Could some of you who are canvassing on the doorstep do some pieces on the sort of feedback you’re getting and the comments people are making/concerns and issues they have? I don’t mean that in a smartarsed way – I’d really like to know what everyday punters are saying and thinking as the election draws near.

Oh, this should be entertaining.

Wait while I go and get a bag of popcorn.

The EU, perhaps get Tim W to post on why the left should oppose the EU.
The amazing thing is that it was the left who strongly opposed the EU in 60′s and 70′s. Far more than the conservatives.
Wilson although voted to remain in the EU during the referendum, he wouldn’t have been to bovvered if the answer would have been to get out. Also the SDP wasn’t set up because of the militant tendency or Clause whatever but the Labour’s anti EU philosophy.

Better comment moderation and/or log-ins so people identities are protected perhaps?

Well, since Sunny went away I haven’t a clue what’s going on with Iain Dale or Paul Staines…

More seriously, there’s a two-day PCS strike this week. How about a left-leaning site that isn’t afiliated to the SWP publishing something about union activism?

We get more on air-brushing in posters than about unions.

I second what Shatterface said above.

More posts by anarcho-syndicalists.

Though I’m interested in the Mid Staffs inquiry I think its been well covered.

I’d like some more analysis of how perceptions about the NHS are being manipulated to prepare us for more privatisation, the various restructurings there have been that may be used to break up the health service and perhaps an analysis of what the various parties are going to do with the NHS once their manifestos are out.

The involvement of private companies in healthcare provision, EG Doctor Fosters involvement with data collection, consultations with US health firms such as Kaiser Permanente and the revolving door used by ministers and civil servants from the DoH into private companies.

Thats a start

I’m new to this supposedly “left-of-centre politics” blog. I’m a bit surprised that some of the articles and many of the posters are right of centre. Nothing wrong with that, but it is misdescribed in my opinion.

David, what articles here do you consider right of centre? All the people that write them I think would consider themselves left, if you mean by posters those that leave comments then I agree with you on that.

I think you should have a word with that lovely Derek Draper and ask him if he’d like to temporarily edit this website. He has previous experience in this field, and it would certainly provide no end of entertainment for bloggers currently obsessed with writing dull articles about how there’s going to be an election called in the next 10 minutes and how bloggers are apparently going to decide who wins the aforementioned election.

In short, fewer pointless pieces about Mugabe allegedly supporting Dave Chameleon, and fewer rants about the so-called lies/misrepresentation/other horseshit about Iain Dale/Guido Fawkes/Donal Blaney/other right-wing bloggers. More intelligent pieces about the issues of the day – I would suggest getting in touch with someone such as David Osler (Dave’s Part) and see what he comes up with.

9 “I’m new to this supposedly “left-of-centre politics” blog. I’m a bit surprised that some of the articles and many of the posters are right of centre. Nothing wrong with that, but it is misdescribed in my opinion.”

That is because this site is infested with right wing trolls who are always sticking their noses into things that don’t concern them. It is a Conservative trait. They just can’t deal with other views which is why any left wing trolls are taken down on most of the Conservative sites.

‘Better comment moderation and/or log-ins so people identities are protected perhaps?’

Logins maybe, if it prevents fuckwits impersonating other people and taking threads off-topic yet again.

Couldn’t agree more Shatterface.

Following from my previous posting, here’s a brilliant paragraph from M. D. in Private Eye 1257: ” That New labour could contrive a culture where £105bn could go into the NHS and its still no safer than bungee jumping, with widespread staff shortages, overcrowded emergency departments, disillusionment and patient harm, suggests that much of our increased funding hasn’t gone where its needed. Oh, and we’re desperately short of inspirational managers who’ll stick two fingers up to Whitehall and focus on helping staff to serve their patients.”

I would also like to put our Whitehall mandarins under the spotlight. They are the one common factor in our successive shit governments. Should we have new administrations with each new legislature, like the USA? Is there a middle way? (I have attended seminars where senior civil servants have shown some very true blue colours, despite their supposed neutrality.)

I would also like to look at our transport system. Can the left find a way to improve the railways, reduce traffic congestion and deal with our responsibility to reduce our impact on the environment?

Lordy, Daniel, I’m beginning to wonder whether its your popularity or your personality that singles you out.

Yurrzem!

Both I imagine, I also think that this obsessive web stalker is particularly in wonder of me and quite determined to follow me wherever I may go, a bit like a dog but nowhere near as useful or as nice.

@15: “I would also like to put our Whitehall mandarins under the spotlight. They are the one common factor in our successive shit governments. Should we have new administrations with each new legislature, like the USA?”

As we can gather from the recurring debates about the NHS, for some any mention of markets and competition can seem heretical and the unwelcome offspring of diabolical political associations when the fact is that most economists and business people habitually revert to thinking about markets as a natural means of allocating resources between competing uses according to buyer preferences. Some civil servants do too although some believe that only with their personal intervention can the world operate as it ought to.

