The next reforms will be much further-reaching. We’re getting to the heart of the matter, at last. To remind everyone where our priorities lie, I’ve had a large notice pinned to the walclass="underline" it says
FREEDOM
COMPETITION
CHOICE
I’ve also decided to take a strong line with the word ‘hospital’. This word is no longer permitted at discussions: from now on, we call them ‘provider units’. This is because their sole purpose, in future, will be to provide services which will be purchased from them by Health Authorities and fundholding GPs throughnegotiated contracts. The hospital becomes a shop, the operation becomes a piece of merchandise, and normal business practices prevaiclass="underline" pile ’em high and sell ’em cheap. The beautiful simplicity of this idea astounds me.
Also on the agenda today was income generation. I see no reason at all why provider units shouldn’t impose car-parking charges, for instance, on visitors. Also, they should be encouraged to rent out their premises for retail developments. There’s no point in all those closed wards standing empty when they could be turned into shops selling flowers, or grapes, or all those other things people feel like buying when visiting a sick relative. Hamburgers, and so on. Little knick-knacks and souvenirs.
Towards the end of the meeting somebody brought up the subject of Quality Adjusted Life Years. This is one of my own personal favourites, I must say. The idea is that you take the cost of an operation and then calculate not just how many years’ life it saves, but what the quality of the life is. You simply put a figure on it. Then you can work out the cost-effectiveness of each operation: and so something basic like a hip replacement will come out at around £700 per QALY, while a heart transplant is more like £5,000 and a full hospital haemodialysis will cost a cool £14,000 per QALY.
I’ve been arguing it all my life: quality is quantifiable!
Most of the Board, nevertheless, don’t think the public is ready for this concept just yet, and they may be right. But it can’t be long now. We’re all feeling tremendously buoyant after the election result. The sell-offs have been proceeding at an amazing rate – Aerospace, Sealink, Vickers shipyards, British Gas last year, British Airways in May. Surely the day for the NHS can’t be far off.
Such a shame Lawrence never lived to see it happen. But I shall do his memory proud.
We must never forget that we owe it all to Margaret. If ambition turns to reality, it will be thanks to her, and her alone. She is magnificent, unstoppable. I’ve never known such resolution in a woman, such backbone. She cuts her opponents down as if they were so many weeds blocking her path. Knocks them aside with a flick of her finger. She looked so beautiful in victory. How can I ever repay her – how can any of us even begin to repay her – for all that she’s done?
November 18th 1990
The call came through at about 9 p.m. Nothing had been decided yet, but they were starting to canvass opinion among the faithful. I was one of the first to be asked. The poll findings are grim: she gets more and more unpopular. In fact it’s gone beyond unpopularity, now. The plain truth of the matter is that with Margaret as leader, the party is unelectable.
‘Dump the bitch,’ I said. ‘And fast.’
Nothing must be allowed to stop us
October 1990
1
‘The fact is,’ said Fiona, ‘that I don’t really trust my GP. From what I can see, most of his energy these days goes into balancing his budget and trying to keep his costs down. I didn’t get the sense that I was being taken very seriously.’
I did my best to concentrate while she was telling me this, but couldn’t help keeping a watchful eye on the other diners as the restaurant started to fill up. It was beginning to dawn on me that I was underdressed. Hardly any of the men were wearing ties, but everything about their clothes looked expensive, and Fiona herself seemed to have been much more successful in judging the mood: she wore a collarless, herringbone-patterned jacket over a black cotton T-shirt, and cream linen trousers, cut a little bit short to show off her ankles. I hoped she hadn’t noticed the worn patches on my jeans, or the chocolate stains which had been ingrained on my jumper for longer than I cared to remember.
‘I mean, it’s not as if I’m some flappy little thing who comes running into his surgery every time I get a cold,’ she continued. ‘And this has been going on for nearly two months now, this flu or whatever it is. I can’t just keep taking days off work all the time.’
‘Well, Saturday’s probably his busiest day. He was bound to be rushed.’
‘I think I deserved more than just a pat on the head and a few antibiotics, that’s all.’ She bit into a prawn cracker and sipped some wine: an attempt, it seemed, to wash the irritation away. ‘Anyway.’ She looked up and smiled. ‘Anyway, this is very nice of you, Michael. Very nice, and quite unexpected.’
If there was an irony intended, it managed to pass me by. I still couldn’t quite get over my amazement at the thought that I was actually sitting with another person – a woman, no less – at a table for two in a restaurant. I suppose part of me, the most vocal and persuasive part, had simply given up believing that such a thing might happen: and yet it could hardly have been easier to accomplish. I’d spent the previous evening slumped in front of the television, almost mad with boredom even though my intentions had been admirable enough. Over the last few years I’d accumulated a pile of unwatched videos, and it had been my hope that this time I’d find the stamina to get through at least one of them. But it seemed that optimism had got the better of me again. I watched the first half of Cocteau’s Orphée, the first thirty minutes of Ray’s Pather Panchali, the first ten minutes of Mizoguchi’sUgetsu Monogatari, the opening credits of Tarkovsky’s Solarisand the trailers at the beginning of Wenders’ The American Friend. After that I gave up, and sat in front of a silent screen, steadily making my way down a bottle of supermarket wine. This continued until about two o’clock in the morning. In the old days I would have just poured myself a final glass and gone to bed, but now I realized that this wasn’t good enough. Fiona had called by a couple of hours earlier and I hadn’t even answered when she knocked; she would have seen the light under my door and must have known that I was ignoring her. And now suddenly, sitting by myself with only the television’s dumb flickering to combat the darkness, it seemed ridiculous to me that I should prefer these blank, unresponsive images to the company of an attractive and intelligent woman. It was anger, above all, which drove me to perform an impetuous and selfish act. I went directly on to the landing and rang the bell to Fiona’s flat.
She answered after a minute or two, wearing a light, Japanese-style dressing-gown. An expanse of freckled breastbone was exposed, sheened thinly with sweat although I for one thought the temperature had dropped quite sharply this evening.
‘Michael?’ she said.
‘I’ve been really unfriendly these last few weeks,’ I blurted out. ‘I came to apologize.’
She looked puzzled, of course, but managed to take it in her stride.
‘That’s not necessary.’
‘There are some things – possibly there are some things you ought to know about me,’ I said. ‘Things I’d like to tell you.’
‘Well, that’s wonderful, Michael. I certainly look forward to that.’ She was humouring me, I could tell. ‘But it is the middle of the night.’
‘I didn’t mean now. I thought maybe … over dinner.’
That seemed to surprise her more than anything. ‘Are you asking me out?’
‘I suppose I am.’
‘When?’
‘Tomorrow night?’
‘OK. Where?’
This put me in a corner, because I only knew one local restaurant and didn’t want to go back there. But there wasn’t much choice.