It’s little surprise Lionel Shriver tells it as she sees it. Once you’ve changed your name from Margaret Ann, because you’re a tomboyish teenager with brothers, why fret about what others think of you? The Suffolk-bound author tells Steven Russell what she’d do with the NHS. It ain’t necessarily pretty

LIONEL Shriver, whose novel We Need to Talk About Kevin lifted her from near-obscurity and brought the 2005 Orange Prize, is the sold-out headline guest at next weekend’s Aldeburgh Literary Festival. She’s looking forward to visiting an unfamiliar place – even though I’ve warned her about chilly north-easterlies worsening her Raynaud’s syndrome, which means she often wears gloves – but has one regret about having accepted the invitation. “Apparently my local library, the John Harvard over on Borough High Street, are holding their World Book event and wanted me to participate. It’s a 10-minute bike ride from here. I have used that library a lot and have a lot of affection for it. I was so sorry to have to decline. That’s a sacrifice. But I honour my commitments.”

The writer – on her way to becoming an honorary Brit because of time spent on this side of the Atlantic – feels strongly about libraries, under threat across the country as councils slash budgets. In Suffolk, 29 could close if community groups aren’t found to run them. Over the border, Essex plans to reduce opening hours.

In principle a fan of slimming the state, Lionel would protect this area.

“I’m a little suspicious that there are some councils radically slashing things like libraries in order to show off – ‘see what you’re making us do’ – in a way that people are going to notice and find painful. There’s an element of political motivation there.

“OK, I want to see government pared back – bloody hell: 53% of the economy?! I think that’s insane! – but I think you have to be cautious about destroying institutions and even buildings that would take huge amounts of money to replace.

“A library is the product of many years of effort, acquisition and investment. You save only so much money if you stop running it. But if you were to try to re-establish it, it would cost you a fortune.

“I realise that everybody wants to ring-fence their own pet concern, but that’s the one area where I really think we get our money’s worth.

“It’s also an institution that makes it clear to people that they get something from government. And, you know, for people who are taxpayers and not on benefits, it’s hard to point to what you get.

“Libraries for me have always created a sense of exhilaration: that all these resources are at my disposal for either nothing or practically nothing.”

Many of Suffolk’s rural branches will probably end up being run by volunteers. What does she think of that?

“It’s better than closing them. I do think that volunteers can’t substitute for well-trained staff who really understand how things work and the extent of the library’s resources. But I far prefer that than shutting the library.

“I just think libraries are a great portal into the information world. OK, most people have some access to the net, but libraries can help you with it. It’s a crude tool and it’s easy to get lost in it. It’s easy not to find your way around or what you need to know, without a little help.

“I think they are wonderful places in a community where people can get together, come in from the cold, do something useful, and I’ve been very impressed with the way libraries have moved with the times. It’s not just that we’re dealing with a bunch of mouldy stacks nobody’s checking out any more.

“They’re getting into e-books, they’ve for a long time been doing CDs, DVDs and all kinds of media. You can use their printers; they often have cafes, which I think are a great idea. They add to the sense of pleasure and leisure and can also raise some money for the place.

“Across the board, I think libraries have adapted incredibly well to changing times. They don’t cost that much money. I’m much bigger on making public workers work as long as everybody else, and not paying extravagant executive salaries; cutting back on a lot of middle management positions . . .”

So what would she cut, nationally, if she were David Cameron?

Well, “a grotesque proportion” of this country is on benefits. “And I don’t think that’s good for anybody.” Research shows a large proportion of people receiving disability-type benefits don’t belong on them, she points out.

“I don’t have any problem with Britain cutting down on its defence. This is not a world power anymore; might as well take advantage of the fact you are de facto dependent on the US by saving some money. If that keeps you from adventuring along with us into places like Iraq in the future, all to the better as far as I’m concerned.

“I’d get the hell out of Afghanistan. I’d cancel Trident submarines. I would reduce the size of Parliament – much more than they’re planning. I don’t think you need that many MPs to run this country.”

She wouldn’t take benefits away and leave people to fend for themselves, though, surely – especially with job opportunities incredibly thin on the ground?

“Well, the trouble with benefits culture is that once you get people dependent on state money, how do you get them off?

“Do you let people starve to death? Probably not.

“It is a terribly hard economic environment in which to be trying to move lots of people off benefits and into work. I can see that right upfront. And I don’t want to seem hard and unsympathetic, either, but I firmly believe it is not in the interests of grown-ups, who are not otherwise impaired, to be living off of a cheque that comes every month. There’s no dignity in it, there’s no pleasure, there’s no satisfaction and there’s no sense of self-worth.

“My sense of self-worth comes enormously from my work, and for me to wish any less than that for other people would be hypocritical.”

But we couldn’t leave them with few opportunities of gaining self-worth and compound it with the loss of that cheque, could we? With no safety-net, the consequences would be cataclysmic.

Yes, she agrees, it would be difficult to achieve. “I wouldn’t want to be simplistic about it.

“Trouble is, Gordon Brown grew the size of the state so much. There’s a big difference between hiring someone and sacking them, and never having hired them to begin with. And Gordon Brown has put us in a position where a lot of people have to be sacked.”

If we hadn’t created such a vast public sector, she argues, most people would have found jobs with private firms. Now, the upheaval will be traumatic and tragic, as people who have been developing careers find they’re ending prematurely. (As with the RAF pilots.)

“Growing the state is ‘a nothing’; clawing it back is very, very difficult and creates a lot of damage.”

Lionel’s ninth novel – the paperback edition of So Much For That is out in the middle of March – like most of her fiction tackles aspects of human existence we’d probably prefer to keep buried.

