Tag Archives: consequences

Reform or no reform, decision or indecision, government choices about the NHS have real consequences for patients like me


2011 is already shaping up to be a hugely important political year. We’ve had the Arab Spring and in the last couple of months alone, landscape shifting national crises in phone hacking and the riots. Coalition government is still a whole new kettle of fish that could boil over at any moment. No one’s quite sure, still, where Ed Miliband is going to take the Labour party. The Euro continues to dance with death. And Obama may have killed Bin Laden but is yet to throw his own economy a convincing lifeline.

Amidst the naming, shaming and blaming in the aftermath of England’s rioting, debates about coalition cuts and reforms have once again been lost in the robotic chanting of ideology. Earlier this year the general public mobilised in a reassuringly democratic fashion to force a pause or “listening exercise” in NHS reform. There are whispers in some parts that David Cameron and Andrew Lansley intend to ignore the concerns of the people, under the radar. But Nick Clegg, following his electoral and referendum humiliation in May, ensured us he’d keep an eye on them. Trouble is no one trusts him anymore.

What I’m about to write is more personal than political. I’ve said before that all my political writing has an element of my personality, in that I do my best to express strong opinions, beliefs or half formed ideas I’ve concocted from things I’ve read or consumed. Even professional political commentators are aware that their own preferences influence their coverage. But I’m the first to admit that, as a young man, I am often dealing naively in the abstract. My opinion on defence cuts or the symbolic importance of the Euro is rather ignorant and useless in reality. The NHS however is for all of us and can affect the quality of our everyday lives dramatically. We should all feel able to speak out about its future.

In late September I will begin university life after a gap year I probably wouldn’t have chosen to have. A couple of years ago I was very ill. I lost a lot of weight and barely ate anything. I was frequently in severe pain and unable to socialise with friends in the summer holidays. I could muster enough energy to complete school work and little else. Eventually I was diagnosed with the digestive condition, Crohn’s Disease (http://www.nacc.org.uk/content/home.asp).

After passing through various rungs of the National Health Service I found myself with a steady and capable team of staff at the Inflammatory Bowel Disease clinic of my local hospital. A variety of treatments got me through Sixth Form and I was relieved to do well in exams, unaffected by the Crohn’s. In order to continue my recovery I chose to have a gap year, although it didn’t feel like I had much choice. I simply had to get healthier.

I started a new treatment of fortnightly injections. This was intended as a longer term solution because I had been taking powerful drugs that could have harmful side effects in the future. Thankfully the injections worked and continued to do so. I could return to a “normal life” with the limitations of my condition minimised. I felt grateful to be as healthy as I could be. My worries were mostly those of ordinary people my age and I was able to grow as a freelance writer and enjoy the year.

Now though health related stress is making a comeback. With university imminent I am organising the altered delivery and storage of my treatment. And at the last meeting with my doctor a few months ago I was told that the National Institute for Health and Clinical Excellence or NICE, who are basically in charge of what doctors can spend on expensive drugs, would want to reassess my case at some stage. The guidelines say that if you’ve been well for a year you should be taken off the costly treatment. I was assured this wouldn’t happen during my transition to university but I am not naive. At some point the decision will be taken away from my doctors.

So then we come back to NHS reform. I had always been instinctively against the predominantly Conservative proposals. But my doctor said something along the lines of; if it were his choice he obviously wouldn’t even consider withdrawal of the treatment for a long while. David Cameron has constantly talked of empowering GPs and specialists to make decisions like this which could benefit patients like me. Was I against these reforms or not?

The main problem is a lack of understanding. Do you fully understand what is being proposed? I don’t. I’m betting no one, bar those involved with the actual legislation, really does. The pause has actually complicated things further. In fact even those with all the facts of the legislation can’t comprehend every little consequence in real life for real people. Letting doctors decide sounds good. But shouldn’t the bulk of their time be spent treating patients? Shouldn’t someone independent make such decisions?

My attitude towards NHS reform has taught me that whilst I lean to the liberal left or centre with my political thinking, my actual opinions can be rather conservative. Change has always stressed me out in everyday life. If something as vital as the NHS ain’t broke, don’t meddle with it, especially when the country is trying to save money. I got better eventually, that’s all that matters.

I’ve long thought that the real way to help improve standards and ensure sustainability for the future is to cut down the sprawling responsibilities of the NHS, whilst reinforcing vital areas. It seems logical and fair that treatments that aren’t essential should not be given priority. Equally those that bring about their own illnesses should come second to the more deserving and hard done by. We need tougher health based taxes to directly fund the NHS and ease its burden, doing whatever we can to discourage the abundance of drinking and smoking cases that weigh it down. Granted this view comes from the fact that I was born with asthma and have other conditions, like Crohn’s and eczema, I could do nothing to prevent. I hold a selfish view. But then everyone gets their opinions from somewhere and all I believe in is a fair, efficient health service.

