Not How it was Supposed to be…

The terror of Jeremy Hunt’s Monday morning meetings to review trusts’ debts and waiting lists forces managers to put satisfying the health secretary above patients.

– Polly Toynbee: For a clear view of the NHS, look past the politics and promises of a cure

Generally, I love the NHS, I really do. Specifically, I love the fact that it exists; I love its founding principles; I love the many saints that work there, pushing the limits of responsibility; I love what it can achieve, as an organization, when it works well. However – and you could see this coming, couldn’t you…? – I do not love how it frequently functions in the real world; in my real world; how so often it has let me and my family down – whether through its lack of realistic funding; its commoditization of patients (turning us all into market-oriented ‘customers’ or ‘consumers of services’); or simply the arrogance of those in command.

Seven years ago, my partner had a life-saving operation – which, later, the kindly surgeon told us, he believed she had only a small chance of surviving – because A&E had failed either to take her complaint of pain and illness seriously; or were just too rushed to bother; and had sent her home. I am fortunate – and selfish enough to appreciate it (despite the mind-body conundrum stemming from my inherent, lifelong socialism (and lengthy Labour membership)) – that, although I no longer work, because of my disability, my employer still provides me with private medical care: so the surgery was carried out, yes, privately. Otherwise, she simply would not be here. Obvious, urgent symptoms were ignored, disregarded, or just not noticed by those at the NHS hospital.

Similarly, after each of the three serious road traffic collisions that caused my disability, my attendance at hospital – and, after a long waiting period (“it’s only whiplash”) – was addressed with proffered, low-dose painkillers. Again, each time, I was sent home. After the last incident, my then GP – having, because of my obvious difficulties (and agony), sent me for immediate CT and MRI scans: which revealed serious damage to my cervical spine – ranted at the hospital involved: but with little effect. Again, it was private medicine – and a long series of complex, expensive surgeries – that saved me. At best, I would not now be able to walk (although it’s still an intense struggle). At worst, I would have been paralysed from the neck down.

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It is yet another example of the NHS’s ongoing failure to provide deaf patients with information or dignity during their treatment while also denying them the chance to express their wishes and feelings….

     “He’s an intelligent man but in there they don’t value his intelligence at all.” They added.

     “He has his rights trampled on, he can’t express himself, he doesn’t know what’s happening and he’s left behind a curtain. Even if some nurses just learned the basics of how to communicate with deaf people that would make a huge difference but it just feels like it’s too much to ask.”

– Andy Palmer: The story of a Deaf man in hospital at Christmas showed me how the NHS continues to fail deaf patients

I have always, though, tried to give the NHS the benefit of the doubt; and – apart from the time I lived in north London – have often been rewarded with, at least, caring, thoughtful GPs (especially the rural ones: where care was more personal; more considered). Referrals to local hospitals, however – maybe because my condition is extremely complicated; and involves more than one specialism (a failing of the NHS itself, I believe – not everyone’s sickness slots easily into one category…) – have nearly always left me disappointed; physically worse off; or both. Much of my treatment – which basically consists of me coping with whatever my body decides is going to fail next – has stemmed from thorough research on my part being reinforced by my GP (and none better than my current one: who is as patient (sorry) an exemplar of the intelligent, knowledgeable, honest, kind-hearted, country doctor as one could ever hope for).

However, last year, the surgery where she works changed hands: it has new partners in charge; and seems to be morphing into the very (uncaring) model of an urban practice – with a real, demonstrable, lack of understanding of the skewed needs of the skewed demographic of its aging, rural population. For instance, being extremely hard of hearing (as are approximately one-in-six in the UK), I have always communicated with the practice through email (although, initially, I had to stress the making of “reasonable adjustments”, etc. to achieve this). That way, I can choose and format my words carefully, and attach relevant documentation.

Having an email address (especially for deaf patients) – according to Action on Hearing: citing their advice on Medeconomics – is also best practice. So, having read that article, I contacted my GP (as you will soon learn why, via Twitter):

Me Do you have an email address for patients like me? It appears to have vanished from your website!

Surgery we prefer patients to use the secure patient access app

Me When I have used this in the past, it has been hit & miss; also not useful for detail or longer messages. Email is simpler.

