Sunday, 30 June 2013

How Wendy Davis stands up for us all. And Nigel Farage demeans us.

Every now and then, in the midst of all the ghastly and demoralising examples we see of morally rotten if not actually corrupt behaviour by politicians, we come across an instance of real courage and decency.

When it comes to rottenness, we have for some time been exposed to an instructive example in England, for instance. Here we
ve been enjoying the antics of UKIP, the United Kingdom Independence Party, ostensibly campaigning for British ‘independence’ from ‘Europe’. This is an extraordinary position to take, particularly at a time when:
  • we have just seen the sentencing a teacher who absconded with a fifteen-year old pupil and was only brought to justice thanks to a European Arrest Warrant 
  • it has become apparent that the only thing standing between us and continued intrusive snooping into our daily lives by the security services is the European Convention on Human Rights 
  • there is a chance of signing the biggest trade deal in history, one between the US and the EU

The reality is that UKIP is in fact anti-immigration, which means that it’s based on a lie. ‘Anti-immigration’ sounds superficially reasonable when it argues that we need to protect domestic resources for our own people, but it is in fact just a cover for racism: none of the anti-immigrant ranters ever denounces immigration by white English-speakers, from the Commonwealth, say, or the United States.

But it isn’t surprising that UKIP has a lie at its core. Its leader is Nigel Farage, who likes to present himself with a pint in one hand and a cigarette in the other, as a shining example of the ordinary Brit you could meet in a pub anywhere.

Actually, that may be true: I’ve met some pretty toxic individuals in pubs.

Above all he puts a lot of effort into cultivating an image of honesty. ‘You can trust me, guv’, that kind of thing. Sadly, the last politician who tried that was Tony Blair and look where that led. And it’s no different with Farage. He’s spoken forcefully against tax havens in the European Parliament (yes, not the least paradox of the man is that the only body to which he’s managed to get elected is the European parliament, from which he wants us to withdraw). Yet it
 recently emerged that he set himself up a special account in the tax haven of the Isle of Man. ‘A mistake,’ he’s assured us since, but isn’t that the plea of every politician caught with his hand in the till?

Wendy Davis: inspirational,
as she talks out a bad bill limiting freedom of choice
With the atmosphere being poisoned by men like Farage over here, it was a delight to read about Wendy Davis in Texas. She’s the State Senator who talked out a bill restricting access to abortion, by speaking for ten and a half hours, without taking a break, eating or drinking or even leaning on any furniture. It was an act of great courage and tenacity in defence of an important principle.

A key part of Wendy Davis's armoury in defence of principle:
comfortable shoes to support ten and half hours on her feet
Sadly, Davis has only won a stay of execution. The bill will return and this time Texas Republicans will ensure it has the time to survive any filibuster and become law. The effect, according to today’s Observer, will be to reduce the number of clinics offering abortions in Texas from 42 to five.

Now I fully understand the objections many have to abortion. To be honest, I’ve never met anyone who’s in any sense pro-abortion, least of all the women I know who’ve had one. It’s always seen as a at best a least-bad option. And no-one’s suggesting they should be made obligatory, under any conditions. The other side of the debate is called pro-choice for a reason: it believes women should have that choice, and whichever option they choose, it should be respected.

What is it with people who feel that they have the right to restrict, on the basis of their own convictions, the rights of other people to exercise a choice? Certainly, they have every right to follow their convictions themselves (though I notice that they often don’t, as Farage showed). But those convictions are their own. Others don’t share them. What gives those who uphold certain values the right to impose them on others?

It’s time to proclaim that the equality of rights, enshrined in the Declaration of Independence of the United States and shared – in principle at least – by other democracies, specifically means not limiting other people’s choices to suit the views of others, however sincerely held.

That’s why we need more courageous and decent politicians like Wendy Davis.

And fewer Farages. Thank you very much.

Friday, 28 June 2013

Information is light. Particularly in healthcare

28 June: a date to remember for healthcare information in the National Health Service.

The government has launched a service to allow ordinary citizens to compare the performance of surgeons, within a discipline, with each other. By name. We’ll be able to see how well an individual does relative to all the others in the specialty, and to the average for the country as a whole.

In particular, we’ll be able to see if a surgeon is an ‘outlier’: achieving results so desperately different from the average as to be seriously worrying.

Taking part in the scheme is voluntary for surgeons, but if they refuse they will be named. I rather suspect that those who are identified as refuseniks will face far too many embarrassing questions to want to stay out of the system for long.

The first part of the service, covering vascular and adult cardiac surgery, went live on the 28th, and quickly created a lot of discussion. It identified no outliers: everyone in the field is sufficiently close to the average not to be spectacularly under-performing. On the other hand, the figures show clearly something we’ve known a long time: the fewer of a certain type of cases a surgeon does, the poorer their performance is likely to be when they do one. The argument in favour of specialisation in the kind of procedures an individual surgeon undertakes is starkly made by the evidence.

Identifying outliers: above the line is really bad
Fortunately there were none for vascular surgery

Bruce Keogh, Medical Director of the National Health Service in England, was interviewed by BBC Radio in the morning. He admitted that there was much to be done to improve the service. There will be questions about the reliability of the data, which have to be addressed. Even more important, as he pointed out, the service currently only measures performance in terms of mortality, which is inadequate as there are so few deaths in surgery these days: we need to start looking at the impact of the operation on the quality of life of the patient as well.

Even so, Keogh was right to claim that the initiative is a highly welcome innovation, and all the more so because it’s an exercise in transparency at a time when the health service is reeling under the impact of several scandals concerning attempts to hide information about its failings.

