Putting Ability into Accountability

On the back of the Marble Arch Hill disaster, Mike Bodnar wants to see those in charge of huge infrastructure and vanity projects held to account…

London is hopeless. Not the city itself or its lovely notable bits – give me an ancient alleyway, historic pub or the Tower of London any day – no, I’m talking about bureaucratic London, the one that looks to spend taxpayer money on public works. Because very few of them work as planned, or open on time, and some don’t even reach completion.

The value of the mound has dropped. Image: The Guardian

The latest debacle is the Marble Arch ‘hill’, a frivolous folly rooted in good intentions that has suddenly closed after three days due to its universal unpopularity. Online memes suggest the Teletubbies’ mound was better executed, while even the media has called it ‘crap.’ One woman who paid her £8 to climb to the top said it was the worst London attraction she’d ever experienced.

It was supposed to give unparalleled views of inner central London; instead it has given us a clear panorama of wasted taxpayers’ money - all £6 million of it - stretching to the horizon.

But that shouldn’t be a surprise since none of the other recent proposed taxpayer-funded attractions or infrastructure projects have resulted in overwhelming approval, or completion.

The dream: the Garden Bridge. Image: Heathwick

Four years ago former London mayor Boris Johnson’s proposed garden bridge over the River Thames was abandoned after five years of hype with not a single bucket of concrete poured. The total cost? A staggering £53.5 million, of which about £43 million was from the public purse, according to an inquiry by Transport for London (TfL). Worse, it is now costing a further unbelievable £5.5 million as part of a ‘cancellation agreement,’ so the bridge spans the gulf of incredulity from one side to the other if nothing else.

By now, July 2021, I should, in principle be able to travel in some luxury and great convenience across London and out to Heathrow in under an hour via the Crossrail Elizabeth Line. I should have been able to do this for the past two years, but I haven’t because it’s still – after ten years since its inception – not finished.

Crossrail. Or not. Image: The Guardian

It could be argued that when it does finally open it can at least begin to recoup some of its cost (unlike the Bridge of Nothing to Nowhere), except that to date that cost is over £18 billion, which in itself is about £2.5 billion over budget. Yes billion, that’s not a typo. Okay, it’s apparently Europe’s largest infrastructure project, but that doesn’t excuse the ineptitude of those responsible for it, including Mayor Sadiq Khan who has been accused of taking too much of a ‘hands-off’ approach to it.

Should I mention HS2, the much-hyped fast rail connection between the north and south? Should I note the original proposed cost of £32 billion then became £55.7 billion which then further escalated to £88 billion in 2015? It now currently stands at an estimated £107bn, a figure not unreasonably suggested by Lord Berkeley, former deputy chairman of the government's independent review into the project.

We may as well just do some Swedish rounding right now and call it £200 billion by the time it’s finished (yeah, sure) in the 2030s.

High Speed 2 (HS2). Image: City A.M.

The problem we have here is unaccountability. Those in public office at the time of origin of such fantasies tend not to be in power later, and therefore escape the net of inquiry. There are few checks and balances, and public inquiries after the event are toothless in apportioning blame and – especially – recovering wasted money.

Imagine for a moment that you or I – normal everyday individuals – wanted to take out an extension on our mortgage. Do you think for a moment that the bank will agree to it without first going into extreme detail about our income plus the value of the property plus our equity in it? And, even if they agree to the extension, they will also draw up a contract that puts them first in the queue should we default on our payments and the property has to be sold. In short, they want a guarantee that they will get their money back plus interest in the event the deal falls through.

So why then are people in public office like Boris Johnson able to dream up fantastic schemes, invest millions of public funds, and not be held accountable? If they had to sign a personal guarantee that they would refund lost taxpayer funds in the event of a project’s collapse, the project would then never go ahead. But it’s not their money that’s involved.

Image: Free Enterprise

I know, you’re saying, ‘But then nothing would ever get done.’ Well, in the case of the garden bridge it didn’t anyway, yet it still cost over £50 million. But yes, there has to be a compromise between pie-in-the-sky or much-needed projects, their costs and their over-runs, and appropriate accountability in the event of significant delays or no-shows. 

Independent reviews after the event are too late – the money has gone. What we need is accountability at the top level on a weekly scale, independent fully-armed, locked-and-loaded reviews that have the ammunition to call a halt to a project in the public interest at a time before the damage is done. Whoever heads these accountability crack squads should also have the ability to fire at will (in the sense of ‘You’re fired,’ rather than actually putting the culprit in the cross-hairs and pulling the trigger. Although…)

Darfield Earthquake 2010, NZ.
Image: Mike Bodnar

And there should be some insurance to safeguard the public’s funds from misappropriation. Because in the end that’s what is happening: taxpayer money is being thrown away. I’m no expert in high finance or international economies, but if entire countries can take out international insurance against devastating earthquakes (viz. New Zealand and others) then surely we can do it on the basis of our own domestic home-engineered disasters.

