Friday, 25 October 2024

Bit of a Saga Holiday

 

The Athogion – Part One - Desperate Departures

In the thirty second year of King Andrweg and Queen Margaret’s reign, in the kingdom of Gwynedd, news reached the peaceful holiday resort that trouble was a'brewing in far off London Town.  All were filled with fear and dread, because that was a long way away.  Not a single citizen volunteered to come the the royal couple's aid.  So the beautiful princess Joanwern step forward.  “Send me” she called, “for I have a young person’s railcard - just (ends on the last day of her 26th year), and fear no guard.”

And so, with a heavy heart, the king and queen sorrowfully agreed, and with a small (and appropriately economic) entourage, journeyed with their daughter to the departure point in the middle of a great marsh.  Uncertainty gripped the air.  That very evening, news had arrived of a fearful and savage attack further up on the line.  Indeed, one 60-year-old man had died of a heart attack. Fifteen others had got away with minor injuries. 

But despite protestations from her concerned parents, Joannwern the brave, determined to travel on, even if this meant she might have to spend a night sleeping rough on the rude boards of a railway waitingroom. 

And in time, the train arrived, on time.  But the lily-livered engine driver refused to travel on into certain doom. Joannwern would only travel as far as Machynlleth, a short distance down the coast.  Vast tracts of land still stood between her and her mission.

Taking destiny in both hands the gallant princess forged on, with a prayer to the Almighty God, and a furtive scrolling of various timetables, she embraced her quest.  From Machynlleth, her journey took her by oxen cart through the Badlands, on to the kingdom of Shrewsbury.  In that county the trains worked reasonably well.  For certain she would succeed.  Doubts remained. Strange foreboding was heard on the tannoy. But onward the journey went, to Wolverhampton and then to Reading.  Here the passage came to an abrupt halt. Joannwern may have been unceremoniously thrown out into the dark inhospitable night, but for a kindly horseman who swept her up behind him on his steed and taxied off into the night.  Before the final stroke of midnight, Joannwern arrived at London (well, on the outskirts- it is a very big place). 

In the next episode - find out what the quest actually is.   Does Joannwern succeed in resolving these terrible issues so far away?  Was that awful journey worth it?  Do the royal parents ever see her again?  All will be revealed in the next episode of The Athogion.


Tuesday, 22 October 2024

Fixing the NHS


The NHS is not broken.  It is a large ramblings house. An army of itinerant plumbers have been at work; tutting as they remove vast organs, replacing them with incomprehensible new pipework: the gurgling continues. Various wings have been sold off, re-emerging as smart incongruous glass-clad boxes.  A general air of tender dishevelment pervades.  Cleaners gather around a cafe table, playing cards,  Doctors in blue pyjamas strid the corridors, stethoscopes draped round their neck denoting status.

An American psychotherapist joined our out-patients clinic.  She took one look at the plastic covered hotchpotch of low slung chairs, and spent most of her budget converting her consulting room into a set from a Woody Allen film.  I imagine an exasperated Allen sitting up from the analyst's couch exclaiming "you cannot be serious". 

Lucy eventually retired, and items from New York clinic gradually spread themselves round our building.  Now I walk into a room full of an eclectic mix of furniture.  I enquire "shall we put your mum in the chippendale high-backed chair, or on the moth-eaten waiting room chuck out?"

The land where I used to park was converted into a new Public-Private Partnership (PPP) GP surgery.  The day before the building opened someone sprayed across a bright azure blue painted wall, "stealing from the people".   It was quickly covered over, but I noted that the tone of the erasure paint was slightly too light. leaving a shadowy scar.

The NHS is supposed to be a 'service', but as we all know, the population now appears to 'serve' the beast.  The only way to change this is for the power balance to shift.  This is a mighty challenge, because some of the most powerful people and interests in the land are tied up in this enterprise.

Research showed how illness and calamity during a weekend (especially one with a bank holiday) results in a much higher rate of fatality.  The government moved towards a 7 day a week NHS.  But this was very problematic. No one wanted to work at the weekend.  The only way to archive this is to use highly paid locums.  Locums are the people who prefer to live on the edge of the system.  They are modern day peddlers. 

