This post was written by my regular correspondent “ARC”, who has several family members working in the NHS. – NS
I’ve been discussing the NHS A&E issue that’s been in the news of late with the medically knowledgeable and NHS-aware members of my family and thought you might be interested in their background information, so have written it up while the conversations are still fairly fresh in my mind. I summarise, then give my own thoughts at the end.
The immediate cause of the NHS A&E issue being such a story in the media at this time (other than the upcoming election, of course) is simply that at Christmas a great many staff take holidays. The resulting shortfall exposes long-term trends in an area under pressure. There is no other immediate cause, as distinct from long-term trends: these problems have been growing for 15 years and more as follows.
1) Flow-though is crucial to A&E: you must get people out the back-end of the process to maintain your rate of input to the front-end. However ever-increasing regulations mean a patient without family cannot be released until a boat-load of checks have been done. This is clogging up the back end. It may be preventing the release of a few who had better not be sent home yet (not much and not often, is the general suspicion) but it is definitely delaying hugely processing the release of all others who could be. All this admin takes time and effort – delaying release and also using up time of staff in non-health work – and costs money.
This effect needs to be understood in the context of the 15-years-older story of the destruction of many non-NHS nursing homes by galloping regulation. These homes were mostly owned and operated by senior ex-NHS nurses and provided low-grade post-operative care. The NHS relied on them as half-way houses to get patients out of NHS hospitals when they no longer needed intensive care but were not yet recovered enough to go home. These nurses did not want to spend time form-filling instead of caring for patients, and for each home there was always one of the 1000+ rules that was particularly hard for that given home to meet without vast expense or complication. So they died one by one. The ‘waiting times have increased’ story of Tony Blair’s early-2000 years – “If the NHS were a patient, she’d be on the critical list” – was caused by this and the resultant bed-blocking more than any other one cause.
A more recent context is over-regulation of local councils’ social services leading to declining throughput, unrealistic expectations for their visit times, etc., and there have also been some social services cuts by said councils. These also have an impact on a hospital’s ability to get people out of the back-end to free up beds for A&E incomers.
2) The new 111 service is sending many more patients to A&E.
2.1) The service’s advice is very risk averse. The people who set up the process were afraid of the consequences of the statistical 1-in-a-million time when anything other than mega-risk-averse advice would see some consequence that would become a major news story blaming them.
2.2) Thanks to the post-1997 reforms, GPs work less hours on-call but the doctors are not just slacking off and doing nothing. The huge growth in regulation means they are in effect putting in as many hours as before, but on form-filling and admin to provide all the info the NHS and other government demand, to ensure they tick every box, etc. The out-of-hours on-call time they used to have is now swallowed by this work. So they are not in fact working less; it is the balance of what they are working on that has changed: less on healthcare, more on admin. Thus 111 must send people to A&E, not an on-call GP (and, of course, fewer on-call GPs mean more people phone 111).
3) Regulation prevents fixing the problem as well as causing it. A Birmingham hospital (Queen Elizabeth in Edgebaston IIRC), said to be very efficient as such things go, tried to create a low-level care unit precisely to solve the problem. Because of the regulations, the attempt had to be abandoned – they just could not tick all the boxes.
4) Back in the early-80s, when my sister (a doctor) did her elective in A&E, she loved it. Now, doctors are avoiding A&E as a speciality because they know how brutal is the pressure there. So the problem is beginning to compound itself.
There is a great deal more one could say, but the above are what my informed relations see as the key immediately-relevant causes. So far my summary. Now some thoughts of my own.
What I observe has most changed in the last two decades in these either left-leaning or were-left-leaning people is firstly their belief that “No party can fix it”. (This I heard from a previously definitely-left individual who would probably still cut her hand off before it voted Tory and whose heart wavered between Labour and [Scots] Nats although her head despises Nats ideas and despairs of Labour.) There is an expectation that no likely government will do anything other than talk of reform while actually causing yet more regulation. Some of this in some of them might be a reluctance to think that the side of politics they’ve loved to hate in the past might be the place to look for an answer (I am reminded of Gore Vidal in 1979, “I feel the despair of coming to think that the Soviet Union may be as despicable as the U.S.” – quoted from memory) but it also reflects their opinion that the Tory-led coalition has failed to reverse any of the above trends, and this opinion I fear is not mere prejudice but has a basis in their experience of the last three years, just as much of the above reflects their experience of the last 15 years.
