Bad taxi fare

‘I’m stopping the car now. Could you please help, your friend is nearly strangling me.’

I was 22, driving a St James taxi to pay for uni. It was about midnight and I had picked up a man and a woman outside a nightclub in Hindley Street. She was alternating between singing and abusing him for making her come home early. ‘Who the fuck do you think you are? You’re not my father you know. I’m drunk and I fucking love it. The party was just getting started.’

Then singing ‘And then I’m not, not, not responsible, Oh no, I’m not, not, not responsible, I can’t answer for the things I do. So fuck you’

Brief silence, then I hear ‘And fuck you too, you bearded cunt.’ Obviously meaning me. I really should have stayed quiet, never argue with a drunk, but the man was silent, no help there, so I said ‘Let’s make sure we all get home safely tonight.’ Condescending wanker. It was a very poor choice of words in the circumstances.

‘Make sure? Make sure? Who said that was your job cunt? You’re worse than he is.’ Then she lunged from the back seat and tried to throttle me. There wasn’t a lot of traffic, but I was passing a bus at that moment, and she was pulling my head back so that I could hardly see in front.

I slowed down, moved over behind the bus, banging into the kerb as I came to a stop. The man didn’t do anything, she was still throttling me, so I pulled her hands off by myself, with some difficulty. Then she went for me again, coming over the back of the seat to have another go.

Finally, he acted, and slapped her hard, full on across the face. She said ‘Ow, fuck’, and slumped back, whimpering, into her seat. I asked, with a croaky and wobbly voice, where he wanted me to drop them off. ‘Right here mate. She needs to walk this off. How much do I owe you?’ He paid–no tip for my troubles—I remember thinking ‘Stingy bastard’. She slammed her door violently as she went off with him, starting to yell again.

At least she hadn’t thrown up. They were the worst ones.

Then I started looking for another fare.


The judge began to explain how today’s proceedings would be conducted, but I wasn’t really listening. I was troubled, not liking why I was here; to ask for an aboriginal boy in my care to be sent to an adult jail.

Robert was 17, and had spent most of his life in foster care or juvenile jails. With his parents both violent alcoholics, his sister already dead in a car accident, he may have felt he had little left to lose. That wasn’t unusual: many of the boys in McNally Training Centre, where I was Superintendent, were aboriginal, and their life stories were almost uniformly depressing. But Robert was different; a leader, not because he was smarter or kinder, but because he would beat the shit out of anyone who didn’t do as he asked. He ruled supreme in ‘The Block’, our high-security unit.

It was a nasty, forbidding place, with high walls topped with loose bricks and broken glass. The boys slept in a row of cells with heavy steel doors, and the staff relished slamming them with such force that the floor shook. Most of them were ex-British army, and they saw their job as straightening these boys out, even it meant they had to break them a bit in the process. In my role as ‘the Super’ as they called me, I was trying to change this culture, but largely ineffectually. These men had seen off the Germans and the Japanese, and they were buggered if they were going to let a wet-behind the ears intellectual tell them how to do their jobs.

My agony was that it was a deputation of these very staff who had come to me requesting that I seek a court order for a boy be transferred to an adult jail. It wasn’t the first time, but I had always said no in the past, because their usual position was that a boy had disobeyed too many orders, and deserved to go to jail. This was different; Robert had hurt another boy, the latest in a string of incidents. Badly this time: in a moment when staff weren’t looking, he had smashed a boy’s face into a toilet bowl, gashing his forehead and almost breaking his jaw. They were right on this one. I couldn’t keep the other boys safe in the same space as Robert.

So a few days later here we were in court. Only the judge, a clerk, Robert’s family, their lawyer, I and a barrister supporting me were there at first, but a few police officers filed in later when I gave evidence. Robert had seriously aggravated the police time and again, especially when he filed complaints against them for assaulting him. I have no doubt his complaints were justified. I recognised a chief superintendent no less, and a couple of Inspectors, all of whom had well-known dim views about people like me taking over the care of young criminals.

Robert’s mother and brothers and a couple of other relatives were tightly grouped, mother crying, when the judge asked me to step up and make my case for a Section 77 order. The judge seemed to be a decent man; I thought he looked nicer than I felt about myself that day. My lawyer led me through the basics of our case, with the help of Robert’s files which showed a long history of violent behaviour.

Then it was the family lawyer’s turn. He was good, and soon had me admitting that there were many incidents like this one, and that we seemed to be able to keep those offenders in McNally. I knew before he asked what his next question would be. ‘Why is this situation different—why are you singling out Robert like this?’ I felt so tense and alone at that moment, the police licking their lips at the prospect of some real justice for a change, Robert himself looking at me attentively, the family angry and bereft, the lawyer fidgeting as he waited. After a few seconds he prompted, “Mr Meldrum, shall I repeat the question?’

Then I knew I had to talk to Robert, to bypass all these spectators. I was sure I could rely on his honesty. I asked the judge “Your honour, in answering that question could I speak to Robert?’ The lawyer stated to harrumph, but the judge shushed him and said that sounded like a fine idea. Robert and I turned to each other. I said ‘Robert, have you hurt other boys in McNally?’ ‘Yes Mr Meldrum.’ Have you hurt them badly?’ ‘A couple of times, yeah.’

‘The boy this week, why did you attack him?’ ‘Because he had it coming.’ ‘Robert, think about this carefully before you answer me. If you stay in McNally do you think you will hurt other boys?’ I guessed the lawyer would object, and he did, but the judge waved him down. Robert didn’t hesitate. ‘For sure, there’s lots of them deserve it.’

‘You know I’m here saying the other kids aren’t safe around you, so I think you have to go to Yatala jail. Can you see why I think that?’ Full eye-to-eye contact, and he straightened up and said ‘Yeah, it’s probably the right thing to do.’ I looked over at the family, and again at Robert. I think we all looked worn-out at that moment, and deeply sad. But I honestly don’t think any of us were angry at each other. In a fucked-up world, a very damaged and dangerous boy had just run out of options.

The lawyer said ‘No more questions your honour.’ The police folded their arms and smiled at me. I felt angry with them. Were any of them there when some compassion and flexibility could have come up with better solutions than charges of ‘abusing a police officer, resisting arrest and assaulting a police officer’? Had they beaten him personally? When would they recognise their role in protecting community safety began with prevention, with understanding and foresight, with some love even?

The judge’s quiet voice cut across this tableau. With no preamble he found the order to be justified, and instructed that Robert be taken to Yatala prison forthwith. I stepped down from the witness box, as did Robert. Then he crossed the floor and shook hands with me. I said something lame like ‘Look after yourself in there.’ He said ‘Thank you’ then looked at the floor as he turned and was led away. I’m good at doing calm and composed in a crisis, but I was working hard to keep it together just then.

The Chief Superintendent came over to speak to me, which was something I had hoped to avoid. But he surprised me when he said ‘I guess there were no winners here today, but good on you for putting that lawyer in his place.’ In terms of mutual understanding, it was better than nothing, and I accepted the offered handshake. I bowed my head to the departing judge, and walked out with a stone in my heart.

The Barr Smith Lawns

Sergeant Peppers Lonely Hearts Club Band. Yes, it’s more than 50 years old. It’s difficult today to describe the importance of the Beatles’ music in 1967. I may have missed something, but I don’t think any act before or since was so dominant world-wide. This album stayed number one for 27 weeks in England, and 15 weeks in the US. I can’t imagine there are too many people alive today who would not recognise at least one of the songs.

I was studying at Adelaide University and the adjacent Teachers College, and the hub of the campus was the Barr-Smith Lawns, just outside the main library. Without computers or the internet, if you needed to read a reference you had to come to the library to do it. The grass, the low walls and a few seats to sit on would be filled with hundreds of students, especially at lunch-times. Here those at the top of the A-list could hold court with their faithful, while us mere mortals tried to find a friendly face to share a sandwich with. It was the ultimate people-watching spot, and I hung around there too long and too often to get the higher grades I needed.

