I don’t usually find much to sympathise with over at the Bella Caledonia blog. This account by Jonathan Rowson, whose brother has been committed to a psychiatric ward, was an exception:
Smoking and the Forbidden Garden – a Dereliction of Sanity?
Defending the rights of the mentally ill to do something that harms them is not a popular cause, but this much needs to be said: preventing psychiatric patients from smoking on hospital grounds is inhumane.
I am responding to the situation in a particular ward in a hospital in NHS Grampian region. At the time of writing my forty year old brother Mark is there, as he has been before. He is surrounded by other adult patients, many of whom are thought disordered, dysfunctional, and up to their eye balls in medication. Mark has given me permission to write publicly about his situation, but he is not well enough to grasp the full context. I am taking the liberty of making the following case on his behalf.
Many psychiatric patients are habitual smokers, but at the moment they are strictly not allowed to smoke anywhere on hospital grounds. Smoking has been banned in hospital buildings for about a decade, but in the hospital in question secure gardens adjacent to the locked wards and smoking shelters within the general grounds of hospitals were available to smoke. This arrangement seemed to work until the authorities decreed that the shelters should be knocked down and the secure gardens should be smoke free. Some psychiatric patients, staff and visitors now face the mild stigma and hassle of having to escape the hospital to smoke, but if you are sectioned under the mental health act it’s not so simple. The hospital ward is your de-facto home, and also your de-facto prison, so where do you go?
The ruling is unenforceable. In fact most staff feel they have no choice but to turn a blind eye. Patients are now smoking in their rooms or in the bathrooms; anywhere where the staff can have plausible deniability of not seeing them. Alas, the collateral damage of this necessary open secret is that none of the patients can now go to the outdoor area assigned to the ward. The small secured gardens are the most humanising place on the ward and a vital source of fresh air, but they lie unused due to the risk, not that patients will smoke, but that they will be seen to be smoking, and get staff into trouble as a result.
Most of the comments are supportive, but not all. This one by Clive Scott was notable for its self-righteousness:
What about the employer’s responsibilities to provide a safe working environment for employees and the rights of non-smokers for wholesome air? It would be ridiculous to permit the mentally enfeebled to flout regulations for the common good simply because of their illness. Smoking is a disgusting foul habit and addiction and every step possible should be taken to eliminate it from society.
Scientists find mutation that protects against ‘mad cow’ disease after studying cannibal group
Scientists have found a genetic mutation that imparts complete protection against the human form of “mad cow” disease, which could lead to new ways of tackling similar incurable brain diseases.
The researchers discovered the mutation after studying the genes of the Fore people of Papua New Guinea who until recently had practised a form of cannibalism where a related disease was transmitted by eating the brain tissue of the dead.
At the height of the kuru epidemic in the mid-20th Century, the disease was killing about 2 per cent of the Fore population every year. Some villages had become so severely depopulated they risked dying out, with few if any women of child-bearing age left alive.
However, the scientists believe that people who had been born with the resistance mutation may have helped to re-populate the Fore villages, leading to a rise in the number of individuals who were resistant to kuru.
If I had more brains my first thought on reading this article in the Independent would have been, as it was for Professor John Collinge, director of the Prion Unit:
“This is a striking example of Darwinian evolution in humans – the epidemic of prion disease selecting a single genetic change that provided complete protection against an invariably fatal dementia.”
But if I had more brains I wouldn’t need a second thought.
The UK Labour government mentioned is that of Wales. One of the advantages of devolution is that it allows people to compare the results of different laws in the various constituent countries of the UK. The Welsh Government wants to promote and protect the health of Welsh people in the same way that it has promoted their education since devolution. Very badly.
Wales to introduce e-cigarette ban
Electronic cigarettes are to be banned in enclosed public spaces and workplaces as part of a raft of radical health plans announced by the Welsh government.
The law would be the first such restriction in the UK and would be hugely controversial among thousands of users, producers and campaigners who believe the use of e-cigarettes can help smokers of conventional cigarettes quit.
Other measures proposed by the Labour-controlled government is the creation of a compulsory national licensing system in relation to acupuncture, body-piercing, electrolysis and tattooing.
Weirdly, or perhaps not so weirdly, the archetypal fake charity ‘Action on Smoking and Health’, which gets less than 2% of its funding from public donations, is actually on the side of health:
Action on Smoking and Health a charity that works to eliminate the harm caused by tobacco, said it did not support the sort of ban proposed by the Welsh government.
It said there was emerging evidence that e-cigarettes helped people quit smoking and there was little evidence they encouraged “never smokers” to take it up. A spokesperson said: “We think they should be appropriately regulated. That does not include banning in public places.”
I have recently been suffering from one of those annoying state-of-the-art flu bugs that made me properly ill for only a few days, but which then hasn’t allowed me to get truly better for another month. I still await full functionality.
When in such a state, I find serious writing difficult. (I can still manage unserious writing.) But what I really like to do when thus semi-incapacitated, is to read. And there is nothing, I find, like reading well-written history about long-ago times to make me count my modern blessings and cheer me up.
