Thursday, 6 December 2012

Death by negligence in the NHS

I read with sadness this morning, Mary Riddell's interview with Ann Clywd for the Telegraph. Ms Clwyd may be at the opposite end of the political spectrum to me, but no one should go through what happened to her and her husband and I whole-heartedly support her campaign to do something about it.

Six weeks ago, Ms Clwyd's husband, Owen died of hospital-induced pneumonia. She descibes him, crushed against the bars of his hospital bed, shivering with cold, his lips cracked from a nearby fan, his eye weeping from an untreated infection. And not a nurse in sight. It is a depressing tale of neglect and callousness and sadly it is all too common.

My own mother died in a not dissimilar fashion. She was 83 with dementia when she found herself in the local hospital with a broken hip. They operated and the following day she was bright and sparky and the best I had seen her for some months. Then something happened. Her cognitive abilities plummeted. I asked the nurses what it was. They were dismissive. I asked if she could be in pain. They were dismissive. Everyday I asked a different nurse to investigate and every day I was fobbed off, and meanwhile my mother became more and more withdrawn.

Then I had a brainwave: maybe she had a urinary tract infection. I knew that could affect her cognitive abilities. So I asked the nurse if they'd tested her urine, adding that she was catheterised and wasn't a routine test standard in those circumstances. The nurse said it was and she was sure it had been done but she'd check. The following day, there was no change. So I asked about the urine test again. It hadn't been done, but the nurse said she would do it as soon as she had a moment.

Two hours later I got a call from the registrar to inform me that my mother had end-stage renal failure. It's pretty clear to me that a simple failure of compassion and a large dose of negligence killed her. The NHS went to great expense to replace her hip, successfully, and then failed to spot the signs of and test for a UTI. I find that stunning.

But what can we do about it? I don't think it's simply about slagging off nurses. The consultant who spoke to Ms Clwyd described her husband's death as a nursing failure and I'm sure my mother's death falls into the same category. But that's too easy.

I think the key lies in the fact that nobody takes responsibility for each patient's care. When you enter a hospital you are, nominally, put under the care of a consultant. In practice, you may never see that consultant and if you do, it will be a quick hello, scan of the chart and onto the next. The sense in which the consultant is responsible for the totality of your care is theoretical. They may wish to. Their Hypocratic oath may even require them to be. But nobody could possibly have personal responsibility for that many sick people.

What would happen, though, if you did make someone truly responsible for each individual patient? It doesn't have to be a consultant, or even a junior doctor. All you need is someone with enough good sense to spot when something isn't right.

Anyone old enough might remember the discussion back before the Japanese showed us how to build cars about the difference between the British way and the Swedish. The Swedes back then were producing cars that, in build-quality terms, were second to none. And they were doing it by having small teams who each had resposibility for building a car from start to finish, whereas we were handing off from one team to the next as the car passed along the production line.

It seems to me that the Volvo method might provide an answer to this particular problem of the NHS. When large numbers of people are all, corporately, responsible for an outcome, it doesn't tent to turn out that well because no one person sees it as their responsibility to do something if someone else migth do it instead. But assign one individual to each patient and make them responsible for that patient's well-being and then see what happens.

It's got to be worth a try hasn't it? Or do we have to wait until more elderly people die ignominiously and unnecessarily?

Wednesday, 5 December 2012

Letting the spinners get away with it.

You can't really blame the politicians for massaging facts to fit their story. It's what they're there for. But I really think the journalists interviewing them could be a bit more ruthless in pinning them down sometimes.

A couple of incidents have particularly hit me recently. This morning I heard the sainted Margaret Hodge being interviewed on Radio 4. She was wittering on about tax evasion. Again. This time she was hitting out at the Big 4 accoutnancy firms, but, predictably, she just couldn't resist sniping at the government too. She pointed at the contracts these accountancy firms have with the government, contracts, which she said had multiplied because of a Tory obsession with contracting out to the private sector. Then she listed some of them: payroll, pensions, auditing local authorities, auditing hospitals. Her implication was that these were all new contracts and all went to the Big 4.

But take another look. Payroll? Pensions? Apart from the fact that many of these were contracted out under the last Labour Government, and in some cases under the Tory Government before that, the big players in this business aren't accountancy firms anyway. They're huge services companies, like Capita and Serco. And what about those audits? Yes the Big 4 do these, and they always have done. It's a statutory requirement. Is she seriously suggesting that Local Authorities shouldn't be audited? Surely the Chair of the Public Accounts Committee wouldn't be saying that? So why didn't the journalist let her get away with this?
There was another example yesterday: Rachel Reeves, the Shadow Chief Secretary to the Treasury was interviewed about the £5bn of infrastructure spending that the Prime Minister had just announced. In that interview (which is reported by the BBC here - scroll down about half way) she stated that the "extra funding for new free schools will be smaller than the huge cuts he made two years ago to school and college buildings."

She was referring, of course, to Labour's massive 'Building Schools for the Future' project. Now, on the face of it, that was a school building scheme, but what few people know about are the layers of bureaucracy, the form-filling, report-writing, and hoop-jumping that was involved and the money that had to be spent on employing 'advisers' and 'consultants' to do all that work. And worse still, at the end of all that, did Local Authorities get money from government for their new schools? No. They got a Private Finance Initiative scheme.

So let's look at Ms Reeves' claim again. 'Huge cuts'? Are we talking about the money wasted on bureaucracy Ms Reeves? Or the amount of our children's and grandchildren's money we were going to spend paying off those PFI deals?

So why are the journalists not asking these questions? Why are they letting the spinners get away with it? It would be easy to say that it's just the good old BBC bias at work again. But I think it's deeper than that. I suspect they don't know what to ask. They haven't done the research. They don't have the knowledge. Maybe, in some cases, they just don't have the experience. But if that's the case, then those of us who do need to stand up and call them to account.

So please, if any other journo is interviewing these ladies again, can they please remember a few of things written here and start to challenge some of their statements?

Friday, 30 November 2012

The NHS's Structural Deficit

Today's Telegraph has a fascinating and deeply depressing little article on the latest outbreak of hooping cough that has now taken 13 little lives. Those deaths are saddening of themselves, but what affected me more was an overwhelming sense that they were avoidable but for a structural deficit within the NHS.

What do I mean? The NHS's aproach to diseases like hooping cough is simple: immunisation. Think about it for a moment. We now routinely immunise out children against hooping cough (that's the P in DTP and stands for pertussis), dyptheria and tetanus, measles, mumps and rubella, meningitus of various alhpabetical types, HPV and tuberculosis. Many of these are given together in cocktails. Several involve boosters. And if, as a parent, you decide not to agree to any of these innoculations, for whatever sensible and cogent reasons, boy, do you get harassed by the local arm of the NHS.

Now many will say this is right. That disease control is all about building up a herd immunity. But is it that simple? Let's take another look at the hooping cough outbreak. Apparently current vaccination levels are high and health experts (whatever they are) say that the outbreak is not due to parents shunning the jab. Even so the NHS is urging women in their third trimester to get vaccinated. Why? Could it be because it's just another way for the NHS to keep tabs on us; to fill out forms, tick boxes, achieve the trigger levels for payment schemes, control our lives?

Hold that thought for a moment and look at the reasons that are being given for the current outbreak. 'Whooping cough cases tend to come in waves as immunity against the disease provided by vaccination wanes over time and allows small outbreaks to occur' the Telegraph reports.  The article then goes onto describe the symptoms in both babies and older children and adults. And that's when it hit me. You see, in older children and adults the disease presents as a prolonged cough, just like the one that was sweeping around Sussex, for example, this summer. My daughter had it. Several of her friends had it. And when they went to the doctors they were all given the same story. Yes, it's a nasty cough, it lasts about 8 weeks and it will go away on its own. At no point did the GP mention hooping cough, or warn them to keep away from babies.

And when you think about it this is typical. One part of the NHS is massively pushing immunisations against a disease that kills babies while the other part of the NHS fails to spot (or doesn't bother to mention) it in older children. And the funny thing is that it's not two parts of the NHS, because the GPs who aren't bothered about hooping cough in older children are the same people who are pushing the vaccines. But then again, there aren't any boxes to be ticked, forms to be filled, payments to be won when someone comes along with a cough, are there?

So is there a structural failure here? I'd say so. And it's deeply disturbing when it leads to the death of so many tiny lives.