This doesn’t mean economists are unaware of the possibility of market failures. In fact, there is a large professional literature on market failures – a recent book on the subject being John Cassidy: How Markets Fail (Allen Lane 2009).
http://www.businessweek.com/magazine/content/09_47/b4156079791251.htm

The trouble with changing the senior civil service with every change of government is that option dumps administrative knowledge and wisdom gained with the job. Incomers have to learn afresh about what (and who) works and what (or who)doesn’t.

Politicians are apt to think that because they were elected, they are bound to be correct. Of course, the views of ministers and the Cabinet (if consulted) must ultimately prevail with Parliamentary government but as we’ve seen in the health service, ministers can be ignorant and stupid. Major IT companies have dropped out of developing a national database of personal medical records, usually after losing many millions.

Dr Brian Jones, head of the branch in the Defence Intelligence Service tasked with assessing incoming intelligence on WMD disowned the government’s dossier on Iraq’s WMD published on 24 September 2002. And he was proved to be correct. Elizabeth Wilmshurst resigned from the Foreign Office saying the Iraq war was illegal. Lord Bingham, previously Lord Chief Justice, in his book: The Rule of Law, also argues the war to have been illegal.

Thank heavens there was some sanity around at the top.

[19] “As we can gather from the recurring debates about the NHS, for some any mention of markets and competition can seem heretical and the unwelcome offspring of diabolical political associations when the fact is that most economists and business people habitually revert to thinking about markets as a natural means of allocating resources between competing uses according to buyer preferences”.

Then you are labouring (no pun intended) under a FUNDAMENTAL misapprehension.

The current NHS debate is not so much about the effectiveness (or otherwise) of market solutions, although the evidence, such as it is is, does not provide much support for them, but rather the SURREPTITIOUS trend toward covert privatisation without meaningful public consultation (until it is all rather late in the day – see proposed closure of Whittington A&E).

Maybe you can accept sneaky privatisation on the basis that anything must be an improvement on the monolith – yet curiously those areas of the NHS that have been handed over to private contractors (cleaning, IT, management consultants, ISTCs, PFIs, out of hours care, etc) have hardly been a roaring success have they?
http://www.bjhcim.co.uk/news/2008/n802034.htm

Have a look at this – another barnstorming performance from Lister, this time on the way the media mismanages important health messages;
http://www.youtube.com/watch?v=c2yOyH9pmJE

What about the paucity of coverage from outside of England, but without having to blanket cover the USA? There’s a bit of Welsh coverage from time to time, but scant little from Nthn Ireland, and not much from Scotland (how quiet has the site been about Sturgeon, and silent on Purcell?). There are other parties, left-of-centre,other than (New) Labour (not that I’d class them as left, in the slightest) here in the UK, even wielding power, but not much of a squeak on LC.

I agree with Shatterface, I think logins would help a lot. At present this is not somewhere where I would necessarily expect to find a reasoned, sustained, left of centre discussion. It’s too open to trolls, impersonation of log-ins, postings under multiple user names etc.

I suspect there are quite a few visiting undergrads from that ‘Tory madrasa’ we learned about yesterday.

http://www.guardian.co.uk/world/2010/mar/06/tory-madrasa-young-britons-foundation

@18 Bob B

I agree with the concerns about loss of experience if the civil service changed with the government. However I am also interested in the quality of civil servants and their role in government. Its too easy to just let them carry on because of the dangers of political meddling in the civil service, but I am concerned that there may be a sort of innate conservatism in the service that works against any progressive government but smoothly runs a tory administration.

At one education seminar I attended we were harangued by a senior DoE mandarin that we, “Should remember that government subsidises education in schools by 100%.” Obviously this was a while ago…

Yurrzem,

You are describing what is known to sociologists as ‘Sir Humphry’ culture, a culture of innate conservatism in the civil service, probably caused by the fact that managers are promoted from those they have trained, which is opposed to most different ideas. It is indeed hostile to socialism, but it is equally hostile to devolution of state control (and as such, has probably not been happy since Heath’s government?). There is probably a lot to say about civil servants and beauracrats in general though, and I think there would be benefit to the left in addressing the issue, rather than assuming that right-wing attacks on government mean the systems and those that run them must be good.

Shatterface @ 13 and DHG,

Unsurprisingly, I agree too! Either that or some other technical solution.

@23

Agreed, “My enemy’s enemy” is false logic.

@23: “You are describing what is known to sociologists as ‘Sir Humphry’ culture, a culture of innate conservatism in the civil service, probably caused by the fact that managers are promoted from those they have trained, which is opposed to most different ideas. ”

With respect, that’s nonsense – have you ever worked with civil servants?

