Cost-cutting at NHS Lothian

NHS ‘moles’ are like the Malawian Orphans of the British blogosphere.

Doctor Crippen and Devil’s Kitchen think they are soooo clever with their inside information, don’t they? The Doc reports on the persecution of junior doctors, by revoking their right to prescribe drugs; while the Devil has a bizarre story about nurses secretly performing medicals on asylum seekers.

Well, I’ve got one too (actually, I have five or six, but let’s not be boastful). I’ve been forwarded a particularly amusing letter from Mr Mike Grieve, University Hospitals Division, NHS Lothian. He is leading a financial recovery team to reduce over-spending, which is currently running at £1 million per month.

Our immediate task is to return to a position of month-on-month income and expenditure balance … Much of this is incurred in four areas of expenditure namely, the cost of doctors in training, bank and particularly agency nursing costs, clinical supplies and some medicines.

So, they need to cut costs in the areas of: doctors, nurses, medical supplies, and medicine! Is that not, like, everything that goes into making a hospital a hospital!?

To be fair, at least they are on the case, and trying to get back on budget. My source is not impressed:

Without bank and agency nursing staff the service would collapse. There is a high level of sick leave amongst nurses, due to high levels of stress, low morale, poor pay, shift working etc.. A ward not well staffed by nurses is not safe.

What is interesting is there is no mention of managers, the ones who clearly fucked up in the first place.

That’s fine, but I can’t shake the worry that this would be not so different if the running of hospitals were sub-contracted out to private companies. What’s to stop them cutting the same costs and services to maintain profit margins?

NHS lothian logo

The Point of Vanishing Interest

I have said before that the operative word in ‘citizen journalist’ is not the latter, but the former. Fay Young’s short, personal report on the happenings of an Edinburgh City Council meeting seems to be a good example of ‘citizen journalism’ and the importance of new Internet technologies. The happenings at the meeting were probably not newsworthy enough for The Scotsman or even the Edinburgh Evening News, so a reporter might not be paid to file a report on it. Now, Fay is an established journalist, but it was in her role of ‘citizen’ that she was present and able to post her report (“Hot air stifles climate change debate”) on her blog. More information for the rest of us, which we hope leads to a more accountable, participatory democracy.

Fay was not impressed by the councillors’ collective time-management:

The meeting rattles through some fairly important stuff about poverty … Then the meeting spends 25 minutes debating whether to replace or restore the old Davenport desks and chairs. Finally one Labour councillor protests at this waste of time when there is still a motion on climate change to debate, not to mention the capital city’s alcohol problem. Still they drone on, and it is another five minutes before they vote [27 to 29] to replace the old heavy mahogany with something that can be easily shifted and stacked when it is not in use.

I wonder if Fay Young has read C. Northcote Parkinson’s eponymous Parkinson’s Law? This is a fantastic compendium of satirical essays, first published in the Economist, and collected in book form in 1958 (I have a fourth edition from that year, which carries some delightful illustrations by Osbert Lancaster). In his essay, “High Finance; or, The Point of Vanishing Interest”, Parkinson describes a committee that bears a remarkable similarity to that which Fay witnessed last week. Finance committees are, he says, made up of people who know nothing of millions, but well accustomed to thinking in thousands:

The result is a phenomenon that has often been observed but never yet investigated. It might be termed the Law of Triviality. Briefly stated, it means that the time spent on any item of the agenda will be in inverse proportion to the sum involved.

So, Fay’s experience seems all too familiar! Parkinson also presents an amusing essay on the ‘Coefficient of Inefficiency’, definied as the size at which a committee ceases to be of any effective use whatsoever. This he puts at somewhere between 19 and 23 members. It is interesting to note that the number of councillors voting at Fay’s meeting was more than double that estimate…

Whatever the accuracy of his theories, Parkinson’s Law is a great read, and a highly recommended stocking filler for the economist or policy wonk in your life.

Stadium, overheard

I’ve been pottering about quietly in my flat, with the windows open. It is a still kind of day here in in Edinburgh, and the sound from Tynecastle wafts over the tenements. In this manner I deduce that Hearts are beating whoever it is they are playing.

I’m reminded of my time in Rio de Janeiro, living near the Parque Guinle, in the shadow of the Corcovado. If Fluminese or Botafogo happened to score, the city would erupt in a joyous cacaophony, like a jungle awakening.

