Drew Payne

This is the last blog in this series because this was the last comment piece I had published in Nursing Standard magazine. Early in 2020 they changed their format, going from a weekly publication to a monthly one, and where less in need of content. After then I started to return to blogging. Life is changing. Britain is far more welcoming than it was twenty years ago, and certainly more than it was thirty years ago, and I am sure that has a lot to do with more visibility over the years. The more people who are out than the more people know someone who is LGBT, and the more they realise the reality of our lives. There has always been a move to the city for anyone "different", our cities are more liberal and open places, certainly more multicultural places (I've been doing some reach on this for something else I am writing). Which has left life outside of them still very conservative. Things are changing but there are still a lot of push-backs against. Our right-wing media is certainly pushing back, with their "war on wokeness" (which equals a war on diversity) and their anti-trans views make me sick (especially as they are the arguments they used against gays thirty years ago). I have a hope for the future, based on my own experience. I started to come out in 1984 and the world today is totally different from then, the changes are breath-taking. Yes, there is a lot more that needs to be done and that's why we should never stop pushing for equality. I'm going to write a postscript to this blog series. Something happened at this year's London Pride that showed me how far we have come. But I haven't written it yet and I've got other blogs to post first.

But the Government does manage so much of what the NHS does, but they do this with targets, requirements and policies. They also police so much of this by directly fining NHS Trusts for breaching them. These all dictate what different Trusts can and cannot do and many of they dictate the day-to-day running of a Trust. Most of these targets, requirements and policies come from the Department of Health and NHS England, who are directly under the influence of the Minister of Health. One example is an Accident and Emergency departments. If a hospital’s Accident and Emergency has dangerously high demand levels and/or is dangerous under-staffed and it is temporary closed to manage that demand, then that Trust is fined by the Department of Health for doing so. Therefore the pressure on a Trust’s management is not to close it. This is the Government directly managing a hospital. And there are a lot more targets and requirements that impact on the day-to-day running of a Trust, there are targets that impact were a patient can be placed on a hospital ward, and the Trust is fined for breaching. This is on top of the requirement for yearly “savings”. Hospitals do not even get to chose their own specialist services, this is decided upon centrally. My yearly mandatory training requirements aren’t set my employer, they were set by the Department of Health and they are not related to my job. They are divided up into clinical and non-clinical training streams and that is about it. I work in the community, actually working in people’s homes. I have to do regular training on how to deal with and prevent fires in hospitals. This training has zero relevance to my job but the Department of Health says I have to do it. The Department of Health sets targets for recruitment and all Trusts use the same disciplinary procedures, as laid down by the Department of Health. The government has never treated the NHS as an arms-length body, they (whichever party is in charge) have always been very involved in the management of the NHS. Since 2010, the NHS has seen major strategic reforms that have completely changed how the NHS is run and managed, and this was all directly from Government policy. The Department of Health was very silent about the recent Stonewall reports into the homophobia in the NHS, the government was also very silent and the media was very uninterested. It feels as if no one cares and I am very frustrated by this.

@Mancunian, thank you for this. I am so proud of being given the chance to originally write these comment pieces and have them published, at the time I felt I could, maybe, change some attitudes. I fear I didn't achieve that because so many of them repeat the same themes, how homophobia is still prevalent in the NHS, as it is in the rest of our society. I decided to re-post them as blogs because a friend of mine complained to me that she had never been able to read them because she doesn't subscribe to Nursing Standard magazine, where they were published. I have been so surprised by the response they have generated as blogs. I was so angry about NHS England going to court to get the right not to fund PrEP. It was breath-takingly prejudiced, even if they didn't think it was meant to be. In October 2016, I wrote an in-depth blog about why this was such a fundamentally wrong decision. You can read it here.

Thank you. When I originally wrote this article, I was trying to be positive about the future but events decided to stop me.

