Box-ticking, bean-counting, target-meeting in the NHSdoctors

March 4, 2013

Here, in a  comment is free  column for today’s edition of The Guardian north London GP and Urgent Care Centre doctor,  Dr Fred Kavalier , gives readers some insights into how the flawed management of which Simon Caulkin wrote on Friday is viewed by someone who has seen it close up.

In today’s box-ticking, bean-counting, target-meeting NHS, doctors and nurses are forced to concentrate on things that can be measured and quantified. In the process, we are forgetting many of the things that really matter – the things that are difficult to count and measure.

From 1 April, when all NHS services will be up for grabs by the private sector, it’s going to get much worse. For all its failings, some of which were highlighted by the recent Francis report into deaths at Mid Staffordshire hospital, the NHS has always had the care of patients as its core activity. GPs and hospitals were all singing from the same NHS hymnsheet.

In the new privatised NHS, many of the players will be singing from hymn sheets written in corporate boardrooms. Every single activity will need to be specified in a commercial contract. If some vital aspect of a service is left out it will not get done, or it will appear as an “extra” when the bill comes in…..

All of  which goes to show that the NHS has been in wrong hands for some considerable time now.


Shaming the poor at will.

March 3, 2013

In a thought-provoking article published in today’s issue of The Observer, columnist Barbara Ellen, using the findings of  a multi-faith sponsored study called The Lies We Tell Ourselves. which highlights myths surrounding people and poverty, explains how shaming the poor has become the new blood sport

 The report argues that the government is “deliberately misrepresenting” the poor, blaming them for their circumstances while ignoring more complex reasons, including policy deficiencies. Moreover, they feel that this scapegoating is the result of collusion between politicians, the media and the public.

The reader does not have to wholly believe her assertion that it  does seem so long ago that most people would think twice about villifying fellow citizens for being down on their luck to see that she means that  thses days it appears “to have been sanctioned as a new national bloodsport, regularly slipping under the PC-radar as little else manages to.”

Is this our new default setting – that the needy are greedy? This chimes with a slew of government policies that appear to be founded on notions of bulletproof self-reliance, making no allowances for circumstances or sheer bad luck, and which many would require huge amounts of help to put into practice, never mind sustain. Meanwhile, the more fortunate are invited to pour scorn upon anyone who fails.

One could argue saying that it simply the “more fortunate” are the only ones invited to pour scorn on the failures ignores the fact that some of those pouring scorn are not always  especially fortunate themselves.  So what we have is the almost-poor being encouraged to  blame those below them for the situation they find themselves in.

Ellen has a neat explanation about how this came about.

 How does this kind of thing escalate? That’s easy. At the risk of stating the bleeding obvious, the poor are poor. They have no money, no voice, no representatives, and no means to establish their own public profile. Poverty is a big domino – once it falls, everything goes. In such circumstances, if a group of people are “deliberately misrepresented” then there’s precious little they can do about it. The churches got it right – if anything, the truth seems so much worse that it must surely be time to put the shame back into poor-shaming.

All I would add here is that the same could be said about those who who are almost poor.  They are encouraged to echo the those who are fortunate because while they may not have no money,  they almost certainly have “no voice, no representatives, and no means to establish their own public profile” Nor does it look like they will have in the very near future.

The Mid Staffs NHS scandal – the consequence flawed management system?

March 2, 2013

There was a terrific piece in last Friday’s edition of The Guardian by Simon Caulkin auggesting that ‘NHS management failures stem from the same flawed system that gave us Enron and Lehman Bros in the private sector’

The Mid Staffs NHS scandal will not go away. The collapse of the hospital trust into administration and the subsequent resignation of two board members. ensures that the wound will continue to bleed, ratcheting up the pressure on the embattled NHS chief executive Sir David Nicholson. Investigation of suspicious death rates at a number of other hospitals just increases the sense of foreboding.