Me Just discovered a message sent in Jan 2015 that has no reply. Surely communication method should be the *patient’s* pref?

Surgery You can copy and paste your enquiry that you would have sent via email on to web version of the patient access app

Me I’m sorry: but that’s really poor. Did you actually read the original article? I don’t think you actually understand just what barriers are in place for those of us who cannot use the phone. I am deaf and disabled: and you are making life even more difficult: when I thought you were there to help/listen. Not happy; and seriously thinking of changing GP.

Surgery I gave simply advise to send electronic communication via the secure patient access app that is the same as typing an email

Me Is the word “care” actually in your vocabulary? This is *not* the way to talk to your patients.

In other words (although I accept that I – justifiably – lost my rag…), I am now instructed to communicate in an extremely limiting, difficult manner: which only allows me 450 characters; no formatting; almost no punctuation (“The only characters allowed apart from numbers or letters are full stop, comma and apostrophe”); no attachments; and is governed by a huge set of ‘Message Guidelines’ – including a prohibition of “sending medical information about your condition or treatment”. It is therefore cumbersome in the extreme. And not fit for purpose. Indeed, it has obviously been established simply to be convenient to the receiver – i.e. the practice – not the patient. (With only ten-minute appointments, it is hard to see how the patient’s needs are ever a driver for good customer care, though.) How am I – as someone who cannot use the telephone; and cannot always travel (I have probably cancelled more appointments than I have attended – due to ‘ill-health’); and who often is at my ‘best’ (my most conscious) during the night – therefore supposed to communicate; ask (scream, sometimes) for help; discuss my treatment? (In emergencies, my partner can telephone for me – but she does have to go out to work, you know.)

It is bad enough when commercial enterprises struggle to understand the needs of the deaf and disabled (therefore, of course, contributing to that disability) – but I find it utterly insulting that a public body meant to support my health deliberately erects health-related barriers in my way. Are my medical needs so complex that the practice cannot – or do not want to – help me? Or are they just so insolent that they – and by this, I really mean the partners who have instituted these new self-defeating decrees – believe they can dictate to a patient how they must comply with regards to their own (in my case, bloody awful) life?

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In the entrance of the headquarters of the University Hospitals of North Midlands NHS trust in Stoke-on-Trent is a small plaque. “A patient,” it discreetly says, “is not an interruption to our work, [but] the purpose of it. They are not an outsider in our hospital, they are a part of it. We are not doing them a favour by serving them, they are doing us a favour by giving us an opportunity to do so.”

– The Guardian: A portrait of the National Health Service: ‘It’s almost like a religion’

Currently, The Guardian is running an admirable four-week series, This is the NHS: stressing its advantages; its benefits; its successes – contrasting these with the present Government’s atrocious attitude to funding (completely in line, of course, with its atrocious attitude to anyone who is not stinking rich, like its own members). But where – asked one reader – are the “stories about misdiagnosis and poor treatment”?

Admittedly, both my parents owe their sight – and their ripe old age – to certain aspects of the NHS: but even these “successes” have been riddled with mistakes; with ignorance and arrogance:

“Your dad’s old: he’s therefore bound to be a bit forgetful.”

     “No, he’s had a stroke; and, before it, his mind was as sharp as a tack; he completes the crossword and sudoku every day; used to teach mathematics to A level; and, physically – well, apart from the arthritis that comes from a lifetime of cricket and football – is fitter than I am: by a long way….”

      I had to have a major, extremely public, shouting match – way beyond my normal, reclusive levels of embarrassment – to get him treated (both senses) seriously. He is now fine – probably because of his innate strength; and a supportive GP.

Although my favourite snafu has to be waking up on the operating table, when I was eighteen, about to have my appendix removed – because I had an obvious-to-everyone-but-the-registrar kidney stone. Yup. (Admittedly, having been very ill when I was born – having to spend a long time in hospital, having then developed pneumonia, with my mum always at my side – I would not have been in that operating theatre without amazing post-natal treatment. But that was decades ago: when there were enough doctors and nurses to be able to offer such prolonged intensive care.)

