SOCIETY TODAY

Medicine

The strike to end all strikes

John Linklater

A healthy young plasterers mate with a super hod, working a fortyhour week, has admitted* that he can take home £400 for his week's work. This is presumably the sort of thing that Sir Fred Catherwood, chairman of the Council of the British Institute of Management, had in mind when he pointed out, recently, that some sections of manual labour were entering higher income brackets than many doctars. Most doctors would indeed thi_ik themselves lucky if they managed to take home a bare third of the wages of this young plasterer's mate, and no doctor could reasonably expect to have as much time off work as he does.

When the plasterer's mate gets home after his eight-hour day, his time is then his own. He does not find his wife with a message requiring him to go back at once to a house which he has already passed twice, that morning, to attend to old Mrs Jones's plaster which has been slipping for the past week, and which is now causing her some discomfort. And if he were requested to do this, he would expect to be properly compensated. He would not be expected to make the journey at his own expense for no extra pay at all. He earns a take home wage of £10 an hour during his normal working day and he would expect as least twice this rate for overtime.

The sad thing is that human nature is human nature, notwithstanding socialist ideology and the doctrines of the welfare state, and a service which so provided totally free on demand, gradually comes to acquire low value in the eyes of the user. We universally accept the basic premise that nobody resident in the United Kingdom should ever lack the best medical care because of poverty, but that premise has become corrupted. The ancient deterrent against abuse of the service has been removed so completely that a patient can now frequently be better off financially in hospital than out of it.

The result of this absurd, Kafkaesque situation is, of course, that the service, as a whole, deteriorates and none of the patients get the degree of proper medical attention to which they are entitled. , Meanwhile, the national health bill continues to soar, now standing at about seven per cent of the gross national product, and most civilised

nations have come to understand that the concept of a backlog of disease, was an illusion. There was no backlog; only a bottomless demand for more, and yet more treatment. This is perhaps why the self-employed person is statistically five times as healthy as his salaried counterpart.

Nearly a year ago Sir Keith Joseph, in the Marsden Memorial Lecture, reproached the medical profession for failing to give the Government any concrete proposals for limiting costs. But this is not the duty of the medical profession, which can only do its best to treat every patient who asks for treatment. If the Government persists in removing the natural deterrent of, at least, a token consultation fee of, say, 50p for the first consultation in any illness, then it must itself lay down and publish priorities and limitations.

Of course the simplest way to economise is progressively to reduce the salaries of the doctors themselves, and this is precisely what successive governments have .done. The result it that some 500 British-trained doctors have been emigrating annually, to be replaced by an equivalent number of lesswell-trained doctors from even poorer countries, who enter Britain and practice without any formal examination. The public are thus forced to accept a progressively diluted service which now contains more than twenty-five per cent of doctors from overseas.

Emigration is itself a form of industrial action but disenchanted doctors have at last been driven reluctantly to stand and fight. The Government sees fit to spend some £300 million annually on salaries, offices, wall-to-wall carpeting and transport for a vast new network of unproductive Area Health Authorities, whilst clearly content that the patients continue to be treated in dingy consulting rooms and insalubrious operating theatres by inadequately-trained doctors with whom they cannot communicate, and who are earning 82p an hour for an eighty-hour week. The correct and fair rate for fullytrained medical overtime is at least E20 an hour and, at this rate, emigration wonld virtually cease. Orwell himself could not have done better, The machine has gone mad and even the British Medical Association negotiators have been brainwashed. How else could they have agreed with the life insurance companies that a general practitioner should be paid £2 for examining a complete medical record, extracting, copying and checking any significant data, assessing and extracting relevant pathological and radiographic findings, and giving an overall opinion? At what real rate do they imagine that they are employing his skill? A solicitor or surveyor would, quite rightly, charge £50 to £150 for doing a similar task. The house cannot be worth that much more than the man who lives in it.

These are some of the reasons for which resolute action is now needed. The predicted consequences of government wishful thinking are now upon us** and, when the latest Government Review Body report is published in a few days, the hospital consultants work-to-contract will, very likely, be extended to include general practitioners. We may yet be seen to be of greater value to society than a young man with a super hod.

**Collapse of the NHS, Spectator, January 6, 1973.

Press

Short haul

Bill Grundy

I suppose his mother must have loved him, but I find Sir Edward Short, the Leader of the House and Deputy Leader of the Labour Party (can they really be as desperate as all that?), I find him, 1 say, a definite drag.

