague, policy-free statements of rejection: "I don’t agree with austerity" and "I oppose attacks on the working class and the poor!"

This is, I would suggest, the sum total of the Corbynite project: the installation at the head of the Labour Party of a "socialist", i.e. a person upon whom Marxist-Leninists can pin hopes, and who makes statements aligning himself or herself against right-wing policies (such as "austerity") and with "the working class" and "the poor". What do actual "working class" or "poor" people think of this? They certainly aren’t very keen to vote for it.

In contrast to all the above, and without claiming that it typifies the views of any particular group, I offer the following report of a working-class individual’s discourse on Corbyn, simply to remind my readers of what the Labour Party might look like to those who turn to left-of-centre politics in hope of what George Orwell characterised as "better wages and shorter hours and nobody bossing you about" as opposed to the revolutionary’s "vague threat of future violence":

My Mum, brought up working class in a railway worker’s house, got a phone call today from the Labour Party about her direct debit being cancelled.

She gave them both barrels about how Corbyn was a traitor to the working class by dooming Labour to opposition and bringing about a further decade of Tory government. She said that she would not give another penny to the party until Corbyn had gone. She told the person on the phone that the best government she had ever known was the Blair government and that Gordon Brown saved the world only for this Jeremy Corbyn "tosser" to put it all at risk.

I would like to apologise to the poor bugger who made that phone call as well giving a big shout out to my Mum.

(Taken from the Labour’s Future Facebook group)

Unheard of talk! Blair’s government the best that a "working class" person had ever known? Perhaps the National Minimum Wage and the Sure Start Centres and the extra billions for education and the National Health Service counted for something after all. And Corbyn a "traitor to the working class"? The latter accusation is more typically levelled at Labour Party centrists such as Blair and Brown — the "Tory-Lite" leaders who (we are frequently informed) took the votes of working class people for granted while selling out their interests for the sake of "neoliberal capitalism".

Although Trotskyists, Stalinists, and Bennites alike tend to present Corbyn as the champion of "working class politics", it should be recognised that his programme has very little to offer working class people in the here-and-now. Even in the fantasy scenario of a Corbyn-led government, the hoped-for benefits to the working class would still be indirect: rather than implementing policies to the direct material benefit of actual working class people, a hypothetical Prime Minister Corbyn would — according to the AWL — implement policies to facilitate the working class’s fulfilment of the destiny assigned to it by classical Marxist theory, i.e. the overthrow of the capitalist order and the institution of social ownership of the means of production and exchange, which an elected government could not achieve even "if it wanted to". In the real world and at the present moment, in which the proletariat does not yet acknowledge its revolutionary future role, actually existing working class people are of interest only insofar as representations of them can be conscripted in support of arguments over who will lead the Labour Party.

Meanwhile, those same actually existing working class people repay the compliment by taking little or no interest in the Labour Party. A survey carried out before the 2015 General Election and again in December of the same year found that both before and after the increase in party membership driven by Corbyn’s leadership campaign, over 75 per cent of Labour members lived in households headed by someone in an "ABC1" occupation, i.e. that less than one in four would ordinarily be classified as working class. In socio-economic if not in cultural and political terms, the new membership was indistinguishable from the old membership. The fight to transform Labour from a party seeking to achieve limited although concrete reforms through engagement in the work of local and national government into a social movement more interested in exercising "the power to speak, to influence, to demonstrate, to demand" is therefore probably best understood as a form of middle class identity politics (the identity in question being "left").

The immediate beneficiaries of Corbynism are not working class people per se, but members of "left" political organisations or factions either (a) seeking power within the Labour Party, or (b) directly competing with it in their efforts to win votes in elections and/or to recruit members. Some of those people are working class, but most are not. The Morning Star responded to last summer’s challenge to Corbyn’s leadership with an editorial headlined "Justice must be won for the working class", in which it argued that "[t]he cumulative anger and frustration that’s been building in working-class communities across these lands over the last few decades has found an outlet" in support for Corbyn and opposition to his detractors in the Parliamentary Labour Party.