I took particular pleasure in seeing this initiative take off, partly because I felt the health service needed some good news, but also because it reminded me of a man I knew and admired a couple of decades ago. Brendan Devlin was co-founder of the ‘National Confidential Enquiry into Perioperative Deaths’, NCEPOD (pronounced en-see-pod).

Devlin was a quiet-spoken Northern Irishman with an accent I’d have enjoyed listening to even if I hadn’t been fascinated by what he had to say. He had a remarkable way of seeing to the core of a problem and expressing an opinion as striking for its clarity as for its wisdom. One that has stuck with me was his reaction to the proposition that ‘one avoidable death in 5000 operations is an acceptable level.’

He would point out to audiences that there are 5000 plane movements a day at Healthrow, and would then ask:

‘Would we find one crash a day at Healthrow acceptable?’

The only acceptable rate of avoidable death, he never tired of repeating, was zero.

NCEPOD was a highly original initiative. Surgeons who took part submitted data about any death occurring during surgery, immediately before or immediately.

‘We guarantee confidentiality for anyone taking part, and it’s completely voluntary,’ he would assure us, before adding with a twinkle, ‘though we do name anyone who doesn’t volunteer.’

His contention was that, while the primary cause of death during surgery was severity of illness over which the surgeon was powerless, there was an unacceptably high rate of other causes, such as inadequate supervision of junior practitioners. The result of NCEPOD’s work was a major change in approach towards surgery in the NHS, in particular with systematic supervision of juniors performing surgery. Rates of avoidable mortality fell dramatically.

Today’s initiative goes one step further: like Devlin’s, it names those who refuse to take part, but unlike his, it also names those who do allow their figures to be published.

In one major respect, though, it mirrors Devlin’s work: it is based on the proposition that information can lead to change for the better. Just knowing how professionals perform will lead to pressure to improve performance. That’s why this is such a welcome development.

Devlin died in 1999 but it’s great to see that his spirit lives on in this initiative. I imagine he’d have been pleased to see the NHS launching it, and leading the world in transparency in healthcare by doing so. 

Wednesday, 26 June 2013

Healthcare gatekeepers

Curious the similarities and dissimilarities between the US and Europe.

On both sides of the Atlantic, we live in societies that proclaim the sanctity of human rights, and which honour them except when some overriding factor, such as the race or creed of the individual, makes it more convenient to flout them.

Equally, our societies uphold the rule of law, except when governments feel that it’s too constricting and they think they can get away with circumventing it.

Finally, our nations are built on the principle that power is exercised by consent and that government can only rule with the support of the people, except on those occasions when ministers want, say, to wage a war and therefore need to ignore the pusillanimous refusal of voters to see that this is the right thing to do.

However, striking though the similarities are, there are also major transatlantic differences. For instance, a large majority in the US remains wedded to the retention of the death penalty, a view they apparently regard as justified by the astronomically high murder rate they enjoy.

Another significant difference is the approach to healthcare. A great many European nations feel that a person needing care should receive it without consideration of his or her ability to pay. Many in the US, on the other hand, see this idea as a dangerous concession to socialistic thinking, one that infringes the individual’s fundamental right to be kept waiting for treatment while finance staff check on insurance or, in the absence of cover, other means of paying for care.

It has to be said that the European model of treatment free, or nearly free, at the point of care, does make it difficult to limit demand on hospitals.

In Britain, the issue was addressed by asking General Practitioners to act as gatekeepers. Except for emergency patients, hospital care was only available on referral by a GP to a hospital physician.

That ‘except’ is the problem, of course. Because people who don’t want to go through their GP just recategorise themselves as emergencies and turn up at Accident and Emergency departments. A good article in today’s Guardian relates some horror stories from the Bradford Royal Infirmary: a patient in A&E to have a false nail removed, another for a pregnancy test she could have bought from a pharmacy…

But these are exceptional cases. What is clear is that there is mounting pressure on A&E departments, leaving them under a strain that is close to unbearable, and putting hospital budgets in jeopardy. There is, it seems, an increasing tendency in society to view a hospital A&E department as a first port of call in injury or sickness rather than a last; at the same time, in a society where more survive into frail old age, a greater number of people are showing up with serious problems requiring treatment.

A&E may sometimes look like a substitute for a GP surgery,
but it really, really isn't

Clearly the GP as gatekeeper system is failing. I saw this when I was working with my local hospital: A&E attendances were climbing inexorably, and emergency admissions growing with them, putting services under intolerable pressure. 

One attempt at a solution the hospital explored was to open a general practice inside the hospital, right by the main entrance. This seemed a good idea: patients would have the impression they were going to hospital but would be seen by general practice rather than far more expensive hospital staff. The sustained increase in A&E attendance showed, however, that it wasn’t working.

In my view, the scheme had one great flaw: the practice was to one side of the entrance to A&E.

What I’d like to see happen is the practice to be set up right in front of A&E so that only people arriving by ambulance would be able to access emergency services directly. Everybody else would have to pass through the GP practice, where they would be triaged: those absolutely requiring hospital services would be passed through, the others would be treated by practice staff.

That would make GPs truly gatekeepers to the service.

It strikes me that it’s an idea worth trying. Apart from anything else, it might help us preserve the specific characteristic of the British system, an idea I rather like, not just because I prefer not having to reach for a wallet at a time when I’m already seriously off colour, but because, funnily enough, our system costs little over half as much as the American model.

Which sounds like win-win to me.

Monday, 24 June 2013

Shades of 1984?

It’s wonderful when two items in the news reinforce the insights each provides. Synchronicity, one might call it, or does that imply that the events described are gratifying? Because these ones certainly aren’t.