Civil servants are not monolithic and nor are government departments. Argued dissent or criticism is appreciated but it better be well-argued and evidenced-based because most of one’s colleagues will be articulate and literate with good degrees.

IME the civil service is far less hierchical or inclined to be deferential than local government – and I’ve fairly long experience of both.

A true story from the 1990s – I was bounced into responding to a long policy email within 40 minutes of a deadline. A few days later, I had a pre-arranged meeting with colleagues on a totally different issue at a university. At a reception afterwards, I learned from one of the professors there that he had been sent my response for his comments – something of which I had no prior knowledge. Evidently, he regarded my comments as OK or he would have picked me up on the analysis and probably wouldn’t have mentioned that he’d been sent my comments had he intended to demolish them. Now that is the real civil service culture at work and that kind of double checking with external experts is fairly common place.

Look at the recent reported comments by Sir Alan Budd, chief economic adviser in the Treasury and head of the government economic service 1991-97, on his concerns about the risks of a double-dip recession in the event of early steep cuts in public spending:
http://www.independent.co.uk/news/uk/politics/tories-economist-criticises-partys-plan-for-cuts-1917785.html

Check out his academic background:
http://en.wikipedia.org/wiki/Alan_Budd

In the context, does he strike you as anything remotely like the Sir Humphrey character in the “Yes, Minister” series?

Btw it tends to get overlooked that only c. 18% of the civil service work in London and only c. 12% in central London.

A&E,

Maybe you can accept sneaky privatisation on the basis that anything must be an improvement on the monolith – yet curiously those areas of the NHS that have been handed over to private contractors (cleaning, IT, management consultants, ISTCs, PFIs, out of hours care, etc) have hardly been a roaring success have they?
http://www.bjhcim.co.uk/news/2008/n802034.htm

I have been following the NHS IT programme. Fault does not wholly lie with the private sector but once again the failures common to large government IT projects (and, I suspect, other government projects). Being overly-prescriptive from the centre, changing specifications throughout development, and underestimating the work required from the start, do not seem to be factors conducive to success. ]

Nor is, it seems, allowing Tony to get involved.

@26.

A culture does not need its members to fit a stereotype. The problem with civil service is that whilst only a proportion work in London, those levels dealing with policy and implementation (instructions rather than actions) are located there. I have dealt with these folk also, and I have no problem with this.

Incidentally, conservatism does not imply lack of consultation or professionalism. In fact, I would say excessive consultation would be more likely, and a very high level of professionalism. Does it not concern you that you defence against my accusation of instutionalised opposition to radicalism is to show that they send comments on comments for consultation? It implies they do not see their job as making recommendations and supporting, but rather collating and building consensus.

[27] agreed – private providers, per se, cannot be blamed for the NHS computer, but neither can they take much credit for their role in this costly debacle?

Maybe Accenture were right to bail out, although this report claims they were squabbling with contractor while being taken to task by the very medical staff they were meant to be assisting;
http://www.independent.co.uk/news/business/analysis-and-features/16312bn-nhs-computer-upgrade-faces-fresh-turmoil-418040.html

The NHS overlords who awarded contracts in the first place, hardly come out of it looking well, either?

I accept that in some instances a private provider might be the preferred option but let’s at least have some transparency (not to mention evidence) in the processes, otherwise we might end up with more crappy projects involving large vans and MRI scanners operating out of a hospital car park;
http://www.timesonline.co.uk/tol/news/uk/article517898.ece

@28: “Does it not concern you that you defence against my accusation of instutionalised opposition to radicalism is to show that they send comments on comments for consultation? It implies they do not see their job as making recommendations and supporting, but rather collating and building consensus.”

No, I’m not in the least concerned. On innovative technical issues, when the technology envelope is rapidly expanding, it is very sensible (on the prudential principle) to seek and check out alternative sources of informed advice.

One of Churchill’s great strengths as PM during WW2 was his willingness to keep around him competing sources of scientific advice and intelligence on defence and weapons systems: Prof Lindeman, his personal scientific adviser, and RV Jones, often disagreed. See: RV Jones: Most Secret War.

Around the mid 1990s, there was a conspicuous powerful political lobby for public spending in the order of £15 to £20 billion to put down a national fibre optic network for wide broadband. At the time, I was suggesting that ADSL, using existing telephone cables, would be a more cost-effective solution and that is what most of us are using right now.

It would seem the civil service can’t win whatever it does on your view. Either the civil service is consulting externally – in which case they aren’t being pioneering and innovative – or they aren’t consulting, in which case they are being imperious and foolhardy by failing to seek external advice when the range of feasible policy options is opaque or disputable. Thanks.

Consider the Iraq war: Dr Brian Jones, head of the branch in the Defence Intelligence Service tasked with assessing incoming intelligence on WMD, disowned the government’s dossier on Iraq’s WMD published on 24 September 2002. And he was proved to be correct. Elizabeth Wilmshurst resigned from the Foreign Office saying the Iraq war was illegal. Lord Bingham, previously Lord Chief Justice, in his book: The Rule of Law, also argues the war to have been illegal.