As the interesting affair of Mr John Stonehouse unravelled itself I heard Mr Short being interviewed on the radio. He was, as he so often seems to be, completely bewildered. "It's like a detective story" he remarked at one point in breathless awe, producing, as ever, le mot juste. I've got news for Mr Short. It is a detective story. And the people who have been doing the detecting are the police and the press. That sort of detective work requires a lot of patience, a lot of work, a lot of time, a lot of money, and a few inspired hunches. One inspired hunch the press had was that Mr Stonehouse was not dead. "He didn't drown" one editor said to me at the beginning of December. "He's done a bunk."

The reason for such cynicism on the part of Fleet Street isn't hard to find. As long ago as November 1972, the Sunday Times Business News revealed that not everything in the Stonehouse garden was lovely. The occasion was the flotation of the British Bangladesh Trust. The Sunday Times asked five pertinent questions. Mr Stonehouse was undoubtedly embarrassed, which was unfortunate — for him; but that's what journalists are for. And then, on November 15, just five days before Mr Stonehouse disappeared, Private Eye published a piece about him, recounting all the , facts about his financial manoeuvring and bringing it up to date. It was headed 'Bungler Dashed,' and it was more prophetic than anybody could have dreamed of.

The only question was where had he dashed — not whether he had.

Naturally, the press began to make inquiries. That, despite Mr Wilson's holier-than-thou attitude in the Commons, is again what journalists are for. It was inevitable that some of the inquiries would distress the Stonehouse family — anyone who has reported even an ordinary bereavement knows that the simplest routine questions can upset people. But those questions had to be asked if the hunch that Mr Stonehouse was not dead were to be proved or disproved. Our Beloved Leader did not think that such questioning was necessary. He said in the House: "I understand that the mother of my Right Hon Friend has suffered a serious heart attack because of the anxiety and pressure. Some members of the press are hounding them [the Stonehouse family] in their tiomes It is time for these people to be given a little decent privacy."

Well, perhaps it is — now. But was it then? And if the search had been dropped would Mr Stonehouse still be getting away with it? Probably not, as the police would presumably have got him sooner or later (although it is one of life's lovely little ironies that they actually thought it was Lord Lucan they were picking up at Melbourne Central Post Office, but let that pass). But that is no reason for saying that the press shouldn't have been asking questions, even though they may have been causing some distress. How much, I can't say. I leave that to the Editor of the Sunday Express, Mr John Junor, who, in the column he has now taken over from the late John Gordon, remarked that Mr Stonehouse's eighty-year-old mother "seemed to have made a remarkable recovery when she appeared on the telly the other night."

Well, she might have done. She's obviously a tough old bird — I use the phrase admiringly. But, on the other hand, she might not. The 'serious heart-attack' may not have been serious after all. It may not even have been a heart-attack. It may have been just another case of Mr Wilson mounting that hobbyhorse of his; anything is good enough to beat the press with. Either way, the remark comes oddly from a man who, along with Mr Short, alleged last September that certain newspapers were out to smear the Labour Party, but who, as I said a fortnight ago, hasn't yet offered one word in substantiation of the claim, nor presented one scrap of evidence to the Royal Commission on the Press.

Not that I am giving the press more than two distinctly-qualified cheers for their work on the Stonehouse story. As the Sunday Times said in a leader: ". . . journalists do well to recognise that their handling of the story has not been faultless." That must, of course, include the journalists employed by the Sunday Times. For the leader went on: "more than two years have gone by since the disclosure that there had been serious irregularities in the way Mr Stonehouse floated his Bangladesh Trust; yet there was no further press investi

gation of the Trust until his temporary disappearance in Florida last month." But just as Man embraces Woman, so the press embraces the Sunday Times, which must therefore be just as guilty of sloth as the rest of the press, and perhaps more so, since the November '72 disclosure was the Sunday Times's own exclusive story.

Nevertheless, the investigation ultimately did get under way. The press was doing its job. And the importance of that job was made clear in the last sentences of the Sunday Times leader: "Men who enjoy public position must accept public accountability. The rules for commercial disclosure in this country are in any case lax and ill-enforced: in the important task of checking that organisations trading in public are respecting the trust of those who do business with them, the press has often been alone."

It is because the press is often alone, working on hunches and tips long before there's any hard evidence that its work is so important. If at times it does indulge in what the Sunday Times calls "nudge and wink journalism," well, OK, we're none of us perfect. But for all its blemishes, we'd be a damn sight worse off without a freely-investigating press, and the sooner Mr Wilson and his mournful side-kick Mr Short realise that, and rid themselves of their persecution complexes, the better for both of them and all of us.

