The coming of the Maily Express

It makes sense - the two newspapers have printed the same stuff with different fonts for a while now

Talk of a merger between the Daily Mail and Daily Express seems a mixed blessing for those of us who wouldn't ordinarily read either. While it might seem like good news to be rid of at least one of them, how powerful would the resulting über-tabloid become?

It's probably best not to fall into the trap of imagining the worst-case scenario – a monstrous great politically incorrect Death Star of a newspaper blasting out lasers of bile across the galaxy, journalists dressed in scary black uniforms . . . because that's exactly the kind of catastrophistic panic-porn those papers like wallowing in.

No, the reality would be more mundane, less scary. Instead of a gigantic, slavering right-wing chimera, a Brundlefly with a cruel streak for minorities lurking on the shelves in WHSmith, the Maily Express could just end up being a rather dull, mid-market tabloid grasping for the same waning readership.

Instead of two sets of headlines panicking about "them" coming over here and taking our jobs, there would be just one. At least we'd only have to avoid one publication, rather than two.

After the sudden death of the Daily Sport and Sunday Sportwhich leaves a gaping void on the news-stands for upskirt photos of minor celebrities and very little else – it would be another blow to the newspaper industry. Would it be a sign that the tide really is turning, and the inkies running out of time? Those of us who harbour dreams of having gainful employment through the purchase of printed words on paper might like to hope not, but what if this is the second domino falling over?

If the Express and Mail really did merge, I don't think the Express would end up tremendously well represented, given the relative size of its circulation and readership. Just as Spitting Image's David Owen puppet told David Steel their amalgamated party would have "one name from your party and one name from mine . . . from mine, Social Democratic, from yours, Party . . ." you can't help seeing the resultant publication as being anything other than the Daily Mail. That would be disappointing from the point of view of losing the Express name from the news-stands, given its history as Britain's most popular newspaper for decades; but then again, the Express of those days died a long time ago.

Of course, this is all just idle speculation. Why would the Mail want to do anything other than see the Express wither on the vine and die away as its readership gets older? Why would the Express want to admit defeat and couple itself to the Mail as very much the junior partner? None of that seems to make any sense, but perhaps there is some logic in it: with 2.7 million potential readers, any joint force would be in a healthy position.

The two newspapers have been pretty much the same story in slightly different fonts for a while now. It's a sadness, perhaps, that there isn't room for a Daily Express that is markedly different from its main mid-market competitor, but maybe that's just the way these things are going. Maybe we really are going to face a future with fewer national newspapers, and maybe we're just going to have to get used to it.

Patrolling the murkier waters of the mainstream media
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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage