The NHS's Structural Deficit

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

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

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

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

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

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

Half-Way to Zero

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

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

Departmental budgets can be huge numbers. Back in the 1990s the running costs budget for the Education Department was £90 million and it is several times larger now.(The actual figure is difficult to uncover as the expenditure groupings have changed since then.) Traditionally, we had always come to our budget via an exercise which involved every individual management unit in the Department. It worked something like this:

• Each management unit looked at current and projected staff numbers for the forthcoming year.
• They then looked at non-staff costs, usually by reference to the current budget, and adjusting them according to policy or procedural changes
• The forecast staff numbers and non-staff costs were sent to the Finance Department
• Finance reviewed the figures and held a number of 'challenge' meetings with senior staff in the management units to test the robustness of the assumptions that had been made
• Finance turned the staff numbers into costs, added in overheads and assembled the whole into a budget, which was then challenged again by the Treasury

That might sound like motherhood and apple pie to anyone in the private sector. I've outlined it in detail, though, because, when we merged with the Employment Department an entirely new method of budgeting was brought in, where Finance applied an inflation figure to last year's budget and then just checked with each management unit as to whether they needed anything different to deal with new policies and procedures. Surprise, surprise, of course, no-one ever said they needed less money and the budget just kept getting larger.

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

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

Multiculturalism: the new CND?

It seems like another time, and it was another century: the Campaign for Nuclear Disarmament? Remember wearing its symbol, that vertical line bisected by an inverted V, which has now morphed into an icon of peace?

A 'Heart Peace Necklace' currently on sale at a shop popular with 'indie' teens.

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

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

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

Why?

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

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

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

The Moral of Missing Sandy Island

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

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

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

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

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

Looking towards Empire?

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

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

 

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

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

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

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

    

In honour of International Men's Day

So, today, 19th November is International Men's Day. 'International Men's Day?', you ask. Yes, I know it sounds a bit strange, what with all the talk about the low representation of women on the boards of our major companies, in parliament, and so on. But think about it for a moment. And if, like me, you're a feminist, think about it a bit longer too. Are things really so loaded on the side of the masculine, that we don't need to think about men as needing help sometimes too?

Think about boys for a moment. According to the Office for National Statistics, there are currently 18.2 million 'families' in the UK, of which 2 million are lone parents with children. Now, the majority of those lone parents are female. (Let's park the issue of lone fathers for the sake of this argument, but acknowledge that they have no end of problems, many of which International Men's Day was set up to highlight.) So, any boys in those lone parent families will be more or less fatherless. They may, if they're lucky have a strong male role model in a grandfather or other relative. They may not. If they are astonishing lucky, they may find themselves in a primary school with one or more male teachers and one of those might teach them. They probably won't. There's a pretty strong chance that most of their teachers at secondary school will be female too.

This isn't just a question of role models. The feminisation of the education system has a much more serious impact. It introduces different norms into what is regarded as acceptable behaviour: sitting still and listening quietly is good, jumping around and kicking a ball is disruptive. OK, that might be a caricature but the fact remains that an awful lot of young boys find themselves labelled as trouble-makers for typical boyish boisterous behaviour and from then on they are launched on a trajectory towards suspensions, exclusions and asbos. And probably, all they needed was a bit more time blowing off steam on a football field.

There's another, even more insidious side to this feminisation. It sometimes goes under the name of misandry and it has spilled out into the media and popular culture. It's the female equivalent of locker-room sexism: giggling comparisons of male inadequacies in the bedroom, around the house, cooking, driving, you name it, and culminating in the conception that the only thing men are good for is providing sperm. There are a whole TV programs centred on this idea. And they make me shudder.

Nicely reasoned articles like the one in today's Guardian by Ally Fogg make the case for men and women working together to solve common interconnected problems of, say, mental health or violence. He argues that before this can happen the commonality of those problems needs to be acknowledged and hopes IMD will help bring that about. No-one could fail to agree. But in my opinion there's a step that comes before this. Let's recognise all that female banter for what it is: sexism. And let's start by getting it out of our primary schools.

PCC Elections and the Absent Voter

There'll be a lot in the mainstream press in the next 24 hours or so about the appallingly low turnout for yesterday's PCC elections. There will be soul searching and blame-dishing. Was it because all the candidates basically said the same thing? Was it because the LibDems pushed the elections from May to November when no-one wants to vote? And there will be point-scoring, especially from the more left-leaning arguing that the PCCs have no mandate as a result of the low turnout. (Although where that leaves Lucy Powell in Manchester, I'm not sure.)

So why am I adding my own three-penny-worth to it all? Well, from where I'm sitting I think it's quite clear what went wrong and I'm not sure that the press will necessarily pick up on all this because, in some cases, it was there fault.

