Tuesday, 28 June 2011

A glimpse of the high life on a commuter train

Commuting is a pretty dull activity – a necessary chore that one gets through on the way to doing something else that is, we hope, more interesting or at least more productive. So it’s great to come across people for whom, on the contrary, it’s a source of fun in itself.

I spotted these two women on the way home tonight. Their smiles, their good cheer were a delight to behold, and highly infectious. And why not enjoy a can of cider on the way home, as one of them was doing? But the touch that really got to me was the green cocktail glass.

Commuter with the cocktail glass
It contained a light coloured bubbly fluid – it might have been cider too but I didn’t ask – I prefer to think it was a fine champagne, to wash down the wasabee peas you can just see on the table, the snack of choice of the discerning commuter. Even if that was merely an illusion, it was one I didn’t want shattered: I was too attached to the idea that here were people who were putting a real fizz into life – with style.

Monday, 27 June 2011

Outlook on car parking and humour

Don’t you just love Microsoft Outlook? I’m completely sold on the way it tells me what I should be doing at any time. ‘Meeting in Leicester in fifteen minutes’ it warns me when I’m already sitting in the room. The alert tone always worries me, as though I’d forgotten something, but when I find that I’m already doing what I should be, the sense of blessed relief is nothing short of wonderful.

What could possibly be more reassuring than an alert that confirms you’ve got things right? Thank you, Mr Gates, for having provided a small comfort in a world usually so perturbing.

I was badly perturbed this morning. I drove to the station and into the car park. I don’t usually try to find a spot on the first floor because it’s usually full, but I thought I’d try it for once, just on the off-chance my luck was in.

It wasn’t. The only free spaces were for mothers and children or handicap card holders only. I drove down the dip at the end of the floor and up the other side, and decided to try my luck again on that level.

It was no better. In fact, to my surprise, the only empty spaces were again all handicapped or mother and children’s. ‘Amazing,’ I thought to myself, ‘how many floors have they reserved spaces on?’

Down I went again and back up again, and as I drove past exactly identical handicapped and mother and children’s spaces, a nasty suspicion began to form in my mind.

A nightmare
Had I wandered into some nightmare world where all the floors of the multi-storey car park were identical? Would I be condemned to drive from floor to identical floor, never finding a spot?

Or worse still, had the car park shrunk, the previous five floors coming down to just one? That was a fear that received reinforcement when I caught sight of the sign saying ‘level 1’. Still ‘level 1’? Despite having gone up twice?

But then it slowly dawned on me that all I had done by going up was to make up for the fact that the end of each level went down half a floor. I hadn’t managed actually to climb a level. There was one further moment of panic when it occurred to me that the up ramp had disappeared, the only explanation I could at first accept for my having failed to see it before, but then I spotted it, drove up, found a space and parked.

What a relief. As good as an Outlook reminder, really.

Not as good though as the supreme compliment I was paid in Kharkov last week.

Friends from abroad have occasionally congratulated me on my ‘British’ sense of humour. At one level this is genuinely flattering, because British humour enjoys a generally good reputation internationally. At another level, however, it has a backhanded quality, as though to say ‘quite funny, but a bit weird – the British are like that, aren’t they?’

So it was particularly gratifying to be told last week that my sense of humour was ‘Ukrainian.’

Nothing ambiguous about that, is there? Surely no one can bestow a higher accolade than to describe a foreigner as being up to the standards of their own nation?

Why that’s even better than the best Mr Gates can do, and more than makes up for any sense of inadequacy in my handling of car parks.

Thursday, 23 June 2011

Putting words in their place

In these posts, I return with regularity, some might say monotonous regularity, to the theme of words. It’s a subject that constantly attracts my attention, because I feel that communication through words is a key element of what it means to be human.

So it was an edifying to find myself in one of those situations this week when they are completely unnecessary.