One reason that scandals like these both run on and recur is that we persist in thinking of them as exceptional; one-offs caused by a few incompetents or rotten apples in an otherwise wholesome barrel. But they’re not. The terrible outcomes at Mid Staffs were the logical consequence of a disastrously flawed management system that systematically forces people to face in the wrong direction, counts the wrong things, and focuses management attention on the wrong part of the job…….

What’s flawed about the system is, according to Caulkin, performance management, which was originally presented as “an enlightened expression of shared interest’ has in reality “morphed into its dark opposite, synonymous “not with developmental HRM and agreed objectives but with a claustrophobically monitored experience of top-down target driven work”.

Applied to individuals such tactics lead directly to Mid Staffs, a system which reshaped people into target-chasers who couldn’t afford to care. At the level of the supply chain the same kind of fierce control gives us a different form of butchery. Scaling up the performance-management tyranny, the big supermarket chains treat meat suppliers as adversaries, writing short-term term contracts, playing one off against the other and driving prices way below the point where something had to give. The immediate result was horseburgers. But behind the scenes is a much bigger, very British tragedy: a meat industry that is in long-term crisis and decline, wholly unable to defend itself against less cannibalistic European counterparts.

Anybody who has read Caulkin over the last 20 odd years, as I have, would expect him to end on an upbeat note. Much of what he has been saying in that time has gone wholly unheeded. Why should things be different now?

Few these days would want to be treated with the mixture of superstition, ideological prejudice and pseudo-science that constituted medical knowledge in the Middle Ages. But that’s hardly an exaggeration of the state of management today. It is management not medicine that has put our institutions in intensive care, and until we decide to do it better unfortunately that’s where they will remain.

Mistrust Wikipedia? You should..

February 20, 2013

Under the heading of  How Paul Krugman broke a Wikipedia page on economics, Salon has just published this story:

There’s a lockdown on the Wikipedia page for Austrian economics and wouldn’t you know it, one or way or another, it all seems to be Paul Krugman’s fault.

Broadly speaking, Austrian economics, for those who have not yet had the pleasure of being introduced, are characterized by an extreme distrust of state intervention in markets, a distaste for statistical modeling and a general confidence that markets, left to their own devices, will avoid booms and busts and nasty things like inflation. From a political perspective, Austrian economics tends to lurk to the right of even such conservative icons as Milton Friedman.

For more detail, you can go, of course, to the Wikipedia page for Austrian economics. But until at least Feb. 28, if you do so, you will find that the page “is currently protected from editing.” An “edit war” has been raging behind the scenes. Two factions were repeatedly deleting and replacing a section of text that had to do with a description of a critique of Austrian economics made by economist Paul Krugman.

The closer you look, the more the whole affair appears at first to be a demonstration of Sayre’s Law, which holds that “in any dispute the intensity of feeling is inversely proportional to the value of the issues at stake.” One side, which seems from the Talk page chronicling the argument to  be just one very stubborn person, is objecting to the inclusion of Krugman’s critique on the grounds that what Krugman describes as Austrian economics doesn’t actually represent the reality of Austrian economics. In other words, it’s as if Krugman was saying “the problem with blue is that it is red.” Therefore, his views should not be included as an example of a valid critique. The other side is basically saying that Krugman is Nobel Prize-winning economist whose opinion is well worth including according to the standards of Wikipedia. So there. And back and forth the argument went, with lots of torturous discursions into the process weeds of Wikipedia editing policies, until it got too heated and provoked a lockdown.

On one level, it is amusing that Paul Krugman, a man whose Nobel award (technically, “the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred”) was lambasted by one Austrian school acolyte as “the worst decision in the history of the prize” and caused another to sigh “that those of us who believe in liberty are in for a long time in the intellectual wilderness,” is indirectly responsible for a Wikipedia Austrian meltdown. But there’s also a serious issue at stake.