The other thing that people do not know about the NHS is how the private sector lives off the main body of the NHS.  The private sector could not exist without the NHS.  If any emergency occurs during a private procedure, it's off the local A&E.  Private hospitals employ NHS staff.  They are essentially a 'queue jump'.  You get the same service from the same people, but quicker.  People think they reduce the burden on the NHS.   But private staff are all subsidised by the NHS.  They trained in the state system.  When the insurance runs out, the patients get shipped back to the NHS.  The private sector is far more likely to invest in commercial products that are not really essential.  If they were essential, they would be in the NHS already. 

So what do we do to 'fix; the NHS?  The first thing will be to set a charter that defines how it is to be run.  The NHS has a constitution (with many fine words).  The first line is "The NHS belongs to the people." However, if you wanted a plumber to do urgent work and got the response, "sure, I'll be with you in six months", you would say, "sorry no, I'll get another plumber." 

My Constitution for the NHS

1) To remain free at the point of use.  No money to be exchanged.  The act of collecting the money in the first place will cost more than the benefit accrued.  This includes the threat of fines for non-attendance.  And also so called NHS tourism, which again is not as significant a problem as is made out to be.   

 People who miss appointments are likely to be elderly.  A significant proportion of NHS services are used by the elderly, and quite sophisticated reminder systems are in operations to get them to appointments.  Some appointments are clearly not needed if forgotten.  Much NHS admin time is dependent on people not attending appointment.  

2) Be open and honest about the resources available.  Elect regional juries to help the specialists allocate these resources to mitigate against powerful commercial interests.

3) Define functional waiting times for all disciplines.  Waiting times are part of very well known 'demand- capacity' economic formulations.  There are three things that affect waiting times. the first is increase the resource.  This works when the need and capacity are very close.  The second is work with greater efficiency, which also includes 'cutting corners', such as admin/ letters and reducing 'belt and braces' assessments (such as MRI scanning).  Increasing tolerance to 'risk' will need public approval, because the system is very averse to risk.  

4) Redefine the nature of liability.  Much of what the NHS does is governed by the fear of litigation.  This means it is constantly 'looking over its shoulder', rather than looking forward.  With a new partnership formed with the public, financial recompense can be seen as insurance, rather than redress.

5) Weed out people in the NHS who are there for the wrong reasons.  As with all industries, there are parasitic behaviours that are not healthy in any organism.  The NHS needs to be more welcoming to the good people who work in the system, and show less tolerance to those who abuse the system.  Since I joined the NHS I have seen a greater level of what I see is counterproductive harshness to staff.  New starters have to argue about their starting salary.   They begin in the system with a bad taste in their mouth.  There is a fear that management in soft, so no time allowed for a Christmas lunch, when across the whole country is relaxing together.  A bit of discretion is allowed.  Let's call it team building.

6) Ensure that the NHS works on the basis of equity.  This means that equal access incudes ensuring that people who will find access difficult has their pathway eased.  The NHS is good at providing an equal service, but we are not all equal.  Equitable means that these differences are accounted for.  



 





Saturday, 12 October 2024

Ignorance is Bliss

 

Ignorance is Fear, by Keith Harding
Credit: artfinder.com

Thoughts prompted by listening to Rory Stewart's podcast called 'The Long History of Ignorance."

Ignorance, similar to other words such as anger, sadness and effeminate, trigger pejorative thoughts.

Stewart comes to the defence of ignorance using the ancient socratic notion that ignorance has a lot going for it.

I was interested in the idea put forward that ignorance can be a maladaptive coping strategy.  Stewart points to the sensational German film, 'Zone of Interest', which follows the fortunes of the commandant of Auschwitz's family during the Second World War.  Life has never been so good for them.  They are now able to live their dream, designing and constructing a beautiful garden.  The only problem is that on the other side of their wall, a terrible evil is taking place.  Their idyll is in exchange for a horror.  The film leaves the viewer conscious that this is not an isolated story; could I too be living my dream concomitant on the suffering of others?  In the film 'Ignorance is bliss', but no one is ignorant, and everyone in the family suffers the consequence of the evil going on, each in their own subtle way.

Stewart links this with the 'White' ignorance of the West's past exploitation of mainly African people over hundreds of years, and the fact that the current status of African countries and peoples may still be affected by this.  Some people have 'woken up', and in response, mainstream culture does it's best to put them back to sleep.