Here we go:

• compared to a typical parliamentary election or council election, the candidates for PCC were almost invisible. Yes, you could read their manifesto on a website or call a freephone number and have it sent to you. But that takes initiative. The British voter is used to being bombarded with election literature. They may hate it but some of it does leech into the brain and at the very least acts as a reminder to vote.
• too many people bought the 'politicisation of the police' argument that was being pushed by the 'liberal' press. Most people are blissfully unaware that the police forces used to have police authorities running them and that those authorities were stuffed full of all manner of political placemen, none of whom had been elected to do that job. Grant Shapps has been tweeting today that even with the low turnouts PCCs had a larger mandate than what preceded them. Maybe more should have been done to put that message about before - maybe our beloved state broadcaster, who has a mission to educate, had a role to play there?
• and yes, it was difficult to distinguish between mandates that were so bland as to be almost meaningless and that meant you had to try reading between the lines. This one was a former police officer - would he really take on the vested interests? This one seemed to be a bit of an eco-freak - did that mean she would have the usual Green attitude to expenditure. And so on...  But this is probably inevitable first time around and, at the very least, there will be things to vote against if it turned out your PCC didn't do such a good job after all.

Maybe these elections haven't been such a great success and maybe things could have been better. At least we can learn from the mistakes and  keep an eye on our new PCCs to make sure that if they don't do what we want we come out in force to get rid of them when their time's up.

UPDATE 17/11/12: Since writing this, several stories have started to spin around the internet reporting that a number of the elected 'Independent' PCCs are actually members of the Liberal Democrat Party. I confess I don't know whether this is grounds for disqualification, but, if true, it certainly brings into question their suitability to undertake a public role in which being trustworthy is a key quality.

Cutting back the layers in the Department for Education

The good old BBC has reported today that the Department for Education is to cut 1000 jobs in an effort to cut its administrative expenditure by a whopping £290m. No doubt there will be screams of anguish from all the usual suspects about how this tallies with the GCSE grade fiasco a couple of months ago, or all those new primary school Academies. But they would be missing the point spectacularly.

These cuts are in 'adminstration', and follow on from a review that was kicked off in June this year. According to the BBC the review found that decision-making was often "slow and laborious", with "unclear roles and processes" and that new ways of working were needed that would remove "the barriers which sap energy and prevent people being as effective as they can be so that less time is wasted on activities which add little value".

This fascinated me. Back in the mid 1990s in a brief interlude between consultancy jobs I spent two years managing the running costs of the old Department for Education. Back then we spent about £90 million on adminstrative costs. Now the £290 million mentioned above represents about half the total adminstrative costs for the department and its agencies. As I recall in the 90s we spent another 4 or 5 million on them. So let's be generous and say that it cost £100m just under 20 years ago as opposed to £580m or so now.

Of course, there has been a bit of inflation since then. So let's apply that to our £100m. I used the This is Money calculator and ended up with a figure of £156m. So where did the extra £400m or so come from?

I think the clue might be in some of the report words quoted above: slow, laborious, energy-sapping. None of those are adjectives I would have associated with the Department when I was there. Sure, there were inefficiencies: I recall cutting back my own team by 25% by the simple expedient of using a computer for our spreadsheets! But on the policy side, we ran a sleek ship, something that the report clearly doesn't think is happening any more.

What went wrong? Well, first there was the merger with the bloated old Employment Department, then all the splitting up and re-engineering that came about when the department was recast as the Department for Children, Schools and Families. And finally the repositioning back as the good old Education department again. My guess is that all this change has added layers after layers and the only solution is a totally Augean Stables type clean out.

So, good luck to the people behind all this. A 50% cut sounds perfectly doable to me. In fact you might want to try for a bit more. And as to those naysayers, I have one question for you: Wouldn't you rather that £290m was spent on the kids rather than a bunch of nameless officials?

The other abuse of looked after children

Far be it for me to plough in with commentary on the BBC's woes, Jimmy Saville or paedophilia but several years ago I pitched to Lord Adonis, in his old post at the Department for Education, a proposal for, maybe, just maybe, improving the lot of looked after children. Needless to say it didn't meet the Department's priorities and while the good minister and his aides were interested, they respectively declined the opportunity to take it further.

Don't panic I'm not going to pitch it here. But all this talk about care home abuses got me wondering whether the plight of the main run of so-called looked after children had improved at all since I did all the research for that proposal back in 2008.

And I have to report things still don't look too good.

In 2011, there were over 89,000 looked after children in the UK of which about 65,000 were in England alone. Over half of these have been taken into care as a result of abuse or serious neglect. So they've not exactly had a great start to lives (and that, incidentally adds a further layer of poignancy when they are abused again in care). These numbers had been falling over the past 30year but since 2008 (co-incidentally when I had that meeting) they have been on the rise again.