Given the historically low vote share of candidates for Corbyn’s Labour Party in the strongly working class constituencies of Copeland and Stoke-on-Trent Central last month, such assertions should not be taken literally. Retaining Corbyn as Labour leader wins no justice for the working class; it only consolidates power within the Bennite faction of the Labour Party and provides members of Trotskyist and Stalinist organisations such as the SWP and Communist Party of Britain with a path to greater influence within the Labour Party and greater esteem within the wider Left. The anger and frustration that really troubles the Morning Star is that felt within the revolutionary socialist sects that take themselves to be the guardians of the best interests of the working class of Marxist theory and feel aggrieved that the UK’s largest left-of-centre party is not run by the most left-of-centre people in the UK.

5. They, Daniel Blake: the great spoken-on-behalf-of

One of the defining moments of Corbynism was the release of I, Daniel Blake: a critically-acclaimed BBC Films movie about a tragic working class welfare claimant. It was directed by Ken Loach, a long-term friend of Jeremy Corbyn and the creator of an hour-long promo video in support of the latter’s re-election as party leader. I, Daniel Blake had such an impact on Corbyn’s followers that many of them renamed themselves "Daniel Blake" on Twitter in perhaps the quintessential statement of socialist fandom. "We are all Daniel Blake" was another popular slogan, and — coincidentally — the headline of an article that appeared in the same issue of The Socialist as the editorial quoted above. Following the unprecedented drop in Labour’s vote share in the Copeland and Stoke-on-Trent Central by-elections last month, Loach wrote in defence of Corbyn’s leadership in a Guardian article saturated in Corbynite commonplaces.

The article begins with Loach’s recollections of his own visits to Stoke-on-Trent and Whitehaven (the centre of the Copeland district), promoting I, Daniel Blake with Labour Club screenings organised by activists from Momentum, the privately-owned pro-Corbyn organisation briefly discussed above. Having pointedly criticised Labour activists outside Momentum by commending the behaviour of the Momentum activists in question as "a model of how Labour activists should work" and recalled audience complaints of "the failure of Labour governments… and, importantly, Labour councillors", Loach cut to the chase:

"Now let’s ask the real questions. What are the big problems people face? What is the Labour leadership’s analysis and programme? Why is Labour apparently unpopular? Who is responsible for the party’s divisions?

The problems are well rehearsed but rarely related to the leadership question. A vulnerable working class that knows job insecurity, low wages, bogus ‘self-employment’, poverty for many including those in work, whole regions left to rot: these are the consequences of both Tory and New Labour’s free market economics. … The central fact is blindingly obvious: the Blair, Brown and Peter Mandelson years were central to this degeneration. That is why Labour members voted for Jeremy Corbyn.

Corbyn and his small group fight the Tories in front and deal with the silent mutiny behind them. Yet the MPs, unrepresentative of the members, are doing immense damage. How come the media don’t put them in the dock? It is they and their backers in the party bureaucracy who have been rejected.

It was their Labour party, not Corbyn’s, that lost Scotland, lost two elections and has seen Labour’s vote shrink inexorably. … If Corbyn can be removed, it will be business as usual, with scant difference between Labour and the Tories. If it is to transform society, the party itself must be transformed."

As we see from the above, the priority for Loach — who in 2013 founded the rival Left Unity party and in 2015 campaigned for it against Labour — is the transformation of the Labour Party (yes, that again). That — on his account as much as on that of the Trotskyists and other Corbynites quoted in previous sections of this essay — must (naturally) precede any significant external politics. What is at stake is not the day-to-day work of parliamentary opposition to the Conservative government, nor the short- to medium-term ambition to replace that government with a Labour government that would implement specific policies for the benefit of actual working class people (say, a higher minimum wage and an improved public health service), nor the still less glamorous equivalents in local and regional government, but the eternal — and fundamentally aesthetic — imperative for ‘difference between Labour and the Tories’, i.e. for Labour to be led by the kind of person for whom a socialism fan would like to vote.

