National Information Forum Newsletters Page

CARE QUALITY COMMISSION (CQC)
In our October and December issues I referred, briefly, to some misgivings concerning this health watchdog. The last word was given to Richard Douglas from the Department of Health who said that the department’s role in reviewing the Commission’s work was a normal part of government business. Since then things have moved on apace. First came the closure of a public inquiry into the failings at Stafford hospital. Its remit had been to consider the role of the commissioning, supervising and regulatory bodies and systems in detecting and correcting deficiencies in service provision. One of these bodies, of course, was the CQC. A final report will not be published until early in 2012, but media coverage of the remarks of Tom Kark QC, counsel for the inquiry, has been such as to suggest that its findings will be highly critical and “may stain reputations and possibly even end some careers”.

This was quickly followed by a report from the National Audit Office: impressive, balanced and fair. Amyas Morse, head of the NAO, points out that the CQC had been working against a backdrop of considerable upheaval and had experienced serious difficulties. And that action is now being taken to improve performance. Nevertheless, as the report makes clear, the Commission has not so far achieved value for money in its regulatory function.

The CQC replaced three predecessors and took on greater responsibilities. Its budget was less than the combined budgets of all three of the earlier organisations. The report does not say so, but this was to be expected. Economies would be a normal part of such a rationalisation, and in practice there were under spends in the last two financial years. It seems that the heart of the Commission’s problems was rather inadequate staffing, combined with an initial hurdle of registering [care providers?]. The latter task was given priority over review and inspection work, so that there was a significant shortfall against planned targets for compliance activity. In the extreme case, the number of inspections and compliance reviews fell to a low of 511 in the second quarter of 2010/11 from a peak of 4,288 in the first quarter of 2009/10.

This pattern of work “increased the risk that unsafe or poor quality care went undetected”. Inevitably the NAO report focuses on the serious abuse uncovered at Winterbourne View, the winding up of Southern Cross, the Mid-Staffordshire NHS Foundation Trust public inquiry, the Commission’s own report on dignity and nutrition in NHS hospitals and its investigation into Barking, Havering and Redbridge NHS Trust. In summary, criticism is centred on:

This, of course, is only a brief review of some features of the NAO report. It can be found in full at www.nao.org.uk/publications.

DIVIDED BRITAIN
Not to be missed is the annual report of the National Centre for Social Research (NatCen), which among many other things explores the pervasive effect of private education in elevating the perceived status of a ruling class and creating a divide in both society and government. Top positions in our parliament, civil service and judiciary, it is argued, are increasingly dominated by a “segregated elite” that neither shares nor understands the views of the vast majority of the populace, thus perpetuating a kind of “social apartheid”.

OPPOSITION TO WELFARE REFORMS
The disability newspaper All Together Now! reports that Anne McGuire MP, co-chair of the All-Party Parliamentary Disability Group and new shadow Minister for Disabled People, has claimed that plans to introduce a ‘universal credit’ would halve support for disabled children, and scrap the severe disability premium paid currently paid with income support. She is quoted as saying: “We believe there can be reforms made to the system, but this is the wrong way to do it, and we will do all we can to stop these changes.”

DIVORCE
My piece on divorce attracted some interest and, surprisingly, no dissent. Peter Salter invokes the definition of a bachelor as “a man who never makes the same mistake once”, attributable I think to Wentworth Dillon, 4th Earl of Roscommon. Chris Bazeley sends a Robin Williams quote: “Ah, yes, divorce – from the Latin word meaning to rip out a man’s genitals through his wallet.” And Cathy Mason conjectures that one of the reasons for divorce is the burden of repaying the cost of the wedding.

AFTER CAPELLO
There is some feeling that England’s next football manager should be English. Should we not be more concerned that the post has carried so absurd a salary? Football, for many people, has replaced religion, but it really isn’t that important: it’s only a game. Yet the potential fortunes of the English team gives rise to interminable, tedious and fruitless speculation in the media, while the most devoted Euro 2012 fans are prepared to travel thousands of miles into deepest Ukraine, at huge expense, to follow the team. To my mind the obsession that England may again win trophies should be balanced against the reality that on current form it is most unlikely. The rational probability is rather at what stage England will exit the various competitions. Even in our club football success is largely built on the importation, at great cost, of foreign players.

