Sunday, 25 September 2016

Bristol and reminders of colonialism

Bristol, in the West of England, has a distinctive accent with, as a particular characteristic, a tendency to add an ‘l’ to words that end with a vowel. “Africal,” they apparently say there, “is a malarial areal.”

It was fun to be there this weekend, partly because we saw friends I liked already but whom I shall miss even more after the wonderful time we’ve just spent with them. But the visit was also a success for allowing me at last to get to know the city well: I’ve been there at least a dozen times, but usually on fleeting visits, for work, turning up in the morning and clearing off again in the evening.

Not this time. We walked around the place, we sat on the top floor of an open-top bus like any tourists, we even took a boat trip around the harbour. Boat tours are particularly striking because they give such a lovely view of a city, from below, but also in the case of Bristol, because they show the might of the city as a port. It was seagoing trade that made Bristol great, as it did those other fine cities, Liverpool in north west England, or Nantes in western France – and predominantly in the same kind of trade: slaves. So many suffered and died in the past to make some wonderful cities today.

Edward Colston commemorated in Bristol
as a humanitarian and philanthropist
Thanks for a fortune made by enslaving Africans
What struck me most, though, was the guide on the bus, who spoke with the unmistakeable local accent. Though what touched me about that accent wasn’t hearing it there, but the memory it evoked of a time I heard it once before.

For many years, I travelled regularly to Northern Ireland for work. It was the time of the troubles and, though I never witnessed an attack, the atmosphere was strongly moulded by the threat: police stations were fortified, police looked like soldiers, soldiers were out doing police work. I became friendly with a particular taxi driver who regularly picked me up from the airport and ran me back at the end of my trip, and he would show me around the place too, including some districts which he entered with some reluctance, and left with equivalent alacrity.

One night, as he was driving me back to Aldegrove, Belfast International airport, out in the country south of Belfast, we were stopped by an army patrol. At least, I assume it was a patrol, though we only saw one soldier.

It was dark and the road was deserted. As he came over to the driver’s window, the soldier, helmeted, flak-jacketed, with a machine gun on his hip, looked the model of the arrogant warrior. But then he crouched down and we could see his face. He must have been nineteen. And then he spoke.

It was that accent. Bristol. Pure and round and unmistakeable.

And all I could think was, “what on Earth are you doing here? Young, totally uninvolved in these troubles, from a place not that many miles away but in a different world, policing an emergency in which you have absolutely no interest. Out on a dark road, at night, a figure of oppression to the opponents of a power exercised by people you’ve never met, and a target yourself.”

I’ve never felt the tragedy of colonialism more strongly.

British soldiers at a Northern Irish roadblock in 1988
Doing a favour to few, least of all themselves

Friday, 23 September 2016

Brexit: trying to tame the monster

George Osborne, former Chancellor of the Exchequer – the quaint British term for Finance Minister – who campaigned for Britain to stay in the EU and was unceremoniously dropped by his boss David Cameron’s successor as soon as she took over – has said that “Brexit won a majority. Hard Brexit did not.”

One of the other figures who disappeared in the wake of the vote was Michael Gove. He’s a real hard case. He betrayed his old friend David Cameron by campaigning for Brexit alongside his new friend Boris Johnson. He then betrayed Johnson by announcing he would stand against him for the Conservative Party leadership, in effect forcing him out of the contest. He then went on to be soundly trounced. By then he had become too toxic even for the Tories, which is pretty remarkable in that company. So he found himself relegated from any kind of office, cast so far into the outer darkness that he can’t even hear the weeping and gnashing of teeth.

Even so, he’s managed to make his voice heard, and even he, unworthy he, has a point worth making:

George Osborne is absolutely right that a hard Brexit has no mandate and would be no answer to the problems Britain faces.

In fact, it would put jobs and livelihoods at risk by erecting new barriers to trade with Europe. As he said, being close to Europe despite the Brexit vote is vital for Britain’s future.

Our economic future depends on membership of the single market, while cooperation with Europe on security is crucial in the fight against terrorism and organised crime.

So even Gove, keen Brexiter though he was, is panicking now that he sees just what benefits Britain would be giving up. His solution is to stay in the single market.

Mike (top) wanted us out, George wanted us in
Now they have to try to stop the runaway train
I’m afraid that might cause some ructions. Because a great many of those who voted for Brexit did vote for a hard Brexit. They want out, and completely out. In particular, a great many of them want to get out of the EU to put an end to what they see as the sheer horror of immigration – they belong to the growing camp of xenophobes who are rounding on people they feel they can scapegoat, but don’t realise that it isn’t they who will gain from attaining their aims.

As I argued before.

Interestingly, even Theresa May, Cameron’s successor, who started off constantly repeating “Brexit means Brexit” (whatever that means) has been softening her tone on the single market recently. It really is possible that we shall see her government come up with an arrangement whereby Britain would remain in the single market despite leaving the EU.

That would be gloriously ironic. Because staying in the single market means accepting continued freedom of movement of people. Norway, which never joined the EU but is in the single market, has long had to accept that EU citizens can freely move there, live there, work there. It also means continuing to pay contributions to the EU budget. As Norway does. Finally, it means accepting EU regulations. As Norway does.

Leaving the EU in these conditions only means giving up any say in making regulations or setting budget levels. Amusingly, the Norwegians used to rely on Britain to speak up for them in EU deliberations. But who now will speak for us?

The Brexit backers who were voting for a hard Brexit won’t be at all happy about that state of affairs. Their dissatisfaction is more than likely to lead to tensions within the Brexit camp.

The statements by Osborne and Gove rather suggest that they’re trying to head them off. Gove and his mates let the Frankenstein monster out. Now they want to prevent his doing the damage they have at last learned to fear.

I don’t think they’ll succeed. Instead we shall simply see another phase in the debate, in which the Brexit camp itself splits, into the hard and soft trends. That only strengthens my conviction that we need another referendum. Not a second referendum on the EU, but a completely new referendum on what the alternative to the EU actually means.

You see, we know what the majority in the first referendum were against: they wanted no further part of the EU. But it didn’t make clear what they were for. And I suspect they won’t be able to agree on being for any one option.

In which case, given no satisfactory alternative to the EU – hey, why not decide to stay in after all?

Tuesday, 20 September 2016

Xenophobia: the comforting game everyone can play. Well, nearly everyone

The great thing about xenophobia is that it makes you feel so good.

All you have to do is belong to the majority. In England, say, you just need to be white and native-born. Though it helps if you’re not associated with any of those tedious minority religions – you know, Islam or Hinduism or even Judaism, I suppose, except that the Jews are pretty much part of us’ now.

Then, because you’re in the majority and we live in a democracy, which is about the rule of the majority, you’re basically doing all right. And you can blame all those other people for everything that’s going wrong. You know, their skin’s a bit too tanned, say, so they’re trouble makers. Maybe they speak some strange language you don’t like the sound of, so you ask them when they’re going back home, now we’ve voted for Brexit. Or worse still they say silly things like “Allahu Akbar” when they pray, which is a war cry, isn’t it? So they must be terrorists.

The trick is to keep those people out or, if they’re already here, keep them in their place, because they’re different. We can go round telling them to stop being different – demanding that they dress like us, for instance. After all, we want to see their faces, so that we can see the colour of their skin and feel superior.

Being white and ‘Christian’ – which basically means not one of those annoying minority religions – is good but it’s even better if you’re also male. And, to be honest, despite gay marriage and all that, it helps if you’re straight. It’s true that if you add those characteristics in, you’re not part of the majority any more, but hey, you can still behave as though you are and, oddly enough, the electorate seems to treat you as though you’re the majority which means you still have the whiphand, and that’s what matters.

And, if we’re going to be really honest, even within that slightly artificial – perhaps we could say ‘constructed’ – majority things aren’t completely the same for everyone. Some are from the north, and England being England, that means they don’t count for much. Actually, the Midlands and the South West don’t really have much weight within the constructed majority either. Basically, the majority is men who live or work in London.

Even there, though, there’s a bit of a difference. Some people, unbelievably, even in London, are only on median salaries or maybe just a small multiple of the median. What do they add up to? They can’t be said to matter as much as those who are on 40 or 50 or 100 times the median.

"And all those poor morons are focused on their Xenophobia?"
Laughing all the way to the bank
I suppose that’s the real majority. The ones who’ve bought themselves the power and can really call the shots. But of course they don’t add up to an awful lot of voters. So the key thing is to get a few more people to do the right kind of voting, so that the fake majority – the ones who are just white, native-born and not in a minority religion – hand the real majority – the handful on seven-figure salaries – the authority they want and know they deserve.

That’s the beauty of xenophobia. It keeps the numerical majority fixated with outsiders rather than the insiders who are living on their backs. It makes them feel good about themselves because they think that just by being ethnically and religiously with the mainstream, they’re part of the real majority, the constructed majority. That makes sure they do the things its authentic members need.

Wonderful arrangement, isn’t it? Xenophobia’s such fun for everyone.

Well, nearly everyone.

Well, at any rate, the tiny number of people who make the decisions for everyone.

Sunday, 18 September 2016

Luci's diary: water – when it's fun and when it isn't

They left me behind again the other day. Went out for the whole evening. And the worst of it was that, when they got back, number 2 smelled of another dog. Another dog! All over his hands. Like hed been stroking the ghastly thing. I had to lick his fingers for ages just to get the smell off them. It was quite fun, actually, and by the end his hands smelled right again – that is, they smelled of me.

Talking about smell and getting clean, the humans decide every now and then that I need to smell of something else. So they wash me.

“What gets into them?” I ask Misty the cat, “why do they say I smell? I don’t smell.”

“You do smell,” he says, “you smell of dog.”

“Well, what’s wrong with that?” I ask, “what’s a dog supposed to smell of? You wouldn’t want me to smell of cat, would you?”

“I don’t know. Cats smell good. I wouldn’t mind if the whole world smelled of cat. Except for the bits I want to hunt and eat.”

“That’s just silly. You like my smell. That’s why you always want to lie on my blanket. Even when I want to.”

He looked a bit embarrassed then, like I’d caught him out in something he didn’t want to admit to. He just sort of mumbled back at me.

“I just like the feel of the blanket. It’s a good blanket. Nothing to do with you.”

“Anyway,” I went on, “even if I do smell a teensy weeny bit of dog, that’s no reason to clean me is it?”

“I keep telling you. They’re domestics. That’s what they do. Clean things. If you let them. I only let them serve food, but that’s because I’ve shown them who’s boss. You just let them push you around, so you get washed. Serves you right.”

It wasn’t very nice. Hot water and silly soap suds. And it lasted for ever. And left me all wet. So wet that I had to run around and roll everywhere just to get a bit drier. That left the couch quite wet which made it less comfortable to lie. Human number 2 wasn’t pleased.

Me. Wet. Miserable. Getting the couch damp
Why do they keep doing this to me?
“Why’ve you made the couch all wet, you silly dog?” he asked me, all annoyed.

He doesn’t like it when he can’t sit at his end of the couch and play with his dratted computer. It makes him quite irritable. Usually I just give him the sad-eye look and he stops, but this time I was fed up myself, what with being all bedraggled and all that.

“Don’t blame me,” I told him, “it was human number 1 who put me in the bath. Why don’t you get her to stop?”

But it didn’t do any good. He never understands when I talk to him. It’s so sad, isn’t it? They have such limited intelligence, humans.

Talking about water, though, we had a bit of fun when we went to see that other family we visit sometimes and who sometimes visit us. They have the granddaughter, apparently. I don’t understand why they keep her if she’s our granddaughter. We ought to take her home with us so she can play with me a bit more often.

Anyway, near where she lives, there’s this place with loads and loads of water. Believe it or not, it just goes on and on, so you can’t see the end of it. It’s OK, because you can wander in and paddle around a bit in it, and it’s fun: not hot, and it has no soap suds. Tastes odd, though – terribly salty, which makes me feel funny sometimes, but still you can play a lot of games in it – I played that silly game with the humans, where I bring them a stick so they can throw it into the water. They so enjoy that and I think it’s terribly fun to see them with their trouser legs rolled up over their knees…

Only thing I really don’t like about that water is that it’s a bit tricksy. It can be all quiet and flat like, and letting you wander around in it, and then it suddenly gathers itself together in a big lump and throws itself at you. Usually when you’re not watching, so it catches you from behind. Rotten trick. It meant I had to keep an eye on it and sometimes had to belt back to the line to stop it catching me.

Come to think of it, that was quite fun too. Outrunning it, you know. That water, it’s going to have to learn to be bit quicker if it’s going to catch me. At least, when I’m watching out for it.
Loads of water. Fun when it’s behaving itself, like here
When we got back home, Misty was on the couch. At my end. The bit that smells of me. And I couldn’t help noticing that he didn’t have the excuse of lying on my blanket because it wasn’t even there: I’d taken it with me.

It’s the blanket he likes, is it? For the feel, not the smell? Yeah, right. 

I reckon everyone likes my smell, even the humans, who keep rubbing their noses on me.

Which just leaves me wondering: why on earth do we have to keep going through that stupid bath business?

Thursday, 15 September 2016

Polish residents, Polish police, in Britain

It’s curious to read that two Polish police are being deployed in each of London and Harlow, the latter the scene of a recent fatal attack on a Polish resident which also injured another.

Polish police join an English colleague on patrol in Harlow
The Poles have become the biggest single group of foreign-born residents in Britain. In the atmosphere of heightened xenophobia, which I assume was present but pent-up before the Brexit vote but has been released by it, Poles have become the major target of the increased wave of hate violence.

On a couple of occasions recently I’ve been accused of displaying insufficient pride in my country. I’d have no difficulty pleading guilty to the offence if I thought it was one. I have a hard time, however, thinking of patriotism, notoriously described by Samuel Johnson as the last refuge of the scoundrel, as a virtue.

What, after all, am I supposed to feel proud about? I take pleasure in the great results won by British athletes at the Paralympics, feeling a bond with my compatriots. But pride? I didn’t contribute to their success except indirectly and at tiny scale through taxes. The achievement was theirs, not mine; to take pride in it feels terribly like claiming undeserved credit.

In any case, it’s not as though my country’s only achievements are matters of pleasure. Am I supposed also to feel pride over our forces’ involvement in Iraq? Our role in the badly-judged and ill-fated intervention in Libya? Or, looking at other areas, in Maggie Thatcher’s attempt to ban literature about homosexuality from our classrooms? David Cameron’s sustained assault on the miserly support we provide to the poor and ill? The aversion towards foreigners that inspired Brexit and the murder in Harlow?

Perhaps a small anecdote will explain why I don’t go along with these feelings.

For our first two years where we currently live, we were cursed with a neighbour from hell. She would hold all night parties five or six times a month, apparently drug-fuelled events which would run from midnight until midday, where festivities followed a constantly repeated pattern: raucous laughter and merry shouting, followed by karaoke singing at volume, followed by tearful recriminations and fighting interspersed with cursing and the noise of breaking crockery; after a brief pause, the cycle would start again with the laughter and shouting.

The police, starved of resources, would not assist. That’s in spite of one police employee telling me down the phone, one night at 2:00 am, “Oh, my God! I can hear her from here!”