Again though what I thought I believed has been turned upside down by what’s happening to me in real life. NICE are the body responsible for ensuring that the NHS spends its money wisely and on those who need it. They are also the body that could at any point in the future remove my funding and leave me without treatment. I might stay healthy or I could plunge back into an illness it will take a long time to escape from. It could be even harder to recover second time round and the injections might not work twice.

The NHS is something Britain is envied for around the world and it is a genuine reason to be proud of our country. Cameron is saying Britain is broken again and pictures of the riots have been beamed out internationally. But we can be proud of the NHS. Overall I am happy with what it has done for me but the uncertainty hanging over my future proves it’s not perfect. It can’t be. It aims to be perfect, trying to make everyone better all of the time. Because it reaches so high it can’t get it right for each individual; whatever politicians decide to do will not change this fact.

But every decision they do make about the NHS will have life changing consequences for someone, somewhere in the system. For people like me
and people far worse off than me. So they should continue to think carefully
and trial new ideas before making sweeping changes. I’ve written before about
the government’s NHS plans but this article is an admission. I do not know
whether it’s best to stick or twist. All I can yelp ineffectually into the
blogosphere is that I hope the decision makers understand the gravity of what
they are doing, and that we keep doing our best to keep up and pay attention.

Film Review: Ghosted


Do you think you could hack it behind bars? If you’re a Daily Mail columnist you probably dispute the fact that prisons even have bars anymore. They’ve all been replaced you see, with tasty sticks of rock more in keeping with the dangerously liberal, comfortable satellite TV approach to treating filthy criminals. Being locked up is preferable to a five star hotel. Prisons are merely lavishly furnished warehouses for feral beasts that will be released back into the wilds of society unchanged. The fear factor has gone.

Bring back that shit yourself punishment and all of Britain’s ills will be cured. All this claptrap about human rights and civil liberties has been diluting the taste of our justice system since the 60s, so that it’s nothing more than a bitter sip of lemonade. Prisons should punish first and foremost, to act as a deterrent to the bad apples on the nation’s tree. When they fall they need to be crushed into a pulp and left to rot as an example to others; so the argument roughly goes.

Of course films are not the place to look for a frank and faithful look at the realities of prison life. Just because I’m put off a casual mugging by the possibility of gang rapes such as those in The Shawshank Redemption, doesn’t mean that actual perpetrators within the system encounter such things or that they are deterred by them. Cinema is a place for drama, tension and excitement. But a certain mould of gritty British drama always seems to capture something true about the cooped up existence of convicts, whatever the exaggerations.

In the case of Ghosted, the debut film of writer/director Craig Viveiros, the principal truth is that for many men, the haunting consequences of their crimes are punishment enough. There is also a heightened but believable look at the community of prison life, with its rival factions and dominating personalities pulling the strings. And much of the dialogue is insightful but understated, with main character Jack musing that, if nothing else, empty hours in a cell day after day give you plenty of time to think.

Jack (John Lynch) is a sensible prisoner, keeping his head down and away from trouble, serving his time. He is approaching the end of his sentence and desperate to get out to see his wife. But at the start of the film she fails to visit him and blanks him when he calls. Just as freedom is within sight his marriage collapses, destroying his hopes for a life on the outside. Gradually we find out more about Jack, eventually getting confirmation that his young son is dead. He burns most of his pictures of him because “sometimes the reminders are too hard in here”.

With just months until Jack is free, a new inmate arrives in the shape of young Paul, played by Martin Compston of The Disappearance of Alice Creed fame. Paul is immediately welcomed by the manipulative Clay, who is described on the marketing material as a “wing overlord”, which sounds like an all powerful evil super villain, but in reality just means a nicer cell, a mildly lucrative drugs racket and the odd fellow prisoner to bang. After the initial niceties Clay starts to use Paul, so Jack steps in and gets him moved to his cell.

This puts Jack in the firing line, resulting in some tense standoffs. The balance of the prison politics is disrupted and Clay is humiliated more than once, prompting him to get revenge. But despite the palpable sense of threat, the really interesting part of Ghosted is the relationship between Jack and Paul.

Jack is the heart of Ghosted and Lynch relished playing him, praising the creative talents of newcomer Viveiros: “It’s been a long, long time since I read a script that’s centred absolutely one hundred per cent on the characters”. In return the director praises his cast who “pumped blood into the story”. Both men are right.

Ghosted is well acted, with even the thugs coming across as something more than just two dimensional bad guys; they have their vulnerabilities too. But Ghosted is also well written and confidently directed so that it does not feel like a debut. Some of the scenes in which Jack and Paul open up to each other, often simply discussing old memories such as when Jack was in Brazil or when Paul was in care, are exemplary examples of characterisation rarely seen in today’s commercial world of cinema.