Advertising

Loss-making space

Philip Kleinman

The future of the national press — and indeed whether it has a future

is a subject that has been exciting a large amount of debate Just recently. My erudite colleague William Grundy can be relied upon to keep you informed of the progress of that debate. I would like, however, to bring to your attention some facts and figures of a kind relevant to it but not always given due weight by those whose preoccupations are with the ownership, management, editorial character and circulation of newspapers. I am, of course, talking about advertising. The specific facts and figures I have in mind are those Which have been compiled by D. avid Aitchison, a research specialist on the press, and which a few of You may already have read in Marketing, journal of the Institute thereof. One does not have to be a Member of the Institute of Marketing, however, to take an interest in Aitchison's thesis, namely that as a result of economic developments Fleet Street's mass circulation dailies were in 1974 publishing advertisements at a much smaller Profit than previously and even Possibly at a loss. This statement is so much at variance with assumptions nor

mally made in discussions about the press that it needs to be spelt out in some detail. Aitchison emphasises that the rates charged by newspapers for their advertisement space have not kept pace with the rise in the cost of newsprint and that in practice advertising agencies expect to pay less than the official rates anyway.

Taking the Daily Express as an example, it has been charging £5.27 per single column centimetre per million copies sold. Take away 15 per cent agency commission and you are left with £4.48. Take away E2.09 for newsprint plus uncomputed sums attributable to special discounts and to overheads (i.e. cost of advertisement staff and share of printing and other general costs) and you see how one can rationally arrive at a suspicion that the advertiser, far from subsidising the paper as is often thought, may well be subsidised by it.

The position is somewhat different with the quality dailies, because a much higher proportion of their revenue is derived from advertising. According to Aitchison's figures, advertising provided 38 per cent of the total revenue of popular dailies (Express, Mail, Mirror, Sun) in 1973, and 70 per cent of the total revenue of quality dailies (Telegraph, Guardian, Times, Financial Times).

Of course, 1973 was a boom year for advertising and the proportions have changed since then. Taking into account increases in • cover price and relative stagnation of ad rates, Aitchison calculates that in 1975 advertising will account for 60 per cent of the quality dailies' revenue and a mere 26 per cent of the populars' income. The posh papers also charge

much higher rates than the populars – that is if you compute the rates, as all admen do, according to the number of people reached as well as the amount of space taken. Thus, while Aitchison's figures show newsprint devoted to ads as costing 47 per cent of net revenue from them in the case of the Daily Express, the percentage in the case of the Times drops to no more than 12 (on a rate of £19.94 per single column centimetre per million copies sold, though actual circulation is, of course, little more than a third of a million).

Aitchison's conclusion is that newspaper advertising space has been sold far too cheaply and that if advertisers want the medium to survive they will have to pay more and haggle less. He offers some interesting calculations to show that newspapers would be better off raising their ad rates steeply, even if that entailed a drop in the volume of advertising, than keeping the rates down and the volume up.

I am not sure how sound is the premiss on which these calculations are based, namely that a rates rise of 25 per cent is likely to go with a volume drop of 20 per cent, rather than with one of, say, 40 per cent. That surely depends on the state of the advertising market as a whole, which in turn depends on the state of British industry in 1975.

On the latter question it hardly needs to be said that the most enormous uncertainty reigns, an uncertainty which one can expect to be reflected in the minds of Fleet Street managements as they ponder whether or not to take Aitchison's advice. In the next few months the problem of their ad rates and revenue will probably cause them rather more anxiety than will that of what the Royal Commission on the Press may eventually recommend.

The Good Life

Gasteroptimism

Pamela Vandyke Price

Other people's lists make one feel cosily superior, whether they are in cookery or wine books. Nothing is easier for me than doing without larding and barding prongs, nor do I wake guiltily at 4 a.m. because I have not a cod-shaped aspic mould. And there are multitudinous bottles that I not merely do not require to drink but which might well make the vinegar crock erupt into plopping sounds like a New Zealand mud geyser. So other people's resolutions for 1975 are reassuring to compile. I do not have any difficulty keeping them.

Restaurants: If you must think in terms of the sort of helpings that would be appropriate to a heavyweight in training, how about giving people the option of having half portions, as Chinese eating places do? At a recent dinner so much was wedged on to my plate successively that by the time four hunks of elderly ewe, masquerading as crown roast, towered before me, I had that despairing claustrophobic sensation previously associated with the first sight of an algebra examination paper.

Advertisers handling wine accounts: If you want the public to

enjoy whatever beverage you are showing them — at vast expense to the producers — do not display same in the sort of glass in which neither smell nor taste can be enjoyed. Currently, a fine port is being shown in a miniature, trian gular cordial glass, and a chain of nosheries have just sent out a drinks guide that shows sherry in that abominable receptacle known as an 'Elgin' or 'schooner' — fit only for grinding under the heel.

