Wednesday, June 22, 2011

Darling, We Must Act Now

More renowned for his eyebrows than economic competence

Alistair Darling writes in today's Times...

"Can the eurozone survive in its present form? Not if its members carry on the way they have over the past year. Hoping that something will turn up won’t do. If we have learnt anything from the economic crisis for the past three years, it’s that if you have a problem, you need to fix it now."

Did he really learn that lesson? There's not much evidence on the deficit front from the time he was chancellor. Although, at least he planned to get round to doing something about it after the 2010 general election (if Brown/Balls had allowed him, and, indeed, if he were kept on as chancellor at all). But his replacement as shadow chancellor wasn't and isn't so keen on fixing the deficit problem "now" or even then or after that for that matter.

Such a statement is a bit rich coming from a key player in the creation of the deficit disaster, and in no way reflects his real actions while in government or his successor's intentions now.

Sunday, June 19, 2011

The Khan Academy, Philanthropy and The Big Society

It gets 2 million hits a month but I've only just heard of Salman Khan's Online Academy, and it's very impressive.

The free resource, provided through the effort and commitment of Khan himself with philanthropic backing from the likes of Bill Gates, has gone from strength to strength since he started tutoring his niece in maths (or math as our American friends insist on calling it). The 2 million visits a month are to over 2,300 separate tutorials covering subjects not just limited to mathematics (which includes everything from simple arithmetic to calculus) but also several science subjects (biology, physics etc), history and finance.

For all those who snort in derision at the concept of the Big Society and the idea that people may give up their time to pursue worthwhile projects (albeit voluntary work is only an element of the rather nebulous concept), this is an excellent example of how it can work (at least in the US). Salman Khan was a hedge fund analyst before developing this idea. He now commits all his time to it relying on donations to continue development, and to live.

Admittedly, philanthropy is much more common and engrained in US society. But it would be nice to think that we too could develop a similar culture of giving amongst the better off in this country to support the bright ideas and efforts of others. But before that happens we have to remove the attitude and, in many cases legal and commercial obstacles, that discourage or stop private individuals or organisations from contributing in health, education and other public services.

Recent events point to a lack of political will to drive the agenda forward. I hope this has been just pragmatic, tactical manoeuvring and that the strategy remains alive and well. Because I'm sure there are just as many great ideas and people in this country that could complement public services and improve our quality of life without having to rely on the approval, control and largesse of the state.

Who Was Most Influential On NHS Reform?

After all the threats and brouhaha that the Lib Dems put up over NHS reforms following their poor local election results, they must be disappointed with this finding in today's YouGov poll for the Sunday Times.

Who do you think is most responsible for influencing the change in the Government's policy regarding the NHS? (%)

Mind you, not as disappointed as Labour must be. They are clearly seen as complete irrelevant and ineffective by voters currently.

Wednesday, June 15, 2011

Angry Doctor vs Cameron & Clegg

On one level I sympathise with the consultants anger at journalists not following the correct hygiene regime but mostly I find the arrogance and rudeness sadly typical of the self important, jumped up little hitlers that are all too evident in our health service, especially at consultant level.

If you listen to what he's actually complaining about, it's not that the hygiene of the ward is at risk from the tie wearing journos, but that "we", as in him and his colleagues, have been made to remove ties etc. (whether he means just for that day or always is unclear). In reality, he's offended by the presence of the prime minister and his deputy and outraged that his entourage should be allowed to break a rule.

One has to wonder why he didn't take this up with the ward sister who is responsible for hygiene on the ward and who asked Cameron and Clegg to remove their ties but not the journalists. I suspect he just wanted to show how much more important he was than the visitors he had on his ward and the staff running it, despite the great publicity they were bringing to his hospital (until he turned up).

"I'm not having it", he exclaims as he is ushered away by mortified managers and more level headed colleagues. Any normal concerned professional would have been asking questions of those very same managers and ward staff as to why the rules were allowed to be broken. The ward sister must be furious. It's her domain of responsibility after all. Now, if Cameron was suggesting what kind of operation the patient should have on his leg, then fair enough. The senior orthopaedic surgeon would have been rightly outraged at such temerity and impertinence. But instead he's lost his rag over the apparel of some journalists.

I think this illustrates something I've observed in my dealing with the medical profession and, to varying extents with other professions. That is the almost total and unquestioning respect and deference these people receive from those around them for achieving the position they have. While most deserve the respect and don't let it go to their heads some, like this chap, truly believe they are above everyone else, not just in terms of attainment, which is often true, but they actually believe they are better, more important than all those around them. In this case, he believes he's better than the managers, the ward sister and the prime minister and his deputy.

It can't be healthy when such deferential treatment produces such utter arses. It's certainly been my experience that NHS consultants are not infallible. Given their mistakes can cost lives, a bit of humility might not go amiss and may even make them better healers, as well as people.

Tuesday, June 14, 2011

NHS Reforms. What's Changed?

Good summary of the NHS reform changes, from The Times...

Monday, June 13, 2011

Muscular Liberalism or Lack of Leadership?

I always vowed never to subscribe to The Times when it disappeared behind a pay wall. But then I began to miss some of my favourite columnists such as Giles Coren, Hugo Rifkind, Daniel Finkelstein, David , Rod Liddle and Matthew Parris.

But Saturday's column by Matthew Parris hits the nail on the head on the subject of NHS reform.

He imagines a Britain where our agricultural system is run like a Soviet collective. Everything is controlled by the state, everyone involved is employed by the state, all supplies are directed centrally. He then develops this crazy fantasy. The government decides on reform to allow farmers to choose between suppliers. He describes the response to this suggestion as follows...
"Now picture a special conference called by the farmers’ trade union to debate the proposals. Here is an extract from a union leader’s speech to the conference. He is railing against a duty, in the proposed legislation, to promote localised competition . . .