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A last thing that peeves me about the NHS is how we have been taught to treat it as a charity – when it is supposed to be a fully-funded public institution. There are volunteers – which I would understand were it the National Trust – and we are also supposed to be delighted to donate to campaigns such as the Stratford Hospital Cancer and Eye Appeal. As much as I love the Orchestra of the Swan, I really do not understand why they felt it necessary to record a CD (however wonderful) in aid of this – when, to me, such facilities should be part of the ‘core offer’ paid for by the Government.

The NHS was great – and can be again. Of that I am certain. However, until we stop believing the Westminster-issued propaganda that sells it to us as a luxury (similarly, disability and sickness benefits – don’t get me started…), such greatness will not be achieved (again).

I am lucky enough to have seen in great detail (although what took me there was the exact opposite of “luck”) how efficiently private medicine functions – much of which is obviously down to the exorbitant amounts of money involved. But private medicine also delivers from an ethos of individual healthcare and trust that is beginning to fade from some areas of the NHS (even, though, frequently, there is an overlap of personnel); and from a lack of management interference. Surely there are lessons to be learned…?

(Minus) eight degrees of reparation…

Although my head felt a little like Trotsky’s must have – or even because my head felt like that… – just before sunup (a little past eight o’clock, this morning), I headed towards Windmill Hill to watch the curtain rise on a new day. I was not to be disappointed.

Frozen into the crusted, sodden ground was evidence of those who went before me: deep tractor tyres (looking like a dinosaur had passed by, wearing wellingtons); sturdy-soled boots; the clawed stamps of walked pets – mixed in with those diamond dog‑prints so familiar around here: perhaps lured by the many rabbits visible in last night’s headlights… – and a bonus trail of crisp cleft deer impressions heading away from the footpath.

Very little sound, though – the odd chattering blue tit, and belligerent robin, against a background of commuting cars – and very little movement: even the fluffed kestrel I passed, highlighted by the first rays, was content just to gaze from its perch on the power-lines.

Eventually, the low, undulant cloud would overwhelm the brightness; sap the colour from the sky – bringing rook calls and repeated pheasant crowing – but my timing was perfect: a hearty, cold breath of pale ice-blue; then a blaze of rose-gold, charming the frosted stalks and leaves, warming my soul.

This may not be alpine Buttermere – here is a different kind of beautiful; a daily delight – but it still embraces me as only home can: the rolling layers of hill, fog, light, tilth and rime, cordial companions; the cereal crunch beneath my feet, affectionate assurance: earthing me in nature… yet again.

Hook, line and sinker…

Rhys Rusbatch (Peter Pan, centre) and the Shadows – photo by Manuel Harlan/RSC

I want to always be a little boy and to have fun – says Peter – his final line in Wendy & Peter Pan (on until 31 January 2016) pretty much encapsulating (apart from the enticement of paying only a tenner for a centre Circle, front-row, ‘superseat’) my reason for being there. I needed cheering up; to reconnect with the theatre; to participate in something (a panacea, perhaps?) that would play directly to the bits of my instinctive anatomy that had been left uncommonly unchallenged by Queen Anne – i.e. my funny bone; my chuckle muscle; and the hot and cold faucets that operate my emotional waterworks. I had also entered the Pantheon that is the Royal Shakespeare Theatre – on Friday night – presuming that my grey matter, in contrast, wouldn’t get much of a work-out – after all, this was going to be a ‘childish’ (in the very best sense of the word) not-really-a-pantomime, wasn’t it? (The nearest we got to such a fabled beast, though, was Martin (the adorable Adam Gillen) – one of the most characterful members of the cast – They’re behind me, aren’t they?)

But this is the RSC at its gobsmacking best: and, therefore, nothing can – or should – be taken for granted. (You really would think I’d know better, by now. Although it is so good to be nonplussed now and then; and have your cocksure conjectures soundly quashed.) Not just a technical tour de force – which bodes well for next year’s “not-really-a-pantomime” – but an intelligent, wilful, tongue-firmly-in-cheek, almost metaphysical – I’m just expressing myself creatively through the medium of food – multi-layered, moralistic, magical mystery tour around Neverland.

