What is quality of life?

The challenge of deciding how we should decide who deserves treatment from an NHS of finite resource

It cannot be an easy or pleasant job to inform terminally ill cancer patients they will be denied access to effective drugs that have the capacity to extend their lives by months or years.

Moreover, in a society with a publicly funded health service, it is particularly difficult to justify the denial of effective treatment to patients who have paid their taxes, over their working lifetimes, in expectation that they will have access to high quality medical treatment if they fall ill.

Just such an unpleasant, difficult and controversial task has just been carried out by Professor Peter Littlejohns, the clinical director of the National Institute for Health and Clinical Excellence (NICE).

Littlejohns has released a preliminary ruling, denying access to the drugs Sutent, Avastin, Nexavar and Torisel to patients with advanced metastatic kidney cancer. These patients will, on average, die months earlier than those with the same condition in other countries in Europe where such drugs are available.

How can NICE justify its refusal to allow these patients a few extra months of life? Its methodology looks at the cost-effectiveness of medical treatments in terms of cost per extra 'quality-adjusted life year' (QALY).

If a drug or other treatment delivers an extra QALY at roughly £20,000 or less, then the treatment is judged to be cost-effective, and hence recommended. If the sums come out less favourably, then NICE decides against making that drug or treatment available on the NHS.

Although the system has some room for other considerations and can be responsive to special cases, this procedure strikes many as frighteningly cold-hearted and mechanistic. In matters of life and death, these sorts of accountants' calculations can seem cruel and out-of-place.

But what could the alternatives be? The alternative of leaving decisions to the judgement of individual hospital trusts or medical teams has little to recommend it. Firstly, it is difficult to justify a policy that depends on subjective individual judgements. Unless there are explicit public guidelines, like those followed by NICE, it is impossible to see how decisions over health-rationing could possibly be justified to those affected.

Secondly, if such decisions are made locally rather than nationally, we are thrown into the familiar problems of the 'post-code lottery'. A patient in Nottingham may find herself denied treatment that is provided to someone in Newcastle. Allowing matters of life and death to depend on the good or bad luck of geographical location seems like the very opposite of finding justifiable policies.

Another alternative might simply be to fund all medically effective treatments. But this aim would be impossible to realise. One could, after all, always produce some small marginal gain in expected QALYs with a limitlessly expandable healthcare budget.

It may be that, even with the massive increases in the NHS budget over the last eleven years of Labour government, we still do not spend enough on health care. In the UK, we spend somewhere between nine to 10 per cent of our GDP, as against other advanced countries (for example, France and
Germany) which spend nearer to 11 per cent. (Whereas before 1997, Britain spent under seven per cent of its GDP on healthcare.) But no matter how large a proportion of GDP we spend, we would still face budgetary constraints.

Hard choices have to be made: funding certain treatments will always mean not funding others.

Perhaps NICE has found the least objectionable way of performing an unenviable task. But there are potential problems with its QALY-based methodology. First of all, there is the very idea of 'quality-adjusting' a year of life. The intuitive idea is that a year of pain-free, high-functioning life is better than a year of painful, highly limited living. This seems plausible enough, but it is notoriously difficult to make judgements of 'quality of life' in any kind of fine-grained way. Some patients may consider another year of life to be of enormous value, no matter what its pains or indignities.

The calculus of QALYs can also lead to some strange decisions. For example, giving an extra 10 years of healthy life to a 15 year old would be weighed identically to giving 10 years of life to a 65 year old. But, looking beyond QALYs, most people would think it right to favour the younger patient over the older. The QALY approach had no room for these ideas of a 'fair innings'.

It can also find no room for favouring those already suffering from other forms of disadvantage over those who are otherwise advantaged.

Indeed, the QALY-approach will favour a treatment that gives X additional years of life to a 30 year-old able-bodied person, rather than X additional years to a 30 year-old disabled person, which seems quite unjust. A more just system might also give more emphasis to the diseases of the poor over the diseases of the wealthy.

