First there was the Winter Fuel Allowance, which turned up unannounced in my bank account – and very welcome it was, too. Then I received a letter from HMRC with a forecast of how much retirement pension I can look forward to less than two years hence. And the other day Weasel the Whippet and myself went shopping in Brighton on the bus – for free, using my Senior Citizen’s Bus Pass.

But then I also remembered the final line of Jules’s (Hugh Paddick’s) Polari rendition of the Seven Ages of Man (from King Lear): “Nanty hampsteads, nanty minces, nanty riah, nanty everything.” And I realised I’ve still got a long way to go before I catch up with Lear.

For those young enough to be unfamiliar with either King Lear or Julian and Sandy (Hugh Paddick and Kenneth Williams, in the BBC radio show “Round The Horne” from the mid-sixties, when homosexuality was still illegal and punishable by imprisonment), here’s a translation of Jules’s plaint: “No teeth, no eyes, no hair, no everything!”
 

Polari is a “secret” language that is said to have originated amongst fairground travellers and Romany gypsies, part dialect, part lingua franca, and aimed to allow conversations to take place in the hearing but without the comprehension of the uninitiated. It drew its words from eastern European and Yiddish sources, with the addition of some English backslang and rhyming slang. (So, for example: “riah” = hair; “hampsteads” = Hampstead Heaths, teeth.) In the first half of the twentieth century it was adopted by homosexuals and significantly “camped up”. I’m absolutely certain that the secret aspect of Polari was eventually abandoned, and with it the protection from being “outed”, for, even if outsiders couldn’t understand what was being said, it was pretty clear who was doing the saying.

This is an abstract from an article with the same title, written by C Huff and published in the journal Hospital Health Network. I was moved to add these comments.

I haven’t read the full text of this article, but the topic is one that has been exercising doctors for some time here in the UK.

It has several strands, but most of them come back to money. Hospitals and medical facilities are coping with more patients than ever, but doing so with less money; and what money there is is being invested as much in layers of management as in better healthcare provision. One result is that patient “face time” is being cut to the minimum, and practitioners (some of whom, although they are no doubt admirable doctors, for a variety of reasons lack communication skills) often are unable to tell their clients what they need to know.

It is the same in the primary care setting. My own GP said to me last year that his best treatment tool was time – time to deal adequately with his patients’ needs, and to make certain that they both understood one another – but it was a tool that was missing from his toolkit.

In fact, he has introduced a simple method of reassuring himself that at least some of what he tells his patients has sunk in. I wrote about it in my blog, Oliver’s Twists, a couple of months ago (http://martynoliver.wordpress.com/2011/09/21/what-did-i-say/).

… And the next day:

I’ve just re-read my original comment, and I realise now that I appear to have responded to only part of the whole issue (the issue around which this LinkedIn group has presumably coalesced). There are of course other factors in play than the direct lack of understanding between healthcare professionals and their clients, and I should have recognised this in my first remarks.

For example, it is not only patients who suffer from poor health literacy; I work with the written output of clinicians and medical academics/researchers on a regular and frequent basis, and it is often very difficult to unravel what is really meant from what is actually said.

A further example might be the normally quite articulate and educated patient who is anxious to the point of stress at the realisation of illness and the consequences of treatment, and who fails to grasp what the practitioner tells them. (This is where the patient education programmes run by Emmi Solutions in the USA can be so valuable.)

And of course there has to be the will on the part of the healthcare practitioner to communicate as part of caring, no matter how “literate” the patient may be. Today is the day the Francis Inquiry into the failure of patient care at the UK’s Mid-Staffordshire Hospital officially concludes, and the National Health Service claims that there has already been a huge change in the way that patient care has been prioritised in UK hospitals. Bruce Keogh, the NHS’s Medical Director, declares that today’s NHS is “a much safer place than it was three years ago”. “What is different now,” he says, “is that the focus is not just on finance. We’ve put Quality right at the centre of our NHS, and all Trust boards are expected to focus on each and every service they provide in terms of effectiveness, safety and patient experience.” ["Today", BBC Radio 4, 1 December 2011.] One has to ask where Quality was three years ago, if not at the centre, and why; and in light of Keogh’s claim, one has also to ask why there are still frequent reports of breakdown in care at ward level, where it counts the most. Often such breakdowns are failures of communication between staff and patient in the most basic of services, and the only conclusion can be that in such instances there is either not enough time, or not enough will, for staff to fulfill their prime duty of care.