'I want proper controls nationally considered, not locals trying to sort things out . . . I want politicians of every stripe to understand that we do not need competition to run Britain’s food production. It creates duplication that is wasteful — and why give state agriculture’s money to private shareholders? What Britain’s food production needs to improve quality and efficiency is collaboration and co-operation across [all] sectors, [not] different materials being delivered by different providers in order to try to get a cheaper deal — fertilisers in one place, feedstock in another, veterinary services in another and follow-up somewhere else.

'Which brings me to one particularly unacceptable idea in the Bill: performance-related bonuses ... otherwise known as the ‘quality premium’. The idea is that farmers’ groups that ‘purchase well’ — ie, save money — will be given some money to hand out to their members . . . this idea stinks.'"

Only Parris doesn't have to imagine this response. These quotes are taken from a keynote speech by a Doctors leader at a British Medical Association conference in London last week. All Parris did was change references from healthcare to food production.

It highlights the perverse sentimentality we have in this country about maintaining a Marxist style healthcare system despite all the evidence that things could be so much better if a degree of competition, even if it is only in the supply of certain services or supplies, were introduced.

But the main point he makes is how today's Conservative party is failing to champion capitalism. Nothing illustrates this more than the backtracking on the NHS reforms we're seeing now. Many will put this down to the influence of the Lib Dems but the truth is that it is also a symptom of the Tories desire not to re-contaminate their brand. The simplistic messages put about by socialists is far easier to get across in soundbites on the telly and in newspaper headlines than some theory associated with free markets. Free markets that many people associate with selfish pursuit of profit by "fat cats".

A leader must make and keep his party electable. Cameron has gone some way to detoxifying the Tory brand (although not far enough to win a majority, it has to be said). However, sometimes public opinion needs to be led, not followed. Tragically, the case for reform has not been made effectively enough, so a dilution in the proposals was inevitable. But that doesn't mean the case for change shouldn't continue to be made and made strongly, one might say muscularly. A case that, given enough effort, would convince a sceptical public that a free at the point of use health service doesn't have to be totally provided by the state working to some monolithic central plan. That real responsiveness and quality improvements can be achieved through providers competing to be chosen by GPs and patients rather than there being only one option.

It's here David Cameron still has to prove himself. Will he lead a muscular liberal coalition that brings true liberalisation to Britain's public services and with it much improved service and efficiency? Or will he allow the left's preferred definition of the word liberal to prevail, an option that pollsters would tell him would be the best option. In which case we'll miss the greatest opportunity for decades to setup the high quality and high value health service that we need.

This article on the ConservativeHome website by Paul Goodman (@PaulGoodmanCH) covers the liberal/pragmatist debate really well. Definitely worth a read.

Thursday, June 9, 2011

Rowan Williams Slams "Undemocratic" Coalition

Williams: "You're unpopular because you don't believe in my God,
you know that don't you?"

Dr Rowan Williams today slammed the coalition government for having no democratic mandate. The God Doc (as he likes to be known) was elected as Archbishop of Canterbury (although not Westminster as he sometimes thinks) by an overwhelming majority of deities (well one, there is only one - and it's his one, not one of the other ridiculous fantasy ones) and his son, who has 3 votes of course. "Just like with the Labour Party leadership elections", he explains. He used his infallible democratic credentials to highlight how the coalition barely received over 50% of the vote at the last election. Not like his 100% of God's and Jesus' votes. And with this pathetic number of votes they have the audacity to attempt to implement reforms. Even after the recent increase in the rate of sacrificial u-turns, the Archbish (as he likes to be known) said he wanted more laid on the alter of his all seeing, all knowing, public sector loving God.

Accident At Work?
God, said Doctor No (as he likes to be known in reference to any policy that isn't left wing), is a good God. A God who likes to see spending far outstrip the income of the government. So much so He has bankrupted heaven 1000 times. He even had to send His Son down once so He could make an "accident at work" claim. He made millions after He proved there were ample signs his Son would come to harm that were ignored by the Jewish and Roman authorities of the day. That money is now gone and there's talk of a rapture happening that would enable God to take possession of all the non-believers stuff and flog it on G-Bay - God's heavenly online auction site.

David Cameron responded politely saying that the Archbishop had every right to his opinions, even if they are the opinions of an out of touch leftist, expressed congruously in the New Statesman.

Ken Clarke was less diplomatic. When the a journalist suggested the one and only God that is real (and better than the other Gods, who are just made up) backs Dr Williams, Clarke blurted "But God is not God - there are lots of different Gods, some more serious than others". He was forced to apologise and drop a couple more reform ideas as penance.

Monday, June 6, 2011

Shame On A Stick

I'm was thinking of ordering a Shame Kebab. But I'm not sure what it's made of. Could be either ignominy or disappointment. Either way, I feel I may regret my decision.

I decided against the Shame Kebab in the end. Had a Melancholy Curry instead, with a side order of Disgust.

Friday, June 3, 2011

Private Provision Of Social Services

From The Economist
The recent stories in the press, and on TV last night, exposing abuse in care homes for the mentally ill and elderly along with the news that Britain's largest care home provider, Southern Cross, is in financial difficulty, have caused much concern about the role of the private sector in the provision of social care.

My last blog post extolled the virtues of the market in the NHS, much to the annoyance of an anonymous commentator. Predictably, these private sector failures were used as examples of why any involvement of the private sector in social care is a bad idea. I replied in kind but subsequently have read an excellent piece in The Economist, published today, on the same subject. You can read that article here... When carers fail: Southern Cross’s problems are a business failure, not a policy failure.

It's worth a read if your interested in the implications of increased private provision in our social services.