We should also bear in mind that the costs of various drug treatments are not entirely fixed. Instead, those costs often depend on the price levels that profit-maximising pharmaceutical companies think they can get away with. Many pharmaceutical companies spend vast sums on the questionable practice of direct marketing to doctors, as well as funding partisan or self-serving forms of research, all of which push up the prices paid by the NHS.

Bob Essner, the CEO of Wyeth (which makes Torisel) took home $24.1 million in pay in 2007, while Jeff Kindler of Pfizer (makers of Sutent) made $12.6 million. The cost per-QALY of these drugs could no doubt be reduced if they didn't have to generate the obscene salaries of corporate fat cats like these.

NICE's QALY-based approach is a useful tool, creating the possibility of publicly justifiable decisions over healthcare rationing. But we should not lose sight of the broader regulatory context when considering how the NHS should apportion its spending on drugs. There is little doubt that a more responsible and better regulated pharmaceutical industry would mean NICE had fewer tough choices to make.

Perhaps the most interesting aspect of a QALY-based approach, though, is what it can tell us about broader issues of government policy and health outcomes. For, it turns out, what really makes a difference to the number of QALYs that individuals can look forward to depends more on factors like diet, exercise and early detection of disease, rather than the availability of expensive pharmaceuticals.

Following NICE's procedures to their full conclusion would suggest a massive move towards a pro-active rather than a reactive NHS, with more resources devoted to screening and public health measures, rather than to the treatment of those who are already nearing the end of their lives.

Moreover, as public health researchers like Sir Michael Marmot, Richard Wilkinson and Ichiro Kawachi have discovered, social inequalities have a massive impact on life-expectancy (and hence on QALYs).

More egalitarian societies, like Sweden, Denmark and Iceland, have higher average life-expectancies, even when controlling for all other factors, than do less just societies like the UK.

Indeed, as inequalities go on rising in the US, average life-expectancy is actually falling there for the very first time.

So, if NICE's approach has much to recommend it, it leads us to the conclusion that a concern with the health of our society leads us beyond thinking only about the NHS, but encompasses much broader policies for securing social justice.

Martin O’Neill is a political philosopher, based at the Centre for Political Theory in the Department of Politics at the University of Manchester. He has previously taught at Cambridge and Harvard, and is writing a book on Corporations and Social Justice.
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Rebel with a realist cause

Michael Winterbottom, Britain’s busiest film-maker, discusses cinema, social mobility and how we are returning to the 19th century.

In the early 1960s, Lindsay Anderson was enjoying the power and esteem that he had always thought the English would be too philistine to grant him. His Free Cinema movement, launched in February 1956 with a series of modest, hand-held documentaries and a strident manifesto, had mutated into “kitchen-sink realism”, a series of popular feature films that included Tony Richardson’s Loneliness of the Long Distance Runner, Karel Reisz’s Saturday Night and Sunday Morning and his own This Sporting Life. Anderson seemed dangerously close to becoming the  leading spokesman of mainstream British cinema. But then, as he recalled, “Realism gave way to the myth of Swinging London. The Americans, God bless them, put up a lot of money and the British made a lot of bad films.”

When, bored and broke, the Americans went home, taking many of his colleagues along with them, Anderson stayed behind. He made if . . ., which won the 1969 Palme d’Or at Cannes, and a sequel, O Lucky Man!, and then – nothing. For most of the 1970s, British cinema was virtually an oxymoron. But when the industry came back to life at the start of the next decade, with GandhiChariots of Fire and the formation of Channel 4 Films, he refused to celebrate or capitalise, preferring to tut and clutch his brow.

In November 1985, the month when his former protégé Stephen Frears first startled a general British audience with My Beautiful Laundrette, which updated kitchen-sink realism with new causes (multiculturalism, gay rights) and villains (Thatcher, the National Front), Anderson was making gentle progress on a backward-looking endeavour – a television documentary about Free Cinema, to form part of an initiative he despised called British Film Year. A born dawdler, equally petrified of success and failure, he was having trouble with the stills and inserts. “I finally get the operation organised,” he wrote in his diary, “by insisting that the attractively cherubic Michael Winterbottom be my assistant.”