The abstract was posted on the Health Literacy bulletin board at LinkedIn.

Go to any high point in Sussex on a bright sunny day, look north, and you’ll see the flash of reflected sunlight from Solar PV rooftop arrays on farmhouses and in towns and villages across the countryside. Since the government established its earn-as-you-generate scheme in April last year, Solar PV installations have increased month on month, as we discover our green credentials.

So what is Solar PV, and how is it different from traditional solar heating panels?

“Solar panels” have been around for several years now, boosting our hot water and central heating systems. Mounted on a south-facing roof to catch the heat of the sun, they typically provide sufficient hot water for showers or a bath during the summer, and raise the temperature in our storage cylinders by several degrees in the winter. “Solar PV” panels (“PV” is short for photovoltaic), on the other hand, are similar to the panels that power pocket calculators or pathway lights in the garden, only on a much bigger scale. Sunlight (rather than heat) is converted to electricity and fed to a box in the meter cupboard. From there it is used either by lights or by household appliances, or it is fed into the National Grid. Both solar panels and Solar PV use the sun’s energy, free of charge, and so both help us contribute towards the drive to reduce our reliance upon fossil fuels.

Solar PV, however, earns its keep. Every unit of electricity generated by the panels qualifies for a pay-back from the government: for panels installed on existing private houses, this stands at 43.5 pence for every unit; and every unit not used by you and fed into the grid earns an extra 3 pence; you’re buying less electricity from your power supplier too, so your bills are less. What’s more, these figures are index-linked and guaranteed for 25 years.

I spoke to John and Christine Wilson, who live in a small village just outside of Lewes. Their array of 12 Solar PV panels was fitted last summer.

“We’ve always done our bit,” said Christine, “recycling and composting, but we couldn’t really see a way to be ‘greener’. Then the people from Ovesco [a local energy-saving campaign group] gave a talk in the village, and we realised that Solar PV was something we could do. Since our panels were fitted, there’s only been one day – when the roof was covered in snow – that we had a zero reading on the meter.” “There was brilliant sunshine that day, too,” said John. “But over the year we’ve earned about £850, and our electricity bills have fallen by about 10 per cent.”

“It’s definitely been a good move for us,” said Christine.

Ovesco can be contacted at http://www.ovesco.co.uk

The exhibition was called Small Scents, and the images were from a set of perfume miniatures that had been part of the collection of my late mother, Peggy.

She was fascinated by the tiny bottles and flasks, and had dozens of them scattered amongst the gloves, handkerchiefs and scarves in her dressing-table drawers. But this was no sterile glass-cabinet collection; she used the perfumes every day, and – as you can see in the pictures here – many of the bottles are almost empty.

 
Parfum d’Hermès, 1984
•
After an original design by Jacques Llorente, the flask is in the shape of a harness ring, recalling Hermès’ origins in luxury leather goods.
Parfum d’Hermès was created by the perfume house of Roure. It is an oriental floral perfume, with top notes including rose on a base of incense and woods.

 
Cristobal, Balenciaga, 1999
•
From an original design by Thierry De Baschmakoff, the bottle is based on drapes of rich brocade.
Cristobal was created by Olivier Gillotin. An oriental, its top notes include fig and bergamot, with base notes of patchouli and vanilla.

 
Shalimar, Guerlain, 1921
•
After the original design produced by Baccarat for Raymond Guerlain.
Created by Jacques Guerlain in 1921, Shalimar is a classic soft amber oriental, with top notes of bergamot, lemon, mandarin and rosewood, based on vanilla and rosewood.

 
Rumba, Balenciaga, 1988
•
Ribbed bottle after a design by Jacques Konckier, in the shape of a Roman vase.
Created by Ron Winnegrad and Jean-Claude Elléna, Rumba is a fruity-floral chypre with top notes of peach, Mirabelle plum, bergamot and basil on a base of woods and Tonka bean.