Not only did we get a whole heap of humble history-lessons with a Panglossian perspective – the finest strands of feminism and suffrage – woven in (sometimes with subtlety; sometimes a little less so…) with our humour (suitable for children of all ages, etc.); but a slick social study of family dynamics infested with unabashed grief. We will have little arguments that may seem awful at the time but in the long run will only serve to develop character and bring us closer together. As with all worthwhile fairy-tales, though, any visible merriment is merely an unstable oil-slick floating on a deep lagoon of pain and darkness. It does not take much force, much of a splash, to reveal the terrors beneath. It is only a game… to die will be an awfully big adventure.

Cleverly and consciously, though – principally due to writer Ella Hickson; ably partnered by director Jonathan Munby and designer Colin Richmond (conjuring up a veritable pantechnicon of delights) – the younger the audience member, the more opaque that dankness. Not only mischief-making, wicked wisecracks and cultural references – You can’t handle the truth! – floating over the smallest ones’ heads like so many fireflies; but the fatal snicker‑snack thrust of swords (brilliantly, robustly choreographed, as always, by Terry King) having as much impact on these innocents as (I hope) Tom and Jerry.

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Okay, okay – wait – slow down or you’re going to break your head. Look, stories are written by people that already know the ending, they go back and fiddle with the middle to make it match afterwards; they’re cheating. When you’re right in the middle – no one knows their aa-aardvark from their elbow.

The writing, for me, then, was just as able, as intellectually stimulating, as high-quality, as Helen Edmundson’s – with double-meanings, wily wordplay, and keen insight in abundance. She looks exactly like she might say – ‘Curly, it’s naptime – how about a little crumpet and a snooze?’ The text (and acting) is also imbued with a highly-infectious charm – cushioning you like the finest eiderdown – allied with a clear desire to portray all kinds of love as worth investing in, fighting for, risking. It looks like your face might rain. Please don’t rain, biscuit face, you’ll go all soggy.

And yet the menace (often in the shape of the sly, slithering crocodile – Captain Hook’s very own vindictive white whale – played effectively and super-creepily by the slick, double-jointed Arthur Kyeyune) is never shockingly, tick-tockingly, far away.

Characterization is exemplary – each rôle is so individually written and perfectly performed (every actor outstanding); decked out with a panoply of meaning and vigour – although there is the odd slip into stereotype. But that’s probably just me being a grumpy grown-up… – I’m sure that such devices make it easier for the kids to follow the more obvious aspects of the storylines and interactions.

The philosophical, world-weary, wrathful (and yet occasionally quite charming) Hook – The sun is setting – the evening of my life draws in – himself is played by the stupendous, soul- and sabre-rattling – and frequently immensely scary – dapper Darrell D’Silva: with a keenness more than capable of skewering any noisy, naughty children in the audience. (Just a shame, really, that it didn’t extend as far as the Circle….) Not only is this weapon polished to perfection, glinting throughout; but there was a permanent twinkle in Hook’s eyes, too, as he swung from foe to supposed friend, and back again. This is a man never to be trusted – albeit with a sentimental streak – Oh, Smee – I never knew – as wide as his evil, lecherous grin and tricorn hat.

Darrell D’Silva (Captain Hook) – photo by Manuel Harlan/RSC

And talking of twinkles, whatever jiggery-pokery was used to enable the miniaturized Tink (Charlotte Mills, in the flesh: a cheeky delight as Barbara Windsor on steroids) to fly from hand to hand, was seamlessly synchronized – just one of a myriad of transparent technical tricks that made the show so thrilling and watchable. And, therefore, however wonderful and awe-inspiring Mariah Gale is as Wendy (and she is quite rightly at the centre of so much of the action) – just the right mix of girlish innocence, studied sensibleness, joy and grit – it is the set that wows most; that prompts most of the many, many gasps of astonishment and delight.

Like Wendy and Peter (the acrobatic, joyful Rhys Rusbatch), a fair proportion of the cast spend a great deal of time soaring through the air: and from my viewpoint, not only was this frequently balletic, but also unremittingly brave – I am terribly scared of heights… – especially considering the glitch experienced earlier in the run of this mechanically-daunting production. The coordination and concentration required to keep every single cast member, prop, gizmo, bit of set… in perpetual motion is magnificently overwhelming (and must be completely knackering for those behind, under, above, the scenes…) – but, on the night, invisible in their fluidity.

Mariah Gale (Wendy) – photo by Manuel Harlan/RSC

This play is called Wendy & Peter Pan. Why is that?

