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The Gift: New Writing for the NHS
  1. P Wainwright
  1. p.wainwright{at}

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    Edited by D Morley. Stride, 2002, £7.95, pp 261. ISBN 1-900152--1

    The Gift is an anthology of writing, prose, and poetry, commissioned by David Morley, who heads the Warwick writing programme at Warwick University, in the United Kingdom. It includes 114 pieces, some from professional writers, others from National Health Service staff who took part in writing workshops with the editor, and one from the editor himself. The professional writers include Dannie Abse, Hanif Kureishi, Doris Lessing, Fay Weldon, Tom Paulin, and many others. Much of the work is excellent. It is arranged thematically, progressing from birth, through growth, and the process of illness and death. It was produced as a joint project with Birmingham Health Authority and a copy given to every member of National Health Service staff in Birmingham, UK—31 000 copies in all. This, according to the preface, was to “celebrate the NHS workforce in Birmingham, to acknowledge the role they all play in this endeavour that is so much part of all our lives”. Ironically, less than one year after the publication of the book, the Birmingham Health Authority ceased to exist, having been amalgamated, in the most recent NHS reorganisation, with neighbouring authorities in Dudley, Solihull, Walsall, and Wolverhampton to make one of the new Strategic health authorities.

    David Morley describes the book as “writing as an act of community, even solidarity” and this is a book with aims and objectives, with purposes. This may be fitting for a project involving the management of the National Health Service, but as with so many products of NHS management, when you try to probe the mission statement for meaning there is a slightly uneasy sense of things half glimpsed, half grasped in the gloom, but slipping away from you without ever quite revealing themselves, never quite taking form. What kind of community is it that consists of 98 writers, ranging from the poet laureate to a specialist nurse in Birmingham, and who come from all over the UK, and from North America, France, Germany, Pakistan, Guyana, and Australia?

    What kind of solidarity do such people share? How much do they have in common, other than the fact that they write? In a sense, of course, being a writer is sufficient to make one a member of a community, of writers, and to invite one to express solidarity with one's fellow writers, but I suspect that was not quite the kind of community or solidarity that David Morley was trying to claim.

    At first sight, one is led to believe that a substantial proportion of the book will be by people who work in the NHS. Morley tells us that the contributors include “not only authors such as Doris Lessing, Fay Weldon, Hanif Kureishi and Les Murray, but also staff in the health service . . . . Writers in the NHS worked with me on new writing . . . in workshops at Warwick University or via email”. Morley sings their praise: these NHS writers, “they are a force: read their writing” he tells us. But they are a pretty small force—on closer inspection we discover that of the 98 contributors, only nine could be described as not being professional writers, but simply part of the NHS workforce. Of the 89 professional writers, many names are familiar, some not so. But from the biographical notes supplied, it is clear that their collected novels, plays, and volumes of verse would fill a decent library and their collected prizes and awards would make a substantial trophy cabinet. We have the poet laureate, we have “one of the greatest living British poets”, we have “Australia's leading poet”. And we have, necessarily, a different kind of book.

    This is a book with a mission, a purpose, and ideas. The first purpose is “to produce a book of literary merit that stands on its own”. There is no doubt that the content has merit, each piece by itself, but whether the book as a whole has sufficient merit to stand on its own, and whether it is a whole, is more difficult. And the problem is that it also has other purposes. “The second [purpose] is celebratory”—the book is to celebrate the 50th birthday of the NHS and to look forward to the next 50 years. And still more purposes—“the book wants” (if a book can have “wants”) to give the NHS workforce “something which is serious, entertaining, permanent, meaningful, and articulate”, that might “inspire medical workers to reflect on how people who use their service feel and think about their experiences” and encourage them “to find little or big things that they can do or change to make a difference to the human dimensions of the NHS”. It may sound uncharitable, but reading this my heart sank and, metaphorically at least, I wept for all these fine writers commissioned to produce what turns out to be propaganda, one more tool in the quality assurance strategy, an instrumental good, a means to an end. There is a clue in the Preface, in which Alan Wenban-Smith, the (then) Chairman of the (then) Birmingham Health Authority, tells us that in 2001 “the government asked all who work in the NHS to spend time finding new ways of thinking through how to ensure that the service develops and grows to fit the requirements of a new Century as set out in the National Plan for the NHS (the exercise was call Local Modernisation Review)”. This book was one outcome of that activity.

    Much of the work in the collection is very fine. At times the connection to the National Health Service is very direct and obvious, at other times it is tenuous to the point of obscurity, but that is as it should be. In a real and important way, the NHS is superfluous to the writing in this book. If it is good writing, that is because it engages with some experience of life and succeeds in communicating that experience, with some force, to the reader. But health and wellbeing are so central to any literary account of the experience of life that to justify it, as Wenban-Smith does, on the grounds that “much of the quality of people's experience of the NHS . . . is about the human dimensions of giving and receiving care” and that creative writing can encapsulate this in a way that is “more meaningful than managerial exhortations!” is rather to miss the point. Almost anything could encapsulate the quality of human experience and the human dimensions of giving and receiving care more meaningfully than managerial exhortations—be it Proust or Thomas Mann, or Agatha Christie, Casualty or EastEnders. The paradox is that to take a piece of literature or a work of art and turn it to some purpose is to turn it, in that context, into something else, of (supposed) instrumental value. The fine writing in The Gift thus seems reduced by the act of compiling it and giving it to all the people working in the (former) Birmingham Health Authority. Each piece on its own is fine but the book becomes just another managerial exhortation.

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