Wednesday, 28 November 2012

Half-Way to Zero

Peter Hoskin, writing in the Tory Diary of Conservative Home today provides a bluffer's guide to George Osborne's fiscal rules and suggests that he should toss them both in the bin, take the inevitable flak and move on. It's a well-argued article and he's probably right. But I don't want to talk about that here. Rather, I want to pick up on his final sentence: 'In the meantime, a “zero-based” review of government spending would probably be a good start.'

I blogged a couple of weeks ago about cutting back the administrative layers in the Department of Education and mentioned that back in the mid nineties I was responsible for managing the Department's running costs.  What I learnt then about the possible approaches to budgetting in government may well explain why Mr Hoskin's suggestion is so important.

Departmental budgets can be huge numbers. Back in the 1990s the running costs budget for the Education Department was £90 million and it is several times larger now.(The actual figure is difficult to uncover as the expenditure groupings have changed since then.) Traditionally, we had always come to our budget via an exercise which involved every individual management unit in the Department. It worked something like this:
  • Each management unit looked at current and projected staff numbers for the forthcoming year.
  • They then looked at non-staff costs, usually by reference to the current budget, and adjusting them according to policy or procedural changes
  • The forecast staff numbers and non-staff costs were sent to the Finance Department
  • Finance reviewed the figures and held a number of 'challenge' meetings with senior staff in the management units to test the robustness of the assumptions that had been made
  • Finance turned the staff numbers into costs, added in overheads and assembled the whole into a budget, which was then challenged again by the Treasury
That might sound like motherhood and apple pie to anyone in the private sector. I've outlined it in detail, though, because, when we merged with the Employment Department an entirely new method of budgeting was brought in, where Finance applied an inflation figure to last year's budget and then just checked with each management unit as to whether they needed anything different to deal with new policies and procedures. Surprise, surprise, of course, no-one ever said they needed less money and the budget just kept getting larger.

I'd lay odds that this is pretty much how Departmental budgets are still done.

Now, zero budgetting proper is a pretty scary proposition for a civil servant. It's tantamount to asking you to justify your own existence. Many of us might think that's a good idea. But in the interests of keeping the whole thing ticking over, maybe something like that half-way to zero system we had in the old Education Department might be a good place to start. It introduces a sense of financial discipline and once that is in place zero budgetting becomes a much more acceptable proposition.

Monday, 26 November 2012

Multiculturalism: the new CND?

It seems like another time, and it was another century: the Campaign for Nuclear Disarmament? Remember wearing its symbol, that vertical line bisected by an inverted V, which has now morphed into an icon of peace?
A 'Heart Peace Necklace' currently on sale at a shop popular with 'indie' teens.

Remember how you sort of wanted to be part of it all. It sounded so right, didn't it? How could stockpiling mind-blowingly destructive weapons ensure peace? But then something at the back of your mind, a little spark of extreme rational thought, reminded you that if facing up to an armed bully with no means of protecting yourself didn't work in the playground it wasn't likely to work in the grown-up world of geo-politics either.

And, as we now know, it wasn't unilateral nuclear disarmament that brought down the Soviet bloc in the end at all. So that little rational spark was right.

Now, a thumping great wave of deja-vu hit me over the weekend. I was listening to Joyce Thacker witering on about how UKIP voters didn't have the right attitude to multiculturalism. As someone who has never voted UKIP, what was my attitude, I asked myself. And that's when it hit me. I was feeling just the way I'd felt all those years ago over the subject of nuclear disarmament. My liberally educated self wanted to say, 'Of course, I'm in favour of multiculturalism. We're all human beings and we all have the same rights.' But with a slightly sour taste in my mouth, I realised, that the rational, well-informed, experienced part of me was screaming no.


Multiculturalism isn't some nice, wishy-washy 'we all have rights' sort of thing. For those in authority who practice it, multiculturalism has become a mindset. And it is a mindset which cripples decsion-making and good sense. So children who are desperately in need of a loving family are taken away because the adults support UKIP. Other families are turned down as adopters or foster parents because they are from the wrong social or ethnic group. And it gets worse. Female circumcision. Honour killings. (And I'm only talking about the UK). All can be explained away with an appeal to multiculturalism. All can be accepted when multiculturalism overrides everything else.

