On the back of Scotland’s decision not to become an independent country, it occurs to me to ask …
How many “countries” (states, provinces, or whatever you want to call them) have ever voted in a free and fair election NOT to take independence from their “imperial masters”?
The only other which comes to mind is Quebec in 1980 and 1995. Are there any others since (say) 1800? One hears of so few that it seems to me that if independent sovereignty is sought, it is almost always attained.
Category Archives: current affairs
Welsh Cannabis
Following on from the previous post about the liberalisation of prostitution, here’s another piece of unexpected sensible news.
The NHS in Wales will be the first in the UK to fund a cannabis-based medicine for people with multiple sclerosis. The drug in question is Sativex which has been on the market for some time.
Bravo for them as this is in line with current medical research, but directly contrary to the the recent draft NICE clinical guideline which rejected the drug for use on the NHS in Wales and England based, apparently, on a flawed assessment of its cost effectiveness.
You see, by chipping away, entrenched attitudes can be changed.
Wales 1, Blinkered Politicians 0
Internet Prostitution
There was a very interesting article in the Economist on 9 August under the headline “Prostitution: A Personal Choice”.
The first interesting thing is that such an august institution as the Economist does not support the UK government fetish of zero tolerance because the buying and selling of sex is dangerous, immoral etc. etc.
Instead the writer makes a number of points supported by recent research. First and foremost:
The internet is making the buying and selling of sex easier and safer. Governments should stop trying to ban it.
While they agree …
Some prostitutes do indeed suffer from trafficking, exploitation or violence; their abusers ought to end up in jail for their crimes. But for many, both male and female, sex work is just that: work.
This newspaper has never found it plausible that all prostitutes are victims … the commercial-sex trade [looks] more and more like a normal service industry.
They go on …
Moralisers will lament the shift online because it will cause the sex trade to grow strongly … But everyone else should cheer. Sex arranged online and sold from an apartment or hotel room is less bothersome for third parties than are brothels or red-light districts … the web will do more to make prostitution safer than any law has ever done. Pimps are less likely to be abusive if prostitutes have an alternative route to market. Specialist sites will enable buyers and sellers to assess risks more accurately. Apps and sites are springing up that will let them confirm each other’s identities and swap verified results from sexual-health tests. Schemes such as Britain’s Ugly Mugs allow prostitutes to circulate online details of clients to avoid.
Governments should seize the moment to rethink their policies. Prohibition, whether partial or total, has been a predictable dud. It has singularly failed to stamp out the sex trade.
Moreover …
The “Swedish model” [criminalising the purchase of sex instead of its sale] … is misguided, as a matter of both principle and practice. Banning the purchase of sex is as illiberal as banning its sale. Criminalisation of clients perpetuates the idea of all prostitutes as victims forced into the trade. Some certainly are — by violent partners, people-traffickers or drug addiction. But there are already harsh laws against assault and trafficking. Addicts need treatment, not a jail sentence …
Sweden’s avowed aim is to wipe out prostitution by eliminating demand. But the sex trade will always exist — and the new approach has done nothing to cut the harms associated with it.
And finally …
Prostitution is moving online whether governments like it or not. If they try to get in the way of the shift they will do harm … the unrealistic goal of ending the sex trade distracts the authorities from the genuine horrors of modern-day slavery … and child prostitution (better described as money changing hands to facilitate the rape of a child). Governments should focus on deterring and punishing such crimes — and leave consenting adults who wish to buy and sell sex to do so safely and privately online.
One day governments will start taking real notice of research findings and start understanding.
NHS Funding
So. According to all the media reports, and the scaremongering from professional bodies, the NHS is in crisis and falling apart because it is significantly under-funded and a political football. It is barely “muddling by” [1,2,3].
Well maybe.
It cannot be denied that the NHS is in crisis. It is badly organised and badly managed. And yes it is a political football.
I’ve written about this before [4,5] and I make no apology for doing so again.