First, there’s the furore over the revelations by Edward Snowden. It seems our esteemed British institution, GCHQ or the Government Communications Headquarters, has been tapping fibreoptic cables and gaining access to colossal volumes of internet and telephone communications – as many as 600 million phone calls a day. Mind-blowing stuff.

GCHQ. A building as impressive as the Pentagon.
And an organisation just as troubling.
I didn’t know there were enough people to say that much to each other on a daily basis. Perhaps it’s just proof that we always find things to talk about even when we don’t have much to say.

Now I have mixed feelings about GCHQ’s activities.

In the first place, it reassures me that nobody can do anything with 600 million phone conversations. At least, not with all of them. It seems there are nearly 6000 employees at GCHQ, so it’s pretty easy to do the arithmetic: if none of them did anything else, each would have to listen to 100,000 messages a day. Since there are fewer seconds than that in 24 hours, they clearly aren’t listening to the lot.

More positively, I actually favour intelligent intelligence work. It’s what has kept the terrorist attacks in the West down over the last few years. And as well as being more effective, it strikes me as infinitely preferable, morally, than invading another country, killing a lot of civilians, and then clearing off again with our tails between our legs with nothing resolved.

On the other hand, even if our governments are making good use of this intelligence right now, there’s no guarantee they always will. That’s where the other news item becomes so interesting.

A second scandal that has been running and running, and has erupted again int he last few days, concerns the police penetration of various environmental groups, such as Greenpeace, for several years from the mid-nineties. Some of the undercover cops took their James Bond fantasies a long way, forming relationships with a several women and then abandoning them, some with kids they’d fathered. All a little upsetting, if I can indulge in a little British understatement, particularly as the organisations targeted were often no more threatening to society than groups of tree-huggers.

What makes things worse is that
 allegations have now emerged, from one of those cops turned whistle blower, that some of the undercover operations were directed against the family and friends of Stephen Lawrence. He was the black teenager murdered by a racist white gang while he was waiting for a bus home, twenty years ago. It’s clear the spying wasnt designed to uncover crime, but to try, by discrediting their targets, to protect the reputation of the Metropolitan police which was making a complete hash of its investigation of the murder.

Stephen Lawrence, victim of a racist murder
The police apparently ran an operation against his family
One of the friends targeted was Duwayne Brooks, a witness to the murder, who found himself facing charges of criminal damage. They were thrown out by the judge as an abuse of the legal process, which to a layman like me, sounds about as close as legal discretion will get to an accusation that the police tried to frame him.

So at the time that the Lawrence family, and Brooks as an eye witness, were depending on the police to help them obtain justice for an appalling crime, they were themselves targets for covert police action designed to discredit or even jail them. No wonder justice was for so long denied them (just two of the perpetrators have been convicted so far, and only last year, though it is well known who carried out the killing). We should probably just be grateful they escaped being made victims of even greater injustice themselves.

Now set that second story alongside the first. I bet you that somewhere among those 600 million phone calls a day, it will always be possible to find a few by some new victim of police harassment. And by selecting odd sentences out of context from some of them, and stringing them together, to present a damning picture of that victim. That could then be leaked to some open gutter masquerading as a newspaper, to turn the victim’s life into a living hell.

The Lawrence case shows what the police are capable of when they lash out in self-defence. Why not other parts of the security state? Why not ill-intentioned groups on the extreme fringes of our political life? Why not some of the deeply unhealthy elements in those fringes that now look poised to make a bid for a share of power in the future?

I’m keen on seeing intelligence intelligently used. But far less keen on the indiscriminate collection of information, with no clear security goal defined. Particularly as we know how easily secretive organisations can be tempted to abuse the power this gives them.

Saturday, 22 June 2013

Criminal Defence: just who's the criminal and what's the defence?

Great to see a sign advertising the availability of ‘Criminal Defence’. Now, I know what the words really mean, but I find what they could mean – if taken at face value – far more interesting. 

OK. So who's being defended?
And with what sort of defence?

On the one hand, they could mean the defence of criminals only. That idea opens up quite a can of worms. After all, no-one’s a criminal until convicted by a court. So a lawyer doesn’t know whether he’s really engaged in the defence of a criminal until the case ends. What’s more, he’ll only be sure of his ground if he loses. 

That might lead to awkward moments between lawyer and client in the cells afterwards.

In one scenario, the lawyer would be saying, ‘well, it turns out you’re a criminal after all, despite all your assurance to me, you vile piece of scum. So criminal defence fees apply and you owe me ten zillion pounds.’

In the other scenario, the client would be saying: ‘see? see? I didn’t do it. So I’m not a criminal and I’m obviously not paying for criminal defence. So, thanks, but you know what you can do with your invoice.’

Not sure how well the system would work, though. It would rather incentivise failure in the profession, wouldn’t it?

On the other hand, ‘criminal defence’ could mean that the defence itself is criminal. Not perhaps technically criminal, in the sense that it actually breaches the law, but morally criminal in the sense that it resorts to practices that are simply unacceptable in a society with any claim to upholding civilised values. Bullying rape victims in cross examination, perhaps, or even those ethically greyer acts such as getting telling evidence excluded on the basis of some trivial technicality.

But I have only to write those words to know that such an interpretation is quite untenable. No lawyer would ever sink so low.

Which reminds me of my wife’s favourite joke.

An engineer dies and finds himself in Hell. He looks around and immediately sees that it badly needs sorting out. He gets straight to work, installing air conditioning, escalators, refrigeration, proper lighting and ventilation. Within six months, he’s transformed the place.

News of his work filters upstairs. St Peter gets straight on the blower to Satan.

‘What’s are you playing at down there? In Hell’s name?’ I apologise for the weakness of the pun, but that
’s Peter for you: he has a taste for them. A historian in this matter, I merely record.

