Druin Burch

These days I barely know what my own handwriting looks like; about my friends, the knowledge is all but lost. Seeing their pen strokes has grown rare. But, for a brief period each winter, that odd intimacy returns as Christmas cards – some with messages, most with just a scribbled name – land on my mat. I adore receiving cards. Even ones from people I cordially dislike, or frankly loathe, are welcome There used to be something exciting about the sound of the postman’s footsteps, of letters being pushed through the door, of their thump as they landed within. That was during the days when there was a great deal of post. Even then, unexpected letters from old friends arrived rarely and, strange to say, the endowment begging me to write full time never arrived at all.

'Moaning Minnies' is how the Health Secretary Wes Streeting has described GPs opposing his rollout of online appointment booking. Originally, that moniker referred to German artillery pieces – and it’s pleasant for a doctor like myself to imagine we still possess that sort of firepower. But Streeting meant that the British Medical Association’s GP committee, which he has accused of undermining the attempt to make primary care more accessible, are a bunch of whining complainers, rather than us ordinary doctors. So, is Streeting right? General practice, as everyone is painfully aware, is in trouble. Except in a shrinking minority of places, the old model that made it so valuable is dead.

A research letter in the Future Healthcare Journal, laying out the scale of performance failings in the NHS, has attracted a lot of attention today. It has shone a spotlight on the fact that, to fulfil its pledge to voters to reduce waiting times and 'fix the NHS', Labour must somehow find a way to cut the health service's treatment backlog in half. The research explains that the NHS has a constitutional requirement that 92 per cent of patients must wait no longer than 18 weeks for treatment after being referred by their GP. That target was last met in November 2015. At that point, the total national waiting list was 3.5 million. By the end of 2024, it was 7.5 million.

Until Tuesday, I’m once again working as a junior doctor: trying to remember how to take blood, print labels, and manage being bleeped by three wards at once, two of them by mistake. For my troubles, I'll be earning £200 an hour – a rate far above standard consultant overtime. I'm taking a fat fee from the NHS to fumble through chores a junior could do better. As you spend hours waiting to be seen by an overstretched medic moonlighting as a junior, remember this: the strikes are completely avoidable Yes, junior doctors are on strike again – and the depressing thing is how preventable this walkout is. No money was needed; the NHS could have avoided the costs and harms of the strikes, and even come out ahead. That it didn’t is a fine example of how Britain contrives to fail.

The generation that fought in the First World War is gone, and the days are closing for those who served in the Second. Since I started as a doctor, one of the standard questions, to check whether people were oriented, has been to ask them the dates of World War Two. In the past few years, for the first time, I've met people who look outraged or indifferent, saying they couldn't be expected to know. What was once a universal cultural possession has, for them, become trivia. Something has happened to the way we mark Remembrance Day The question used to yield remarkable stories, but it has been years since I met anyone for whom it brought back memories. I stand to meet no others. History moves quickly: the generation that stood for freedom is almost gone.

It is strange to see Maccabi Tel Aviv fans banned from a Villa match because the British state won’t protect them from Islamist mobs. I grew up in Birmingham – my formative under-age drinking took place by Villa Park – and it was a more racially mixed environment than any other I’ve come across outside my NHS work. Although I was Jewish, I never felt threatened. My experience of Birmingham – which might not have been yours, but was nevertheless mine – was of a city with a high degree of racial harmony. I thought the cracks I saw at 16 were superficial, that medieval impulses had no real purchase on my friends' lives. I was wrong This was in the 1980s.

Party conferences are less about conferring than about speeches and announcements. Today Keir Starmer revealed NHS Online, a virtual hospital of vast scope and wonderful promise. Patients will be able to swiftly connect to clinicians at a time and place to suit them. NHS Online, said Starmer, demonstrates that Labour favours 'renewal', while Reform only pursues the 'politics of grievance'. Grievance is a miserable trade. Presumably it wasn’t grievance that led Starmer to call Reform's policies racist and their supporters – if not racist themselves – too stupid to understand what they were backing. Insulting Reform voters is always likely to land well at the Labour party conference, although it’s not an obvious route to winning those voters back.

Reform’s proposal to scrap indefinite leave to remain for foreigners is racist, according to Keir Starmer. 'I do think it's a racist policy,' the Prime Minister told the BBC yesterday. 'I do think it's immoral – it needs to be called out for what it is.' Removing people who were here legally, he said, was wrong. That’s a reasonable stance for a lawyer, but odd for a PM, whose role isn't compliance with the law but deciding what new laws should say. Starmer is wrong about Britain. We live not only at the least racist point in history, but in one of the least racist countries in the world Supporters of Reform are not themselves racist, Starmer was quick to say – merely 'frustrated' by 14 years of 'Tory failure'. But the Prime Minister could soon regret his remarks.

NHS England has today introduced Jess’s Rule, asking doctors to take a ‘three strikes and rethink approach’. The rule is named for Jessica Brady, who died in 2020 aged 27, having had more than 20 appointments with her GP surgery in the six months before her death. Mostly seen virtually – a fact attributed to Covid – she eventually went private. There, her terminal cancer was belatedly diagnosed. She died three weeks later. Discussions about Jess’s Rule began under the Conservatives and have come to fruition under Labour. Both parties have shown an unshakeable commitment to taking a serious problem, highlighted by a tragic death, and turning it into performative bureaucracy which won’t fix the problem it pretends to honour.