But one day in June 1967, a team of guys from the theatre department came to install some huge speakers, hanging them from the trees and perching them on the roof of the locker rooms. The news spread quickly—the newest Beatles’ album was out, and they were going to play it full blast. Within half an hour, the area was jam packed, and the whiff of dope smoked by the most daring wafted over us.

When that first line, ‘It was twenty years ago today’ came after a classic guitar intro, the place went wild. People started dancing and yelling, some trying to sing along, others telling them to shut up and let us all hear it. The speakers were awesome, at least for 1967, and there were complaints from all the adjoining study areas that no-one could hear the lecturers trying to teach. Many gave up, and streams of students kept joining from ‘serious’ faculties like medicine, law, engineering and even economics, the people we arty types thought incapable of aesthetic emotions.

A little over half an hour later, the last crashing chords of ‘A day in the life’, which many critics think of as their finest work, faded away, leaving almost total silence across the lawns. We were stunned. Great art can leave you speechless; in fact it should, while you process something overwhelmingly new and important. Conversations began quietly, and people began to drift away to usual campus life. Of course, we all went out and bought, borrowed or pirated copies of the album over the next weeks. I went to at least two parties that were specifically about listening to it, while we drank bad wine and smoked the foulest cigarettes we could stand. But nothing compared to the shock of the new, shared with an awed crowd, the day Sergeant Peppers was released in Australia.

Dudley Brown

And there he was. Just as I had imagined he would look on his yacht. Over the years I’ve sometimes wondered if I partly invented Dudley Brown. Sure he was a colleague of mine for a couple of years, and I know he was building a yacht, because I saw it. But the adventure he was planning, to be first to sail single-handed around the world in the 20th century on a boat which he was building in his front yard, with no motor, seems fantastical. Especially for a man over 60 with minimal sailing experience, who was a social worker in the Northern suburbs of Adelaide. And yet here in 2018 was his story on a website by one of my fellow bloggers, recalling his times with Dudley in 1988 in Hawaii.

He had been in the army at the very end of WW2, training as a paratrooper. He just missed out on mortal combat, but spent time rounding up surrendering German troops. Coming to Australia after leaving the army, he went outback to work with ‘Aboriginal Affairs’ departments, which at that time ran reserves that had mostly been established in the late 1800’s by various Christian Churches bent on conversion and moral education. With his military background, Dudley had been seen as a well-organised and resourceful man (they were always men) who could evolve into a valuable leader. By the age of 30 he was a Superintendent of a reserve. I think it was Cooberpedy in the far north of South Australia—certainly he worked there, because I remember his tales of living in a corrugated iron house when the temperature was over 50 degrees, of course without air conditioning.

So why was he in Salisbury, a base-grade social worker, with me, 25 years his junior, as his boss? A bearded, weather-beaten nugget of a man, smoking constantly, who looked completely out of place in a city, let alone in a government welfare office. He claimed it was all to do with building his yacht, which was obviously impossible unless he lived near a port. And he was only a couple of years off getting his superannuation pension, and therefore wasn’t too worried if the work wasn’t at a level, or in an environment, that he was used to. But I did pick up snippets of another story, that Dudley slid away from revealing whenever I probed gently. He had a pistol, souvenired from a prisoner of war, and was happy to admit that he fired it in the air several times when drunken men on a reserve were threatening mayhem. This alone should have led to full investigations of whether his behaviour was justified. But it appeared that Dudley the cowboy Superintendent was untouchable because nobody else wanted to do his job, almost alone in a bleak, isolated and very depressed township with little or no prospects of good futures for the people in his care.

However, I heard second-hand that on one occasion the gun was fired at a person, resulting in serious injury, Whatever the truth, Dudley appeared as one of my social work staff, not wanting to talk about why, other than that his boat was slowly taking shape only a couple of kilometres down the road from our office. And that this was therefore a perfect pre-retirement posting for him. So here he was, decades older than the rest of us, and decidedly right-wing in some of his views on young offenders and child abuse, which were our chief concerns. This office was famously left-wing; in fact I had been sent there as the District Officer to bring some troublesome workers into line. So staff meetings could be a chaotic affair, with the rump Trotskyists refusing to do anything that our clients didn’t agree with, and Dudley opining that a ‘good kick up the arse’ would solve many of the issues we seemed so ill-equipped to deal with. I shouldn’t appear to make light of this; there were the lives of some very damaged people at stake here; and we actually made some very important concessions to each other’s points of view. None of us had good answers to some really awful dilemmas, that we supposed to resolve without offending anybody too much. Admitting that made for some grown-up thinking, and positions we found we could all work with, including Dudley.

He and I got on really well. Dudley thought I was ‘officer material’ who might turn out all right if I tolerated less slacking off from some of our workmates. With some mutual respect growing, the conversations turned more often to his plans for becoming a round-the-world lone sailor. I knew enough from my own sailing efforts to keep up with his stories of great deals on boat-parts, and his thinking on a design that would serve him well alone at sea. And for his crazy dream, I admired him so much. Entirely self-taught, just finishing the boat was going to be an epic achievement. I looked forward to each exposition on the best route around the world, the foods he would store, the sails he needed; even the name that he would give his boat.

One day he came in to tell me had just saved himself $1300, a large sum in 1982. He wanted the best possible wetsuit in case he fell overboard while sailing in the freezing latitudes just north of Antarctica. The salesman explained that Dudley could survive 12 or 13 hours in the latest neoprene suit, instead of a few minutes in normal sailing clothing. Then it hit him—if he fell off his boat, it would sail on without him. There was no chance he could get back on board. So why choose a slow and miserable death? He had decided to get a better harness instead.

I left the Salisbury office before Dudley retired. About three year later, I met his wife Nina, who was herself now in Cooberpedy, managing the welfare office. She told me Dudley had just left Port Adelaide on his way to Tasmania, from where he would head due south. There had been a few problems during some shakedown cruises near Adelaide, but overall the boat was behaving perfectly. He had actually done it.

I heard nothing for a couple of years, then came a story in the media about a lone yachtsman from Australia who had gone aground in Hawaii. It was Dudley, or as the Hawaii press had named him, ‘Crocodile Dudley’, because of the Australian film that had come out the year before. Local people and tourists alike had rallied to try to save his boat. The CEO of the Ford Motor Company, Lee Iacocca, had a house just above the reef where Dudley’s boat was stuck, and he and Dudley became great mates for a while.

Because of the blog I found recently, I now know that his boat sank, and a 1988 version of crowd funding saw him in a new boat within a few months. He had so much charisma; the unmistakeable whiff of the authenticity of a truly free spirit. Just like me, no-one could resist being part of his adventure. But it was a boat with a motor—that was one concession his benefactors insisted on. Dudley had to admit that it was the lack of an engine that saw him drift helplessly into that reef, and next time he might not be so lucky.

My fellow blogger doesn’t know what happened after Dudley went round Cape Horn, via San Diego in California. If he’s alive he would be about 94. I like to think he made it, or maybe he froze to death quickly in his deliberately inadequate thermal gear in the Southern Ocean. However long he lives/lived, Dudley will have done it his way, enriching the memories of all who met him.

Mr Hopper

I have decided to start writing about specific characters who impacted on my life-mainly brief sketches. The first is one of my high school teachers

Even after all this time I can’t say Brian Hopper—he will always be Mr Hopper to me. Which probably means that some part of me is still that 15-year-old who was awed by this big, slow-moving man. Movie-star handsome, built like a brick shithouse and always immaculately dressed, he had gravitas to spare. He took over our year 10 classroom for maths and science like some general with the power of life and death. His was a very quiet room, and I can’t recall anyone taking him on, not even the class smart-arse, who stayed wary like the rest of us.