‘Great guy. Love what he’s done with the old place. Delighted to have him with us.’

‘Well, you won’t be having him long. Send him up here.’

‘Send him to you? No chance. He stays with us.’

‘You’re going to fight us on this? Watch out. We’re ready to sue.’

‘Sue? Don’t make me laugh. Where are you going to find a lawyer?’

Note to my lawyer friends: I really do know what ‘Criminal Defence’ means. And I appreciate the people who do it. I always remember the words of John Mortimer, pointing out that the defence barrister is the only person who stands alongside someone in trouble when the full panoply of the state’s arrayed against him. That’s admirable.

I just think that lawyers should be able to roll with the punches and take the jokes in good part. And, if they can’t, they’re probably paid enough to cope.

Thursday, 20 June 2013

You don’t have to be Orpheus to descend to Hell, you just need a ticket

Most major cities pride themselves on putting in underground railway systems.

Odd, really, since when you plunge into any of them they generally turn out to be pretty ghastly places. They show how right most religions are to place Hell underground.

The London tube is one of the worst. It always seems to be horribly crowded.

Now I know it
’s a bit of a paradox to say that. I mean, if I weren’t there to experience how crowded it was, it would be marginally less crowded. But like most others, I suspect, I view myself and anyone with me as travellers, and everyone else as a crowd.

Even without the crowd, the tube is painful. It’s hot and clammy and claustrophobic, partly no doubt because it’s really squeezed into its tunnels: there are often only inches between the edge of tube cars and the tunnel side.

The London Tube: no margin for comfort
Still, in being uncomfortable, the London underground’s no worse than most others.

For instance, I’m always amazed that people write in such flattering terms about the New York subway. It’s always struck me as desperately old-fashioned, noisy and bone-rattling. Badly out of place in the home of technological innovation.

As for the Paris metro, it’s particularly dismal. First of all, it stinks. I don’t know whether it’s burning brake pads or what, but the smell is one of the most unpleasant I’ve come across in any city’s underground system. Everyone always looks absolutely miserable too; again, I realise that I’m guilty of some kind of solipsism here: I regard all the others as being miserable, and making me miserable by contagion, but I appreciate that others might see things the other way round.

Occasionally, underground systems can be quite interesting. For instance, before the wall came down, the Berlin U-Bahn had quite a few ‘ghost stations’. These were closed stops on the eastern side of the wall, their names still in Gothic script from the thirties, no adverts up on the wall or the tattered remnants of posters decades old, dim lighting, armed police on the platforms making absolutely certain that no-one got off the trains from the west or, more important, tried to get on.

Ghost station on the U-Bahn in the bad old days.
Fascinating but spooky
That was pretty spooky and interesting, but it wasn’t exactly pleasant.

In fact, the only metro system that I’ve been on recently and found relatively tolerable is the one in Madrid. It’s one of the more modern ones, so that’s perhaps not so surprising, but it does show that things could be less awful.

What makes the Madrid metro more attractive? There really is space in the tunnels around the carriages, and the carriages themselves are wider. Stretch out on the London tube, and even I with my short little legs am practically touching the passenger opposite. In Madrid there’s space between the rows to fit in people, legs, luggage, whatever.

Madrid Metro: room to breathe. Until it fills up at least
The greater width and the clearance in the tunnels makes the whole system much airier and fresher. That’s helped by air conditioning which is actually switched on from time to time. And they even have mobile signal down in the tunnels.

It still isn’t exactly fun, particularly when the carriages fill. But it’s a lot better than Paris or London.

Still, to be fair to poor old London, at least the tube does have a couple of jokes associated with it.

‘Do you know the way to Turnham Green?’ is one. The answer is, of course, ‘Leave 
em out in the rain.’

And the classic ‘Is this Cockfosters?’ to which the answer is 
well, it’s certainly not mine.

And the tone of that joke probably reflects pretty accurately the quality of the experience of travelling on the system.

Unusual passenger in Madrid

Tuesday, 18 June 2013

18 June: a day to remember, but perhaps not to celebrate

Before 1973, the United States had never lost a war. Why, back in the eighteenth century, they beat Britain, the foremost naval force on Earth at the time and also one of its greatest military powers. They repeated the trick thirty years later, in the War of 1812.

Thereafter, they won war after war, not always to the greatest glory of the nation: defeats of native Americans were impressive and comprehensive though perhaps hardly the stuff of which proud legend is born. They also kicked the stuffing out of Mexicans (repeatedly, including multiple invasions in the twentieth century), the Spanish and pretty well anyone else who tangled with them.

Why, in 1865 they even scored a notable triumph against themselves and conquering oneself has to be the great test of will, hasn't it? At any rate, it was a victory over the most militaristic section of the country, the Southern States who seceded from the Union and precipitated a Civil War that was catastrophic first and foremost for themselves.

And of course, in the bitterest conflicts they faced abroad, they tipped the balance in the First World War and won the Second, with massive help from the Soviet Union in Europe, to all intents and purposes alone in the Pacific.

Then came January 1973 and the Paris Peace Accords between North Vietnam, South Vietnam and the United States. Those agreements provided a fig leaf to cover US withdrawal in Vietnam, and withdraw they did. Two years later, the North Vietnamese completed their victory over the South, confirming that what had happened in 1973 was the utter defeat of the US-backed side in the conflict, and very far from the ‘peace with honour’ that had been claimed.

For the first time in its history, the US had lost a war.

As so often happens, the first occurrence of an event was quickly followed by others.

Some have been minor. Following a terrorist attack on a marine barracks that left 300 dead, the US was forced out of Lebanon in 1983 having achieved none of its goals; ten years later, US troops were killed in Somalia and their bodies dragged through the streets, leading to another humiliating withdrawal.

