It is a privilege to be asked by Dr Diana Pearson to write the introduction to her new book. A year ago her name meant nothing to me. I had just finished my Master’s degree course in Women’s Studies at York University and urgently needed a job. Teaching had never appealed to me but I knew I wanted to make a difference somewhere, however minimal, in the culture of the second sex. I sent my CV to a score of organisations that actively supported the cause and collected some extremely polite rejections before finally hitting lucky with Virago Press. The publishing director regretted that she had no vacancies but was kind enough to mention another London based company. She knew for a fact they wanted to recruit a junior admin assistant. Would I be interested? My email earned me an interview. I drove down to the capital and the panel seemed to like me. They wanted to know how soon I could start. “Is Monday too soon?” I replied and they liked me even more. The offer consisted of a four day week and a six months probation period.

It became immediately clear that I would be a dogsbody, working through an enormous slush pile on the trail of a marketable product, a human filter trusted to alert senior colleagues when or if quality appeared. The partners told me to use a JIP grading system. J stood for junk, I for interesting but flawed, P for publishing potential. Of course these distinctions often overlapped at the edges. The seniors had different specialisms and tastes. One reader’s interesting could be another’s junk. What I learnt early on, however, was that potentially publishable manuscripts were at an absolute premium. Effectively I’d been sent diving for pearls in a darkly polluted sea. Several weeks in and I didn’t seem to make economic sense on the payroll. Ten thousand to one is a long shot in anyone’s language. That’s on average how many oysters a diver opens before he hits lucky. So the reward to the company, should I happen to surface with one, needed to be significant. Even so I had to be operating on borrowed time. No pearl, no job. And in the meantime my chosen career preference – to undermine the patriarchy – remained a mere pipedream.

Three months on, having unearthed from the ocean floor of literary good intentions nothing but junk, I had begun to suffocate with frustration when everything suddenly changed. Normally an author who is not represented by an agent will dispatch their submissions by email. These take the form of an introductory letter, a narrative synopsis and up to three sample chapters. One of the partners had mislaid a luncheon invitation from the American Embassy and asked me to look for it while he was out; in the course of which I came across a bulky brown package that had been opened but buried beneath some industry brochures in a cupboard drawer. I handed it together with the invitation to my supervising colleague. The next morning I found the package on my desk when I arrived for work, attached to a note instructing me to return the contents to its owner together with our standard ‘thank you but not for us’ rejection message. In her letter the author, Diana Pearson, explained that she had spent over forty years working in the National Health Service as a general practitioner and advisor. Since retiring she had become a trustee of a hospice and set about writing her memoirs. She called the autobiography A Doctor’s Dilemma.

My involvement with Dr Pearson might easily have ended then and there but for the fact that I had spent a quarter of the year immersed in fiction – romance, whodunnits, sci-fi – all of it derivative and mentally wearying. I badly needed a long stiff draught of reality to blow away the cobwebs. So I sat down and read the three sample chapters straight off. The first about the invisible relationship between poverty and ill health, the second about the government’s fit for work test, the third about the state’s covert surveillance of sickness benefit claimants. I was gripped. It felt like someone was pouring a bucket of cold water very slowly over my head, urgent and real and something else, too, that I couldn’t quite put my finger on, something awful buried out of sight in my early childhood that I had decided not to remember. What was it? I took the typescript back to the south London house I had recently begun sharing with four other working women and read through it all again after dinner. The truth only began to dawn on me as I climbed into bed. Diana Pearson had chosen my father to use as one of her case studies!

During a dislocated night’s sleep the fragments of memory pieced themselves together. I was six years old when my father ended his life by swallowing an overdose of drugs. The illness from which he had suffered debilitated him dreadfully. It never had a name that I could recall. The trigger had been a viral infection, an extremely persistent bout of influenza that eventually compromised his immune system, leaving him chronically fatigued both physically and mentally. He had been retired from work, necessarily spent much of the day in bed and became increasingly depressed as the prolonged state of inertia showed no sign of abatement. As time passed, however, certain clinical interventions were made available to him. Some psychological like cognitive behavioural therapy and others physical such as graduated exercise programmes and cold water immersion. Gradually he learnt how to manage the worst symptoms and to develop a few oases of quality into an otherwise completely blighted life. Of course this is not how I understood daddy’s situation at the time. I had been a baby when he fell ill. The specific details must have been conveyed to me later by my mother after his passing.