Further, while I’m on a roll, let’s see those in charge of huge infrastructure and vanity projects are held to account by having contracts that stipulate no bonuses where targets are not met, no pension pay-outs in the event they lose their positions, and no golden handshakes either whether they are fired or resign in disgrace. It’s exactly what the rest of us humble individuals would be up against in the workplace. 

And public office is just that: a workplace. Let’s make it work.

 

 

 

Heart Break

Mike Bodnar suffers a major heart attack and tells the story from the inside

Image courtesy BAPS Charities

You read about these things and see them in the movies or on telly: heart attacks. 

Typically the actor clutches their chest, looks bewildered, maybe mutters something about a pain in their left arm, and then they keel over and - sometimes - expire. Cut to concerned partner going, 'Oh my God, Ron! What's the matter?' (Followed fairly quickly by tears, hysteria, so forth)

The reality is somewhat different, as I've just learned from experience. To be fair, the scene above could be totally accurate in some circumstances, but mine was perhaps more common. There's no denying the drama though.

Sunday morning on one of the hottest days in Britain so far this year, Liz and I had decided to tidy up some timber in our chaotic garden (read: builder's yard) and take garden waste and rubbish to the tip. We lead an exciting life.

At one point just after putting some waste bags in the car I said to Liz, 'I feel a bit funny.' Not the best of medical descriptions, but it essentially captured what I was experiencing: a mild dizziness and a slight tightness across the chest. It was hot so I was already sweating. Anyway, it seemed to pass and we carried on.

After stacking some scaffold boards I went inside, and then my chest tightened considerably. It was like someone had pulled a strap across it, with more wooziness and the beginning of a chest pain too. I probably didn't need to say it out loud but I told Liz, 'I really don't feel well.' She looked appropriately concerned. (And the Best Actor goes to...)

Except she wasn't acting, and nor was I. I sat on the edge of the bed and the pain got worse, and my chest felt as though someone was sitting on it. Sweat poured off me. I told her I thought it was a heart attack, and although I'm known in our house for being a bit of a drama queen (you should see the performance when I catch my finger on a sharp nail or get a splinter; Olivier would be proud) Liz didn't question it. 'Do you want me to call an ambulance?'

Yes please. I would normally hesitate to interrupt the important work of the emergency services, but this felt like the real thing, so I nodded and groaned. She got on the phone, I lay down and tried massaging my chest. It didn't help. We went upstairs to the lounge (it's an upside-down house, the lounge is at street-level) and I lay on the floor while she quickly got through to the ambulance service. The pain in my chest was increasing rapidly now, an intense crushing pain, and nothing I could do - no position I could get in - was helping. 'Tell them to hurry,' I pleaded needlessly.

999 Emergency dispatcher. Image courtesy Kent Police

So here's what happens when you dial 999: Firstly they identify that you've dialled the emergency services, then they ask which service you want - so far, so film script. The ambulance dispatch man came on and asked Liz about the nature of the emergency. I can tell you now that saying, 'I think my husband's having a heart attack' doesn't do it - the dispatcher wants to go through a mandatory checklist first. 

This included asking Liz a whole raft of questions, not one of which included, 'Is your husband lying on the floor in agony holding his chest and rolling round breathing shallowly and sweating?' He instead wanted to know whether I had vomited in a particular colour, did I have a history of heart problems, was I subject to bouts of anything, and occasionally asking questions that wouldn't be out of place in a biology quiz.

Liz put the phone on speaker so that we could both answer (conferring allowed, your starter for ten...) but I was rolling around in agony and, it has to be said, real annoyance that this guy wanted to tick boxes and hadn't yet dispatched the ambulance.

At some time during the game of 20 Questions he interrupted to say that an ambulance was now on its way (Liz had given our address) and continued his interrogation. He finished up by saying that if my condition worsened in any way to call back, the line would be kept clear. By now the pain was showing up in my left arm between shoulder and elbow as well, with sweat running off me in rivulets. This could have been partly due to the scorching weather but the dispatcher had asked whether I was sweating and did I feel cold and clammy. Liz checked and confirmed, so there's an oxymoronic clue - you can be both cold and sweating during a heart attack.

By now Liz was really upset. I asked if she knew how to do CPR should it be necessary. She did, but we both hoped that wouldn't be the case. She called one of our neighbours to come and help because, she admitted later, she felt 'completely useless.' I meanwhile was getting worse and asking where the ambulance was.

