Dec 2007 18

The bureaucratic procedure attached to the simple act of clearing up a broken lightbulb is more important than it might seem.  It is important because it demonstrates just how unwieldy the procedures are becoming in too much of the public sector for even the most basic of task.  All this, as the Times is quite right to note, means far less time to do the vitally important real work they are supposed to be doing:

"So how many government ministers does it take to unmask the identity of a lavish donor, or to rescue Northern Rock, or sign an EU treaty at the same time as other EU leaders, or to ensure discs containing confidential details of millions of Britons don’t get lost? Answer: Are you crazy? Do you imagine that MPs have time for all that when so many lightbulbs need changing?"

Dec 2007 17

Not content with spending thousands of pounds a month on publicity and hiring a new PR exec on a bumper salary, Stoke-On-Trent City Council have outdone themselves again by blowing almost three quarters of a million on refurbishing their offices.

The Sentinel reports that many have questioned whether £729,000 of taxpayers’ money should have been spent on revamping the civic centre with new carpets, furniture, lighting, pictures, cabling and partitions, particularly in view of recent redundancies and other cut-backs, including a £500,000 cut in the funding the council gives to museums and libraries.

A substantial £475,000 of the money will come from local quango, Staffordshire Regeneration Partnership. According to the newspaper this is an umbrella organisation that encompasses the city council, Renew North Staffordshire and the North Staffordshire Regeneration Zone, who presumably couldn’t communicate with one another without it…

Worst of all, many have said that the civic centre does not need refurbishing at all, and mountains of perfectly good furniture have been disposed of and replaced at the expense of the taxpayer.

The redundancies of over 250 staff in 2006/7 resulted in a £4.5million pay out from the council who hope that this will produce net savings of over £41million over the next five years, so why can’t this belt-tightening extend to all areas of council spending?

Aside from being counter-productive, this indulgent move gives out the wrong messages to both council staff and residents of Stoke who would surely rather see this money go towards services or a tax cut? Cutting back in order to fritter any money saved on things like this, that are of no tangible benefit to the taxpayer, only serves to make the public wary of cutbacks.  From the outside it looks like they are ridding themselves of bureaucrats, only to make the ones that stay more comfortable.

Stoke Council really should be commended for attempting to make big savings by letting  unnecessary workers go, but they should be looking to pass on these saving to the taxpayer rather than channelling thousands into spin and refurbishments.

Cutbacks and savings could be the positive publicity that the council needs, but when accompanied by frivolous spending like this when services aren’t improving, local residents will continue to believe that they are losing out, and stumping up their tax money for less and less in return.

Dec 2007 17
Why have three out front when none will do?

Worrying news from Cricklade:

"NORTH Wiltshire’s top cop has warned residents in Cricklade they could be responsible for the closure of their own police station.

Cricklade Police Station, in High Street, no longer has a manned front desk due to cutbacks, but Chief Inspector Boland urged residents to use the station as much as possible.

When members of the public complained it was closed, Ch Insp Boland assured them it was manned and officers at the station would respond if they were not tied up.

"It is not closed but when the accountants come to review our expenses the first thing they will say is that it is perceived to be closed anyway’ and they will close it," he warned."

Did you follow that? Cricklade residents (aka the customers) are angry because their local police station is closed- ie if you go there you find nobody manning the front desk, and even if you shout, nobody comes. But rather than putting it right, North Wiltshire’s top cop advises them to pretend the station’s functioning properly as it is. Otherwise, he says, it will be perceived the residents perceive it’s closed, and it will be closed. Even though in real world terms, it’s closed already.

Only in Stalin’s Russia is such madness possible.

And there’s no doubt Stalin would have approved of the commissars’ programme to streamline policing by closing stations. As he would have appreciated, manned stations open to the public are a huge distraction for the police. Far more efficient if they concentrate 100% on their core function, which is to carry out orders from above.

So all over the country, stations are closing. According to the Sunday Telegraph, more than 600 have already closed since Big Government Labour came to power:

"Only one police station in eight is now open 24 hours a day and 18 out of 43 forces do not have a single station open around the clock."

It is true that new stations have opened, but these tend to be of a very different type, often closed to the general public altogether. For example, in the Met area, the plan is to close local nicks and organise policing around out-of-town mega-bases. According to the Register:

"This gives a basic blueprint along the following lines. Most conventional policing, and most police, will be at the ‘flexible warehouse’ that isn’t open to the public, but that is quite likely to occupy industrial estate sites. Visible policing (aside from the ones tearing around with flashing blue lights) will be in shop-style high street premises."