Exactly as in the examples quoted in the previous sections, a historic struggle is said to be in progress, with, on one side, Corbyn and his followers, and on the other, a coalition between the Conservative Party, past Labour leaders and cabinet ministers, and "[Labour] MPs, unrepresentative of the members": because the job of Labour MPs is to represent whoever currently constitutes the majority of the (now very middle class) Labour membership, rather than the ordinary voters whose representatives in Parliament they officially are. But this inversion of democracy is no problem at all, because, under Corbyn’s leadership, the party is not unpopular, but only "apparently unpopular", its true popularity presumably concealed in the voting booth and revealed only at screenings of I, Daniel Blake.

Loach’s essential argument is that the sufferings of working class people require Labour MPs and bureaucrats to submit — and submit enthusiastically, for the quiet resignation with which they accepted the result of the September 2016 leadership election is here condemned as "silent mutiny" — to Corbyn and his circle, who will rule over the party in the name of the working class — that is, of them, Daniel Blake.

6. Selling a piece of St Jeremy

We can see how this plays out on the ground in in John Harris’s short video documentary about the Stoke-on-Trent Central by-election. The film is well worth watching as a whole, but the part to which I would like to draw attention is the interaction between a Labour Party activist and a potential voter. Here, PV is the potential voter and LPA is the Labour Party Activist:

PV: What you go- what you gonna do for the community and that?

LPA: What do you think needs to be done for the community?

PV: Pff. I dunno. Like, some better shit, init, like, you know what I mean? Like, build fucking, like, I dunno, like, more youth centres, stop closing shit down.

LPA: Yeah.

PV: Like, help people that are vulnerable and that. Put people in better housing.

LPA: Yeah.

PV: You know what I mean? Stop sending people to jail for stupid shit.

LPA: Yeah.

PV: You know what I mean, like?

LPA: Are there any people that you think represent your views, do you feel like the Labour Party represents the, the —

PV: Nah.

LPA: Why not?

PV: ’Coz they’re all full of shit, man, they’re all like upper class people that’ve, you know what I mean? There’s no —

LPA: Yeah.

PV: No people who’ve actually lived it in there, is there?

LPA: Is that something you would vote for? If people were talking about, like, opening more youth centres, and, uhm, making fairer like justice system and things like that?

PV: Yeah.

LPA: Because that is what, uhm, Jeremy Corbyn, the leader of the Labour Party, stands for at the moment.

PV: But everyone says that, everyone makes, like, promises and that but shit don’t get done, does it?

LPA: One thing I’d say about Jeremy Corbyn is that he’s quite different from politicians that’ve come before – like, do you know that none of the Labour Party want him, basically, like, to be the leader?

PV: No-one wants him ’coz he’s a dick.

LPA: (laughs)

PV: You know what I mean, like?

LPA: Why do you think that?

PV: Well, he was saying stuff like, ah, he doesn’t wanna use our c-, our Trident missiles and all of that shit

LPA: Yeah.

PV: ’Coz if someone come over here and started blowing us up, like, what are you gonna do, pour ’em a cup of tea and be like, "Yeah, crack on."

LPA: But do you not know that Trident costs, like, six hundred billion pounds, so if we didn’t have Trident, all the things that you’ve just said — youth centres, better justice system —

PV: Yeah but the thing is, I don’t actually care, like.

LPA: You do!

PV: But I don’t.

LPA: You do!

I shan’t dwell on the fact that the estimated cost of Trident renewal is not £600bn but £17.5-£23.4bn according to the Ministry of Defence, which supports it, and £100bn according to the Campaign for Nuclear Disarmament, which opposes it. It’s easy to make a mistake in the heat of the moment.

It is more helpful to focus on the radical disjunction between the priorities of the activist and the Stoke resident to whom she is speaking. The latter expresses concern for the local community and with things that affect his life directly: local issues such as housing, youth centres, and institutions that have closed down, as well with what he regards as unjustifiably high rates of incarceration among community members.

But instead of talking about what the Labour Party has done for Stoke-on-Trent, or for people like this potential voter, or about what the previous Labour MP for Stoke-on-Trent Central achieved, or about the merits of Gareth Snell, the Labour candidate for whom the activist is nominally canvassing, and about what Snell might yet do to improve this specific Stoke resident’s life, what does the activist choose to talk about? Why, the leader of the Labour Party, of course! Moreover, she talks about him by commending him for his difference from other politicians and she evidences this difference by stating that other Labour Party politicians do not want him to be their leader.

