Tuesday, 25 August 2009

NHS v US Healthcare

So it seems that Michael Jackson's private physician would prescribe anything he wanted, so long as he paid the exorbitant fees - reported to be $100,000 per month. Can't really see that happening on the NHS. Probably something to do with medical ethics:
"I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism." (from The Hippocratic Oath)
If Michael Jackson had believed in an ethically-based healthcare system uninfluenced by money at the point of delivery, he would still be alive today.

Thursday, 20 August 2009

Education spending

We really need to move the argument on government expenditure forward. Take education - specifically secondary education.

Using Dept for Children Schools and Families own statistics, £21,441m was spent on secondary education in 2007/8. This represents total expenditure of around £5360 per pupil. What we need to be asking is how much per pupil is actually spent in schools - at the sharp end of the business – on the resources that really matt

er: teacher salaries, books, stationary, computers, projectors, smartboards etc. This is the expenditure that really delivers education to the pupil. This is the important stuff. The expenditure we need to be protecting and ring-fencing, with an ambition to increase in real terms such expenditure over time.

I don’t know what exactly this figure comes to. If anyone knows where this kind of information can be seen, I would love to know. But I have a big hunch that the figure will come out at around £3500 per pupil – more than a third lower than the educational spending that is raised through taxation and allocated to secondary education. And it is the difference between these figures representing organisational running costs, publicity, centrally controlled initiatives and top down bureaucracy - whatever you want to call it - that needs to be examined in the cost cutting agenda.

If you want the electorate’s support, by all means guarantee this lower figure being spent on actually educating their children in schools. Pay such money in three tranches – at the beginning of each term – directly to the school. Make head teachers responsible for spending this money in running their schools efficiently and effectively. Judge them on outcomes and results. Not targets and processes.

Friday, 14 August 2009


Wonderful piece in this week’s Spectator from Matthew Parris talking about the death of his father.

When my own father died a few months ago, I asked my daughter to read this letter at his funeral. It was written by the Christian martyr Dietrich Bonhoeffer to his family, before his execution by the Nazi’s in April 1945.

Nothing can fill the gap when we are separated from those we love and it would be wrong to try to find anything. That may sound very hard at first but at the same time a great consolation, since leaving the gap unfilled preserves the bond between us. It is nonsense to say that time, friends or indeed God Himself fills the gap. He does not fill it but keeps it empty so that our communion, each with the other, may be kept alive.

Dietrich Bonhoeffer


My family has enthusiastically supported and used the NHS all our lives. We do not share Daniel Hannan’s views of the service, nor his advocacy for individual health accounts. Clinical need - not wealth - should be the determinant of healthcare. But however well intentioned, the NHS also has a darker side.

My grandmother - once a nurse in a TB hospital in Portsmouth during the 1930’s – died after a long and full life. Apart from the usual aches and pains of growing old, she had rarely been ill before suffering a stroke at the age of 97. I still remember that terrible moment when I first saw her as the GP - attempting to gauge some form of cognitive ability - asked her how many fingers he was showing, as if she were a three year old child. But mostly I remember the look on her face. A face that I had grown up with and loved, a face that had shared so many precious moments, now staring at me without recognition - vacant and distorted - as if someone had drained all emotion and warmth from her cheeks.

Rushed to Hospital, I was amazed at the quality of the care she received. St Peter’s, Chertsey, is a bright new hospital designed intelligently into a series of 10 – 12 bed wards off comfortably sofa’d corridors which soothed both patients and visitors. The ward bristled with specialist stroke equipment around each bed and bustled with serious, green-scrubbed clinical staff. This was modern medicine at its most impressive; spotless, high-tech and concentrated.

The stroke turned out to be minor and within two days she was able to get out of bed. That evening I had my last lucid conversation with her as she sat on a chair beside her bed talking comfortably about returning home.

Two days later, we heard she had been transferred to a general ward at Ashford Hospital - within the same NHS trust – and visited with relaxed expectations. I have never seen such a transformation. Listlessly fidgeting in and out of consciousness, she had been dressed in a tight-fitting, all-in romper suit because she was continually pushing back her bedclothes. High-sides had been attached to the bed in an effort to stop her desperately trying to get out. This was a seriously ill woman. When I visited the next day, she had been moved to a side room on her own. The ward sister explained that all visitors would have to wear gowns, gloves and masks. She had MRSA.

She lasted two more days. I knew she would. She died at a quarter past midnight on the morning of my birthday. I had spent two hours that evening sitting beside her, masked and gloved, unable to even kiss her. And just for the record, MRSA was not listed on her death certificate.

Friday, 7 August 2009


The speedometer cable on my bike broke two days ago.

Unable to know my speed, traffic cameras became unquantifiable and terrifying dangers. Red lights – where bikes routinely speed away before dozy car drivers have even cranked into first gear – became a pointless exercise in bravado. The world of driving to the speed limit completely disappeared. No longer could I know if I was even within the law. How strangely dependent we are in the comfort of rules.

And yet, what a feeling of liberation. Without the aspiration of speed and quite unable to compete, I became totally dependent upon my fellow travellers. The only gauge available was a measure of trust. Trust that they would act within the law. Every journey felt like a lumbering caravan travelling through the desert as we wound our way along lane, high street and dual carriageway – with cars continually peeling off to their destination, whilst others joining in an ever meandering ebb and flow of ordered chaos. No longer was pole position wanted. We had become a community. An inter-dependent whole, held together purely by human trust.

Even so, as each speed camera approached, my doubts emerged. I searched the faces of my fellow travellers looking for honesty and goodness. It’s a strange feeling. There are no moral chins, honest eyebrows or truthful noses – just the subtly-glimpsed mannerisms that might betray a lurking gambler’s streak or the just slightly too casual cornering of a Chardonnay mum.

I have to tell you now that my fellow travellers all passed the test. Sure, outsiders weaved their separate ways around and between us. But we continued, everyone an upright and decent member of our community. Each in their own cocooned little world, yet all travelling as one.

I tried rather unconvincingly to explain this to a mechanic called Miro at a local garage. He smiled awkwardly. “No worries – you’ll be straight back on pole today”.