Ghosted is released in cinemas on the 24th of June and will be available on DVD from the 27th. See it to support a quality British drama with an all star cast, which simultaneously pays tribute to classic prison stories and approaches the issue from a new angle. Try to spot the emotional hammer blow of a twist at the end.

 

A History of Violence


(some spoilers)

I was keen to see A History of Violence, but I also sat down to watch it with trepidation. The title of this film had me envisaging a brutal compilation of some of history’s goriest moments or something similarly horrific like a serial killer’s holiday snaps. Director David Cronenberg had a reputation from what I’d heard, as he followed up the success of this film with hard-hitting gangster story Eastern Promises, containing its own controversial fight scenes. I haven’t much stomach for excessive blood and guts.

 The opening scene was indeed chilling; brilliantly so. From the very start A History of Violence declares itself to be a film that will give its actors room to act, its story room to grow and unsettle, and yet with a runtime of 96 minutes it’s no tedious slow-burner.  The action kicks-off at detailed walking pace, with two shady but calm types loitering outside a motel. They exchange perfectly ordinary, mundane words. One of them disappears inside whilst the other moves the car a little further along. Then we see which man wears the trousers as the driver’s ordered to go and get water from the cooler in reception.

Inside he dawdles, the camera slowly following his casual, deliberate movements. Then he nonchalantly passes the bloody scene of carnage behind the counter to fill up his container with water. By this point the tension’s been skilfully raised to breaking point. A crying girl appears, clutching a soft toy. The man freezes. The gentle manner he adopts to reassure her, to stop her running or screaming, makes you wonder if he’s a reluctant pawn in a criminal world. Or at least he has enough heart to keep children out of his messy business. But then he gradually reaches for his gun.

The next scene starts with a girl waking from a bad dream, worrying about monsters. Viggo Mortensen appears to comfort his child, instantly establishing himself in the caring everyman role he played so well in The Road. He tells her: “There’s no such thing as monsters”. And yet the inhuman calculating coolness we saw in the preceding scene lingers hauntingly, encouraging the audience to feel differently.

The first twenty minutes of A History of Violence following its disturbing opening scene, caught me off guard for their ordinariness. Mortensen’s character Tom Stall is a simple country soul, running his store and looking out for his family. Far from being dull these establishing scenes are touching and add to the meaning of later events. Stall’s relationship with his wife, played by Maria Bello, is tenderly romantic and loving despite the length of the marriage. His daughter is cute, his friends and colleagues kind and his teenage son remarkably perceptive and intelligent for his age.

But then a handful of fleeting moments change everything. The thugs we saw at the start of the film turn up at Stall’s diner and proceed to terrorise his staff and customers. Reacting instinctively Stall intervenes to save everyone and inadvertently catapults himself to fame. His picture covers the town’s paper alongside the headline, “Local Hero”.

At this point A History of Violence’s title starts to make sense, as the film becomes a meditation on the consequences and ethics of violence. We’ve already seen some High School moments in which Stall’s son, played by Ashton Holmes, rose above the aggressive taunts of the sports hot-shot. Now Stall tries to deal with the accompanying trauma of killing a man, two men, in unforgettable close-up fashion. His family and the community rally round to comfort him. We never see the reasons behind the thugs’ killings. Cronenberg is careful to make most of the violence purely about how it makes a deep, repressed part of some people feel; how it satisfies them.

With the unwelcome arrival of more mobsters to Stall’s quiet town, the plot takes another unexpected twist. The story shifts from a thoughtful exploration of the nature of violence, to tense suffocation as the gangsters stalk Stall’s family, to suspicion and confusion as ghosts surface from Stall’s past. It’s all marvellously subtle, but hints from earlier in the film begin to make sense. Those establishing scenes really were good as you hope with Stall’s family that the demons go away. But of course they don’t.

The acting is superb. Mortensen and Bello are not just excellent as a couple early on in the idyllic stages, but wonderfully convincing and captivating later as destructive events unravel. There are memorable cameos from William Hurt and Ed Harris. The way the performers completely inhabit their characters ensures A History of Violence works masterfully as a gripping, suspenseful and action packed thriller, as well as an insightful film questioning ideas like the American Dream, identity, relationships, humanity and the past.

And the cherry on top of a filling, tasty and sumptuous slice of movie cake is a final scene as stylish, patient, subtle and moving as the opening one. If you haven’t seen A History of Violence, do so soon. It was not at all what I expected it to be and well worth a watch. Don’t be put off by the title or the 18 certificate because ultimately it’s a first-rate and surprising story. It won’t mentally scar you, merely make you think.