Sometimes I find it is nice to live in a noisy town. The disturbances, like the roar of Tynecastle, or the One O’Clock Gun, are a kind of language of the city, one that you can pick out and understand above the hum of the traffic. It is a communication (of sorts) with your neighbours, who are elsewhere and enjoying themselves. “We are here,” they say. “You are not alone.”


Plenty of discussion on the blogs and in the media about the london bombings, this time last year, notably from survivors such as the irrepressible Rachel and the idosyncratic Dave Taurus.

The bombings were a terrible punctuation to a bizarre week. The previous Saturday, I had worn white and joined the Make Poverty History march, along with thousands of others. It was a hot day, and we stopped half-way round to have a pint on George IV Bridge. We chatted to a couple who had taken a bus from Bristol to join in the event. The G8 summit was about to start, and there was a feeling of optimisim in the air. It was genuine.

Watching the ‘Live 8’ highlights on TV that evening, and later that week when another concert was staged at Murrayfield, it seemed to me that those events had a certain falseness. Jonathan Ross and his interviewees kept talking about what an historic concert Live 8 would be, before it had even begun. The whole event was a paean to the original Live Aid concert, a consolation prize for those who had missed it first time around. I remember saying that you cannot package and market those moments that will define a decade, and that history has a certain spontenaity – it does not take place at a pre-arranged meeting point.

Of course, the following day four guys went straight ahead and made some real history, at their own pre-arranged meeting point. Not only did they destroy lives and property, but they destroyed the sense of optimism, a rising tide of political activity and awareness, that had been swelling over the previous week. And do you know what? One year on, I don’t think we have regained that momentum. Instead we flounder in scandal and misdirection.


Earlier this week, I was fortunate enough to be invited to an advance screening of Murderball, which opened in the UK yesterday, 4th November. The film follows a group of young men competing in international ‘Quadraplegic Rugby’ competitions, described by one of the players as essentially “bumper cars for wheel-chairs”. It is a fast sport, which the film depicts well with many of the shots from ‘chair-cams’. Our tendancy to think of quadraplegics as people to be treated with awkward pity is totally debunked, as the players swear, shout, and intimidate their opponents. The frequent clashes which overturn the chairs (and their occupants) is an extremely cathartic experience.

Speaking after the screening, co-director Henry-Alex Rubin admitted that the movie was almost ‘ready made’, with a set of strong characters and storylines already in place. The rivalry between the USA and Canadian teams is twisted by the fact that the Canadian coach is Joe Soares, an American who ‘defected’ to Canada after being dropped from Team USA. An early scene depicts three men, all wheel-chair bound, having a drunken argument. “How does it feel to betray your country” says one to Soares. A better set-up could not have been scripted.

Murderball is sentimental in places, but never over the players’ disabilities. It is this robust approach, combined with an uncomprimising wit, whcih makes the film so unexpected. Crucially, the music by Jamie Saft is beautiful, binding the scenes in together in just the way a good sound-track should. This is a surprising documentary that could well receive an Oscar nomination.

Hear No, See No, Speak No…

Of all the plays I have had the fortune (and, my God, the misfortune) to watch, none so turned me so upside-down as much as a bizarre, one-off performance I caught, quite by chance, in the latter-half of September 2005. The venue – the Traverse Theatre in Edinburgh – had advertised the play as ‘an extraordinary experiment in light and sound’, which immediately alienated me. After another season trapped at the Edinburgh Fringe, yet another experiment in ‘light and sound’ gave the impression of vaccuous installation art-as-theatre that had numbed me for three lonely weeks.

However, a good friend of mine had two complimentary tickets to the event. Being the kind of person who assumes that a complimentary ticket usually means a second-rate performance, I would normally have made a snide remark at the offer. But my friend happened to be deaf, which for some reason made me less inclined to turn down her gesture. I accepted the ticket, and braced myself for not just an evening of boredom, but an evening of boredom with someone who would not be able to hear my whining plea to walk out early.

