Thursday, October 25, 2018

Review: 'Mark Thomas: Check Up' at the Arcola Theatre, 24th October 2018

Reviewed by David James
Rating: 4 Stars

Like the vast majority of people in this country, I have never known anything other than the NHS. It's our safety net : setting bones in casts, diagnosing illness and there for the inevitable problems that come with age. Well, that's the theory. The reality is that this safety net is fraying, the holes in it are growing bigger and if urgent changes aren't made it may collapse completely.

Veteran comedian and activist Mark Thomas is, as the police describe him on their database of domestic extremists, a "general rabble-rouser and alleged comedian". To mark the 70th birthday of the NHS he's giving it a checkup, examining its history, its current state and delivering a prognosis for the future.

The show consists of anecdotes from his time embedded in various London hospitals and medical centres, combined with interviews with prominent healthcare bigwigs and his own observations. Before we get into the meat of the show, it must be pointed out that Thomas isn't just a witty campaigner with a talent for meticulous research, he's also an incredible performer. Check Up is delivered at a relentless rat-a-tat pace that barely stops for breath - the information he delivers feeling as if it's downloaded straight into our brains.

A common thread throughout the show is Thomas explaining what NHS staff deal with on a daily basis. For example, part of his research was spending a night in a central London A&E . This sounds like well-managed chaos, with experienced doctors juggling various patients with critical wounds, before zeroing on one in particular who has fallen through a 1st story plate glass window.

He describes being sat in the corner of the operating theatre, trying to make himself as unobtrusive as possible while legions of expert professionals operate, anaesthetise, transfuse blood - all whirring around the patient in a blizzard of limbs, equipment and barked orders. What he's watching is the result of hundreds of thousands of hours of study, millions of pounds worth of training, the pinnacle of mankind's technological medical prowess. The patient dies. 

But there's no time for reflection - the next critical patient is being wheeled through the scuffed doors.

Accurately communicating what NHS staff deal with on a daily basis is impossible, but Thomas does it about as well as anyone reasonably could. Whether it's as high pressure as A&E, regimented as a dialysis centre or just the patience and empathy in a dementia ward, the staff are performing a constant high-wire act: balancing a fierce duty of care to their patients; dealing with cuts to services (there's a particular keenly felt moment where a GP decries the government cutting the toenail clipping service); and, usually a long way behind, their own physical and mental wellbeing.

It's when the heroism of the staff is contrasted with the ideological bent of the government that the show really hots up. While the breadth of what the Conservatives (and their Liberal Democrat stooges) have done to the NHS is difficult to summarise, it's all under the ideological umbrella of free market economics. Socialised healthcare system is anathema to Thatcherite Conservatives, who believe that competition within a marketplace is the only way forward.

As anyone who's used a train lately will testify, they're wrong. While they might sing compelling tunes about Darwinian competition resulting in survival of the fittest, the reality is a race to the bottom as each competitor strives to reduce costs to get a nose ahead of their rivals. And most, tantalisingly to Conservative politicians, opening the NHS up to the market fills their pockets as the private healthcare companies they're associated with (and on whose boards they will inevitably sit) prosper.

Though shrouded in byzantine financial arrangements and many degrees separated from an individual patient's misery, make no mistake: politicians profiting from private healthcare companies are directly enriching themselves via the pain of you and your loved ones. 

Thomas pins this on Andrew Lansley's 2012 restructuring of the NHS (described as an attempt to emulate the privatisation of utilities), a decision which is estimated to cost the NHS £2 billion per year. His reforms in the Cameron government have resulted in, among many other things, fewer nurses, the ruination of mental health care and contributed to Britain having some absolutely dismal cancer survival rates (which, uh, he now belatedly realises).

New Labour is far from blameless too, with the Blair and Brown government's PFI schemes set to funnel money from the NHS into the pockets of private companies for generations to come. 

Thomas' prognosis is bleak. An interviewee explains that we have been having our cake and eating it for decades, enjoying relatively low taxes while expecting the very best in healthcare. It's a situation that cannot continue and future governments will be placed in the awkward political position of raising taxes or abolishing the NHS in all but name (even the most reptilian Tory recognises the worth of the NHS brand). If you can picture any future Conservative government drastically raising taxes to support a non-profit seeking public service you have a better imagination than I do.

It's a worrying future (especially with Brexit looming) and you just have to cast an eye over the Atlantic where a cancer diagnosis can bankrupt a family or a broken leg can cripple you financially and literally. The takeaway from the Check Up is that the NHS isn't just something to rely on - it's something you have to fight for. And everytime someone votes Tory it's just another hairline crack in its edifice.

Appreciate what you've got, because you'll miss it when it's gone.

Mark Thomas: Check Up is at the Arcola Theatre until 3rd November. Tickets here.

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