When I spoke to Winterbottom last year, he told me, “Lindsay Anderson was a director I really admired and I wondered why he had made so few films. Then I met him. There was a lot of messing around” –bickering, procrastination, mischief. And perfectionism: “Even on the Free Cinema documentary, he ended up reshooting ­everything.” Winterbottom wanted to emulate Anderson’s work – the intransigence, the looseness – but he realised that in order to follow those examples and still have a career, he needed to make peace with prevailing industrial conditions and devise a plausible, even hard-nosed working method.

Three decades later, he is constantly in work. Alongside Frears, he is Britain’s busiest film-maker. At any given moment, he occupies two or more points in a process that goes something like: development, financing, casting, filming, editing, festival circuit, domestic release. But where Frears has graduated to working with Hollywood studios, Winterbottom relies on independent financing and employs a no-fuss, often hand-held, digital shooting style. David Thompson, the former head of BBC Films who is now an independent producer, told me, “Michael pioneered a way of working that we tried and failed to get other directors to adopt: if you can’t get the crew in a minivan, then you’ve got too many people.”

The results so far have included 24-Hour Party People, a comedy about the Manchester music scene that captured Winterbottom’s own philosophy of productive chaos, and 9 Songs, in which a climatologist recalls a relationship through nights at rock concerts and uncensored days in bed. Winterbottom’s most recent film, The Emperor’s New Clothes, a documentary about inequality, presented by Russell Brand, was his 28th. And that doesn’t include The Trip, the BBC2 comedy series starring the comedians Steve Coogan – a Winterbottom regular – and Rob Brydon, which was released outside Britain as a pair of films, The Trip and The Trip to Italy: to date, his only sequel.

***

Working alongside the producer Andrew Eaton, Winterbottom has established an atmosphere of rigour and determined focus that allows him to take risks. Eaton, who has known Winterbottom for more than 30 years, told me that “no other director comes to set with such a strong sense of what he’s trying to get combined with a complete openness to what could happen in the day”. When Winterbottom was making the family drama Wonderland in the late 1990s, he took his skeleton crew into London bars that were open for business. Punters became extras. “The people in a place are so much part of the environment,” Winterbottom said. “We were trying to get a different texture, to let the characters interact with the real world.”

Winterbottom and I were having breakfast in a London hotel restaurant. When I arrived, he had just finished a television interview about The Face of an Angel, a rumination on the Amanda Knox trial starring Daniel Brühl and Cara Delevingne, which opened in 2014 to baffled reviews. Winterbottom, who turns 55 in March, still looks like a cherub, but a cherub going grey at the sideburns. He is affable, even happy-go-lucky, but also remote – withdrawn. His gaze carries a slight air of wistfulness, as if he is distracted by some opportunity five yards beyond your shoulder. And though he talks very quickly, he is a specialist in prevarication and reversal. Assertions are parried, questions dodged. But when he’s comfortable, he’s fluent.

Winterbottom continued to tell me about the thinking behind Wonderland, which many consider his greatest film. He compared it to Notting Hill, which was being shot further west around the same time. “As soon as you go in and control everything, you’re destroying the essence of what London is. If you want to catch what normal life is like, you have to work in quite a small way, a hand-held way, in real places.”

Yet Wonderland is never dowdy. Shots of, say, an average night at the Slug and Lettuce or the bingo hall, or yet another frustrating afternoon at Selhurst Park, are offset by the lithe, buzzing images (a 16mm negative blown up to 35mm), the restlessly inquisitive editing and Michael Nyman’s soaring symphonic score. The result far exceeds anything made during the kitchen-sink period in the breadth of its humanism and the range of its social portraiture, and deserves to be recognised as one of the great achievements of British cinema.