It was during my stay in Kharkov. It often happens to me when I’m travelling that I feel an overwhelming desire to eat some fruit. I’d put it down to a sharpened need for vitamins while I’m away from home, except that exactly the same thing happens at home too.

In a country where you don’t speak the language – I have perhaps 20 words of Russian, the main language in Kharkov (even though it’s a Ukrainian city) – buying fruit isn’t as simple as it sounds. This isn’t like Western Europe: maybe after the European Cup brings thousands of foreigners to Kharkov next year there’ll be a bigger incentive to learn the lingua franca of football and of tourism generally, but for the moment English isn’t much spoken in the streets, cafés or shops.

My first problem was to find a shop that sold fruit. I tried a couple of shops, including one marke

‘Producty’, an interesting name in itself – common, I’m told, in the Russian-speaking world, presumably to distinguish those shops from others that sell non-products. At least it means that if ever I want a non-product, I’ll know not to go to one of them.

My particular ‘Producty’ shop didn’t sell fruit.

I was beginning to get a little desperate, to be honest, when I suddenly saw just what I needed, in the form of a non-verbal announcement of the availability of fruit for sale: a shop front plastered with pictures of fruit and, indeed, vegetables.

No words but no uncertainty
There was a delightfully friendly and helpful middle-aged woman behind the counter. She kept up a steady flow of words throughout the ten minutes I was there, not one of which I understood. But the tone was unmistakeable and it was obvious she was being kind and obliging, so why would I complain?

I took things off shelves and handed them to her – a few bananas (she was kind enough to split three of a bigger bunch for me) – some peaches, some cherries. At one point, she waved a plastic bag at me and I was able to place on of my few Russian words, pozhalusta (please). The one-sided conversation (not entirely one-sided: I did a lot of smiling) continued, and then she looked at me slightly more intensely and pronounced a stream of more pointed syllables in my direction.

‘Aha,’ I thought, ‘the price.’

I smiled again and shook my head. She turned to a calculator, typed in the numbers and showed me the result. I gave her a note and she gave me my change. I collected my bag and placed another of my previous stock of words – ‘spasibo’ (thanks) to which she replied ‘pozhalusta’ – the courteous Russian response to 'thanks is ‘please’.

The shopkeeper had made a little money, I had my fruit. The whole transaction had taken place in an atmosphere of goodwill and politeness. But apart from ‘please’ and ‘thank you’, there had been absolutely no verbal communication.

Words really aren’t all they’re cracked up to be. Not all I tend to crack them up to be. In fact, there are occasions when they’re completely superfluous.

A chastening experience which will no doubt be good for my soul.

Tuesday, 21 June 2011

Friendly city where Lenin still leads in little things

There are things that are obvious when I come to think about them, but I only come to think about them when I actually experience them.

For instance, in my mind Asia is the East and Europe is the West. For the most part that’s true. But there are bits of Europe quite a long way East of bits of Asia – most of Turkey, say, and even a sliver of Syria and Lebanon – and I’m in one of them right now.

Kharkov is the usual English name for this place, which is revealing since it’s the Russian name for a city called Kharkiv in Ukrainian, and though it's right up against the border with Russia, the city’s in Ukraine.

Note that I wrote ‘Ukraine’ not ‘the Ukraine’. I’m told that it’s now viewed as faintly offensive to use the definite article with names of countries like Sudan or Ukraine. Odd, given that the last such country I visited, the Gambia, is terribly keen on its article, insisting that it always be used.
In Europe but east of bits of Asia
It’s a bit like the pronoun ‘she’. In England you can still be ticked off for referring to someone present as ‘she’. Now I’m sure none of us like being talked about extensively in the third person when we’re actually there, but only in English do we regard using the feminine form as particularly reprehensible. Or is it only the English?

Of course, the Japanese don’t like pronouns at all. Someone wanting to ask me directly whether I wanted tea would say ‘Does David San want tea?’ My inclination would be to say ‘you’d better ask him’ but they’d be unlikely to appreciate the joke and would simply reply ‘I just have.’