The move to all online training was long before Covid. I originally wrote this blog in 2015 and back then almost all my work training was online. I left being a Nurse Trainer in 2011 when my employer lost several face-to-face training contracts. Training budgets have been cut since 2010, when NHS funding was cut. I don't feel this is all a failure of NHS management, I feel it goes up much higher. This is a failure of the Department of Health and the Minister of Health. Neither of them are very concerned about staff training, or even staff retention. Their attitude, for years, has seemed to be "we can always train new staff." They haven't been very interested in retaining staff. Neither have they been very interested in training and developing staff, we've seen that by the severe cuts to staff training budgets across the NHS. When funding is short, staff training is always the first thing to be cut, but the DoH and the Health Minister have not condemned any of this, or even seem bothered by it. Nothing really came from this YouGov survey because, as a society, we don't really take homophobia seriously. So often its excused as someone's religious beliefs or personal views. We have seen a massive rise in homophobic hate crime since the Brexit referendum and yet there has barely any noise about this, outside of the gay media. I originally wrote this as a response to my anger, but also because no one was talking about this report. I'd hoped that it would open up debate but it didn't, it didn't seem people were interested in it. I still feel so frustrated by this.

I originally wrote this blog as a comment piece for Nursing Standard magazine (as with all the blogs in this short series). I was writing about a report that showed, for so many areas of the NHS, nothing had changed in decades and LGBT staff were still subjected to the most awful prejudice and treatment. I wrote it as an angry response because it felt like, for far too many people, nothing had changed. I wrote it to challenge the magazine's readers. At the time of its original publication, there was a lot of talk of "person-centred care", and a lot of it was just paying lip-service to a very challenging concept, that's why I wrote, “How can we say we focus on person-centred care when LGBT staff’s safety is so bluntly ignored by the NHS?” I wanted to bluntly challenge the magazine's readers. I work in team of twenty-two nurses, all from very different backgrounds, and have never experienced any homophobia from colleagues at work. My husband works for the same NHS Trust and everyone at work knows him as my husband, but they have also approached him for professional advice because they already know him. I was in this job when I originally wrote this article. I was out at work and having no problems because of it, then I read this report and was deeply shocked. It was detailing prejudice that I had thought,had hoped, had disappeared ten years ago. I first thought was, I have to write a piece for the Nursing Standard on this. So I did and they published it. It came from a place of anger because I had thought, from my own experience, we had moved away from this sort of disgusting homophobia. I was wrong.

I work with Christians, Muslins, Jews and people with no beliefs, and my colleagues are from almost all racial backgrounds. I'm out at work and all my colleagues have met my husband, yet I experience no homophobia at work. I love multicultural Britain, and the NHS is very multicultural, well at the patient facing side. Unfortunately, in Britain we have people who are using prejudice and discrimination to give themselves power. We had the sight of MPs, running for party leader, trying to be more transphobic than each other in a TV debate, the other day, and they saw their transphobia as a virtue.

Well, I "outed" myself as a former nurse training, a few days ago, but I never ran any diversity and equality training, and boy I would have had some fun doing them. I have attended many of them in the past and you're right, so many of them were run by people who had little or no experience of being on the receiving end of prejudice. So many times, it has just been a quick summary of the legislation on equality, and those trainers did get annoyed when I know more about the legislation than they did. But we should never under estimate the power of actually knowing people from different minorities, seeing them as people and getting to know their experiences. Like taking colleagues to a gay bar for a drink. But we shouldn't ignore the power of drama and literature too, both of them can demonstrate different people's lived experience of life. British soap operas have done so much for equality because have portrayed the lives of many different and diverse characters. Audiences get involved with those characters' lives and it helps open people's minds. From my experience, I don't feel equality and diversity training has done much for tackling prejudice. People working with and knowing different people from different backgrounds, the raise in out LGBTQ+ people, making us far more visible in other people's lives, has helped far more.

So many HIV services are run by LGBT staff. So many lesbians made those places what they are. My first nursing job, after I qualified, was on a HIV ward and there was one straight woman on the nursing team (no straight men).