The Krugman critique in question pointed out that many self-styled Austrians had declared that a dire, disastrous, Zimbabean/Weimar Germany outbreak of hyperinflation would be the inevitable consequence of the stimulus spending and other federal policies expanding access to credit in the wake of the financial crash. But that didn’t happen. One can argue that just because some people who are affiliated with the Austrian school made terrible economic predictions doesn’t mean that Austrian economics are wrong. Financial writer Tim Carney makes exactly such an argument at CNBC, going so far as to argue that Austrian economics actually predicted exactly what ended up happening since the financial crash. And sure, such reasoning seems to be at the heart of the Wikipedia dispute — Krugman, argues the leading dissident, is wrongly characterizing Austrian economics as guaranteeing high inflation after a big credit expansion.

Personally, I would have been quite surprised to see Austrian economists explain in 2009, that, as Carney puts it, it would have been “entirely in keeping with the Austrian approach to economics … [for] … a combination of a growing fiscal deficit and an accommodative monetary policy … [to help] prevent the housing slump and financial crisis from depressing prices generally.” I certainly can’t imagine any of the founding fathers of Austrian economics, such as Ludwig von Mises, saying such a thing.

For five years conservatives, including many Austrians, warned that stimulus spending and expanded credit would lead to disaster. But hyperinflation is nowhere to be seen, and the economy is slowly recovering. Paul Krugman was right. No wonder there’s trouble in Austrian-school-Wikipedia land.

I asked Krugman if he was paying attention to the Wiki-kerfuffle, and the dispute over whether his characterization of Austrian economics was correct. He declined to plunge in too deep, but did say this: “That is my experience with the Austrians: whenever you try to pin them down, they insist that you fail to understand their profound ideas. And they have indeed been predicting runaway inflation for years now; it’s interesting that they can neither explain why they were wrong nor admit that this poses a problem.”

Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21.

Now what’s interesting here is that shows all too clearly the weakness of Wikipedia,  and it not just that interested parties can edit in or out the material that suits them, but, evn more importantly, it’s that there is no one with the editorial authority to say what can or cannot  be included in the final version of any of its  pages.

Cameron, the Duchess and the rest of us.

February 19, 2013

 Our busy Prime Minister, David Cameron has criticised Hilary Mantel, the Wolf Hall author, for describing the Duchess of Cambridge in a speech rprinted as an essay reprinted in the current issue of The London Review of Books, as ‘machine-made’ and ‘designed by committee’.

Mr Cameron was asked about the comments during a trade visit to India. “I think she writes great books, but I think what she’s said about Kate Middleton is completely misguided and completely wrong,” the Prime Minister said

Like Freddy Gray of The Spectator, I believe this

David Cameron should have read Hilary Mantel’s essay before criticising it.

And while we are on the subject, we might want to ask why it is never move to thinks that some of things his own ministers have been saying about people who will be less readily defended may be just a little “misguided” and on occasion “completely wrong”

Hidden agendas.

February 19, 2013

In the pages of The Guardian  today, George Monbiot describes in some detail how  two secerative organisations – the Donors’ Trust and the Donors’ Capital Fund – funded by billionaires, and which provide a cover for various vested interests,  have financed 102 organisations which either dismiss much of the current thinking on climate change or downplay the need to take action.

These groups, working through the media, mobilising gullible voters and lobbying politicians, helped to derail Obama’s cap and trade bill and the climate talks at Copenhagen.

The large number of recipients, he suggests is deliberate because it “ creates the impression that there are many independent voices challenging climate science”.

By these means the ultra-rich come to dominate the political conversation, without declaring themselves  Those they employ are clever and well-trained. They have money their opponents can only dream of. They are skilled at rechannelling the public anger which might otherwise have been directed at their funders: the people who have tanked the economy, who use the living planet as their dustbin, who won’t pay their taxes and who demand that the poor must pay for the mistakes of the rich. Anger, thanks to the work of these hired hands, is instead aimed at the victims or opponents of the billionaires: people on benefits, the trade unions, Greenpeace, the American Civil Liberties Union.

Although most of what he describes is happening in America, there are it would appear organisations in the UK which are similarly funded and which serve a similar purpose.