I guess he was not yet 40, which in those days we thought of as middle-aged. He had a stiff right arm, legacy of leaning it on the window-sill of the car when he was driving. Hit by another car, he was lucky to keep the arm, but his football career was over. South Australia may not be the centre of the sporting world, but in 1961 a guy who had been a star forward for Glenelg Football Club, before being cruelly sidelined by his injury, stood on a pretty big pedestal even before he displayed his teaching skills.

Which were very good, now I stop to think about it. With a deep, clear voice, and mastery of the black-board, he took us through facts, theories and problems at a measured pace, always checking we were with him. Sometimes he would stand behind your desk, put his big hands on each side of your book, and softly growl something like ‘Show me how this equation works; I just want to be sure you’ve got it. Take your time.’ Over a few weeks, blind terror would gradually be replaced by the feeling you were in safe hands.

But the incident that always brings Mr Hopper to my mind is one that affected my self-esteem for many years. I should set the scene by admitting I was a very lazy boy, relying on my smarts to get me through with reasonable results without ever pushing myself. One day I’ll make sense of that, given that it doesn’t look anything like the adult I became, but it won’t change the student that Mr Hopper found in Class 3A in Mount Barker High School. He’d let me know a few times he was unimpressed with my efforts, telling me that with my brains I should be at or near the top of the class. This day, he was checking our maths homework, set the day before.

Not unusually, after hanging out at my best friend’s place, I’d had a great night listening to the radio, then read a book. Homework could wait until I got to school, when I’d race through the exercise just before maths class. By the time I realised it wasn’t working out, because I hadn’t been paying attention the day before, there he was, coming up my aisle. I started working on an excuse—I was quite gifted in that department. I polished the story as he spent time with the boy in front of me, patiently explaining his errors and helping him get it right. Then he turned to me. As I started to speak, he made a hushing motion with his hand. After a few seconds silence, he said quietly ‘Meldrum, I just don’t care.’ Then walked past me to the next student.

It happened so quickly that I’m not sure if anyone else noticed. But that moment has stayed with me ever since. I felt like the least of my fellow-students, a privileged, clever but spoilt and weak person who wasn’t taking anything in life seriously. I was wounded, starting to concoct defences in my mind, but not believing them. And I think that part of me that pipes up in my psyche, sometimes even now, to say ‘Any minute now they’re going to be on to you’ was shaped on that day. The hot flush when I was criticised, the angry retorts when people close to me would say I wasn’t trying hard enough, were all about trying to throttle that awful feeling that flooded me when Mr Hopper told me I wasn’t worth his effort.

Was that good teaching? Or just a moment of exasperation from a busy man? Was he particularly irritated by me, or barely aware of my presence? I have almost no insight into him as a person. I can’t even remember if he seemed happy, although I do remember him the following year saying something gloomy about the Cuban missile crisis, when any well-informed adult had every reason to be scared. With his star-power, why was he a base-grade teacher at his age? How little I really know about someone who looms so large in my memory.

Whatever his reasons, he marked me that day. A few years ago, a colleague told me he saw signs of “imposter syndrome’ in me, the condition where deep down you think you’re faking it, or at least that people will think that. It didn’t make much sense to him given my generally solid performance and achievements. ‘Where do you reckon that started David?’ OK, I can weave my father and a few others into the answer, but as a simple explanation, Mr Hopper will do.


This is a little piece I did as an exercise during the Creative Writing workshop I attended on the weekend. The only information given was that ‘Liguri was questioning someone’. From that we had to create a short scene that obeyed some of the principles we had been discussing, especially creating a sense of place, embodiment of the key character, and staying in the same voice. This is the first ever try I have had at writing fiction, so I am a bit overwhelmed by the challenges that had never occurred to me.

I chose to speak in the third person about a young Italian woman living with her family on a farm in Tuscany, near the end of the war. The last year has been particularly dangerous and difficult.

Captain Liguri, Carabinieri and the local fascist leader, spoke quietly, smiling slightly. “Sit down Francesca, no harm will come to you if you answer truthfully.” The kitchen was warm, the wood stove heating a rabbit stew that smelt richly of local herbs. Oil lamps flickered, revealing Liguri, Francesca, Mario, his wife Concita, and Antonio their eldest son. All but Liguri were thin-lipped and visibly tense, especially Antonio, who was gripping the back of a chair like a weapon.

‘Francesca, we know you found a dead person. Why did you not make a report?’ For more than a week, Francesca had dreaded this; that she had been seen that night when she found a body near the orchard. But Liguri’s false smile triggered memories of the fascists and the SS in Chiusi, laughing while they rounded up suspected partisans and Jews. After months of saying almost nothing, determined to be invisible, a quiet rage was surfacing. She sat up and looked directly at Liguri. ‘There are many bodies around here Captain. Germans, partisans, innocent local people, even a child last week. Which one do you mean?’

Liguri laughed; perhaps he liked a woman with spirit. ‘My dear, you know I mean
Guiseppe, who was a worker here until recently, and suspected to be a partisan. We have identified him, and we are wondering if you might know why someone smashed his head with a rock and hid his body in that ditch. I mean, we could just say good riddance, but I dislike loose ends. Is it true that he fought with Antonio here about a local girl?’

Francesca laughed back; she was giddy with anger now, with all these men who seem to want nothing but the chance to be violent. ‘Antonio? You must be joking Captain. If Guiseppe had a rival in love he’s not here.’

Liguri turned to Antonio, quiet smile still in place. ‘I’m sure I can get the truth out of Francesca, if I take her to Chiusi. Is that what you want?’

Francesca felt her gut twist. For a few seconds, it seemed no-one breathed. Then pandemonium, as Antonio hurled the chair at Liguri and ran for the door. Liguri drew his pistol and got off one shot as Antonio disappeared into the night. Liguri turned to the others, asking them to get back in their seats, but found himself looking into the barrels of Mario’s ancient shotgun. ‘Don’t be silly old man; give me that gun now.’ But Francesca knew Mario better; no-one could threaten his daughter and try to kill his son and get away with it. Liguri’s smile was erased in a huge blast that threw him against the wall.

In the long stillness that followed, Francesca saw anger, and something new, pride, in Mario’s face. He turned to his family. ‘Today I found out the Americans are only three days away. We will clean up this mess and hide the body. Chiusi is in chaos. I think we will be safe. Now go to see if Antonio is injured.’

As she hurried up the dark road after her brother, for the first time in many months Francesca began to sob. Cracking open with wracking sobs. Maybe this was how hope felt.

The Hill

In mid-1975, I was asked to take on the job of Superintendent of a boy’s reformatory in Adelaide, McNally Training Centre. The previous incumbent had left after a very scary incident that that had seen him in personal danger from a group of lads who had him trapped in a room. He was lucky to get out unhurt, but it was the behaviour of the staff who deserted him in that room that convinced him it was time to go. He remains a close friend of mine, and I know that night haunted him for years.

McNally was a pre-occupation of the press at that time, because of several riots and escapes, and the wider perception that young thieves and worse were getting off with a ‘slap on the wrist and a bag of lollies’ as one reporter put it. My appointment made it on to the front page of the daily paper, and there was pressure on me to get the place under control and out of the newspapers as quickly as possible.

Those were heady days in the Department for Community Welfare, which was responsible for young offenders. At just 29, I was in charge of a facility with 120 staff looking after about the same number of 13 to 18-year-old boys. With long hair, a beard and wearing a leather jacket, I and people like me in the new wave of young managers were a sharp contrast to the older staff. Most of them were English migrants who had been in the army during WW2 and Korea, and in their view they had taken on the job of running a prison for young men who needed to be straightened out. One of the senior people reporting to me had been rejected by the South African prison service as unsuitable, and I was to find out why over the next few years as he featured in one after another incident of excessive force.

