Photo: MIND THE GAP from Sheri Flickr Photostream

A couple of events this past week have put me in mind of some of the insights from John Berger’s classic text ‘Ways of Seeing’. In an age of ‘post-truth politics’, the observations and comments in this 45-year-old book seem to be more apt now than ever before. For example, in talking about how we make sense of the world around us Berger and colleagues state that

“we explain that world with words, but words can never undo the fact that we are surrounded by it. The relation between what we see and what we know is never settled. Each evening we see the sun set. We know that the earth is turning away from it. Yet the knowledge, the explanation, never quite fits the sight, [creating an] always-present gap between words and seeing”

Within this always-present gap, Berger identifies different processes, with a key one being the idea of mystification  – ‘the process of explaining away what might otherwise be evident’. I was put in mind of processes of mystification this week in response to the Red Cross intervention on NHS hospital care. Mike Adamson, chief executive of the British Red Cross, stated that the NHS faced a ‘humanitarian crisis’ and that the charity, was on the front line:

“responding to the humanitarian crisis in our hospital and ambulance services across the country. We have been called in to support the NHS and help get people home from hospital and free up much needed beds.”

The word crisis was not overly dramatic with reports widely circulating of patients dying while waiting on trolleys in corridors for treatment. And just to be clear, the Red Cross is a voluntary body that helps “people in crisis, whoever and wherever they are”.  This charity is now deploying people into our National Health Service  to help alleviate a developing health catastrophe.

The government response to this intervention was not to address what we know, (that people died last week on trolleys) but rather to challenge how these events were seen. Theresa May, in a TV interview, said that she didn’t “accept the description the Red Cross has made of this,” (she repeatedly used the phrase ‘I do not accept that’) and that the problems the NHS was facing were related more to “significant pressures” the NHS faced due to “an ageing population”.

Then on Thursday of last week, it was announced that 20 hospitals had declared a black alert, cancelling cancer operations and shutting birthing units, as they could no longer guarantee patient safety. The government countered that the problem was due to GP opening hours, stating that surgeries that close early were causing a winter crisis in the NHS. The GPs countered this, stating the government were scapegoating the GPs rather than taking responsibility for the crisis.

A counter explanation for all of this calamity might be that it is due to a chronic underfunding of the service, as the Royal College of Physicians asserted last week. Going back to November last year Theresa May, in response to claims of underfunding, said that the NHS would receive £10bn extra funding by 2020-21 and that it was “getting all the money it said it needed” – again, making the NHS responsible, not government. May seems to imply that if the NHS had asked for more money, then it would have received more money, but this is all they said they “needed”. Fast forward to 10 Jan 2017 and it is announced in an emergency debate in the Houses of Parliament that the 4 hour targets for patients being seen in A&E is to be regarded as an advisory rather than a mandatory target. We know that A&E is not working, we know that people are waiting and dying on trolleys, and we know that professionals say the service needs more money. The next day it got even worse for Theresa May, with Simon Stevens, the Chief Executive of NHS England contradicting this government view, stating the NHS has fewer medics, beds and scanners than other European nations. Stevens and NHS England have served as a long term buffer for the government, taking the brunt of public and professional opprobrium at unpopular reforms and insulating the government from criticism. For NHS England to cry ‘enough’ suggests the crisis is beyond the pale.

Back to Berger. In terms of mystification and ways of seeing, two responses are possible. Either pump more resource into the NHS to ensure hospitals are able to maintain adequate levels of patient safety, and meet patient safety and the 4 hour A&E targets, (and hopefully stop patients dying on trolleys); or scrap the 4 hour target (so that the way information is recorded is tweaked and we no longer know how long people are waiting (or dying) on trolleys), blame GPs and other assorted professionals, or even blame patients for trivial use of A&E services – last week Jeremy Hunt claimed 30% of all patients using A&E did not need emergency care. The veracity of this statistic is not the point, it is the way in which these statements make patients and professionals, not the (underfunded) service, responsible for the crisis, mystifying the evidence as we see it.

So it seems that the government’s response is not to address the issue, but rather to challenge the descriptions, or to increase the gap between what we know and what we can see. There has been a political shift from dealing with what we know, to dealing with how it is seen. Furthermore, the media hyperbole that accompanied describing this chain of events as a humanitarian crisis functioned to distract us from important discussions about what we know, i.e. from claims that people died on trolleys. Rather it directs us towards debates about how we might best see it, i.e. as a humanitarian crisis (or not) – the actual events become backgrounded by the battle over ‘acceptable’ ways of seeing what we all know is happening.  We can see the news reports that people are dying, and we know that the NHS is struggling, but the always-present gap between what we know and what we can see is where government is now operating, and that means that politics has become about exploiting that always-present gap.

NB John Berger died on the 2nd January, 2017.