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Interview: Bill Bryson

American born-writer Bill Bryson came to the UK on a whim, but it was a chance encounter with the NHS that was to shape the course of events in Bill's life.

Much like the way plots in films and novels tend to unravel in a series of coincidences and accidental occurrences, it was a chance encounter with the NHS that shaped the course of events in American-born best selling author Bill Bryson's life, including his later settlement in the UK.     

Renowned for his travel books as well as a broadening range of genres including the widely acclaimed A Short History of Nearly Everything, which marked his debut into the realm of Science, Bill's books have sold more than 15 million copies worldwide and been translated into 13 languages.

Bill's first visit to Britain had been on a whim, as according to him, “it was the 70s…everybody got a big backpack and hitchhiked all over Europe.” It was while he was traveling around Europe that he met two girls who introduced him to some work at the Holloway Sanatorium.

“I was hitchhiking around Europe, and just by chance, I ended up getting this chance of working in hospital in Virginia Water because of these two girls who I met. So I took it. I never thought I'd stay permanently. I thought I'd stay for six months or something. Then I met a student nurse, who is now my wife, and that kind of changed everything.”

Bill and his wife, Cynthia, have now been married for 40 years and have four grown-up children. Apart from intermittent periods spent in the US, they have largely stayed in the UK, and Bill, whose book, Notes From A Small Island, was chosen by BBC Radio 4 listeners as the best book ever written on the British identity, is finally in the process of applying for British citizenship. 

In a talk at the Royal Society last month, he says very seriously that the reason for applying for it at this late stage is out of fear of the accompanying written exam, quoting some of the more difficult questions from the practice tests, such as whether pantomimes are based on fairy tales.

While his detour into the NHS was not to be as permanent a feature of his life as his relationship with his wife and the UK, it was definitely more than a casual encounter, as he was later to undertake further training to become a psychiatric nurse.

Giving us a glimpse into a very different stage of his life, Bill said that he had started his journey into the NHS as an orderly, helping out with the daily care of patients.

“I wasn't doing anything important, but every morning I would get an electric razor and shave all the men, that kind of stuff, make beds... physically, [the people] were fine, it was just a question of making sure that they didn't wander outdoors or leave the wards and things like that. It was more supervision than anything else, more like working in a nursing home than working in a hospital.”

Noting that most of the people on the ward didn't seem to be seriously ill but just seemed to “need maintenance,” Bill touches upon an important issue that has led to the closure of many mental health facilities over the years, and attempts to integrate the health and social care system so that patients can be supported at home.

An investigation by BBC News and Community Care magazine last year revealed that despite poor mental health being the largest cause of disability in the UK, at least 1,711 mental health beds had been closed since April 2011, representing a 9% reduction in the total number of mental health beds. 

While they may seem like necessary cost reductions in these times of economical constraints, experts in the field such as Dr Martin Baggaley, medical director of the South London and Maudsley NHS Trust, have expressed that mental health in Britain is in crisis while Care Minister Norman Lamb has said that the situation is "unacceptable" and provisions must improve.

Currently, there is a drive to increase access to mental health services, with £400 million being invested to improve access to psychological therapies between 2011 and 2015. Reducing mental health problems has also been made a priority for Public Health England while emergency support for people in mental health crisis is also set to see dramatic improvements across the country as part of a far-reaching new agreement. 

The Crisis Care Concordat signed by 20 national organisations, including police, mental health trusts and paramedics aims to drive up standards of care for people experiencing crisis such as suicidal thoughts or significant anxiety. With the slightly removed third party perspective of a writer, Bill reflects thoughtfully on his experience of working with patients at the sanatorium.  

“It was a really, really interesting experience, I learned a lot about human nature. And I did learn a lot about people whose lives are seriously lost because they have some kind of trauma in their heads. It's really sad to see people who have been institutionalised for 30, 40 or 50 years.”

The Holloway Sanatorium eventually closed in 1981 and the 500 long-stay patients got transferred to a 20-a-bed unit which according to Bill was “almost like putting them in prison” as it was just so much more confining. Had Bill stayed in the NHS, we might have ended up with the stories of a foreign aid worker rather than a travel writer, but Bill said that nursing wasn't “anything he was ever going to be serious about,” leading to his brief return to the US to resume his studies.