Secondly, they report a widespread belief within the health service that this time “a bit of money can’t fix it”. There is no expectation of an ocean of money (and – I sense – awareness that the NHS already consumes an ocean of money, so can hardly demand another ocean of money even as a righteous goal, however impossible to arrange).
Lastly, I know that behind all this inefficiency of regulation, there lurks a compounding problem of looming social trends. The number of patients who have no family ready to help is rising. The promise that the state will look after all has led more people to lead lives that make no other arrangements. But these long-term trends are not the reason the NHS operates much worse now than two or three decades ago.
“Greece versus Europe: who will blink first?” asks the Telegraph. I care not who blinks, or who wins this contest of braggarts. All that matters is that for Greece to be ejected from the Euro would be good for Greece, good for Germany, and a good example for all the peoples of Europe yoked together in this vainglorious folly. Go on Germany, give that Marxist fool Alexis Tsipras a demonstration that your gullibility is not endless. Go on Greece, plough your own furrow and while you are at it give the Eurocrats a demonstration that their most public and cherished commitments can fail. Remember “Black Wednesday”? Far from being a disaster for Britain, that was the day its fortunes began to recover.
…does not appear to make the British state education system noticeably worse. Perhaps, you know, it’s not really a problem. Private schools are full of unqualified teachers and do fine. Despite Chris Husbands, the director of the Institute of Education, being quoted as saying that the dropping of the requirement for teachers to gain qualified teacher status in state-funded schools “flies in the face of evidence nationally and internationally”, no evidence is provided that teachers without a teaching qualification do any worse than their equivalents with one.
The Guardian commenters, waving their PGCE certificates in front of them as if to fend off vampires, come out with the usual “I would have soon had my children taught by an unqualified teacher as treated by an unqualified doctor.” I get so tired of that one. Commenter “latenightreader” replies:
I think you are being a bit melodramatic here. If your doctor is unqualified you can be dead within half an hour. If your mechanic has no idea what he is doing and you drive out of your garage and the brakes fail your whole family could be dead (plus pedestrians on the street, other drivers etc). If your teacher doesn’t have a formal qualification… well then your child might not end up as well-informed on a topic. Or they might as thousands of people leave private school yearly having got 3 As at A-level taught by unqualified teachers (that is why Gove borrowed the practice), and thousands more are homeschooled by parents who manage.
A commenter called “epidavros” also makes a good point:
They [compulsory teaching qualifications] also deter many from entering the profession who would be excellent. You are asking already qualified people, often with industry skills, to take a year with zero pay and added debt to change career.
Via the Middle East Media Research Institute (MEMRI), I found this interview with Imam Ludovic-Mohamed Zahed, who believes that “Allah does not speak against homosexuality in the Quran”. A transcript can be read by clicking the relevant icon below the screen.
The moon is blue, so I shall defend a socialist prestige cultural project. East Germany had its shotputters, the USSR its grand masters of chess, Venezuela has “El Sistema” – a much lauded system of musical education. Now, however, there is a discordant note:
Author exposes ‘tyranny’ behind musical miracle for poor children
Over 40 years, El Sistema, Venezuela’s music education system, has given a million children the opportunity to play in an orchestra, enriching, they say, the lives of youngsters from the barrios.
Its methods have been emulated in 60 countries, notably Scotland, where a Sistema-style operation was pioneered on a tough housing estate in Stirling with support from the classical violinist Nicola Benedetti.
The mood music has changed, however, with the publication of El Sistema: Orchestrating Venezuela’s Youth, by Geoffrey Baker.