Publishers of cookery books: Before you evolve larger, more

multi-coloured tomes, with pop-up cut-outs of what the be-piped, garnished and graciously served recipes are supposed to resemble, please remember that some people actually use their coffee tables for coffee. Don't strain their sinews as well as their gastric nerves — cooking can be tiring enough without all the heaving about of far too fat volumes.

Wine shops: Be prudent about using the word 'supple' in lists or on price

tickets when you run out of hard hitting sales talk — or when the wine is simply so dreary it has been sweetened to make it swallowable.

'Mellow' is another term of increasingly sinister import, rather like 'interesting' with which the wine lover guest plays for time while deciding between truth ("It's foul") or risking someone else knowing and despising the cowardice ("Oh it's — well — interesting").

People who go to wine tastings:

Please do not clog up the route to the spittoon while you indulge in merry chat about your weekend in Benidorm. Most of my clothes are easily cleaned and I've got past the stage of spitting on to my own feet — but if you make it difficult for me to empty my mouth I can't guarantee you will go unscathed.

The food trade: Eschew the casual use of the word 'fresh.' Everything

was fresh — just as everyone was young — once. 'Fresh,' morning gathered' (on which morning?) 'from the garden,' and 'home-made' are a few of the terms for which purists might demand appellations d'exactitude contrOlees.

PVP: The dear half-dozen readers may remind me about losing weight, not being irritable and checking a tendency to convolute my sentences into alliterative cir cumlocutions. But these really must remain at the bottom of the resolution basket. Meanwhile on my sideboard now stands a plump china owl into whose stomach goes at least part of the price I would have paid for any food and drink I stop myself from buying. The regurgitations of the owl will, from time to time, go to the various organisations who relieve hunger. Food, and wine, which is also a food, are too precious to be wasted, abused, or regarded solely as commodities for trading. (As for

people who use brandy warmers, may their souffl6s sink, sauces separate and rarest bottle of claret break — over the ancestral damask 7 when their deadliest gourmet rivals ring the doorbell).

And an uncurdled New Year to the rest of us.

Pamela Vandyke Price is also wine • correspondent of the Times

hardening

This fertile land...

Denis Wood

Every endeavour must be made . . . to produce the greatest volume. of food of which this fertile island is capable ...

These words of Winston Churchill spoken in the House of Commons on November 15, 1940, are printed in the first 'Dig for Victory' leaflet, 'Vegetable Production in Private Gardens and Allotments.' Then we all knew whom we were fighting against, now the adversary is more diffuse, but the peril is as great and the island still as fertile, and those as yet unconvinced that they are automatically owed a living at undiminished standards will stir their stumps and set about fending for themselves.

A first step would be to begin producing food within our own boundaries by keeping hens once again, making a start with bees and growing vegetables, which are sources of minerals and vitamins and also useful, if minor, providers of carbohydrates and.some protein, but before launching into a vegetarian or vegan diet (a vegan diet is one which excludes not only meat but also milk products and eggs), it would be wise first to read Sinclair and Hollingsworth who point out in Hutchison's Food and the Principles of Nutrition that man has been, for perhaps a million years, a flesh eater. Vegetarians who include milk products and eggs can obtain all necessary supplies of food, but they Would have to follow carefully calculated dietaries. Apart from this vegetables add a quality of freshness and variety which other foods often lack; a daily diet of herrings, cheese, eggs and an orange would, in theory, enable a man to live a healthy life, but if restricted to this his appetite would dwindle from sheer boredom.

The newly converted could begin by deciding upon the amount of space in the garden or an allotment, even if this latter is shared, to be given to growing vegetables. Even a small area can be rewardingly productive; we ourselves when we started made use of only about sixty square yards and were able to grow all the peas and beans we needed, also lettuce and out-ofdoors tomatoes and a fair ration of sweet corn, marrows and courgettes; but this is only one fifth of the recognised size of an allotment garden, 300 square yards, proposed both by the Ministry of Agriculture in 1940 and by the Royal Horticultural Society as adequate for an average family. Convenient dimensions would be 90 ft x 30 ft, the latter being the length of the rows. Beginners should buy from the Royal Horticultural Society, Vincent Square, London SE1, their The Vegetable Garden Displayed which describes the rotation of crops. To this end the plot should be divided into three and cultivated as follows:

broccoli, Brussels sprouts, cabbages and other brassicas.