The word passing here is a misnomer. My father killed himself strategically because the DWP had decided on account of a secret investigation conducted by one of its zealous bloodhounds that he was a fraudulent social security beneficiary and ordered him to repay all the disability living allowance money he had received, thereby loading him with a burden of debt that would be impossible to meet without selling our home and imposing a state of near penury on our family. After taking careful legal advice he realised the debt belonged to him alone and could not be transferred to his wife. Secondly, with no hope of a cure or of being able to work effectively again, his family would be materially far better off if he ceased to exist. This recognition resided in the privacy of his own mind.

The next day I went to see the senior colleague who had instructed me to return Dr Pearson’s manuscript and, without confiding that I had a secondary motive, attempted to plead for a reappraisal of the project. “It comes across as both compassionate and politically relevant,” I argued. “It demonstrates how far government policy has abandoned the founding principles of the welfare state and how devious it has become in pretending the opposite.” I had expected to be reprimanded for insubordinate behaviour as I harangued the poor man about child poverty, the closure of Sure Start centres, the underfunding of mental health services and much else besides – but he listened carefully before finally replying, “Look Lucy, I do not disagree with most of that. The trouble is that this segment of the book market has biome supersaturated. In recent years medical memoirs have been sprouting up like mushrooms on a damp autumnal hillside. The bottom line is that in the present economic climate we cannot afford to risk losing money on publications of such marginal interest. Sorry.” I was summarily dismissed and returned to my slush pile of fantasy, horror and sexual prowess. But just about four o’clock that afternoon my boss popped his head around the door of the cubby hole where I spent most of my time. “I’ve been having second thoughts,” he said. “Why don’t you ask the good doctor to send in the rest of the typescript? If nothing else it will give a boost to her confidence and – who knows? – we might find a unique marketing hook lurking somewhere inside?”

“Thank you,” I said. “But surely we’ve identified that already?”

He smiled and shook his head in such a way that I was left suddenly unsure about my own motives and impetuosity. Perhaps the unique marketing hook only existed in my nettled psyche? Was my father really a main player in Dr Pearson’s opening chapters or had I simply imagined it? After all, the man’s surname did not match my own.

On the train home I engaged in some serious soul searching. The truth was I had grown up deprived of a father simply because of his vindictive treatment at the hands of a hideously vile local government snoop. For weeks this man had parked in an unmarked saloon car right outside our house waiting with a video camera for my father to appear. His intention being to monitor dad, to follow him surreptitiously and to collect pictorial evidence of him displaying a degree of mobility and stamina that failed to conform to the official disability criteria. In fact I became aware of this man’s presence well before anybody else as my bedroom was situated on the side of the house that overlooked the street. The intermittent flow of traffic, the neighbourly comings and goings, the delivery men – all these were my constant companions. Unlike my parents and older brother, I had a front balcony view of our itinerant community. It is impossible to recall exactly how my awareness of the snoop’s malevolent presence gradually developed. I’d see him in the afternoon when I was dropped off by Mrs Kershaw, the kind mother of Tommy who was in the same class as me at infant’s school. He had a fat face with a double chin, a balding head and little squinty eyes. Sometimes he would be there in the morning before I left for school. He came and went unpredictably. As the weeks passed I felt increasingly disturbed by the mystery of his being there. At first neither of my parents took my disquiet seriously when I spoke to them. Sometimes, if I was walking past the car, I’d dare to glance directly at him and he would smirk back in a way that made me squirm with fear. It felt like he was taunting me, as if he had a wicked intention and he didn’t care if I knew it or not. Eventually I began to have nightmares about him. Was that how my parents eventually became aware of the surveillance operation, through my constant mewling?

That evening I rang up my mother to ask her. She now lives in Woking, close to my brother and her grandchildren. “You were a very sensitive little soul,” she told me. “You always picked up on bad atmospheres very quickly. Your father was much too tired and distracted to listen to you and I had that part-time job at the supermarket to keep us solvent. By the time we took your anxieties seriously the damage had been done.” She went on to remind me how all dad’s benefits got withdrawn, how he was grilled for several hours by the snoop in a stuffy office and denied proper legal representation. Afterwards he received a letter informing him that unless all the money was repaid he would be prosecuted for fraud.