I think now of the ignorance of the ruling classes (and that include me).  A wonderful colleague from my early social work days had many stories to tell.  One was the occasion she visited an elderly couple to meet with their children and discuss their care needs.  Judith could see when she met them that something significant had recently occur.  The couple were like young lovers, smiling and giggling.  She enquired why this might be.  The couple confessed that they had just got married.  Judith knew that this was extremely unusual for people from their background, and enquired why it had taken them so long.  The wife explained in hushed tones that when she was just young, she had had problems down below, and visited her doctor.  The doctor had been explained in serious tones that the situation was risky, and that it would be better for her if she 'never got married'.  The couple looked at each other, and sighed. The husband said "We figure that we are so old now that we can take our chance."

I am sure that that advice-giving doctor will have been shocked to observe the power vested in their wise and kindly words.  Powerful people are often ignorant of the degree of power society crowns them with, though salaries might give a good clue.

Ignorance is also freedom.  I recall Joanna coming back from an 'A'level philosophy and ethics class.  The teacher had asked the class to raise their hand if they were prepared to allow what they studied over the coming year to affect what they believed in.  Joanna thought about it, and raised her hand.  She explained that she was a seeker of the truth, and with the presence of God with her, she could safely explore belief.  Is this different for the poster my mother saw outside the Unitarian Church in Hampstead which said "This church does not undertake to believe today what it might believe tomorrow"?  I guess it's a question of motives and motivation. We all have our own beliefs, and relationship with the 'infinite', and as Stewart notes, our own perspectives are riddled with ignorance and prejudice.

Stewart is a Buddhist, and links with  Anthony Gormley, who may also describe himself as a Buddhist.  I am not against meditation, but I did wonder about the use of meditation to cope with the thought that we may never 'know' meaning in life. "Meaningless, Meaningless." If we conclude that meaning in life is unfathomable, are we like the fish in the fishbowl who conclude that 'water' around them is unknowable? (All about me, therefore ironically difficult to see.) Those who claim to have a close (personal) relationship with the Creator perhaps are starting from a different position.  "Given that I stand on this rock, my world looks like this."  

This is where 'not knowing' and belief meet. Stewart visits this are in the past episode. 

We are ignorant, to a large extent, of what the future holds. We have probability and prophecy to guide us.  The Creator has seen it all.  The story of life on earth is like a well worn video tape (disney's Frozen, or the Sound of Music' say).  It has a beginning middle and end.  We are stuck looking at it from the limitations presented by time.

I have been grateful to have been ignorant beforehand of many things that have happened in my life.

As Stewart points out, ignorance is a many splendored thing. 



    



 


Saturday, 28 September 2024

Advent Advert

 

Le Berceau, by Berthe Morisot - Muse d'Orsey -Paris.
Credit: Wikimedia.org

Dear Reader,

As is my habit - I am composing an advent story pointing towards Christmas.  The theme will be 'relationships in the bible', with an analysis on the nature of these relationships.

Christmas is the day we celebrate the ignition of a flame, that went on to develop into a forest fire.  This fire has not gone out, but has engulfed the whole world.  The flame is the spirit of truth, and love, offering redemption to all humanity.  It seeks to restore the relationship between the Creator, all humanity and the world itself.  It is the fundamental core of my life.

Each advent window will contain a picture, a passage, a pithy thought and a pray.   

May it bless the Lord, you and me. 


Sunday, 22 September 2024

Cybernetics

Credit: The King's Fund

The King's Fund published this diagram to explain the complexity that has been created in the NHS.  There is a risk that, just like the many plumbers who visit our houses and stare in disbelief at previous work, our NHS is at risk of strangling itself through ever circular systems of complexity and inept planning.

This blog is a scratch pad to record passing thoughts.  (These came to me at the traffic lights.)

I imagine that I would very much have enjoyed attending the Macy Conferences that took place in New York between the dates of 1941 and 1960.  Here, representatives from different academic disciplines gathered to share their work and perspectives on their subject.  This collaboration allowed common themes to develop, often promoting novel ideas and approaches to be explored through the cross fertilisation of very different ideas and experiences.  The reason I know about this is because the field of Family Therapy was greatly influenced by   the work of Norbert Weiner, an American Mathematician and Engineer, who attended the Macey Conferences, and collaborated with Margaret Mead, and others to create a holist framework to understand the complexity of human interactions and wellbeing.  Chemical Engineering spoke to Sociology (called anthropology at the time.)