SPOTY
Continuing the sporting theme there is also some consternation that the nominees for Sports Personality of the Year are exclusively male. But the contest is so appallingly boring that it might be better to hand out awards for outstanding achievement in matters such as use of the whip, number of red cards received in the season, time spent in the sin bin, abuse to referees, alleged racial/sexual taunts to fellow sportsmen, no-balls bowled to order, feigned injury and managerial reluctance to resign.

DEMENTIA ALERT
The Department of Health, supported by the Alzheimer’s Society, has launched a new campaign across England to raise awareness of the early signs and symptoms of dementia. The campaign targets the families and friends of people at risk of dementia, who are likely to be the first to see the warning signs and can encourage the person concerned to see their GP.

At present fewer than 50 per cent of people with dementia are diagnosed at a sufficiently early stage. Yet, says the DH, early diagnosis can significantly improve quality of life and provide patients with better treatment. The campaign officially closed on 18 December, but its relevance is imperishable.

Comment: It is ironic that this campaign has been followed by a report of an audit by the Royal College of Psychiatrists, in collaboration with a number of key professional bodies, which found that hospitals in England and Wales are failing to provide adequate care for dementia patients, and that only one in 20 hospitals insisted on compulsory dementia training for staff. Full report at www.rcpsych.ac.uk.

FUEL POVERTY
The government’s obligation to eliminate fuel poverty by 2016 seems unlikely to be fulfilled. It is reported that fuel poverty (defined as having to spend 10% or more of household income to achieve adequate warmth and light) now affects over 5 million (one in four) households, a statistic much influenced by staggering increases in the prices charged by energy suppliers.

DISABLED PEOPLE ARE GETTING A BAD PRESS
The University of Glasgow’s Strathclyde Centre for Disability Research has reported a significant increase in the number of negative stories about disabled people in national newspapers. It finds that over the last six years the proportion of stories about disability benefit fraud has more than doubled. There has been a shift from a largely patronising portrayal of disabled people to one where the predominant focus has represented them as scroungers. The Daily Mirror increased its use of unpleasant or disparaging language from 4.3 per cent to 8.8 per cent of articles, but the greatest change was found in the Daily Mail, the Daily Express and the Sun. Professor Nick Watson, of the Strathclyde Centre, said: “Much of the coverage in the tabloid press is at best questionable and some of it is deeply offensive.”
Gleaned from ‘All Together Now!’

GOVERNMENT RETHINK ON WITHDRAWAL OF MOBILITY BENEFIT FOR CARE HOME RESIDENTS
Some good news at last. On 1 December the government announced that after extensive consultation it had decided not to scrap the mobility component of Disability Living Allowance paid to around 78,000 disabled people living in care homes. This latest U-turn follows vigorous campaigning by disability charities. Prominent among those seeking to protect the allowance was Lord (Colin) Low of Dalston, who conducted an independent review of the proposal.

LEGAL AID
Kenneth Clarke has announced a six-month postponement (from October 2012 to April 2013) in the implementation of divisive and savage cuts in legal aid and the abolition of the Legal Services Commission. A Ministry of Justice spokesman is quoted as saying: “The government is committed to providing a legal aid scheme which targets resources at people who need legal support the most, and on the most serious cases.” By such criteria access to free health care would be available only to the most seriously ill. A sign of things to come?

DISABILITY RIGHTS UK
Following the merger of the National Centre for Independent Living, RADAR and the Disability Alliance, the three organisations will share a common address: 12 City Forum, 250 City Road, London EC1V 8AF.

SELF-INFLICTED ILLNESS
My mind goes back to my National Service when I was put on a charge for what were called ‘self-inflicted wounds’ (in my case, sunburn). The fact is that a high percentage of the NHS budget is spent on preventable conditions brought on by excessive or inappropriate consumption. The latest example (widely reported) is that of young people with serious liver disease, caused by irresponsible drinking. Alcoholic liver disease, once rare in young people, has increased to disturbing levels. The evidence is such that, if the government is serious about cutting costs, urgent and decisive action is needed to curb alcohol misuse: a menace both to society and to those who imbibe.