“Dad challenged the ruling through some statutory appeals procedure, didn’t he?” I wanted to know. “Do you remember the name of the health expert who sat on the panel?” But she couldn’t. All she could remember was the two frosty-faced legal beagles who contemptuously refused to understand what a graduated exercise programme involved, namely pushing yourself continually through physical pain barriers, trying however minimally to resume those sporting activities that once gave dad such pleasure. All the names were now lost to her. Even that of the snoop who provided a thick catalogue of written and visual evidence. In the section of the manuscript I had read Dr Pearson writes, “I was dealing week in week out with hard-hearted bureaucratic philistines on that tribunal. The concessions eked out of them after an appellant had left were less than token. I was utterly marginalised and helpless.”

When I told mum about the book she said, “Are you sure the case study relates to your father? After all, that doctor must have attended hundreds of appeal tribunals just like it.” This gave me further pause for thought. Dr Pearson had changed all the names, obviously to protect client confidentiality. But she did reference the fact that Mr Jones, as she calls the appellant in this case study, had a young daughter whose mental health he was extremely protective about, “even to the point of tactless aggression”. Surely that had to be a reference to me? “At the time we compiled a file,” mum told me. “I doubt that I would ever have chucked it away. That will contain some of the answers, if I can find it.”

The next day I rang Dr Pearson to tell her my company would like to read the rest of the manuscript. She reacted with surprise but pleasure. “It’s been such a long time,” she said. “I had no idea the wheels of the publishing world grind so slowly. It will be with you today.” So we chatted a bit and I tried to guide the conversation towards her work as the health expert on those tribunals, only to realise her discretion remained impeccable. “Are you able to tell me which London Borough you were located in?” I persisted. “Or is that confidential too?” It wasn’t. And the answer she gave me supported my assumption.

As soon as the full text of A Doctor’s Dilemma arrived on my laptop I dived into it with an insatiable appetite. It is a compelling read – as you are about to find out for yourself. It reminds us on virtually every page that health care and compassion are abstract values capable of being evacuated of meaning when left solely in the hands of bean counters and profiteers. It reinforced my sense of gratitude to the dedicated people who work on the front line, yet simultaneously sad and angry about the sick in body or mind whose condition is misunderstood or whose treatment is delayed through lack of effective resources. I gave the book a glowing recommendation and passed it on to my boss. There was nothing more for me to do. I had no clout in the company. That would be the end of my involvement with Dr Pearson, I thought.

Or would it?

A few days later my mother rang. She had found the now ancient file they had carefully compiled as the prosecution of the case against dad proceeded. “It’s in the post special delivery,” she said. “If nothing else it will remind you what a decent human being he was and how much he cared for and loved you.”

The evidence against him ran to about forty pages. It included photographs of him walking, shopping, weeding, mounting the steps of a bridge; a log of his visits to a gym and swimming pool; a transcript of the investigator’s interrogation plus a summary describing his attitude as surly, uncooperative and “aggressive to an extent that contradicted his claim to be debilitated and depressive”. On my father’s side there were several concise factual letters from his GP and the consultant hospital immunologist explaining how haphazardly the disease worked. Specifically it stated that the DLA disability criteria were far too narrowly rigid in scope and “could not be meaningfully applied to the illness this patient suffers from, nor the chronic depression or brainfogs that it causes.” Finally I perused his own appeal statement, drafted in long hand on two sheets of A4 paper. I won’t quote it all, just the few sentences that tugged almost unbearably on my strings:

“It is one thing for the state to wage a covert war on those citizens it assumes to be workshy mallingerers or hypochondriacs but it is quite another to punish and torture their children along the way. As a consequence of the crude surveillance activities perpetrated by the DWP’s investigator, Mr W -, my six years old daughter, Lucy, has suffered from hyperanxiety, nightmares and bulimia. She has woken us up in the night screaming with terror that a wicked man was planning to break into the house and murder us in our beds. She stopped eating and developed a nervous tic. To this day we remain uncertain about the status of her mental stability. Our GP has provided her with medication to calm her down and access to a counsellor. But we remain uncertain how deeply the trauma has affected Lucy. If this heartless and entirely bogus legal process has meant to cow and shame me, it has utterly failed. In all matters pertaining to the management of a complex chronic illness, the aetiology of which continues to baffle the medical profession, I have methodically adhered to specialist advice. If anything does shame me, however, it is the naive trust that I placed in the benevolence of the state. As a consequence, I have failed to give proper credence to what my daughter spent months trying to tell me about the thug spying on me and to protect her from harm. For that offence alone I deserve much more than any pecuniary punishment the DWP decides to inflict on me.”

