Archive for November, 2009

Management, private health care and a piss up

November 28, 2009

A new book has just been published which should be required reading for everybody:
The Management Myth: Why the Experts Keep Getting it Wrong – Matthew Stewart
The chief theme is the strange phenomenon of the management consultant. A strange and relatively newly minted creature who is by turns indispensable, omniscient, expensive and frequently wrong. Is anyone recognising the description yet?
Industry and government have already succumbed to an almost terminal infestation. The costs to employees, shareholders and the taxpayer are horrendous.
To those who have come across consultants before they will recognise it as a tacit admission that the current system is poorly run, bloated, bogged down in bureaucracy and could easily lose half its staff with no tangible effect to the service provided.
Stewart succinctly sums up the mystery of the discipline when recalling a conversation with Bruce Henderson, founder of the Boston Consulting Group, one of the best-regarded firms in the world:
“Henderson later described consulting as ‘the most improbable business on earth’: ‘Can you think of anything less improbable [sic] than taking the world’s most successful firms, leaders in their businesses, and hiring people just fresh out of school and telling them how to run their businesses and they are willing to pay millions of dollars for this advice?’ Even more improbable, one would have thought, is that a dozen men with no obvious claim to fame should, one fine Saturday morning, declare themselves experts in a subject whose contents they themselves would get to define, and then turn around and expect the whole world to pay for such expertise. And yet, against all odds, the world proved eager to buy.”
One of Stewart’s former professors from his life before consulting asks a question which needs to be asked by everyone: “How can so many who know so little make so much by telling other people how to do the jobs they are paid to know how to do?”
In this climate of austerity and the need for public sector cuts, when so many are worried about the possibility that nurses, teachers and other such essential workers will be forced out of work as government tightens its belt, it is worth noting that £2.8 billion of taxpayers’ money was spent on consultancy fees in 2005-06 alone.
If you want a definition of a bloated government pouring public money away, read The Management Myth and form your own opinion as to whether it’s money well spent.
An interesting snippet from Canada where the prison medical service has been contracted out to a private provider: Since the contracting out the number of people employed has risen by 13% and the mortality rate amongst prisoners has increased by 1.3%. That’s private health care for you.
A prominent Conservative council leader has cast doubt over the quality of the shadow Cabinet, suggesting they are not experienced enough to run a country.
Stephen Greenhalgh, leader of the London Borough of Hammersmith and Fulham and head of the Conservative councils’ innovation unit, made the remarks at a round table debate on November 26, run by Public Finance in association with Zurich Municipal.
Greenhalgh, who this autumn announced the borough’s fourth council tax cut in as many years, has been held up as an exemplar of good practice by shadow chancellor George Osborne. During a discussion on increasing efficiency through reforming local government, he said that increasing the power of councils would improve the quality of politicians.
‘My mates are all in the shadow Cabinet, waiting to get those [ministerial] boxes, being terribly excited. I went to university with them, they haven’t run a piss-up in a brewery,’ he said.
‘They’re going to get a department of state, in one case running the finances of the nation.’
Greenhalgh pointed to other countries, such as France and the US, where members of the government had typically served at a regional level earlier in their careers. ‘If you’re going to fail, fail running Alabama, fail running Texas, fail running the city of Paris – don’t just take over the country.’
Colin Talbot, public policy professor at Manchester Business School, agreed. ‘It’s not just the politicians – it’s the civil service,’ he added.
‘Despite 30 years of civil service reform, the vast majority of senior civil servants still have no experience of running anything outside public services.’

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Local environmentalism, our first Courant advert and the threat to healthcare.

