Thursday, 21 September 2017

Quote of the day: Vietnam


This is spot on:

The Vietnam War was the greatest U.S. military catastrophe of the 20th century. A conflict begun under false pretenses, based on ignorance and hubris, it killed 58,000 Americans and as many as 3 million Vietnamese. It ended in utter failure. Never in our history have so many lives been wasted on such monumental futility.

My generation (and those a year or so older who sang peace and love) associate the disaster of Vietnam with Richard Nixon - it sort of suits the more lefty-minded for it to be a shockingly corrupt Republican President who shoulders the blame for this awful war. Truth is that the origins of the problem* - at least as far as US involvement is concerned - rests rather with the sainted John F Kennedy.

I've always taken the view that, far from being some blessed individual, Kennedy was as committed to projecting US power as any Republican. Kennedy's knack was to wrap it up in the promotion of democracy rather than the less appealing and blunted cold war rhetoric of Republicans like Eisenhower and Nixon.

*Interestingly the "strategic hamlet" approach developed by the French and US advisors whereby radicalised communities were relocated into controllable locations was a straight lift from the policy used by the British in Malaya. The main difference was that the Malay insurgency was by ethnic Chinese making it far easier to isolate the community hiding guerrillas and terrorists.

What's wrong with the NHS? Bureaucracy - that's what's wrong


Let me introduce you to the Bradford and Craven Integrated Workforce Programme's workforce strategy (this will be referred to as the IWP so often you'll forget what it stands for at some future point). The IWP - Integrated Workforce Programme - reports to the Bradford and Craven Integration and Change Board (ICB) and "aims to work collaboratively to address the commonly identified system wide workforce challenges..."

OK so far? The ICB and the IWP that reports to it works in the context of the Five Year Forward View and the Five Year Forward View Next Steps for Sustainability and Transformation Partnerships (STPs) and the work of these STPs will be delivered through new Accountable Care Systems across the Bradford District and Craven. Part of this delivery cross institutional boundaries and there is an Integration and Better Care Fund Narrative Plan 2017-19 for the Bradford District.

In amongst all this there are "a number of national, regional and local drivers and associated service strategies and plans..."

Five Year Forward View sub-strategies (GP Forward View, Mental Health Forward View etc. etc.)
West Yorkshire and Harrogate STP (WY&HSTP)
Better Health Better Lives (part of Bradford Council - BMDC - plans)
Bradford District and Craven Health and Wellbeing Plan
Bradford District Joint Health and Wellbeing Strategy
North Yorkshire County Council's Health and Wellbeing Plan
Home First Plan
Children, Young People and Families Plan
CCG Primary Care Strategies

This list is preceded by the word "including" which implies that there are perhaps some other plans and strategies not referenced.

In order to "support the delivery of the transformation agenda" there are a "number of collaboratives" which include:

Local Workforce Action Board (LWAB, WY&H)
West Yorkshire Association of Acute Trusts (WYAAT)
WY&H Mental Health Partnership
'Team Bradford' Employers Conference
Bradford Health and Care Education, Employment and Skills Partnership (BEESP)

Apparently the IWP will "ensure alignment with these enablers" and will "work on the footprint deemed most appropriate in facilitating realisation" of the plans. (Takes a deep breath).

There are some workstreams including plans for a West Yorkshire National Skills Academy Centre of Excellence for Support Staff Development and plans for a new medical school in Bradford (apparently the University has to have permission from the NHS or the government to train doctors something that further underlines how stupid this whole system has become).

Somewhere in all this soup of bureaucracy and management mumbo-jumbo there's perhaps some good work going on. The difficulty, however, is that reading the reports reveals little but an enormous and costly bureaucracy directed, in this case, to answering the relatively simple question "how do we improve the quality of our workforce, reduce turnover and meet future needs." Multiply this 'collaboration' across all the UK's myriad health bodies and the result is uncounted millions in taxpayer cash splurged on a pyramid of acronyms, plans, strategies and (new one to me this) narratives.

The NHS doesn't work. And it's only the persistence and creativity of front-line staff (most of the time) that stops the bureaucracy completely preventing anything happening at all. This isn't about funding - most cash will likely, as we've seen with Better Care Fund, result in more new bureaucracy. Indeed what is clear from any encounter with the management of the NHS is that the organisation is at its most creative when it comes to inventing new and ever more complicated systems of bureaucracy.