Neighbour Aaron arrived and did all the things you see in the movies, kneeling beside me, putting his comforting hands on me and telling me to 'Keep breathing Buddy, keep breathing.' I wasn't planning to stop, but I wanted medics leaning over me with oxygen and something to take the pain away. Hearing Aaron admit he felt useless too didn't help, but actually just having people there did.

Liz got back on the phone to ask where the ambulance was and this time got a different, dispatcher who, frustratingly, started going through the whole same checklist the first man had done. All she would say about the ambulance was that it was on its way, coming as fast as it could and would be here soon. Amid my pain and now moaning (and I admit it, some crying) I listened for the siren of the approaching ambulance. Aaron's partner had gone out into the street to watch for it, and unbeknown to me neighbours had moved their cars to create a parking space for the paramedics. We love where we live- I just wanted to live to keep loving it.

Eventually the ambulance arrived. I had my eyes closed now so didn't see the paramedics come in, I listened to the drama as you would a radio show. They too asked lots of questions but I could hear them unpacking equipment, one of which turned out to be a portable electrocardiogram (ECG) to monitor my heart. 

I was given dissolved aspirin and a spray under the tongue. After lying back down on the floor they took an ECG reading, and confirmed the results between them. Finally I heard what I already knew, 'It's definitely a heart attack.'

They called it in (another phrase we get from the movies and TV) and said that a specialist team would be waiting for me at the hospital. I didn't ask which one, as long as it was the nearest, but I wanted them to get me there ASAP. They hooked me up with wires and stuff, loaded me into a chair and wheeled me out to the ambulance. I was groaning in agony and telling them to hurry up, and superfluously yelling that I couldn't stand the pain.

I'd heard them tell Liz that unfortunately she wouldn't be able to come with me but that the hospital would call her. She stood on the road at the back of the ambulance as I was secured, we said we loved each other. 'Tell the kids I love them,' I said feebly, and I watched her sad face as the ambulance door slammed closed. I wondered if that was the last time I would see her.

Image courtesy Daily Mail

 Then we were off. 

As a driver I've always pulled over when spotting an emergency vehicle with siren and lights flashing in my rearview mirror and I remember hoping that every driver between our place and the hospital would do the same. I heard the siren start up and Natalie the paramedic who was monitoring me on the stretcher told me it would be no more than 12 minutes, holding on as the ambulance careened round corners flinging us both from side to side. 

Above and below my chest were two foil pads which, I'm guessing, were connected to a defibrillator should I flatline, but I was too busy going for the Best Portrayal of a Man in Agony award.

We twisted and turned through Lower Sunbury and then onto the motorway. Frustratingly we didn't seem to speed up, but then I heard Natalie say, 'We're on the hard shoulder now,' as the ambulance sped up along the inside on the M25. Or maybe it was the M3. I didn't care as long as people got out of the way. 'Won't be long now, almost there' she assured me. I urged her to hurry, which was a bit useless since she wasn't driving, but all she could do was to keep describing how we were almost there, that a fantastic team was waiting for me, and that it was all good. She did everything right of course even though I didn't appreciate it at the time.

Nor was I relieved or calmed by our arrival. I was lowered from the ambulance and wheeled into what looked like a temporary prefab building, escorted by another medic, then down a corridor where, at last, I could see a group of gowned medical staff waiting for me. I continued to ask them to stop the pain which was now unbearable, all-consuming, intolerable, searing.

They very professionally transferred me to an operating table in a gleaming theatre (I later learned we'd come in the hospital the back way, the shortest route), took the stretcher away, removed my jeans and threw a hospital gown over me. Then it was all on. I heard more than saw the team take their positions, calling out instructions, echoing instructions, swabbing bits of me, applying things to me, then telling me I might feel a small scratch on my right wrist - like that was going to be a worry given what was going on in my chest.

I was given morphine and more spray under the tongue. The pain didn't reduce. One of the team seemed dedicated to my pain management and over I don't know how long administered three doses of morphine and more oral spray but still to no effect. Meanwhile the surgeon was looking at a bank of monitors above me to my left and calling out instructions for the x-ray machine above my chest to be constantly repositioned by an unseen operator. 

Image courtesy verywellhealth.com

I know now that he was trying to clear an arterial blockage in my heart having gone in through my right wrist with a wire or something. He was obviously using Google Maps because I wouldn't have thought the quickest and easiest way to the heart was via the wrist. (Comedian Jo Brand knew this year's ago when she told her audience about the old saying that the quickest way to a man's heart is through his stomach, and then added, 'That's bollocks - it's through his rib cage with a bread knife!')

