Tuesday, May 20, 2014

An unmentionable triumph of privatization in a British hospital

You might think that if one of the Government’s most controversial decisions had been triumphantly vindicated, they would be  shouting the good news  from the rooftops. But not, apparently, if it involves the NHS.

Last week, Hinchingbrooke Health Care NHS Trust was named the top hospital in England, based on 12 indicators for  ‘outstanding performance in high quality care to patients’.

Hinchingbrooke, in Cambridgeshire, had been the only small hospital even to make it onto the shortlist in the 25th year of the annual CHKS Top Hospitals Awards.

Yet the expert panel awarded it the coveted first prize ahead of such leading NHS foundation trusts as Guy’s and St Thomas’ and Chelsea and Westminster.

But Hinchingbrooke is unique: it is the only NHS district general hospital to have been put under the control of a private company — the Circle Partnership, which is co-owned and run by doctors and nurses.

In 2011, Hinchingbrooke was failing, having had three notices served because of ‘inadequate’ results in accident and  emergency, colorectal and breast cancer treatment.

But when the Conservative-led Government approved Circle’s bid to take over its running, there were dire warnings and howls of fury from the unions and the Labour Party.

Unison declared: ‘This is a disgrace, an accident waiting to happen, putting patients at risk.’ Andy Burnham, the shadow health secretary, protested: ‘This is not what patients, public or NHS staff want.’

Yet when I visited Hinchingbrooke in 2012, it was clear that the staff there felt invigorated and liberated, now they were no longer under the intensely bureaucratic management of the NHS.

Its medical director, Dr Hisham Abdel-Rahman, told me: ‘You had to almost kill yourself to get what you needed. The system positively encouraged people to coast — you move up a grade and get more money just on the basis of another year served. Now it’s on the basis of what you have achieved of agreed objectives in  clinical performance.’

And another long-term Hinchingbrooke employee, Jenny Williams, said: ‘Under the NHS routine you have to go through a particular supplier. I remember being told if I wanted a new dishwasher it would cost £5,500 — I’m not kidding.

‘Now I’ve been allowed to find one myself — for £99. All I need is something which gets up to 100 degrees and kills germs. I don’t need something which can give me the time in three different languages.’

The point is that such attention to value — standard in the private sector — releases resources to be devoted to improving patient care.

And with the NHS heading for a funding shortfall of an estimated £30 billion a year by the end of the decade, truly radical improvements in medical productivity are essential. Last week’s news that cancelled operations had hit a ten-year high is just one indication of what the public can expect otherwise.

Indeed, as one Circle Partnership doctor told me last week: ‘I’m deeply worried that as things stand, there will be further disasters like Stafford [where 1,200 people died “needlessly”]. More and more NHS hospitals are being put into “special measures.”’

His frustration is all the greater because Circle’s attempts to get the Government to allow it to bid to take over the management of other failing hospitals have been greeted with not the slightest suggestion of enthusiasm by the Department of Health.

In March, George Eliot Hospital  in Nuneaton, Warwickshire, in special measures for having high death rates, was stopped from going into a Hinchingbrooke-style franchise.

This seems incredible, given the success Circle has made in Cambridgeshire by returning power to clinicians and nurses — in stark contrast to the bureaucrat-led model that became standard within  the NHS.

The reason is that the Conservatives have decided the words ‘privatisation’ and ‘NHS’ together are electoral poison for them in the run-up to the General Election. Indeed, I’m told that Lynton Crosby, the formidable Australian political tactician managing their election campaign, has ‘forbidden any discussion of the NHS’.

So, when Ed Miliband last week declared that the Tories were ‘putting the principles of competition and privatisation at the heart of the NHS.

That’s why it’s going backwards’, not a single Conservative spokesman pointed out that Hinchingbrooke’s winning of the top hospital  award refuted the Labour leader’s accusation that competition was putting the NHS ‘backwards’.

This is shameful, not least because it would have been a much-needed recognition of what the doctors and nurses at Hinchingbrooke have achieved — in the face of a continuing campaign by the unions nationally to have Circle’s management contract cancelled.

It also underestimates the intelligence of the public, who are content with the fact that GP practices are private partnerships, not owned or run by the NHS monopoly.

Thus, when a polling organisation presented the public with the statement that ‘it shouldn’t matter whether hospitals or surgeries are run by the government,  not-for-profit organisations or the private sector’, no less than 83 per cent agreed.

In Germany and France, it is completely normal for private healthcare firms to run hospitals caring for patients within the state insurance scheme.

Unfortunately, many on the Left in this country are still much more concerned about how a service is provided than whether it is any good.

This ideology has actually been revived by Labour under Ed Miliband. His shadow care service minister, Liz Kendall, said back in 2008 that ‘opening up NHS services to new providers — including from the  private and voluntary sectors — can help challenge under-performing parts of the system’. She wouldn’t be allowed to say that now — even though she had been right.