 
Sun, Moon, Stars, Lagerfeld, 1994
•
From an original design by Karl Lagerfeld, the midnight-blue flask was made by Verreries Pochet et du Courval.
Sun, Moon, Stars was created by parfumier Sophia Grojsman. An oriental fragrance with florals including freesia and rose on heliotrope and jasmine, with sandalwood and amber beneath.

To pee, or not to pee:
That, my dear Ophelia, is the question

It was the Wednesday after Christmas. You know, those dog days between Christmas and New Year. No-one’s about. Apart from Oxford Street and Bond Street, the pavements are almost empty, even here in London. Most people are away from work over the holiday, bloated by a surfeit of good cheer. The only people with the energy to venture forth are the shoppers clutching gift vouchers in their hands and heading for the Sales, or carrying crumpled carrier-bags of unsuitable underwear and unwearable woollens, Christmas gifts bound for the Returns counter.

No-one’s about, that is, except me. And my friend Ophelia. Both of us are freelance writers, and both of us actually enjoy this time when the journey to work takes only half as long and the phone forgets how to ring. For us, it’s productive time.

Four o’clock. “Did you have lunch?” Phee’s email asks. “I didn’t. Because if you’re hungry enough I fancy a bowl of pasta and a bottle of frascati after work. What do you think?” I email back “Yes. Where?”

The phone rings, for the first time this afternoon. It’s Phee, of course, and we decide on one of those chrome and black-leather bars in Soho’s Old Compton Street, five minutes from the office and ten minutes away from my flat. The place has just been refitted and I’ve not been there since the refit. But I’ve heard all about it. There’s a little cordoned-off enclave of tables where, early in the evening, they serve fresh pasta with simple sauces. Usually a place like this will be heaving by 6.30. But when we arrive it’s not even busy. Like I said, there’s no-one about.

Phee orders ravioli, stuffed with spinach and ricotta. I go for plain spaghetti tossed in butter with a sprinkle of black pepper. Phee asks for mineral water and I ask for tap; London’s drinking water isn’t as bad as people make it out to be, considering how many pairs of kidneys it’s been through. And yes – an icy bottle of frascati to share.

We push our empty bowls away and carry the remains of our wine over to the bar, perch on high stools, and steal covert glances at the Italian barista. He notices, of course; and ignores, of course. Instead his chest puffs out, his head goes up, and we see him clench his bum in his tight black pants. Phee and I catch each other’s eye and begin to giggle. One bottle of wine between us and we’re schoolgirls again. Time for another bottle, we say. But first, we need to powder our noses.

Before the refit, at least one of the cubicles in the ladies’ room would usually be out of order, and more often than not there’d be a queue for those in use, sometimes stretching out into the corridor. For once, though, the room is empty.

The Lady P

But something else is different, too. There are three less cubicles than there were before, and instead, nestling between deep frosted glass partitions, is a row of gleaming white porcelain urinals.

We stop in our tracks. Phee clutches my arm as a flash of apprehension widens her eyes, and we double back out into the corridor, convinced that we’d walked into the wrong room. But no, there’s a little lolly-stick icon of a woman on the door, unmistakably female in her triangular skirt. We dither, not sure what to do. By this time, though, the wine has turned into water, and is clamouring for release in no uncertain terms; if an accident is to be avoided there really is no alternative. I take a deep breath and march back in.

* * *

Urinals for women aren’t a new thing. My mother tells of using them in the fifties, and describes them as being a bit like a narrow bidet that you straddled. That’s ok when you wear a skirt and stockings, maybe, but not so easy in trousers or tights. No wonder they weren’t popular.
Nevertheless there is a definite need for some way to reduce the time it takes for women to use the loo. I was at the opera one night last summer, and joined the inevitable queue for the powder room in the interval. The girl a yard or two in front of me was visibly uncomfortable, shifting from foot to foot and biting her lip. Then the three-minute bell rang and she turned, said “I’m so sorry”, pulled down her trousers and squatted over a drain in the tiled floor. I wish I had her chutzpah!

