Dear Mr Aliyev,

I recently spent about 9 hours in your country and would like to make some comments about my experiences and observations.

Firstly, there was the extraordinarily complicated procedure for obtaining a visitor’s visa which I endured over several days in Tblisi, Georgia. I have visited some 120 countries around the world and have to say that getting into yours was the hardest,  probably akin to entering  North Korea. Consulate working hours of just 2 hours a weekday,  letters of introduction and photos to be procured elsewhere , payment for the visa only possible several kilometres away in an Azerbaijan bank. It was then required that I leave my passport for several days – this I was unable to do because I was intending to travel into neighbouring countries. On my return a few days later at 10a.m. I was then told to come back at 4p.m. when the long-drawn-out process would be completed .  Honestly ! All this for just a few hours in Baku.

I took the Azerbaijan Airlines morning flight from Tblisi which was fine, although serving a full meal on a 40 minute flight might be a step too far. Luckily there weren’t too many passengers.

On arrival at Baku Airport (oh, I do beg your pardon sir, … at the Heydar Aliyev International Airport) I was extremely disappointed to discover  there were no ‘left luggage’ facilities available which meant I had to lug my case around for the next few hours. Yours must be the only airport in the world with this problem.

After avoiding several aggressive taxi sharks a decent bloke took me via the fascinating Yanar Dag (where the custodians appear to know little about their ‘blazing mountain’) to the Old City of Baku.

I then walked for miles around the city – along the ‘Bulvar’, in my view a poorly designed indentikit effort at a French boulevard / promenade where hundreds of workers were tending their formulaic sections in some sort of Soviet-inspired utopian work ideal. I passed the world’s tallest flagpole (or is it the Heydar Aliyev Flagpole ?), the base of which was out of bounds to us mere mortals – perhaps the Aliyev dynasty mausoleum was being constructed underneath. Yet more workers tended unnecessary, over-engineered verge gardens on the ‘Heydar Aliyev Avenue’ out towards the airport.

It was somewhat galling to note that you have named Zaha Hadid’s rather fine edifice the ‘Heydar Aliyev Centre’ – is your family on some sort of power trip ? These vanity projects are an utter waste of your country’s oil money which you appear to be squandering willy-nilly.

Leaving your country was a bittersweet affair too. The good bit was excellent service in the departure check-in area. The bad bit was truly outrageous … my checked-in bag was taken aside for ‘additional security checking’. A security guard prodded around its contents before asking me to zip it up again. When I arrived home in England I was appalled to discover that this ‘security’ man had stolen 3 packets of Georgian cigarettes bought for one of my daughters. An absolute disgrace.

I gather Tony Blair does your public relations – a rather poor choice in my estimation. He pockets US$ 1.5 million per annum as Middle East Peace Envoy with a free flat in Jerusalem. Have you noticed his efforts to keep the peace in Syria.  No, me neither.

I was just a humble tourist in Azerbaijan who even on a brief visit noticed a vast dichotomy between all this ‘Heydar Aliyev’ stuff and the people at the periphery of your projects. Do you think Allah approves of your activities ?

Yours sincerely,

Jamie Summers

Your ref:  EH/LL449                                                                 Altenburg Gardens

18th May 1992                                                                                    London SW11

Dear Dr Vincent,

Thank you for your letter of the 13th April. There are several inaccuracies in the information you have gleaned. I would like to concentrate on the second paragraph.

Yes, I accept that my prescription was increased at the time of my admission due to my clinical condition. Shortly thereafter, in addition to the daily 800 mg of Largactyl, I was prescribed 80 mg of Droperidol.  My registrar. Dr Hillum. had gone away on holiday and the additional dose was recommended by Dr Vince alone on the basis of my ‘increased state of agitation’, namely opening the ward windows because the internal temperature was about 90°F. It is the unnecessarily large doses and particularly the mixing of these drugs that I object to. I repeat my allegation that in the private sector such practices are considered obscene.

