On Catching Up

I don’t tend to follow the news much on holiday. Anyway, while I was away and since I got back to the UK, various things have happened.
To take a few. The Bank of England has cut base rates from almost nothing to a bit
less. This means our pensions, which were unaffordable, are now
slightly more unaffordable.
The Government has this summer decided, as a consequence of a vote the
result of which the majority of the country now regrets, that any
attempt to bring the country’s finances into balance is no longer
worth attempting. See the above, re pensions.
A hospital in Grantham is no longer offering a 24 hour A&E service. Not, not enough money, but not enough doctors, however much we are prepared to pay them.
Spending on the NHS is rising by 1 per cent a year. The amount that
needs to be spent, because of our ageing population and our refusal to
stop eating ourselves to death, is rising by 3 per cent plus. This is
going to end how?
A review of the banking system which has run for several years has
come to the conclusion that there is nothing much wrong with the banking
system. The man responsible was on R4 Today defending this conclusion.
Not terribly well.
Nothing that has happened over the past decade would lead one to the
conclusion that there is anything wrong with the banking system,
would it?
The Government has decided to delay the decision to build new
electricity capacity that will be desperately needed in half a decade because it
is always easier to delay a decision than to take one. As it happens,
I think that new Hinkley Point plant is the wrong solution to that
problem. But to solve it, we have to decide to do something. Not
nothing.
This means the lights will start to go out about when the country runs
out of money and the pensions of people now nearing retirement prove to be inadequate. That will make for an interesting couple of months, won’t it?
Oh, and staff on Eurostar are going on strike over the Bank Holiday, thereby
screwing up any number of people’s summer holidays. Their reason? With no sense of discernible irony, they are unhappy about their work/life balance.
Welcome home.

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On The NHS

At the start of this week we had a serious medical crisis within the family. A family member was badly ill, and having soldiered through the weekend was plainly in desperate need of a doctor.

We rang the surgery on Monday morning. We were told that someone would call us back in a couple of hours to let us know if we could have an appointment that day. Note if, not when. I know from earlier experience with the surgery, a fairly new and large one, that there was every chance that no appointment would be forthcoming. That was my experience in an earlier medical emergency.

We had three choices. One, wait for that appointment, and accept it might not be available, in which case we would be in serious trouble because the need was urgent.

Two, go to our local A&E. This is something you are constantly being told not to do, because you are tying up essential services for a matter that can be dealt with by your GP. Except that there was every chance that in this case it couldn’t.

Three, pay for a private doctor. This was what happened to me last time – I had to wait for a day, pay for an optician’s appointment and be told to go straight to Moorfields A&E. Something which my GP should have diagnosed free of charge.

We paid for a private appointment, and were issued with the penicillin that was plainly badly needed. We can afford it – others cannot. They have to wait, in great suffering, in some cases, until the doctor is able to see them. And in some cases at a risk to their lives.

Yes, I appreciate that “resources” within the NHS are limited. But this is not even in mid-winter, when flu, etc, is rife. The next time someone comes on the Radio 4 Today programme to warn about the “creeping privatisation” of the NHS, bear in mind that it is already happening.

Free at the point of delivery?

On Mindfulness, And Peak Guardian

A couple of years ago I tried out the currently modish meditation technique called mindfulness.

This involves training yourself to become aware of your body and your feelings, setting aside ten minutes or so a day to focus on sensations, noises and what you are experiencing. Its proponents say it can be used as a form of therapy to fight mental illness, or as a simple process to improve mental well-being.

It has been adopted and endorsed by a range of celebrities. I found it did not seem to make much difference to me, nor did I see much effect, good or bad, when I dropped the practice after a few months. I suspect the perceived benefits may in many cases be down to the placebo effect. Those benefits are, in any case, hard to measure objectively.

Now an attack on mindfulness has appeared in The Guardian, for some reason. The piece claims mindfulness can cause panic attacks or a full-fledged psychological breakdown, and interviews people, unidentified, who have experienced this.

This seems, from my experience, implausible. One of the benefits, I suspect, is bringing the practitioner to a fuller awareness of his or her surroundings. We live much of our lives on automatic pilot. We all know the sensation of engaging in a pleasurable action without really being aware of it, of getting half-way through a meal or a casual drink and then realising we haven’t really tasted anything because we are not aware of what we are doing.

Any process that allows us to better experience such sensations, rather than wasting them, must be a good thing.

I am no psychologist, but I suspect The Guardian has merely turned up a few people with existing psychological conditions that worsened and attached the blame to their undergoing mindfulness – the practice is often diagnosed in such cases. It’s our old friend causation again – event B follows event A but is not necessarily caused by it.

The Guardian piece comes with a political spin attached. We are told the main business promoting mindfulness is worth £25 million. No indication how this sum is reached, but the implication  will be picked up by the paper’s readers. A business, therefore obviously bad in itself.

We are told, again without substantiation, that employers are forcing their staff into mindfulness sessions as an alternative to doing something about excessive workload, poor morale or bad management. It is being considered as “a route to heightened productivity.” Again the spin is obvious.