* * *

They’re quite stylish, these new urinals. They’re broader, and stand out further from the wall, than the men’s one which I sometimes use in my office building’s single-user unisex loo. (No, I don’t mind standing, as long as no-one’s watching.) Side-by-side privacy is assured by the glass partitions, but they’re open to the front. I suppose this is to encourage the user to be as quick as possible. There’s a hook to hang your bag on and a handrail to steady yourself while you strike the pose – a variation on the hover technique. And there’s even an array of tiny graphics to make sure you know which way to face. Smart. But will I use one? Hence my opening question.

The answer is: Ophelia did, I didn’t. I wish I had her chutzpah!

The Lady P was introduced in the UK in 2001, but sales were poor, and Royal Sphinx withdrew the model in 2005.

We were both walking our dogs, and fell into step along the old railway line – as we quite often seem to do. He knows I work in medicine, and so he sometimes opens up about his thoughts in a way that he wouldn’t do with most of his patients. I suppose we’ve become friends over the years, though.

For some time he’s been worrying about the way his patient face-time is being cut. The practice now runs a strict 10-minute-max consultation rule, except by prior arrangement (you book a two-topic session, which gives you 20 minutes of his time – assuming he has 20 minutes to spare). That’s all very well, and it means that the partners get through their lists by the end of the session. But he was worried that much of what he tells his patients doesn’t have time to sink in.

One particular case came to mind. A middle-aged man with high blood pressure wasn’t doing as well as he should, so the GP doubled his dose of antihypertensives. Two weeks later there was a repeat prescription request in his in-tray; it turns out the patient had not only started on 200mg tablets instead of 100mg, he was also taking them twice a day instead of once. (The numbers might not be right, but you get the principle.)

I think the way he’s chosen to deal with this problem is ingenious in its simplicity. He reserves the final minute of the consultation for what he calls “tell me what I told you”, and he gets the patient to rehearse his instructions back to him until he’s certain the patient has understood.

It seems to work, he says.

How can it be right, they would say, for family A, whose adult members have never worked in their lives and whose kids rampage across the neighbourhood collecting ASBOs by the legful; how can it be right for them to receive more income from government handouts than family B next door brings home in hard-earned wages – family B, in which both adults have fulltime jobs and their 2.4 children go to school every day, come home to do paper rounds, and then spend the evening doing their homework? That’s not fair!

How can it be right, they would say, for Mr X to get up at six in the morning and head off to work at his minimum-wage job, knowing that the curtains in out-of-work longterm scrounger Mr Y’s house won’t be drawn before the afternoon, while he sleeps off last night’s skinful (bought, no doubt, with benefit cash, courtesy of the taxpayer). That’s not fair!

How can it be right, they would say, for Ms Z, still in her teens, who has deliberately had herself impregnated by some bloke she met in the pub and whose name she no longer recalls – if, indeed, she ever knew it; how can it be right for her to live in a smart Islington flat whose landlord demands and receives an exorbitant rent paid by housing benefit, while hardworking young teachers and nurses live two and three to a room, an hour and a half’s journey from their jobs? That’s not fair!

The distinction they would make is between the “deserving” and the “undeserving” poor. And they’re right. It all sounds very Victorian, and smacks of the workhouse, but in essence the politicians are right. It can’t be equitable that those who are too idle, or too cynical, to make a contribution to the collective efforts of society should be better off than those who are prepared to work. But the government’s strategy for remedying the situation is wrong. Why? Because it’s not fair!

It’s not fair, for instance, for the government, in order to preserve the vote-saving token of universal benefits, to increase the tax burden of higher earners in order to claw back their child benefit. Especially when one takes into account the anomaly of the two-parent family whose wage-earners both come in just under the threshold and thus keep their entitlement to the lot, while the single parent whose sole salary tips them over the brink loses out. Why not just get rid of the notion of universality – it’s illusory anyway – match child benefit entitlement to household income, and be done with it?