The half-dozen or so new people, including me, were all university educated teachers, psychologists and social workers, keen to lead changes like banning corporal punishment, preparing the boys realistically for the lives they would return to after a period inside, and providing the basic education in reading and writing that most of them lacked. The average reading age of these 15-year-olds was 10, with a good 20% of the boys being functionally illiterate.

The previous priorities, including such highlights as marching practice, public caning for misdeeds, and making cement bricks for the staff to take home at no cost for their own use, were being phased out against fierce resistance from the older staff. Arriving at McNally, I was greeted by the would-be South African and taken on a tour, past rows of staff and boys standing at attention.

By the end of that day I had asked that such welcomes stop forthwith, insisted that my car and those of other senior staff would be parked wherever there was a space and not in the Superintendent’s area, refused an offer of as many bricks as I wanted delivered to my house, stopped the practice of all senior staff being brought their tea and coffee, in bone china, to their office, and asked for a report on why the boys on remand were waiting an average of six weeks to have a court report prepared, which usually resulted in their release. It helped that knew I had full backing on all these changes, from the Director General down to my senior team, but the tensions between the old and the new were always simmering.

The epicentre of the old ways was ‘The Block’, a maximum-security unit for the 20 or so boys judged most dangerous or recalcitrant. With five-metre walls topped with loose bricks, a huge gate opened with a huge key, and individual cells with steel doors, it was a prison in every way. All of the staff except one had been in the English army, mainly Guards regiments, or the military police. The culture gap between them and my sort of manager was enormous. They and I knew it was in The Block that my predecessor had been set-up for public failure and a high risk of injury or worse. Being ‘sent to The Block’ was feared by the boys, and the threat was used regularly when trouble seemed imminent.

Actually, trouble seemed imminent almost every day. Boy-on-boy fights and bashings, allegations of staff assaults on boys and vice-versa, theft, vandalism, escapes and riots all happened regularly during my first few weeks there. One night I was called on my ‘beeper’ to be told there were about twenty boys in a remand unit refusing to go to bed, and threatening to smash their way out if the Superintendent didn’t come to hear their complaints. I had been at a party, and was a bit tipsy, but I went anyway. I strode in, took one look at the situation, and told the several staff present I was going to see what the boys wanted. The door was opened, I went in, and I heard the door closed and locked behind me. I’d been set up. Just as they had expected, my naïve hubris propelled me past any pause for caution, and now I was locked in a room on my own with 20 boys, several of them much bigger than me.

One said, ‘Hey, look, he’s shitting himself. His legs are shaking.’ Some laughed, but I sensed many were frightened too—of what would happen to them afterwards, if the more violent ones went for me. I was very scared, but I was so pissed off with the staff outside just watching that I started walking up and down the aisle between the beds, talking about how this was no way to get on with their lives, and how they would all be home with their families soon if they just took it easy. It started to work, but one of the tough guys told them they could ‘Take this c—t and shut him up.’

As a few formed a circle around me, I resorted to something I had promised myself I wouldn’t do. I said, ‘I haven’t seen anything that would get you guys transferred to The Block—yet.’ Within seconds, everyone was lying on their beds. I strolled to the door as casually as I could, and waited for an agonising few seconds as the senior staff member on duty unlocked the door and let me out. Without a word, I walked out and drove home, stirred up, a bit ashamed of myself, but relieved not to have been hurt. I didn’t sleep much, and by the morning I’d decided two things. One was no repercussions for anyone involved would do any good. And two, I would start thinking about how to get rid of The Block altogether. I’d used it the same way it always had been, and as long as it was there, we could resort to fear and force when these kids needed us to do better.

So we got to work on real change. For a start, there were kids locked in McNally that didn’t need to be. Many of them were staying far too long on remand. I had a very competent and well-informed deputy, even younger than me, and she suggested we should implement a quick turnaround on court reports. We went to see the Chief Justice, and he was completely supportive. Within a month, we were getting boys back to court within ten days. Since about 80% were either bailed from court or given a community order, the population of the remand units plummeted. We also started making greater efforts to organise bail in the first place, so many boys were out the day after coming in on remand. As well as the natural justice of these new policies, we now had spare room for activities, spare staff to supervise and engage with the boys, and capacity to take staff off-line for training, all achieved with no new resources.

Next, we talked with the local high school about having a basic curriculum on offer in McNally, supervised by the high school. Three teachers were found who were keen, and the school was operating within a few weeks. We gave the boys the option of attending school or going to the mechanical, leather and woodwork shops as always, and we were all delighted when classes filled quickly. Illiterate boys, who couldn’t even read the captions in comics were progressing to normal reading ability for their age within three or four months in the school. The teachers inspired me. With their patience and ability to keep such damaged young men focused on the very things that they had failed at all their lives, they achieved more ‘corrections’, ‘training’ and ‘rehabilitation’ than the rest of us put together.

In the workshops, I put a stop to staff perks which were based on what amounted to slave labour. Staff brought in their cars, and the boys repaired, cleaned, re-sprayed and panel-beat them as required—all at no cost to staff and with no income for the boys. In woodwork, the boys had been making household items for the staff to take home. And of course, the brick-making had paved many a staff driveway or even built whole houses—all for free. To my surprise, this was the only set of changes I had to insist on with no support from any of my colleagues. Two of my deputies had already had their cars re-conditioned, and one had a new brick patio. Teamwork is the best way to get stuff done, but just occasionally leadership is very lonely.

We also decided to expand the senior staff weekly meeting to include several of ‘the old guard’, to make this a shared journey. The objective was two-fold. One, to do our best to make sure boys who could be with their families instead of with us on remand got the right help to achieve that. Two, for those that had to do some time, make sure we had as fair, safe and productive an experience to offer as possible. The inclusive meetings made a big difference immediately. I watched as one of the people who had stood and smirked while I was locked in that dormitory joined in enthusiastically with planning a new sport and fitness program. These were good times. But it was during one such meeting that we got an awful reality check.

A worker burst in and blurted ‘There’s been a fire in one of the time-out cells and there’s a boy might be dead.’ I ran with him to where thick black acrid smoke was clearing, to find a 15-year old boy being pulled from a cell. He was aboriginal, and his dark skin was now covered in black soot. It was clear we were too late. This beautiful boy, a great footballer and always cheekily grinning, had got into trouble by refusing to stop talking back to staff, and been sent to do half an hour in a cell. Like others, he had matches stuck up his rectum or under his foreskin, and he had deliberately set his mattress alight. In a poorly-ventilated small room, the poisonous smoke produced would have killed him in minutes.

After dealing with doctors, paramedics, the Director-General and even a reporter who got a tip-off, I spent some time with the worker who had put the boy in the cell. With 120 staff, we had just two who were aboriginal, and he was one of them. He had taken the boy to the cell, locked him in, and forgotten to go back and check after the mandatory five minutes. Usually a confident, cheerful person, he was hollowed out, breathing hard and almost incoherent. His eyes seemed blank and lifeless, as if he was in a deep dark place. I spoke quietly, asking him to sit down and get his breath, but I got nowhere. He was unreachable, and he resigned that same week. The social pressures he would face for years to come would punish him every day. It was risky enough to have been paid to be one of ‘the screws’, but now he was forever the guy who let a ‘nunga’ die in a cell at McNally.

Of course we tried to make sure it couldn’t happen again. We replaced the foam mattresses, maintained constant surveillance when someone was in a cell, and, more importantly, made it a rarely-used last resort, only to be used when the safety of staff or boys was at serious risk. The investigation that followed, and the later Coroner’s enquiry, all exposed a more authoritarian culture than even I had realised, particularly in The Block, where un-recorded use of isolation in cells had been happening every day. That tipped the balance for all of us on the senior team—it was time to find a way to close The Block. It was never going to be easy. Although the head of the staff, a stubborn defender of his regime, had just gone on extended sick leave, we knew the wider beliefs that the Block represented–discipline, ‘the only thing some of these boys understand’, proof that we weren’t just molly-coddling hoodlums, and so on—would make it politically difficult.