Healthcare is not what it was back in the 1990s, so much has changed and for the better. When I did my nurse training, I was the only out student nurse in my intake and ignorance around HIV was breath-taking. Now there are so many out LGBT people in the NHS, my own employer has an LGBT staff network. There were always LGBT people working in the NHS but its only in the last twenty years or so has it been a place where people can come out, especially lesbians and trans women. I'm so glad for that change. There are three more blogs in this series, the next two both came from a place of anger, the next was a very angry reaction, but the last came from a place of joy and change. Collecting them all together I wanted to show how things have changed, because that was the impression I got when I reread them all (They were written at the time they were dated). I have decided, since I started to post these, to write a sixth one, this time reflecting on this year's London Pride because something strange and amazing happened there. I have worked my whole nursing career in London and that is a very different place, but we do have the Metropolitan-effect in this country. Our big cities are liberal while outside of them is still very socially conservative, and people who don't fit in move (run) to the big cities. Unfortunately, it is still taking time attitudes outside of cities. I am so sorry about the treatment those kids receive, there's a few healthcare professionals I'd like to give some severe "clinical feedback" to. But change is happening. My brother is a Scout Leader in a Lancashire market town. He thrown one of the kids out of his Scout troop for being prejudiced. He told the kid, "My wife is Jewish, my boy is gay and I work with black people. You don't talk like that here. Get out!"

I'm so glad you haven't had any problems, that's so good to hear. The beginning of this blog was an act of revenge, I had to expose their homophobia when Freddie Mercury died. They were cruel and deeply homophobic, and they were training to be nurses. I was shocked, during my training, at how homophobic some of my colleagues were, but it was the 1990s. I am glad to say, the student nurses I mentor now, are very different and I don't see the same homophobia now.

Is our society still divided by class, is who you are born to still important or are we divided into haves and have-nots, especially in health and social care? This is the main thrust of Richard Wilkinson’s book. Wilkinson has collected together an impressive library of research into health inequalities, but this book is more than a catalogue of other people’s work. Coming from a social epidemiology background, Wilkinson analyses this research and puts it into a social context. This book doesn’t just look at inequalities in diseases and illness, it analyses the socioeconomic effects of these inequalities and how they impinge on many areas of human life. Wilkinson, in different chapters, illustrates the wide-ranging effects of these inequalities, the psychological and social effects and not only the effects on physical health. This doesn’t make for a comfortable read, but it is a book that can inform any field of healthcare. In 1980, the Black Report was published and exposed the shocking inequalities in British health. This book can be seen as one of the follow-ons from that. Unfortunately, as Wilkinson illustrates here, there has been very little change since then. Wilkinson’s tone is rather dry and academic, but don’t let that put you off because this book is a valuable insight into health inequalities. Here is an examination of the socioeconomic factors of ill health, going beyond a medical model. Also, it is worth its price alone for the library of research study references within its covers. Rating 4/5 (This review was originally written as a commission by the Nursing Standard magazine) Find it here on Amazon

Flower’s stand-up comic career is dead on its feet, Martha is pregnant but can’t remember who the father is, and Sarah’s slobbish boyfriend Billy has started to hit her. These three friends’ lives are intertwined by their friendship but they are also drawn together by Billy’s violent behaviour. Women friends rallying around together to support a friend in trouble is almost a staple of so much Chic-Lit, but Jo Brand takes this premise and turns it into a darkly comic novel. This novel doesn’t sparkle with coffee shops and boutiques, this is a much gritter world of pubs, dirty flats and dingy comedy clubs, and it really benefits from it. Here Jo Brand writes about a world that she knows well, her description of life on the bottom rung of the comedy club circuit is uncomfortably real. She also handles the relationships in this novel well, the friendship between the women and the nature of their relationships with their boyfriends. They all have the ring of real and messy relationships. This was Jo Brand’s first novel and she creates and handles her characters well. There are plot twists that are also handled well, the characters not reacting to them out-of-character and the characters not having insights outside of their characterisation, no one suddenly shows insight out of the blue. Her writing style does owe a lot to writing comedic material, the jokes often coming from the author’s voice rather than the characters. There are too many similes in her text; although many of them are very funny, they quickly start getting in the way of the story, and fewer would have been much better. The ending had an almost filmic set-piece quality to it, neatly tying all the plot strands. A messier ending may have suited the story better. This was a first novel, and many writers learn their craft in their first novel, but its quality does bode well for her other novels after this one. Find it here on Amazon