It took two years to get her out of the place, but we and the neighbours on the other side eventually managed it by dint of constant complaints and phone calls to the landlord and the agent. In the meantime, she’d broken some of our belongings and stolen others, but we felt that was a small price to pay.

Since then, we’ve had a new family next door who never disturb us, for whom we accept packages and who accept packages for us, with whom we exchange friendly greetings when we meet. An extraordinary relief. A way of re-establishing our belief in the inherent decency of people.

The new neighbours are Polish. The old one was English.

Does that illustrate why I don’t go along with appeals to patriotism? And above all reject popular prejudice against Poles?

There may be a new hope for all of us in the arrival of Polish police in Britain. Just as it was a blessing to replace a foul English neighbour by likeable Polish ones, maybe we could benefit from more Polish policemen too – replacing the hopeless English ones who wouldn’t come out when we needed support against the ghastly Englishwoman next door.

In the meantime, anything that helps stop the kind of xenophobic violence that led to the Harlow murder has to be welcome.

Even if, as I suspect, the Polish police presence is just a gimmick for the moment.

Wednesday, 14 September 2016

Avoiding the avoidable: the problem of delayed discharges

So far I’ve mostly talked about avoiding the avoidable in hospital expense only at the start, the admission stage, of a hospital stay. But the problem arises at the other end too, when a patient has to stay on because the discharge process is delayed. 

There are two main reasons why this might happen.

OK, so why can’t I just go home?
The more obvious one is that the discharge has not been properly prepared. Tests need to be carried out to confirm that the patient is fit to go home, but the results haven’t been received – or perhaps the tests haven’t even been ordered. Possibly the patient needs to take medications home and the necessary prescription hasn’t been sent through to the hospital pharmacy. Or, even more simply, the discharge needs the approval of a doctor who simply isn’t available, called away to an urgent conference which perhaps, and entirely coincidentally, is taking place next door to a prestigious golf course.

This kind of problem occurs everywhere. Recently I read a 2014 study of two hospitals in Brazil. It found that in one of the hospitals, delayed discharged represented a 23% extra occupancy rate, a figure that climbed to 28% in the other. That means a massive proportion, around a quarter, of the beds in those hospitals were occupied at any one time by people who should already have left.

The other main reason for a delayed discharge is particularly familiar in a nation such as England. Patients can’t leave because there’s nowhere for them to go where they will receive the ongoing care they need. This is particularly acute for older people who may be living alone with no one available to act as carer. They can only be discharged once there is a social worker or community nurse available to help them, or perhaps a bed in a care home.

Delayed discharges generate two problems. First of all, it’s bad for the patients: people generally recover better in their own beds than in hospital and, in any case, simply by staying on patients are exposing themselves to unnecessary risk, if only of infection from other patients around them.

Secondly, the delayed discharge is bad news financially. Acute hospital care is the most expensive care and, even though costs will be lower towards the end of a stay by which time the patient requires less treatment, the mere fact of occupying a bed is expensive. That’s without taking account of the impact on other patients who might have benefited from being admitted to a bed blocked in this way.

A recent study (February 2016) for the NHS in England by a team headed by Lord Carter of Coles, Operational productivity and performance in English NHS acute hospitals: Unwarranted variations, put a figure on the impact of delaying discharges: “the cost of these delays to NHS providers could be around £900m per year.”

That’s close to 2% of the total expenditure on acute care.

How do we fix these problems?

Both require management action, naturally. For instance, my wife worked until two or three years ago in the Discharge Planning team of our local hospital. Here, nurses, social workers and hospital staff worked out of a single suite of offices, preparing the plan to discharge a patient from the moment he or she was admitted. That meant that the agencies involved in post-hospital care had the greatest possible notice that their services would be needed. They could, therefore, assign staff or find suitable accommodation, at least as far resources allowed, in the most favourable possible conditions, rather than in a rush at the end.