You say there was nothing to suggest my white blood cell count was affected but the relevant blood test showed a level of 77.3% of neutrophils in the total. As my medical notes stated this is ‘considerably raised’. It was when the results of that test came through that I was informed by Ray, the duty nurse, that I quote, ” your white blood cell count has gone bananas and we are stopping your medication for a day or two”. There was never any suggestion that my drugs were stopped because the Droperidol had taken effect.

You say that Dr Gundy prescribes medication in accordance with the British National Formulary guidelines.  Although he was away on holiday for most of my time at Springfield I cannot let such a statement pass.  As regards Largactyl, the BNF states that ‘up to 1 gram daily may be required in psychoses’.  Dr Gundy admits to giving up to 2 grams daily.  Furthermore, the BNF states that ‘prescribing of more than one antipsychotic at the same time is not recommended’.  I suppose I was lucky to only get two, many patients get a ‘polypharmacy’ cocktail of 3 or 4 of these drugs.

About your other points, most patients and ex-patients would concur with my views on the lack of love and care shown by the staff, particularly on the acute wards. Naturally there are exceptions and on Bluebell I would nominate Simon Lancaster, Sheila and many of the night staff for praise.  As regards smoking in the staff room, the chief perpetrator was Dr Vince and although you say this would be taken seriously I somehow doubt it.

Yours sincerely,

Jamie Summers

Droperidol was withdrawn from use some 10 years later – considered too dangerous to use on horses let alone humans.

Dr Gundy was dismissed from his role as consultant psychiatrist due to alcoholism – one wonders if father and son Vince are still practicing ? 

Our ref:  EH/LL449                                                                      Harewood House

61 Glenburnie Road

London SW17 7DJ

13th April 1992

I am writing in reply to your letter to Virginia Bottomley dated 28th December 1991 which was received here at the end of January. I apologise for the delay in replying but you raised a number of issues which required a comprehensive investigation.

You are correct ion saying that your medication was increased at the time of your admission to Bluebell Ward. The dose which you received was prescribed by a doctor in the light of your clinical condition at that time. There is nothing to suggest that your white blood cell count was affected but your medication was stopped temporarily once the sedation due to droperidol began to take effect. This is common practice, I am unable to comment on treatment given to other patients but Dr Gundy prescribes medication in accordance with the British National Formulary guidelines.

I am sorry that you were not happy with the standard of food provided. The quality of catering is regularly reviewed by the Mental Health Unit and comments as to how this might be improved are welcomed. There is a problem with maintaining adequate provisions in the cupboards. It is difficult to maintain a balance between allowing full access to provisions for all patients and rationing, to ensure supplies remain, which does involve less freedom of use. Staff have to use their discretion to ensure everyone has a fair share. I’m sorry if stocks were temporarily exhausted on the day you arrived. Any food which remains after a meal is thrown away to comply with environmental legislation.

Bluebell Ward does have rules with regard to smoking and non smoking areas. These were agreed by the patients and staff in the light of the Health Authority’s smoking policy. Staff are equally bound by the ward policy and if any of them are seen to flaunt it, this would be taken very seriously. As you are not specific about the incidents you describe the managers in the Unit are unable to take further action in respect of this now. The bathroom and utility room are locked at times when nursing staff believe that they are unable to give adequate supervision of these areas but if at any of these times a patient wishes to avail themselves of these facilities they would not be denied access unreasonably.

I understand your concern with regard to incontinence experienced by elderly patients on the ward. Staff do make every effort to maintain a high standard of hygiene and certainly are expected to change sheets as necessary. Without information about a specific incident the Managers have been unable to identify a specific instance that matched your description. With regard to the overall cleanliness of the ward there is a specification which the domestic staff follow and I understand that monitoring on Bluebell Ward shows they do this particularly well.

I am sorry that you perceived a lack of love and care on the ward as the staff there regularly demonstrate their commitment to a caring and sensitive approach to the treatment of their patients. I apologise if you feel the service was not offered to you in an acceptable manner.

I regret that overall your experience of admission to Bluebell Ward was such an unhappy one. I do however appreciate your bringing these concerns to my attention and believe that the Mental Health Unit will continue to keep the standards of care they provide under review.