Luckily for us, the architects and engineers who came to look at the safety of the cells observed in passing that the high walls of The Block were in danger of collapse within a few years at most. It took a few very heated meetings and threats of union action, and some good footwork by me with my worried bosses, but within a month we had closed the doors. Not for the last time unfortunately. After I had left, a future Superintendent re-opened it. I learned a lesson then—if it is there they will use it. I applied the lesson to good effect years later when I was closing a mental hospital. Anyway, The Block walls did become unstable, so it had to be closed and demolished within another couple of years.

Gradually the ethos of the place was changing, at least on the surface. There were still perhaps 25 staff from the old days, and a few of them never adjusted. Although most had modest English army pensions, they were hanging out for their thirty years to get the generous South Australian superannuation, so we were stuck with each other. But now they were in the minority. With rapidly improving wages at the time, young well-educated recruits were not hard to find, with many rising to leadership roles within a year or two. About 50% were women, which was a huge cultural change for the better. Attitudes about how to help young men who had been losers all their lives were becoming more positive, creative and caring. Of course it wasn’t all like that. Institutions, especially locked ones, constantly breed dysfunctional behaviours, and there were many instances of wrong-doing by staff. It’s never easy to sack people, but I confess one or two of those opportunities gave me real satisfaction.

One coup was all about a kitchen door. My deputy had noticed that people often pulled up outside the back door of the kitchen when leaving work. She was sure some stealing was going on, but the head cook was adamant that could never happen with his trust-worthy staff. He came to see me, accompanied by the union representative, indignant that she was ruining his good name. With no hard evidence, I had to back off, which infuriated my deputy. Only a few weeks later, a boy made a successful escape by bursting into the kitchen, threatening one of the cleaning staff with a knife, and leaving by the back door. After checking she was OK, I asked the head cook to come into work. With all the staff assembled, I told them that they would not be at risk in future, because we were going to keep the back door locked, with the key only available from the security staff at delivery times. With no exit via the back door, there would be no more escape attempts through the kitchen.

There was dead silence. Everybody was in on the racket of taking free food home from the back door. From now on they would have to leave via the security check-point, bags checked like everybody else. As I reiterated that their protection was our top priority, the head cook’s contorted face was a treat to watch. The food bills went down by nearly 50% within a month. None of us had even guessed at the extent of the scam, which I later found out had been instituted by a previous superintendent, complete with a strict pecking order of who could take how much.

I’ve often reflected on how much good we did on ‘The Hill’, as people called McNally. For the boys we kept out of the place, by our actions around bail and quicker reporting to court, I’m sure outcomes would have been better. In any case, incarceration should always be a last resort. Some of my colleagues were setting up great programs in the community with families, finding real jobs for boys who were ready, and education and skills development for others. That was the future, not running a better institution.

For the boys who had to stay inside, I can’t say I have any confidence we turned many young lives around. I’m still sure the school was a good idea, and for some of them, I know we offered a respite from abuse, neglect and constant conditioning towards less productive and often shorter lives. And most of the new staff we recruited and trained helped to usher in a fair but firm and caring style that did less damage to already damaged boys than the old regime. I still think anyone making more than these modest claims about the benefits of youth prisons is kidding themselves.

The standout to me was how few of the boys were truly dangerous, or determined to be a criminal. Almost all of them were losers in life, used to failure, with little to look forward to. They had drifted into stealing cars, getting into fights, and falling for the ‘triple whammy’ of ‘abusing a police officer, resisting arrest and assaulting a police officer’. One silly bit of cheek ending with serious charges with no witnesses called except other police.

I think there were only two boys I thought of as evil. One was a gang leader, and the other boys were terrified of him. Whenever some kid got his head pushed down a toilet or a knife was discovered, Tony was not too far away. He always smiled at me and said ‘Hello Mr Meldrum, how are you?’ It made me shiver. I just hoped he didn’t know where I lived. It surprised no-one when he got killed in a shoot-out over stolen drugs a few years later. The other nasty one raped several young women, and I was quite sure he would do it again, first chance he got. He did, and ended doing a long stretch in goal. His mother came to see me, and screamed at me that her boy was innocent, while he smirked in the background. It’s not easy to believe in reform and redemption in those moments, but thankfully they are rare.

Those boys are in their fifties now, the ones that survived. I occasionally run into or hear of some of them. A young man named William D hailed me in the street one day about ten years after I left McNally. I recalled that he had asked to see me in private in my office on the day of his release. He presented me with a perfect copy of the master key to the whole institution. He had made it in the metal-work shop, and had been using It in secret from time to time, just for fun. He’d never told anyone about its existence, until he gave it to me. I checked it on my door—it worked. William told me he had become so interested in locks that he went on to be a locksmith, with his own successful business. He had a young family and owned his house. Maybe he would have achieved all that and more without a spell in McNally. But I prefer to think that, even if by accident, we did our bit in helping him on the way to a good life.

The swimming club minutes secretary

As a teenager, my only claim to sporting ability was with swimming. I was near-talentless at anything relying on hand-eye coordination and balance, although I did go on to be quite capable as a billiards/pool player. The Mountain Pool Swimming Club was the focus of my social life; where I was on equal physical terms with other swimmers, and about the only place where I was brave enough to talk to girls. I missed out on most of that action, but I did start to develop friendships with what had been an alien species for an adolescent boy in a family with no girls.

I still love swimming, but the bigger legacy of those days was my introduction to work on committees. My mother was the Secretary of the Club, and one day she couldn’t go to a meeting. She asked if I could attend and take the minutes. I looked at her hand-written minutes-book, and it looked pretty straightforward. After training that evening, I stayed on, and was waiting in the meeting room when the Club President arrived. He was a tall, loud, abrasive man, who I found out later had a hearing problem dating back to his days as an artillery gunner in the Western Desert. This led to him barking ‘What was that?’ and ‘Speak up’ whenever people spoke quietly. I spoke quietly, as I do still, so our interactions were often fraught.

In his booming sergeant-major’s voice he asked, ‘So young David, what are you doing here?’ I explained, and he said it might be better if one of the other adults did the job, but by then a couple of others had walked in, and one said, ‘Give the boy a go, he’s a loyal member of the club.’ The President agreed on condition that I read out what I had recorded after each item.

My recall has always been good, at least so far, and I love picking the essence out of whatever is being discussed, so it all went quite well, until a long wrangle began on that old chestnut, a possible change to the monthly meeting schedule. Because the President was an active and sometimes belligerent participant about this, he forgot to check in with me for about twenty minutes. No agreement could be reached, so it was to be status quo. He turned to me and said, ‘David, read us out how you summarised all that.’ I read ‘Mr S proposed a change of meeting dates from the first Monday of the month to the first Wednesday. After lengthy discussion, it was agreed to retain the current arrangements.’

The President harrumphed loudly and asked the meeting if they were happy that most of their (and his) salient arguments had been lost to history. They not only agreed with my version, but later talked to my mother, asking her to become an ordinary committee member, so that I could do the minutes from now on. She was more than pleased with that outcome. My life in meetings had begun.

I was really buzzed by the whole experience. I knew I was good with words, and that I had a good memory, but now I could see this actually led to life skills that others wanted. I could sit in a meeting with a bunch of adults, see and remember what was going on, and summarise for them in ways that they found really useful. Just as long as I was careful not to be a smart-arse, because there are people like that president in many meetings, who resent the youngster with the gift of the gab.