It’s the mid-1970s, Northwest London, and an old town house has been divided up into bedsits and small flats. In one of the flats lives Arthur Johnson, a dull middle-aged bookkeeper. A repressed and socially awkward man, who never learnt how to talk to women, he hides a darker and violent side, but he keeps it in check by strangling the “woman” hidden in the house’s cellar. Then Anthony Johnson, a doctoral psychology student in his early twenties, who accidentally shares the same surname, moves into one of the house’s bedsits. These two men’s lives collide as Anthony literally unearths Arthur’s secrets. This novel is Ruth Rendell at her best. The plot is seen from the point of view of Arthur Johnson and Anthony Johnson, but the other characters who populate the lodging house are just as lonely and dysfunctional as Arthur Johnson, yet their lives are desperate in different ways. But it is Anthony Johnson, in his innocent and almost naive way, who changes the equilibrium of Arthur Johnson’s life, causing things to spiral out of control and leading to violence and murder, in a dark plot that Rendell handles all too well. Here she captures the dark and grubby life of mid-1970s London; a world of corner shops, self-service laundrettes, overflowing dust bins and lack of amenities. What Rendell captures even more is the inner workings of a psychopath. Not just why this man wants to and feels he needs to kill, but also the childhood sadism that led to the development of his psychopath personality. She seems to know this far too well. This novel has a theme that Rendell would return to in many different ways in other novels, an innocent person accidentally and unwittingly setting off a chain of events that will lead to tragedy, but it is still a shockingly original novel with an unnerving portrayal of a psychopath. A novel to be read at least with the doors locked, if not the lights left on too. Find it here on Amazon

A Catholic priest is murdered on his way home, after hearing the confession of a dying woman. Mark Easterbrook witnesses a cat-fight between two young women in a Chelsea coffee bar, one woman pulling the other woman’s hair out by the roots. Later, he finds out that woman has died. Later still, he learns that his godmother’s name is on a list of dead people found on the murdered priest’s body, but she died from natural causes. Mark Easterbrook gets drawn into a world of spells, curses and murder for hire, where three witches live in a house that was once a pub called The Pale Horse. This novel is much more of an adventure mystery, rather than her usual murder mystery novels, the style of novel Christie developed at the beginning of her career and returned to periodically throughout it. Here the adventure centres around black magic and the supernatural, which was popular at the time in other novels, and a murder-for-hire scheme for people to “dispose” of unwanted relatives. This should be a great Christie novel, the murder-for-hire scheme is truly ingenious and her use of poison shows her old knowledge and skill for getting her details right where poison is concerned. Christie also captures the changing world of the early 1960s, it was published in 1961. She effectively captures the atmosphere of the beginnings of swinging London, especially in the description of a late-night coffee shop in Chelsea. She captures the changing nature of country life too. Unfortunately, the sum of this novel’s parts does not make up for its structural faults. The biggest problem is at the heart of this novel. Mark Easterbrook, the narrator for most of it, is too dull a character. He reacts to events around him, rather than initiating the action. He is supposed to be investigating a series of murders and yet so many of his leads come to him by accident or coincidence. The plot itself relies too much on coincidence, things coming together by accident. Easterbrook discovers The Pale Horse house, and the three witches who inhabit it, completely by accident. There are also detours away from the novel’s plot that seem to add nothing to it. A prime example of this is where Easterbrook and Mrs Dane Calthrop (a vicar’s wife who first appeared in the Christie novel The Moving Finger) discuss the nature of evil. This may have been fascinating for Christie to write but added so little to the actual story. Christie is to be applauded for trying something different this late in her career. She could have just churned out more Poirot and Marple novels, but she chose to write a different style of mystery story. The premise is certainly ingenious, it is just a shame that the plot isn’t tighter and the narrator more engaging. Find it here on Amazon