Aghast at the book’s claims of corruption, mismanagement and nepotism within Venezuela, a Conservative politician has questioned whether El Sistema should extend its reach any further. Yesterday, Alex Johnstone, MSP for North East Scotland, said that plans for a Sistema orchestra in Dundee must be halted while the claims are investigated.
“This book gives the impression that the system is much more authoritarian and intolerant than some were letting on,” said Mr Johnstone. “Not so much a new idea, as back to the Victorian habits of teaching piano by rapping them across the knuckles.”
Corruption, mismanagement and nepotism in a socialist show project would astound me only by their absence. But authoritarianism is the norm when teaching children to play musical instruments the world over, and has been since forever. The exception is the namby-pamby modern Western middle classes, and not all of them. The common opinion of that portion of mankind that gives music lessons or pays for them is that you won’t be going anywhere until you have done your quota of scales, sweetums, and if your name is Wei or Xiuying, these days that quota is likely to be big.
Do not misunderstand me. I like namby pamby. I’ve been uncomfortable with compulsion in education for decades now, and if not convinced that it can be dispensed with altogether for the very youngest children, am certainly convinced that it can be phased out at a far younger age than most people think. In most contexts I am convinced that education without force is immeasurably better education.
But how do you get them to practise – or don’t you? Given that it takes unfailing hours of daily practice to make a great player, and that for most instruments the great players invariably start young, would the price of freeing children from the slavery of music practice be no more great classical musicians? If so, would it be worth it?
Thomas Friedman has written a piece for the the New York Times called “How ISIS drives Muslims from Islam”.
I do not know whether what he claims is true, though it would accord with the experience of Europe after the Wars of Religion. I hope it is true, and I hope even more that a lot of Muslims come to believe it to be true. That applies equally to peaceable Muslims and to bloodthirsty Muslims. I hope the peaceable Muslims are pushed into differentiating themselves from the savages both in public and in their own minds. Even Al-Qaeda appears to believe that ISIS barbarity loses more for Islam than it gains; it has been pushed by Muslim public opinion into reining in its own penchant for headchopping. Repentance on the part of Al-Qaeda is too much to hope for even for a hopeful person like me, but self-interest can sometimes penetrate where morality cannot.
Via Jim Miller on Politics, I found this:
EU court orders France to pay thousands to Somali pirates
The EU’s top human rights court on Thursday ordered France to pay thousands of euros to Somali pirates who attacked French ships for “violating their rights” by holding them an additional 48 hours before taking them before a judge.
The Somali pirates were apprehended on the high seas by the French army on two separate occasions in 2008 and taken back to France for trial.
(The report is incorrect to call the ECHR an “EU court”. Judgements and precedents may mesh with EU law in ways I do not fully understand; but the ECHR is the creation of the Council of Europe, not the European Union.)
I sometimes think that this sort of judgement can only be the result of a deliberate strategy to discredit the words “human rights” in the eyes of the peoples of Europe. But why would anyone want to do that? Perhaps because it suits the immediate self-interest of the individual “human rights professionals”, and the future be damned.
By the way, it is possible to defend the Somali pirates on quasi-libertarian grounds; that they only do freelance what states regularly do without arousing condemnation. One of the commenters to the MSN piece appears to take that view. I don’t, although I do accept (make that “passionately proclaim”) that states continually get a pass on evil deeds just by calling themselves states. Even so, states that have acted as the pirates do – kidnapping and murdering passing holidaymakers – do not escape condemnation, and nor should anyone else.
So, Rolling Stone magazine have rolled back on Sabrina Rubin Erdely’s University of Virginia gang rape story.
A typical reaction when that story first came out came from CNN Political commentator Sally Kohn: “Stop shaming victims in college rapes”. I quote:
Will Drew and UVA get off easily while Jackie’s life — and other college women like her — is shattered?
If UVA has any sense of moral rightness and wishes to remain a great university, it should conduct a thorough investigation into these and similar allegations and mete out appropriate punishment for the perpetuators [sic].
A more senior colleague might like to take Ms Kohn aside and teach her the proper meaning of two words, “allegations” and “perpetrators”. The spelling correction alone does not put right what is wrong with the way both of them combine in that last sentence.