About 13% of these unfortunate kids stay in care for more than five years. They're probably the most damaged ones and they're also likely to be the targets of choice for the abusers. Now, I'm not saying it's the same 13% but curiously, this is precisely the figure for looked after children who end up the subject of a serious case review, ie, they've been seriously injured or killed. It sends shivers down my spine just to think about it.

It's all pretty depressing isn't it? But what about the 87% who get through without this happening? On an educational front, things don't look too great. A quarter leave school without any qualifications. That compares with less than 1% of all school leavers. A further 25% attain fewer than 5A*-Cs at GCSE, compared with less than 7% of all 16 year olds. And only 7% make it into higher education compared with over 45% of all school leavers. The only statistic where looked-after children don't seem so out of kilter is for the so called NEETs (ie young people not in employment, education or training): 33% versus 20%. But that's hardly something to crow about given the appalling problem of youth unemployment at the moment anyway.

Back in 2008 I discovered that looked after girls were two and a half times more likely to get pregnant than other girls and looked after children in general were also two and a half times more likely to offend. I haven't been able to update those figures but I doubt they've changed much.

Now, if you ask me these figures speak of a different form of child abuse. These kids, mostly for no fault of their own, are taken into care and then dumped. I know there are lots of peope out there with the best intentions trying to help individual kids. But there's a systemic problem here. I cannot imagine what it takes to be one of those 7% who makes it into higher education but maybe we should ask them. Perhaps we should stop blaming lack of educational attainment on the fact that many have special needs too. Seriously, if the vast majority make it out into independent living of some sort, and they do, then their special needs can't have been severe enough to have prevented them from getting a few GCSEs.

So, when we're focussing on all those sad historic cases of child abuse, perhaps we could spare a thought about the routine daily abuse that's going on, and maybe someone would like to take a long, hard and unbiased look at what's gone wrong.

Investment for the future or filthy carbunkle?

Where's Prince Charles when you need him?

In the week which brought us Ben Pile's little movie about wind farms and the appalling environmental damage they wreak, I stumbled across news that, in North Norfolk, one council is contemplating trying to put a stop to another form of eco-inspired vandalism.

Photo: Andrew Kelly

This is a house in a conservation area - you know, one of those areas where you are lucky if you don't have to contact the planning department before you change the colour of your front door and you certainly would need planning permission before, say, installing double glazing (which permission, incidentally, you almost certainly wouldn't get). So you might be forgiven for thinking that you wouldn't get permission to install solar panels on the front roof. Clearly that's the view the Council is taking and that's why they are now considering forcing the owner to remove them.

But this isn't the only place where solar panels are being installed with total disregard to their effect on the street scape. And the scary thing is that the law in this area, although recently reviewed and redrafted, is still a little bit vague. The weasel words are: Panels on a building should be sited, so far as is practicable, to minimise the effect on the external appearance of the building and the amenity of the area. You see the problem. As far as is practicable. But what if the only southerly facing roof aspect is at the front of the house, then surely, it is only practicable for the panels to be sited there.

Frankly, this appalls me. Are we seriously saying that a few extra green kilowatts are worth destroying our built environment? Or is it the serious money to be made from those generous feed in tariffs that's behind this?

Of course, the green lobby don't get my concerns at all. Indeed many of them believe their panels are things of beauty. The picture below for example is actually used for advertisement.

Note the sun glinting off the blue panels. Note also the total lack of harmony with the terracotta coloured roof tiles.

Of course, some do accept that conventional panels are not that attractive, but they disintegrate into rapturous adoration of some of the more environmentally-friendly versions.

Now this one really horrifies me. It's described as 'gorgeous' by ecogeek. Gorgeous? OK so the texture of the panels is in keeping with the rustic tiles, but the colour? It's ghastly. It looks like someone's dropped ink all over the picture. That deep, stark indigo cuts through the muted ochres, terracottas and greens of the the rest of the image like a hot knife through butter.

And it's not only the beauty of buildings that are harmed by these carbunkles. Here's the view from the villa we rented this summer is the stunning Abruzzo mountains in Italy:

 Idyllic isn't it? But wait? Can you see that blueish smudge over the the right hand side? Here's a detail:

Yep. Solar panels. Three vast arrays slap bang in the middle of an exquisite landscape. Same colour tone problem here too.

So here's a question. Why is it OK for environmentalists to destroy the environment? Are we all really that convinced that mankind is headed to annihilation? What happened to preserving our heritage for future generations?

Or are the tweenies destined to be characterised by shiny slate blue installations in the same way as the seventies is by its tackily-built boxes and the sixties by its ugly high rises? So sad. I thought we'd learnt from those mistakes.