The Institute of Economic Affairs is a British group that, like all the others, calls itself a free-market thinktank. Scarcely a day goes by when its staff aren’t interviewed in the broadcast media, promoting the dreary old billionaires’ agenda: less tax for the rich, less help for the poor, less spending by the state, less regulation for business. In the first 13 days of February, its people were on the BBC 10 times.
This Institute, it appears, gets some of its funding from an organisation called American Friends of the IEA.

Moribot’s persuasively argues that we need to know what these organisations are and who exactly it is that’s behind them.

 The answer, as ever, is transparency. As the so-called thinktanks come to play an ever more important role in politics, we need to know who they are working for. Any group – whether the IEA or Friends of the Earth – that attempts to influence public life should declare all donations greater than £1,000. We’ve had a glimpse of who’s paying. Now we need to see the rest of the story.

Atos & NHS in partnership?

February 18, 2013

It is reported in today’s Guardian the NHS trusts  are being handed back some of the work that the Department of Work and Pensions must have originally thought theyit was not capable of doing in the first place.

Atos, the company contracted by the Department for Work and Pensions to carry out medical assessments of people claiming benefits, has subcontracted elements of the work back to a number of NHS trusts in England.


A number of NHS trusts south of the border are now reported to have been contracted by the company to help carry out assessments for a new disability benefit, the personal independence payment (Pip), which is due to replace the disability living allowance from 2013. The government aims to cut spending on the benefit by 20% over the next three years.

University College London, King’s and York will deploy thousands of health professionals to carry out the assessments, according to the Financial Times.

It emerged last October that Atos Healthcare had appointed the Scottish healthcare provider NHS Lanarkshire’s occupational health arm, Salus, to help carry out assessments for Pip.

Lanarkshire NHS will receive £22m from Atos to carry out the work until July 2017. Atos won contracts worth more than £400m in August to test whether disabled claimants were eligible for the new benefit.

Atos is receiving £238m for work in Scotland, north-east and north-west England, according to the Department for Work and Pensions.

At the time, the company described its subcontracting of work to NHS Lanarkshire as a “partnership”, adding: “It means that consultations will take place where people feel most comfortable – in the heart of their local community – and they will be conducted by health practitioners that have first-class expertise in dealing with the needs of disabled people.”

Atos said the supply chain model in Scotland was likely to be similar to those soon to be announced in England.

A DWP spokesperson said: “We are taking a new approach working with regional providers for a service which best meets local needs. It was open to NHS organisations to bid for a place on the health and disability assessment framework but none did so.

“We believe that it is right for Atos to partner with the NHS to offer Pip claimants familiar surroundings and experienced health professionals. The partnership proposed here demonstrated best value for money for the department and its claimants.

I wonder how this so-called “partnership” work when the a person deemed to be worthy of a benefit by the NHS is returned for re-evaluation Atos. Does the the NHS partner stick with the original evaluation, or does Atos have the right insist that the patient be reevaluated?  Ane where is the patient in all of this?

Is conservatism the result of the genes?

February 17, 2013

 Sometimes we try to explain why it is that fear seems to be more a feature of how conservatives seem to think of everything than it is of  liberal or left-wing thinking. They fear big government. If science makes a breakthrough of some sort or other, conservatives inevitably fear that or its being disruptive. If in education changes are made that disrupt a narrow channel, conservatives feel that the whole system is crumbling. They are generally resistant new ideas and so on because, it seems, of fear. Well, it may be that explanation this may, in part, have been found by those conducted a study for the American Journal of Political Science. Some of the conclusions they arrived at were reopoted on in the Saturday edition of Salon.

A new study in the American Journal of Political Science looked at the relationship between fear and political ideology, and it found that people who experience higher levels of fear tend to be more politically conservative than those who are less predisposed to feeling afraid. While the researchers emphasized that their findings in no way suggest that every conservative is more fearful than every liberal, the study did identify a relationship between a fearful disposition and increased support for anti-immigrant and other segregationist policies.

One of the study’s co-authors warns that we should not get carried away with the idea that all conservative people are fearful.

It’s not that conservative people are more fearful; it’s that fearful people are more conservative,” Rose McDermott, professor of Political Science at Brown University and co-author of the study, said in a press release.

