Thursday, 27 October 2011

Isn't it time the Lib Dems saw a shrink?

Chutzpah is a great Yiddish word. It describes the kind of bare-faced cheek that takes your breath away and leaves you scratching your head in amused bewilderment. It’s always good to have a word like this at your disposal when the Liberal Democrats are in your neighbourhood delivering their propaganda sheets.

The latest edition of “Twickenham & Richmond News” (sic) arrived on my doormat in the past few days, thankfully proclaiming that it is ‘paid for by individual donations at NO cost to local taxpayers’. It shows the Liberal Democrats to be stalwart campaigners for local services, sworn enemies of the Conservatives and valiant crusaders against government cuts.

Let’s just take a pause at this point while we slap ourselves vigorously, stick our heads in a bucket of ice-cold water and check that we’re actually awake.

CUTS TOO FAR screams the splash on the front page of the tawdry tabloid, which is packed with endless snaps of Munira Wilson, a Lib Dem candidate in next year’s Greater London Assembly election. Tory-run Richmond Council is supposedly hoarding millions of pounds while ‘needlessly’ cutting services.

This is the politics of the madhouse. The Lib Dems seriously believe that they can form a government with the Tories and help them to implement a nationwide austerity programme, while at the same time pretending in local constituencies that the cuts are all the fault of the Conservative Party.

Note the weasel words. Conservative-controlled Richmond has taken the cuts ‘too far’ and is slashing services ‘needlessly’. Presumably, the Lib Dems are happy with a lot of cutting, but become a little concerned if it passes some completely arbitrary threshold. What shameless hypocrites. If their Tory pals are indeed taking things to excess in south-west London and are sitting on some hidden surplus, then why doesn’t Nick Clegg have a quiet word with David Cameron? Or, better still, make a public announcement condemning the Tories?

Let’s be clear what’s going on here. The Lib Dems believe in coalition with the Conservatives, but know that this is poison for them in certain constituencies. Business Secretary Vince Cable MP goes into every election in Twickenham, for instance, explaining that he is the only viable anti-Tory candidate and that Labour supporters should rally to his cause.

This long-standing claim is now exposed as complete bunkum, but Vince and his band of two-faced followers return to the theme, because they have absolutely nowhere else to go. Even now, they say ‘elections in Richmond and Twickenham are always between the Lib Dems and the Conservatives’.

Wow. What a great choice. Which Chuckle Brother would you rather have deliberating over the hard economic choices? Paul or Barry?

I have no doubt the Lib Dems would make a great psychoanalytical case study. They have forged a marriage of convenience with someone they previously told all their friends they hated. When their domineering partner is away, they slag him off to anyone who will listen, but are all nicey-nicey to him in public when he’s back. Friends feel sorry for their former mate, but start to drift away. There’s only so much sickening hypocrisy they can stand, after all.

Thursday, 20 October 2011

If the Euro goes down, democracy may fall with it.

It’s impossible to tell exactly how the Eurozone crisis will play out, but there’s a danger the political dimension to the ongoing drama is often overlooked amid the economic tumult. When we talk of worst-case scenarios, involving Greek default, countries withdrawing from the single currency or maybe even the collapse of the Euro itself, the financial consequences are almost too big to contemplate. Bank exposures to sovereign debt may lead to a complete unravelling of global markets and a worldwide depression. But what of the politics? Can we be positive that the democratic certainties of modern Europe aren’t in danger of collapsing into the Mediterranean?

One thing that’s easy to forget for those of us born from the late 1960s onwards is that there is not a strong history of democracy in southern Europe. Up until 1975, General Franco ruled the roost in Spain – a fact which didn’t deter the growth of package tourism, as Brits and many other northern Europeans are notorious for putting a spot of sun ahead of any human rights considerations. While students were getting battered by the police in Spanish universities in the late 60s and early 70s, working-class families abandoned Clacton for the Costas.

Greece is another favourite holiday destination with an ugly past. After various constitutional crises and red scares, a military junta brought tanks onto the streets of Athens in 1967 and seized power for a seven-year period. And what about Portugal? The small, western European nation doesn’t tend to get a lot of pages in the history books, but their military actually did its people a favour back in the 1970s. Around the time the Greek Colonels were being forced out of power, Portuguese junior officers brought to an end the Estado Novo (New State) of Antonio de Oliveiro Salazar – a stifling, authoritarian Catholic regime that certainly wasn’t very ‘novo’ by the time it met its demise.

Of all the southern European nations currently in the Eurozone firing line, only Italy really has a claim to sustained democracy since the end of the Second World War. Weak government, corruption, terrorism and organised crime have, however, been a terrible blight on Italian political life. And the cult of personality surrounding Silvio Berlusconi is hardly a model that many democrats would embrace with open arms.

Does all this political baggage actually matter? My feeling is that it matters a great deal. In times of huge economic turmoil, austerity and social unrest, there is every possibility that the ‘normality’ we’ve known for the past few decades could be turned on its head. Greece is the obvious candidate, perhaps, because of its disastrous financial predicament and volatile street protests heavily infiltrated by anarchists.

Let’s imagine we head towards a disorderly exit from the Euro and the creation of, say, a ‘new’ Drachma which is worth very little. People who have already taken pay cuts, lost their jobs or seen their standard of living decline may end up finding half their life savings disappearing too. A whiff of the Weimar Republic would be in the air. At that stage, there’s a danger that any political or military force with a populist agenda might have a strong appeal or be able to fill a vacuum created by the failure of the democratically elected politicians.