The Scottish actress Shirley Henderson said that working on Wonderland, the first of six collaborations, wasn’t like being on a film set, with “caravans” and co-stars. “You were just waiting on a pavement somewhere.” To help Henderson research her role as the working-class Londoner and single mother Debbie, one of three troubled sisters, Winterbottom sent her on what she called “errands”: going clubbing in character, or visiting the sort of hairdresser at which Debbie worked. Henderson added the details garnered on these field trips to a screenplay, written by Laurence Coriat, that was treated as far from sacrosanct. Speaking generally of her work with Winterbottom, she said: “You know the lines – and you might get to say them, you might not. He might run the scene another five minutes after your lines are finished.”

I asked Henderson how Winterbottom’s toss-the-script-aside approach compared with the process favoured by Mike Leigh, who directed her in Topsy-Turvy. With Leigh, she said, “You improvise for hours to find a honed scene that you shoot the next day. With Michael, it’s a quicker process. You don’t rehearse as such. You’re improvising on film. If he’s not got enough, he’ll just go again and again and again.” At breakfast, Winterbottom, who recoils from analysis, defined his ambitions with a shrug: “Try to keep it simple, get as close to the characters as possible, encourage actors to be spontaneous.”

Wonderland was Winterbottom’s sixth feature film and marked a breakthrough for him, in particular a turn away from the professionalism of Welcome to Sarajevo, his polished, starry account of TV journalists covering the Bosnian War, in favour of a realist aesthetic. He told me that he doesn’t see himself as part of any movement – “What, like Free Cinema? No, no” – but his desire to find an alternative to conventional dramatic narrative connects him to a loose group of artists and writers intent on bringing more “reality” into their work. Prominent among them are the authors David Shields, who mentions Winterbottom in his manifesto Reality Hunger, and Karl Ove Knausgaard, whose My Struggle series Winterbottom has been reading (“I’m very impressed”). But where Shields and Knausgaard have turned away from the novel in favour of more direct, less dissembling forms such as the memoir and the essay, Winterbottom’s desire to get as far away from artifice and as close as possible to hectic, complex, undramatic life has resulted not in a choice of one form that solves all the problems but a sensibility that he brings to a range of genres.

Winterbottom’s war against tidy artifice has taken various forms. Sometimes it is built in to a project’s conception: he made 9 Songs because he thought that his previous love story Code 46 had been timid in the way it presented sex. It has determined his approach to source material. When he was adapting Thomas Hardy’s Tess of the d’Urbervilles as Trishna, he combined the roles of the “spiritual” Alec and the “sensual” Angel because, he told an interviewer, “most people are a combination of both”. But with Jim Thompson’s novel The Killer Inside Me, he took the opposite approach: he found Thompson’s portrait of psychosis so complete, so convincing, that he treated the book “like the Bible”.

Winterbottom’s widely acknowledged formal innovations are a means to an end. I mentioned the editing in his 2008 film, Genova, which constantly prevents exchanges and encounters from settling down into a set piece. He dismissed the idea that he was consciously experimenting. “When you’re making a film, you’re worried about the specifics of what you’re trying to do and then building out from that,” he said. The starting point of Genova is the dynamic between the dad and the two daughters. “I have two daughters [from his 13-year relationship with the teacher and novelist Sabrina Broadbent] and one aspect of the film, like with Wonderland and London, was to portray a relationship that I would recognise. The aim was to not make it dramatic, because your relationships at home aren’t very dramatic.”

***

In his diary, Lindsay Anderson – who often quoted the ancient maxim “Character is destiny”– marvelled at Winterbottom’s ability to attend to things that mattered and ignore the things that didn’t. Where Anderson was an idealist and a perfectionist, Winterbottom was “wholly unsentimental” – “conscientious” in tracking down stills, his assigned task, but “quite happy to absent himself from crucial, if routine stages of finishing”.

It was partly a product of breeding. Where Anderson, scarred by boarding school, loved to defy those with power (having a private income helped), Winterbottom attended the local grammar school in Blackburn and grew up in kitchen-sink territory; a scene in John Schlesinger’s 1962 film A Kind of Loving was shot at the factory where his father worked. When he was a teenager, his favourite book was Jude the Obscure, Hardy’s novel about a farm labourer who dreams of going to Biblioll College, Christminster. Winterbottom made it to the real-world version – Balliol College, Oxford – where, in a desultory, distracted way, he studied English. (In 2012 he returned to Oxford to become the first Humanitas Visiting Professor in Film and Television.)