A CHRISTIAN COUNTRY?
The prime minister has said that “Britain is a Christian country and we should not be afraid to say so”. And that a return to Christian values could counter the country’s moral collapse. He blamed a passive tolerance of immoral behaviour for the summer riots, the financial crash, the expenses scandal and Islamic extremism. These views were tempered, however, by accepting and respecting that many people do not have a religion, and that he is “incredibly proud” that Britain is home to many different faith communities who do so much to make our country stronger”. He explained that what he was saying was that “the bible” has helped to give Britain a set of values and morals which make our country what it is today.

Given that he was speaking to Church of England clergy gathered to mark the 400th anniversary of the King James’s Bible, a certain amount of hyperbole is perhaps understandable, But few people of intellect can now argue that the bible, literally and in its entirety, is a sound guide to moral behaviour or that Britain is a Christian country in the sense of having an overwhelming majority of genuine adherents.

The difficulty for confirmed atheists, such as myself, however, is a recognition that even if God is a myth and a delusion, the values of much of the New Testament, embedded in our law, culture and language, can be a powerful force for good.

ON THE BUSES
We have previously criticised the information bypass on our buses, based on our own experience in London. An ‘Insight’ article in the RNIB’s magazine NB (December 2011) is therefore welcome. It refers back to a research study commissioned by RNIB in 2006, but now supplemented by a new survey. Naturally, this focuses on the difficulties experienced by blind and partially sighted travellers, but its conclusion that bus operators need to make changes is of even wider relevance. Hugh Huddy’s article refers to EU proposals in 2010 for new regulations for bus and coach operators, to include an obligation on all member states to implement mandatory disability awareness training for all bus and coach drivers. RNIB joined forces with Sense, Guide Dogs and a range of other charities to lobby the Department of Transport and the EU to seek the introduction of this new regulation. Although it was accepted in March 2011 that the new law should come into force in the UK in 2013, an option to postpone disability awareness training for up to five years was conceded. However, there is now (until the beginning of March) an opportunity (“a golden opportunity”) to submit views to the Department of Transport on the urgent need for mandatory disability awareness training. Guidance on how to do so can be found at www.rnib.org.uk/campaign (or phone 020 7391 2123).

A CODE OF PRACTICE FOR COMMUNITY DISABILITY EQUIPMENT
We are talking here of what has previously been called assistive technology, and specifically about the supply of potentially unsafe or inappropriate equipment. It is an issue being addressed by Brian Donnelly MSc who has founded and directs the company Community Equipment Solutions Ltd. Donnelly argues that “under-regulation” in this sector results in thousands of injuries and even fatalities. He advocates national minimum standards, a concept already adopted by the Welsh Assembly and welcomed by a number of key organisations across the UK.

The response of the Department of Health has been disappointing. According to the Community Equipment website, DH, while in part acknowledging some of the issues raised, has said that it does not advocate a national approach to minimum standards and that all the issues raised are the responsibility of local areas.

Donnelly has nevertheless set up and currently chairs a UK-wide group of organisations and professional bodies with an interest in improving the provision and safety of community equipment. A Code of Practice for England was launched at the King’s Fund in November.

RESPECTING THE UN CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES
This September, the European Network on Independent Living (ENIL) launched a proposal for a European Parliament resolution on the effect of cuts on community-based services for people with disabilities in the European Union. The resolution, already supported by the European disability and anti-poverty movement, asks member states to respect their obligations under the UN Convention on the Rights of Person with Disabilities. If adopted, it would send a clear message that human rights must not be compromised by the need to make savings.

Comment: The concept of independence worries me. I know full well that pro-active disabled people find the idea of dependence repugnant and are determined to move away from a patronising model in which only the non-disabled determine social policy on behalf of disabled people. But there is a sense in which everyone is dependent on others, and I would hate a divisive doctrine that only disabled people may have a say in decisions affecting their lives. Better that people of like mind should work together as allies.

CHILD POVERTY
In a Guardian interview (14 December), Alison Garnham, CEO of the Child Poverty Action Group, is quoted as saying that the coalition government is in danger of emulating Margaret Thatcher’s record on poverty. “It has been said her governments did two things for poverty: they increased it, then they pretended it did not exist. The coalition must avoid a similar, devastating legacy…what we’ve seen is the poorest families taking the biggest hit. The poorest 10 per cent has been hit ten times harder than the richest. It is not defensible.”