The Studio 3 space was small, as was the audience. This I had anticipated, because the event was clearly the one performance in every run which is signed for the deaf. Hence the complimentary tickets. Reading the programme before the lights dimmed, I noticed that the play did actually include a deaf character, so I assumed that the play, whatever it was about, would be of particular interest to Joey. I resolved to stay until the end, and try to enjoy it. The programme also included a slip of paper which explained that not only was this the signed performance, but it was also the audio-described performance. I remember thinking that someone in the scheduling department at the Traverse had clearly been pushed for time, and decided to shove all the disabled people in together. The Deaf, the Blind, and me. Great.

The set was sparse and disorientating. The audience, all fifteen of us, stood in a semi-circle along one side of the room, while the actors, all five of them, came and went from behind two or three sheets of gauze. Each actor played just one character, with none appearing to have more lines than the others. Dressed in white shirts and blouses, with neutral black trousers, they lacked a certain distinction of character, and sometimes it was difficult to remember who was who… especially remarkable since one of the actors was black. Another character, a charismatic artist named ‘T’, was revealed to be blind only in the second scene, the first time in the play that he had cause to actually get up out of his chair. This twist was well timed, coming as it did after a particually verbose monologue from the same character that threatened to send the whole play into an arid exposition on the nature of perception.

The plot, confusing at first, fell into a decent rhythmn when it was finally allowed to gather pace, towards the end of the first half hour. The pain of some characters unrequited love becoming most apparent in those scenes where other characters were oblivious. In the interactions between the pale young girl and the older man, most poignant were those scenes of contrived social interaction, where what was being said and what was meant were two very different things. The slightly cliched plot device of having a sixth character created entirely ‘off-stage’ slightly punctured the overall coherence of the story in my opinion. However, the dark reason for the absence of this friend, the man at cause of all the heart-ache, was only hinted at, leaving the audience guessing and adding a layer of uncertainty to the piece.

At just over an hour, the story was wrapped up with a rather weak final line (“I thought you knew each other?”) which sounded incomplete to me. The absence of the sixth character was never quite explained, but the couple in love achieved some kind of closure, if not happiness. The philosophising of the first section never returned and I applauded with enthusiasm, more at the discernible talent of the actors in creating believable characters, rather than because any profound statement of human nature had been achieved. We retired to the bar.

Sitting awkwardly among the punters, the conversation meandered onto other subjects – the play, I considered, not being controversial enough to provoke debate. However, as I was returning from the counter with another whiskey and soda, I had to avoid one of the actors from the play, the one who had played the middle aged man, who was on his way home. I smiled as I squeezed passed. Back at the table, Joey nodded towards him, and said something so odd, I was sure I had misheard.

“I wonder what happened to the little boy we never saw?”

She was talking about the play again, but clearly this was a mistake. The the absent character was definitely a man, an adult, but Joey had called him a “little boy”.

“In the play? You mean, ‘the man we never saw’?” I corrected.

“No, the little boy. The person who they all talked about but who wasn’t on stage.”

“That was a man. An adult.”

Joey looked puzzled, and slightly offended, as if I was making fun of her. She could see from my face that I wasn’t joking. To resolve the matter, she turned around and tapped a bald, bearded man on the shoulder. He was also deaf and she apparently knew him. Either that, or she at least knew he was deaf. They signed a quick exchange, before Joey turned back to me. “It was definitely a little boy.” she said. They both stared at me, waiting for a response.

And so the short, yet fantastic detective story began. At first, it began with a simple disagreement over the facts of the story, but it soon became clear that the woman signing the translations for the deaf audience members had been referring to the “boy” off-stage, while those of us with proper ears had been lead to believe that person was a man. I was tempted to write it off as a mistake, until the man with the beard signed something at me. Joey translated.

“He says, ‘if it was a man’ then how come they were so worried he had left them?’”

It was if they had seen a different play. The key elements were there, of course. A tale of unfulfilled love, the same essential character. But the story Joey and the Beard had percieved had taken on a profoundly different tone. Rather than worrying about what sinister motivation had removed the sixth character from the scene (A prison sentence, I had half-conjectured), they had been concerned for the well-being of a missing child. There was even, Joey said, the strong possibility he had been murdered. I was baffled that something so fundamental to the story and the characters could have been missed, or altered. I excused myself and made for the toilets.

Splashing water on my face, I became aware of someone behind me. Looking into the mirror above the sink, I noticed a man in dark glasses stagger out of the cubicle. His walking stick betrayed him as blind, and I offered to get the door for him.