November 21, 2009

Newcastle has been voted Britain’s most sustainable city (http://www.forumforthefuture.org.uk/blog/balance-makes-newcastle-britains-most-sustainable-city). This is excellent news both for Newcastle and the whole North East.
The Sustainable Cities Index ranks Britain’s 20 largest cities according to their performance in three broad areas: their impact on the environment, their citizens’ quality of life, and their readiness for future challenges. The full results are as follows:
Overall city rankings
2009 rank (2008) [2007]
1 (4) [8] Newcastle
2 (1) [3] Bristol
3 (2) [1] Brighton and Hove
4 (8) [14] Leicester
5 (9) [10] London
6 (13) [5] Leeds
7 (6) [2] Edinburgh
8 (10=) [11] Nottingham
9 (7) [7] Sheffield
10 (5) [6] Cardiff
11 (14) [17] Coventry
12 (3) [4] Plymouth
13 (12) [13] Sunderland
14 (15) [12] Manchester
15 (17) [20] Liverpool
16 (10=) [9] Bradford
17 (19) [19] Birmingham
18 (16) [16] Wolverhampton
19 (18) [15] Glasgow
20 (20) [18] Hull
This sort of success must be a stimulus to further progress and not an excuse for complacency. There is always more to do and local action – at parish or even street level – is a particularly important element.
At the parish level in Haydon Bridge, using a Development Trust approach, we are making progress with our community power project and mean to take steps in all three energy related areas – energy saving, energy making and energy storing.
The importance of effective action at Copenhagen has been underlined this week in a report in the journal Natural Geoscience in which it is shown that CO2 outputs are rising even faster in recent years due to China’s rising industrial activity. This makes the worst case scenario painted in the most recent IPCC report increasingly likely – in this scenario, global average temperatures rise by 2100 by six degrees centigrade, rather than the currently suspected ‘safe’ limit of two degrees. Such a change would melt most ice at the poles and in glaciers resulting in rises in sea levels measured in metres and the extension of the Sahara desert over much of France and southern Europe.
Such global temperatures have not been encountered for 100 million years and then dinosaurs were grazing in tropical type vegetation at the poles.
The alternative theory, that global temperature rises are related to some ill defined ‘natural’ temperature cycle or solar activity is no real comfort. If that is true then there is nothing we can do about it and we need to adapt to survive anyway. We have to hope that the changes are manmade because we can make at least some difference by changing our behaviour. Either way the whole world needs to get into gear immediately and make huge changes to our mode of living.
This election campaign stepped up a gear last week with the publication in The Hexham Courant of our first full page advert (http://stevenford.co.uk/3×3%20ad.pdf). This has been well received and resulted in a gratifying number of personal contacts through the website (http://stevenford.co.uk/index.html) and many comments passed by people as I encountered them around the constituency. So far only the Labour PPC has made a public response in the correspondence column of the Courant.
The date of the next election is much in debate at present. I have heard every month between now and June mentioned except January and April. The most recent suggestion was February but I think this would be a surprising choice in view of the possibility/probability of a low turnout due to bad weather and a low turnout would typically hurt Labour more than the other parties.
The sooner the better for me and the whole of our country I believe.
For an authoritative view on the dangers that face out health service have a look at this link:
http://www.healthcarerepublic.com/news/966034/Professor-warns-corporatisation-UK-primary-care
I think you will agree it’s a very sobering warning.

Cameron and Murdoch, healthcare variation and the war on drugs.