The link I made at the changing of the lights was between economic models of understand the world, and and that of the inner world of the child, in particular, how we learn to regulate our emotions.  

The story goes like this. 

Young babies are born with the greatest capacity to develop in any direction they will ever have.  From day one, this is reduced by their environment until the child is set on ever limiting course of expectations.  For example, little children have the potential to speak any language perfectly.  Adults will struggle to do this.  To communicate audibly, young babies just cry.  Their cry is set to be very disonat, requiring attention, as with a house or car alarm.  The parent is left wondering what the cry means.  Is it serious, or trivial?  Consult the doctor, or Health Visitor.  Over time the child learns that it is useful to adjust the crying from Red, to Amber to Green.  The parent lead as they become experts in assessing risk.  The collaboration  reassures both parties, this helps the  child to self regulate.  For me, the most exciting thing to come out of Solihull (other than my great grandmother) is the Solihull Approach, which says to the professional - "start by containing yourself".  This will help contain those around you.  "Panic" is not likely to be helpful, though sometimes we do have to act quickly and urgently.

In a similar way, children learn to control their bladder.  At the beginning it's complete guess work, like flicking the switches on a fuse box in the dark, watching to see which is the most effective. Eventually the child works out what they have to do in their brain to control the bladder, and with a few mistakes, the skill is mastered.  In the same way we learn to manage our emotional state so that it does not spill out at awkward moments.

And world economics?  Economics is likewise a very complex affair with many factors at play, some with in our control, some our influence, and some beyond our reach.  Control over emotions has a complex array of influences, and we learn that we tamper with the controls and influences at our disposal.  For children up to the age of about eleven, that control is not very strong.  We accept this, and children are only regarded to be responsible in law for their action only when they have reached their eleventh birthday.  This is why counselling young children is controversial, because it is important that they do not get the message that we expect them to be in control.  Indeed, we take preventative action all about children, removing hazards as they haphazardly wonder through their lives. 

PS - Keir Starmer said recently that the NHS must "Reform of Die".  

I say (though it matters little) The NHS requires commitment to the cause of providing an excellent health service to the rich and poor alike.  This means common sense principles that we have not seen for many years.  In my book (blog) these are:-

1) Share Health and Social Care budgets.  The money comes from the same place, and needs to be unified and rationalised.  My CEO (of Leicestershire Partnership NHS Trust) once told me that he has a Sunday morning call with the other NHS CEO in the area to discuss the current conundrum.  Ambulances late to attend vulnerable patients because eight of them are clogged up at A&E, with no room to transfer patients because others cannot be discharged because the care they need is waiting for social work and OT assessments (Local authority budget).  Where do we find the incentive to crack this crazy problem?

2) Get rid of waiting lists.  Lots of social care systems do not work with waiting lists including Ambulances, A&E, the police, the fire service and social services.  Long waiting list are a sign of very poor management, like someone living on their overdraft limit.

3) Prioritise how funds are to be spent, and maximise the efficiency of the system so that maximum treatment can be offered.  At the moment long waiting lists and dysfunctional poor coordination cost 15-20% of the overall budget.  When the system is working well, people are more confident, less ill, and the staff have greater pride in their work, and so work harder.

Starmer speaks as if the NHS is a naughty child that must reform or die.  The responsibility is with the Government to steer the system into better ways.  If it dies, it is because it likely to be homicide, or murder.







Monday, 9 September 2024

What happend?

 

What Happened at Grenfell?

The Grenfell Tower was named after the road where it is to be found, which in turn was named after the 1st Baron Field Marshal Francis Grenfell, a war hero of the Sudanese and Boar wars.

On the 14th June 2017 seventy two people died when a fire broke out on the fourth of twenty four floors in the tower.  It was thought to have caused by an electrical fault in a refrigerator.  Seventy other people were injured and two hundred and twenty-three people escaped the fire.