Yours sincerely,

Dr Enid Vincent

Chairman

Wandsworth Health Authority

c.c. Virginia Bottomley

Your ref: POH(2)1701/418                                                 Altenburg Gardens

7th March 1992                                                                              London SW11

Dear Mrs Bottomley,

Thank you for your letter of the 27th January replying to mine of the 28th December and I presume my ‘chaser’ of the 16th January although you made no reference to this second letter.

Whilst I accept your comments that decentralisation of the NHS has transferred power from Government to the local health authorities I regret this seems to have done little to speed the wheels of reform. You promised to send a copy of my first letter to the Chairman of Wandsworth Health Authority, Dr Enid Vincent and I am sure you did so, but I have to inform you that after some 6 weeks I have yet to receive any comments from her. Perhaps a reminder from you might hurry her up ? I would very much like to meet her personally to air my grievances, and those of current patients at Springfield.

I am currently preparing an article which has been promised national newspaper coverage highlighting the heinous practices of ‘megadosing’ and ‘polypharmacy’ so much in vogue at Springfield, together with the disgraceful lack of care and respect exhibited by the majority of doctors and nurses. One suspects this is a nationwide phenomenon and I hope you will devote more of your time in the future (re-election permitting !) to improving conditions for these downtrodden and forgotten human beings.

Looking forward to receiving Dr Vincent’s reply,

I remain, yours sincerely

Jamie Summers

Thursday 16th January 1992                             from  Springfield Hospital                                                                                                           61 Glenburnie Road

London SW17 7DJ

Dear Mrs Bottomley,

I wrote to you 19 days ago on matters of great import concerning your department and have not received a reply, not even a cursory “Mrs X thanks you for your letter and has noted its contents”. Perhaps you dismissed my words as the ramblings of a mental asylum inmate and binned them ? A brief phone call to Carole and Andrew, your friends, would have sufficed to allay your doubts, but no, you chose to ignore my letter. Well, I have more to say – should you require a copy of my earlier epistle please do not hesitate to ask.

My comments of 19 days ago still hold true and far from improving, the general situation has indeed deteriorated since then. Just 3 days ago for our breakfast there was no tea, no coffee, no butter, no margarine, no bread and no sugar – please think of us sometime over your muesli and poached egg won’t you ? Whilst I am delighted to report that I had my second change of sheets this morning in 5½ weeks  I regret that they were unable to provide a clean duvet to replace my existing one which reeks of stale urine (not mine either). The washing machine which conked out soon after Christmas has fortunately just been repaired – thank heaven for small mercies.

More importantly I have to mention some individual cases which must come under your aegis as number 2 in your department. The most horrifying was the man at Springfield who around New Year’s Day started getting severe chest pains – an ambulance was called and he was driven down to the nearby St. George’s Hospital, I hope you know the one, it’s your showpiece NHS hospital for South West London – you’ve closed most of the other ones. On arrival he was turned away because the doctors there don’t want the loonies from Springfield on their wards. I have to report that he died in the ambulance on the way back. I quote your boss speaking on the 14th January … “more and better care is being extracted from the resources available and in a more efficient manner”. Oh yes, Mr Waldegrave ? One expects more from Eton/Christ Church men, let alone fellows of All Souls. Why does he tell such porkies and massage his facts ? We all remember there are lies, damned lies and statistics … his reforms are working well are they ? Not here they aren’t.

Let us move to the private system. BUPA not only won’t pay for my stays in mental hospitals but I understand now they won’t pay for any psychiatric care whatsoever. I assume private hospitals do come under your remit as well ? Being connected to health as they are, although I am told extracting money from them for treatments received often causes more anguish than the illness itself. I have another medical case to bring to your attention and the name may well ring a bell with your husband. A close friend of mine called Mark Faber, who was about your husband’s vintage at school and played cricket for Sussex in Tony Greig’s era, undertook a fairly routine operation to remove a varicose vein that had troubled him for some years. This was about 12 days ago … something obviously went wrong in the operation, Mark screamed in agony but no doctor came for one hour and he died. And that is the private sector.