Betty Forbes has a handsome and well-dressed new husband, Graham. The problem is that Graham would rather watch Footballers with Their Shirts Off, on late-night television, than go to bed with his new wife. Graham does not want anyone finding out that he “isn’t the marrying kind,” especially his wife or his mother. This all generates a plot of sex, lies and blackmail in West Yorkshire. This short story is Alan Bennett’s take on a sex comedy; unfortunately, it is low on sex and the comedy often misses the mark. Bennett has always been best when he is writing about people he knows, people he has grown up with and/or lived around. Here he is writing about the new middle class, the people whose parents prospered under Thatcher and have now moved into the middle class, living in their new out-of-town housing developments (just don’t call them estates), and he just doesn’t know these people well enough to get under their skin and make his characters live. The characters here feel flat and the plot does not have the real feeling I am used to with Bennett’s writing. The characters feel as if they are there to serve the plot, rather than the plot coming out of their actions, and the plot just took one too many unrealistic turns. This story just failed to score a bullseye, though it doesn’t fully miss its target. Anything by Alan Bennett is worth reading, he isn’t the waste of time and effect I can feel trying to read lesser writers, but sadly this isn’t one of his top-level stories. It is a fun read but doesn’t provide the insight and depth that stories like The Uncommon Reader and The Lady in the Van did. Find it here on Amazon

In post-war New York, seventeen-year-old Grady McNeil is left alone in her parents’ expensive Fifth Avenue penthouse for the summer, while her parents holiday in Paris, before Grady’s season as a debutant. Once her parents are on their ocean liner to Europe, Grady ignores her older sister Apple and begins to run around New York as a free spirit. She has been carrying on a secret relationship with Clyde, a working-class young man from Brooklyn. Now her parents are gone she is able to turn up the heat on this relationship, ignoring the rich young man from her own social class who is also romantically interested in her. This is Truman Capote’s lost first novel, which might not have been finished, which could explain its very strange ending, and it was only discovered and published after his death. This is a very slight novel, both in number of pages and insight into its characters. Grady comes across as an overly privileged and spoilt young woman who seems to have little concern for those around her. Her relationship with Clyde feels more of a distraction than anything serious. Her behaviour, though not commented as such by Capote, feels selfish and self-centred, a distraction from her bored and privileged life. This book has nothing new or original to offer on this subject. There have been many other books about the gilded rich New York socialites, before and after this one, and several of them have offered much more insight than this one and have certainly painted deeper portraits of their characters. Is the problem here that Capote was writing about a world he wanted to belong to rather than one he knew about? Sometimes novels are unfinished or lost for a reason and it is best that they stay that way. I’m afraid this was the case here. At least Capote would go on to write much better books and they’re the ones we should read. Find it here on Amazon

Nick Nowak is back in three mysteries that follow directly on from the first book. It is the second half of 1981 and Nowak has three new cases to solve. Firstly, he is hired by a defence attorney whose client is refusing to help in his own defence. Next, he is hired to find the killer of a porn star. The last story sees Nowak searching for the only survivor of that most American of crimes, a serial killer. These are tight and involving mysteries and on their own would be interesting reads, but again the joy here is Nick Nowak’s life, which also fills these stories. He is now in a relationship with Detective Bert Harker and dealing with having a lover in the profession that has excluded Nowak. But he also has to deal with the return of his ex, Daniel Laverty, the first man he loved. Nowak handles this all poorly, doing the wrong thing as he realises he’s doing it. This makes the character all too real. He’s not a hero, he’s a real character and very flawed; he still carries a chip on his shoulder for the deeply homophobic treatment he received when he was thrown out of the Chicago police force. He also has a bad habit of sleeping with clients, witnesses and the wrong people. He is also the narrator of these stories and his voice is refreshingly original. These stories are firmly set in a time and place. Chicago is so prominent here that it’s almost an extra character. It is also set in 1981; Nowak and Harper discuss the emergence of AIDS in America via obscure newspaper stories about gay men coming down with strange cancers. Marshall Thornton has hit on a great detective story series with Nick Nowak, interesting mysteries, character development and a story arc for a personable narrator, with all his flaws. Fortunately, there are a lot more books in this series. Find it here on Amazon

Thanks, I enjoyed this book, and the white hot poker scene sticks in the memory.