In contrast, from testimony at the Chilcot inquiry, government ministers can’t even converge on the rationale for starting the Iraq war:
http://www.guardian.co.uk/politics/2010/mar/08/david-miliband-iraq-war-inquiry

According to Iraq government estimates, about 100,000 Iraqi civilians have been killed as the result of the war.

@29:

New Labour health ministers failed to ask the most obvious, basic questions about IT policy for the NHS.

- How do other west European countries manage without constructing national databases of personal medical records and yet achieve better patient outcomes in terms of life expectatncy, cancer survival rates etc?

- As an alternative to commissioning a national project costing – at the latest estimates – £12.7 billions, isn’t it feasible to set out a code of practice and computer protocols for communications and interchange of data and allow hospital trusts to buy and adapt off-the-shelf software? Reportedly, this is what some trusts have done.

Btw “The multibillion-pound national progamme to overhaul NHS computer systems could be cancelled in this week’s Pre-Budget Report, Alistair Darling has said.”
http://business.timesonline.co.uk/tol/business/economics/pbr/article6946336.ece

Try this from EIGHT years ago in The Economist for 2 May 2002 (sorry, subscription only):

“Government IT disasters: IF GORDON BROWN is still basking in the apparently widespread approval for his plans to revive the National Health Service with a massive transfusion of cash, a small item of seemingly unrelated news last week, reported in Computer Weekly, should worry him. A leaked memo from the Lord Chancellor’s department indicated that Libra, a £319m IT project designed to link magistrates’ courts with other organisations, such as the police, customs and the Crown Prosecution Service, was on the brink of collapse. Libra’s problems are the latest in a long list of government IT horror stories (see table) which bode ill for the government’s ambitions. NHS reforms, like all public service improvements, depend heavily on IT. . . There is now a raft of Whitehall-wide guidelines aimed at trying to learn from past mistakes. These include: the need for projects to be ‘owned’ by one responsible and competent individual; recognition of the fact that projects are often over-ambitious and need to be broken down into bite-sized chunks; the realisation that the way people work has to change when new technology is installed; the importance of drawing up contracts that have the right mix of sticks and carrots to make vendors deliver on their promises; and, above all, the need for clear and precisely-defined objectives. . . ”
http://www.economist.com/displaystory.cfm?story_id=E1_TTTTJJD

@31

Some figures concerning the cost of the NHS programme for IT put the spend at over £20bn. It is an absolute disaster that needn’t have happened.

How much treatment, how many nurses, has this fuckup cost?

A&E,

Maybe Accenture were right to bail out, although this report claims they were squabbling with contractor while being taken to task by the very medical staff they were meant to be assisting;

The article does not say Accenture were taken to task by medical staff, it says “the project has been… dogged by criticism” from medical staff.

I do not know what happened with Accenture. Regardless, the NAO’s list of eight of the most common reasons for IT project failure do not include issues with the private sector, they are all about incompetence in the public sector.

Look, I am not denying that a company might take advantage of public sector incompetence and there have been occasions on which companies have been dishonest about what’s going on. I seem to recall that one of the companies involved in NHS IT fiddled their accounts, too, and later went under.

But what I am trying to get at is that it’s in the nature of how such decisions as “let’s improve NHS IT” end up being made in government that lead to such huge risks and costs and failures.

Including in this case, because it’s related to our health, risks to our very lives.

As Bob B asked, “isn’t it feasible to set out a code of practice and computer protocols for communications and interchange of data and allow hospital trusts to buy and adapt off-the-shelf software?”

And the answer is “yes it is”, and yes it was, and yes the government was advised that this was the case during consultation well before the contracts were drawn up. But because certain people wanted a legacy system and to spend lots of our money gift us with their largesse, etc, we are where we are today.

(iow, had we not been so centrist, Accenture wouldn’t have been among few companies involved, the risk would be mitigated, etc.)

You see this sort of thing time and time again, which is why the NAO writes about it (and do note that we rarely see the version that hasn’t been through the clearance process, where the criticised party gets to delete some things they aren’t happy with).

/rant

[33] Unity, few would argue that since it’s inception the implementation of the national NHS computer system has been profoundly flawed – but I think the million dollar question remains WHY are NuLab so committed to such a grandiose project? (leaving public sector incompetence to one side for the moment).

Personally, I think the simple answer, and the reason why NuLab have plowed on despite the army of head-shakers and finger waggers, is because a national computer (ultimately) enables a comprehensive billing system for EVERY episode of treatment in an NHS hospital – in short, a national network is an essential precursor to the breakdown and privatisation of the NHS.