When I read the original book and play again I was struck by how much fun the boys were having and how Wendy had very few choices outside of just ‘playing mother’. That was one of the elements that didn’t seem very true to today’s world. I was interested to see what the story looks like told from Wendy’s perspective – what does Wendy want and how is it her Neverland as much as it is for the boys.

– Ella Hickson: Q&A

I’m not utterly convinced by the parallels drawn between Wendy’s plight and Mrs Darling’s earthbound sojournings – but the narrative arcs, on the whole, work well; this is as fresh an interpretation as I think I’ve ever seen; and the audience is never very far away from those traditional oohs, aahs, titters, guffaws and shocked silences (as well as frequent tugs on the heartstrings, and an occasional stir of the old noggin).

You could have left your brain at home, though, quite easily, and still enjoyed the show: letting the laughter flow over you like the incoming tide (eroding the sandcastle of your cynicism…). Two nights later, and I’m still buzzing with the childish thrill of it all! Stupendous energy; wizardry and humour! What more could you possibly want?

I’d just like cake… – once cake is in your head it’s very difficult to think of anything else.

What a dream I had last night…

Emma Cunniffe (Anne) and Natascha McElhone (Sarah Churchill) – photo by Manuel Harlan/RSC

I have written before – possibly(!) more than once – how a play only (usually) really comes to life when it is staged. And yet – because this was another captioned performance at the RSC – as is now my habit, I studied the text for Helen Edmundson’s Queen Anne in advance: so that, with my truant ears, I would not miss anything. (As hard as I try, keeping one eye constantly on the action, and one on the surtitles, can leave me gledging like Marty Feldman, with a poor head (and poorer neck); or means that I miss a vital word or crucial move.)

What readily became apparent is that this is an experienced and award-winning playwright at the very top of her game: crafting words that are intelligent, subtle and addictive – with canny characterization and mesmerizing momentum inked into (and woven between) every single line. I cannot remember a time – even with the harrowing Hecuba or awe-inspiring Oppenheimer – where I have pored over the pages of a script so eagerly: greedily devouring the clarity, the twists, the language, the turns, the subtleties, the leitmotivs, the emotions, the excitement, the interweaving arcs of power… as the drama continues to build: each and every word contributing a small, sparkling, essential grain to a soaring, incandescent pinnacle of theatre. In just one enthralled sitting, I discovered stagecraft and authorship of the highest quality. No wonder, last night, I entered the addictive Swan Theatre with even more excitement than usual (and, although this is near the end of a very successful run – so successful that it is sold out until it finishes on 23 January 2016 – convinced – fortunately – that just one sitting would (have to) be enough for the experience to remain with me for a very long time). The night before, I did not sleep.

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This production – whose programme is a work of art (as are the costumes) – features many of the same actors as the marvellous, side-splitting Love for Love; and yet, despite the synchronism of the two plays – Queen Anne herself attending the former on her thirty-second birthday – there could not be more of a contrast in the ribaldry of Congreve (here echoed in the decidedly bawdy Inns of Court scenes) and the artful nuance of Edmundson. These two masterpieces certainly fulfil the RSC’s professed aim, with new work, to create “an ever more urgent sense of enquiry into the classics [by] engaging with living writers and other contemporary theatre makers”. “Radical mischief” indeed!

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However, cometh the night… I left the Swan with my mind filled only with questions. And could only dredge up a few (and then only partial) answers.

Such as… Do the captions get in the way? I don’t honestly think so. My seating position meant that most of the action actually took place directly beneath them: enabling me to keep everything in eyeshot. And, they haven’t formed any sort of stumbling-block between the acting and me being captivated, in previous productions. Was the script simply so perfect that it could not actually be improved by enacting it? This, I do not know the answer to – although I suspect the answer is “no, not really”. Were the company just plain tired – and going through the motions – after an arduous season (commencing last October): which is now approaching its end? (This is my gut reaction, I suppose.) Or are they simply more attuned to the riotous Congreve than the niceties of Edmundson? Maybe. Those “bawdy Inns of Court scenes” certainly seemed to have more panache, carry more weight, be more appealing, be discharged more wholeheartedly… than the ‘serious stuff’. Or was it just ‘one of those nights’ when everything is just so teensily-weensily ‘out of phase’ – timing sometimes really can be everything… – not quite on the ball – that the whole thing just does not hang together; doesn’t flow; doesn’t have the energy of those occasions when the show has mysteriously been at its best; when the celestial spheres have aligned; and everything has just ‘worked’…? Is this related to the peak of the long run having now been climbed; and the fact that we’re rapidly descending the other side…?

