FIRST, DO NO HARM

Does Her Majesty's Government deserve our sympathy? To anyone daft enough to tune into the "keynote address" recently given by the Chairman of the BMA to its annual conference, the answer has to be a resounding "Yes". Sporting a natty little gong which may have had medical significance, but was equally likely to have been one of those inconsequential chevalier de fromage medallions so beloved of "civic dignitaries" to puff up their self-importance, Dr Chaand Nagpaul delivered 25 minute's worth of unmitigated bile from which a listener would have deduced that if only the BMA had been running the show, the UK would have avoided the worst ravages of the Covid pandemic altogether.

No-one seemed to escape denunciation. Naturally, the government was flayed for its alleged uselessness, incompetence and U-turns, but Nagpaul even managed to stick the boot into the NHS (gasp) for failing to defend GPs from the accusation that some of them may, perhaps, have shirked just a tad on their duties during the crisis. Barely drawing breath, he also pilloried the General Medical Council for having the audacity, from time to time, to bring proceedings against BAME practitioners. Nagpaul pronounced himself "stunned" that the government simply doesn't get the structural racism that is, apparently, poisoning the medical profession. Perhaps Dr Nagpaul forgot to ask himself why, if the UK's healthcare arrangements are such nests of racial discrimination, nearly one quarter of serving GP's received their training outside the EEA or why nearly two thirds of new registrations to the GMC in 2019 qualified abroad. But what is the point of positive  outcomes in a healthcare crisis if they are delivered by a system based upon "oppression" or, even worse, by "private sector" providers? 

Can no-one be found to stand up to this divisive and mendacious man, or to his idiotic assertions, such as "No-one is safe until everyone is safe" ? Nagpaul is that public sector type to which elected governments give far too much consideration - a taxpayer subsidised, special-interest agitator who thinks problems can only be solved by adding to them, preferably with oodles of cash that can be directed at the producer interest rather than that of the patient.

Certainly the things that seem to exercise the BMA would appear to have little relevance to the healthcare needs of UK citizens. Once they had finished denouncing the lack of consideration given to the "suicidal" propensities of BAME medics (huh?) and Johnson's personal responsibility for deaths due to Covid, Nagpaul led his delegates, without a trace of irony, into a discussion about what is modishly called "Assisted Dying". By the slenderest of margins, the delegates voted by 49% to 48% that the BMA adopt a position of "neutrality" on whether or not the profession assists patients to commit suicide. We should perhaps be grateful that BMA members are at least trained in medicine if not in ethics or logic. How can doctors be professionally agnostic about such a matter of human life-and-death? And what about the  3% who abstained on this motion for abstention? Was it an acte gratuite of some new and obscure philosophy? Bizarrely, the lobby group Dignity in Dying hailed the vote as a "victory for common sense". It was anything but.

Members of the Palliative Care profession, who (unlike the practitioners represented by the BMA), rely upon charitable donations for nearly two thirds of their funding, could be forgiven for blowing a raspberry at this post-Modernist nonsense. Certainly a Macmillan nurse would appear to have a better grasp of how to deal sensitively and effectively with the sometime painful experience of that inescapable part of human existence than do the Confused.coms at the BMA. What ethical or medical problem is the Assisted Dying lobby trying to solve? Can it seriously believe that the patient/practitioner relationship will not be fundamentally altered by a move to Assisted Dying, with all its "protocols", flimsy "safeguards" and a new army of apparatchiks to oversee the whole "process"? At what part of your cancer diagnosis will you be asked to "consider" an assisted death or be offered "counselling" to "inform" your decision? And what about that cohort of nurses and palliative care experts who get both pleasure and professional pride from the comfort they can give to the afflicted? What dismal path will we be invited to walk in which a diagnosis of terminal illness takes on a whole new and frightening meaning? Will councils decline to offer funding to guests at respite homes or hospices on the grounds that they haven't yet properly considered topping themselves? (Please tick Box A. The security of your data is important to us).

Naturally, the Assisted Dying lobby scoffs at such doubts. No one will be put at risk, it says. This is about "dignity" and that most unanswerable of modern morals, "choice". No one will be forced or cajoled into sitting on the ejector seat. Palliative care will still have an "important" role (although not one that might commend itself to the bean counters in the NHS or other funders). This might sound all fine-and-dandy for a cancer riven investment banker or lawyer who is in charge of their mental faculties, with a loving family, and who has had a high life but a currently low tolerance of pain and "indignity". But it seems far less appealing to a poor widow with no grasp of the probabilities of her medical condition, stuck in her tenth floor flat, and with indifferent relatives who live miles away. No doubt she will be an incentive to the management consultants who will measure how speedily local Health Boards whizz around doing their suicide "counselling". (Whoops - she wasn't actually terminally ill. O well, we'll "take learnings" from her premature "choice to die"). To the system, the frightened widow will be just another instrument of our valueless and post-Christian polity.

On this, as on pretty much every other issue Dr Chaand deems important, the BMA needs to be told to put a sock in it.

 

WHEN THE HURLY BURLYS DONE

Action Stations. It may be the silly season, but we've got the largest military and civil evacuation since Saigon in 1975 and we've also got the BBC to explain what's going on and why. As the nation stared frowningly at its TV sets, the first things our intrepid correspondents had to get right were the scene of the action and who were the bad guys. The first bit should have been easy: Lyse Doucet, being the Beeb's Chief International Correspondent, would surely be on top of that. But Lyse has a voice like a Chinese person trying to speak with an Irish accent, which is putting it kindly. With a whine like finger nails being dragged down a blackboard, she averred from the top of her hotel in the distinctly un-dangerous Abu Dhabi that events were unfolding some place called Gor-bull, which might be in Glasgow. Back at the mother-ship, Mishal Husain essayed that it was in fact Garbool in Arfgarnystarn. Happily, the BBC has its own Arfgarn correspondent (of Pakistani heritage), who definitively pronounced it Karboole.