It occurred to me that I needed an ally in my argument with Joey. “Did you just see that play in there?” I demanded.

He chuckled at my insensitivity, and nodded. “They gave us some ear pieces, with a narrator telling us the actions. Fucking weird. Can you help me back to my table?”

I sat him down on the table next to ours, where Joey remained seated with the Beard who had joined her. They were furiously signing in utter slience, while the bar chattered around them. I waved at her, and they stopped signing. “This guy saw the performance too.” I mouthed the words slowly. They looked at him, as if waiting for some kind of revelation.

“Odd bit of fun, wasn’t it?” He was from Essex. “Don’t know why those two didn’t just knob each other and get it over with, but still.”

“I should have thought it was obvious, the strain they were under.”

He looked at me (or rather, he turned his head in my general direction, the eyeline was slighty off, but I couldn’t mention it). “You what?”

The riddle had become a conundrum. The blind man had been in the studio with us, but the audio description had given him yet another angle on the play. The action he described was more frantic, more angry, and more farcical than what the rest of us had witnessed. He had come away from a performance that was satire. It had made him smirk.

It was obvious that the director and the actors had been a part of this triplicity. They had been putting extra information and false descriptions into the audio feed, and the translator performing the sign translations had blatantly been mistranslating the story. It was irritating that I had fallen for such a plot. I was particularly annoyed that I hadn’t managed to spot the different reactions on the faces of the other audience members. Why had I not seen the blind man smile, or Joey gasp, at moments when I was cringing? The company had been playing with us, and I didn’t like it.

“Well this is really not on!” I said eventually. “They’ve been telling you the wrong story. They shouldn’t play with people’s disabilities like that. Its mean.”

Joey knocked on the table. “But we saw the right story, not you. We didn’t need a translation for Miranda’s part, did we?” Miranda was the deaf character that Joey had been interested to see. Half the time, the actress spoke normally, but signed at the same time. In a few scenes she simply signed to another character, apparently her brother, without speaking. He always answered her properly, but her words were spoken by the interpreter, the woman at the side of the studio who usually translated the rest of the play back into signs. I could not even remember what the translator looked like, but it was beginning to seem as if she had some diabolical hold over the entire performance. Not only had she deceived the deaf people, she had deceived me too. Joey had a point.

I rescued myself. “Well, they definitely fooled you,” I said, turning back to the blind man.

“I suppose so. It took me a little while to recognise that one of the characters was deaf! They never told us that, and I only worked it out when I heard the bodies moving in the one place, and the voice for that Miranda girl coming from off stage.” He chuckled and felt on the table for the stick.

I didn’t say anything then, but I knew he was wrong, and that I was wrong too. This man had heard body movements from the other side of the room, movements I had not noticed because I was too engrossed in my own, critics eye-view. Perhaps scenes that I assumed were heavy and brutal had an underlying spring in their step that only a blind man could hear. Perhaps the key moments in the scene were not the confrontations that distracted me, but a slient resolute expression that only the deaf would see. It was not that the performance had been audio described, or sign interpreted. It had been vocally and visually translated for me.

The show had a run of only three nights. I attended the third. The magazine I wrote for had huge lead times, and in any case was struggling to break out of the niche market it had dropped into, so I never had a chance to review it. It was ignored by the tabolids, of course, but a couple of the broadsheets summarised it in a couple of paragraphs, giving it three stars and using words like “standard” and “interesting”. Someone told me that Mark Lawson on the radio had called it “pedestrian,” but I didn’t hear the programme so it might have been something else.

There has not, to my knowledge, been a revival. I am left with a perennial weed in my stomach, the feeling you have when you suddenly realise you have seen something fantastic, but did not realise at the time. You look back, but it’s gone.

All that remains is the memory, bliss and agony, of the moment we finally stood up, put on our jackets, and went to leave the bar. I suddenly remembered the innoccuous final line of the play: “I thought you knew each other?” I imagined that line, in the light of the master plan we had revealed. I considered the alternatives witnessed by Joey, the Beard and the blind man, and suddenly the various possibilities of the story were open to me. Far from being weak, that final line had brought those parallel stories together. With all the clues in place, that line revealed exactly why the sixth character was missing. Too late.

I winced for breath as we emerged into the breeze on Lothian Road. The Deaf, the Blind, and me, struck dumb.