Similarly, in 2007 Andy Burnham declared: ‘Now, the private sector puts its capacity into the NHS for the benefit of NHS patients, which I would think most people in the NHS would celebrate.’ Indeed, as the final Health Secretary of the last Labour government, Burnham set in train the process that ended up with Circle taking control of Hinchingbrooke Hospital.

Now, under Miliband’s comprehensive rejection of public sector reform (to the delight of trades union leaders), Burnham is in the absurd position of criticising the sort of policies he promoted when in power.

Yet even that is less absurd than the Conservative Party’s Trappist silence at the remarkable success at Hinchingbrooke. It could have exposed Labour and the unions as NHS scaremongers. Instead it has run scared of any debate at all.

What a betrayal of principle — and of some wonderful doctors and nurses.


Hagel: Military Should Review Transgender Ban

The prohibition on transgender individuals serving in the U.S. military "continually should be reviewed," Defense Secretary Chuck Hagel said on Sunday.

Hagel did not indicate whether he believes the policy should be overturned. However, he said "every qualified American who wants to serve our country should have an opportunity if they fit the qualifications and can do it."

A transgender individual is someone who has acquired the physical characteristics of the opposite sex or presents themselves in a way that does not correspond with their sex at birth.

A panel convened by a think tank at San Francisco State University recently estimated that about 15,450 transgender personnel serve in the military and in the National Guard and Reserve.

In 2010, Congress passed legislation allowing gays and lesbians to serve openly. Hagel said the issue of transgender people serving in the military is more complicated. He said "these issues require medical attention" that at times cannot be provided in austere locations.


An apology to all the mothers I used to hate

“I have to get out of this neighborhood,” a young woman wrote on a real estate website. “There are too many [mom]s. I keep almost getting run over by huge strollers. Some of these moms seem to use their babies as an excuse to be rude, pushing everyone else out of the way.”

Not too long ago, I would’ve nodded along. So many times I’d been impeded in the grocery store, backing up through a narrow aisle with a menacing double stroller coming at me from the other end.

“Sorry! I’m so sorry!” the moms usually said, but I barely heard them. I was in a hurry.

Reading the young woman’s comment now, I feel a little hurt. An excuse to be rude? Have you tried navigating a city footpath with an infant stroller? I want to ask her. It isn’t easy! It’s like an obstacle course with a crying baby and deep social potholes thrown in. When I first ventured outside after having a baby, I felt like all I did was apologise and try to stay out of people’s way. I felt slow, off-balance, distracted. I was trying to do five things at once. I was trying to muster a smile at the same time.

I remember, when my baby was new, meeting a group of other inexperienced moms at a restaurant. I parked in the back, pulled my wriggling baby out and settled at a table, leaving a trail of fuzzy hats, nappies, and brightly colored baby toys in my wake. I was awkward. Things that I had once done without thinking, like taking the train or using a public bathroom, now seemed complicated and overwhelming. But worst of all, I couldn’t help but notice that everyone hated me.

OK. That’s an exaggeration. Not everyone hated me. Some people cooed at the baby and called, “Congratulations!” and “He’s adorable!” (my daughter apparently gives off distinctly male vibes). But much of the casual compassion I’d experienced during my pregnancy had been replaced with expressions that plainly read “not another damn mom with a stroller clogging up the footpath", and it was worse in restaurants. It was especially bad when I was out with other new mothers. Young women at the next table over shot us annoyed glances that grew openly hostile as the babies began to fuss. They had laptops, they were trying to do important things on them, and we were interrupting everything.

During the winter, it isn’t easy to get together with other mums and babies in the city. There isn’t enough indoor space anywhere. Apartments are small and so are cafes. The park is freezing. It’s something that I’d never given a moment’s consideration until I had a baby. When I became a mother, I started thinking differently about many things, and the animosity between the young women at the next table over and the new moms suddenly struck me as strange, disorienting.

Maybe because I had just a moment ago been in the other camp.

We are so close together, our lives are practically brushing, like our nappy bags and sleek purses. We are just a phase or two apart. I was a single woman and then I was a married woman and eventually I had a baby and guess what? This is all very, very ordinary. These are predictable, normal phases of life. Which is not to say, of course, that everyone will experience them or wants to experience them. This isn’t a judgment about any of that. I really don’t care if you decide not to have kids or to never marry.

What I mean is, if you do decide to get married and have a baby, you will find yourself suddenly like me, the way I found myself suddenly like the women whose strollers I’d hopped around in the grocery store. I was an unattached young woman who couldn’t be bothered to sympathise, and then one day I was a mother, my world automatically, unavoidably redefined.

But of course, I was the same woman all along. And sometimes I still feel like the woman at the next table over, rolling my eyes at my friend, inconvenienced by the loud, cluttering mums’ group. That was just three seconds ago. I blinked, and now I’m here.

I guess this is just human nature. Us/them. The satisfying, reaffirming dismissal of the “other,” whatever that other currently is.