A typical reaction now that the story has been semi-retracted came from Guardian columnist and Feministing founder Jessica Valenti. “I trust women,” she tweets. She disavows the idea that her choice to trust a person is made on the basis of any assessment of individual trustworthiness; she simply trusts the 50% of the human species who belong to the same group as she does. It is group loyalty. On the same grounds, given that she is white, she might as well say, “I trust white people.”
Kohn, Valenti and their like present themselves as the friends of rape victims. There is such a thing as toxic friendship. Before the retraction of the story, I read this account by Liz Seccuro in Time magazine. Ms Seccuro was raped, at the University of Virginia, at the same Phi Kappa Psi fraternity, thirty years ago in 1984. “Do you believe me?” she asks. The answer to that is yes. A man was convicted and jailed for her rape, though she says that there were others who escaped any punishment. But observe that I had to make it very clear that she really was raped. Because after the Duke University lacrosse team affair and this recent one, “rape at frat house” stories (including that of Jackie as described by Erdely, which will now be entirely dismissed by most even though some of it could still be true) provoke an involuntary twitch of doubt even in observers wishing to remain impartial.
Not that the feminists I’ve read on this story ever had any such wish. They said, very clearly, that unquestioning partiality was exactly what they wanted. “I trust women.” They said, as they have been saying for years now, that even the attempt to judge any rape claim on the evidence was to be a “rape apologist”, as Rachel Sklar was quoted as saying here, or was an instance of “rape denialism”, as Amanda Marcotte tweeted here, adding for good measure that it was equivalent to Holocaust denialism.
It is they who are the rape denialists. Or perhaps “deniers that rape matters” would put it better. If you don’t care whether or not a rape actually occurred, then you don’t care about rape. It is a tautology, and a separate point to the one about the trauma faced by real rape victims who seek justice being intensified by the additional scepticism with which their account will now be met. If you think that the moral force of a claim of rape cannot be diminished by evidence that it is false, then in the same act you believe that it cannot be added to by evidence that it is true.
What to make of this?
Shia LaBeouf: I was raped during performance art project
In an interview with Dazed, the actor says that a woman ‘whipped my legs for ten minutes and then stripped my clothing and proceeded to rape me’ during his silent performance art work #IAMSORRY
My question “what to make of this?” is a real one. There is a whole slew of issues involved in this story, ranging from the double standard surrounding female-on-male rape (or allegations of rape), to the extent to which silence can be taken to be consent (particularly the absence of any appeal to bystanders when they were present), and including issues of fairness to the woman accused of rape and to the spectators implicitly accused of indifference to it, and the propriety of staging such an event “starring” a person whom all sides admit has mental issues, which leads us to the politically-charged question of how far one should question the testimony of one who is or may be mentally incapable . . .
Frustratingly, the Guardian story gives much more detail on LaBeouf’s philosophy of art than on what actually happened. A follow-up story quotes his collaborators in the art project as saying they “put a stop to it” as soon as they became aware of it. No mention is made of force being used; apparently she did stop when told to.
So why didn’t Mr LaBeouf say a word to stop her himself? As far as I can make out his reason was because the point of his performance was that he should sit still and not react. On its own, “I could not object because it would have spoiled my artwork” appears ridiculous. Yet people do sometimes freeze when subjected to sexual assault in a public place; it is a common reaction when women are groped on trains, for instance. Then again, what might the woman say in her own defence if these charges were put to her? Was not the whole point of this famous artwork that Mr LaBeouf consented to being humiliated? What did the spectators think was going on? If, as seems to have been the case, his artistic collaborators held that this was something to which a stop should be put, why was no attempt made to arrest the woman? In general I reject the blanket assumption that a person initiating sexual activity must obtain explicit and ongoing verbal assent before continuing. Such an assumption would only apply to creatures not human; the vast majority of all voluntary sexual intercourse takes place without anything remotely resembling such a procedure. But the vast majority of all sexual intercourse does not take place between strangers in public during performance art.