November 12, 2009

The unspeakably sinister developments that appear to be taking place in the relationship between the Murdoch clan and the Conservative party should give anyone inclined to cast their vote in that direction a deafening wake-up call.
The deal is suspected to involve not only crippling the BBC and removing the long standing obligation on the media to observe balance and impartiality in their news coverage but also steps to disable other private sector media providers. The only party to gain from the deal is, of course, Murdoch’s News Corporation and Sky, as they inch toward domination of the world media. The public’s interests are, needless to say, of no interest to either the Conservatives or Murdoch.
An impoverished, struggling rump of public service broadcasting and an unopposed glossy, plausible deluge of extreme right wing propaganda on all other channels would be extraordinarily dangerous for any country but News Corporation’s reach is global… Worse still, by the time the deal was to be delivered James Murdoch would be in charge and his delusional world view is perfectly embodied in the aphorism: Socialism without capitalism is tyranny and capitalism without socialism is barbarianism.
Profits and power before people always and everywhere with Murdoch and the Conservatives.
There is one bright spot in all of this gloom and that is the misfire that the politically promiscuous Sun experienced with its story on the PM’s letter to Jacqui Janes – 65% of its readers are reported to have been affronted by the story. This grubby, spiteful and mean exploitation of a real man’s sacrifice and a mother’s grief should be a warning to all of the depths to which some media players and Conservative politicians are prepared to sink.
The Social Market Foundation (http://www.smf.co.uk/) has produced an interesting report of a survey that it conducted into public views on local healthcare provision.
The area under consideration is what is often referred to as the postcode lottery on healthcare provision. Local control can cause local variations but, on the other hand, central control can cause patterns of care provision that are locally unsuitable. Where is the balance to be struck?
The SMF survey asked questions about access, involvement and funding.
73% of respondents stated that treatments should only be available on the NHS if they were available to everyone. 23% said availability should be determined by local need.
54% said the public should be consulted about decisions on services and treatment but that the final decision should be made by health professionals. 20% favoured greater public involvement and 20% preferred no involvement.
When prioritising funding choices 30% favoured Government prioritisation and 28% by the NHS. 18% favoured tax rises and 13% said individual contributions should rise.
The discussion groups that SMF organised came up with four areas in which they considered the public should have greater say:
• Issues affecting a lot of people a lot of the time – e.g. GP services
• When the NHS is getting it wrong
• When people think they know better than the service providers
• Where public acceptance is crucial to success – e.g. reducing childhood obesity
There were two areas where the public should not be involved:
• When the NHS is getting it right
• Where clinically based decisions must be made objectively
Overall, the consensus appeared to favour the existence of local variation (postcode lottery), especially when explanation and involvement were provided. Further, decision makers would be better explaining unpopular actions properly than attempting to mitigate them.
‘Government and local healthcare commissioners may be able to build on the public view that the NHS is a precious resource that should be used responsibly, to introduce certain charges or discourage certain healthcare seeking behaviours that jeopardise the ability of the health services to perform their most important functions – dealing with serious and ongoing disease’
Would you vote for a 60% reduction in burglary, an end to street homelessness and a 147% increase in drug users in effective rehabilitation programmes? These are the sorts of results that have been achieved in Switzerland and Portugal following reform of drug laws. Contrary to expectations, use did not increase when drugs were more freely available, in fact use dropped.
The ‘war on drugs’ was lost at the same moment it was begun. Prohibition fails routinely. It is time for a grown up discussion about legalising drugs, making safe provision for users to acquire their supplies and providing proper, well funded rehabilitation.
Above all we must kill off the massive organised crime gangs that currently provide almost all the drugs. They achieve thousands of per cent profit on their trade and it this that fuels the ruthlessly lethal nature of their operations.
Alcohol causes 13 deaths per day in the UK and costs £2.7 billion in annual health service costs and yet it is legal and supplied at lower profit rates by high street retailers who do not routinely shoot each other over turf wars and other disputes.
As has been pointed out recently, horse riding is more dangerous than Ecstasy use.
The crazy positions that political parties find themselves in on the drugs issue and their craven subjugation to media opinion results in much harm to our country and even further damage to the reputation of politicians. An official Flat Earth policy is not sustainable.
Independent MPs can act where party politicians dare not.

Nuclear power in a democracy, care homes and the death penalty.

