The wonderfully uplifting and generally obstetrically sound BBC series Call the Midwife has got Dr No worried. Playing catch up on the current series, he worries about the way the plots are getting more extreme, as if the writers, lacking the discipline of Jennifer Worth’s now expended memoirs, have decided to go commando. We’ve already had outbreaks of diphtheria, syphilis and rats: will bubonic plague be next? Or will it be World War Three? Dr Turner is burning out and booze has crept up on Trixie: when will the sponge-o-cidal Sister Monica Joan’s magic mushroom habit be exposed? Is unflappable Sister Julienne unflappable because she smokes cheroots behind the bicycle shed? Having put her back in a nurse’s uniform, will Dr Turner’s wife Shelagh now be transformed, Dennis Potter style, into a Singing Receptionist, complete with leather crop and corset? Will Dr Turner’s stress trigger a bout of crippling psoriasis? Such are the possible alarming developments on which Dr No frets.
Some of the snootier upmarket broadsheet reviewers – the ones the get the wood on Wood Hall, the black screen adaptation of a Booker Prize winner where much of the acting is limited to Cromwell’s eyebrows going up and down, like the channel bars on a stereo recorder with the speaker muted – tend to look down on Call the Midwife’s cockle warming – in the musical Oliver! way – spirit. When will the nuns start singing Food Glorious Food at Compline? Why not welcome new staff – and on new staff, where the hell is Honeysuckle Weeks when you most want her – with Consider Yourself (one of us)? Come to think of it, the whole thing could be reinvented as a musical: The Sound of Midwifery. Sixteen Weeks Going on Seventeen, Climb Every Contraction, it’s all already there. No reviewer, though, has yet gone as far as to borrow Clive James’ 1976 take on Demis Roussos, with talk of ‘immense reserves of inner warmth, as in a compost heap’, but it may yet come it, as for some time Vanessa Redgrave’s opening and closing homilies have been revealing worrying signals of vast reserves of inner warmth; but for now Dr No is content to have his winter cockles warmed.
There are many levels on which Call the Midwife works. On one level it is an iron fist in a latex glove, hard-hitting social commentary on post war Britain wrapped up in Sunday evening fluff. On another, it is about convent-fever, the condition caused by housing a bunch of feisty same sex characters under one roof. On yet another, it is about stoicism in the face of adversity. Long before Barack Obama borrowed the phrase, the nuns and nurses of Nonnatus embodied the spirit of yes we can. And it is because they do that our cockles get warmed.
The NHS of Call the Midwife is the NHS Dr No was born into. The NHS Dr No trained in is closer to Call the Midwife than today’s NHS. We knew the NHS cost money, but the shadow of the market had not yet fallen. Commissioning was for the Armed Services, not the health service, and pathways were for walkers. The perfidies of purchaser-provider splits, and the flummeries of bean count flannel were as yet unimagined. Instead, we just got on with it, and did what we could, because we could.
Some but not all of Dr No’s own recent experience of the NHS, and tales he has heard from others, suggest the yes-we-can NHS has become too often a no-we-can’t NHS. A few years back Dr No had to give a talking protocol disguised as a radiographer a poke in the eye to get a chest x-ray he was due. He has described elsewhere on Bad Medicine some of the NHS misfortunes that befell his mother in the last weeks of her life. The internet is awash with dossiers of NHS despair, too many with a common theme of no we can’t. The freedoms of professional practice – yes we can – have given way to the prisons of protocol, the world of no we can’t, the computer says no.
But yes we can is still very alive. Earlier this week, Dr No attended an annual review appointment at his local hospital. In the weeks before the appointment, he had developed unrelated symptoms of concern, in so far as cancer was an unlikely but possible diagnosis, that came under the same specialty. Being new, the protocol pathway – or it may have been the pathway protocol – mandated a new separate referral. Still, here was Dr No, in the right clinic, at the right time. He decided to ask, despite fearing a no we can’t, you need a new referral reply, whether the doctor would consider the new symptoms. The answer? Yes we can! And quicker than one can say local anaesthetic, Dr No got the necessary examination, which he is pleased to report was clear.
This is superb service, an agile smart and supple health service doing what it does best, looking after patients. Dr No suspects he crashed a pathway, and may even have caused somewhere in the bowels of the hospital a protocol pile-up. But so what? The patient got looked after, mountains of paperwork and aeons of delay were avoided, and both doctor and patient were content. All because one doctor took the old line: yes we can.