Anyway, what of Kharkov? I’ve just been out running along tree lined boulevards and through parks beginning to fill with warm June sun, so I approve. Whether I would have felt the same if I had been here in January, when the temperature was down to -20, is difficult to say.

Why was I out running? Because I've been met by some of the kindest and friendliest people you could hope to have welcome you to a new city. And they’ve taken me to some remarkable restaurants. I’ve run about as far as I can manage but I’m still left with the feeling that I could have gone twice as far without making much of a dent in the effects of their hospitality.

Photographer photographed, in the courtyard of a Jewish Institute.
It also contained the first fine restaurant I enjoyed.
The most curious aspect of the run was the statue dominating one of the squares I crossed: none other than Vladimir Ilyich Ulyanov, better known as Lenin, not a stone’s throw from a boulevard full of shops offering 30% – even in one case 70% – sales discounts on luxury goods and designer clothes. A salutary reminder that contradictions from the still recent past have yet to be resolved in the former territories of the Soviet Union.

Lenin shows the way to relief in Kharkov
Lenin as always bestrides the scene, showing the way forward. Or at least, if you follow the direction of his right hand, the way to the toilets in the park.

He always wanted to be the champion of the masses. It may be appropriate that he continues to serve the convenience of the public by guiding them towards the nearest public conveniences.

Friday, 17 June 2011

Station trap

It 's so unfair.

I had travelled down to Torquay for a presentation. You don’t know Torquay? Seaside town in the glorious county of Devon. I thought I knew it but discovered I didn’t, although I’d been there several times. It was only last night that I first saw the little fishing harbour with the old town clustered on the slopes around it. Quite charming.

The meeting went well too, but I’m not here to talk about work. The important thing is that the meeting was brought forward a couple of hours which meant I could get an earlier train home. Since my ticket wasn’t the type that could be used on other trains, I had to buy a second one.

The train left from the market town of Newton Abbot. It holds a particular place in my affection. It was there that I heard a Devon accent for the first time, an accent which no description can really make you appreciate if you haven’t heard it, and nothing can ever drive from your memory if you have. So I’m fond of the place. It was horribly disappointing to discover just how tricksy and devious it can be, at least if the station is anything to go by.

Newton Abbot station: a charming exterior but a base personality
I turned up in plenty of time for my train and headed for platform one to wait. Only to realise with horror that the platform I was on, nearest the ticket office, the platform with the café, wasn’t platform one at all but platform three. So my train came in and I had the pleasure – using the word in a loose kind of way – of watching it collect lots of passengers, of which I wasn’t one, and then pull gently out of the station again.

So back I went to the ticket office to buy a third ticket. This time I was determined not to fall into the trap. I went and sat on platform one and patiently waited the hour and more for the next train to arrive.

Only to realise that it was coming in on platform three.

Desperation lent me wings. I’d been caught by Newton Abbot syndrome once, I wasn’t going to be denied departure by the malignant demon that inhabits the place again.

Panting and sweating, a bag on each shoulder, I got to the train as the final door closed. With the last of my strength, I dragged one open and flung myself onboard. The door shut again, but behind me. The train pulled out of the station, but with me on it. I’d made it. I had escaped the accursed place. With three tickets to bear testimony to my determination to do so.

It hasn’t done any good to my previously favourable disposition towards Newton Abbot.

Of course, I can imagine that some people might be inclined to put the difficulties I'd experienced down to incompetence on my part. But surely that’s not an idea we can entertain? It must be more plausible to believe that a malign spirit sent to torment me inhabits the town, or at least its station.

Mustn’t it?

Wednesday, 15 June 2011

The Guardian Angels seeing to my financial sicuriti

There are times these days when the institutions we have to deal with became faceless, anonymous, uncaring.