My bewilderment is genuine. All serious comments are welcome, and I would not be surprised to see serious disagreement among the comments. I do not expect to delete remotely as high a proportion of comments as the Guardian moderators did to the comments to the account in the link, but will not hesitate to delete any of which I disapprove.
Hat tip to “bloke in spain”, who pointed out this article by Dr Helen Pankhurst in the Telegraph:
95 years since its first female MP, Britain is lagging behind.
We brag about our democracy, but women are still less represented in our legislature than in Kyrgyzstan, China, Rwanda and Sudan
“Now there’s a list of democracies to regard with awe & envy,” said bloke in spain.
Before I turn to the article, a word about the author. At the bottom of the piece there is a note saying, “Dr Helen Pankhurst is the great-granddaughter of Emmeline Pankhurst, one of the original Suffragettes, and a special adviser on gender equality at CARE International UK.” If you were wondering, CARE International UK is a charity adequately described by the fact that it has a special adviser on gender equality and Emmeline Pankhurst was a great name in the fight for women’s suffrage, and, equally admirably, though this is less celebrated in the history books, a pioneer in the struggle against Bolshevism.
It is heartening to see Dr Helen Pankhurst gain entry to the pages of the Telegraph on the strength of the name of her great ancestress, thus upholding the hereditary principle in these Jacobinical times.
Ninety-five years ago today, on November 28, 1919, an American became the first woman in Parliament. Technically, she had been beaten to it the previous December by the countess Constance Markievicz, an Irish nationalist who fought and won her campaign for Dublin St Patrick’s from Holloway Prison. But Sinn Fein, her party, was boycotting Parliament, and with them she refused her seat.
So it fell to Lady Nancy Astor to enter the House of Commons as its first female member (and first female Conservative), succeeding her husband in the by-election triggered by his ascent to the Lords. It was one year since the Act of Parliament which had given propertied women over 30 the right to vote and stand. She would serve her constituency of Plymouth Sutton for another 26 years.
Yet since then the progress for women’s representation has been slow. Until 1987 women represented less than five per cent of MPs; this doubled in 1992 then doubled again to 20 per cent in 1997. Even now, nearly a hundred years after the initial Act, only 23 per cent of representatives in both houses are women. Will it take until the 200th anniversary of Lady Astor’s election before we write about equal representation as if it were business as usual?
I disagree that the progress for women’s representation in the United Kingdom has been slow since 1919. Progress was quite fast between 1919 and the passing of the Representation of the People Act 1928, when women gained the vote on the same terms as men, and nonexistent since then. Progress has been nonexistent for the excellent reason that there was no more progress to be made. Once women and men had equal rights to vote or stand for office they were equally well represented by being represented (not duplicated) by whatever representative they had voted for. You know, voting for your unrestricted choice of candidate, like you do in a representative democracy. One of the things you’re allowed to do is vote for someone not like you in the nether regions. This innovation seems to have worked out OK since 1919; I think we might keep it on. Does Dr Pankhurst think that Lady Nancy Astor MP was incapable of representing her male constituents?
Reported in yesterday’s Daily Mail:
Company bosses who claimed £130,000 in benefits for sign language interpreters despite not being deaf walk free from court
Two company directors who pocketed tens of thousands of pounds in taxpayers’ money from bogus claims for sign language interpreters have swerved prison.
Tracy Holliday, 39, and Ian Johnston, 43, sent their children to private school off the back of the £134,000 they made from bogus claims for interpreters and support staff they did not use.
Despite their crimes being branded ‘sickening’ by the Minister for Disabled People, the pair have walked free from court on suspended sentences.
The Northern Echo has the same story, although Ms Holliday’s name is given as “Tracey”, as it is in several other sources.
This being the Daily Mail, everybody is outraged about everything. The Mail commenters are outraged that the couple committed the fraud, that they escaped jail, and that they get to keep the money. “People like this are crippling our welfare system by stealing from us daily – they never suffer any kind of real punishment and so it will continue,” runs a typical comment.