To an individual not steeped in Corbynite commonplaces, it must have seemed a funny sort of praise for a leader — and a still funnier sort of reason to vote for one of the people he will lead. Among Corbynites, the truly great thing about the Labour Party still appears to be that its MPs are led by someone they don’t want to be led by. But in the world of ordinary people, that is not really a hot sell.

Neither is opposition to the renewal of the Trident nuclear programme, which many British people believe to be necessary to their own safety and that of their families. And, given that — in conversation with a potential voter focused on local issues — this particular activist can only argue for the benefits of such opposition through appeals to the attractions of entirely hypothetical policies — Corbyn has never proposed investing money saved from Trident in youth centres, there’s no connection between Trident non-renewal and justice system reforms (which Corbyn has not in fact proposed), and, in any case, the Labour Party voted to renew Trident despite Corbyn’s opposition, so this is all rather beside the point — it is hardly surprising to hear that the potential voter in question doesn’t care about what he’s hearing. The activist doesn’t seem to believe that he doesn’t care, but I do. Why should he care about the virtues of her grey-bearded, white-faced saint? All that has nothing to do with him.

At the end of the day, the activist speaks as she does because she’s there for Corbyn’s sake. The potential voter to whom she speaks responds as he does because he’s not there for Corbyn’s sake, but because it is his home and he lives there. His concerns relate to the conditions of his day-to-day existence; hers, to the internal power struggles of the Labour Party. To a member of the Labour Party, it may matter greatly whether the latter has a representative of the self-described Left for a figurehead, but what can that matter to anybody else?

Indeed, this particular non-member expresses frustration with Labour for being full of what he calls "upper class people" who have never "actually lived it" — which, give or take a quibble over the meaning of "upper class" (which in Britain traditionally refers to members of the hereditary aristocracy, such as Tony Benn, rather than to the merely well-connected and well-heeled), is an accurate description of the wealthy, metropolitan, privately-educated career politician that Corbyn empirically is.

The fight to defend Corbyn’s position as Labour leader may be carried out in this man’s name as a presumable member of the working class, but that doesn’t mean he has a dog in it.

7 The beating heart of Corbynism

During the Cold War era, the Communist Parties of North Korea, China, the Soviet Bloc, and elsewhere gained what legitimacy they had as rulers of their respective territories from their claim to represent the workers — but as everyone but the Stalinists now admits, they only ever represented their own interests as the elite of a now-discredited political system.

Corbynism makes the same false claim, but its ambitions are smaller: rather than aiming to govern a state, it aims only to govern a political party. And while it can’t win an election in which the general public participates, it can probably still count on winning multiple internal leadership elections, because the only people who can vote in those are the kinds of people willing to join a party led by Jeremy Corbyn. I have made no pretence of trying to persuade such people in this essay; if a three-line whip in favour of the Tory Brexit bill and the loss of a safe Labour seat to a Tory candidate are insufficient to dislodge St Jeremy from the special place that he holds in their hearts, then nothing I can say will make a difference.

There are enough socialism fans in the UK to vote Corbyn into the Labour Leader’s office, but not enough to vote him into 10 Downing St, and they’re rotten useless at persuading anybody else that voting for Labour candidates might be a good idea, so this — to be perfectly frank — is where we’re stuck (at least until 8 June).

Corbynism is a paranoid and inward-looking politics, obsessively focused on the relationships between and within the groups that make up the self-identified Left. It has little interest in — and still less to offer — the outside world. While Corbyn alienates most members of the public, enamoured socialism fans regurgitate a stock of commonplace platitudes to anyone who will listen, reassuring themselves that the leader of "their" party is a politician wonderfully unlike all others, and that they are right to support him, and that anything that others might suppose to have gone wrong must have been somebody else’s fault (if indeed it was wrong at all). That’s what they’ve been doing ever since he got onto the leadership ballot, and it’s what they’ll still be doing on 9 June, no matter how many talented and hard-working Labour MPs are reconciling themselves to the end of their political careers.

Because that’s just how socialism fans like it. If it wasn’t, they’d shut up and go home.

Daniel Allington teaches and researches in the School of Media, Communication, and Sociology at the University of Leicester.

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