For instance, I hardly ever go into a bank these days. For years, I managed my account through occasional conversations with disembodied voices on the phone. More recently, even the voice has gone, replaced by the cold indifference of web access. So it’s wonderful, and reassuring, to know that there are still people who take a personal interest in our affairs, even in the wellbeing of our bank accounts.

Having lived out there for ten years, Danielle and I still have a bank account in France. So when I saw ‘Crédit Mutuel’ on an e-mail I received the other day, I thought I’d better take a look and make sure nothing untoward was happening.

Well, it was just as well.

The e-mail concerned a possible unauthorised use of the card associated with the account. It asked me to complete an attached form so that proper checks could be carried out and the card blocked if necessary.

Obviously, it was important or they wouldn’t have brought it to my attention.

Equally obviously, it was an urgent matter. So urgent, in fact, that they didn’t even have time to proof read the form properly. So there were occasional, excusable errors – the ‘security’ that was their principal concern on my behalf came across, for example, as ‘sicuriti’, which is odd because if I say it out loud, it reminds me of an accent I’ve heard somewhere.

In any case, when someone’s looking out for you, it would be churlish to cavil over such trivial points of detail.

Indeed, so anxious were they to protect my sicuriti that they didn’t limit themselves to considering only one bank card. On the contrary, they thoughtfully allowed space to enter the details for fully eight cards, helpfully providing a box where I could record the PIN for each.

As it happens, however, I no longer have a card with the Crédit Mutuel, so I didn’t avail myself of their kind offer of service.

Still, isn’t it great that someone took the trouble to write in the first place?

Nice at least that someone cares





Tuesday, 14 June 2011

First prize for effort

There are films that leave you asking ‘how on earth did they make that?’ For others the question is ‘why?’

We watched one of the latter the other night. I was divided between one friend strongly warning us against the film and another strongly recommending it. Unfortunately we listened to the wrong one and watched Black Swan.

Nathalie: top marks for trying
As far as the plot is concerned, it's just one more in a lengthening series about how tough it is to be at the top of your profession in music, the theatre or, as in this case, ballet. Everyone wants the role you’ve been given and is just waiting for you to trip up so they can pounce. Plenty of dramatic material there, and it’s been mined many times before and will be many times again.

What was different in Black Swan is that they took it all much further, with a descent into madness by the key character, where scenes of rivalry or attraction – or both – degenerate into gory violence or passionate sex – or both – only for them to be revealed to have been fantasies.

The final act of (literally) bloody violence turns out to have been a fantasy about something that really happened. Or perhaps not. It’s never made fully clear. I guess it depends on whether you can believe that someone bleeding to death from a fatal wound can dance a particularly gruelling passage of ballet. You decide just how far your capacity to suspend disbelief will stretch, and you make your choice.

All that being said, obviously I can't really be in any doubt as to why the film was made. It was a money spinner, up into the seven figures. As H L Mencken put it, ‘The movies today are too rich to have any room for genuine artists. They produce a few passable craftsmen, but no artists.’ That’s Black Swan to a T: craftsmanlike, professional, uninspired and uninspiring.

The real ‘why’ question concerns Nathalie Portman’s Oscar for her performance. Now she may be an extraordinarily good actor, but how could anyone tell from that role? She seemed to spend practically the whole film looking frightened. A woman at the top of her profession, the envy of all around her, supremely gifted and supremely capable – and she spends the whole time looking like a child outside the headmaster's study. Or was that what the Oscar was for: best performance in a leading role as a frightened woman?

I’ve been assured, however, that the Oscar wasn’t for her acting but for the way Portman danced so much of the role herself. OK, right, but however fine an actor she is, she certainly isn’t a top flight ballet dancer. Do they really hand out Oscars for doing better than one might expect at something one doesn’t do terribly well? Has it become a prize for effort?

Dr Johnson once said that ‘a woman's preaching is like a dog's walking on his hind legs. It is not done well; but you are surprised to find it done at all.’ Underneath the misogyny, there’s insight in Johnson’s point about the sense of wonder at something being done, however badly, by someone you wouldn’t expect to be able to do it in the first place.