It cannot be denied that some sectors of the NHS are woefully under-funded. This is especially true of GP services where funding has fallen from a high of 11% of NHS budget in 2006 to around 8.3% today against a background of significant increases in the number of consultations and demands from politicians [6].
However overall I cannot believe that the NHS is under-funded. It seems to me the NHS has shed-loads of money to do everything you and I could reasonably want it to do. But that money is badly used, in large part because of the appalling level of wastage.
The NHS employs way more managers and administrators than it needs. That in itself is a huge waste of resources. Just take a look next time you visit a hospital at how many staff are wandering about apparently aimlessly. What do they do? Is it useful? How many are doing nothing but moving pieces of paper from A to B? In this day and age moving pieces of paper around by hand is an inexcusable waste. Do it electronically! Use email, or on-line documents, or database systems.
Yes, to get the NHS using pervasive electronic communication is going to take time, and will need an up-front investment. It will also need the Civil Service and government not to cut corners on cost by being constrained to choose the cheapest bidder, to understand how to manage a big IT project (like don’t keep changing the project scope) and to listen to advice from their trusted suppliers.
The NHS also has far too many managers. Their lives seem to be predicated on bullying staff and chasing meaningless government targets. If we could get rid of the pointless targets and teach the managers how to manage people the NHS would need far fewer of them. In doing this it will take the NHS quite a long way towards trusting and empowering its employees. Trust them to do their job. Trust them with the empowerment to do it efficiently. Empower them to change things sensibly if they can see a better way. In other words, act like a good private company.
Somewhere else the NHS wastes money is in the sheer waste of supplies. One hears stories of hospitals where Ward A needs supply Y but can’t buy it because there’s no money; yet Ward B has a cupboard full of the same supply but has to throw it away because it has gone out of date. In one instance I know of where this happened, and it was pointed out to the top brass by a junior nurse, just changing the procurement policy saved the hospital several million pounds in the first year. Practices like this are not uncommon.
And let’s not talk about hospital food. If patients were fed properly, not only would there be a lot less food waste but the patients might actually get better quicker so they could be discharged sooner.
This is all well and good but I fear it will never happen. For a start politicians, almost by definition, have to keep meddling. Not only is it ideological but it is the only thing they can do to try to show they are doing something.
The other reason it will never happen is that there is no-one at the top of the NHS who has the ability to grasp the whole organisation and energise it. That is not the Civil Service way. But without this there will be no change. The NHS needs someone highly skilled, robust, no-nonsense and bloody-minded to head it up. Someone who will energise the employees, from top to bottom. Who will empower from the top and support empowerment from below. Who will give his or her henchmen a job to do and expect them to get it done — or get out. And most importantly someone who will tell the politicians to butt-out and stay out.
Names like Richard Branson, Alan Sugar and Digby Jones come to mind. You may not like them, but they are the type of people who are needed. Badly needed.
Without someone like this, and without government getting a proper, business-like grip, the NHS is indeed going to go nowhere except, as predicted, down the tubes. And that is something the country cannot afford!
——————————
References:
[1] Observer; 28 June 2014
[2] Daily Telegraph; 18 June 2014
[3] Independent; 29 June 2014
[4] https://zenmischief.com/2014/02/transforming-the-nhs/
[5] https://zenmischief.com/2012/08/reforming-the-nhs/
[6] Royal College of General Practitioners; 27 June 2014
Oddity of the Week: Legal Tender
Now here’s an oddity which I found out by chance the other day …
Bank of England sterling banknotes are the only paper money which is legal tender in England and Wales. No banknotes are legal tender in Scotland or Northern Ireland! (Bank of England coinage is legal tender throughout the UK.)
The following quotes come from the Wikipedia article on Banknotes of the Pound Sterling which, for those in doubt, is well referenced.