The only other document I found in the musty old file was the summary judgement, a two sentence bureaucratic note signed off by the tribunal’s panel which included the name Dr Diane Pearson, its heroic fifth columnist.

In the days that followed I could not stop obsessing about Mr W – . Where was he now? Still alive and snooping? Still embroiled in the guerilla war against the toxic scrounger culture? I rang the borough DWP office and made a few inquiries. Nobody knew him. As surnames go it was certainly an unusual one, I thought. Surely somebody had to remember the man? Or had he simply retired and dissolved into the nondescript suburban landscape like a slug? Next I tried a directory enquiries check of greater London and several W – names cropped up. But one stood out geographically more than the others. This W – lived in a leafy neighbourhood of the borough in which I had been raised, close to Osterley Park and the directory supplied the address. So on my next day off I drove over there, parked up outside the house and waited, wondering what on earth to do next. A case of history repeating itself in reverse perhaps? I had the option of ringing up and saying something facetious if he answered. For half an hour I just waited and watched while rehearsing scurrilous questions in my head. Attic extension. Dark blue BMW in the driveway. Trim lawn and borders studded with rose bushes. A sumptuously large detached home. Either state sponsored sadism paid very well or I had got the wrong person.

Eventually curiosity got the better of discretion. The compulsion to know one way or the other consumed me. I alighted from the car, opened the wicker gate and walked up the path to the front door as if an automaton had taken control of me, propelled by some atavistic fantasy. Once my index finger had reached out and pressed the bell, time seemed to stop. I could feel my heart pumping with trepidation. Then the door creaked open and there he stood, wrinkled with age, flaccid, double-chinned, reptilian eyes – an infant’s nightmare made suddenly flesh. The shock rendered me speechless. I must have gawped at him like a cretin. “Well, what do you want?” he asked. His stare felt as if it was blistering the skin on my face. I tried to move my lips but no sound was emitted. Then my body turned away and began to scuttle back down the path. Somewhere in the remote distance of my confusion I heard the door slam shut. Reseated in the car I seemed to be hyperventilating. I closed my eyes. One part of me wanted the world to end right there and then, the other part urged me to go back to his door and begin all over again.

After that I returned to my vigil every day of the week with the exception of Mondays, parking as close to the front gate as I could. Invariably I took my laptop and a sandwich for company and read one novice typescript submission after another. Monday became my solitary day in the office. The partners had no problem with that. Most of them worked from home too. What I wanted exactly remained unclear to me. Revenge had to be a large part of it. Validation. Recognition. These too played must have been motives. My problem was compounded by the fact that I experienced myself as a coward. I had never intentionally hurt anyone in my life. To be frank, I couldn’t blow the skin off a rice pudding. On the infrequent occasions Agent W – emerged from his lair he studiously pretended not to see me. But he knew alright. His swivelly lizard eyes betrayed him. He walked with the aid of a stick, his gait slightly compromised as if by a limp or a recent hip replacement. A few hundred yards away a small shopping parade served his exercise needs. At least he headed in that direction and waddled back holding a newspaper or occasionally a carton of milk. Nobody lived in the house with him. I became certain of that fairly quickly. No Mrs W – . No lodger. No pet dog or cat. So he wasn’t just a reprobate, I concluded, he was a solitary one. A loner. Every Friday an Ocado van arrived with a crate of groceries. He would exchange a few words with the delivery man, sometimes rendering him a tip.

How did he occupy himself all day, I wondered. Read? Watch television? Perhaps he was a reclusive author of pulp fiction, emailing his stuff around the publishing circuit under a pseudonym? Maybe I’d actually read one of his submissions? Sometimes he would go for a drive in his car. Never very far. Once I followed him to Richmond Park. He completed almost a full circuit before stopping off at Pembroke Lodge presumably for lunch. Another time he came close to crunching my front fender as he backed out, misjudging the angle of turn. We exchanged glances – in his case a glare. And so several weeks passed. Power is such a peculiarly addictive thing, isn’t it? I never had an inkling before. Now however the power had become transferred entirely to me. I had the evil old martinet on the end of a string – wondering, doubting, assessing – hopefully having disturbed dreams. Not once did I ever feel bored. “This is for you, daddy,” I used to mutter to myself. It never occurred to me to question the validity of this surveillance. I supposed myself enjoying the kind of serenity a fisherman attains as he waits patiently on the bank of a river, his line in the water, contemplating the meaning of every casual ripple.