Feels like Portman got a Johnson Oscar. In a Mencken film.

Sunday, 12 June 2011

Don't mess with the NHS

If there’s one institution that the English are particularly fond of it has to be the National Health Service. Even fonder, I sometimes think, than they are of the royal family.

That doesn’t mean we don’t complain about it. Everyone has a horror story of nurses behaving with cruel indifference, doctors failing to make obvious diagnoses, or staff generally being incompetent or downright lazy.

But raise a finger to damage our NHS and the English will be down on you like a ton of bricks. That’s ours. Lay off.

Funny considering that anti-healthcare reform Americans pointed to the NHS as a cautionary tale of how awful a national system could be. And yet over this side of the Atlantic, we love that curious old institution.


The cry running through the land
So if you’re going to come up with a brave new plan to revolutionise the way the NHS works, you’d better make sure everyone out there thinks it’s really smart, really good and really going to deliver everything you claim for it.

Which is why it looks as though the present government is about to scrap all the most radical proposals in the reforms it proclaimed with great fanfares on taking office last year. It hasn’t convinced anybody very much that they’re going to make things any better. Or even that they’ll avoid making things a lot worse.

In particular, it looks as though the government will massively water down the plan to hand over budgets for hospital care to General Practitioners. It sounded like a good idea when they first came up with it but, you know what they say, the devil’s in the detail.

On the surface, it makes perfect sense to have GPs controlling hospital care. After all, they’re doctors so they know what the treatment involves and they know whether the patient needs it. What could be more appropriate?

The problem arises when you start to dig down a bit into the detail, into the actual practicalities of how to make the idea work.

First of all GPs are supposed to be treating patients. When are they supposed to be negotiating with hospitals about the care they’re going to provide? When are GPs going to find the time to get the best deal on the charges for that care? Because, oh, yes, if GPs hold budgets, they’ll have to get up to speed with financial management. And why should we imagine that because they’ve had seven or more years training in medicine, GPs are going to be particularly good at running businesses and managing finances?

It’s curious how many people seem to think that management doesn’t need specific skills. Management, like parenting, is one of the jobs that society generally assumes we can take on without any kind of training. The media report daily on the trail of disasters in family life or the business world that demonstrate how dangerous it is to make such blithe assumptions.

With neither the time to do the job themselves nor the specific skills or training , GPs would take on professional managers to do the job for them while they concentrate on delivering care to patients.

Which is exactly the way things are now. Making it surprising that anyone should propose to spend so much money, at a time when funds are in such short supply, on a series of reforms that would change so little.

Now it looks as though they’re going to abandon the reforms anyway. Which might make some of us wonder why they put them forward in the first place. Then again, perhaps it’s unfair of me, a mere private citizen, to expect to understand the subtle workings of the minds that get to the top in politics.

On the other hand, it may not be irrelevant that politics is another of those areas in which people expect to be able to shine with no specific training. And no particular evidence of skill either, for that matter.

Friday, 10 June 2011

Corporate words

It’s funny how organisations develop their own particular variants of language.

Where I’m working now, we don’t phone or write to people, we ‘reach out’ to them, as in ‘could you reach out to her to find out how she wants to take this suggestion forward?’ Naturally, we never act on ideas or apply them, we take them forward, unlike our competitors who presumably take them backwards.

‘Reaching out’ is an odd phrase. The most attractive aspect of my present outfit is the strength of its products. In other companies, I frequently had to talk fast in presentations to skate over weak areas, but here we can let the products speak for themselves. Yet ‘reaching out’ has a supplicant quality, as though we’re begging for attention, even perhaps for rescue.

Reaching out may work for God, but surely he wouldn't have
given us mortals mobiles if he hadn't wanted us to use them?
Then yesterday I received the instruction to ‘take the lead’ on a job which involved looking up some information. It’s a one-person job, so who am I going to be leading? It reminds me of that line in The West Wing: ‘without followers, a leader is just a guy taking a walk.’