The Bank of England [acts] as a central bank in that it has a monopoly on issuing banknotes in England and Wales, and regulates the issues of banks in Scotland and Northern Ireland …
… some of the monopoly provisions of the Bank Charter Act [of 1844] only applied to England and Wales. The Bank Notes (Scotland) Act was passed [in 1845], and to this day, three retail banks retain the right to issue their own sterling banknotes in Scotland, and four in Northern Ireland …
English banknotes … The majority of sterling notes are printed by the Bank of England. These are legal tender in England and Wales, and are always accepted by traders throughout the UK …
Scottish banknotes … are the recognised currency in Scotland, but are not legal tender. They are always accepted by traders in Scotland, and are usually accepted in other parts of the United Kingdom. However, some outside Scotland are unfamiliar with the notes and they are sometimes refused. Institutions such as clearing banks, building societies and the Post Office will readily accept Scottish bank notes.
The situation in Northern Ireland is exactly as in Scotland except that Northern Ireland banknotes are seldom seen outside the province.
And here now is the interesting part …
The concept of “legal tender” is a narrow technical definition that refers to the settlement of debt, and it has little practical meaning in everyday transactions such as buying goods in shops (but does apply, for example, to the settling of a restaurant bill, where the food has been eaten prior to demand for payment and so a debt exists). Essentially, any two parties can agree to any item of value as a medium for exchange when making a purchase (in that sense, all money is ultimately an extended form of barter). If a debt exists that is legally enforceable and the debtor party offers to pay with some item that is not “legal tender,” the creditor may refuse such payment and declare that the debtor is in default of payment; if the debtor offers payment in legal tender, the creditor is required to accept it or else the creditor is in breach of contract. Thus, if in England party A owes party B 1,000 pounds sterling and offers to pay in Northern Ireland banknotes, party B may refuse and sue party A for non-payment; if party A provides Bank of England notes, party B must acknowledge the debt as legally paid even if party B would prefer some other form of payment.
Banknotes do not have to be classed as legal tender to be acceptable for trade; millions of retail transactions are carried out each day in the UK using cheques, bitcoin, or debit or credit cards, none of which is a payment using legal tender … Acceptability as a means of payment is essentially a matter for agreement between the parties involved.
Bank of England notes are the only banknotes that are legal tender in England and Wales. Scottish and Northern Ireland banknotes are not legal tender anywhere … The fact that these banknotes are not legal tender in the UK does not however mean that they are illegal under English law, and creditors and traders may accept them if they so choose …
In Scotland and Northern Ireland, no banknotes, not even ones issued in those countries, are legal tender. They have a similar legal standing to cheques or debit cards, in that their acceptability as a means of payment is essentially a matter for agreement between the parties involved, although Scots law requires any reasonable offer for settlement of a debt to be accepted.
Until 1988, the Bank of England issued one pound notes, and these notes did have legal tender status in Scotland and Northern Ireland while they existed. The Currency and Bank Notes Act 1954 defined Bank of England notes of less than £5 in value as legal tender in Scotland. Since the English £1 note was removed from circulation in 1988, this leaves a legal curiosity in Scots law whereby there is no paper legal tender in Scotland.
And here’s a further curiosity …
Bank notes are no longer redeemable in gold and the Bank of England will only redeem sterling banknotes for more sterling banknotes or coins. The contemporary sterling is a fiat currency which is backed only by securities; in essence IOUs from the Treasury … Some economists term this “currency by trust”, as sterling relies on the faith of the user rather than any physical specie.
In other words all money is worthless; it is all either physical tokens (banknotes, coins) or electronic bits in a computer system and it is all government IOUs. But it was the definition of “legal tender” and the lack of banknotes as legal tender in Scotland and Northern Ireland which piqued my interest.
"Another NHS cock up"
This is an absolutely classic example of why NHS — no actually not just NHS, but all government — IT projects fail so spectacularly.
There are a couple of telling comments in the report on the NHS decision to quietly close the “Choose and Book” outpatient appointments system.