The Minister for Disabled People, Mark Harper, shares the commenters’ outrage and manages to get in a plug for the Access to Work scheme the defendants were abusing, “This is a sickening example of two people milking a system designed especially to support disabled people to get or keep a job. ‘Access to Work helps over 35,000 disabled people to do their job. More and more disabled people are getting into work thanks to this fund and our Disability Confident campaign – as employers recognise the tremendous skills they bring to business.”
Even Ms Holliday and Mr Johnston themselves manage a little hopeful outrage, over the way that that they were, they say, obliged by family circumstances to plead guilty with all its potentially unpleasant consequences (not that the actual consequences for them were much more than bad publicity), when really they just didn’t get how the system worked and hadn’t noticed the illegitimate origin of all that cash piling up in their bank accounts.
No one seems outraged or even surprised by the idea that even if Ms Holliday and Ian Johnston’s claims had been genuine, their company would be getting services worth approximately forty-five thousand pounds a year provided by the government to make it worth their while to employ deaf people who could not do their jobs without an interpreter. You don’t get 45 grand per annum to make it worth your while to employ monolingual Tagalog speakers, although by some counts the number of people in the UK whose first language is British Sign Language and whose first language is Tagalog is similar. You might argue that, unlike those who have a foreign mother tongue, deaf people have a disability making them deserving of state aid to compensate for their misfortune – but if you did you would be contradicting Deaf (note the capital D) activists who maintain that deafness is not an impairment but a cultural choice, not to mention government guidelines on how to refer to the Deaf community.
Nobody seems to give any credence to Holliday and Johnston’s claim that they just did not realise that what they were doing was wrong. Could they really be capable enough to run a business and yet still be under the impression that the government would every year squirt tens of thousands of pounds in their direction without checking how it was spent, just because some of their employees were deaf?
Be fair, why should they not have received that impression since that is indeed the way the system is meant to work?
Here is an almost spookily similar case from 2008. Notice how the culprits in that case sought out employees disabled enough to qualify for the Access to Work benefits. Applicants who could not apply for AtW support were ignored. Notice also how the real business of the “businesses” in both cases was subsidy farming. There are thousands of deaf employees and employers doing real work, providing things that people both deaf and hearing really want enough to pay for – including, of course, translation between signing and English. There are no doubt thousands more who would like to do likewise, but the mushrooming of “Community Interest Companies”, “Social Enterprises” and similar much subsidised and little scrutinised sources of employment has normalised a sort of performance dance choreographed to look like people working. Deaf employees, sign language interpreters, support workers, and those whose jobs depend on administering and policing Access to Work and similar schemes all join the dance, gracefully exchanging partners until La Ronde is complete.
Via a mailing from Jews for the Preservation of Firearms Ownership, I was directed to this interesting development:
Vladimir Putin’s Russia Adopts Concealed Carry
Russia, which according to official figures has the fifth highest murder rate in the world, has relaxed its gun ownership laws.
Yep. The land of Vladimir Putin, run by an oligarchical collection of cronies and criminals, is about to relax their gun laws… And not by just a little. After the reforms, they’ll make some US jurisdictions look positively Soviet. While places like New York and Washington DC continue to make it (almost) impossible to get a permit for carrying a handgun, Putin’s Russia is about to make it easier.
Previously, Russians were only permitted to own firearms (subject to approval) for hunting or sporting. But under the new law they will soon be allowed to carry guns, open or concealed, for the purposes of self-defense. (Yeah… A background check and training will be a prerequisite.)
And let’s face it, having a gun for self-defense is probably not the worst idea in Russia. While America saw its share of homicides in 2011 (roughly 13,600), Putin’s homeland saw far more… Despite having a population that is almost half of the US, Russia recorded over 21,000 homicides in the same year. (Wow… So much for believing that gun control works, right Chicago?) The new laws aim to curb that trend, and add to Russia’s homeland defense against outside threats.
The report above is by Michael Schaus and links in turn to this report by Tom Porter in the International Business Times.