It was an epiphany for me. I started to listen to my Dad talking about his job as manager of a local factory, and director of the parent company. It turned out to be a safe zone in our conversations; one that didn’t veer to competitions that I would always lose, often painfully. For whatever reason, Dad was happy to share with me every aspect of his leadership style, and the difficult decisions of the day—and showed genuine interest when I made suggestions. Management had its hooks into me, and it would never let go.

For the next few years, I was absorbed in the adventures of growing up; getting engaged and married, getting though my university studies by the narrowest of margins, and becoming a teacher. Along the way, there were many situations with friends, fellow-workers in my various part-time jobs, and with student groups, where I found myself being a facilitator, chairman, spokesperson or reporter. But I don’t recall thinking about becoming a manager as soon as I had the chance. Perhaps I just assumed it to be the natural order of things for a capable, well educated young man from a well-off family. Conversely, I did rather badly in my first couple of years at university, and I know that dented my confidence for a few years.

Whatever the reasons, I was completely pre-occupied by teaching and post-graduate studies until I was about 24. That year, 1971, I was selected to be part of a conference on the development of ‘open-space’ teaching settings, which put several classes, with their teachers into one large area. I was surprised to find that it was a small symposium, with about thirty people participating. Half were teachers, and half were principals. In the first session, the facilitator told us we were going to swap roles. The teachers, many of us very young, would role-play being a school principal, and vice-versa.

The facilitator then paired us up with one other, in the opposite roles, and gave us a problem to solve about open-space teaching. I remember the first issue we were handed was about four teachers working together in one unit. One is not pulling their weight; not helping with discipline, not preparing for lessons as agreed, etc. How should this be dealt with? After 15 minutes or so, the pairs reported briefly, then each person worked with someone else. By lunchtime I had teamed with about six principals. Initially I was hesitant: the first was a man about 60 years old, a vastly experienced and widely admired professional. But he immediately accepted that I was the decision-maker, and we had a sensible discussion that I summarised from time to time.

Each pairing worked better than the last, with several of the real principals saying very nice things about how much they enjoyed problem-solving with me in the lead. I shouldn’t have been surprised: there is ample literature on how readily people fall into new roles in these sorts of experiments. But I was not just doing my part; I was also loving it. My listening, reasoning and clarifying skills fitted the situation like a glove. By the end of that day I had made up my mind; I was going to get into a position where I could give effective leadership to help teams of people make progress on things that mattered to me. I had no plan yet, but from that day I was thinking about opportunities.

1971 was a very busy year for me. I was teaching, and struggling to do that well, although I loved it. I was also studying political science, doing what was called a Masters Preliminary, the equivalent of an honours year, and tutoring first-year politics students at University two evenings a week. I was at a crossroads. If I had really buckled down and applied myself more to the tutoring, I could see an academic career beckoning. It was fun, but my heart was in the leadership thing now, and I had a view that teaching at University was never going to be ‘the real world’, whatever that is. Late in the year, I got my chance

I had a friend working in the ‘welfare department,’ and he told me about an up-coming fast-track executive development scheme for outstanding candidates. The new department head had decided he needed a few people to completely disrupt the models for working with neglected children, victims of family violence, young offenders and others served by approaches that hadn’t changed much since the nineteenth century. I had a preliminary interview, and everything I heard convinced me this was what I wanted. The big jump in salary wouldn’t hurt, although it wasn’t the main driver for me. They short-listed me, but now I had a problem. In those days teachers who had been assisted though college had to serve out a three year ‘bond’, and go wherever they were posted. I had been lucky with that one because of my Masters’ studies and because I was married with a wife who worked in Adelaide. I dodged the bullet that saw friends doing three years in one-teacher schools in remote country regions.

Leaving the Education Department a year before my bond expired was regarded as career suicide, as well as risking a demand to pay back of all my student assistance. So I asked my principal at the time if there were ever any exceptions to this policy. He was adamant—no-one could evade a bond. Then he added, ‘Unless the Director General himself agreed that was the right thing. And that will never happen, so just accept that you have to wait another year.’

To the principal, after forty years of loyal service, the Director General was a remote, almost mythical figure of authority. To me, brought up in a household where my father had a very senior job, the Director General was just a man who was a boss. That day, I rang his office, and his assistant said she would check his appointments and get back to me within a couple of days. Very soon, I had an appointment. I told the principal, and he was so shocked he excused himself and stayed pruning the roses in the school garden all day. This was his standard response to difficulties, along with constant smoking.

A few days later, I went to head office, and met with the DG and his deputy. They asked me why I wanted to take on ‘welfare’ work with very difficult people. I told them the truth—I wanted to be in a position to make a difference for people who needed better government services. The DG was quiet for a while, then said, ‘The point of the bond scheme is to keep good people in the public service where they are needed. It seems to me you will be doing just that, even if you are in a different department. I’m going to tell my colleague in the Department for Community Welfare that if he wants you he can have you.’

I got the final interview for the position of ‘Assistant Supervisor in Training’ that same week, and was offered the job. Three weeks later, my teaching career was over, and I was a management trainee. At just 25, I was in a department of a thousand or so staff where I was in the senior ranks, on track to become a member of the Executive. Writing about it now, the situation seems outlandishly lucky, but at the time I thought only of how much fun I was going to have. I was so young I was puzzled by the awkward reactions I got from people thirty years older than me, who I had just leap-frogged with no apparent effort. I got humbler and kinder about that sort of stuff over the next few years, but early in 1972 I was completely absorbed with possibilities that seemed endless. I was going to be a boss, and I was going to help make a better world. The swimming club minute-secretary was on his way.

The bike thief

He nicked it right under our noses. Charmaine’s gorgeous almost new touring bike; so new she was still thinking about a name for it. And now she doesn’t have it; someone else has.

As soon as the letting agent told us our bikes would have to stay in the street, we were all a bit dubious. ‘Not in the lounge room? They’ll fit in easily?’ No way, so we went along with her, no choice really, privately resolving to move them inside when the coast was clear. After all, we thought we had made it clear when we booked that we needed safe storage for four bikes. In retrospect, with Air BnB, the letting agent in Avignon, and the actual owner all in contact, I can’t actually remember who, if anyone, agreed they could be kept off the street.

So the bikes were outside chained to a railing, in our full sight through the front window. Unpacking, planning the evening meal, arguing the merits of various wines we had drunk in Provence, we knew we needed to shift the bikes soon, but didn’t do it as an hour or so went by. The owner had left us a bottle of rose in the fridge, so we opened that and toasted the success of our bike riding for the day. Charmaine and Lynne noticed that a young man was beside our bikes, on his own bike, but as he rode away they thought no more of it.

A few minutes later, Charmaine looked up as the same man popped his leg over her seat and rode off. Yelling ‘My bike’s gone’ she ran outside to see him disappearing down the street. She pursued on foot, and I jumped on my bike, noticing the cut chain on the ground beside it, and rode off in that direction as fast as I could. As I passed one tiny, winding ancient lane after another I realised I had no chance. In any case, what was I thinking? A fit 20-year-old; what was I going to do? Knock him off the bike? Yell something to passers-by, when I speak almost no French? Sad and defeated, I rode back slowly up streets I had flown down, to find Charmaine trudging back to our apartment.

It was very quiet inside now. Charmaine was shocked and getting miserable about her loss. This was a very special bike, bought specifically for this trip to France, and she had loved it unreservedly for the last few months. It fitted her like a glove; comfortable, well-equipped and beautiful to look at. Meanwhile, the rest of us were beating ourselves up; for leaving the bikes outside; for not reacting more when we saw the guy parked there for no good reason; and in my case for depending on a chain that I knew wasn’t really up to the job. He had a go at Lynne and Len’s lock, failed, then moved on to ours.