Far more serious are two new conflicts which the West is still trying to pass off as victories. In Iraq the fact that Saddam Hussein has been overthrown is presented as some kind of victory; the huge loss of life among the civilian population as well as among Western soldiers is talked down, as is the fact that the regime is increasingly a puppet of Iran. The latest disaster is in Afghanistan, where the Taliban grows in power and strength every day, while the government NATO put in power is mired in corruption and disarray.

Well, that went so well, let's try our luck again somewhere else
Today, 18 June, NATO handed over responsibility for military operations in that country to the Afghan military. It did so despite knowing that the Afghan army has been infiltrated by Taliban agents, many of whom have turned their guns on NATO troops; it knows too that the same army has established a mode of operation in which it pulls out of areas where the Taliban wishes to carry out a mission, and only moves back once that mission is complete.

In other words, handing over to the Afghan army is tantamount to admitting yet another defeat and preparing the ground for a return to Taliban rule.

The series of failures of American, or American-led, armed interventions that started with 1973 therefore continues its disastrous course.

It’s far from clear to me that this series of defeats does anything to further the cause of democracy or human rights, or even simply the interests of the West. The countries invaded suffer enormously. The cost to our nations is far from negligible either. Might it not be a good idea to cut our losses?

But far from our nations drawing any wisdom from this experience, West is now considering taking a more active role in the Syrian conflict. Initially that would mean arming the rebels, even though the main rebel units – which would undoubtedly get their hands on any weapons sent out there – are controlled by Al Qaida, and it was to root out Al Qaida that we first went into Afghanistan. There is also talk of a more active intervention, imposing a no-fly zone, which would mean committing NATO forces once more, if only in the air.

Ah, well. Here we go again. Proving, as if proof were needed, that if you don’t learn from your mistakes, you condemn yourself to making them again and again.

Sunday, 16 June 2013

Why vote Labour? It's the poverty, stupid.

It’s amusing to watch the state of the parties in Britain at the moment. Why, there was even an article in the Guardian yesterday about how the leadership of both Labour and the Conservatives is expecting to lose the next election. This is quite curious as it’s highly unlikely that anyone else will win, so it looks like we have political leaders who have all of them, across the board, resigned themselves in advance to losing.

A pretty dismal spectacle, to be honest.

Not a piece of advice enough people are heeding
But they should

I can understand how it happens. Labour is sitting on a lead in the opinion polls which was up to around 11%, on average, for quite a few weeks, but has fallen to 9% now. Reproduced in a general election, that would give the party a sizeable majority. But would it be reproduced? An opposition heading for victory should be sitting on a much bigger lead than that two years out, to counter the almost inevitable swing back to the government in the final phase of a campaign.

So how did Labour get into this position?

First of all, there has been a surprising bit of sleight of hand carried off by the right. Surprising because it seems almost incomprehensible to me that they should have got away with it. Somehow, a large section of the British electorate has let itself be persuaded that Labour is to blame for the financial crash that hit us in 2008.

This is presumably based on the fact that Labour was in office at the time.

What no-one has ever explained to me, however, is how this squares with the fact that Labour wasn’t in office in the US, Japan, Italy, Ireland or any other of the countries far worse hit by the crisis even than we were. I accept that Labour – or at least Tony Blair’s version of it, New Labour – was insufficiently active in trying to control the scandalously irresponsible behaviour of international finance that precipitated the difficulties.

But that was international finance. It was an international crisis. No British government could do much on its own to prevent it or stem it.

Secondly, and this is a much more serious problem, Labour is being abandoned by many of its natural followers on the left. Criticised for having done far too little on the domestic scene, and with great justification for having taken Britain into a lamentable war with disastrous consequences in Iraq, Labour has haemorrhaged support from its core voters.

My message to such voters is extremely simple. There are times when the behaviour of Labour ministers leaves me in despair, if not disgust. To give just one example, the recent revelations about snooping on private citizens, which was clearly going on under the last government as well as the present one, show how easily Labour succumbs to the temptation to be as authoritarian as the Tories.

But against these lamentable acts, there is one simple observation that cancels out all the others.

The Blair and Brown governments failed in their mission to cut child poverty in half by 2010. But they did manage to take over a million kids out of poverty, and that was a remarkable achievement.

We learned a few days ago that by 2011/12, the present government had plunged 300,000 children back into poverty. Along with 600,000 adults. The numbers will have got worse since that deplorable achievement.

Just remember that one fact. Think of the back-breaking, mind-numbing effect of poverty. Think of it applied to children. Think of how it affects its victims for life, through lost opportunities, poor education and unrealised potential.

And then ask: can you possibly allow this government to get back in? And not voting Labour will let them back – or possibly something worse: UKIP is only too ready to out-Tory the Tories in their onslaught on the poor.

To avoid that fate, it’s worth swallowing hard and putting your cross on the ballot paper in the Labour box. You can always take them to task over privacy, or Trident, or secret courts afterwards.

After all, you might just get a bit of a hearing from them. You certainly won’t from the present lot.

Friday, 14 June 2013

Sumeria: just the guide for modern living

Occasionally we come across a religion that seems to speak directly to our hearts, because it embodies our own feelings about life and we can relate immediately to its underlying principles.

The Judaeo-Christian tradition sets the origin of mankind in the Garden of Eden. Now, don’t get me wrong, I love a garden. I particularly like the small one we have at home. And I like it not just because under the careful hand of my wife Danielle, it’s becoming an increasingly attractive place to eat outside on the few occasions our English weather allows it, but also – dare I admit it? – because she’s decided to have flowers, vegetables and trees, but no grass.