Let’s face it, none of the major parties (since the days of Thatch) have had the balls to openly admit that burgeoning privatisation is the longer term objective of both main parties, but mark my words the supa-computer is an essential step in this unstoppable (yet barely admitted) process?

A&E, it could well secretly be about billing, you may be right, but again there is no need to go to the lengths they have gone to. I think the grandiosity of the project is attractive to the overlords. Remember, Tony was told by experts that if he wanted everyone to have a standardised electronic medical record the best way was to set a minimum standard and let the NHS Trusts figure about the best approach for themselves – he instead plumped for the whole thing being directed from the centre, mandating purchase from five or six big suppliers (one of which went under, another of which pulled out).

I think it is about willy-waving (“the biggest IT project in Europe!”) and anally retentive, centrist control over the tiniest details.

(Incidentally, please don’t misunderstand, I’m not blaming everyone in the public sector or saying they are incompetent – far from it – I am saying that our political masters make particular decisions and the nature of how they are made as well as the decisions themselves leads to high risks and costs. And no-one is held to account.)

… and collecting records on everyone for administrative convenience.

…he instead plumped for the whole thing being directed from the centre, mandating purchase from five or six big suppliers (one of which went under, another of which pulled out). …

Worth noting that some suppliers did not want to touch this with a barge pole.

@34: “because a national computer (ultimately) enables a comprehensive billing system for EVERY episode of treatment in an NHS hospital – in short, a national network is an essential precursor to the breakdown and privatisation of the NHS.”

How do all those other countries manage without constructing national databases of personal medical records at a cost to taxpayers of £12.7 billions?

To change tack as this is an open thread, shouldn’t we discuss this issue in today’s news?

“The government target of getting 50% of people under 30 into higher education should be scrapped, the Association of Graduate Recruiters (AGR) has said. It also wants a phased increase in student top-up fees by 2020, with safeguards for disadvantaged families.”
http://news.bbc.co.uk/1/hi/education/8556231.stm

FWIW I think we need to worry more about getting a larger percentage of 16 year-olds up to the benchmark standard of 5 GCSEs at A*-C grades, including maths and English, than getting 50% of the under 30s into higher education. At present, less than half 16 yr-olds can reach the benchmark.

In deciding the percentage of 30 yr-olds who go into higher education, it makes sense to look at how much of a premium in earnings graduates attract over non-graduates:

Try this report of research published last September:
http://www.timesonline.co.uk/tol/life_and_style/education/student/article6843191.ece

The rise in the drop-out rate from universities is one reason for worrying about whether the current 44% or so of under 30s who go into higher education is too high:

“There has been a rise in the drop-out rate at UK universities, figures show. Annual performance indicators from the Higher Education Statistics Agency show 7.4% of young undergraduates left after a year in 2007 against 7.1% in 2006. State school pupils made up 88% of young undergraduates, up from 87.8%, and 9.7% were from low participation neighbourhoods, up from 9%.”
http://news.bbc.co.uk/1/hi/education/8083373.stm

Btw some 93% of all pupils at schools are attending maintained schools – less than 7% attend fee-paying schools.

[38] “How do all those other countries manage without constructing national databases of personal medical records at a cost to taxpayers of £12.7 billions?”

You misunderstand – I’m not saying that there HAS to be a national computer system (for a billing) just that this property was the main driver for NuLab’s folly.

At present we are sleep walking toward increasing fragmentation of health services (a development the public are largely unaware of) and now we have the electronic means to itemise every single treatment, or intervention.

Now given that clinical activity is captured electronically in the general medical notes why on earth are separate entries required (on a separate part of the computer system) whenever a procedure is performed, an investigation is initiated, or medication is administered?

My guess is that when a polyclinic, for example, is handed over to Richard Branson there is already the means to bill the PCT for every single item of work carried out by minions of the bearded entrepreneur?

Here’s the sort of menu that in the not too distant future we can all come to expect as our health care is handed over to the market;
http://www.casualtyplus.co.uk/page.php?n=100

Hi Bob,

By coincidence, we’ve got a post on this subject going up at lunchtime, comparing British and German responses to youth unemployment.

More generally, thanks to everyone who has commented and made requests – hopefully you’ll see some of these subjects being covered over the next few days.

@40: “At present we are sleep walking toward increasing fragmentation of health services (a development the public are largely unaware of) and now we have the electronic means to itemise every single treatment, or intervention.”

In today’s news:

“Patients are routinely being treated in areas of hospitals not designed for care, a Nursing Times survey has revealed. Nurses are being asked to treat patients in store rooms, mop cupboards, wards that are already full and, in one case, a kitchen area.