But the government, or at least the prime minister and the work and pensions secretary, take a different view. Having to admit that George Osborne’s autumn statement will mean another 100 thousand being added to the total of those deemed to be in child poverty, they call into question the way that it currently measured: related to household incomes of 60 per cent or less of the national median. This measure, enshrined in the Child Poverty Act and introduced by the Labour government, has been described by Ian Duncan Smith as an “approximate and by no means perfect measure of family wellbeing.” Simply comparing relative incomes”, it is argued, “leads to perverse incentives and does little to promote better life chances.” Thus it appears that the legal measure of child poverty will no longer be a central goal.

WE HATE NO.49: THE HIV/AIDS MENACE
“Si no puedes ser castro, ser cautos” (If you cannot be chaste, be cautious)
Spanish proverb

Twenty three years ago Ann and I devoted a chapter of our Sex Directory to this sexually transmitted infection - then a novel subject. We explained that AIDS starts with infection by one of a number of closely related human immunodeficiency viruses (HIV). The virus attaches itself to, and damages, certain lymphocyte cells, whose normal function is to promote an immune response against infection, causing their depletion in the blood and thus reducing the person’s ability to resist infection. The number of people in the UK then carrying the virus was estimated as between 30 and 50 thousand. Fewer than 1,000 of these cases had then progressed to full blown AIDS, but a steep increase was predicted. 371 of these patients had already died.

The danger of an explosive rise in the incidence of HIV infection was clearly recognised. The call was for ‘safe sex’ and STI clinics and organisations such as Terrence Higgins Trust provided a range of services, and the risks attracted huge publicity.

This information from 1988 provides something of a baseline to evaluate the present state of affairs. And notably we now have a current report from the Health Protection Agency. The first thing to say is that treatment has greatly improved. On the HPA website Dr Valerie Delpach, consultant epidemiologist and head of HIV surveillance at the HPA, is quoted as saying that those infected with HIV, if diagnosed promptly, can look forward to experiencing similar life expectancy to an individual without the infection. She explains that thanks to the development of anti-retroviral treatments and universal access to world class health care through the NHS, HIV is now a manageable illness for the vast majority of people affected in this country. What gives rise to concern, however, is that a significant number of people are unaware of their HIV status and are diagnosed late, sometimes too late.

The number of people living with HIV in the UK reached an estimated 91,500 in 2010, with approximately a quarter of them unaware of their infection. One in five people who visited an STI clinic did not accept an HIV test, prompting the HPA to advocate that no one should leave such clinics without knowing their HIV status. Indeed, in areas with a high prevalence of HIV, the HPA suggests that there should be universal testing of all new GP registrants and of in-patients admitted to hospital. As things stand, over half of people diagnosed in 2010 had come forward for testing only after the point at which treatment of their infection should ideally have begun. Two thirds of those who died in 2010 had been diagnosed late.

The HPA’s annual report on HIV recorded 6,660 people newly diagnosed in the year, and said that infections probably acquired in the UK almost doubled between 2001 and 2010; from 1,950 to 3,640 (the latter total exceeding the number of those whose infection was probably acquired abroad: 3,020). And this rise was mainly due to infections acquired among men who have sex with men. One in every 20 gay men is now infected with HIV nationally (one in 11 in London). The HPA predicts that by the end of 2011 more than 100,000 people in Britain will be living with the virus. Yet the subject is one that has somewhat faded into the background.

In part the increase in people carrying the HIV virus is due to the effectiveness of drug treatments in keeping people with HIV alive and well, but this comes with a huge cost tag. Far better to avoid infection, essentially by always using condoms or, if that is unacceptable, renouncing sex altogether. We could learn a lot from the pandas.

Saving Lives UK, a public health awareness campaign, which began as a local initiative in a Birmingham Foundation Trust, is working to educate people about HIV, and to encourage testing., Not only are those unaware that they are carrying the infection missing out on the effective treatment now available and are at greater risk of developing AIDS, but they may be passing the infection on to others.