But still, I wish I could retroactively apologise to those moms apologising to me in the grocery store.

OK, I’ll just do it: I’m sorry, moms! I didn’t know. Now I do. I’ll try to be more compassionate, in the future, about the other people who are doing something I’ve not yet done. Even if I never end up doing that thing. It’s still better to be compassionate.

Also, as a continuing favour to all you people without babies out there, I will make a huge effort not to run you over with my stroller. I swear.


US legal bubble can't pop soon enough

by Jeff Jacoby

IS AMERICA'S lawyer bubble getting ready to pop?

Critics have long bewailed our national glut of lawyers, to little effect. Chief Justice Warren Burger predicted 35 years ago that America was turning into "a society overrun by hordes of lawyers, hungry as locusts." At the time, the population of attorneys in the United States had surpassed 450,000, and law schools were graduating 34,000 new ones each year. By 2011, the annual production of law degrees was up to 44,000, and at 1.22 million, the number of lawyers in the country — which included me — had nearly tripled. Over the same period, the population of the United States had risen just 40 percent.

But the wind has changed. In 2011, the number of students entering law school dropped by 7 percent, an unprecedented fall. In 2012, the drop accelerated: Enrollment of first-year law students sank another 8.6 percent. It plunged still further in 2013. According to the American Bar Association, 39,675 new law students matriculated last fall — an 11 percent decrease from 2012, to a low-water mark not seen since early in the Carter administration.

Much of the flight from law school reflects the brutal reality of the employment market for lawyers. The National Association for Law Placement reports that fewer than half of lawyers graduating in 2011 eventually landed jobs in a law firm. Only 65 percent found positions requiring passage of the bar exam. At a time when many law school graduates are shouldering student-loan debts of $125,000 or more, compensation has declined painfully — the median starting salary for new lawyers in 2012 was just $61,000. And quite a few can't find any work at all: Nine months after receiving their law degrees, 11.2 percent of the class of 2013 was unemployed.

Only some of this is cyclical. The legal profession, like so many others, has been permanently disrupted by the Internet and globalization in ways few could have anticipated 10 or 15 years ago. Online legal guidance is widely accessible. Commercial services like LegalZoom make it easy to create documents without paying attorneys' fees. Search engines for legal professionals reduce the need for paralegals and junior lawyers. Maurice Allen, a senior partner at Ropes & Gray, is blunt: "There are too many lawyers and too many law firms," he said in a published interview last week. That means less work for new law school grads, and therefore less reason to go to law school.

And who, except perhaps for law school admissions deans, would be sorry to see America's lawyer bubble finally burst?

With almost 1.3 million lawyers — more by far than any other country, and more as a percentage of the national population than almost all others — the United States is choking on litigation, regulation, and disputation. Everything is grist for the lawyers' mills. Anyone can be sued for anything, no matter how absurd or egregious. And everyone knows how expensive and overwhelming a legal assault can be. The rule of law is essential to a free and orderly society, but too much law and lawyering makes democratic self-rule impossible, and common sense legally precarious.

Scarcely a day goes by without a fresh example of the damage caused by a legal system that so often puts the innocent at the mercy of the spiteful. To avoid legal liability, companies and institutions must comply with brain-numbing regulations and restrictions that destroy initiative, smother good ideas, and force grotesque results that benefit no one.

Because it is so overlawyered, "American culture is corroding before our eyes," writes Philip K. Howard, a big-firm lawyer and well-known reform advocate, in The Rule of Nobody, his new book. "It would have been inconceivable, a few years ago, for a teacher to be scared to put an arm around a crying child, or for a fireman to stand on the beach for an hour and watch a man drown because he had not been recertified for land-based rescue. Creeping legalisms are eating away at America's social capital."

From environmental rules so inflexible that fixing a bridge can take years to licensing rules so onerous that kids' lemonade stands get shut down, all of us are paying for those "hordes of lawyers, hungry as locusts," that Warren Burger warned of long ago. Students by the thousands are shunning law school? That's the best trend I've seen in ages.



Political correctness is most pervasive in universities and colleges but I rarely report the  incidents concerned here as I have a separate blog for educational matters.

American "liberals" often deny being Leftists and say that they are very different from the Communist rulers of  other countries.  The only real difference, however, is how much power they have.  In America, their power is limited by democracy.  To see what they WOULD be like with more power, look at where they ARE already  very powerful: in America's educational system -- particularly in the universities and colleges.  They show there the same respect for free-speech and political diversity that Stalin did:  None.  So look to the colleges to see  what the whole country would be like if "liberals" had their way.  It would be a dictatorship.

For more postings from me, see TONGUE-TIED, GREENIE WATCH,   EDUCATION WATCH INTERNATIONAL, FOOD & HEALTH SKEPTIC, AUSTRALIAN POLITICS and  DISSECTING LEFTISM.   My Home Pages are here or   here or   here.  Email me (John Ray) here


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