One Monday my boss told me he’d been collating the responses of his colleagues to Dr Pearson’s manuscript. They all liked it but had reservations similar to his own about its commercial viability. “Something is missing,” he confided. “I’m not sure what exactly.” Still this sounded like melodic music to my ears. So the following day when I drove round to W – ‘s house after the morning rush hour had abated, I felt wired. Proactive. Ready to push the surveillance envelope further. I recall it as a sunny spring day. Pink blossom on the trees. Just after eleven out he came and opened the BMW with an ostentatious flick of the fob key. I immediately switched off my computer and stowed it away. He backed out slowly, veering round in the opposite direction to the shops then accelerated away. The traffic was light and I had no problem following him. He turned left off the estate then left again at the traffic lights into the main trunk road that links Central London to South Wales. Within half a mile he pulled into the local underground station, parked up in a disabled bay and alighted. Luckily for me a regular space was simultaneously being vacated and I slipped quickly into it. Keeping close behind him as we advanced through the ticketing gates proved unproblematic. All his movements struck me as arthritically laboured. If he had not been such a monster I would have felt sorry for him. There was no lift and he negotiated the steep flight of steps down to the east bound platform with difficulty, stopping and leaning on his walking stick a couple of times. When the train arrived I followed a safe distance behind into the same compartment, certain that he had not detected my presence. Not that it mattered. This was a game and he had invented the clandestine rules. I was merely reenacting them.

Where is he going? I wondered to myself as we wooshed through the west London suburbs still above ground, Boston Manor, South Ealing, Acton and Turnham Green, the seats filling up at every stop. Then as the train approached Hammersmith he levered himself into an upright position and hobbled towards the doors. This appeared to be his destination. The train lurched to a halt, an electronic swish of fresh air wafted across my face and I followed him out onto the concrete esplanade. But after a few steps he hesitated. The platform was crowded and he seemed disorientated, unsure which way to go. But finally he did not head for the exit as I had anticipated, he crossed towards the District Line platform presumably to make a connection. In due course a one minute warning of an approaching train flashed up and he moved closer to the edge. We could have been no more than a couple of yards apart at that point when he suddenly twisted round, his veneer of composure totally abandoned. He thrust his stick into my midriff and roared, “Why are you following me, you stupid bitch?! What the fuck do you want with me?!”

He must have had eyes in the back of his head, I thought in amazement as I pushed the end of his stick away from me. Finally I had been brought to account but I was not phased. “I want to know why you treated my father so cruelly,” I said, discovering a voice of defiance that I never imagined I possessed and recited dad’s full name. Mr W – pushed the stick back into my stomach even harder than before and I felt winded. “You effectively murdered him,” I continued regardless. The torpid expression on his face changed, the piggy blue eyes widening as if a penny had dropped. “Didn’t you?” I persisted, liberating myself from the piercing pressure of the stick and stepping right up close so we stood almost nose to nose.

“Keep away from me!” he snarled, shuffling backwards with apparent revulsion. It all happened so quickly. The words. The fall. The scream. And then the long grinding screech of braking wheels as the train ploughed over his body.

When Dr Pearson, in consultation with my senior colleagues, suggested that I should tell this story as a prologue to the book, my instinct was to decline. After all, questions had been asked in parliament as to why I had not been prosecuted for aggravated assault, manslaughter and stalking. Driven by the media, public opinion became inflamed about who should be held accountable for the tragic death of Mr W – . I almost certainly owe my liberty to the several witnesses unlucky enough to be located in the immediate vicinity of the accident and also to Dr Pearson herself who was not slow in briefing the relevant authorities about the psycho-dynamics of delayed trauma. (See appendix 3) This is the reason that I was finally persuaded to write the introduction.

I am not proud of myself but neither am I ashamed. My sincere hope is that A Doctor’s Dilemma will promote a wide ranging debate about the urgent improvements needed to our national health and welfare support services, and that our understanding of disability and illness will as a consequence be significantly enlarged.