“In a Nursing Times survey responded to by more than 900 nurses, nearly two thirds said patients at their hospital were being treated in areas not designed for clinical care. They highlighted threats to safety including patients having no access to call bells, water and suction facilities, missing emergency equipment, risk of infection and fire exits being blocked.”
http://www.nursingtimes.net/whats-new-in-nursing/news-topics/nursing-quality/full-hospitals-are-treating-patients-in-non-clinical-areas/5012320.article

[43] the issue of capacity in the NHS has been raging ever since this infamous quote, by Dr Gill Morgan – “But we won’t be able to make these changes and invest in the community unless people start to abandon the idea that (hospital) beds are sacred. They are just a piece of furniture, that’s all.”
http://www.guardian.co.uk/uk/2006/may/21/politics.health

From the same item in the Guardian it was noted that “although the NHS has lost more than 25 per cent of its beds since 1984, ‘There are a lot of beds that could still go (according to Dr Morgan). It’s hard to predict how many because the numbers will differ between areas.’ – perhaps an important variable is the amount of cupboard space available in each hospital?

Alternatively we could reinstate much longer waiting lists, or perhaps introduce an elaborate system to deny patients access to care much like the do in the States?

Maybe Branson will provide some exciting solutions?

Oops [43] refers to [42] ……… but I’m sure you’ve worked that out.

I’m a little concerned that there’s been no response to the whole “violent crime up 44% thing.” A lack of response from the Guardian and the BBC has just added fuel to the raging blue (f)ire.

I mean, apparently the research librarians worked out that when police were asked to report every crime in 2002, the numbers shot up by 23%.

I’ve not seen any explanation as to how this figure was derived, or any serious rebuffing of this claim.

You misunderstand – I’m not saying that there HAS to be a national computer system (for a billing) just that this property was the main driver for NuLab’s folly.

I see no evidence for that. I see evidence for taking the opportunity of turning improvement in NHS IT (which apparently everyone involved supported – they just disagreed about the extent and the method) into a centrist vanity project. As Bob B suggested, there are surely other ways to bill patients than spend £12.4bn (and the rest).

In this context privatisation of the NHS per se is irrelevant – what concerns me is why decisions are made, how decisions are made, the outcomes of decisions, and how we can mitigate the costs and risks. I have only talked about government IT because I started looking into it due to the privacy implications of some projects. Many of the projects seemed to be plagued by common problems and I subsequently had this opinion confirmed by the NAO when I discovered its report on the eight most common problems. Unless one takes such an interest one has no idea at all about how much of our money is being pissed away as a result of centrism, incompetence, and vanity. And I think it is reasonable to suspect that this is not limited to IT projects.

We know, because we have lots of evidence (e.g. that NAO report again), that high risk and cost is inherent in the nature of particular decisions, but our beloved leaders keep making those same decisions. We know what failures to avoid but we do not avoid them. Why not? And why aren’t people held to account? And there is active deception, too. Why?

This unnecessarily costs us money (in the billions), time (in years) and, in the case of the NHS, people’s lives (when records are corrupted or missing).

A dossier of failure.

[46] “what concerns me is why” – well, NuLab are hardly likely to announce that such a network will make the billing process so much more convenient as covert privatisation continues to be rolled out across the NHS, are they?

I agree entirely that our money has been pissed away while accountability, as ever, is virtually non-existent – such points are made ad nauseam by the likes of Wat Tyler, amongst others.
http://burningourmoney.blogspot.com/2006/01/spinal-problems.html

I have repeated the very same message on a recent LC thread only to be shot down by one commentator who had a go at me for criticising public expenditure when the likes of the banking sector has been guilty of far more serious financial misjudgement and waste.

So perhaps we are going round in circles?
Most, including myself, agree the NHS IT system was doomed from day 1, not least by the hubris of it’s architects – while the true motives for it’s conception are about as easy to tease out as the events that precipitated the invasion of Iraq?

Today the privatisation issue might seem ‘irrelevant’ but once markets really begin to effect the way we access health in the UK, I feel certain the NHS IT project will be viewed as an important plank in the transition from a public system to one dominated by a small number of ‘for-profit’ health conglomerates – at least Wat Tyler will be happy about that?

@46:

Failings in managing large computer projects in Britain aren’t peculiar to the public sector, hence this news report about the London Stock Exchange:

“City in £275m computer fiasco: Stock Exchange chief resigns after Taurus shares system is scrapped, threatening 1,000 jobs”
Independent, 12 March 1993

Nor is it a peculiarly British syndrome. Infamous examples from other countries include the abandoned, multi-million Denver Airport Baggage Handling System in the land of the free:

The airport’s computerized baggage system, which was supposed to reduce flight delays, shorten waiting times at luggage carousels, and save airlines in labor costs, turned into an unmitigated failure. An opening originally scheduled for October 31, 1993 with a single system for all three concourses turned into a February 28, 1995 opening with separate systems for each concourse, with varying degrees of automation.