Oh, and the NHS is promoting the practice because it’s cheaper than other psychological therapies. It’s “the cuts”, you know.

It is, and you can believe me on this, impossible to “force” someone to practice mindfulness. All very Peak Guardian, then. Set it up to knock it down, with a political, anti-business spin. Mindfulness has previously been attacked by practitioners of organised religion as a fake one, a cult. It is not that, either, and comes with no spiritual baggage.

Hmm. With enemies like that, I am rather coming around to the idea again.

The NHS, And Population Density

We read that such is the crisis in the NHS that a dozen or so large hospitals have put themselves into special measures, declaring that because of the huge numbers of people piling up at their A&E departments, routine operations are being suspended.

There is one odd fact that seems to have been missed. The hospitals affected are in some of the more prosperous parts of the country. Cheltenham. Guildford, one I know rather too well. Cambridge. Croydon. Brighton. Other bits of Surrey.

These are not sink hospitals in desperately poor parts of the inner cities overwhelmed by an avalanche of migrants, as the stereotype might have it. They are in some of the parts of the country, I would suggest, most affected by the housebuilding boom that kicked off in 1997 and has continued, financial crisis notwithstanding, in such areas ever since.

There are other factors, the changes in the hours of GPs that make it difficult to find anyone at weekends, untrained staff, as my own paper has reported, on the 111 helpline who automatically send callers to A&E rather than risk a tragedy. If your child is running a raging fever, there is no one available at your local health centre, and the 111 staff are unable to advise, what else do you do?

I live in one of the more prosperous parts of the capital. Walk around my local area, and you notice that large chunks of the housing stock, mainly flats, have been built in the last 15 years. Offices in the town centre have been converted to six storey blocks, any light industrial space on the market, however unattractively sited by a main road or a railway, is replaced by flats.

My local football ground is now a vast mini-village, conveniently located for fine views of the electricity pylons and the scrapyard.

The reason for this is that in the boom years of the 1990s and Noughties, it was almost impossible to lose money buying land in such areas, turning it into flats and, in many cases, passing it on to buy-to-let landlords who, funded by freely available mortgages, let it out to those who could not afford to buy.

At the end of my road, an old Victorian house, somewhat run down, came up for sale. It was bulldozed, and turned into nine flats. A population density of four or five became, potentially, nine couples.

Extend that across the borough. The council loves it – one rateable property becomes nine. Planning permission is not a problem.

Over the two decades I have lived there, the population density has rocketed. Each year there are more queuing at the local bus stop, more crowding onto the same number of trains. And it is more and more difficult to get through to the same surgery we have used all the while for an appointment.

I have been doing some research. The population of my borough, according to the Office for National Statistics, a scrupulously reliable source, was 191,100 in 2001. By that time the building boom was well under way.

In 2012 it was 202,200. The ONS estimates it in 2014 at 215,000. That’s a 12.5 per cent increase, nine people where 13 years before there were eight. That may not sound much, but the arrivals are likely to be young, mobile and placing more pressure on transport. And, on producing children, more pressure on the health services.

Meanwhile those already living there are getting older. Ditto, more pressure on health.

By 2020 the ONS forecasts the population of my borough will be 239,600. A 25 per cent increase in less than two decades. Greater London Authority estimates are lower, for some reason, but are still talking about a 12 per cent increase. These numbers are unsupportable, unless you add to services. Which isn’t going to happen, is it?

On The NHS

A cancer surgeon has become the latest healthcare professional to discover that telling what you see as the truth about the NHS is not a clever career move, no matter how much protection is promised to whistleblowers.

An official inquiry actually concluded that an obsession with secrecy was one of the problems within the NHS and said those professionals should be allowed to speak out. Those that have have almost all regretted it.

Let me tell you a story from a few years back, though I doubt it has changed greatly since. This is true. I saw it. I was sitting in a hospital corridor waiting to see the specialist. There was a two hour delay between the time of my appointment and when he actually saw me.

(Why? Because the time wasted by such delays is of no concern to the NHS or its staff. This is because few people using the NHS have any choice. See my posts elsewhere on monopolies, public sector or elsewhere. Monopolies always exploit their position.)

An elderly orderly was sitting on a bench near me. A nurse came out of one of the doors off the corridor and asked him to replace the toilet paper in the ladies loo.

The man sat there unmoving. About 15 minutes later the same nurse reappeared and repeated the request. The man sat there unmoving. Perhaps ten minutes later the same nurse repeated the request again. The man lurched slowly to hit feet and shuffled off to do what he had been told to do 25 minutes before.

He was plainly poorly paid, utterly unmotivated by the job and, as a member of a public sector union, unsackable. It is inconceivable that such a vignette cold be played out in any private sector organisation, such as the one where I work. It just wouldn’t happen.

What was so disturbing was the reaction of the nurse. It was clear that his behaviour was nothing out of the ordinary, and nothing to remark about. I am not saying all NHS employees are equally lazy. But remember this next time you are told about the shortage of “resources” the NHS is suffering from.

Death On The NHS

This is beyond parody, surely. The Guardian has dug up a report from a Washington-based foundation that says the NHS is the world’s best health care system among developed countries.