Mowing strikes me as one of the deadliest punishments invented by man for the torment of his fellow creatures. Though I have to say that breaking clods of earth up is even worse, and schlepping great sacks of compost isn’t far behind.

So I’m not sure about a religion with its roots in a garden. That’s why I was so inspired by a recent visit to an exhibition about Sumerian society. Even though those guys lived in Mesopotamia some five millennia or so ago, they had a message which spoke directly to me down the ages. 

OK, so they may have been a bit odd on style,
but they knew a thing or two about life
Their creation myth was based around the city.

Now I really like cities. They’ve got theatres and cinemas and museums and shops and restaurants. And cafés. The café, or at any rate the coffee it serves, is on its own sufficient evidence that human evolution hasn’t been entirely in vain, that despite appearances to the contrary, there has been some progress towards civilisation.

It has to be said that the city in the Sumerian creation myth left a little to be desired. Uru-ul-la, the city of distant times, was black and bleak, inhabited only by dead souls, making it somewhat lifeless and dismal. Think Birmingham on a wet autumn evening, perhaps just at the fag end of the rush hour. And if you don’t know Birmingham, I’m sure you can think of other examples.

Gloomy and miserable it may have been, but it was the model on which all other cities were based. It was the birthplace of the gods and it there even before living beings had emerged. They came along when one of the gods, Enki, decided to create men, as helpers to make things a bit livelier. Presumably, he needed some of them to be barristas in the cafés which, no doubt, he knew the cities would eventually attract.

Clearly, we owe it to Enki and his human assistants that we can enjoy Chinatown in San Francisco, Covent Garden in London or the Ramblas in Barcelona.

Pretty smart: the Ramblas brings the garden into the city
Now that sounds like a religion worth following. Certainly preferable to all that stuff about apples you should or shouldn’t eat. 

I mean, when it comes down to it, wouldnt it be more fun to have the apple in the form of a cold cider on a café terrace anyway?

Wednesday, 12 June 2013

Persecuting the Irish: icon of our times

Noble, that’s the word for the Colegio de los Irlandeses, now part of the prestigious university of Alcalà de Henares near Madrid. 

Quiet, understated but self-assured, it is a fitting tribute to the offer of Spain to the persecuted Catholics of Ireland, to a refuge where they could safely study within the tenets of their faith.

Colegio de los Irlandeses, Alcalà de Henares
Makes you wonder what the ancestors of today’s Brits were up to, oppressing Irish Catholics. What good did it do them? Today Ireland is still Catholic and, what’s more, it’s independent of Britain. All that pain and suffering Britain imposed, and it gave neither nation anything benefit at all. You’d think we might learn.

The truth, of course, is that some people did very well out of the arrangement. A tiny number of people, but they were powerful. The holders of great fortunes in Ireland, particularly in the form of land, were doing just fine and saw no reason to loosen the reins. On the contrary, they felt they were absolutely entitled to see the army doing whatever it took to put down anyone uppity enough to question their right to enjoy what they, and their ancestors, had always enjoyed.

Meanwhile, in Spain the founding of the College had nothing to with preserving liberty from persecution. Far from it. Spain itself was more than happy to do its full share of persecution. Protestants: burn them. Moors, Jews: drive them out. And if they don’t go: burn them. Just like the Mayflower pilgrims, Spanish Catholics weren’t out to obtain religious freedom, just the freedom of their own religion to persecute anyone who belonged to a different one.

And in just the same way, a handful of people did very well out of the arrangement: the owners of the great fortunes, in Spain, Latin America or anywhere else controlled by force of Spanish arms, were convinced that this was right and proper and the preservation of their way of life was a divinely ordained duty.

That’s what makes the College in Alcalà so eloquent a monument. So eloquent today, I mean.

When a couple of crazed, misfit Muslims, who can’t distinguish between an act of political courage and a simple piece of barbarism, hack to pieces a British soldier in Woolwich they are perpetuating the attitudes that drove Britain to impose its will by force on the Irish. Or Spanish Catholics to force the conversion of Spanish Jews. Or Pakistani Sunnis to murder Pakistani Shiites. Or orthodox Jews to deny the right of Jewish women to pray like their male counterparts at the Wailing Wall.

What they are perpetuating is the mindset of anyone who is so sure of being right that it justifies inflicting suffering or even death on those who disagree.

That goes just as much for those, in the English Defence League and outside, who’ve reacted to the Woolwich murders with violence against Muslims and their institutions. Less obviously, it also applies to organisations that don’t themselves promote violence, like the United Kingdom Independence Party. They may not actively condone persecution, but by their attacks on immigration, they sustain the belief that a nation is better for being homogeneous.

Homogeneity was what all those persecuting powers, driving out Muslims, Jews, Catholics or Protestants were trying to do, too. Looking back on their attempts in the past, as I did when I saw the Colegio de los Irlandeses, I had to ask myself ‘why did they bother?’

Though, seeing how many people seem to be rallying to the banner of intolerance again today, perhaps the question ought to be, ‘why do they still bother now?’

Monday, 10 June 2013

The rain in Spain

It’s always fun to test received phrases and sayings in practice.

Travel broadens the mind, I’m told.

This I’ve always taken as meaning that they do things differently in other places and visiting them helps understand that one
’s own way isn’t necessarily the best, let alone the only one.

Sometimes, though, travel can reveal things to be exactly the same somewhere else. In a village, up in the mountains north of Madrid, we came across an English party over for a wedding. Spain in June: unbearably hot, flooded with sunshine, making a high-factor sunblock vital for health. Not hard to imagine what the happy couple were expecting.

They didn
’t get it. Instead they, and we, found fine rain alternating with grey skies which would have felt like that most comforting of places abroad, a home from home. Except that England enjoyed superb weather over the weekend. 