During a recent investigation … MPs were told by NHS staff that while some GPs liked Choose and Book, many did not, and that not all outpatient appointment slots were available on it, limiting its usefulness.
Whether GPs like it or not, that’s the process they have to use; so get on with it and then get it improved. But not having all the appointments there is inexcusable. And the appointments aren’t there; I’ve recently had the run-around getting an audiology appointment because Choose & Book can’t get their act together. (And to be fair my GP went ballistic because of the inefficiency.)
But then it gets worse …
NHS England said … the new e-referral system would use different technology, but it was unable to say how much the scheme would cost.
(Emphasis mine.)
This is the crux of the matter. If you don’t know how much a project is going to cost, then you do not have a project because you cannot commit funding. There are three prerequisites to running ANY project: a sponsor (ultimate responsibility), a coherent defined and documented set of requirements (the job) and committed funding (ability to pay). Without all three there is no project. Ever.
And government never provide any of the three. They are totally unable to define, specify, cost and manage projects (and they will not take sensible advise from their suppliers). The right level of funding is therefore never committed. And no-one takes overall responsibility.
So things either never happen (because suppliers won’t accept rubbish contracts) or they go tits up (because what is specified either can’t be delivered at the agreed price or isn’t fit for purpose).
So it seems likely that this new project will either be stillborn or will fail within three years. And that is our money — our taxes — down the drain. Again!
Why is there no-one in government, the civil service or parliament with any teeth?
Sports Disgust
First of all the retailer Sports Direct bans a mother from breastfeeding her child in their Nottingham store.
Then when a group of mothers protest outside their Ealing store (as mothers apparently have been around the country) the staff gratuitously photograph them and call the police.
Now I admit I do not know all the ins and outs of this case, just what has been reported by Ealing Today, but this seems like a disgraceful over-reaction by Sports Direct.
£50m? That Goes Nowhere!
In a widely reported impending announcement David Cameron is allegedly to pledge £50m to fund 1000 GP surgeries (roughly 1 in 8) to open 0800-2000, 7 days a week. See for instance here.
Yes, these extended GP hours are something we, the patients, are asking for. And there is a need because currently there are people (just how many is really debatable) who can’t (for lots of reasons) go a GP appointment but unnecessarily clog up A&E.
But yet again the UK government has proved it doesn’t have a clue about how to actually run the NHS. Cameron doesn’t stand a hope in hell of achieving what he’s pledging, because $50m by my reckoning will pay for a quarter of that for just one year.
Here’s why …
Opening 8-20, 7 days will mean around an extra 34-40 hours a week to be covered. (It’s 34 hours if the practice is currently open 0800-1800, 5 days a week; and many aren’t.)
This means every GP practice which is going to extend their hours, as demanded will need to employ at least one extra full time equivalent GP.
And to cover the extra hours they will also need at least one full time extra member of reception/office staff.
Leaving aside where they are going to find all the suitable, spare GPs, let’s look at the cost. Here’s a very broad brush, back-of-envelope, estimate:
Assume that a GP costs the NHS £150K pa (that’s salary plus pension contributions, plus employers NI contributions, plus other benefits like holiday etc.).
Assume similarly that a full time trained receptionist costs £30K pa (again salary plus benefits package). (Yes you do need trained receptionists; medical work is not something anyone off the street can do, and certainly not safely.)
And then remember that the extra hours will also incur costs for heat, light, hot water and other services — let’s assume that’s £25 per week per practice.
Which means each practice would need funding of around £181K a year.
Dividing that into £50M would provide enough funding for around 275 practices, or about a quarter of what is proposed. And 275 practices is little more than 1 for each NHS area (CCG) in the country (by my count there are 211 of them in England).
So even if the “reorganisation” also provides 100% efficiency savings (which would be a world first!) that still means we’ll achieve only 50% of Cameron’s pledge.