And it’s not fair for the government to re-assess those on incapacity benefit with the declared intention to get them back onto the job-seekers register, using yet another arbitrary box-ticking exercise, especially when they cite as justification the specious platitude that the claimants’ health will be better if they do a job of work. Agreed, there is likely to be a proportion of malingerers among them, but these could be much more efficiently and fairly weeded out by means of a proper medical assessment. Too dear? Not if one takes into account the cost of the appeal tribunals that most of the tick-box-decided cases go to, and which evidence suggests most of them win.

It’s worth asking what fairness is, in relation to society. Arguably we had a much fairer society in the middle of the last century, for instance, although it took a world war to achieve it. Take the case of women, who were enabled to work in the place of men sent off to fight, and they did a magnificent job of it too, gaining volumes in self-respect into the bargain. And though there was some slippage when the war was over, the attitude to women in society has remained much more equitable since then. Rationing, too, was applied equally across society. The rich were entitled to the same pinch of dried egg per week as were the poor. There was always the black market, of course, and money could make life a lot more bearable; but even so there was a sense of levelling, of being “all in the same boat” brought about by rationing.

More specifically, it can be argued that fairness is an attribute of the way that society deals with individuals that doesn’t disadvantage one against another, and at the same time takes their dignity into account. Another view of fairness would discount the individual in favour of the greater good of the community (a rather Socratic way of looking at democracy, maybe? Or a Benthamite way – the greatest good of the greatest number?).

The coalition government’s way seems to rest on making distinctions on the grounds of input, regardless of capability (“Put more in and you’ll get more out, and never mind the fact that you’re physically or emotionally unfit to work”). And that’s not fair!

Finally, we should ask what work is there for our unemployed masses to do? Very little. Very little, at any rate, that brings a sense of self-respect to the worker. It’s all very well for (the otherwise admirable) Iain Duncan Smith to prate about so many million jobs available on the Job Centre lists. But how many of them are real jobs in which, at the end of the working week, something has been made, something that can actually be used, maybe even – heaven forbid – exported? No. Our “me” society has forgotten – abandoned – its work ethic, preferring instead to be managers or entrepreneurs, getting fat on the sweat of someone else’s manual labour. Except there is no labour for someone else to do, because we sold our manufacturing industry down the river 30 years ago. The overwhelming majority of employment “opportunities” are in service-industry jobs, part-time and at minimum wage. And if the claimant is fortunate enough to land one of these shameful excuses for a job, then it will almost certainly be three bus rides away in another town, and most of the paltry income will be sucked up in fares. And that’s not fair!

As for me, I’d just as soon dig holes in the ground, or paint window-frames for OAPs, or whatever other modern-day Speenhamland system is devised to give me some notion of achievement and self-respect.
 

For the philosopher’s take on fairness as it applies to the spending review, read what Angela Hobbs, Senior Fellow in the Public Understanding of Philosophy at Warwick University, has to say on the BBC “Today” programme’s website.

I have bees in my bonnet. Writers who cannot grasp the correct way to manage “both” binaries (“ … both ‘a’ as well as ‘b’ ″: GRRRR!) test my patience, as do those who have never learned to forget the rule that you don’t put a comma in front of “and”. But it’s often very good for me to realise that I, too, can make mistakes. I do have my own blind spots. For instance, I have trouble with “which” and “that”. (“Which is the house that Jack built?”). I tend then to fall back on the teachings of my two “mentors”, Guy Keleney of the Independent and the late Bill Whimster of King’s College Hospital. To discover one’s own error in a published text is a sobering experience; for a moment, for me, the ground shifts beneath my feet and my whole professional edifice threatens to crumble. But I don’t think I’d ever go to the extreme demonstrated by David Mitchell at the end of this clip.

I found this at the bottom of my wardrobe this morning:

If I were tempted to try to defraud a railway company by travelling without a ticket, the fear of disgrace in the event of discovery would be a far more powerful deterrent than the legal penalty.

Not so any longer; there is now no fear of disgrace.

 
Whoever wrote the original, I salute you.

Tilda Swinton 2010 (photo by Ryan Pfluger)

The image was originally uploaded to flickr by Ryan Pfluger and captured (RP was notified) for use here. Ryan eventually reorganised his flickr photostream, but I like the image so much that I’ve retained it.