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Wednesday, 20 September 2017

East Riding CCG: Nasty judgemental fussbucketing nannies.


You're in pain. You've already waited an age for the operation. And then you get a letter from some nameless, faceless official of the NHS telling you that because you're a smoker or a bit chubby you have to wait an extra six months. Just because the bosses of that nameless, faceless NHS bureaucrat disapprove of your lifestyle.
The measures have been introduced by East Riding CCG, which has denied that it is about saving money, saying it is to "encourage and empower patients to take greater responsibility for their lifestyle choices."
This won't save the NHS a farthing. It's just being used as a painful and unpleasant stick to beat up people whose choices the scummy fussbuckets in the East Riding NHS don't like. I've no issue if a surgeon or doctor says "look mate, there's no point in me doing this knee operation until you lose some weight" or "you should quit smoking if you want this treatment to work" where the evidence is based on the actual case, the real information about a real patient. But to impose an arbitrary delay - a nasty, uncaring delay that might kill people - just to make a point about their lifestyle is worse than unforgivable, the people saying it should be escorted out of their well-paid NHS jobs because they clearly aren't suited for a caring service.

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The measures have been introduced by East Riding CCG, which has denied that it is about saving money, saying it is to "encourage and empower patients to take greater responsibility for their lifestyle choices."

Read more at: http://www.yorkshirepost.co.uk/news/health/overweight-people-and-smokers-to-be-denied-surgery-for-six-months-in-four-yorkshire-hospitals-1-8763080
The measures have been introduced by East Riding CCG, which has denied that it is about saving money, saying it is to "encourage and empower patients to take greater responsibility for their lifestyle choices."

Read more at: http://www.yorkshirepost.co.uk/news/health/overweight-people-and-smokers-to-be-denied-surgery-for-six-months-in-four-yorkshire-hospitals-1-8763080

Sunday, 17 September 2017

And you thought central London was crowded?


There's a new Atlas of Urban Expansion published and New Geography review it - including this piece of information:
Dhaka's urban density has risen three percent over the last 25 years, as much of the additional population has been housed in low-rise, unhealthful shantytowns (see: The Evolving Urban Form: Dhaka), where densities are reported to be as high as 2.5 million per square mile or 1 million per square kilometer (photograph above). This is 35 times the 70,000 per square mile density of Manhattan (27,000 per square kilometer) in 2010.
The writer points out that Dhaka is an exception - most large cities are getting less dense. But nevertheless - wow.



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Friday, 15 September 2017

On planning appeals (and lawyers)


Andrew Lainton reports on the Appeal Court (Mansall v Tonbridge and Malling):
Appeals should not, in future, be mounted on the basis of a legalistic analysis of the different formulations adopted in a planning officer’s report. An appeal will only succeed, as Lindblom L.J. has said, if there is some distinct and material defect in the report. Such reports are not, and should not be, written for lawyers, but for Councillors who are well-versed in local affairs and local factors.
Andrew thinks planning lawyers will have nothing left to do! An excellent outcome (although I doubt it is true).

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Quote of the day: On knowledge...


From Don Boudreaux at Cafe Hayek:
Too many are the people who, having mastered econometrics and gathered lots of data, wrongly suppose themselves thereby to possess knowledge. Likewise, too many are the people who, having mastered mathematics and memorized the mechanics of lots of theoretical models, wrongly suppose themselves thereby to possess knowledge. Too rare are the people who correctly understand that, no matter how smart they are and how much they might genuinely learn about economics, econometrics, and ‘the data, neither they nor others can ever hope to come close to knowing the details of economic reality in the same way that, say, a physicist can know the details of some physical material under his or her investigation.
What we call facts (and they aren't always facts, especially in social sciences) do not constitute knowledge. That knowledge comes from thinking about those facts and what they mean, what they tell us about the world.

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Thursday, 14 September 2017

Restoring community - an imperative for conservatives


Each day I see more and more that us conservatives, by allowing assorted Marxists to capture sociology, have done the world a disservice. This is because Marx was an economist meaning that he had little or nothing to say about sociology - as a result left-wing sociologists became activists not academics. Much - not all, a long way from not all - of the subject is arrant nonsense.