So not only will Joe/Josette Public not realise that this may mean his/her GP isn’t open (and they have to go several miles across the borough to find the practice which is open — on a Sunday when there are no buses), but it is going to go nowhere near meeting Cameron’s pledge.
And that’s without all the fancy gizmos, like Skype video consultations, which are being promised. They have to be paid for too!
Oh and if you read the articles don’t be deceived by all the twaddle about the over 75s. That’s been in the plan for a long time; it isn’t new. Just as I suspect the £50m isn’t new money either.
How do we get these people to understand that healthcare is expensive, that the available funds are being misallocated and mismanaged, and that GP services are hugely underfunded compared with 10 years ago? Because they really don’t have a clue how to fix things.
Coming up in March
Interesting events an anniversaries in the month ahead.
4 March
Shrove Tuesday, and therefore Pancake Day. Traditionally this was the feast to eat remaining winter food stocks on the last day before the fasting of Lent. It was also the day when the penitent went to confession (hence “shrove” from “shriven”) in preparation for Lent.
Pieter Bruegel the Elder; The Fight between Carnival and Lent (detail)
5 March
The day after Shrove Tuesday is therefore Ash Wednesday, the first day of Lent.
8 March
International Women’s Day. Find out more at www.internationalwomensday.com
11 March
This day in 1984 saw the beginning of the National Miner’s Strike in which Prime Minister Margaret Thatcher defeated the Miners’ Unions and effectively killed the British coal industry.
14-23 March
National Science & Engineering Week is a ten-day national programme of science, technology, engineering and maths events and activities across the UK aimed at people of all ages. Find more at www.britishscienceassociation.org/national-science-engineering-week.
21 March
Spring (Vernal) Equinox and the pagan festival of Ēostre (which the Christian church subsumed into Easter and made a moveable feast).
21 March
Composer Modest Mussorgsky was born this day in 1839.
25 March
Lady Day or the Feast of the Annunciation of the Blessed Virgin. It is the first of the four traditional English quarter days when servants were hired and rents were due.
26 March
The UK Driving Test was introduced on this day in 1934.
30 March
Mothers’ Day in the UK, which is always celebrated on the fourth Sunday in Lent.
31 March
Paris’s Eiffel Tower was opened this day in 1889.
Farming Floods
Yet again George Monbiot has applied his pitchfork to the tender parts of the government’s environmental policy. Yet again it is all to do with flooding. Here is the large part of his article in the Guardian of 17 February — he says it all so much more succinctly than I could.
How we ended up paying farmers to flood our homes
This government let the farming lobby rip up the rulebook on soil protection — and now we are suffering the consequences.
It has the force of a parable. Along the road from High Ham to Burrowbridge, which skirts Lake Paterson (formerly known as the Somerset Levels), you can see field after field of harvested maize. In some places the crop lines run straight down the hill and into the water. When it rains, the water and soil flash off into the lake. Seldom are cause and effect so visible.
That’s what I saw on Tuesday. On Friday, I travelled to the source of the Thames. Within 300 metres of the stone that marked it were ploughed fields, overhanging the catchment, left bare through the winter and compacted by heavy machinery. Muddy water sluiced down the roads. A few score miles downstream it will reappear in people’s living rooms. You can see the same thing happening across the Thames watershed: 184 miles of idiocy, perfectly calibrated to cause disaster.
Mud (aka. silt) pours straight off this field near the source of the Thames.
Photograph: George Monbiot
Two realities, perennially denied or ignored by members of this government, now seep under their doors. In September the environment secretary, Owen Paterson, assured us that climate change “is something we can adapt to over time and we are very good as a race at adapting”. If two months of severe weather almost sends the country into meltdown, who knows what four degrees of global warming will do?
The second issue, once it trickles into national consciousness, is just as politically potent: the government’s bonfire of regulations.