Winterbottom likes to say that he’s simply attracted to good stories and interested in the same things as “everybody else”, but The Emperor’s New Clothes, which came out in April last year, emerged from his personal history. A product of grammar schools and grants, he considers himself a beneficiary of the “social mobility and access” that burgeoned after the Second World War. (He campaigned for Jack Straw in Blackburn in 1979.) “The idea that to be ‘modern’, you need an unregulated free market that helps the rich get richer is bullshit,” he said, adding that its widespread acceptance has been “one of the triumphs of that ideology”. He continued, “We had a phase of about fifty years where what was ‘modern’ was the idea that things will get fairer – there will be a narrowing of the gap, maybe not in a radical way, but at least a general trend in that direction.

“It’s fairly hard to believe that we used to collectively own the water, gas, coal, trains, telephone. People were being taxed at 98 per cent on unearned income, 83 per cent on earned income. Instead, we’ve returned to the 19th-century idea that if you’re born poor, you’re going to stay poor.”

After his English degree, he completed a one-year course in film-making in Bristol. Then he needed a job.

“There was no way I would have been able to hang around and do ‘internships’,” he told me. “I became a trainee assistant film editor at Thames Television” – which is how he came to work for Anderson and where he was given his first professional directing job, on a pair of documentaries about the Swedish director Ingmar Bergman, from whom he learned that if you establish fruitful partnerships and retain a clear sense of what you’re trying to achieve, film-making is “not that hard”. (Bergman may have been “just as complicated psychologically” as Anderson, “but when it came to the work, he was disciplined”.)

In 1993, after the Bergman documentaries and then a run of commissions in television drama, including the opening episodes of Jimmy McGovern’s ITV series Cracker, Winterbottom was itching to make his first feature film. Frank Cottrell Boyce, a friend from Oxford, had written a script entitled Delirious, about car thieves in Liverpool, but it was failing to attract a backer, so they moved on to a new idea: another crime thriller set in Lancashire, but with a difference – it could be done cheaply, with money cobbled together from public funding bodies. “All our anger and frustration about not making the other one went into it,” Winterbottom recalled. “We did it for nothing. It was a very stressful phase. And that was Butterfly Kiss” – in which a pair of chalk-and-cheese lesbians cause havoc on the M6.

In Icons in the Fire, an attack on “practically everyone in the British film industry”, in which Winterbottom is one of the few heads spared, the critic Alexander Walker recalled his surprise when the director followed up Butterfly Kiss with a “period drama”. But Jude – the first of Winterbottom’s three Hardy adaptations – was fast-moving and stark, not at all Merchant-Ivory. After Jude, there came, in swift succession, “Bosnia war reportage, period western, East End soap opera, Ulster social comedy, glam-rock clubland, overland asylum-seeking” – the films in question being Welcome to SarajevoThe ClaimWonderlandWith or Without You24-Hour Party People and In This World. (Walker forgot I Want You, which should probably be characterised as Hastings psychosexual noir – still, somehow, a genre of one.) “Bewildering,” Walker concluded: “at the same time, curiously courageous for a British director.”

***

Winterbottom has continued in this bewilderingly courageous way, combining speed with variety, adding to his genre hoard and keeping the operation small. While former collaborators such as Rachel Weisz and Kate Winslet have been starring in globetrotting thrillers and 3D blockbusters, or, in the case of Christopher Eccleston, David Tennant and Peter Capaldi, playing Doctor Who, Winterbottom has carried on telling intimate tales about what he calls “home, family, things like that”; among them Everyday, a drama about a struggling mother (played by Shirley Henderson) that was shot over five years. Where his near contemporary Danny Boyle went off to make Slumdog Millionaire, Winterbottom made Trishna, an Indian adaptation of Tess, described by its star, Freida Pinto, who was also the lead actress in Slumdog, as “a hardcore independent project”.