 “It was fascinating, but it wasn't a calling,” said Bill, “I loved 

the hospital, I loved the social club, but there was no way that I 

was going to spend my life looking after people, I'm not compassionate enough.”

Yet despite his feelings on being a carer himself, Bill clearly has a strong perspective on the subject of compassionate care, telling me that he emphasises to his son David, a doctor trained at Leicester University, that he should always put compassion at the top of his list.

“As a consumer of health services, I've always told him that he should act like he cares about every person. I think he does, but I think it's so important that every time he meets a new patient, that he's a little bit positive about something and that he's encouraging, because that makes a difference psychologically.”

Indeed, compassionate, patient-centred care has been the mantra for health providers following the Winterbourne and Mid Staffordshire scandals, the latter of which included neglect of the most basic elements of care such as patients being left unwashed for months at a time and being left in soiled sheets. Speaking from his own personal experience of the importance of compassionate care, Bill talks about being cared for in Australia after developing a deep vein thrombosis (DVT) while traveling there on an assignment with National Geographic about 14 years ago.

“Luckily it turned out not to be anything serious, but I had a couple of weeks when I was in Hobart [Australian city]. And the thing with DVT is that you don't know what's going to happen... I have to say, if you're going to get sick Australia's a really nice place to do it - they do have a kind of friendliness, an optimism. Because I was a long way from home, it's nice to feel like you have people who are genuinely compassionate. Personally, I think that's absolutely the most important element of healthcare anywhere is kindness. I'd rather have somebody be kind than competent in a way because that's such an important part.”

Though Bill describes this experience - fortunately one of the very few he has had with health - as almost pleasant, calling it a “really cheerful experience,” he is quick to stress however that the health system in Britain is in no way lesser than those he's encountered elsewhere, something we can take genuine comfort in given his extended travels around the world.

“I think that Britain really could be a little more proud of the NHS and public transport, because compared with a lot of countries, they're really very good…The two things that people in Britain are always hard on are railways and the NHS. They think that both things don't compare with the rest of the world, but in fact both of them actually do. They could both be better, because everything could be better, but the experience in healthcare is world class. It's as good as you're going to get in most places.”

As with most conversations that concern the UK, there's an irresistible temptation to talk about public transport, especially given Bill's extensive knowledge on the subject, so we make a slight digression.

 “You don't have the high-speed trains here like in France, but if you go on a local train in Britain, it's better than going on a local train in France in my experience. It certainly compares with taking most trains anywhere in Europe.”

Although I make a quip about the small fortune I've amassed from the refunds I've claimed from tube delays, Bill is quick to defend the system, telling me that while his recent journey from Heathrow into London after a trip abroad “was a little bit crowded" and not the “most fun” he'd ever had, it was a lot better than what most American cities offer, as New York currently doesn't have a subway from JFK airport into Manhattan. Having journeyed through a myriad of topics, I ask Bill if he might be able to leave us with some valuable insights about health precautions to take when traveling. Expecting to learn about elaborate preparations he's had to make before embarking on extended expeditions to the Appalachian National Scenic Trail, or while on his travels around Kenya in Bryson's African Diary, where he fixates on the dangers posed by snakes, insects and large predators, Bill's pre-journey preparations are in fact very simple.

“I only just take the very obvious and basic ones. If I'm going some place where there's any risk of malaria or anything like that, I will take spray. For example, when I went to Costa Rica, I took a powerful insecticide - which I didn't end up using - just to make sure [even though] I wasn't out and about or exposed much.”

He adds that the only other thing he does is eat really carefully. Stressing that poor hygiene isn't necessarily the problem, Bill says that from his experience, despite having a really good stomach, there is a danger to exposing yourself to microbes that your body may have not coped with before which would most likely result in “some kind of queasiness or diarrhea.”

“You really want to be careful you're not eating an apple that's been washed in the local water or things like lettuce - it's better to just eat packaged food and biscuits and things… it's usually just that sort of thing, I wouldn't say that I'm obsessive about it.”