My title comes from the words that Dorothy Parker used whenever
she answered the phone. These last weeks I have felt the same, and
suspect I am not alone. True, there have been the occasional pieces
of good news. Wales lifted the spirits of anyone who likes
football. A Brit won Wimbledon and another one looks likely
to take the most difficult prize in sport - the Tour De France.
Having said that, as I
write this in a café the TV screen on the wall is showing Chris
Froome running up Mont Ventoux, lacking what one would have thought
was essential for a cycle race - a bike. This is further proof that
we have entered a space time continuum plunging us into a new world
where the impossible has become the normal.
Such is the pace of events, that when I started to write this
blog Jeremy Hunt was still Secretary of State. Half way through the
first paragraph the BBC announced he was sacked, then going to
another department, and as I now plod on he seems to be back where
he started, still in charge of the Department of Health. I
have no idea if that will still be true when you read this. Perhaps
Jamie Oliver will be in charge – or Katie Hopkins. In a world where
Boris Johnson can lead us out of Europe on his personal journey to
become Prime Minister, then be cast in the wilderness by a
treacherous colleague only to end up as Foreign Secretary, and all
in the space of a few days, anything is possible.
OK, back to the serious business. The results of the EU
Referendum have precipitated a series of events that few, if
anyone, could have foreseen and none can know the eventual outcome.
When Zhou En Lai was asked by Richard Nixon in 1972 what he thought
had been the impact of the French Revolution he replied “it’s too
early to say” [i]. So no one can yet have the faintest idea of how
our own turmoil will end. Those who led the campaign to leave
seem to have been following Napoleon’s maxim – “on s’éngage, et
puit on voit” – loosely translated as “One gets into the battle,
and then who knows?”
At the moment no one knows. Many, myself included, are worried
about the future.
Here is what I wrote the day after the result and
again today, concentrating on the impact on science and then
And what about the wider NHS? The only people who still believe
in the £350 million a week that will come to the NHS as a “Brexit
Bonus” still believe in Tooth Fairies and Santa Claus. To their
shame even those who promised this bonanza lost no time in
admitting it was a mirage. The new boss of NHS Improvement
was closer to the truth when he said this week that the “NHS is in
a mess” and one that is set to become even worse as we start to see
- as we are already doing - signs of the economic down turn
triggered by Brexit.
But it’s not just about the money. Immigration dominated the
referendum debate, and what a nasty debate it was. The author
Robert Harris tweeted at one point “How foul this referendum is.
The most depressing, divisive, duplicitous political event of my
lifetime. May there never be another”.
But I wouldn’t be here without immigration. My father would for
certain have perished in the land of his birth, Czechoslovakia. And
the NHS wouldn’t be here either, whilst British medical science
would be infinitely poorer as well. Brexit or no Brexit, the NHS
and science both can only flourish with immigration.
So we as Royal College of Psychiatrists celebrate the fact 25%
of all NHS doctors were not born in this country – a figure that
rises to 35% for psychiatry. We are delighted that 10% of all NHS
doctors come from non UK EU.
Thus message is being echoed across the NHS, from the very top
and throughout the organisation. But it is natural for those of you
who are from the non UK EU to be directly concerned about your
future, and I have received messages from several to this
effect. Frankly, I doubt very much that anyone already
resident here has anything to fear. The government has
already acknowledged that anyone who has been resident for five
years is protected by existing legislation, that this cannot change
until we have actually left, and even the most ardent “leavers”
made it clear that there was never any intention to interfere with
EU nationals currently living and working here.
The problem will be whether or not we are permitted to recruit
more of the doctors, nurses and scientists that we will continue to
need for as long as we continue to fail to produce enough within
this country – in other words for a very long time. That we
don’t know, and it may be a long time before we do.
But worse, even if they are permitted to come, will they want
to? And here is the most pernicious consequence of the
As the Lancet pointed out this week the increase in
nationalistic sentiments “manipulated by some leaders of the leave
campaign, is already reducing the attractiveness of working in the
UK”. The Lancet continued that “it is a bitter irony that the
NHS was used so deceitfully as the very embodiment of a British
institution in a struggle over sovereignty and control, and yet now
the future of this great tradition is so under threat” [ii].
As Francis Urquhart, the anti-hero of the British “House of Cards”
might have said, “you might very well think that; I couldn’t
But what all of us in the Royal College of Psychiatrists can say
loud and clear is that the reports of an increase in petty and not
so petty intolerance and xenophobia directed against both EU and
non EU migrants shame us all. I witnessed such an episode recently
and it sickened me. Two young men started verbally abusing a man on
a station platform opposite me who looked “foreign” (he was in fact
a Mexican) - swearing, demanding to see his passport and saying it
was time he “p***ed off home”. But what I also saw was that within
a short space of time a far larger number of people had intervened
to protect the man, prevented the abusers from leaving until the
police arrived - which they did - and made their abhorrence
for the incident extremely plain. There is hope.
I openly campaigned for Remain (not wearing my Presidential hat
I hasten to add in case the charity Commission is listening).
Along with most doctors and virtually all scientists I warned of
the probable consequences for health, science and medicine should
we vote to leave. Now we have left, all of us who supported Remain
must work just as hard to prove ourselves wrong. This is a task for
everyone, whichever way we voted.
I do not think we are doomed – and was cheered up by the
wonderful science blogger Jenny Rohn only a few days ago.
As she says, there is a storm coming, but we can weather it. It
will take hard work on our side and good will from the rest of
Europe – something that might be in short supply at the moment –
but perhaps as raw emotions settle will return. But most of all, I
genuinely believe that after a campaign that spoke too much to
division, fear and prejudice, we will again see the better angels
of all our natures reasserting themselves and showing to the world
that this is still a wonderful place in which to live and work.
So let me end with a French film. Made in 1966, it is called Le
Roi De Coeur, the King of Hearts. Set in 1918, it takes place in an
old mental asylum in the countryside, which then becomes engulfed
by the Great War. As a result all the doctors and nurses flee,
leaving the patients to their own devices. Cautiously they open the
doors and gates and set off the first time in years to explore the
countryside and town nearby. In a series of episodes they encounter
the folly, stupidity, madness and absurdity of the world of the
so-called sane. One by one they make their way back to the
hospital. In the final scene a hand reaches out from inside the
asylum to pull the door to the outside world shut again.
So may I wish you all a pleasant and happy holiday wherever you
are going, and hope that you will have at least some respite from
all the anxiety that so many of us are feeling, before we have to
reopen that door and return to the chaos of the real world.
i] Pedanticus writes “it’s possible that Zhou En Lai’s most
famous quote was not quite as wise as it sounds. Some think
he misunderstood Nixon’s question and thought he was being asked
his views on the 1968 student riots and upheaval, not the 1789
ii] The lancet editorial also called on the government not to
impose a contract on the junior doctors at this time, “rather than
taking stock to re-evaluate the repercussions on a post-Brexit
NHS. I am afraid I very much doubt the government will heed
this advice, but the world is so strange at the moment that one
never knows. Anyway, I will return to the junior doctors’ dispute
in my next blog.
Professor Sir Simon Wessely