Harry Starks is the quintessential 1960s London gangster, an Eastender, thuggish, violent, sharply dressed and homosexual, but he also loves Ethel Merman, Judy Garland and opera music. This novel tells his story from the 1960s until the early 1980s, portraying the changing face of London’s organised crime. In the 1960s he’s a racketeer, running cons and criminal corruption, but he has a pathetic desire for respectability too, first through his nightclub, at the wrong end of Soho, and then through foreign investments. By the 1970s he has become a porn king, but his crown is tarnished and grubby, with “bent coppers” snapping at his heels. In the 1980s it all catches up with him. This novel isn’t narrated by Harry Starks but by five different people from his life, in five different sections. They are the toy boy boyfriend, the disgraced lord, the petty criminal, the actress (the failed blonde bombshell) and the university lecturer. This isn’t an original idea but Arnott handles it with skill and insight. Each narrator has their own distinctive voice and a distinctive view of Harry Starks and his life, giving their own insights into him. But each narrator, in their own different way, is corrupted and changed by their relationship with Harry Starks. With this style, Arnott paints an interesting picture of a complicated character; Harry Starks is more than just another stereotyped Eastend gangster. This novel also paints a picture of a very changing world. Harry Starks is a crime boss, but his criminal empire is a changing one. The crimes he is living off at the beginning of the 1960s are different to the ones that make up his empire in the 1970s. With this changing world of crime, we’re given a window onto the changing world of London society in the 1960s and 1970s. This is a fascinating read and an equally interesting reread. There is so much here, both in the fictional world and the real world and real-life personalities that also make cameo appearances here. The description of Judy Garland in London, very much at the end of her life and her career, is so pathetic as to be heart-breaking. What is most memorable here, though, is the character of Harry Starks, a much more complicated and nuanced character than is usually presented as a crime boss in fiction. Find it here on Amazon

Back in 1986, Michael Nava published his first novel to feature the West Coast American lawyer Henry Rios. Over the years that followed, Henry Rios featured in seven novels and all of them have been highly readable and enjoyable. But Henry Rios is not the clean-cut, all-American male lawyer who breathlessly solves murders. Henry Rios is a defense lawyer who usually defends the underdog, but that is where the similarities end. Henry Rios is Mexican, from a forcefully working-class family and gay. Ghosts of a macho-abusive father and a pathetically Catholic mother constantly haunt him. For many years he was estranged from his lesbian sister (his only living relative). He is an AIDS-widow, having found and then lost his lover to AIDS over the course of these novels. His outspoken views have made him as many enemies as friends. This man has enough emotional baggage to fill an SUV. This man is a real character. He is everything Perry Mason wasn't. Rag and Bone is the last Henry Rios novel and so I started to read it with a heavy heart, so much had I enjoyed the previous novels. But this is a novel with which Henry Rios leaves the literary world on a high note. Rag and Bone opens with Rios collapsing, in court, with a heart attack. While he is recovering from this, slowly regaining his confidence, he repairs his fragile relationship with his sister, Elena. This leads to Elena telling him she had a child while in college and has not yet come to terms with her sexuality, so she gave the child up for adoption. Later, when Rios is home, his newfound niece and her young son turn up on his doorstep. She is on the run from the police, who want her for the murder of her husband. As Rios takes on her case, he also meets a man, John, a builder who was once married, with whom he starts a tentative relationship. The main thrust of this novel isn't the murder Henry Rios investigates; that takes second place to the main theme, which is the mid-life change he makes following his heart attack. It is also about him building a family around him, not the apple pie propaganda of the far right but a real-life family. Rios also becomes a substitute father for his great-nephew. Nava sensitively and insightfully writes about a middle-aged gay man finally coming to terms with his life and exorcising the ghosts of his past. He writes with great insight about Rios' heart attack, not just the medical details but also how it changes a person's priorities through 180 degrees. He also explores what it means to be a father figure/role model for a young child. Not least are the complex and alive relationships in this novel, they are more than mere plot devices, from Rios' rebuilding those with his sister and niece to the emotional minefield with his great-nephew and the tender but no less difficult relationship with his new lover. If you are looking for a tense courtroom mystery, this isn't the novel for you. If you enjoy a novel that explores how people react to unusual events in their lives, how their lives are changed and rebuilt, then I certainly recommend this novel. Find it here on Amazon:

This is a gay comedy of manners and that can be a genre. It is the early 1990s and Lenny, in his early twenties, is trying to find his way through gay London. He lives in a gay house share; he works as waiter at a restaurant and dreams of finding a boyfriend and a better job. He has run away to London from his suburban Evangelical Christian home; unfortunately, he might not be in Kansas anymore but London is certainly not the Emerald City. Lenny, the narrator here, is a likable and engaging character, quickly winning the reader over onto his side, making us root for his success. The humour ranges from broad to the very poignant, in some places lingering long in the memory. But the most memorable parts of this novel are when it turns dark and inward looking. Unfortunately, Robert Farrar does not make the most of these dark moments, exploring Lenny’s inner life when they happen. This novel did ask a question about sexual fluidity long before we were even discussing it. With this novel, Robert Farrar showed he was an emerging talent, certainly a writer to watch out for. Unfortunately, he only wrote one other novel and that is impossible to find. I don’t know why he stopped writing, but we lost so many writers like him when we lost all our small and medium-range publishers. At least we have this novel, but what would Robert Farrar have gone on to write? Find it here on Amazon:

It is 1979 and Alan Groombridge, the manager of a small, provincial town bank, has a fantasy. One day, he’ll steal all the money from the bank’s safe and run away from his suffocating life. A life with a wife and children he no longer loves and doesn’t even like. But he only gets as far as taking the money out of the safe, when he is alone in the bank, putting the money in his pocket, fantasying about where that money will take him, before putting the money back. Then one day, as he holds the money from the safe, the bank is robbed at gunpoint. But these robbers, Marty and Nigel, are almost comically inept; they end up taking the bank’s cashier Joyce and one other employee hostage and leaving with a fraction of the bank’s money. On a wild impulse, Alan runs away with the rest of the money to fulfil his own fantasy. This is only the premise of this novel. This is no comic story of a failed bank robbery but instead a downward spiral of four characters swept up in a moment’s bad decision. Ruth Rendell charts these characters’ lives and bad decisions with spot-on physiological skill; her plot comes out of her characters’ psychology rather than forcing them into her plot. She unnervingly captures the changing dynamics in her characters’ relationships, the shifting power dynamics. An illegally acquired gun becomes a lightning rod for the power between three of the characters, corrupting and ultimately destroying them. This isn’t a conventional crime novel, where a crime is committed and a detective must solve it. This is a novel about the effects of a crime, the effects it has on all the lives touched by that crime, the guilty and the innocent. Rendell wrote these psychological crime novels alongside her Chief Inspector Wexford detective novels and later alongside her Barbara Vine novels. At their best, and this novel is her at her best, these psychological novels are refreshingly interesting and darkly original, and several of them were her best novels. Make Death Love Me is an uncomfortably original novel and, if you have never read one, a good place to start reading Rendell’s psychological crime novels. Find it here on Amazon