But I suppose that ‘taking the lead’ on something is just the new company synonym for getting it done.

When it comes to odd ways of saying things, some of the best examples come in translations. So I’m impressed that the announcement at St Pancras station correctly translates ‘arrived’, for a train, by the French ‘est en gare’ (is in the station). That is what station announcements actually say in France.

By way of a contrast, in the days when I regularly had to use the car park at Roissy-Charles de Gaulle airport in Paris, I would always smile over the injunction to pay for the car park before ‘regaining’ my vehicle, a great word-for-word rendering of ‘regagner’, which actually means ‘returning’. It seemed to me that ‘regain’ suggested something much more exciting than the usual car park experience – I might find myself tryng to win back a car I’d previously lost in some kind of dangerous roulette game.

At Strasbourg station, the announcement told us that we were at the ‘end station’ and included the injunction ‘all passengers please leave the train’. Perfectly correct, of course, but entirely foreign – in Britain we're told that ‘this train terminates here’ and ‘all change please’. It’s true that ‘all change’ is a strange expression itself, suggesting that you ‘change’ from train to foot, in the same way as you change from one train to another. Still, that is the way we say it.

Obviously, there’s no reason for French station staff to know that. Unless they actually bothered to ask, as to their credit the people at St Pancras clearly have.

Or do I mean that they’ve reached out?

Tuesday, 7 June 2011

Misty meets his match

It's beem exciting to be spectators to a life and death struggle going on just across the street from us, between land and air power, fought out with bitter deliberation.

It all started a couple of weeks ago. Danielle called me to witness a strange sight. On the roof of one of the garages behind our garden was Misty, our cat, flat on his belly between two crows. He was in his habitual hunting stance, crouched, ready to pounce, birds after all being no more to him than conveniently air-delivered parcels of meat.

Not these two. In turn, each would move in closer to Misty, tempting him, provoking him to attack; if he moved, off the bird would fly, and the partner would immediately take over, distracting his attention, teasing and provoking him too.

The message seemed clear. ‘You want to catch those fat lazy pigeons? Go right ahead. They’re easy game. You want to catch us? You’d better learn some new tricks. You’re nothing like quick enough or cunning enough.’

Why were they behaving that way? It seemed extraordinary to court such danger.

We found out the answer at the weekend when we were woken at 5:00 in the morning by a pandemonium of cawing from across the road. One of the crows’ fledglings was on the ground. It was out of its nest far too soon and couldn’t begin to fly. Easy prey for a powerful cat undeterred by any sense of compassion.

That’s Misty through and through. He’s one of the biggest cats I know, in his prime, quick and strong. Neighbours of ours have complained to us that he’s an exceptionally vicious cat and that we ought to do something about him. I’m not sure what I could actually do – I’ve tried reasoning – ‘help yourself to the pigeons, carriers of disease as they are and more than plentiful enough, but please draw the line at blackbirds’ – but does he listen? I might as well be talking to myself.
Ruthless predator
Inevitably, in that fateful dawn, he’d caught the crow fledgling and caused all the commotion.

Danielle rushed out to try to save the bird, but she needn’t have bothered. The wildly cawing parents had set about Misty with resolution and single-mindedness that fully matched his. Pecking and clawing at him, they quickly showed him the error of his ways.

So clearly in their garage roof dance they had been giving him a warning and a chance. ‘Fancy our young, do you?’ they had been saying. ‘Think again, sonny, think again. You may be biting off more than you can chew.’

It didn’t take Danielle’s intervention to get him drop the young bird, the parents had seen to that. The fledgling was apparently unhurt, though presumably shaken by his brush with death. And Misty’s lesson seems, at least for now, to have sunk in.

A morsel not on his menu today
The next morning there was cawing from across the road again, but in a much more restrained way. When I got downstairs, Misty was outside the door, keen to get inside. The crows had seen him and their cawing was just a further warning, to remind him of his lesson.