The cardio surgeon was, I understood, also following up the blockage clearance with a stent insertion - a sort of tube - to keep the artery clear and open, and I could hear him constantly reporting to someone else that, 'The O-ring is open... the O-ring is closed' repeatedly until satisfied.

And then I died.

Just for a few seconds, and no longer than about a minute according to one of the consultants later, but I did flatline. I was lying on the operating table feeling better that the pain was lessening, and relaxing for the first time in what seemed like hours. As I relaxed, the room started to go dark, and I remember thinking that maybe they'd decided to knock me out since none of the morphine had had any effect, or possibly that this was the morphine finally working. I welcomed the fading to black and let it flow into and around me. I felt at peace. I didn't know it then but I was actually 'resting in peace.'

No, didn't happen. Image courtesy Daily Express

Bang! Suddenly my world exploded in golden light. Above me I saw what looked like the underside of a stunningly bright gold bar with bright sparks all around it. I felt myself thump back onto the table so I assume I'd physically jerked up off it, again as we often see in the movies.

'Jesus Christ!' I shouted, as I realised where I was and guessed that more than a few volts of national grid had just passed through my heart. But invoking the name of Jesus was the closest I got to meeting my maker; there was no bright light at the end of a tunnel, no St Peter ready to welcome me through the Pearly Gates (or turn me away more likely) and I didn't have an out-of-body experience where I looked down on the team in the theatre as they worked on my lifeless body. None of that - I just faded to black. It was warm, calming, and maybe even welcoming.

I recovered quickly and was pleased to see the surgeon and the team were still working, and still intent on the stent insertion. The bank of screens beside me showed the action.

'Shocking,' I quipped, stealing the groan-worthy pun from a scene in Goldfinger, to which someone nearby said, 'Yes, literally!'

But I felt good. The pain had gone, I had stopped squirming and moaning, and a short time later it was all done. Whatever clever things they'd inserted up through my arm were withdrawn, my entry incisions were sealed up, and finally the sensors were detached. After the surgeon had explained what he and the team had done I was transferred onto a trolley and wheeled up to a recovery room in the hospital's Birch Wing, and there I stayed, plugged in to seven sensors scattered around my torso for the next three days. I had survived.

Image: Mike Bodnar

More than that, I had survived a massive heart attack. One of the consultants, Doctor Beeton, told me that if I'd been in the heart attack Olympics I would have won a gold medal. He showed me two charts, one was my heartbeat at its normal rate - clean and regular - and the other was of my heart activity when I was brought in. Nothing regular or even in that one - it looked like a toddler's drawing of a storm at sea, a terrible tempest of spiky waves and troughs.

'The scale of these charts is in millimetres,' Mr Beeton explained. 'We'd normally see a heart attack rise up to maybe two or three millimetres, but yours is up there around the ten mil mark!' So, big then. This wasn't me being a drama queen, this was the real thing.

As I write this I am still in the hospital but looking forward to going home tomorrow. The care from the NHS staff has been absolutely amazing, exemplary, and wonderful consultants have visited me each day to talk through my progress and enlighten me on some bits I might have missed due to being dead.

Selfie in the 
Birch Acute Cardiac Unit

I've had more blood tests, blood pressure readings, injections and pills than I've had in the past five years, and I will be on a pharmacy-load of pills from here on. 'Will I be on the medication for the rest of  my life?' I asked Dr Beeton. 'Only till you're 99,' he said. 'Then you can do what you like!'

I feel very lucky to live in an age when medical science can save my life with absolutely astounding technology and skills. I also feel very lucky to have a wife who wasn't going to wait around to see if I was being a drama queen, and who called the ambulance quickly. (I learned later that it took about half an hour to arrive, but it seemed like an eternity)

I wondered out loud to a consultant whether the doughnuts I'd eaten the day before had contributed to the heart attack, or maybe that I'd been working overly hard on our home renovation project for the last three years. 'Hard work doesn't cause heart attacks,' he told me.

I had a blocked artery, and certainly a life of doughnut eating would contribute, but I don't actually eat that many. However, my LDL cholesterol level was six, when it should have been below four, so a better diet is coming, along with a reduction (but not an elimination thank heavens) in alcohol consumption. There's more, and I have quite a bit of post-op literature to devour instead of doughnuts.

For now I just give thanks - to Liz, our neighbours, the ambulance paramedics, the team waiting for me at St Peter's Hospital Chertsey, and of course all the lovely NHS recovery staff in the Birch Acute Cardiac Unit. 

Thank you with all my heart.

(PS: Liz gave the remaining doughnuts in our house to nephew Sam!)