Her breakthrough We Need to Talk About Kevin brought us Eva, the mother who never wanted to be a mum. After her son kills seven students, a cafeteria worker and a teacher she re-evaluates her life and asks the taboo question: did her own patent dislike of her child help mould him into a murderer?

So Much For That looks at the effect of a medical crisis on a marriage. Having sold his handyman business for a mint, Shep Knacker is ready to change life dramatically by moving to an island off Africa. His wife digs in her heels and is then diagnosed with aggressive cancer. Her husband devotes himself to her care, but their insurance policy only partly covers the huge medical bills and threatens to devour money earmarked for that new life.

The story has been described as a biting criticism of America’s healthcare system, and Literary Review said readers on this side of The Pond would feel grateful for the NHS.

Lionel’s views on what we should and shouldn’t pay for here, in terms of health, are thought-provoking. (Oh, all right then: contentious.)

“I believe in a very good core service of public healthcare, like the NHS. But I think the NHS needs to cut back on some of the things it covers.”

Such as?

“This is controversial . . .” Can’t stop now. “I think it can’t afford to fund things like IVF; much less would I be funding sex-change operations.

“Now, that said, you cut back on that kind of thing – things that don’t involve someone actually being ill, injured – it’s not going to rescue the health system from being overburdened by an ageing population. The big problem is people living longer, but not necessarily living longer in a state of good health.

“I am big on letting people who are going to die anyway die a little sooner, and save us that money. That sounds cruel, but I think that often the quality of life you preserve in people who have terminal conditions is too poor to merit the expense.”

Spending $2million, say, on three extra months of life – the quality of which isn’t necessarily great – is something we need to reconsider, she argues. “I think we have to start being practical – in a way that doesn‘t come morally naturally; and it’s not nice.”

Specialists in medical circles are already having that type of debate, she says. “In individual cases, doctors are making these decisions all the time . . . albeit quietly.”

Underpinning So Much For That is the experience of one of Lionel’s best friends from way back. Terri developed an aggressive form of cancer and died as the author hit the big-time. Lionel later read about the number of people tumbling into bankruptcy in the United States because of their medical bills.

It’s all getting a bit heavy . . . so what keeps her sane?

Well, the writer – who has lived in London for about a dozen years and before that in Belfast for roughly the same time – appreciates Brits’ “certain verbal energy – a slightly more creative way of talking; a richness of lingo; a little more poetic”.

Provocative articles in the newspapers get her going – such as one about a young athlete who suffered a fractured skull, fractured eye socket and broken nose when a youth threw a brick through a car window. The culprit received a �200 fine and a 12-month referral order.

“Talk about the world being crazy. British jurisprudence is just full of disproportion.”

Lionel’s by turns exasperated by aspects of Britain and energised by them, but admits she’d miss it if she left. “I’m addicted to it.”

Bizarrely, the weather is one of the things she rather likes. “My work is indoors, stationary and very boring, so there’s something about this dark, drizzly s--- that is very useful to me!” she laughs.

“I don’t want to go out and I don’t want to do anything; and that leaves nothing else but to work on my new book. I honestly think that this horrific weather has improved my productivity.”

n The paperback edition of So Much for That is published by HarperCollins on March 17, at �7.99

n Lionel Shriver’s talk is sold out, but more details about the Aldeburgh Literary Festival can be found at www.aldeburghbookshop.co.uk

Game control

LIONEL Shriver is famously frugal – which she attributes to her upbringing – and generally does not turn the heating on during the day . . .

‘Although I did something very indulgent this season: I recently moved and unfortunately the room I chose as my study is the coldest in the house, and so I installed one of those oil-filled heaters. I could not believe what it did to my electricity bill! Ever since I got that bill for the winter quarter I haven’t turned it on. Ridiculous! It put it up by about �100 in the quarter

‘To me, it was like getting a demerit. It’s not just the money; I felt I’d been morally wrong!’

n She’s a committed cyclist – though her trusty steed is currently being repaired

‘It’s 20 years old. I’m doing to my bicycle what I have just advised the NHS not to do for human beings – keeping it alive. Putting way too much money into a bike that’s not worth it. I’m sentimental – and also lazy, because I don’t want to go shopping for another one’

n Twitter? Facebook? No.

‘I’m sorry; there’s just not enough time in the day. I have a hard enough time keeping up with email and I don’t want to hear from several hundred people a day. Why would I?

‘If you want to go to the post office, go to the post office. Just don’t tell me about it!

‘I try to communicate with the occasional journalism and books. Call me old-fashioned but that is the way I communicate.’

n Mobile phones? Not really.

A workman gave her ‘one of those sad little top-up phones’ when her landline was cut off early during a house-move a year ago. ‘I still have that, but it’s not charged. People ask me for the number and I won’t ever give it to them, because if they ever ring it I won’t have it on’

n She doesn’t think a Sarah Palin could achieve such prominence here. ‘There’s still a fundamental regard for people who have an education and are articulate. That’s not to be classist – it’s not to say everybody has to have gone to Eton. In the US the mob has taken over, and more and more they’re looking for people who are just like them’

Lionel’s life

n Born 1957 in North Carolina

n Father was a Presbyterian minister

n Studied at Columbia University in New York

n Moved to Belfast in the 1980s to write her third novel, Ordinary Decent Criminals, which was set in the city

n Intended staying no more than 12 months, but was there about 12 years

‘It wasn’t a time when I was doing professionally very well, but it was politically and intellectually a very interesting time, and a great education’

n Bolstered her income with journalism

n Novels include Game Control, A Perfectly Good Family and The Post-Birthday World

n Now lives in south London

Husband is jazz drummer Jeff Williams

n Lionel’s at least a third of the way through a new novel. It’s about fat, as in obesity. ‘It’s both a massive social problem and searingly personal’