Just in time?

I got home after midnight. On a normal day, this might be considered a little late for a septuagenarian, but, having left home at 3pm to go to the hospital, it seemed very late indeed. The problem was, hours earlier I had fallen over and was later told I had a torn meniscus, a very damaged calf muscle and a swollen wrist. My knee was swollen and I couldn’t stand without gasping in pain.

I couldn’t talk to my GP, because, according to her receptionist, for the period of coronavirus she would only talk to patients on the phone and the next available phone appointment was for two weeks time (although if I could wait until tomorrow, I could speak to a locum). So the thing to do was phone 111.

The young person who answered was following a script he had difficulty reading: “Do you have red blood coming from anywhere?” Although he had already asked me my age and birth date, he said, “Could you be pregnant?” I sincerely hope not! I answered mostly useless questions for about 15 minutes, until he finally said, “Based on what you have told me, you should go to the hospital within the next four hours.” “Why four?” I asked him, constantly curious. “That’s what the computer says,” was his reply.

A half-hour taxi ride later, I was standing behind a barrier at the accident and emergency department, even though standing was very painful. A nurse came from behind the desk and asked sweetly, “What brings you here?” I explained from behind my mask, and I was asked to sit and wait for triage.

I was just one of three people in A&E in a major urban hospital. As the nurse explained, people are not coming because of the pandemic. A short wheelchair ride later I was in the ambulatory care area - this time one of two people. At no time in the hours I was there, were there more than three patients being treated. I was asked to lie down on a bed with wheels, where I stayed for the next five hours. A nurse came to take my blood pressure - a normal and usually uneventful procedure.

This time, however, the machine flashed red and bells rang. “That’s why you passed out and fell,” she said, “Your blood pressure is dangerously low.” Quick as a flash, I was cannulated, and liquid was pouring into my arm. Then came the electrocardiogram, to make sure the low blood pressure was not because my heart wasn’t pumping well enough. So far, so good.

Fifteen minutes later I was wheeled to have my chest X-rayed then back to ambulatory care, with the liquid still pumping into my arm. A young doctor strode in. “Your leg is fine. It doesn’t need X-rays. No broken bones. Just muscle damage.” “Just?” I replied. “It hurts!” But my pain and inability to walk was dismissed with a wave of the hand. Half an hour later, another young doctor poked his head in for three minutes: “We’ve decided that you should have your knee X-rayed.”

So I was wheeled back to X-ray for yet another round, and then back to AmCare. I asked why both couldn’t have been done at the same time and was fixed with a direct gaze - no answer, but obviously he didn’t like the question. And what prompted the change? At no time did the doctors introduce themselves or explain their reasons. All of the nurses did.

Nine blood pressure results later, we were interrupted by the arrival of an occupational therapist. I would be referred to physiotherapy, and in the interim I would be given a booklet with exercises to do (she disappeared and the booklet never arrived). More blood pressure tests.

The first doctor returned. “Take paracetamol for the pain. Keep your leg up, don’t do any wild dancing and your leg will heal in a few weeks.” By 8pm my blood pressure looked something like normal. And I was taken to the main waiting area to be on the lookout for the transport ambulance, which had been booked to take me home. I had come prepared - book, newspaper, magazine and knitting.

By 8.30pm I was very hungry, having not eaten since 12 noon. Being diabetic and having to eat to a fairly tight schedule, I asked very politely where I could get something to eat, since the cafeterias were all closed. The very kind (male) nurse asked me if a sandwich would do and, when my eyes lit up, he disappeared for five minutes and came back with a sandwich and tea. This would be the first of four cups of tea this lovely man would provide.

At 8.45 yet another nurse told me that they could only phone the transport ambulance every hour and a half to ask what their ETA was, and they had phoned at 8pm. The private outsourced company which was tasked with moving patients from hospital to home had its own rules. And, since the ambulance covered every hospital in north London, it could be anywhere. Another cup of tea later, I was told the ambulance had “one more person” to get home and then it would be with me.

At 10.30pm, another phone call. Still “one more person” to take home and then they would be with me. Another cup of tea for consolation. I wanted to call a taxi, but was told I couldn’t leave on my own. Having arrived as the result of a fall, I needed at least one person to take me home. Being a relatively law-abiding person, I acquiesced.

At 11pm, another cup of tea and a message - they were on their way! They arrived, finally, at 11.45. Why had it taken them longer than the time I had spent with four nurses, two porters, an occupational therapist, two doctors and two sets of x-ray technicians? Apparently they had taken a patient to a hospital, which was supposed to be expecting her, but when they arrived it turned out the hospital knew nothing about her. Then they were told she needed to be taken to a different hospital - this time in south London! - which also knew nothing about her.