He was beating a hasty retreat, thoroughly cowed. Or perhaps thoroughly cawed.

Sunday, 5 June 2011

The path that leads to understanding healthcare

It's Sunday afternoon, which reminds me of how bad a time this was for one of my sons when he was a young child. His good cheer would start to dissipate from about lunchtime, to be replaced by something altogether much bleaker. As often as not, the evening would end with tears.

That was what the prospect of the coming week did for him. And yet, oddly, he enjoyed school.

I would try to comfort him by pointing out that this Sunday evening melancholy would probably only last until he was 65. Of course, I was wrong, but hey, I didn’t realise then that the retirement age would start to climb long before he reached it.

Still, it’s true that Monday morning syndrome is a pretty universal condition. Why, even Garfield the cat suffers from it, and what affects a cartoon cat must surely affect us all.

Funnily enough, it’s not a condition from which I suffer at the moment. This is because work has done something for me which hasn’t happened for a few years. It’s give me the opportunity to focus on a topic which is a hobby horse of mine – some might even say an obsession. Give me a podium and a projector these days and I’ll drone on about it endlessly. It probably doesn’t bore people who hear it for the first time, since the enthusiasm of a speaker tends to excite a reciprocal reaction in an audience, my poor colleagues must find it truly tedious.

The subject of my fixation? Pathways. Not the ones you cut through jungles or stroll along on country walks. Not the spiritual ones leading to moral high ground or low. I’m talking about pathways of care.

In healthcare as in life, you have to follow the pathway 
Over the last few years, it's becoming increasingly clear that we have to stop thinking of care in terms of events taking place at points of time. It's not easy to get away from those old habits of thought. In the general view of medicine, what matters is what happens at a particular moment, saving a patient in an emergency department or carrying out heroic surgery in the tense atmosphere of an operating theatre. Incidentally, it really is called ‘heroic’, usually because it stands little chance of success but will undoubtedly cause a great deal of suffering to the patient, which always makes me wonder whether the surgeon is the real hero of the story.

To doctors, too, what matters is what they’re doing right now to help the patient, and what happened before is only a source of information, what happens next a mere vague outline plan.

Increasingly, though, if you want to understand what is being done for patients and judge whether they’re receiving the most appropriate and effective care, you need to lift your eyes above this level. You need to understand what was done before the surgery and to follow it up afterwards. You need to compare all that with the treatment other people received. Did they perhaps not have surgery at all? Are they any the worse for it? Or are the results better if they have the operation?

As soon as you start asking that kind of question, you’re no longer talking about healthcare events but about pathways. The events are still there, of course, but strung together into pathways, like beads on a necklace. Taking the long view sees events only as components of something bigger, and that’s a much richer view.

One of the reasons why this is becoming more important is the sheer number of conditions that are the subject of chronic care, extended through time, as opposed to acute care, delivered over a relatively short period. Heart disease, diabetes, respiratory problems and many other medical conditions need treatment over a long time. That’s even truer of an area of illness we tend to talk about less, though it’s likely to affect one in three of us in our lifetimes: mental illness. Mental healthcare seldom takes less than a few months, often lasts a number of years, and can continue throughout life.

To think about healthcare in terms of extended pathways poses all sorts of new problems for information handling. In particular, it requires us to bring together items of information from many different areas and link them in a sensible way.

That’s what my present job has given me free rein to do. Since it’s something I’ve wanted to work on for years and have only touched on superficially in my previous roles, you can imagine the extraordinary (if slightly geeky) satisfaction it gave me recently to work with my colleagues to build views of events in care pathways. The other day, I scrolled through the records of care delivered to a patient who had suffered a stroke: not just the emergency attendances or the outpatient clinics and inpatient stays, but the time in care homes, the visits by district nurses, the physiotheraphy sessions either in or out of hospital.