The study does not, it has to be emphasized, suggest that it’s all in the genes.

As the study’s co-author Peter Hatemi, associate professor of Political Science, Microbiology and Biochemistry at PennState, told Chris Mooney at Mother Jones: “Nothing is all genes or all environment.” But together, these things make us who we are.

There is no reason for us to believe that if we are biologically predisposed to go in a certain direction, we must continue in that direction. Biology does not have the final say on which party you support or how one votes election day.  Education, in its broadest sense, plays a huge role in the way we develop and evolve.

As we experience more of the world and gain exposure to different cultures, people who are different than ourselves can become, well, less scary, researchers say.

So rather than creating an immutable link between biology and ideology to forever bind us to a single party, the study actually suggests that people can change overtime, overcome their natural predispositions and maybe even come around to new political ideas.

The problem is that it is the natural predispositions that are nurtured.

Displacement of the poor…..

February 14, 2013

The forced displacement of according to an identifiable policy is, I’m reliably informed,  an example of “population transfer”. Is this an example of “population transfer”?

A council is planning the largest single displacement of poor people from London in the wake of the coalition government’s controversial welfare reforms, singling out more than 700 families to be moved up to 200 miles away.

Camden council said that it would shortly be contacting 761 households, comprising 2,816 adults and children, because the coalition’s benefit cap – which limits total welfare payments to £500 a week for families – will mean that they will be unable to afford their current accommodation or any other home in the south-east.

The Labour-controlled council warns that the majority of these families have three children and, once the cap is imposed this summer, will need to find on average an additional £90 a week for rent to remain in their homes – which means “sadly the only long-term solution for some households will be to move”…..

We come to this sorry pass when we have to seriously consider whether what we are seeing within our borders is “population transfer”, “development-induced displacement” or, my own preference, “disaster-induced displacement”.

Another view of Michael Gove’s reforms

February 13, 2013

Seumas Milne, writing about education secretary Michael Gove,  in today’s issue of The Guardian , argues the education secretary’s attempts to reform education may well be the work of a destructive ideologue. When on very bright columnist atttacks a man who, when he was a Times columnist Michael Gove, was thought of as one of Britain’s leading writers and thinkers – admittedly Gove’s  expertise was terrorism and foreign affairs – then one’s ears prick up.

,…. Gove is considered a Conservative success, despite his multiple failures. The education secretary is an ideologue in a government whose Tory base chafes at the constraints of coalition, a neoconservative who believes the Iraq war was a “proper British foreign policy success” and a Thatcherite traditionalist itching to give for-profit companies the right to take over state schools.

Which is why Gove is lionised by the Tory right and Conservative press as a true believer, prepared to transform English education in their own image. While Gove is courteous, a praetorian guard of apparatchiks does his dirty work, seeing off educationalists’ resistance to their permanent counter-revolution and running web campaigns against recalcitrant critics.

Milne has notes that setbacks, such as his being compelled to drop his twin plans to replace GCSEs with an English baccalaureate and introduce a single exam board for each subject, can be portrayed as a “tactical setback” by The Times and can be glossed over as his having  “lost a skirmish, but….still winning the war“.

They’re mainly right. Gove has had to drop his baccalaureate scheme but he’s forging ahead with plans to ditch modules and controlled assessment in favour of more traditional exams and 1950s-theme park rote learning. And his new draft national curriculum is a Daily Mail dream.

Milne rightly says that there is no evidence any of the so-called reforms that Gove’s proposing is going to make actual improvements in education itself.

…..Gove and his supporters are convinced that marketisation and privatisation are the route to transforming English schools for the better, though it must help that a whole “educational services industry” is also gagging to benefit.

In the long run, as Miline persuasively sees it,  the education secretary is morphing into being the right man to lead the Tories when his time comes.

But most of all, championing traditional teaching and the breakup of the country’s education system offer a powerful boost for Gove’s career. When David Cameron is finally unseated, the battle for the Tory succession could yet come to a fight between the incompetent Gove and Johnson . It’s a chilling prospect.