The tower was designed in 1967 by Clifford Weardon and Associates in the brutalist (or strong) style.  The design was praised for been adaptable and enduring. It was said to have had a projected lifespan of 100 years.  Each floor had six generously proportioned flats.  It quickly became known as the Moroccan Tower, because it appeared to be adopted by the local Moroccan residents of Kensington and Chelsea.  In 1974 when it opened, each floor had six flats, with 120 flats in total.

What went wrong?

The first issue was the cladding, fitted to the tower in 2016.  It was designed to fulfil the UK government requirement to reduce harmful climate affecting emissions. Cladding was sourced from an American company called Arconic.  It was a polyethylene and aluminium ply.  Before the cladding was fitted, it can be argued that a fire in this massive concrete tower block would have been quite easily contained.

The cladding appears to have passed fire safety standards by the lax building and fire regulatory systems at the time.  At £8.6 million pounds, a close eye will have been kept on the public expenditure involved.  Ironically, the subsequent fire will have turned this cost into pocket money.

Who are the protagonists?

The Government.

The Government is responsible for setting the building regulations and agreeing acceptable levels of risk.  In times of austerity, corners are often cut.  The acceptable level of risk for people in highly congested public housing appears to be significantly lower than anything that would be allowed for the wealthier residents of the borough.  Successive governments have encouraged the building industry to set their own standards, to avoid the cheapest product always winning contracts, irrespective of safety.  This did not happen, and the inevitable consequence of capitalism prevailed where the cheapest and most irresponsible product was chosen.  It can be argued that ethical building contractors could not exist in this climate.

The Building Contractors and Suppliers.

Arconics has become the villain of the piece.  They argued that they played no part in the decision making of what was put on tower.  “Nothing to do with me mate.”  As has been pointed out, some buildings are clad in wood.  Here the risks are very clear to see.  Would a tower block clad in wood be allowed?  What would the supplier of tons of wood cladding say to an inquiry?  “More fool you?”

The Architects and Planners.

Architects and Planners should put the needs of the residents of the tower block, and the borough, at the heart of all decisions.  Fire testing is conducted by the industry itself.  Architects and planners are able to choose the materials they are working with and should be clear about what is in the best interest of the residents.  The voice of the residents appears to be a muted whisper.  These people are not likely to be stupid.  They will know about the risks posed by aluminium and polyethylene.

The Fire Brigade.

One of the roles of the fire brigade it to prevent fires.  This is why electrical items in public places are PAT tested.  Should tower block residents have their appliances regularly tested?  This would certainly reassure neighbours of their communal safety.

Fire in London has a horrific history. In 1666 the ‘Great Fire of London’ destroyed most of the then city.  However, Grenfell’s horror far exceeds the estimates of death in 1666 with only 6 recorded deaths at the time.  Why did so many people die?  One answer is because the fire brigade gave outdated advice for people to stay in their flats until rescued by the fire fighters.  Fire doors are said to offer protecting for 30 minutes.  There was an idea that the block could be evacuated in a systematic way with sufficient time for people to be escorted from their flats.   This was not the case, because at high temperatures created by burning aluminium and the ferocity of the fire.  Also the cladding created a hazard in itself as it fell off the exterior walls, coated in highly flammable and toxic polyethylene, onto the firefighters below. 

Why did the System go wrong?

Systems are as good as the people who create them.  Where there is power, there is also abuse of power.  Systems need to be held to account by non-profiteering parties.  These parties need to have substantial power.

When things go wrong, it can be observed that time appears to slow down…. considerably.  One mechanism of obfuscation used by the system is to inject what appears to achingly slow processes.  The Grenfell report was concluded last week, seven years after the incident occurred.  Currently, we are told, 4000 building in the UK still have similar dangerous cladding.  One of the reasons for this is that people who have bought their flats have been told that they have to pay to have the cladding removed and replaced.  Often these are some of the poorest people in our society.  They have become victims to the system.

The enquiry drew a picture of responsibility for the fire at Grenfell as describing a perfect circle of blame.  One participant pointed to the next and so on, much like the Flanders and Swan song called “T’was on a Monday Morning”, where tradesmen create work for each other in a never ending relay.

Ultimately Government must fix things.  Government will pick up all the major parts of the bill.  This will be in legal fees, demolition and recompense to victims.  Government will have to work out how this tragedy does not happen again.