The experience at least gave me the satisfaction of learning that the rain in Spain by no means stays exclusively in the plain. You can get plenty of the damn stuff up in the mountains too. Even in June.

We took advantage of the occasional gentle rain and the cool temperatures under grey skies to tackle a bit of a hike to a place called ‘the cascades of purgatory’. Interesting notion. The place is actually rather attractive, the waterfall impressive. The purgatorial bit is the eight kilometres to get there, including a 500 metre rise. 

The Falls
Not so purgatorial as the way to get there

The irony is that the walk took us two hours each way, admiring the falls about two minutes. As they say, what matters isn’t the destination, but the journey.

Danielle in the Sierra
Proving that the journey matters as much as the goal
and adding a splash of colour as vivid as the flowers she's photographing
Of course, once we’d finished the sixteen kilometre round trip – something good about that number, incidentally, since it just takes you into double figures in what I still shamefacedly regard as real money, working out at ten miles – my youngest son Nicky felt he’d barely scratched the surface of his need for exercise. So he went off to climb another mountain pass by bike, to ensure that he didn’t have a wasted day of it.

He was doing the same stuff today, though this time we went up ahead of him by car and could greet him, cameras at the ready, as he reached the top. 1796 metres above sea levels, after a 700 metre climb. And barely out of breath.

Hard to tell from the photo, but he's smiling
Watching him convinced me that every remarkable endeavour includes a measure of madness.

Nicky reaches the top.
He seemed disappointed there wasn't any more
That isn’t a received expression, though. I offer it as a modest contribution to the world’s stock of proverbial sayings. And at least I can attest to the truth of this one, from the behaviour of a member of my own family.

Thursday, 6 June 2013

Sarin in Syria and toxic reactions

So France and Britain have unearthed evidence that the Syrian government has used the nerve agent Sarin against its own people.

That’s a shameful act, and it’s understandable that for the US as well as the French and British governments, it represents a red line they’ve said they won’t let the Assad regime cross. So their accusations, coming on top of the successful British and French move to lift the EU arms embargo on Syria, suggest there’s a head of steam building up to intervene against Assad. At the very least, the governments seem intent on supplying weapons to the rebels.

’s impressive, at first glance at least, is that they’ve gone to the trouble to build up some evidence for their view before acting on it. The problem is they’re ignoring rather a lot of other evidence.

The first is that Western intelligence agencies don’t have a terribly good track record on information about inhumane weapons in the Middle East. We went down that road over Saddam Hussein in Iraq, and it didn’t lead anywhere we’d want to go again.

Qusair. Now recaptured by government forces.
Is this somewhere we really want to get sucked into?
The Iraq experience rather makes my second reason for reticence over renewed Western intervention in the region. All these Arab springs, they’ve had mixed results. Probably the one that has done best was Tunisia, and even there there’s plenty to question, not least the current trial of feminist activists. But whatever Tunisia achieved, it managed without Western involvement. On the other hand, where we have stuck our oar in, things have often gone pretty badly. 

In Libya the results have been at best patchy. And in Iraq, they were disastrous: at huge cost, above all in Iraqi lives, we’ve converted that country into a client state of Iran, the nation the West most loves to hate in that part of the world. Which presumably wasn’t the aim of the exercise.

It looks as though we could end up doing the same thing in Syria, by putting entirely the wrong people in power. Al Qaida elements are increasingly dominating the rebels. Certainly, we’d be supplying arms to the nice guys, but how could we prevent them sliding into the hands of the bad guys

It’s hard to see how anyone can possibly still believe that getting involved in warfare around the Middle East will do the West the slightest good. That our governments still indulge that fallacy can only be a tribute to the power of their faith, or at least its capacity to overwhelm any aptitude 
they may have had for sober policy-making.

The faith in British and French government circles may not move mountains but it can shift arms and involve us in another debacle. Which has already started: the first, and dramatic, consequence of the ending of the EU arms embargo is that Russia has provided Assad with advanced anti-aircraft missiles. Emboldened, the regime has since recaptures Qusair, for a long time a major rebel stronghold. And the conflict now has the potential to become a proxy war between Russia and the West.

That the British government should be that wilfully blind is perhaps understandable: Britain has previous form on blundering into Middle East wars on misleading or even faked evidence. But the French? They had the good sense to stand out against the Iraq disaster. They got that one right, so why are they out there beating the drum with Britain this time? Such a disappointment, that Hollande fellow.

The British electorate is way ahead of its government in the good sense stakes. Polls suggest that three quarters are apparently opposed to our arming the rebels. Sadly, however, I remember the biggest ever demonstration in British history: two million people opposing intervention in Iraq. Blair took us in anyway.

We seem to be standing on a dangerous slope we could slip down to results as toxic as any nerve agent being used in Syria.  That would put us in danger of proving Hegel right: ‘What experience and history teach is this – that people and governments never have learned anything from history, or acted on principles deduced from it.’

We fail to learn from our errors and condemn ourselves to repeating them. The saddest consequence is that the price will be paid first by the Syrian population, and then by our own.

The sword-waving politicians responsible will merely wipe the blood from their hands, write best-selling memoirs and make a fortune on the speaker circuit.

Monday, 3 June 2013

A century on, women are still suffering for human rights

Spare a thought today, 3 June, for a woman of 41 who, this time a hundred years ago, was preparing to spend her last night of health on earth: the following day she would make a gesture that would win her undying fame, by her death.

It now seems clear that Emily Davison had no intention of sacrificing her life as she prepared for her symbolic act. She had written to her sister about her forthcoming visit to her in France; in her pocket were found a return ticket to London and another to a suffragette dance that evening.

