A suburban nightmare

The death of Ahil Islam in a Watford hospital highlights failings in the NHS. But it also suggests a deeper problem - the decline of London's outer neighbourhoods.

Published in the Evening Standard, 13 October 2005

Even in a week full of needless death, the story of one human tragedy can still shock. Tens of thousands of people were killed in Saturday’s earthquake in Pakistan, and yet somehow the event that led yesterday’s Standard – a catastrophe with a death toll of one – will have affected many who read it just as intensely.

It told of 13-month old Ahil Islam, who suffered minor burns from a spilt cup of tea – but was then sent from one hospital to another, including a four hour wait in the A & E department of Watford General, before dying in his father’s arms.

There will, as there should, be a series of inquiries into what systemic, serial failure could have led to such an unnecessary death. But I can’t help but have two reactions to such dread news. One is personal, the other is to wonder about the state of our city.

The personal reaction came first. As it happens, my own 18-month old son also suffered a minor burn at the weekend. Boiling water scalded his foot; we took him to the Whittington Hospital in Archway and he was bandaged up within a couple of hours.

As so often with the NHS, I left struck by the effort of staff working in the toughest conditions: they are always over-stretched. I was struck too by the fact that no matter how much money we spend on healthcare, it seems there can never be enough: there will always be demand that cannot be met. And I saw that the way this imbalance between demand and supply often gets resolved is that those who are most assertive get dealt with first.

I confess that on Sunday that was me. We were one of three families left waiting for half an hour. I found a doctor, asked what was going on – and we got treated. We weren’t rude; we didn’t shout. But by speaking up, our baby got the attention he needed. My fear is that Zia and Nazmin Islam either did not know that that’s the rule with public services – that the squeaky wheel gets oiled – or, worse, that they did know but that rule did not apply to them. Put simply, the question Watford General has to answer is: if the Islams had been a white, middle-class family, would their baby have suffered the same fate?

Still, it would be too easy to cast the hospital as the sole villain in this desperate episode. For there may be a larger trend at work here.

Watford is one of a string of places that ring London in a kind of doughnut now facing a double squeeze. On the one hand, they increasingly face all the traditional problems previously associated with the inner city: rapid turnover of population, a diverse community, a shortage of housing. And, on the other, they come equipped with little of the armoury that inner London now takes for granted.

So while people in my own borough of Hackney may live in poor, crammed conditions, they are also never far from a world class teaching hospital in UCH. Inner London has many of these “super-facilities”; the suburbs do not. The likes of Enfield, Redbridge or Hounslow, as well as Crawley, Luton or even Brighton, are experiencing what used to be inner city problems - thanks to the outward pressure of migration – but have no inner-city equipment to deal with them.

Of course some suburbs still retain an advantage. Parents clamouring for a place in Enfield or Barnet state schools know that some outer boroughs have maintained a standard which inner London can only envy. A place like Redbridge has held its own too, favoured by waves of immigration – first Jews, then Indians – that pushed the quality of education upward.

But none of this should obscure the emergence of what the experts are calling ‘rough suburbs’, places that have spent decades slipping into genteel decline. You know them when you see them: the parades of 1930s shops now reduced to a couple of kebab outlets and a massage parlour. The wide roads of pre-war housing beaten down by thundering traffic. The arteries in and out of London – think of Eastern and Western Avenues – which hardly give a good first impression to visitors but, more importantly, have become bleak places to live. Northern parts of Croydon, chunks of Hounslow, the hinterland between Barking and Dagenham. All these are areas which badly need attention.

Yet politicians have barely noticed them. Margaret Thatcher famously vowed to “do something for the inner cities” after her 1987 election victory – but few on either the Labour or Tory side ever talk about the suburbs. The result is that many of our urban landscapes have undergone improvement: not just in London, with Docklands as an example, but in downtown Manchester or Glasgow. The countryside has never suffered for lack of defenders either. So left in between are the places in between – the suburbs, with few champions.

That should change. Not that there need be a scorched earth revolution. If metropolitan planners come in determined to chop down the labernum and acacia trees and demolish the Terry and June houses, they will soon be sent packing. Tony Travers of the LSE suggests instead that the suburbs recover some of their history, that they look again at “Metroland,” the name John Betjeman, the laureate of the ordinary place, gave to the Rickmansworths and Northwoods along the Metropolitan Line, leafy refuges from the smoke.

Who might speak for them now? Labour should: after all, it saw losses in the doughnut around London at the last election, losing seats to the Tories in Ilford, Gravesham, Braintree and the like. For that reason, the Conservatives might make a further push, hoping to win back places like Watford – arguing that they are over-stretched because they have lost out for too long. Whoever gets their first, it will be a new noise in British politics: the sound of the suburbs.

Posted on October 13, 2005 05:43 PM

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