The citizens of the UK will pay the bill. 

What is to be done?

The best way to prevent tragedy is to construct systems that monitor and balance the selfish inclinations of the powerful parties involved. Each will have it’s own vested (and often secret) agenda.  The key is for a commonly help charter of standards to be formulated and agreed by all parties.  These agreements can happen at a national level, and a local level.  They will require a legal backbone, and not act as guidelines.  The obvious bottom line will be that the living conditions of the tenants in any tower blocks need to be those with which the vast majority of the population would be able to agree. 

Political mess-ups of our time.

Housing:  The Office of National Statistics says that 8% of homes in London are vacant.  Of these 8% are second homes.  That is 87,700 empty homes.  The London Mayor says 66,000 new homes need to be built right now.  Does anyone want to try to put these two things together?

Water:  My understanding is that The EU was cracking down on water quality around the coastline of all EU countries.  Funny how the UK's seas become polluted again after the UK leaves the EU.  The government is in a cosy relationship with the water companies.  They pay fines for breaching pollution targets, and everyone's happy.  The companies themselves have very little interest in improving their environmental rating.

Pensions and Health:  We all know that the longer people live for, the state's greatest expense will just increase.  It's a vicious circle because the older people live, the less likely they are to be able to contribute to the economy.   Also the Health service grows larger and larger.

Health:  another part of the health problem is the inability to define limits.  Need is infinite.  If demand exceeds capacity, waiting lists grown there are certain factors that moderate the waiting lists, but they grow to some natural limit which might be 2 years or 4 years, depending on the situation.  People on long waiting lists either go private, which in itself reinforces the long waits, because with is just paying to jump the waiting list.  Or people have a crisis, and become urgent.  Or they grow out of one list and onto another- or die.

Alcohol and Drugs:  It has long been known that 20% of all hospital admissions have alcohol as a component. Drugs are used in society to pacify certain populations.  In the West, Alcohol and Drugs are part of the culture, and it is almost too difficult to extricate society for this problem.  In Scotland this is more of a priority with minimum alcohol pricing laws.  

Petrol and Coal:  We all know that our society must move over to electric power.  But the shift is so slow.  National government could do so much through incentives, but none exist at the moment.  Part of the problem is not only that the oil companies have such significant power over our lives, but that the electric only infrastructure may yet prove a disaster.  The weight of electric vehicles is considerably more than petrol vehicles.  There is talk of multi-story car parks falling down and bridges having to be rebuilt.

 Travel:  In order to reduce congestion and pollutants, we all need to travel less, and use public transport more.  Public transport must be significantly cheaper that uses private cars.  People must stop flying so much.  Trips into space are unsustainable.  We have seen this with the increase in wealth across certains parts of the world leading to a dramatic increase in air flights. This cannot go on indefinitely.  The individual is not likely to have the will-power to create the change needed.


Saturday, 20 July 2024

Memories of a Live saving Uncle

 

Upside down photography 
credit: PetaPixel.com

The Pinetum is on the edge of Kent near Hedgebury.  I remember visiting it a few times with my Strood grandparents.  On one occasion Peter and I joined our young uncles, Dave and Adrian, for an adventure and a picnic. We set up camp by a brick header-tank which fed a small stream.

The thin-walled dam provide an inviting vantage point to examine the deep water for something yet invisible.  I tried to push past David to get to the waterfall, where the excess water over-topped the barrier to plunge into the stream.  Predictably I lost my balance and fell headlong into the water.

This was an amazing and unforgettable experience.

In an istastance I was transported into another world.  Sound switch off. Bright light shone beneath my feet. and large bubbles of air gently meandering downwards.  

Time stood still, I felt peaceful, mesmerised; in another state. 

David reached down and grabbed the protruding ankle of the small nephew.  He pulled me up out of the water like an exhibit.  The world returned to its regular form.  I felt an intense sense of being cold, and then fear followed. I was wrapped in the picnic blanket along with muted concern.  Next I remember the warm bath back in Strood, with the familiar objects about me.  The plastic soap holder full of the remnants of old soap cakes, confusingly rough to the skin.

And my uncle, quietly but profoundly present in my life.  Now deceased. Rest in Peace, in that other world.