Second year on well manured soil, peas, beans, onions, leeks, lettuce, spinach, celery, tomatoes. . Third year, potatoes, carrots, beetroots.

As soon as soil conditions are suitable (and much damage can be caused to the structure of the soil by cultivating it when it is waterlogged and sodden) all three plots can be roughly dug in preparation for the production of fine seed beds in March and April; lime being added to the brassica plot and animal manure or garden compost, or failing this, peat which has been mixed with bone meal and hoof and horn meal or Marinure, to the second plot for peas, beans etc.

It would be well to send immediately for seedsmen's catalogues and to study these in peace at home rather than to trust to ad hoc impulse-buying in a jostling garden centre. Catalogues which I have already received are those of Samuel Dobie & Son Limited, Upper Dee Mills, Llangollen, Clwyd; Sutton & Sons of London Road, Reading, Berkshire; Thompson and Morgan of London Road, Ipswich, Suffolk; and W. J. Unwin Limited, Histon, Cambridge. Although not • planted until March or April 'seed' potatoes ought to be put on order at once to ensure delivery in February. For the typical plot, 90 ft x 30 ft, the Ministry of Agriculture recommended three rows of early potatoes planted a foot apart and six rows of main crops, 1 ft 3 ins apart. Of the earlies, Arran Pilot crops heavily, it begins to sprout rapidly and should be put into trays or boxes immediately it is received. The standard main crop is Majestic, generally the most popular potato for baking; another one worth trying is Desire.

Religion

Accepting the challenge

Martin Sullivan

Two thousand four hundred years ago a Jewish poet sand that his people sat down beside the waters of Babylon and wept. They hung their harps on nearby willow trees and brooded in silent shame. This proud and independent race was under the conqueror's heel and the flower of its population had been deported to foreign and hostile shores. The country had been split in two. The Jews, as the Babylonians called them, were now being assimilated. Many of them enjoyed the experience and took the line of least resistance; but some kept the home fires burning. It was they who wept by Babylon's waters, who could not, upon taunting request, sing the Lord's song in a strange land but who vowed that the faith of their fathers would never die while they lived. "If I forget thee, 0 Jerusalem, let my right hand forget its cunning." But what hope was there? Was this faith a pipe dream or a reality? In

their midst was a small and select cadre of prophets and leaders. They counselled their expatriates to steer clear of any compromising attempts at legislation, at any burst of insurrection or any alliance with a coup d'&at. They asked for the impossible — an unshaken faith in the future which they painted in unforgettable terms. "Comfort ye," they said, "comfort ye my people. Every valley shall be exalted, `every mountain and hill laid low; the crooked will be made straight and the rough places plain. Even the youths shall faint and grow weary and the young men shall utterly fall; but they who wait upon the Lord shall renew their strength and ' mount up with the wings of eagles." There is the exciting promise of restoration, freedom and a glorious future.

But the hope was tempered by reality. The end was as yet afar 'off and men would reach it only by tears and sweat and blood. The road to be travelled was the path of redemption and costly suffering. Perhaps the nation would rise to it, and if not the nation a piece of it, a remnant torn from it, might accept the challenge; perhaps in the end it would fall upon the broad and willing shoulders of one man. The prophets could not see clearly what the end would be, but the way to it was unmistakably clear in their minds. So they could write, "He shall bring forth judgement and truth. I gave my back to the smiters. I hid not my face from shame , and spitting. I was not rebellious, neither turned away back. Surely he hath borne our griefs and carried our sorrows. He was wounded for our transgressions, he was bruised for our iniquities, and with his stripes we are healed." All that said at this time we now read in the book of the prophet Isaiah. Through the gloom his disciples peered, and into the future they walked by faith and not by sight.

And now two thousand four hundred years later, their future becomes our past. We look back, believing that in Jesus Christ all this sublime teaching has been summed up and has come to pass. On Calvary's Hill the nation had disappeared and the remnant was lost. One man alone hung between earth and heaven. The Lord's song is enacted not sung and its hearers now live in a hungry world and in a violent wdrld. Every man as a modest beginning, anonymously, can do something to feed the starving. If that is enough, and probably it is not, nevertheless it makes its own continuing demands. A violent world needs a similar contribution. Those who are called upon to sing the Lord's song in this unfavourable atmosphere do so by a steady refusal at all costs to allow hatred, bitterness, calculating cruelty, even cold-blooded murder itself, to possess them or to make them like those who perpetrate these evils. The world cries out for suffering servants, lights to lighten the world at large and people who will indeed show forth God's glory.

Martin Sullivan is Dean of St Paul's