For the first time, I was able to see a full pathway of care. I’m not a clinician so I can’t judge whether the care was the most appropriate. What I do know is, in that slowly scrolling list of records, I had all the information a clinician would need to make the judgement.

It gives me a buzz to know that, thanks to the outstanding support of highly proficient colleagues, I can now make a tool that powerful available to our clients.

Tomorrow's Monday. The prospect of a new week, of commuting back into the office, inspires no dread. Unlike my son in his childhood, I’m suffering from no Sunday evening blues at all.

Friday, 3 June 2011

To clean up a mess, a pair of dirty hands may be what you need

There will be an anniversary later this year which few in the media and probably no-one in government will mark.

On 12 November, it will be forty years since then US President Richard Nixon told the world ‘there are no American combat troops in Cambodia. There are no American combat advisers in Cambodia. There will be no American combat troops or advisers in Cambodia.’ By then the US had been waging its covert war in Cambodia for eighteen months.

It actually caused me to laugh out loud when I saw four former US Presidents and the incumbent – Ford, Carter, Reagan, the elder Bush and Clinton – attending Nixon’s funeral with its orations in memory of a great statesman. Tricky Dicky set the bar so high when it comes to mendacity in public office that no-one has come near him since. Why, even Tony Blair, a byword in Britain for the crooked politician with his on-air ‘I’m a pretty straight sort of guy’ and his deceptions over the Iraq War, isn’t remotely in the same league as Nixon.

The President didn’t do it all on his own. He was ably assisted, in particular by his his National Security Adviser, Henry Kissinger, another man who could look straight into a TV camera and come out with a string of bare-faced lies. Kissinger was untiring in his efforts to prevent any news of the Cambodia bombing getting out, so when there were some leaks he moved vigorously against their suspected source Morton Halpern, an adviser to the National Security Council. Kissinger persuaded the head of the FBI, J. Edgar Hoover, hardly a paragon of transparency himself, to put a wiretap on Halperin’s phone. An illegal wiretap.

Amusing, isn’t it? It was illegal bugging that spelled the end of the Nixon Presidency. But it was Kissinger who started the practice.

Now scroll forward through the decades to the present day.

An extraordinary amount of newsprint and air time has been devoted to the troubles of FIFA, the world governing body of football. I have ambivalent feelings about the organisation: some of its decisions strike me as completely reasonable. For example, although it put a lot of noses out of joint in England, denied the opportunity to host the world cup itself, I can’t help feeling that the decision to award the cup to Russia in 2018 and Qatar in 2022 was entirely right. Neither had ever previously hosted the competition. And there was something squalid about the cosy old arrangement whereby the honour alternated between a set of usual suspects in Europe and another set in Latin America.

However, even if the decisions are right, the process by which they’re reached is hardly edifying. It seems that the way is always littered with grubby little cash payments, and some that are far from little. Even the election of the organisation’s President, Sepp Blatter, to a fourth successive term of office this week was an ugly spectacle: he was unopposed, his nearest rival eliminated just days before as a result of an investigation into corruption. That investigation, run by Blatter loyalists, also exonerated the President from any suspicion of wrongdoing.

Not so much the Thomas Jefferson standard of democratic practice, more Robert Mugabe.

Blatter has promised to turn FIFA into an honest and transparent organisation. A ‘Solutions Committee’ will look into any shady dealings and propose means to prevent them happening again.

And here’s where that forty-year anniversary becomes so significant.

Blatter and Kissinger: made for each other?
Who’s been pencilled in to head that committee? Why, none other than Henry Kissinger.One day FIFA will get its house in order, I’m sure. But I suspect it may take a while yet.



P.S. A footnote on Morton Halperin. He once summed up NATO policy as follows:

‘The NATO doctrine is that we will fight with conventional forces until we are losing, then we will fight with tactical weapons until we are losing, and then we will blow up the world.’

No relevance to the stuff about Blatter. Just seemed worth quoting.