And the high street premises will be small kiosks in shops or libraries, manned by those Community Support "Numpties in Yellow Jackets" (see this blog), and only open 9-5. Need to see a cop outside office hours, and you’ll have to take your chances on waiting for a blue light car to come available. Which wasn’t good enough for 14 year old Jack Large who died earlier this month after being stabbed outside an unmanned station in Chigwell.

Regular BOM readers will already be aware of how this plays out in affluent areas. In places like Primrose Hill- part of LB Camden- local residents have given up on the police altogether, and hire private security guards to patrol the streets. That’s despite the fact that Camden reportedly has 827 police officers, 169 police staff and 98 Community Support Officers.

What do they all do? You know the answer- six out of every seven hours is spent doing admin and taking meal breaks (eg see here).

In Primrose Hill, residents buy their way round the problem. As with the rest of our dire public services, everything’s fine so long as you can afford to pay twice.

Of course, if you live in Chigwell or Cricklade and you can’t afford to pay twice, you’re stuck.

Bring on those elected sheriffs. The ones that have to serve their local customers or they get slung out.

HTP: John B

Dec 2007 17

We already have not just a two-tiered health service but a many tiered one.  The top tier is occupied by the roughly 13 per cent of the population who have private medical insurance.  The other tiers are composed of the various sections of the population who get very different results from the NHS.  A recent Civitas study exposed how the middle class are able to play the system and get better results than the poor.  With all that in mind it is pretty clear that a dogmatic insistence that everyone treated by the NHS occupy some nominal single tier is a bit of a joke.

Unfortunately, a report in the Sunday Times set out how that joke isn’t proving terribly funny for Colette Mills, a former nurse.  Her local NHS Trust uses Taxol to treat breast cancer but she thinks that her chances would be a lot better with Avastin.  She is willing to pay for the drug and any costs to the hospital associated with using it, about £4,000 in total, but is not able to afford the £10 to £15,000 cost of treating her condition entirely privately.  That would mean paying for nurses’ time, blood tests, scans and the countless other costs associated with cancer treatment.

So, let’s get this straight: the hospital she is being treated at will treat private patients with Avastin, will treat NHS patients for free but won’t let an NHS patient pay a little extra for a drug that might save her life.  All because "co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS".  Are those principles worth people’s lives?

A two-tier system will necessarily exist in any rationed healthcare system.  You’ll never be able to provide all the healthcare people can use, to everyone, at any time.  That will always leave some people, who are able to pay, wanting to buy more.  Even if you ban private treatment people can still go abroad.

With that in mind making it artificially difficult to move up a tier doesn’t strengthen the principle of a universal NHS.  All it does is mean that a lot of ordinary people can’t get drugs reserved for the super-rich.  One can believe that the NHS should provide Avastin itself.  However, so long as it doesn’t it is fundamentally inhumane to make it unreasonably difficult for people to move up a tier when their survival is at stake.  To risk Colette Mills’ death in a vain hunt for an illusory principle.

Dec 2007 17

Researchers at the Karolinska Institute in Sweden have taken a look at the amounts spent on cancer care in the UK and have found that the Department of Health’s picture of low cancer survival rates but low costs isn’t quite accurate.  The Department of Health’s analysis apparently fails to include spending by cancer care charities like Marie Curie Cancer Care.  OECD data suggests that the UK spends £143, compared to the £80 that the Department of Health claims.

While the Swedish researchers acknowledge that UK cancer spending "is a very muddy picture" where precise and reliable figures are hard to come by this is another nail in the coffin of the "spend more and the health service will work itself out" approach.  The numbers released by the Karolinska Institute suggest that the UK spends 36 per cent more on cancer care than Germany.  Despite that additional spending in the UK a German man diagnosed with cancer has a 25 per cent higher chance of surviving five years and a German woman a 26 per cent higher chance of surviving that long compared to UK patients.

Professor Karol Sikora, advisor to the World Health Organisation who uncovered these figures, offers some recommendations on how to improve the situation:

"I think we should involve the independent sector and get systems that are more efficient and we should be looking at how things are done in America and Europe – there are simply no waiting lists there.

People in Europe cannot understand waiting for cancer treatment.

That is one thing that bedevils healthcare in the UK. No-one waits 31 days for radiotherapy in Europe yet that is our new target here. Most people currently wait much longer.

There is no reason why we can move from a target driven culture to a highly efficient system with no waiting lists with the money we are currently spending on cancer in the UK."

It is the uniquely centralised, politicised and monopolistic fashion in which healthcare is organised in the UK which leaves so many paying such a tragically high price for poor healthcare performance.  As Professor Sikora says we can learn lessons from other nations in Europe who do things differently.

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