Don’t get me wrong. I did enjoy it. I just didn’t – which is a rare thing indeed – engage with proceedings. None of my compulsory copious weeping (either from sadness or high spirits). And even those laughs that did emerge – as with the majority of the audience’s – felt and sounded half-hearted. (In fact, there were a couple of moments when the cast appeared to expect a huge guffaw that never materialized. Which must be heartbreaking for them…. (Sorry.))

Normally, a second sitting would resolve many of these debates (coming down on one side or t’other); provide me with more concrete answers. But, unless I am lucky enough to nab a return ticket – or three – in the final week, this looks highly unlikely; and, of course, I am probably in a minority of people who routinely (want to) go and see a play more than once (or thrice).

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One of my biggest issues, I’m afraid, was with the casting. I found Natascha McElhone surprisingly two-dimensional – especially set against the sublime (I have no other word) Emma Cunniffe. Perhaps this was deliberate…? But at no point did I sense much depth in McElhone’s power-grasping Sarah Churchill; nor feel the attraction that both her husband and the queen supposedly had to her – there was no chemistry. However, Cunniffe’s Anne visibly grew in power, stature, emotion and authority in front of our eyes: emerging, butterfly-like and almost radiant, at her coronation, from her earlier subdued, impotent cocoon of self-doubt. Watching her wings dry and spread, and her face transform, in the spotlight of monarchy, was immensely affecting – a masterclass in playing the long-game. This was certainly her night.

Even those members of the company who had so truly excelled in Love for Love – which is why I asked if they were “just plain tired” – such as Carl Prekopp, here as an angry King William III, and, later, a not-very-bothered Daniel Defoe; Tom Turner, as Jonathan Swift; Robert Cavanah, as John Churchill, Duke of Marlborough… seemed only half-involved. Jonathan Broadbent, though, as the wily manipulator, Robert Harley, shone again (as did his wig (again)); and Richard Hope (who was not in the companion play), as the wise, conscientious Sydney Godolphin, really tugged at my soul (the nearest I came to shedding a tear) as his well-earned authority was snatched from him: “You splice me then indeed, and through the heart.” Beth Park, as Abigail Hill; and Hywel Morgan as Prince George of Denmark (or consistently thereabouts) – “…in some strange, official way, he’s only twelve. And yet he’s such a man…” – both also played their rôles with conviction and veracity.

The music fitted perfectly, as well – a little Nyman-like in its periodicity, perchance… – and was also beautifully performed: both the sublime and the ridiculous bits. And the lighting intelligently revealed – and concealed – hidden dimensions, and that quite wonderfully.

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I honestly don’t like leaving the theatre, or any performance of any sort, dry-eyed. It makes me feel uncomfortable: as if a barrier has somehow been erected, which has muffled communication between the creatives and me; or as if I have somehow missed the point. And yet the words on the page spoke directly to me; grabbed me by the lapels, and sucked the very breath from me. Why was their power so obscured, last night? It is, indeed, a veritable puzzlement. And I am unhappy that I cannot fathom the reason…. This has therefore not been a review that I have enjoyed writing. (And I thought I always gained some sort of pleasure from stringing words together….) Bugger.

Postscript

A big thank you to the technical crew for replacing the faulty caption box at the interval. Yet again, the RSC’s customer service was spot on: and those of us who rely on the surtitles are grateful to you for listening; taking our comments seriously; and resolving the issue immediately.

For those confined…

I must down

Ensnared by a sea of sheets and squalls of sickness,

Out my rain-spattered porthole I peer:

Steaming by, a breasting behemoth of cloud –

A veritable fleet of weatherships – crowning Tysoe Hill.

The trees beneath are porous at this time of year:

Squint between their splayed withy fingers

And foresee remembrances, which

In summer will be masked by verdant fire;

Yet now thaw my beached body, deep in its brumous sleep.