Neither would be used. Because in between, as the Epsom Derby on 4 June 1913 was drawing to its close, she ran out onto the track towards the King’s horse Anmer and, it was thought at the time, deliberately threw herself under his hooves. She sustained a fracture to her skull from which she died in hospital on 8 June.

Emily Davison falls, fatally injured
But did she throw herself under the horse?
She was however clutching a cloth in her hand, believed to be the ‘Votes for Women’ sash later found nearby, and it now seems likely that her plan was to throw it round the neck of the horse. What a great gesture that would have been! As the King’s horse crossed the line, it would have been sporting a suffragette banner.

Instead, she was fatally injured and attained mythical status: the woman who gave up her life for the vote.

This evening I’ll raise a glass to her memory and try to imagine what her last night at home must have felt like. How nervous she must have been, knowing that the following day she was going to provoke shock in some, admiration in others, by an act that at the very least would expose her to great danger.

An admirable woman who deserves out heartfelt gratitude, not only from women but also from men: a century on, women voters are all that stands between the British electorate and a renewal of the mandate of possibly the worst government the country has seen since the War. Well, since the last Tory government, anyway.

Far too many men have been taken in by the jolly affability of an indolent, incompetent and brutally uncaring Prime Minister. A majority of women has seen through him. Thanks to Emily Davison and her fellow suffragettes, they have the vote and the opportunity, in 2015, to rid us of this wearisome cheat.

My only regret is that the Bank of England, when it designed the new five pound note and removed the only woman’s face other than the queen’s to appear on any of our banknotes, did not choose to replace it with Davison’s instead of Churchill’s. Can you imagine? Davison on one side, the Queen on the other. It would have been as deliciously ironic as the King’s horse carrying a suffragette banner a century ago.

Nor shall I be thinking 
only of Davison as I raise my glass tonight. My thoughts will also go to another woman, in a country at least as badly in need today of the kind of radical reform that Emily Davison sought back then.

Today, Maria Alyokhina of Pussy Riot, jailed and shamefully treated in a Russia that has come a lot less far from the Soviet Union than we hoped when the Berlin Wall fell, ended an eleven-day hunger strike after extracting some concessions over the conditions of her imprisonment.

The Pussy Riot defendants in a Russian courtroom
I’m delighted she was able to end her hunger strike before it took her life, and glad she’s won concessions. But it would have been far better that neither she, nor her friend Nadezhda Tolokonnikova, had been gaoled in the first place.

Two regimes denying human rights. Women a hundred years apart suffering to resist them. Surely a cause that deserves a thought tonight.

Saturday, 1 June 2013

Whistleblowing isn’t always good for your healthcare

‘The press lives by disclosure,’ wrote John Delane, iconic editor of the London Times in the nineteenth century. 

It isn’t even any old disclosure. News is something we all want to know and someone else wants to keep quiet. Publishing it is journalism at its most effective.

The whistleblower has a key role in making it happen.

Not the least shameful aspect of many recent scandals has been the attempt by people in authority to silence potential whistleblowers, and much of the outcry has been over the failure to listen to them in the past it time to correct problems: it’s often the people at the coalface who know what’s going wrong and who could launch action to correct it if only they could gain a hearing.

So I’m keen on a campaigning, disclosing press, and I’m keen on whistleblowers having the opportunity to make themselves heard.

However, there needs to be some intelligence in the way information is handled as well. Otherwise, as much damage can be done by irresponsible disclosure, as would have been done by unprincipled concealment.

My local hospital, the Luton and Dunstable, has in place a well-resourced discharge planning department, putting it at the cutting edge of health service management today because it embodies a goal pursued across the NHS, to encourage collaboration between social workers and district nurses as well as nurses and managerial staff from the hospital. 

The aim is to prepare for the earliest possible discharge of patients, under the best possible conditions: there is nothing to be said for keeping patients in hospital any longer than necessary, if only because hospitals are dangerous places (full of sick people) with a high chance of infection, patients recover better in their own beds, and beds are at a premium for others impatiently awaiting their turn.

Most discharges are uneventful. But sometimes discharge planning has to make sure that
 patients have district nurse or social care support in place, that their medication is ready, that they are going home to an environment in which they can continue to recover, and so forth. It’s hard work, under great pressure, involving the coordination of many different agencies and their staff.

Now it’s impossible to do good work without occasionally getting it wrong. The only people who never make mistakes are those who never make anything. The trick is not to be put off by fear of making errors, but to recognise them quickly, take action to correct them and learn the lessons.

So the Luton and Dunstable hospital is to be congratulated for carrying out regular audits of its discharge planning work. It’s entirely right that the department should understand its shortcomings and plan how to make sure they don’t occur again. Audit is a key way of providing information to support appropriate action.

So what a pity it is that a reporter on the Herald and Post, perhaps seeing himself as a latter-day Bob Woodward, got an article on the front page of the paper denouncing the cases that went wrong, such as the two patients discharged with cannulas still in place, or the dementia patient sent home with no-one ready to receive him. These are highly regrettable incidents, but the journalist might have mentioned that the problem discharges are a tiny proportion of the total, less than one in a hundred, and that the hospital has an exemplary record of handling discharges.

The press lives by disclosure.
But sometimes that’s less than helpful
The publicity won’t produce an improvement in service: the hospital was working on that already. Instead, what we’ll see is an increased reluctance to make information available if it can be abused. That can only increase the difficulty of achieving improvement.

Whistleblowers are essential in a healthy society. And the press does indeed owe it to itself, and to us, to live by disclosure. But it would be useful if the press learned that the disclosure of information is a right that comes with an obligation to exercise it intelligently.