Generally, his dealings with the US have been marked by resistance. On its release in 1997, Harvey Weinstein’s company Miramax distributed Welcome to Sarajevo – even screened it at the White House for Bill Clinton. But when Weinstein offered Winterbottom $1.5m to direct Good Will Hunting the director said the script wasn’t good enough. It took him months of conversations with the novelist John Irving to reach the same conclusion about another Miramax project, The Cider House Rules. (Each film won an Oscar for its screenplay.) Winterbottom didn’t make a film on American soil until 2009, when he went to Oklahoma to shoot The Killer Inside Me, a thriller whose violence against female characters prompted outrage and earned him a nomination for the Sexist Pig Award from the Alliance of Women Film Journalists. (He lost out to Mel Gibson.)

On two occasions – both before the sexist pig accusation – he had been approached by women bearing offers too good to refuse. In 2004 Angelina Jolie brought him A Mighty Heart, an adaptation of Mariane Pearl’s memoir about her husband, the murdered journalist Daniel Pearl. Then, a few years later, Naomi Klein approached him to make an archival documentary based on The Shock Doctrine, her book about disaster capitalism. (Klein later changed her mind about the format – she wanted something more topical and responsive – and the film was made without her input.) But on the whole, the ideas for Winterbottom’s films have emerged from Revolution Films, the production company he started with Andrew Eaton in 1994.

In 2001 Winterbottom and Eaton were developing a project about illegal immigrants but couldn’t decide on a starting point. Then the 9/11 attacks happened, and within a few weeks Winterbottom and the writer Tony Grisoni were wandering around a refugee camp in Peshawar, looking for young Afghan men willing to play a version of themselves and do the trip to London for real. (“I thought it was going to be in English,” David Thompson, one of the executive producers of the film that emerged from the trip, recalled. “I was somewhat surprised when it came back in Pashto.”)

The year 2003 marked the high point of Winterbottom’s acclaim. In February, barely a year after Winterbottom had touched down in Peshawar, In This World – the asylum film’s eventual title – was accepted to show at the Berlin International Film Festival, where it won three prizes, including the Golden Bear. When it was released in Britain, the critic Sukhdev Sandhu, who was born in 1970, called it the best British film of his lifetime. Soon afterwards, Winterbottom appeared in a Guardian critics’ poll of the best directors currently practising. The citation announced: “British cinema would be lost without him.”

Peter Bradshaw, the Guardian critic who wrote that citation, has been less impressed with the films he has made in the past decade. “It’s all very good letting narrative and all those traditional things go hang,” he said recently, “but it does make for a rather miscellaneous experience in the cinema.” He described the films’ “rough-and-ready quality”, which he identifies in all Winterbottom’s recent work except for The Killer Inside Me and The Trip, as “more lax than loose”, and added: “I often wonder whether he’s thinking about the next project.”

Eaton identifies misunderstanding in both criticisms. To the idea that Winterbottom’s work since around Wonderland has been lax or slapdash: “Do you have any idea how hard it is to make stuff as natural as that, to have that flow?” To those who say Winterbottom makes too many films: “If Michael was a plumber, and you asked him to do work on your house, he wouldn’t say, ‘Oh, I’m far too creatively exhausted, I couldn’t possibly do it.’ It’s just the next job.”

Thompson offered a more matter-of-fact reflection. “That’s just the way he works –he does these things in a white heat,” said. “He’s finished them before you realise he has shot them. It’s like writing a song. Some film-makers spend two years fiddling with a film. Michael would go crazy. And I don’t think the result would be any better.” (Bradshaw conceded that “part of his mojo is to keep moving – something we critics don’t understand”.)

Thompson added, “Some of his films work better than others – he knows that.” In 1997, when he had made four films, ­Winterbottom reflected on the benefit that Ingmar Bergman derived from a hefty back-catalogue: “There’s actually enough volume that if he does a comedy that doesn’t succeed, it’s merely a blip in the overall work.”