Equally, steps can be taken in plenty of time to ensure that all necessary processes are carried out, the appropriate tests or medications ordered, and the paperwork prepared for someone to sign who will be around at the right time.

Computer systems can help, of course. The kind of pathways management software I’ve been talking about in this series can be used by hospital staff as it can by people in primary care. It can issue alerts not just to physicians but to nurses and care assistants: “for this patient to be discharged tomorrow morning, you have to request this test today,” for instance.

When it comes to helping with groups like my wife’s former colleagues, what’s needed is ways to improve collaborative working between different systems. Social work management software needs to interwork with nurse management and general hospital systems. Fortunately, none of that is impossible and over the last few years, great strides have been taken towards making it happen.

What that means is that avoiding the avoidable can now be tackled at both ends of a hospital stay: discharge, with its own specific problems, as well as admission.

Monday, 12 September 2016

Brexit: some of the people apparently fooled all of the time. And happy with it

“No one in this world,” H L Mencken claimed, “so far as I know—and I have researched the records for years, and employed agents to help me—has ever lost money by underestimating the intelligence of the great masses of the plain people. Nor has anyone ever lost public office thereby.”

Mencken wasn’t particularly charitable and the judgement is harsh, but the Brexit vote and its consequences do seem to confirm his point. Or at least Lincoln’s view that you can fool some of the people, all of the time.

The pro-EU campaign was unfortunately led by a number of the weakest politicians we’ve had in Britain for decades: David Cameron and George Osborne for the Tories, Jeremy Corbyn for Labour. The first two came up with dire predictions of what would happen after a Brexit vote, which have naturally not been fulfilled – we’re still in the EU, for Pete’s sake, how could a disaster have happened already? And even when things start to slip, nothing happens that fast in economics. Even the crash of 2007-2008 took pretty much a year to develop fully.

As for Corbyn, he said practically nothing throughout the entire campaign, which at least has the merit of making him immune from being disproved by events.

On the other side of the fence, there were Labour figures such as Gisela Stuart MP, campaigning with the anti-immigrant lobby though she’s German-born herself, renegade Labourites like David Owen who split Labour in the eighties, the hard right like Nigel Farage of UKIP or nearly-as-hard right of the Conservative Party, such as Boris Johnson and Michael Gove (the latter so disloyal, to rebels and loyalists alike, that not even the Tories can stomach him in government any longer).

As the devil has the best songs, so the Brexiters had the best campaign. They travelled up and down the country in a battle bus emblazoned with slogans pledging that Brexit would save “£350 million a week” that could be used for the NHS.

Economical with the truth, effective for the campaign
The battle bus with the £350m claim
The figure was a lie and plenty of people pointed it out. But the lie took hold and many voters believed it and passed it on. Fool me once, they say, shame on you. The Leave campaigners certainly fooled enough people once to feel that shame, but clearly don’t: in fact, lying served them so well that they’re using the tactic again.

The campaign has morphed into “Change Britain” but the usual suspects are back: Gove, Johnson, Stuart and Owen are heading the organisation once more. What are they saying about that £350 million pledge?

It’s brilliant! They’re saying absolutely nothing at all. Dead silence. To admit it was a con trick would be out of the question and I didn’t expect it. But simply to pretend it never happened is pure George Orwell.

Instead they’re now offering to fund agriculture, poorer regions of the UK, scientific research and the universities out of savings generated by Brexit. In other words, to replace the funding that the EU currently provides and which we’d continue to receive if we didn’t leave.

There can be only one judgement of that pledge: it’s worth exactly the same as the one they made before. There’s zero chance of its ever being honoured. That’s not a problem, though: these are promises not intended to be fulfilled. They’re only intended to suck in the gullible again. And just watch: the gullible will lap them up.

Fool me twice, they say, shame on me. Plenty should feel that shame but just like the con artists themselves, they’ll know no shame. Because they don’t even know they’re being fooled.

Some of the people, you see. All of the time.