I recently began what looks like being a very good book about King Edward I. (A short excerpt from this book, on the subject of medieval historical evidence, can be read here.) Edward I was the English monarch who won the Battle of Crécy, and who soon after that presided – if that’s the right word – over the Black Death. You want a bug? That was a bug.
But I haven’t got to the Black Death bits yet. …
(LATER: And I won’t ever. I’m muddling Edward I up with Edward III, see commenter number one below, to whom thanks, and with apologies to everyone else. Edward III was the victor of Crécy, and I will wait in vain for anything about the Black Death in this book. I will be learning about such persons as Simon de Montfort. But the Black Death was, as I have read elsewhere, very nasty.)
… In the bits I have read so far, Edward is still a teenager, and his dad, Henry III, is fretting about how to crush a rebellion in his French possessions, and in particular (p. 16), how to persuade his English subjects to foot the bill for that enterprise:
The obvious solution was to impose a general levy on everyone – a tax – and Henry’s immediate predecessors had on occasion done just that. King Richard and King John had found that they could raise huge sums in this way – England, it bears repeating, was a rich and prosperous country – but such taxes proved highly unpopular, …
It is always worth keeping an eye out for a use of the word “but” when it would make more sense to have encountered the word “and”, or “therefore”. The unpopularity of taxes in England on the one hand, and on the other, the fact that England was a rich and prosperous country sound to me a lot like a cause and an effect. But the way that modern-day author Marc Morris phrases it, if your country is rich, it can accordingly afford to pay higher taxes without its richness being in any way disturbed.
It was this next bit that made me laugh out loud:
… but such taxes proved highly unpopular, and were regarded as tantamount to robbery.
Ah those medieval fools, so lacking in our modern grasp of the obvious and fundamental differences between taxes and robbery!
Here is a way in which things – things that in general are so much better now than then – have actually got worse.
I do not want to single out Marc Morris for criticism here. He is only describing matters in a way that most of his readers will immediately understand. Taxation? Of course. What he personally thinks about the idea of there now being higher taxes, to pay for such things as foreign wars, now, I do not know. As for me, although I will not live to see it, I look forward to a time when both taxation and death (at the sort of age that I will in due course be encountering it) are thought of in the same kind of way that we now think only of such things as the Black Death.
How on earth could those blundering and miserable twenty-first centurions not understand such obvious ideas?
On the NHS, that has gone far beyond a joke. It is not enough to value the idea of universal healthcare free at the point of use as a concept – one must “love the NHS”. Doctors and nurses are not doing their job in difficult circumstances – they’re fighting on the front line. Nobody wants to reform the NHS – Labour leader Ed Miliband wants to “rescue” it. The debate is uncritical, nostalgic, what The Economist called “ideological, ahistorical bunkum” – and nothing short of cowardly.
Andy Burnham, Labour’s Shadow Health Secretary, has warned that there are “24 hours to save the NHS” so often over the past five years that people are beginning to doubt his grasp of Babylonian concepts of time.
– Andy Silvester
I was ill recently. In the end it was “just a virus” but I had symptoms enough one Saturday that I braved the local NHS walk-in centre. This is where you end up if you have the bad manners to get ill on a weekend.
It was functional, in its way. I was told there would be an hour-and-a-half wait and that is what it was. There are no doctors, only nurses, but they are skilled enough to determine whether you are likely to survive until Monday, or so I imagine. But the economics of this kind of place are such that every body through the door is nothing but a drain on resources, and no-one is making any effort to conceal this fact.
Truly it is a miserable place to be. I do not expect a medical waiting room to be jolly, but I saw not the merest hint of a smile from any staff, and the receptionist was very grumpy about my address being out of date on her computer. There is no welcome; no sympathy; no bedside manner.
If you want to find a deep root cause of problems with the NHS, I submit the inevitable hatred of the staff for the burdensome customers.
Here is another piece of evidence: when I said “thank-you” to the nurse, she replied, “you’re welcome.”
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.
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.
Back in the bad old days, Kremlinologists used to try to figure out what was going on in the leadership of the USSR by observing signs and portents.
During the Cold War, lack of reliable information about the country forced Western analysts to “read between the lines” and to use the tiniest tidbits, such as the removal of portraits, the rearranging of chairs, positions at the reviewing stand for parades in Red Square, the choice of capital or small initial letters in phrases such as “First Secretary”, the arrangement of articles on the pages of the party newspaper “Pravda” and other indirect signs to try to understand what was happening in internal Soviet politics.
To study the relations between Communist fraternal states, Kremlinologists compare the statements issued by the respective national Communist parties, looking for omissions and discrepancies in the ordering of objectives. The description of state visits in the Communist press are also scrutinized, as well as the degree of hospitality leant to dignitaries. Kremlinology also emphasizes ritual, in that it notices and ascribes meaning to the unusual absence of a policy statement on a certain anniversary or holiday.
Brian Micklethwait has often written of the “sovietisation” of various parts of the British State such as state schools and the NHS. To illustrate this process, take a look at the way a “major incident” at Colchester Hospital has been reported.
What major incident you ask? My point exactly: you ask, they don’t answer. Likewise “safeguarding” is repeatedly mentioned. Something needs to be safeguarded.