November 10, 2009

In the news today we hear that new nuclear power plants are going to be built regardless of what anyone thinks and that the planning processes will bent to that end. The suggestion is also made that the same set of arrangements will be employed for other major developments, by which, I assume the government means airports, major roads and new towns, amongst other things.
It may well be that the Severn barrage will be included in the new arrangements. This will put me on the horns of a dilemma in that I am very strongly in favour of that development and am, if I am truthful, somewhat hostile to and contemptuous of those who oppose it.
Dick Tuck, a rumbustious American politician, known especially for playing cruel tricks on Richard Nixon, lost an election and is immortalised for his response – ‘The people have spoken, the bastards!’ Democracy is difficult and can lead to irrational outcomes at times. People have views, often strongly felt, that conflict with the objective evidence. Are governments right to plough ahead despite popular opposition – thinking of wars perhaps? Are they right to defy popular demand – the death penalty perhaps?
‘First past the post’ elections, leading to governments that the majority of the population did not vote for and may have voted against, make these sorts of questions particularly sharp.
A hung parliament with a large block of Independents and small parties holding the balance will make a fascinating challenge to our political class. In my judgement it will, if handled well, permit a rare flowering of democratic influence. Coalitions are not necessarily weak and they can produce not poor government but finely honed and enduring law that commands the respect of a much larger than usual section of the electorate.
Back on the subject of nuclear power: For reasons that are not widely discussed, someone somewhere has to have functioning nuclear reactors. They produce electricity and waste that has yet to be stored securely for geological time periods but also they produce isotopes upon which modern industry and medicine is critically dependant. In recent years there have been times when a critical shortage of these isotopes developed and significant delays developed in diagnosis and treatment in health services around the world.
When the time comes to reduce nuclear armaments, functioning nuclear reactors will have a role to play in processing the fissile elements. In the light of all this I support the possession, by stable states, of a minimal number of reactors. I am opposed to the use of nuclear power as a main or even substantial power source in the long term.
I am sure that we are all profoundly surprised by the eventual closure of all the care homes in the county… Sorry. Did I sound a mite sarcastic there for a moment?
An ageing population is going to need more and better care and by the middle of this century the problem is likely to be very acute. Care at home is desirable, where possible, but this will not always be an option.
Care homes will always have to be available for both long term, respite and crisis situations. Whether these homes are privately operated, or provided by the state, or a mixture of both, and if the latter in what proportions, these are the questions. Standards of care can be secured with existing legislation and may even improve if the stiflingly small print nature of the law were eased.
The overwhelming push to privatise everything remains an enigma to me. So long as it is done well, there are no compelling reasons for preferring private or third sector provision over state provision in my view. Time and resources expended on shuffling between these sectors is wasted and unavailable for the real business of providing care. The ideologues are getting in the way again.
Channel 4’s docu-drama on the execution of Gary Glitter was no triumph by all accounts. I found plenty of better things to do than watch it myself. It does, however, provide a small stimulus to discussion.
Every few years the death penalty re-emerges into the light of public discussion. It is suggested that 54% of the electorate support it and some political obsessives use this as a reason to deride popular democratic initiatives.
I am opposed to the death penalty for any reason and by any means. Full stop.
The numbers of people who are granted posthumous pardons, the doubtful verdicts, the political distortion of the judiciary in many countries, the number of overturned verdicts and the ex-residents of death row who now walk the streets because they were innocent all along – these things taken together ought to prevent even the most fleeting consideration of the restoration of the death penalty. Even the most fastidious legal processes are as vulnerable to error and miscarriage as many other human endeavours.
If you are keen to investigate the matter a little further, let us consider the means of execution. It has been objectively established that beheading or guillotining leaves the severed head conscious for up to thirty seconds. Hanging being a, usually, incomplete form of beheading must be similar. Electrocution is notoriously unreliable and protracted. Gassing is not instantaneous. Injection has lately been found to be unreliable and sometimes impossible. A firing squad, aiming for the heart, will result in a few seconds agony.
Strangely, the customary Chinese approach, a bullet at point blank into the join between the neck and base of the skull, may be the most efficacious method if you are looking for instant effect. This may be some small consolation to abolitionists, as China currently has the highest rate of execution and is therefore the subject of much condemnation.
Michael Portillo featured in a programme in which he sought the ideal method of execution by which he meant as humane as possible. A particularly memorable sequence involved an American prison official (I think) emphasising that he definitely wanted the prisoner to suffer a good deal as that was a legitimate part of the procedure. Portillo was dumbstruck.

Prof. Nutt, Kelly’s report and too many wars.

November 4, 2009

In the last few days we have had the unedifying spectacle of a senior minister and a senior scientific advisor at very public odds over the meaning of figures. The suggestion has been made that ‘scientists should be on tap but not on top’ or that ‘advisors advise and ministers decide’ – neither aphorism stands much examination. It is axiomatic that ignoring or acting counter to objective evidence will result in poor quality decision making and worse legislation. The real world is not all about politics and politicians delude themselves and harm us when they forget that.

Legislating to control social ills (drug usage, prostitution, gun crime etc.) is fraught with difficulty and unintended or unforeseen consequences.