This might come as a surprise to those of us who have experienced some Continental health services – the Spanish one comes to mind, on a personal note. The study, by the Commonwealth Fund, “respected around the world”, finds the NHS scores highest for quality, access and efficiency. The US ranks at the bottom of the table of 11 nations.

There is just one minor drawback with the Envy Of The World. The NHS ranks bottom but one on a composite “healthy lives” score. This includes factors such as infant deaths and the number of people who would otherwise have survived had they received the right treatment on time, though the Fund thinks this might have something to do with social and economic factors.

As the paper puts it, apparently without irony, “the only serious black mark against the NHS was its poor record on keeping people alive.”

Yes, one can see how that might be regarded as serious.

On Smoking, and the NHS

I met a chief executive the other day who refuses to employ smokers. Not out of personal antipathy to the habit, but on purely commercial grounds. He has a lot of employees in the US, and offers medical care as part of their remuneration package. This is more expensive if they are smokers.

He made an interesting suggestion. It is increasingly obvious that we cannot afford to maintain the National Health Service in its current form. The drugs are getting more and more expensive, people are living longer and requiring more treatment. This is a fact. The NHS is not, a couple of decades hence, going to be able to continue as it is.

Something will have to be done, and it will require a departure from the founding principles of “free at the point of delivery”. Why not, my chief executive suggested, charge people according to the extent that their lifestyles, smoking, drinking, obesity, whatever, contributed to their need for treatment?

If you are treated for a smoking-related condition, you get charged for treatment. Ditto all those other bad lifestyle choices. Lead a blameless life, as healthy as possible, and you don’t get charged when you need the NHS.

There is one counter-argument. If you smoke, you and your fellows already contribute billions in taxes to the State to help fund the NHS, among others. One Nobel prize winning expert suggested the other day this was the real reason why tobacco had not been banned along with other dangerous substances.

Plus, if you smoke you probably die earlier, and do not create such a burden for the NHS as you grow older. Earlier, and often very quickly.

A Blind Eye?

I spent much of one day this week at the south London offshoot of Moorfields Eye Hospital. No complaints, the staff were cheerful and efficient. As they should be, of course, and in my experience of the NHS generally are.Whatever applies elsewhere. Something rather odd struck me, though.

I will state this as neutrally as I can. I estimate about a third of the crowded waiting room could have been identified as ethnically British, by name or appearance. Significantly more than half had names that suggested they were not. A number will have been recent or long-standing immigrants, of course.

But Moorfields is not like a typical A&E, which can be expected to reflect the make-up of the local population, large numbers of whom in some areas are of course members of ethnic minorities. Including that part of south London. It is a centre of excellence for ophthalmology. You have to be sent there, often from some way away.

The ethnic make-up should, therefore, more reflect the make-up of the population generally. It plainly did not.

You have to wonder why. One explanation is that a certain number in that waiting room were so-called health tourists, people only here to take advantage of what is a world centre of excellence, as I said. I have no idea if this is true or, if it is, to what extent.Some may have been from overseas and paying for their treatment, of course.

As it happens, I was asked to fill in a form that stated my ethnicity, how long I had been in the UK, and so on. At no point during my stay did anyone look at it.

Middle Class Vested Interests

I worked with Michael Gove for some years and can confirm that he is a genuinely decent man, a politician who came into politics to make life better for his fellow citizens. Brought up in fairly modest circumstances, he gained a scholarship to go to a good school and his prime motivation is to ensure that as many pupils as possible today get the best possible education.

My teenage daughter went to 6^th form college, where it is fair to assume she absorbed the demonisation of Gove by the staff there and others of the educational establishment, that amorphous mass of naysayers and foot-draggers that he himself calls The Blob. She genuinely seems to think he has a personal animosity towards the young, all of them. Teenagers are prone to silly ideas.

Gove is up against that constant of the advantaged professional classes the Middle Class Vested Interest. The same is true of those who have tried to reform the NHS or other parts of the health establishment.

They have an inbuilt advantage, these MCVIs. They are articulate, and present well on the Today Programme, where half a dozen of them – that soft-voiced Scotsman who used to speak for the BMA, the woman from the NUT – have become fixtures, on speed-dial on the producers’ mobiles.

What they have in common, aside from that voice of sweet reasonableness, is the determination that the people they represent do not want change, that the practices enshrined in their professional codes of conduct must never be amended and that those privileges their members enjoy are not to be eroded in any way. No matter that it might be to the benefit of the people they are pledged to teach, or treat, or serve. And that the money is always there, somewhere, to support the status quo.

They are no different from any other  knuckle-dragging trade unionist, but that articulacy and voice of sweet reason is very difficult to combat, as Gove has found out. The one vested interest that Mrs Thatcher never dared take on was the law, although some of the lawyers’ privileges are now being eroded by market forces and the arrival of competition from outside the profession.

And which profession is disproportionately represented in Parliament? Indeed. Funny, that.

(Disclaimer – my daughter, who designed this website, is actually incredibly intelligent and I’m lucky to have her around. Her opinions are her own, as mine are.)