***

A few days after I first interviewed Winterbottom, I went to the Revolution Films office in Clerkenwell, central London, to meet Melissa Parmenter, the composer who is now his regular producer (Eaton serves as an executive producer). Parmenter has a fondness for rhyme: “totes mahotes”, “okey-dokey”, “good plan, Stan”. Instead of “meltdown”, she says “granny panic”. She described Michael Nyman’s music for Wonderland, not inaccurately, as “an insane score – the best score ever”.

At first, Winterbottom and Parmenter, who live together and have a four-year-old son, seem an unlikely partnership. Where Winterbottom can be evasive, perhaps defensive, Parmenter is open and unguarded. She seems clearer about who Winterbottom is than he is. She is also more outwardly passionate. During my talk with Winterbottom, he used the word “love” twice – about Nyman’s music and Robert Altman’s McCabe and Mrs Miller. Parmenter, by contrast, said she “loves”, among other things, The Killer Inside MeGenova, “the melancholy bits of The Trip to Italy”, Nyman, and “the fact that Michael does what he wants”. But under the Noughties colloquialisms and granny-panic veneer, Parmenter is grounded and – to use a phrase that she might – on it, a total convert to Winterbottom’s heads-down ethos. She resembles her own description of Tracey Emin, whose 2004 film Top Spot she produced: “She looked like she had no idea what she was doing, but she knew totally what she was doing.”

“We make quite different films,” she told me. “It’s weird. What’s Michael’s most commercial film? But he doesn’t aim for that. He just makes what he wants to make.”

I asked Parmenter why he is so good at winning permission to do that. “Well, the idea of all his films is interesting. I mean, Road to Guantanamo: who wouldn’t want to see the story of the Tipton Three? It’s got to be made. Or 9 Songs – we’re going to show real sex. Filming Everyday over five years – that’s an amazing idea. We went to Tessa Ross at Channel 4 and said, ‘We’re going to film these people doing nothing.’ She said, ‘Here’s £1.1m. Bye!’ Obviously we reported back to them.”

It must help, I said, that there hadn’t been any disasters.

“That’s down to Michael. He’s so aware of all levels of the film-making process. He’s got his fingers in all the pies. It gets a bit much sometimes. [As Winterbottom told me, “When you’re a director, everything that happens is kind of your fault.”] But if you’re doing a small film, you can’t say, ‘Actors aren’t allowed trailers’ – if there’s a trailer even anywhere near, he goes mental – and then turn around and say, ‘I don’t want to know anything about the budget.’”

When I caught up with Winterbottom last summer, he expressed some frustration that The Emperor’s New Clothes – the documentary with Russell Brand – hadn’t been shown more widely, and that The Face of an Angel – the Amanda Knox drama– had been rounded on by British critics. Yet it was clear that his heart wasn’t really in it: both films were well on their way to becoming past obsessions. He’d been up at 6.30 that morning, doing rewrites for a new project, Russ and Roger Go Beyond, a comedy starring Will Ferrell, about the making of Russ Meyer’s camp musical Beyond the Valley of the Dolls. (I asked if Ferrell was someone he knew socially and he replied: “No, strangely not.”) Although the script originated in Hollywood and the production, based in Los Angeles, would almost certainly involve trailers, Winterbottom talked about Russ and Roger less as a necessary commercial compromise (“the money isn’t vastly better”) than as a much-needed break. He reminded me that “developing a film from scratch comes with a burden of effort”.

Still, it turned out that his heart wasn’t really in that one, either. Just before the end of the year, he quit. Someone muttered something about creative differences. Burdensome or not, it seems he prefers success – and failure – on his own terms: working under the Revolution banner with a small, familiar crew and room for improvisation with actors he calls friends. It is said he’s getting ready to shoot The Trip to Spain.

Leo Robson is the New Statesman’s lead fiction critic

Leo Robson is the lead fiction reviewer for the New Statesman.

This article first appeared in the 28 January 2016 issue of the New Statesman, Should Labour split?