I don't fully agree. I've never worked in aviation but I have worked in the NHS all my working life and my brother works in the nuclear power industry, so I have been able to compare my working environment with his. The big differences with the NHS is that it is seriously under staffed and is under a great deal of pressure from the government to meet their targets and requirements, including annual "efficiency savings" each year. 8.6% of all roles in the NHS are empty, that includes 5.8% of all doctors' posts and rising to 10.3% of all nursing posts. The only role that isn't short staffed is senior management and Trust chief execs. But the vast majority of empty posts are in patient-facing roles, people like me. It is hard to raise concerns when so much of your time is taken by making sure patients are safe and receive their required care. But even under these current impossible conditions, staff are still raising concerns. Clinical staff are very concerned to learn from all their experiences, it has been ingrained in us to do from the being of our training. For registered healthcare professions, reflexion on practice is part of our re-registration requirements. But the NHS is under a lot of government requirements and targets that senior management see as the priority because of their consequences. One example is A&E departments that have dangerously high levels of demand. If an A&E department closes to admissions, even if only for a short period, because they have more patients than they can safely treat (And it is only closed to ambulance admissions, who are diverted to other hospitals) then that Trust if fined by the Department of Health for doing so. The Trust is fined if their A&E Department is at Level Black, that's the highest level of alarm that their level of clinical demand is approaching a dangerous level, then they are fined. There are a lot of these targets that if a Trust doesn't comply with or breaches then it is fined. So senior management are under a lot of pressure not to breach them, or else a Trust loses money and Trusts' funding is stretched to the maximum as it is. Two of the biggest NHS scandals of recent years were because meeting targets was put above anything else, and those Trusts were also struggling with low staffing levels. The North Staffs scandal was, partly, because senior management were under a great deal of pressure not to breach A&E waiting times, so patients were being admitted from there as quickly as possible, often onto already over-full wards, that were under staffed. Staff raised concerns about this repeatedly but were ignored. Some senior management were even changing figures to reduce waiting times (Two senior nurses were struck off for it). The Shrewsbury and Telford Hospital maternity scandal was due, in part, to serious under staffing in their maternity department, especially with midwifes and doctors, and the culture of the Trust to meet Department of Health targets to reduce caesarean section. Therefore, caesarean sections had to be avoided at all costs, therefore putting mothers and babies at risk. Unfortunately, so much of the culture in the NHS is to meet or not breach the targets set by the Department of Health, because if they do it will cost them, and there are penalties for over spending too. This does not create a culture of openness. The NHS also has direct demands placed on it by politicians, to meet their own agendas, and if they are unrealistic there is nothing that can be done (The currents Secretary of Health has demanded a massive reduction in the Covid back log without any investment in more staff). There is also often a huge divide between clinical staff, those on the "front line", and senior management, it often feels that the two are working to completely different agendas. This too is a huge barrier to openness. All my nursing career, which is over thirty years, people from outside the NHS keep saying that the NHS needs to "learn" from the private sector. But you are comparing completely different organisations with very different objectives and environments. I would love a completely transparent environment in the NHS, then the public would see how bad and over worked and underfunded it is, but there is no political will for that. Last month the government voted down an amendment that require the NHS, every two years to have an independent workforce audit and the results be published, then everyone could see how under staffed it is. That was all the amendment required, to find out and publish how under staffed the NHS is, not even to act on the results, but that was too much for the government. I don’t want this to be a rant, and I’m not having a go at anyone, but I do want people to know how difficult the situation is.

Homophobia is a word used frequently in our media, but what is meant by it? The dictionary definition is fear of someone homosexual, but Julie Fish (senior lecturer and research fellow in social work at De Montfort University, Leicester) doesn’t think it goes far enough to define the discrimination faced by lesbian, gay and bisexual people. This is the argument behind her book. In her opening chapter, Fish argues for the use of the term Heterosexism for prejudice/discrimination against LGB people. Her argument is homophobia is seen as a personal fault, the prejudice of just one person, it doesn’t have the social/political element of sexism or racism and therefore can be marginalised as the fault of the individual and not society. Changing to the use of Heterosexism also encompasses this social/political element. This might not be a new argument, originating in America, but Fish firmly roots it in British culture and health and social care, making this book very relevant for British readers. Other chapters analyse LGB health care needs (not just sexual health), how stereotypes feed into discrimination (not just negative ones), the barriers to LGB research (why often there is so little published), why information on LGB demographics is often poor, examples of Heterosexism from research, and the last chapter is a review of the current government’s legalisation that affects LGB people and the way forward for social equality. Though coming from a social care background, Fish’s book has plenty to offer for nurses and healthcare professionals, especially challenging us in how we marginalise LGB people often without thinking. Though an academic, Fish’s tone here is straightforward and readable, not the dry and uninteresting tone that often creeps into academics’ writing. The main drawback is its price, which for such a concise book is high—which sadly shows how little faith the publishers have in it. My advice, if you can’t afford it then pester your Trust’s library until they get a copy. Certainly a must-read for all in healthcare. (This review was originally written as a commission by the Nursing Standard magazine) Find it here on Amazon