Back to Springfield – why is it that these human beings are denied access to non-psychiatric doctors ? They suffer from physical ailments just like you and I and yet their G.P.s become non-persons once they have crossed this threshold. There is a lady here who is 64 but looks 94 (you should see the cocktail of drugs swilled down her throat every night), she is incontinent at both ends, she slobbers continuously, her clothes stink permanently, she has a gout-like swelling on one ankle and her lungs are feeble. This is long-term care under your blessed NHS. She has no teeth and consequently is nigh impossible to understand, she can’t even eat a sandwich without spewing it out. There is a dentist on site, some 300 yards away who could fix her up with some dentures but does he move ? No. She needs a doctor badly, not a shrink, or she will die soon.

I reckon someone could present a good case against your department for gross negligence or at the very least driving without due care and attention. I am sure it is now possible to sue the government; there is that wise man who is currently tackling Norman Lamont and his team at the Treasury. He followed government advice regarding small businesses for 11 years and eventually went broke – well I could have told him a thing or two about your counterpart at the Treasury, John Patten, who came as a supply teacher to Eton in my time. I well remember his lectures on the economics of imports/exports which were so nonsensical they were almost farcical. What a dismal science it is. And if that man has reached such an exalted position in government, God help the rest of us ! My apologies for being somewhat rude but one can’t help becoming angry in a place like this.

By the time you get this letter you will have had 3 weeks to muse over the first one and had it been an electricity bill you probably would have been cut off by now. I want to see some action, and I want to hear some truths from you and Mr Waldegrave – no political double-dutch, no side-stepping the facts.  None of this “the NHS is safe in our hands” lark because very clearly at the moment it isn’t.

This is my last time of asking. I want answers.

Yours etc.

Jamie Summers                                                                              c.c. Bernard Levin

Reply from Virginia Bottomley, 27 January 1992:

Here begins my saga of trying to complain about treatment in the NHS.  Eventually I got absolutely nowhere but to start with I went straight to the top …

Saturday 28th December1991                          from Springfield Hospital  61 Glenburnie Road
London SW17 7DJ

Dear Mrs Bottomley,

Allow me to introduce myself. My name is Jamie Summers, age 37½, educated Eton College and Christ Church, Oxford (14 ‘O’ levels, 3 A grade ‘A’ levels, 2 S levels). I believe we have a connection – my brother-in-law, Andrew Ingram is I think godfather to one of your children (very good choice).

Firstly, a brief summary of my personal predicament. Nearly three weeks ago I voluntarily admitted myself to the above establishment on the instigation of my wife, Sue, in order to ease the pressure on her mind caused by my somewhat restless and sleepless behaviour. Armed with a prescription from my G.P., Michael Gormley (who also looks after most of the Royal Family, not to mention the members of the group, Genesis), I presented myself at Bluebell ward under the auspices of my allocated NHS doctor, a man called Jonathan Hillum. Without my knowledge or consent, Michael’s prescription dosage was immediately almost tripled and administered – this being that favourite toy of the psychiatric profession, namely Largactyl now called Chlorpromazine. Two days later, when this cosh was not having (in their eyes) a sufficiently stultifying effect on your’s truly’s brain a second doctor, one Dr. Vince, without even consulting Dr. Hillum, who was absent, decided to give me 80 mg of Droperidol liquid – I would here like to point out that the maximum dose given by Desmond Kelly and his team at the lovely Priory in Roehampton Lane is 5 mg at any one time …  I was pole-axed for 10 hours, stiff as a floorboard from the neck down. Anyway, blood had been taken (yet again) and glory be, when the analysis came back, I was told by a member of the night nursing staff that they were worried because my white blood cell count had increased dramatically and that I was to be given no drugs at all for two days (yippee !). This white blood cell problem is usually due to some infection but in my case had clearly been caused by massive over-prescription of these dangerous drugs, as I am not a sick person by nature and have never taken antibiotics in my life.

Two days off these substances gave me sufficient breathing space to recover my senses and to assert my rights in refusing to take them. Thus for the past 12 days or so I have simply taken 800 mg of Lithium Carbonate (Priadel) at night as I have done religiously for the past 19 months. I have been able to view the system dispassionately ever since.