The horror and loss, the grief and lasting desolation that followed Hungerford (1987) and Dunblane (1996) can never be overstated. The subsequent outlawing of all handguns (1998) may have been reflexive and have matched the public mood but only today have I come across the outcome.

In 1988 there were 1,484 crimes involving handguns, in 1998/9 there were 2,687 and in 2007/8 there were 4,172. In 1969 there were 173 deaths and injuries from illegally held guns, in 1988 there were 410 and in 2007/8 there were 2,203. Only for shotguns, probably the most widely legally held firearm category, has there been a noticeable decline in homicides – 19 in 1999/00 and 3 in 2007/8.

It isn’t what you would expect or hope for is it?

Furthermore, these figures should be read in conjunction with the knowledge that since the late 90s the number of firearms licenses has decreased by approximately one third.

Banning things outright or introducing draconian control legislation may not be the best approach after all. A more deliberative approach, calmer, balanced reasoning and the piloting of proposals would be likely to achieve more, I suggest.

If legalising and regulating drug usage and prostitution were properly considered and implemented, even for a trial period, information would be gained and legislation could be refined or changed wholesale. That’s the way to run a country – not having running brawls between gimcrack politicians, questing after votes and column inches, and official advisors, all in plain view of a sullen and restive electorate.

The general public, although not all of the broadcast and published media, are much more grown up than politicians fear. The political class would gain credence by sharing the evidence and their lines of thinking in more detail with the public. This is not a development I foresee with the existing parties.

Just as I was about to climb aboard, the Westminster gravy train has hit the buffers. Timing was always my strong point too.

Even now MPs are squirming on the hook and indulging in a certain amount of shroud waving. I am reminded of Ken Clark and his comment about the BMA – [when ever reform is mentioned] “they feel for their wallets”.

If MP’s pay becomes too low there will be problems of recruitment but how low is too low?

A similar dilemma affects doctors. There was a time in the early years of the NHS and before when most doctors, especially GPs, were poorly paid. The inception of the NHS improved matters somewhat but by the mid 60’s things had deteriorated and the development and modernisation of the general practice was severely hindered by low pay.

The mid 60’s Charter helped and then, whether by cock-up or conspiracy, GPs in the last few years have had a large pay rise and some have been earning vast sums by exploiting the system and their colleagues quite ruthlessly.

It has been suggested that there is a trade off between the high esteem in which doctors were generally held and the modest pay they received. Now this balance has been reversed and for the first time in a long time doctor’s esteem is falling in surveys.

There is a message here for MPs. Here’s another:

It has also been suggested in the professional press that doctors who are preoccupied with making money are often not very nice people and not much good as doctors either.

What are we to do with all the wars in which we are presently engaged?

Just before sitting to write this piece came the news that an Afghan trainee policeman had killed five UK soldiers and several of his police colleagues. Also mentioned was the fact that of the nine thousand UK soldiers in Afghanistan only about a third are actually routinely engaged in combat – the size of the logistic tail for a modern military is not widely understood.

Iraq is now almost entirely a USA theatre but the problems encountered by our troops are fresh in everyone’s mind. It is worth noting that the Iraqi insurgents, with hand held weapons or improvised munitions, have managed to destroy more than eighty Abrams tanks – these are a superpower’s main battle tanks that are claimed to be the best there is.

A friend of mine was caught in a roadside bomb incident in which one of his colleagues was killed. I suspect that most people will know someone who has been killed or injured in warfare over the last few years.

It’s looking more like Vietnam every day. The chief difference being that Harold Wilson kept us out of that one. Today a senior MP has been more outspoken than many in saying that the time has come to disengage militarily and approach the problem from a different angle.

Vietnam is now developing economically and is increasingly well integrated into the world at large. Can Afghanistan and Iraq do likewise?

The cultures are radically different and the circumstances too, that may represent a major stumbling block. In approaching a solution it is important to have in mind that those who oppose us are, by their own lights at least, rational actors with legitimate aspirations.

Violence almost never accomplishes anything of lasting value for the instigators. It’s time for “jaw, jaw” again. Not engaging in meaningful negotiation, without preconditions, is sure recipe for prolonged conflict. Can anyone provide historical evidence to the contrary?