Late last night or early this morning there were oracular bulletins from the Telegraph and Times, all chock-full of unspecified “incident”. From the Times:
On Wednesday, the Care Quality Commission (CQC) inspected Colchester Hospital’s accident and emergency department and emergency assessment unit and told trust it had concerns over “safeguarding” there.
The major incident is likely to last for a week, and the trust has reminded members of the public to only visit A&E if they have a “serious or life-threatening condition”.
A spokesman for the hospital said the inspection was not the sole reason for the major incident being declared, although it played a role.
All clear now? There was a similarly opaque article on the AOL homepage. It has been updated since, as has the Telegraph one, I think, but the Times, like a good horror movie, is delaying the big reveal.
The BBC followed suit: “Colchester Hospital declares major incident.” The BBC did tell us what sort of general thing might constitute a “major incident” but not about this major incident. As a result everyone thinks it’s ebola and as I write this it’s the most looked-at article on the BBC website.
Stand down. It’s not ebola. The Guardian was slow to get the story but does actually tell it:
A major incident has been declared at Colchester hospital after a surprise inspection this week found patients being inappropriately restrained and sedated without consent and “do not resuscitate” notices being disregarded.
The ward concerned has been closed to new admissions, an emergency control centre has been put in place to address capacity problems, and patients are being urged to go to A&E only if they have a serious or life-threatening condition.
Inspectors from the Care Quality Commission (CQC) found that the Essex hospital is struggling with “unprecedented demand”, but the Guardian understands concerns were also raised about safeguarding issues relating to inappropriate restraint, resuscitation and sedation of elderly people, some with dementia.
Oh dear, what a let down. Just as it used to in the days of Pravda and Izvestia the secrecy concealed mundanity. It’s just the NHS in crisis again. Can’t they do anything right? The zombies they make aren’t even dead yet.
This is how in 1918 Times readers first found out about Spanish flu:
The Times 3 June 1918 p5
You can say that again. It ended up killing 40 million people.
Incidentally the Wikipedia page on the subject is an appalling mess. At one point it claims that it began on the Allied side of the front, at another that it began on the Central Powers’ side. At one point it claims that it was particularly lethal to those with strong immune systems and at another to those with weak immune systems.
Having said that I love the suggestion that it was called Spanish flu because that was the origin of the first reports of the disease. It was the origin of the reports not because it was the first place to get the disease but because wartime censors did not want to encourage the enemy by admitting its presence.
So, it’s possible that this was not how Times readers first found out about it.
Here is an interesting observation by Jo Nova of two sets of reactions in an article titled Company stops Ebola, Bureaucracy puts it on a plane:
The rubber plantation has 8,000 workers with 71,000 dependents. It is an hour north-east of Monrovia, surrounded by Ebola outbreaks. The virus arrived on the plantation in March. Knowing that the UN and the Liberian government were not going to save them, the managers sat around a rubber tree and googled “Ebola” and learned on the run instead. They turned shipping containers into isolation units, trucks into ambulances, and chemical cleaning suits into “haz-mat” gear. They trained cleaners, and teachers, they blocked visitors, and over the next five months dealt with 71 infections, but by early October were clear of the virus. There were only 17 survivors (the same 70% mortality rate as elsewhere). But without good management, there could have been so many more deaths.
In contrast, the nanny-state takes a good brain and stops it thinking. In Texas, trained health professionals were caught unprepared, following inadequate protocols they assumed were good enough, and even risking their own lives. A nurse who cared for a dying Ebola patient — and knew how bad Ebola could be — still needed to phone someone to ask if it was OK to board a plane with a slightly raised temperature (99.5F or 37.5C). The official she spoke to “didn’t Google”, they just said yes because her temperature was lower than the official threshold of 100.4F.
Read the whole thing.
Bryan Caplan, over at the EconLog blog, has issued a sort of challenge to folk in the US getting worried about Ebola:
Mainstream scientists assure us that Ebola poses very little threat to Americans; unless you’re a health worker who cares for the infected, Ebola is almost impossible to catch in a rich, modern society. Yet many populists and borderline conspiracy theorists are convinced that the experts are seriously understating the danger. In their contrarian opinion, we desperately need to close the border now. Fortunately, this is an easy argument to put to a bet. My tentative offer: $100 says that less than 300 people will die of Ebola within the fifty United States by January 1, 2018. I’m willing to switch to “Unless the U.S. changes its Ebola-related policies, $100 says that less than 300 people will die of Ebola within the fifty United States by January 1, 2018,” but then we’d have to carefully define what policy changes count.
Leaving aside what you think about the specifics of the Ebola case, this idea of economists and other commentators making hard financial bets on specific claims has the merit of injecting a certain edge to proceedings. There is nothing quite so much like a bet to make people prove they are convinced of something. And as the late Julian L Simon proved when he bet against a neo-Malthusian about commodity price trends, there is nothing more satisfying than being proven right. (Paul Ehrlich, who lost the bet to Simon, was invited to have another go and declined the offer, despite responding to Simon with singular ill grace.)