Enough of my story. I hope, nay I am convinced that you are of as compassionate nature and will take it upon yourself to come and see some of the evils that are masquerading as care in the rotten apple that is psychiatric medicine in the National Health Service. Perhaps you and your boss, Mr Waldegrave and your underlings have been concentrating your energies on the normal hospitals, but your eyes and ears are needed here.

Let us start with the quality (sic) of the food. Perhaps Caroline Waldegrave could take an interest here – I hear she knows her onions ! When I arrived the cupboards were nigh bare – oh, the staff have their cosy little locked cupboards full of reasonable things but us patients/animals for our hungrier moments had little. For 10 days there was no sugar, no butter – only the lowest form of ‘spread’- then the cheapo powdered coffee and the tea-bags ran out and were not replenished. The bread was the pappiest form of white trash available – any salad left over from ‘supper’ (at 6 p.m.) is generally thrown away vindictively by the staff. Fruit ? There might sometimes be 5 bananas or oranges between 28 of us.

As for the regular meals dished out from the kitchens ¼ mile away I would not deign to feed pigs or rats on the stuff. The mashed potatoes look tainted, the vegetables are boiled dry of nutrients, the meat if any is poor poor quality and our boiled eggs at breakfast are regularly done to a turn of 17 minutes – marvellous for everyone’s bowels ! Since I arrived I have done my utmost to upgrade this miserable diet with injections of fruit, butter, cheese, mayonnaise, marmite and loaves of my own bread – you see I am a wholesale baker by trade, We are what we eat after all.

Secondly, one must comment on the nursing. As in all things there is good and bad, but regretfully I have to report that predominantly the curtain falls on the distaff side. People crying in pain for help are left smirkingly to flounder on the floor, pleas for aid go unheard … ” no, I’m busy” is a favourite excuse. Vomit, shit and urine are left to be smeared around the ward. There is little love and care here. Petty rules abound; the kitchen, bathroom & washing/utility room are almost permanently locked and out of bounds to the ‘loonies’ – smoking is confined to a sauna (the radiator is jammed on) and the dining/play area, and yet the staff and doctors flaunt their own no smoking sign in their office, the hypocrites. Us patients do 90% of the nursing of our elderly co-sufferers – the incontinent ones  often awash in their own urine and faeces slumped on their soiled and never-changed sheets. I am not over-painting my canvas.

As for the doctors here I shall name names. I can only speak about those I have met here on the ward and compare them with the doctors I met almost 12 years ago in the Priory and more recently briefly 19 months ago before the money ran out (it’s £400 per night now privately) and BUPA, bless their little cotton socks, won’t pay for my stays in these places. But I digress. The chief rottweiler in the pack of Wandsworth hounds is a man called Greville Gundy who has been in this game for many years (he featured in Jonathan Miller’s recent madness series). Nearly retired now, he has been pushing drugs down people’s throats with relish for ages – not long ago he gleefully told me that he has prescribed 2 grams per diem of Largactyl to some patients. Let us take this in context – Desmond Kelly probably wouldn’t give anybody more than 300mg per day possibly half that – so we are talking 7 or 8 times the doses meted out under the private system. It is like taking 10 paracetamol or aspirin at a go – not good for the liver or the arteries as I am sure you will agree. Does he want the animals to become vegetables ?

Second in command are his lieutenants Hillum, Vince and Potter. Of these only Vince incurs my wrath, probably because of his spiteful treatment of yours truly not to mention others under his ‘care’. If only the doses of these terrible body-shaking drugs, which I believe are desperately expensive anyway, were reduced to a palatable level or better still switched to more natural remedies available then the money saved could be reallocated to give more nursing staff, better wheelchairs etc.. Excuse my Bernard Levin length sentence !

One last gripe concerns the lamentable cleaning staff – a cursory wipe here and there simply ain’t good enough – new brooms are needed.

Please let me know your views.

Yours faithfully and sincerely,

Jamie Summers                                                                              c.c. Bernard Levin