Somewhere, someone had made an error in recording her postal code and this was compounded each time, because no-one actually knew what they were doing (the patient herself couldn’t speak English). Finally, they were told to take her to the hospital where she had come from, so she could go to the correct place the next morning. The driver shook her head in despair: “She’s an elderly woman, with all sorts of problems, and no English, and we had to drive her all around London for almost four hours. Shame. It’s a real shame.” So the “one more patient” in the one vehicle responsible for all of north London made all other pick-ups later and later. Which was why, at 12.35am, I finally arrived home - nine hours after I left.

All of the staff were patient, caring, kind and professional, and laughed at my jokes. If only there was better coordination and less ‘just in time’. Although there were few patients, it took just as long as if A&E had been packed. The bureaucracy meant that some people simply followed a computer script; with others I was made to wait for lengthy periods for treatment or results or for different medical people telling me different things, some of which never came to pass. If the processes had been better joined-up, a lot of time could have been saved.

My smallish but painful problems could have grown to larger ones if they hadn’t been caught in time. It would have been very easy for the first doctor on his own to ignore my inability to walk - convinced as he was that it was a minor problem.

Really, this system is struggling to survive. The NHS is, slowly but firmly, being pointed in the direction of the US ‘pay as you go’ system, with only private patients having the kind of care that all should have. Government planning and investment in our “wonderful” health system (sayeth the government), for all their applauding on Thursdays, is clearly inadequate. ‘Just in time’, combined with the profit motive, makes for inefficiency. A medical system for the few, not the many. Unless there is a major fightback, we will eventually be reverting to pre-1945.

As for me, if I have to go to the hospital again, I’ll know to bring a picnic and Jack Conrad’s Fantastic reality, which I’ll finally have time to read.

Gaby Rubin


It was a pleasure to get together on Zoom with my local Labour comrades in Momentum Hammersmith and Fulham on July 14. As a founder member of the local group, along with comrade Scott Reeve, I am one of the few who, after being expelled from the party (for being a Marxist) by Iain McNicol’s gang, has remained a Momentum member.

Despite paying my monthly £3 membership fee, I had not received an email invitation to this Zoom meeting, and I began to worry that my name might have been surreptitiously deleted from the membership list. But it turned out that I was not the only one to have been missed, and the fault lay with the poor upkeep of the organisation’s national database. Local circulars are sent out via Momentum’s central database with no local control, and the database is evidently in a state of neglect.

The meeting was addressed by two of the four London reps newly elected to the national coordinating group - both on the Forward Momentum slate. Deborah Malina - one of the founders of Forward Momentum six months ago - announced that she had been heavily involved for the past five years in The World Transformed, so I was able to point out that TWT’s supposed presentation of lively left debate has actually been censored: for example, by refusing to present Jackie Walker’s film Witchhunt after Chris Williamson was prevented from showing it in parliament. The second FM rep, Mike Moore from Chingford, confessed to having been on the Centre Left Grassroots Alliance’s slate selection panel last week, and had supported rejection of the left membership’s favourite, Jo Bird - the only open opponent of Starmer’s ongoing anti-left witch-hunt on offer.

A number of comrades highlighted FM’s first broken promise: to give members a say by organising primaries to select NEC candidates. The feeble excuse that “there was not enough time” convinced no-one, and the promises of primaries “next time” and “we will insist on member democracy” ring hollow. By their deeds shall ye know them. Deborah Malina pointed to another FM manifesto promise: to “refound Momentum”. How? “In steps”, starting by “reforming how the NCG works”, as “the chair had too much power”. Indeed he did - and still does. “We will democratise the database”, so that local groups can get hold of their local membership lists. “Jon [Lansman] says he doesn’t mind handing over the data” to the new leadership. And lastly, “a refounding conference will be organised in May or June 2021”.

As I told the meeting, I will eat my hat.

Stan Keable

Lessons learned?

Readers will be glad to know that John McDonnell is back up and ready for whatever the future may hold. In an interview with Jacobin (July 7) he speaks of his constituents, his background and family - and, among other things, some lessons learned.

His constituency (Hayes and Harlington) includes Heathrow Airport. With British Airways redundancy announcements, whole families there face economic ruin. Worse, “they’re laying off workers here to undermine wages and conditions, but they’re using their resources … to buy up other airlines”. Meanwhile, “What I was arguing for when I was shadow chancellor is resources going into protecting wages, not profits …” He’s further convinced that big corporations will not let this crisis go to waste - so there’s a bit of insight.

He thinks that the left has opportunities in the current crisis, but warns that, unless these are seized, the right has opportunities too - “That’s what we’ve got to guard against first of all.” The left, meanwhile, needs a “narrative” about where it’s going, but also a policy programme, along with identifying people who will campaign on it. It is, apparently, “the old Marxist concept of praxis”.