That settled, the next bit of key info was trickier to grasp: Lyse sounded as if the enemy were the Americans, a view later endorsed by some uneducated buffoon in our very own Foreign Office, where a "senior source" scoffed to the Times that the USA had been late for World Wars I and II and had cocked up everything else ever since. But who were these geezers in beards and tea towels from whom everyone seemed to be fleeing? Mishal thought it was an outfit called the Dallybun. Lyse said it was the Tallybun, but the Beeb's wallah in situ seemed surer it was the Dollybon, a word he repeated about twenty times in every piece to camera. 

Sadly however, the BBC no longer really likes to get close to the action to check the veracity of stories on the ground, where reporters such as Martin Bell  were once wounded by flying shrapnel in Bosnia and Martin Taylor was nearly lynched by an angry sectarian mob in Belfast. Nor are there authoritative correspondents like Charles Wheeler, David Lomax and Michael Cockerell back at base to explain lucidly and convincingly what on Earth it all means. Now the Beeb is about risk assessments, "threat level" protocols, security and diversity awareness training and Lyse giving her personal "take" on events from a very safe distance, her barnet ludicrously covered by an out-size helmet to protect it from the odd stray bullet fired high into the air by Dollybon celebrating miles away. Standing amidst the peaceful wreckage of helicopters disabled by the departing Americans, Lyse gravely told us that the US would have to live "for a very long time" with the "chaos" they had caused. Tomorrow, she said, 39 million Afghans would wake up in fear of the future. What, all of them? 

Yes, it's open season on the USA all right. The Brits are letting it be known that the Americans left them in the lurch, although it now appears that the UK's embassy staff bailed out before nearly anyone else, and had to be ordered back to their posts where they "heroically" went through the papers of the few refugees able to present them. Rory Stewart was grabbed by the media to give an opinion on the basis that he walked, rather quixotically,  across Afghanistan in 2002. Alas, Stewart's somewhat romanticised view of why the Afghans have been so badly let down by the West in 2021 does not seem to have been very much informed by the passage of the intervening years. An eloquent and empathetic man, he nevertheless gives the impression that our own governance would be massively improved if only we sat in a circle, cross legged in our jim- jams, silly hats on our heads, gossiping and drinking chai. Perhaps he thought that would work in London, where he briefly ran to be the capital's mayor. But it would be wrong to single Stewart out for wishful thinking. In the wake of the appalling suicide attack at Kabul airport, credence was given by the BBC to the hope that the Taliban might include some "moderates", as if cutting the hands off transgressors counts as being  liberal on the spectrum of psychopathy. Suddenly, everyone is an expert on the wise and ancient habits of Afghanistan and of a  people seemingly "abandoned". 

Who on Earth are we trying to kid? The ruthless invasion of Afghanistan by the USA in 2001 was a calculated and justifiable act of war, the response to the mass-murdering terrorist attack on New York and Washington on 9/11. Indeed for the first time the USA invoked the NATO charter, which held that an attack on one member was an attack on them all. The Americans must indeed be rueing the day that they didn't just leave it at that - a devastating punitive expedition followed by a swift withdrawal, but one which would have left no doubt about Western (or at least American) ferocity in defence of its legitimate security interests. 

The intervening years have taught the US quite a few things about the reliability of allies, not least when it extended the scope of its retribution by its questionable invasion of Iraq. But the attack on the regime of Saddam Hussein gave those allies the excuse to soft pedal on their far more justifiable involvement in Afghanistan. Over time, the US came to shoulder an incrementally heavier burden for both security and nation building in Afghanistan while their NATO and ISAF allies penny pinched and insisted on deployment to less challenging areas and tasks. Trump was the first to grasp that nettle, and now his successor has finished the job which (in hindsight) should have been done nineteen years ago.

Naturally, in choosing its own role, the UK managed to get the worst of all worlds. Castigated for its seemingly blind devotion to the US mission in both Asian theatres, London still contrived to deploy resources which were inadequate even for one area of operation, never mind both. By "going in", we merely got in the way and had to be bailed out in turn in both Southern Iraq and Helmand by the Americans. In Afghanistan,  the politicians and the brass thought that a large Brigade would do the trick, and for a while and with the overwhelming and sometime indiscriminate use of firepower, it did. But given that Afghanistan is nearly three times the size of the UK, sending in a Brigade was like sending in a platoon to subdue Wales. In such circumstances achieving basic security for the citizens, never mind nation building, was nigh impossible.

Europe has thrived comfortably under the blanket of security provided by the USA since the end of the Second World War. But like a lot of folk who have had too much of a good thing, Europeans have increasingly questioned the manner in which American support is provided, while failing to deliver it on their own account. Ingratitude and impotence have been reinforced by cultural disdain too. Look at those silly Yanks, we seem to say, with their Bible bashing, daft Presidents, obese citizens and the occasional deployment of automatic weapons by crazed nutters against school children. Being anti-American is so courant, and "progressives" can have their cake and eat it. How awful the US was to invade Afghanistan they say, and how awful they are now to leave it, thus depriving Afghan women of an exciting education in trans-genderism, or Kabul of its version of the Turner Prize. 

Quite sensibly, the USA has decided to cut the crap.