PUBLIC LIBRARIES AND SOCIAL JUSTICE
Right now we face a great deal of social injustice. Yet our public libraries, one of the avenues for redressing inequality and disadvantage, are seen by some local authorities as a luxury and expendable. A new book by John Pateman and John Vincent, though regrettably expensive, is timely and welcome. Public Libraries and Social Justice points out that social exclusion is relatively neglected, with much of the library profession still in denial. Yet the need to address this agenda is becoming more urgent as the gap between rich and poor widens, and the future development and growth of pubic libraries and their relevance to the majority of their local communities depends on a recognition of the need to abandon outdated concepts of excellence, based on middle class values, and fully grasp the equity agenda.

The book examines the historical background to social exclusion and its strategic context in terms of government and professional policy. It looks at what social exclusion means in practice and suggests an appropriate service response. It proposes a ‘manifesto’ for change and considers ways in which local libraries can be transformed into needs-based services,

John Pateman, Information for Social Change UK, is Head of Libraries, Learning and Inclusion at Lincoln. John Vincent, a good friend, runs ‘The Network’, dedicated to tackling social exclusion in libraries, museums, archives and galleries.

In hardback the book costs £40 (online £36) and it is also available as an ebook. Sample pages are available at www.ashgate.com. Search for the title and scroll to extracts. To order, visit the website or contact Bookpoint Ltd, Ashgate Publishing Direct Sales, 130 Milton Park, Abingdon, Oxon OX14 4SB; tel: 01235 827730; e.mail: ashgate@bookpoint.co.uk.

CHRISTMAS ROUND ROBIN LETTERS
I have recently acquired a copy of Simon Hoggart’s The Hamster that Loved Puccini, a cautionary tale of the folly of his bête noir of the Christmas post. I take it personally and have decided that in future it might be better for me to offer total honesty in Christmas greetings: like Samuel Johnson’s comment “Little done … my mind has neither been improved nor enlarged. I have read little, almost nothing, and I am not conscious that I have gained any good, or quitted any evil habit.”

SPEAKING FOR OURSELVES
This is a two-year oral history project, funded by the Heritage Lottery Fund, to communicate the living heritage of people with cerebral palsy and aged over 50 to a wider audience. 16 volunteers, themselves disabled, have been trained to record life-story interviews. The recordings will form part of a collection held by the British Library Sound Archive.

For further information contact Project Co-ordinator, Speaking for Ourselves, Scope, 6 Market Road, London N7 9PW; tel: 020 7619 7228; website www.speakingforourselves.org.uk.

SURVIVING CANCER
Macmillan Cancer Support reports that median survival rates, averaged across all cancers, have risen from one year to nearly six years since the 1970s. But while remarkable extensions have been achieved in respect of some cancers, very little change has been recorded in others. In some, survival times are still counted in weeks rather than years.

Macmillan cautions that where improvements have been made, the time gained can pose a huge challenge in planning better care services.

For more details go to www.macmillan.org.uk. Go to ‘about us’; then ‘media centre’; then ‘The cancer survival lottery. The release is dated 22 November and has a link to the research briefing paper. There is also a brief report at www.bbc.co.uk/news/health.

PATIENTS ASSOCIATION SLAMS CARE IN ENGLAND’S HOSPITALS
Following critical reports in 2009 and 2010, The Patients Association has again drawn attention to some shocking accounts of poor hospital care across the country. The report, We’ve been listening, have you been learning?, focuses on 16 accounts of patient experience, but these are said to be drawn from many others sourced from the Association’s helpline. Concern centres on four fundamental aspects of care: communication, access to pain relief, assistance with toileting and help with eating and drinking. The chosen cases show that patients are continuing to be failed in these key areas.

Speaking on Radio 5Live, the Association’s Vice President, Angela Rippon, stressed the need for action rather than yet more enquiries and reports: the evidence is already clear.

The report, which can be downloaded from www.patients-association.com, is particularly concerned with the care of elderly patients. The Association’s helpline is 0845 608 4455.

Comment: We referred to a range of criticism of hospital care for older people in Briefing 31 (March 2011). This report adds to that concern and is based on personal calls for help. But the evidence of only 16 cases, presumably chosen as particularly disturbing, is too small a number to extrapolate conclusions about the NHS as a whole, without knowing more about the database from which they were drawn. In England alone over 3 million patients are treated in the NHS every week. In this context even the 9,000 complaints received last year by the Health Service Ombudsman represent less than 0.006 per cent of those treated.