Then we realised the bike out on the street now was his—the one he rode up on. He had left it there. We debated what to do, but because we couldn’t be quite certain it was his, we dithered while we got a meal ready. Eventually we parked it right out front, where we could watch to see if he came back for it. And still he got away with it. Somehow, he waltzed up, and took it, and we didn’t see him do it. Lynne suddenly called out ‘It’s gone’. Great surveillance team we made. A nice pasta and a glass of red, and we didn’t see a thing. As a bicycle thief, this young man must have been euphoric; it would have been a close to a personal best. An almost new, quite expensive touring bike to sell on, and he even got his own bike back.

Of course, life goes on. No-one was hurt, and insurance will cover most of the loss. A replacement will be found. With any luck, the thief’s family may even have benefited from the proceeds. We have all moved on from Avignon now, so that’s that, just a memory of a sobering experience. I’ve bought a thumping great bike lock, but my heart’s not in it. I don’t want to live ready for the next thief. Not sure what I’ll do about that conundrum yet.

It was very interesting finding a new lock. The bike shops in Avignon are all in the less salubrious suburbs outside the city wall. I walked through many streets, getting directions from friendly people whose French I mostly didn’t understand. The contrast with the centre of Avignon, with its super-clean streets and endless choice of shops and restaurants, was stark. It hit me, this was round about where he must live. Washing on balconies, older cars and motor bikes, people of every colour and costume, young men with nothing to do showing off to each other on street corners, pot-holed streets. My angry fantasies of the day before shifted to sadness about the limited choices of our thief and his family and friends. I may have no solutions, but I’m pretty sure that Charmaine getting her bike back and him going to jail, probably mainly for knocking over a silly old man who thought he could win a fight, would do nobody any good.

Whatever it takes

Whatever it takes
I’ve been reading about the L’Hopital General, a very old building in the small city of Uzes where we stayed a few nights ago, on our cycling tour around Provence. It was established in 1214 as a ‘hospital for the poor, thanks to a generous donation’. Most of its functions were convalescence, a place to die quietly, or isolation when infectious disease was about. In 1720, almost all of its patients and staff were killed by the plague, so no-one went near the place for decades.

The story set me thinking about my own brief foray into a modern attempt to keep people out of hospital, unless they really needed to be there. I was the first and only CEO of the Advanced Community Care Association, begun in 2003 and voluntarily wound up by administrators in 2006. During 2002, our enthusiastic Minister of Health had announced a “Generational Review’, a ‘root and branch analysis’ of the health system in South Australia. I was brought in as one of a number of senior people who would hold consultations, sift the evidence and write position papers on how services could and should change. Unfortunately, it degenerated into a very expensive talk-fest followed by fiddling with the organisation charts, none of which actually promised to give anyone a better health outcome. Within a few months I was desperate for a real job, somewhere I could improve the experience and survival chances of actual people dealing with serious health issues.

An old friend rang me out of the blue, suggesting I apply to run the newly formed Advanced Community Care Association (ACCA), an NGO created by three leading community health organisations. The three CEOs wanted to reduce what they saw as widespread unnecessary hospitalisation. They had already managed to talk the Government into giving them a small grant to provide care to people in aged care facilities as an alternative to a trip to hospital. Two phone calls, one interview, and within about a week, I had the job.

I started with just a desk, a phone and a small budget. I recruited two colleagues who had the skills and networks I needed for ACCA to have an impact in the system. There was a lot of reading and talking to do, in an effort to get up to speed with current practice, evidence of what did and didn’t work, and at what comparative cost. I quickly encountered the basic conundrum that hampers these programs. A Treasury official told me coolly, ‘Your new program will only interest us if hospital beds close as a result—and that will never happen.’ In general, history since then, in Australia at least, has proved him right.

So I decided early on not to argue that we would save public money, but instead to show that people/patients wanted these new alternatives, and that they were not very expensive to provide. The evidence, from Australia and several other countries, was certainly there. More than 90% of people facing hospital care, if asked whether they would prefer some or all of their care to be at home, say yes, as long as their GP is supportive. This strong preference holds up across gender, socioeconomic status and age, but is routinely ignored, especially in a crisis, resulting in large numbers of people in most hospitals being there more often, and for longer than they need to be.

The ancient hospital in Uzes demonstrated a simple principle; people only went to hospital when there was no acceptable alternative. They knew even then that putting together a lot of people with serious diseases, away from their family and friends, could be a risky proposition, but sometimes poverty and/or the severity of your condition leaves little option. Today, rich countries vie to provide the best hospitals they can, at huge cost, with full support from public opinion. For many conditions and treatments there are complete or partial alternatives to hospital care, but closing beds to provide home care is still seen as political suicide.

In ACCA, we started by getting to know emergency department leaders. Everybody knows many of the people presenting in the ED don’t need to be there, and in some cases definitely shouldn’t be there because of the health risks involved. So it wasn’t controversial to ask about who might be candidates for diversion to home care. ‘Do something about the psychos and the wrinklies’ came up often. Blunt but honest. ‘We can’t help the psychos and we hate seeing the wrinklies falling apart under the stress of ambulance trips, waiting around on stretchers and getting infections.’ Because we had the small grant I mentioned, we decided to have a go at reducing the number of people from aged care homes that were taken to EDs.

It was easy. We advertised to community nursing agencies, looking for competent people prepared to be on call at short notice when either a GP; a nursing home or a paramedic felt that good nursing care would be a better alternative than a trip to hospital. In the first month, we had about two calls a day to our telephone hotline; within six months it was up to 50 a day. GPs loved the service, because the first thing our call centre operators did was call them and ask for advice about one of their patients. Aged care staff, paramedics and ED staff were all equally enthusiastic. And the private nursing operators were ecstatic about so much new business that they didn’t have to chase. Most important, residents and their families spoke highly of this new home care, with wonderful new stories coming in every day.

The disruption and anxiety created by a trip to an ED in an ambulance was only part of the problem we were trying to solve. Even when the health issue is relatively minor to start with, like being dizzy after a fall, or having a cut that needed more than a band-aid, when someone who is extremely old and frail comes into a system geared to diagnose and manage all health risks, getting home any time soon is unlikely. OK, sometimes people get lucky when a previously unknown and easily fixable problem is uncovered. Much more commonly, questions lead to tests and more tests, each taking time to arrange, deliver and analyse. Precious time, when an unhappy, anxious person, possibly already coping with some dementia, deteriorates rapidly, sometimes dying within less than a week. It’s hard to imagine a more lonely, frightening and confusing way to die than this. Most health professionals agree, but seem incapable of coordinating their activities to stop it happening. We made it easy for them. Call ACCA and someone will be there to provide an alternative within the hour. Whether it was to prevent the trip to hospital, to get them out of the ED, or to get them home a few days earlier, we made it all as easy as a phone call.

The best statistics we could find came from the ambulance service. With their help, we could track the impact of the new program on each aged care facility, on each hospital and even on individual residents over time. Within six months, the overall number of ‘carries’ from aged care to EDs was down by 15%. Some patterns began to emerge. For example, some facilities were dramatically more likely to call an ambulance than others; some 10 times the average. We began to dig a little deeper, and found these were all privately owned, and known for penny-pinching on staff selection and training. All too often, their policy when a resident had a minor accident or became unwell was ‘When in doubt, ship them out’. So we offered extra training in first aid and wound management, at no cost to the proprietors. Some took it up, and hospital transfers began to reduce almost immediately. Some turned down the offer because they wanted us to pay for replacement staff while theirs were being trained for a day. We just couldn’t bring ourselves to reward that level of selfishness.

The good stories came in thick and fast. One night-duty nurse rang in to say a very old lady had become delirious and paranoid, and was disturbing the other residents. She couldn’t do anything, because she was on her own, and couldn’t sit with only one of her 75 residents for hours. About to call an ambulance, she remembered ACCA, and rang to talk it over. One of our staff asked who the lady trusted most, and it was a cleaner. We asked if the cleaner would be interested in a few hours overtime to sit with the lady, with us paying. She was, she did, and within an hour the resident was calm and going to sleep.

