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. 

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.

, 

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 1^st Baron Field Marshal Francis Grenfell, a war hero of the Sudanese and Boar wars.

On the 14^th 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.