THE CARE QUALITY COMMISSION
We referred to misgivings about the CQC as recently as October (issue no.38). It is in the news again. Devastating coverage appeared on the front page of The Guardian of 15 November, and in its letter page of the next day. It was reported that the health regulator was being “urgently investigated” by the Department of Health. I was particularly interested to learn that the CQC is headed by Cynthia Bower, formerly CEO of the NHS West Midlands’ strategic health authority, where she was responsible for supervising the performance of the troubled Stafford Hospital.

A further article on page 12 concluded: “Rarely has a regulator inspired such a broad consensus that its performance, in scrutinising standards in the NHS and social care, is inadequate.”

In response, however, Richard Douglas, Director General of Policy, Strategy and Finance at the Department of Health, said that the article misunderstood a normal part of government business. It was only right that the DH, which funds and sponsors the CQC, should “periodically take a view about the organisation’s capability.” The review had the full co-operation and participation of the CQC. Just administrative routine then.

INCAPACITY BENEFIT REFORM: THE HUMAN COST
As widely reported, The Centre for Regional Economic and Social Research at Sheffield Hallam University has published a report, Incapacity Benefit Reform; the local, regional and national impact. Written by Steve Forthergill and Christina Beatty, the report makes the following key points:

Comment: I am, of course, on-side with the authors of this report, but I think it has to be conceded that whereas the welfare state was intended as a safety net, some claimants are treating it as a hammock.

IS WELFARE BENEFITS REFORM UNRAVELLING?
Channel 4 News Social Affairs Editor, Jackie Long, reports that the Coalition’s Employment Support Allowance (ESA) programme is being undermined by the weight of appeals, some repeated, against ‘fit for work’ findings. The number of appeals has almost quadrupled in two years, from 68,000 in 2009 to a projected 240,000 by the end of the current financial year. The cost so far is said to be £80 million and rising.

Nor is the programme succeeding in getting significant numbers of claimants back to work. Channel 4 has been told by a number of the organisations contracted to carry through the Coalition’s ‘Work Programme’ that they have serious concerns about the numbers of people moving from ESA to work: in one example only 3-5 per cent rather than the anticipated 25 per cent.

Comment: DWP statistics indicate that around 21 per cent of those found ‘fit for work’ go to appeal. This takes no account of those who are not well enough to undertake an appeal or who lack the capacity or support to do so. Of those who do, the success rate is said to be 40 per cent (unrepresented) and 70% (with representation). I am unable to verify these statistics.

DIGITAL INCLUSION
Martha Lane Fox, the UK’s ‘Digital Champion’, is certainly single-minded and energetic in seeking to get more of us online, particularly those who are disabled. Race Online 2012, which she leads, has the strapline “We’re all better off when everyone’s on line”. Using ONS statistics it says that 1.6 million people have been added to the online community since 2009, but that there are 8.4 million to go. At that rate there is no chance of achieving its objective in time for the 2012 Olympic Games.

But Ms Lane Fox is not deterred. On BBC’s You and Yours on 17 November she regretted that 4.25 million disabled adults have never used the internet. She pointed to “an enormous benefit” for disabled people to be online, estimating that they could each save a net £200 a year by being connected. She said that she would “like to see more championing of the opportunity to transform disabled people’s lives, and perhaps some bolder and bigger thinking around how we can solve some of these problems.”

She was joined by Nigel Lewis, CEO of the charity AbilityNet. He offered an explanation of why disabled people make up such a large proportion (36.3%) of those still not online: “Often it’s because it is not accessible to them. Either they can’t engage with and use the standard computer out of the box, and so it needs adapting in some way, or the online services, the websites, are not accessible with their adaptive technology.”

Comment: Obviously there are other reasons. The ONS statistics make clear that as the lower personal incomes fall, the greater the number of non-users. While there may be potential for long-term savings, the initial and continuing cost of the technology can be daunting. Disabled people are generally among the poorest members of our society, commonly on the breadline of poverty.