The big idea is to “rebuild” the think-tanks and the unions: we are fortunate, in that “It’s been terrific really. There’s a huge new generation of, as I say, people working in think-tanks in different campaigns, and the creativity is staggering.” The loss of the election was a bit of a blow, but the pandemic has revealed that “People are now waking up and saying, actually, we valued bankers and speculators in the city, who contribute effectively nothing to our society, more than we valued the person who keeps our hospitals clean. Or, if you look after our elderly, if we care for them and treat them, we save lives.”

The answer lies in the state: we need a big and effective state paid for by a redistribution of wealth. We also need to build up a social movement. There is more, but in essence McDonnell remains a left adornment in the Parliamentary Labour Party and is determined to carry on the fight. Against whom? Keir Starmer, Boris Johnson, the PLP? Whoever, but definitely in the British ‘democratic’ parliamentary tradition.

Blair may have felt that he needed the ‘lefts’ to give an aroma of socialism to the PLP, but, with the ‘red wall’ gone, and not forgetting Scotland, will Starmer feel the same need? What purpose do they serve for his agenda? Except perhaps as sacrificial offerings to what he perceives as his ‘base’ and the respectable media.

As I say, there is more, but there is a big elephant in the room: what about anti-Semitism? What about the witch-hunt? Nothing is said. But then the piece I read was a transcript “edited for length and clarity”. Maybe he mentioned these things in the podcast - but life’s too short. But he does say in the interview - and it forms the title of the piece - “Never underestimate the ability of the establishment to divide and rule”.

That ability and the witch-hunt: any connection?

Jim Nelson

King of confusion

If I go “from one ball of confusion to another”, it is because I am dealing with the king of confusion - one Arthur Bough (Letters, July 9)! The number of times Bough misquotes me is simply mind-boggling.

“But for Clarke it is only the permission of the bourgeoisie that signifies ownership.” No, this is precisely what Bough is arguing! He says workers in private business have no ownership rights, but in joint stock companies they do. Why does Bough argue this? Because, according to him, the bourgeois have written up the corporate rules of governance to make the ‘associated producers’ the logical legal owners! Bough effectively argues that it is the bourgeois who confer rights to workers via their corporate law!

There is nothing special about joint stock companies. The capitalists in these enterprises are the shareholders, who delegate the task of extracting surplus value to the managers. The shareholders receive a share of the profits, created by the labour of others. This is capitalism, not some transitional form.

To be clear, my argument is that workers have to seize the means of production by all means necessary, whether they work in a private business or a corporation. But that can and only will be done by workers acting as a class, with a class consciousness. It won’t happen in isolation, one company at a time. It will be via a movement with strategies and tactics. It won’t be a domino effect, but a flood. But Bough seems to have ditched classes altogether and descended into bourgeois individualism.

“To get round this she now claims that Engels and Kautsky made this up!” Another example of Bough’s childish and churlish responses. I did not say they made it up, I said you cannot claim categorically that Marx said this, because it was from scattered workbooks and notes edited by other people. Something may have got lost in translation/editing, for example.

“Maren’s answer to the question of why workers would want to hand control over their property to the capitalist state is bizarre.” This is the fifth time Bough has misquoted what I wrote and we are not even halfway through! In his previous response he mentioned the workers’ state, not just the capitalist state, and when I said workers would demand a say in what got produced and what got consumed it was under the assumption of a workers’ state, which is surely obvious to anyone. It would obviously be ridiculous to make such demands to a bourgeois-controlled state.

The rest of Bough’s response is one misquote after another. Frankly there is no point continuing this discussion any further, I have to spend more time grappling with being misquoted than actually making arguments. I suspect this is a tactic by Bough and I am not playing his game.

Maren Clarke

New mantra

I welcome the news that the government has dropped the target of having 50% of school leavers go on to university. The target was set by Tony Blair as part of his mantra, ‘Education, education, education’, aimed at winning over middle class parents. Blair knew that the middle class is a bulwark against revolution and saw the target as a means to recreate and reinforce the middle class.

However, the Tory government understands that having large numbers of unemployed and underemployed male graduates is asking for trouble. The revolutions in Egypt and Tunisia as part of the 2011 Arab spring were triggered by a revolt of unemployed and underemployed male graduates. At the same time, in Britain there is a huge shortage of robot, laser and accounting technicians, as well as plumbers, electricians and building workers. The emphasis of successive governments on A-level education has been a disaster for the 50% of school-leavers who do not go on to university.

In the 1970s I attended a grammar school where I got a great academic education, but was absolutely useless when trying to get a job. After being unemployed for two years, I eventually did a degree in mathematical sciences, which included one year’s work experience. If I had the time again, I would not have done A levels, but would have tried to get a job as a trainee accounting technician after I had completed my O levels.

The government now plans to transfer resources to further education colleges as part of its own mantra, ‘Further education, further education, further education’. By contrast, all school-leavers in Germany who do not go on to university are offered an apprenticeship as part of its world-beating further education system. This is something Britain should copy.

John Smithee