But it matters. The questions it asks are not answered by economics - for sure there's a bunch of economists splashing about pretending they can inject morality into their subject's dry modelling but this isn't asking the questions a sociologist would ask. Here's Aaron Renn:
There are a number of people in the national media who make the argument that things aren’t so bad, that if you look at the numbers this idea that things are horrible in much of America just isn’t true. It’s easy for me to believe this is actually the case in a quantitative sense. But man does not live by bread alone. When you have an iPhone but your community is disintegrating socially, it’s not hard to see why people think things have taken a turn for the worse.
There are social goods (if you want to use that dreary economics language) that are as necessary as the material benefits brought us by liberal capitalism. And most of these goods are about community rather than anything definable in the typical national politics. As I wrote a little while ago:
If conservatives are to make a difference - and what's the point if that's not the aim - we need to stop trying to make everyone's lives better by centralised fiat. And start with making our and our neighbours lives better. Conservatives should apply that old shopkeeper's adage - 'look after the pennies and the pounds will look after themselves'. Look after communities - the bit you can see from your front door - and the whole of society, even the bits we can't see, benefits.
It may seem trite, as Renn does, to hark back to a past age when we didn't have to lock our doors and left the keys in the car on the drive. The local concerns about burglary here in Cullingworth are real yet we have so much more than a past generation who lived lives less plagued by the fear of crime. But we can't blame the good life, the betterment of our lives as consumers - running water for folks in Aaron Renn's home county and the central heating for families here in cold, damp Cullingworth.

The willingness to be a community is still there but it is suppressed by the manner of public service management, by the transformation of voluntary organisations into agents of the state, and by the permissions and regulations laid down by the state between ordinary folk and helping their neighbour:
That's right - permission to care. That professionals in the employ of the Council, the NHS or their satellite agencies needed to allow people to look out for their neighbour. In this I saw a dead culture - one murdered by the good intentions of public agencies. That we might not be allowed to pop in on Mr & Mrs Jones to make sure they're OK, maybe make them a cuppa and have a chat for half and hour. Unless we've undertaken the official "befriending" course, got the required clearances from the state and been attached to an organisation that "delivers" looking out for the neighbours.
We need to look again at the risks of individual social action and start to err in favour of community and its capacity to self-police rather than respond to every bad case with more rules, controls and regulations. It is the suppression of social innovation, suggesting it is only possible through endorsement by the sate or its agents, that damages community. Anyone who has been involved in local communities (and I've been a local councillor for two decades) will know they are buzzing with ideas, filled with people who want to be involved. We have a generation of wealthy and healthy older people who aren't just looking to have extended holidays, yet so much of public rhetoric seems to be about how those folk are uncaring and selfish.

For me the biggest lesson from things like the Brexit vote isn't about divisions but rather about distance. Government - nearly all of it - is distant, complicated, unapproachable, opaque and thoughtless (and this is a large part of why we dislike the EU so much). We look at what happens and wonder why decisions are made the way they are, why no thought is given to neighbourhood, why the word community is used without, it seems, even the vaguest understanding of what it means, and why the narrow interests of a small economically-successful class seems to dominate the thinking of every political party, every academic and every pundit whose number the BBC producer has in her mobile phone.

When we talk about social capital, we tend to do so in a sort of abstract way - as if it it something that can be bottled by middle-class academics and civil servants and poured onto struggling communities. But social capital is all about people standing on their doorstep, seeing something that could be better and saying "we can fix that, we can do that". It's not about local councils having 'community strategies' or lottery agencies funding middle-class experts to administer to places needing help. Nor is it about trying to turn that willingness to help into the new vanguard of the proletarian revolution let alone the need to resist neoliberal hegemony.

The starting point is simply giving places - local communities, neighbourhoods - the capacity to do what they think will make where they live a little better. From fixing some fences, clearing paths and picking up litter to helping mind neighbour children or doing what Mr Sparks did for me, my brothers and dozens of local children in the South London suburb of my youth - took us to play cricket in the summer and swimming in the winter. So long as people think they have to wait for permission to do these things, they won't do them. The imperative in building that social capital we say we've lost is to get government out of the way of people who want to help.

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