Almost as soon as it took office, this government appointed a task force to investigate farming rules. Its chairman was the former director general of the National Farmers’ Union. Who could have guessed that he would recommend “an entirely new approach to and culture of regulation … Government must trust industry”? The task force’s demands, embraced by Paterson, now look as stupid as Gordon Brown’s speech to an audience of bankers in 2004: “In budget after budget I want us to do even more to encourage the risk takers.”
Six weeks before the floods arrived, a scientific journal called Soil Use and Management published a paper warning that disaster was brewing. Surface water run-off in south-west England, where the Somerset Levels are situated, was reaching a critical point. Thanks to a wholesale change in the way the land is cultivated, at 38% of the sites the researchers investigated, the water — instead of percolating into the ground — is now pouring off the fields.
Farmers have been ploughing land that was previously untilled … leaving the soil bare during the rainy season. Worst of all is the shift towards growing maize, whose cultivated area in this country has risen from 1,400 hectares to 160,000 since 1970.
In three quarters of the maize fields in the south-west, the soil structure has broken down to the extent that they now contribute to flooding. In many of these fields, soil, fertilisers and pesticides are sloshing away with the water. And nothing of substance, the paper warned, is being done to stop it …
Maize is being grown in Britain not to feed people, but to feed livestock and, increasingly, the biofuel business. This false solution to climate change will make the impacts of climate change much worse, by reducing the land’s capacity to hold water.
The previous government also saw it coming. In 2005 it published a devastating catalogue of the impacts of these changes in land use. As well as the loss of fertility from the land and the poisoning of watercourses, it warned, “increased run-off and sediment deposition can also increase flood hazard in rivers”. Maize … is a particular problem because the soil stays bare before and after the crop is harvested, without the stubble or weeds required to bind it. “Wherever possible,” it urged, “avoid growing forage maize on high and very high erosion risk areas.”
The Labour government turned this advice into conditions attached to farm subsidies. Ground cover crops should be sown under the maize and the land should be ploughed, then resown with winter cover plants within 10 days of harvesting, to prevent water from sheeting off. So why isn’t this happening in Somerset?
Because the current government dropped the conditions. Sorry, not just dropped them. It issued … a specific exemption for maize cultivation from all soil conservation measures … The crop which causes most floods and does most damage to soils is the only one which is completely unregulated.
When soil enters a river we call it silt. A few hundred metres from where the soil is running down the hills, a banner over the River Parrett shouts: “Stop the flooding, dredge the rivers.” Angry locals assail ministers and officials with this demand. While in almost all circumstances, dredging causes more problems than it solves, and though, as even Owen Paterson admits, “increased dredging of rivers on the Somerset Levels would not have prevented the recent widespread flooding”, there’s an argument here for a small amount of dredging at strategic points.
But to do it while the soil is washing off the fields is like trying to empty the bath while the taps are running.
So why did government policy change? I’ve tried asking the environment department: they’re as much use as a paper sandbag. But I’ve found a clue. The farm regulation task force demanded a specific change: all soil protection rules attached to farm subsidies should become voluntary. They should be downgraded from a legal condition to an “advisory feature”. Even if farmers do nothing to protect their soil, they should still be eligible for public money.
You might have entertained the naive belief that in handing out billions to wealthy landowners we would get something in return. Something other than endless whining from the National Farmers’ Union. But so successfully has policy been captured in this country that Defra … now means Doing Everything Farmers’ Representatives Ask. We pay £3.6bn a year for the privilege of having our wildlife exterminated, our hills grazed bare, our rivers polluted and our sitting rooms flooded.
Yes, it’s a parable all right, a parable of human folly, of the kind that used to end with 300 cubits of gopher wood and a journey to the mountains of Ararat. Antediluvian? You bet it is.
A fully referenced version of this article can be found at www.monbiot.com/2014/02/17/muddying-the-waters/
From www.theguardian.com/commentisfree/2014/feb/17/farmers-uk-flood-maize-soil-protection
Now tell me, please, why there is no need to reform agricultural practices?