A hospital rang with a different problem—one of the famous ‘bed blockers’. These were people who resisted all efforts to leave hospital because they were afraid of or simply didn’t want what they were being offered. At a cost of more than $1000 a day, and people waiting in corridors for a bed, this gave hospital administrators nightmares. This patient was too unwell to go home, was eligible for aged care, but kept refusing to consider the places she was offered. So, on day 88 of her stay in hospital ($88,000 and counting), we visited the lady. She told us immediately that people who ran nursing homes were all dreadful and uncaring. She had arrived at this conclusion by talking with other patients, but had never actually met anyone who worked in such places. She agreed to let us find three in suburbs near her relatives and friends, and get someone from each to visit her. We would pay the aged care facilities for their time. She liked the first person who visited, and asked if she could come back next day to continue the discussion. She did, and they got on wonderfully. With her visitor still there, she called in the ward nurse and told her she would be leaving to live in her new friend’s facility as soon as it could be arranged. Face-to-face, caring human contact was all it took. The cost to us was less than $150.

Successes like these meant we were offered more funding to work with anyone, not just aged care residents, who might be able to spend less time, or no time, in hospital with the right community supports. With thousands of people a year using our services, it’s hard to select just a few examples that give the flavour of what could be achieved, but here are three:

Bowel preparation: the CEO of an Adelaide hospital rang me to ask if we could take a look at his ‘colonoscopy ward’. It turned out that the surgeons involved had a policy that people over 75, living on their own, had to come in the night before, for their ‘bowel prep’, and stay the next night in case there were any post-procedure complications. Since no other hospital required any in-patient time for such people, and he had a whole ward full staying for two nights, the CEO wondered if I could talk some sense into the medical staff.

Somehow, I managed to get myself invited to the monthly surgeon’s meeting, where I politely asked about the reasons for the two-night policy. The first was that ‘older folks on their own sometimes stuff up the bowel prep, and we can’t do the procedure with bowels full of faecal matter’. The second night had been instituted many years before because someone had a haemorrhage at home alone, and nearly died before they were discovered. I asked what they would think about us providing a trained community worker to spend a few hours with their patients on each of the two nights. The chief surgeon cut short discussion and said it ‘Sounds like a bloody good idea, and I’m all for it unless any of you have any objections.’ All heads nodded, and that was that. Within a couple of weeks, the ward was empty. With one short discussion, hundreds of people each year would not be going to stay in hospital for a colonoscopy. The cost to ACCA? $200-$300 per patient.

Parklands stand-off: one evening, our call centre was contacted by a policeman about a ‘current situation that’s going pear-shaped.’ A young woman lived in a small van, usually parking in the West Parklands at night, driving in to the city each day for a wash and meals. Right now, she was in a tense stand-off with a police patrol. She and her dog, a Doberman, had returned from a walk to find the van’s windscreen smashed. She became mentally unwell very quickly, screaming at passers-by, accusing them of doing it, which soon resulted in a triple-0 call that brought the police. They were confronted by an obviously psychotic person, being fiercely protected by a large dog. Plan A was to separate her from the dog (it was going to be messy) and take her to an emergency department for a psychiatric assessment. The police call centre people agreed with their plan, because she was a ‘well-known mental patient’ who had been in secure care several times in the last couple of years, with a total of more than 100 nights in hospital.

Amazingly, the policeman thought of us in that moment (maybe it was worrying about how to control the dog) and rang to see if we had any other ideas. He said he thought the big problem was her fear of sleeping in the van with no windscreen. We asked him if it would help if we replaced the windscreen. He liked the idea as long as it could happen quickly. It took an hour and the job was done. The woman and her dog drove off in the van, and the police patrol left for another call. The total cost to ACCA? $244 for the windscreen. In a lovely post-script, the next day the manager of Windscreens O’Brian called to ask if the woman was OK, and to say he was reducing the amount owed to cost-price only. Turns out his son had schizophrenia, and he was happy to have been able to play his part in getting this woman out of a crisis, that he knew all too well could have ended very badly. Even if Plan A had gone reasonably smoothly, the woman would have been in hospital again, terribly distressed, probably for a long stay, her choice of lifestyle ruined.

Door locks: a senior nurse from a large psychiatric ward in a teaching hospital asked us to visit to discuss a ‘bed blocker’ who had been there for about 35 nights. She came in as a voluntary patient, during a period of mania due to her bi-polar disorder. A change of medication had calmed her down, but she had remained highly anxious about going home, because she believed that people had broken in and changed the locks. Stronger anti-psychotic medication combined with individual and group therapy had not shaken this belief, so every time they suggested she go home, she became hysterical. The hospital administration was now breathing down their necks about the back-up of people in other wards and the emergency department, needing a bed in the psych ward. In desperation, they called us.

We sent in a nurse who sat with the woman, and asked what we could do to help. She asked us to get her locks changed. We did, at a cost of about $150, and went in the next day to tell her it was done. She asked us to accompany her to her home when she left the hospital that day, so that she could check the locks with us there. We did that, all was OK, she thanked us and told us we could leave.

Of course, there were many times we just couldn’t make any headway, even though we knew community care would be effective and preferable to the individual and their family. Such as when respiratory surgeons insisted that children with cystic fibrosis come into hospital for every appointment, when the wider trend was to keep people with such compromised resistance to all sorts of infections as far away from hospital as possible. Why? Because they didn’t trust GPs. No discussion was even countenanced.

But with such a huge number of people we could help, with full cooperation from the person themselves, their GP and all other clinicians involved, we learned to be patient, and not use up much energy on the ones we couldn’t win. Every hospital, every GP was different, and often the right mix of people would coalesce out of the blue, enabling the previously unthinkable to become what everyone wanted.

We had absorbed some key lessons from all this.

First, most of the reasons for unnecessary visits to or long stays in hospital were not clinical. They were social and psychological. The majority of our interventions were about companionship, practical help with food, transport and negotiating new options in the community. It rankled many health bureaucrats and professionals, but this was just as much about ‘welfare work’ as it was about new ways of delivering clinical services

Second, people didn’t need to be assessed, re-assessed and re-assessed every time they needed help. Virtually all our clients had extensive records in the health system, and we almost never started a new investigation. That took time, and if decisions about alternatives were not made immediately, hospital was the default. We used the information that was already available, because there was usually more than enough.

Third, the slogan we had was the right one—’whatever it takes’. We gave our people the mandate and the means to follow their nose to quickly available solutions, doing things that were just not possible for clinicians in any setting. Usual practice in health systems, then and now, simply doesn’t have all the answers.

After a little more than three years, the government contracts for all this work—by then worth about $7 million a year—were put out for tender. We lost the lot to a for-profit nurse-run company that went on to ignore all three of the lessons above. The delays, unnecessary costs and narrowly clinical understandings were back, and the impact was quickly obvious. The Consultant in charge of one emergency department lamented to me a few months later; ‘David, the wrinklies and psychos are back, and the ambulance gridlocks are back and what the hell was the Department of Health thinking?’

It was hard for me for a while. I suppose it dented my faith in progress. Things don’t always lean towards gradual improvement. This was some of the most satisfying work I’d ever been involved in, in terms of giving people a better health service. But health tribalism, clumsy bureaucracy and some silly interpersonal issues between key players undid most of our work overnight. More than ten years later, I have to admit it still grieves me to think of how all that ended. There are parts of the world—Canada and New Zealand are leading examples—where the lessons we learned underpin widely accepted policy and practice. But in Australia community programs that provide alternatives to unnecessary hospitalisation are still painfully slow to develop; front and centre in every policy document, but usually lucky if they get the small change left over from running hospitals. The age of hospital dominance of health systems has many years to go yet.