The system’s $186 million in original construction costs grew by $1 million per day during months of modifications and repairs. Incoming flights on the airport’s B Concourse made very limited use of the system, and only United, DIA’s dominant airline, used it for outgoing flights. The 40-year-old company responsible for the design of the automated system, BAE Automated Systems of Carrollton, Texas, at one time responsible for 90% of the baggage systems in the US was acquired in 2002 by G&T Conveyor Company, Inc.

The automated baggage system never worked well, and in August 2005, it became public knowledge that United would abandon the system, a decision that would save them $1 million per month in maintenance costs.
http://en.wikipedia.org/wiki/Denver_International_Airport

Its plain to me that I’m not alone in my concerns about healthcare privatisation. New Labour’s excesses have given any incoming tory administration carte blanche to carry out their most extreme privatisation fantasies while the british public buy lottery tickets and the Daily Mail and fantasise about the value of their houses.

I know the NHS is huge and Labour poured billions of pounds into it, but who got the money and why have things not commensurately improved?

The fact that all parties claim to support the NHS indicates they understand how much the public value it and daren’t openly talk of privatisation even though they plan to give in to those nice lobbyists from Doctor Foster, Kaiser Permanente and Virgin etc. and get cosy jobs like Milburn and Hewitt when they leave parliament.

The roots of the current situation need examining as well as the likely outcomes of any manifesto promises (and omissions) once published.

Bob B,

Failings in managing large computer projects in Britain aren’t peculiar to the public sector … Nor is it a peculiarly British syndrome.

Of course – I’m sure there are lots of vain, managerialist incompetents all over the world.

I posted a response to A&E before my comment at 51 – is moderation turned on, or something?

A&E,

Most, including myself, agree the NHS IT system was doomed from day 1, not least by the hubris of it’s architects – while the true motives for it’s conception are about as easy to tease out as the events that precipitated the invasion of Iraq?

I disagree. I dare say most people quite innocently wanted to improve NHS IT and everyone involved appeared to agree that it needed updating. However, Labour was involved and their modus operandi once again became apparent: vanity, hubris, political expediency, and managerialism. I think that in terms of the NPfIT there is ample evidence for this.

[53] NuLab would NEVER openly admit that they intended to privatise the NHS?
I’m sure they have calculated that there would be too much resistance if such a proposal was put to the electorate in such bald terms.

Instead, NuLab ushered in a series of measures (over time) that were intended to create the sort of conditions that the leaves the NHS ripe for take over by the private sector.

Each of theses developments have been wrapped up in the usual jargon and NuLab bullshittery – even so eye brows were certainly raised after the introduction of ‘payment by results’;
http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/NHSFinancialReforms/DH_4065236

According to this source – “one of the purposes of PbR is to allow the private sector to compete with NHS facilities by opening market entry points in nearly every form of care”.
http://www.labournet.net/ukunion/0610/nhspriv1.html

Needless to say PbR becomes far easier to implement once a sophisticated IT system is in place to itemise a complex array of investigation and treatments, not to mention chasing payments for a growing multitude of providers.

Two unrelated and coincidental developments?
I will leave others to draw their own conclusions as the concept of the NHS as a public service continues to unravel.

Did sunny fly ? I think we should be told

A&E, let me clarify what I mean about privatisation being to me irrelevant as a motive in this context, because I wasn’t clear. Suppose a PM says he wants to improve NHS IT with a view to covertly privatising the NHS. The advice is that he could do it in a particular way, e.g. set minimum standards and let NHS Trusts decide for themselves, they could buy off-the-shelf tech if they wanted, and it’s estimated to cost £1bn. On the other hand, if he wanted to be able to PR it, especially as there is an election approaching, and to control it from the centre and leave a legacy, etc, it will cost £10bn. What do you think Labour would go for?

As for privatisation itself I have no opinion on it. You could well be right – I have no idea.

“Privatisation” probably isn’t a term with the correctly intended connotations here. I believe the Blairite stratgey for the NHS was to create verging on independent autonomous hospital trusts run with minimal centralised supervision from Whitehall.

That was the objective Alan Milburn was working towards but he ran into hassle from the Treasury over (understandable) concerns that it would become politically impossible to close independent NHS hospital trusts which, in the absence of central supervision, had been mismanaged and run up huge debts. Taxpayers would become obliged to bail out such hospitals to prevent unacceptable gaps in local healthcare provision. That argument wasn’t resolved though I should like to know how issue is resolved in those other west European countries which have nothing comparable to our centrally managed NHS.

One – likely the main – rationale for the national database of personal medical was what I dub: industrialised healthcare.

The motivating idea was that increasing numbers of patients could be treated at the proposed polyclinics (alternate name: Local Care Centres) by any qualified medic, in all probability someone the patient had never met before and might never see again.

The national database would allow the duty medics instant access to any patient’s personal medical records. Out-of-hours physicians standing in for GPs would also have instant access to personal records, which might avert some potentially harmful clinical decisions.