So I am not in favour of multiculturalism. I do not think all cultures are equal. I do think they are different and that those differences are interesting, valuable and informative. We can learn a lot from Islam, for example, especially from its mediaeval history of scientific exploration and tolerance. But I do not believe it can ever be right to cut off someone's hand for stealing. Or stone a girl to death for being the victim of rape. In fact, I think those things are wrong. So wrong that we should all be standing up and screaming it from the roof tops.

So get a grip, multiculturalists. You are no more going to engender integration in the UK by multiculturalism than CND brought about an end to the Cold War. Maybe a bit more reason and a bit less emotion is what's needed. Maybe you should all open your eyes.

Thursday, 22 November 2012

The Moral of Missing Sandy Island

So a tiny island, called Sandy, sitting (as shown by Google Maps and many others) in the South Pacific between Australia and New Caledonia, does not exist.

Scientists exploring drowned islands off the eastern seaboard of Australia, found themselves sailing over the spot where Sandy Island had been recorded on the World Vector Coastline Database and local weather charts for more than a decade. Only it wasn't there and at no point did the sea depth get less than 1300 metres. So it had never been there in the first place.

How did it end up on all those maps and charts? Apparently the World Vector Coastline Database is a source for many maps, which means that if something is marked as a fact on the database, it will be propagated, as a fact, on all following databases, maps and charts. Sadly, we don't know how Sandy Island found its way onto the World Vector Coastline database yet, but we do know that one of the sources it uses is the CIA!

Now, let's pass over the host of delicious conspiracy theories that could be constructed from the CIA's involvement in this mystery. Does something strike you as remarkably familiar about this tale? Someone in the mysterious world of the CIA gets their facts wrong. The wrong fact finds itself onto a scientifically reputable database and from there ripples around the world where everyone believes it. And when the truth is uncovered, people are still reluctant to change their world view. Apparently the skipper of the boat was terrified that the island was there, even though they couldn't see it, and insisted on all safety procedures being put into place in case they ran aground! So strong is the faith in scientific 'fact' even in the face of reality.

The Climate Change lobbyists are always telling us that the facts are all there and that we are being dumb, biased, bigotted, irresponsible, [supply your own derogatory term] for not believing in their 'science'. Mmmm.  Kuhn has a few words to say about scientific paradigms and how difficult it is to shift from one to the next. Maybe the case of the non-existing island is a nice little reminder of that. Warmists take note: facts aren't always what they seem.

Wednesday, 21 November 2012

Looking towards Empire?

In an excellent article posted yesterday evening in the online Telegraph, Allister Heath argues that the city and big business in the UK need to become more reponsive to public opinion and start to look at the opportunities and advantages offered by a number of possible non-EU futures for the UK. The article systematically destroys the trade arguments typically used to scare off Eurosceptic opposition, demonstrating with clarity how little damage might be done by non-EU tariff structures and pointing out that the UK's trade is already shifting away from the EU and towards the rest of the world.

It's that shift I want to talk about. Take a look for a moment at the tables below. They come from the IMF World Economic Outlook via Wall Street Pit.

Top 30 Fastest and Slowest Growing Economies
Top 30 Fastest and Slowest Growing Economies 

Down in Table 2 we find nestling amongst the economies with the slowest growth (or, indeed, decline) rather a large number of EU lovelies: Greece, Portugal, Italy, Slovenia, Spain, Croatia, Hungary, Czech Republic, Netherlands, Belgium, France, Luxembourg, Bosnia and Herzegovina, Finland, Ireland, and, of course, the UK. 

Now take a look at Table 1. Not an EU state in sight. Granted, many of these booming economies are small and starting from a low base. Some present interesting challenegs politically too. But here's another thought. Cast your eye over the map below:

Does anything strike you? Sierra Leone, Iraq, Ghana, China (via Hong Kong), Papua New Guinea, Mozambique, Solomon Islands, Nigeria, Sri Lanka, Tanzania and Zambia. They're all on that list of booming economies and they all have strong links with the UK as result of the Empire. They happen, on the whole, to be amongst the more stable, politically, of the countries on that list, too.  And, please note, India and a number other Middle Eastern states didn't make it onto Table 1 but certainly provide excellent trading opportunities.

So here's a proposal. How about we stop looking towards the decadent European markets and start to really go for the booming ones many of which just happen to coincide with our our old Empire, and in many cases, current Commonwealth allies? After all the Victorians knew a thing or two about trade and we could do worse than to learn from them.