And neither they nor thousands of non-disabled people may want to join the technological revolution. What can be exciting for some, may be irritating for others. Alongside its undoubted benefits there are dangers and hassle associated with the internet; and not everyone is keen on e.mails, blogs and social interaction. It’s fine to encourage and support, but I suspect that there will always be a sizeable proportion that prefers not to join in.

THE SEVENTH AGE
In October, when I wrote my piece on the ‘Seventh Age’, I finished by saying that I would like to see a legal voluntary opt-out if and when people feel they have had enough, before what has been called “the indignity of decrepitude”. I was then unaware that Yasmin Alibai-Brown had already expressed a similar view in The Independent. Noticing that in a recent poll 66% had said that assisted suicide should be legal, she is quoted as saying: “It’s the law that’s lagging behind, taking no account of the vast societal, environmental and scientific transformations of the past 50 years”. She argued that medical advances meant that sick and old people could now be kept “ticking over” in a state of living death. They could be seen “in nursing homes – inert, staring into the void (what are they looking at with those cloudy, dreamy eyes?), cared for by kind or unkind strangers waiting for the bus of death to come and take them away”.

Barbara Ellen in The Observer objected, troubled by the “unseemly rush to pronounce the lives of others ‘not worth living’ ”. What arrogance, she argued, to assume they know the minds of those who can’t speak for themselves.
(Noticed, belatedly and with gratitude, in The Week, 23 April 2011)

Comment: The point here, surely, is the word ‘voluntary’; a decision taken by the person concerned before their decline into impotence. Nobody, I hope, is suggesting killing off those who have already missed the chance for an earlier exit. I rather regret that the Voluntary Euthanasia Society decided to change its name to Dignity in Dying.

MENTAL HEALTH EMERGENCY TREATMENT INACCESSIBLE AND INEFFECTIVE
Commenting on a new report, Listening to experience, Paul Farmer, CEO of the mental health charity Mind, said: “Mental health crises need urgent treatment, yet our investigation found that far from receiving the instant, 24-7 response we expect for physical health emergencies, people experiencing mental health emergencies can be faced with long waits, poor quality care and in some cases are unable to access help at all.”

Go to www.mind.org.uk, and click on ‘news’ for an excellent summary, with a link to download the full report.

WE HATE NO. 48: DIVORCE
“A divorce is like an amputation; you survive, but there’s less of you.”
Margaret Atwood, Time, 19 March 1973
“Marriage is the chief cause of divorce.”
Groucho Marx

A number of potential subjects for this feature have assailed my mind over the past month. Not least the shock revelation that the royal prerogative extends to Prince Charles, justified by a slender constitutional argument that if and when there is no heir apparent, the Duchy of Cornwall reverts to the throne. This anomaly requires the Prince to be consulted on any legislation that might affect the interests of the Duchy. And because of the controversial royal exemptions under the Freedom of Information Act (News Briefing no.16, December 2009) relevant correspondence with ministers is secret. I have concluded, however, that antagonism on this issue probably has had a sufficient airing elsewhere and that there must surely be a momentum for democratic change, if only in transparency.

Then my thoughts turned to the mounting disaffection between government policy and the populace at large, with protesters taking to the streets because, as the New Testament has it (four times), “unto everyone that hath shall be given, and shall have abundance; but from him that hath not shall be taken away even that which he hath.” Such reflections have been exacerbated by the news that the remuneration of directors of the top 100 FTSE companies has increased by nearly 50% in the past financial year. But we already saw this coming and inveighed against the trend in News Briefing no.8 (February 2009). I’m glad that the High Pay Commission is now on the case.

Another startling proposition was General Lord Dannatt’s view that the military can teach society about the importance of ethics and morality, and that young British soldiers must be able to kill and show compassion at the same time (The Guardian, 8 November). I remembered, however, that we had our say on this dubious morality in News Briefing no.19 (March 2010).

Finally, I was tempted to comment on the dismal performance of the ruling Coalition: most recently the continuing failure to reduce the deficit, and the unedifying confusion over the relaxation of border controls. Aren’t you just sick of the mantra that the previous government is responsible for all our ills?

Eventually, however, I decided to hate divorce, a subject of which I have some personal experience.