One purpose of the polyclinics – which are going ahead btw – is to alleviate pressures on hospitals for a range of fairly routine diagnostic tests regularly prescribed by GPs and for some daycare treatments currently undertaken in hospitals, as well as treatment of many non-urgent A&E cases.

As medics will advise, percentages of patients turning up at A&E departments are not really in need of immediate, acute care. The fact is that some patients turn up at A&E departments, which are costly to run because of the specialised staff and equipment required for trauma cases, when the patients could readily go to their own GP or to local care centres because the specialised skills and equipment are unnecessary. This change is (sorely) needed to reduce the high costs of providing A&E departments – there are reports around that up to a third of A&E departments in London will be closed or switched in status from A&E to “Urgent Care”.

“Privatisation of the NHS” is, I fear, another of those politically motivated scare stories which hinder illuminating analysis of real issues of healthcare policy. How do they achieve better – or as good – patient care in other west European countries without a massive, centrally managed structure like the NHS?

[58] remember that Talking Heads song – ‘Once in a Lifetime”
And you may find yourself behind the wheel of a large automobile
And you may find yourself in a beautiful house, ………. with a beautiful wife
And you may ask yourself – well, HOW DID I GET HERE?
http://www.youtube.com/watch?v=I1wg1DNHbNU

Not a scare story but work in progress – a process being implemented over time to overcome the hurdle of public resistance to loss of a popular, and cost effective institution.

Perhaps all the other medical bloggers and commentators are wrong as well?
http://www.guardian.co.uk/society/2006/jun/30/health.politics
http://www.guardian.co.uk/politics/2005/may/24/society.publicservices
http://gillgeorge.wordpress.com/2007/11/27/ara-darzi-privatisations-biggest-fan/
http://drgrumble.blogspot.com/2009/08/why-is-nhs-being-privatised.html
http://nhsblogdoc.blogspot.com/2008/02/dr-chisholm-and-dr-fradd-are-honourable.html
http://news.bbc.co.uk/1/hi/health/4274164.stm

Dear mods, I posted a response to Bob B @57 last night but it seems to have been lost.

Bob B,

One – likely the main – rationale for the national database of personal medical was what I dub: industrialised healthcare.

This seems a reasonable point and in itself I don’t think we know whether “industrialised healthcare” is a good or bad thing. There is also the usefulness of such a large number of records to researchers.

But again, if these were among the intentions, there are different ways of fulfilling them. What need is/was there for the DoH to have have access to identifiable health information on the whole UK population? And, perhaps more shockingly but not a surprise if you follow such things, why should the DWP be allowed access to it? Why did the original plan not allow for anonymity or pseudonymity of records given to researchers? And years later why are we still arguing about consent (people are being made to jump through hoops to opt out)?

There is nowhere the state can’t go and nothing it may not interfere with. That’s what this government appears to think. The public purse is their largesse. Our data is not our own.

(* This situation has changed somewhat but these were real concerns at the time as my link describes. To me and others though these are no-brainers: there is no need for someone in the DoH to have our full medical records.)

How do they achieve better – or as good – patient care in other west European countries without a massive, centrally managed structure like the NHS?

A question people seem to be unable to answer.

[58] “How do they achieve better – or as good – patient care in other west European countries without a massive, centrally managed structure like the NHS?” – “A question people seem to be unable to answer”.

Maybe because it is one that cannot be answered?

First of all, whenever we talk ‘Europe’ we are actually talking about 50 different countries. Each will have variable standards in data collection, and so on, there are certainly significant methodological issues in the way data is captured or compared.
Try this item to start with;
http://www.ief.es/Publicaciones/Revistas/PGP/49_Health.pdf

These authors conclude;
“Nevertheless, methodological issues in relation to performance indicators remain. As a result, a careful consideration of possible approaches to measure health system performance is needed while employing health performance indicators”.

While theses commentators claim;
“Processes of privatisation and liberalisation around the world would lead us to expect a growth in the private provision of health and social care services, which in turn we would expect to lead to a growth in the international trading of such services. However, THE AVAILABLE DATA ARE NOT ADEQUATE to allow us to develop a clear and comprehensive picture of the scope and nature of this emerging world market. What data do exist may take a variety of forms and be pitched at different levels of analysis. Such data may be focused at the level of firms providing such services, at the national level; at the level of regional organisations and agreements; or at the level of international organisations and agreements. This article discusses the methodological problems and challenges of attempting to integrate such diverse forms of data and levels of analysis. It is concluded that a comprehensive analysis must not only include all of these levels, but take account of the ways in which processes at different levels may interact to reinforce the tendency towards trade in healthcare services.
http://journals.cambridge.org/action/displayAbstract;jsessionid=57D931753070FABB8202DBE9BEC36FA3.tomcat1?fromPage=online&aid=340975