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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

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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.

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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.”

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Seven-Seven

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.

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Murderball

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.