Could a country such as Spain really abandon democracy 35 years after Franco? The chances are probably small, but I would hesitate to say they are non-existent. It’s important to remember that there’s a strong strand of conservative sentiment that runs very deep in the country. While Falangist parties get virtually no support in elections today, there’s undoubtedly an older segment of the population that has a nostalgia for the days of authoritarian rule. More worryingly though, almost half of the young population of Spain is currently unemployed – a situation which is pretty incompatible in the long term with a healthy, functioning democracy.

We are used to dictatorships falling. Just in the past year, we’ve seen the obliteration of the regimes in Tunisia, Egypt and, of course, Libya. It’s important to remember that democracies can fall too. The decadence, liberalism and economic growth of the Goldene Zwanziger in Germany gave way to the Great Depression, hyperinflation, instability, mass unemployment and – ultimately – the brutal oppression of the Nazis.

Europe comes with a lot of history. Merkel, Sarkozy and the others who are dawdling over economic solutions need to remember the potential political costs.

Thursday, 13 October 2011

Is there a doctor on the ward?

The findings of the Care Quality Commission in relation to the appalling treatment of old people in many NHS hospitals will come as no surprise to many families. If you’ve visited anyone on a geriatric ward recently – as I have – the sorry story of neglect and disinterest will ring an awful lot of bells. Unfortunately, you can ring those bells for 45 minutes and nobody takes the slightest notice.

There are a number of fundamental problems at the heart of the UK’s National Health Service and they have nothing to do with the total amount of money in the system. Lack of cash can exacerbate the problems, to be sure, but the problems actually revolve around culture and organisation.

The first thing I’d observe is that many hospitals have the right procedures and approaches in place. They can show you paper policies which sound entirely reasonable and forward-thinking, but they struggle to put any of them into practice on the wards.

A few months ago, I conducted a survey of London NHS Trusts under the Freedom of Information Act to find out how many of them operated what they call ‘protected mealtimes’. This marvellous idea is that patients should be left in peace while they scoff their grub, but if you’re elderly or confused, maybe you forget that someone’s left you a plate of food. Perhaps you don’t even realise you need to eat. Many of the nurses and auxiliaries simply can’t be bothered to help, while others are under severe time pressure with a list of tasks to perform and are unable to spend five or ten minutes spoon-feeding nutrients into the nearest OAP.

Who takes up the slack? Why, the patients’ relatives of course. They are usually committed to the wellbeing and recovery of their loved one and will happily assist at mealtimes. Except... err... they’re not actually supposed to be there. Mealtimes are protected, you see?

Now, here’s the interesting bit. When I surveyed the hospitals, they all came back with reams of policy documents about ‘red tray’ systems to identify the poor eaters and told stories about how flexible they actually were in allowing relatives to stay on the wards and help with the feeding. But my real-life experience of a south London hospital earlier this year was that we were not wanted on the wards at mealtimes. The well-meaning policy blurb means nothing to the people who are slapping trays of food down on tables and doing a runner.

This is a cultural problem. There is no real leadership on NHS wards and an incredible amount of drift. Doctors are a big part of the problem because they are never actually there. There’s a way of working – which dates from the year dot – which says that the medics do daily ‘rounds’, although no one ever knows when they are. The staff members have a very vague notion and the patients and their relatives have no idea whatsoever.

Typical scenario in an NHS ward: an elderly relative has a fall and breaks something. She ends up in a geriatric ward for a couple of weeks, until such time as she has recovered well enough to return home. The family comes to visit. Has she been seen by a doctor, they ask? She can’t remember. Surely a member of staff will know? Unfortunately, they’re vague and evasive. The doctor will be coming tomorrow morning. Everything’s fine. Granny’s having her blood pressure monitored every 15 minutes by someone who’s been taught the skill in the same factory that Charlie Bucket’s grandfather learned to screw lids on toothpaste bottles.

Charts of readings and vital signs are left lying around, but no one ever interprets them or acts upon them. What medicine was our elderly patient taking before she came onto the ward? One of the tablets has been stopped and another one’s been added but no one will explain why. Perhaps no one really knows. It was the doctor, you see.
So, when is the patient going to be coming out? Who can tell? It may be tomorrow. It may be the next day. She’ll need to be seen by the doctor. And when’s the doctor coming? Jesus Christ, are we getting a sense of déjà vu here?

Sometimes when I walk into these places, I really do think that I could make a difference in 24 hours. Communication, communication, communication. Between the doctors and the nurses. Between the nurses and the ancillary staff. Between the staff and the patients. Between the staff and their relatives. All people want to know is what the hell is actually going on.

Major improvements could be made if people simply talked to one another and there was a clear record of what had happened to each individual patient – perhaps in some kind of easy-to-read electronic format. But in itself, this isn’t enough. It doesn’t get over the problem that many of the staff are poorly motivated and lack proper supervision. There’s no easy fix to this and it’s impossible to deny that the jobs are poorly paid and unattractive. Leadership has to play a critical role here in terms of increasing motivation and a sense of purpose among the nursing and support teams. Someone needs to be there to observe and correct poor practice and we also need to provide proper recognition and reward for those people who are getting things right.

The current management of NHS wards is grossly inefficient and leads to so-called ‘bed blocking’. People are often kept in the hospital for days and days unnecessarily, as staff wait for doctor’s assessments, meetings of interdisciplinary teams, visits from social workers and occupational health experts. Until this bureaucratic and uncommunicative culture is tackled, the sad stories of neglect and indifference will continue.