Let’s start with some facts. In 2008, the Office of National Statistics predicted that, if prevailing rates continue, 45% of marriages will end in divorce before their 50th anniversary, with almost half occurring before their 10th anniversary. The divorce figures for the six years to 2009 in fact showed a decline (from 153,065 in 2003 to 113,949 in 2009), but this may have been due to a drop in the number of marriages.

And by this time the incidence of divorce was already in full spate and overflowing. In 1858 only 24 divorces were recorded, but thereafter the annual figure gradually increased. In the 1950s the average annual count was 27,572; in the 1960s 36,217; in the 1970s (when I gained my own experience) 112,985; in the 1980s 150,144; in the 1990s 154,477; and in the 2000s 137,593.

The reasons given for divorce are various. The ONS statistics for 2009 break down as follows:
            Adultery                                              16.3%
            Unreasonable behaviour                      47.8%
            Desertion                                             0.4%
            Consenting after 2 years separation    25.3%
            Separated after 5 years separation      10.0%
            Others                                                    0.2%

These figures (which omit the thousands of couples who just ‘soldier on’) are surely shocking, yet have generally come to be seen – much like road deaths – as simply a fact of modern life. But the economic and emotional impact on couples can be devastating, along with divided loyalties and unhappiness for their children. Family breakdown is seen as one of the major causes of social disorder. Various mediation services are now available, but these are generally a last resort, when marriages are already on the rocks and conflict embedded, and seem to be aimed not so much to avoid divorce as to negotiate on questions of money and custody.

The road to divorce usually begins with an original mismatch of partners; and the need for advisory services pre-dates the marriage ceremony. Traditionally, the church – to some extent – fulfilled this role. But the form for the administration of the solemnization of matrimony in the Church of England’s Book of Common Prayer has a somewhat narrow view when it says that “it [marriage] is not to be enterprized, nor taken in hand, unadvisedly, lightly, or wantonly, to satisfy men’s carnal lusts and appetites, like brute beasts that have no understanding; but reverently, discreetly, advisedly, soberly … duly considering the causes for which Matrimony was ordained”. These are said to be the procreation of children; a remedy against sin and (for those who lack “the gift of continency”) to avoid fornication; and the mutual society, help and comfort that one partner should have for the other, both in prosperity and adversity. I like the latter sentiments best, but if society, help and comfort are to be found wanting, it is by the time of the marriage ceremony already too late; the die is cast.

Let’s face it. The expectation that most marriages will survive a lifetime is precarious. It could be argued that the church is unrealistic in having couples – particularly young couples - give vows of undying fidelity. It might be said, at least from a male perspective, that couplings begin with sexual attraction; yet that is something which inevitably recedes with time, not to mention that younger and more alluring potential partners may appear along the way.

May I offer up my own blueprint of the essentials for a successful marriage, some more important than others? First, I put sexual compatibility. I really mean, in practice, male competence as a lover. Nowadays it is likely, at least in open societies, that this will have been tested (and perhaps found wanting) before marriage is contemplated. Second, a meeting of minds; ideally leading to co-operation: something like the liaison of Benjamin Britten and Peter Pears. Third, an understanding as to whether or not both partners want children. Fourth, some measure of agreement on day-to-day matters such as thrift, work and shared homemaking. Fifth, basic unanimity on religion and politics. Lastly (though I could go on), harmony in matters of taste and pleasure.

Marriage is too important and divorce too traumatic not to have guidance before tying the knot. The breakdown of a marriage is like the damaging of a pot. There may be no more than a hairline crack or it may shatter into a hundred pieces. We may try to restore it, but it can never again be perfect. What should be clear, however, is that at the outset some pots are more fragile than others. I give the last word to William Congreve. In his Old Batchelour (1693) he wrote: “Thus grief still treads upon the heels of pleasure: Married in haste, we may repent at leisure.”

Earlier electronic versions of the National Information Forum's Newsletters can be downloaded as .PDF files from the Electronic Publications Page

Unless you advise to the contrary we will continue occasionally to send you information of this kind. Conversely, we want to give you the opportunity to network with other member organisations through our information sheets. Please let us know if there is a more personal e.mail address by which we can reach you. Membership is now free.

Ann Darnbrough and Derek Kinrade

Not The National Information Forum
33 Highshore Road, London SE15 5AF, Tel: 020 7708 5943

UPDATED January 2012

HOME

ABOUT NIF