Cameron and the EU: in with a roar, out with a whimper

The American commentator H L Mencken famously said ‘no one in this world, so far as I know … has ever lost money by underestimating the intelligence of the great masses of the plain people.’ 

It’s a terrible, cynical indictment, one that those of us who cling to our faith in democracy can only abhor.

On 9 December, Prime Minister David Cameron won himself a reputation for firmness and courage when he exercised Britain’s veto to block EU treaty change aimed at controlling Eurozone budgets. His ‘No’ was seen in many quarters, including the bulk of the British media, as an assertion of national independence and a much-needed stand against bureaucratic meddling from Brussels.

At the time, despite all the plaudits Cameron won, many of his critics pointed out that what he’d exercised wasn’t exactly a ‘veto’. Usually, a veto is understood to be something that blocks an initiative or a law. This one simply meant that the other 27 nations would go right on doing what they planned to do anyway, unblocked, even unfazed by the UK attitude, with the only effect being that Cameron had sidelined his country.

Cameron, however, was at pains to ensure we all understood how resolutely he had acted. He underlined his determination by refusing the right of the other 27 members to use EU institutions to police whatever agreement they eventually adopted, or even to meet in EU premises. Under pressure from his officials, he soon started to row back from this petulant position and his partners (or adversaries) in Europe soon found they could at least use EU office space for their discussions.

That process of rowing back has continued ever since. Just last weekend, it has emerged that Cameron is likely to cave in on his opposition to the use of European institutions such as the Court of Justice to police any fiscal agreement the other members make. So it looks as though the way has been cleared for the Eurozone members to set up their new arrangements and use EU mechanisms to enforce them.

The only effect of Cameron’s ‘veto’ has been to exclude the UK from their operation. But the UK was going to be excluded anyway since it isn’t in the Eurozone. So basically Cameron’s ‘no’ was really a ‘yes’. Or, given his use of a metaphorical megaphone in December, his ‘NO’ looks set to become a ‘yes’.

What is ironic is that in December Labour was running two to four points ahead of the Conservatives in the polls. Hardly a massive lead, hardly even an encouraging one, but a lead all the same.

Since the ‘veto’, the Conservatives have caught up and, indeed, they even took the lead for a while. These days, they are level pegging with the opposition. It seems that the loudmouth ‘no’ followed by the whispered ‘yes’ has done Cameron’s party nothing but good.

The lion that whimpered.
Self-satisfied? He has plenty to be satisfied about

There are admissions that it gives me no pleasure to make. Some indeed give me great pain. Not for the first time, though, in the light of the evidence, I can't help feeling that Mencken was far from entirely wrong...

My exploits and Caesar's, and goodbye to Emeryville

Stations are romantic, exciting places. The sound of the trains sets the heart beating, while all around the joy of greetings for new arrivals mingles with the excited anticipation of those setting out on their journey.

Airports on the other hand are synthetic and soulless. Because San Francisco airport is my gateway back to home and Danielle it promises pleasure, but in itself it’s a miserable place. Utilitarian, pedestrian, rushed. No heart. The contrast is all the starker because I’ve spent a week in a hotel next to the Emeryville Amtrak Station, from which several times an hour I’d hear that haunting sound, iconic of the United States, of a train’s horn. Its mournfulness seems to express the sorrow that this country, which did so much to pioneer the railways, has since turned its back on them, preferring the dullness of air travel. 

How right one of my teachers was to say that  if God had intended us to travel by air, he would never have given us the railways.

While we were here, we didn’t actually use Emeryville Station because, although San Francisco itself is right opposite, the Amtrak lines run all the way along the Bay but not over it or under it. Instead we used the BART, the Bay Area Rapid Transit. We took it several times in complete innocence, not realising until I was warned just a day ago that our nearest station is regarded as a dangerous place.

There’s no way we could have known: we had nothing but pleasant experiences there, above all with a wonderful woman who was manning (womanning? personing?) the information booth. She came out to help us get our tickets from those appalling machines the BART provides for the purpose, and which are entirely incomprehensible until you’ve undergone intensive training. After that, whenever we saw her she would smile and chat to us about how we’d enjoyed the city.

Nor is that the only pleasant recollection I shall take away from Emeryville. For me, the town will from now on be forever linked with Julius Caesar. 

‘Emeryille?’ I hear you cry. ‘Rome, certainly, even Spain, North Africa, Egypt, Asia Minor, all the places to which that extraordinarily mobile conqueror travelled. Even Britain. But Emeryville?’

He never made it to Emeryville, except in (my) spirit

Ah, but Caesar’s association with this little town is my own entirely, a purely personal link. As I’ve mentioned before, I’ve been enchanted by a series of podcasts recommended to me by my son Michael: The History of Rome, put together over a long period with considerable, pretty well unremunerated effort by Mike Duncan, as apparently disinterested in the enterprise as he was interested in the subject. 

This week,while I’ve been pounding the streets of Emeryville, I’ve been listening to his episodes about Caesar. Out running every morning, I’ve heard about the great general’s own feats, to the accompaniment of the boots of his legionnaires hammering the roads, like mine, though in their case they were criss-crossing Europe and the Middle East; as I’ve  targeted my own personal goal for this week’s runs, I’ve listened to the tale of the great statesman’s drive to achieve his objective of power over a great Empire. 

Let me say that my target was was no easy one for me to hit: to complete a half marathon. Not in one session - that’s not quite in my capacity - but at least over several. This morning I made it, as the sun rose above San Francisco Bay and Caesar fell to his assassins’ daggers.

The sun rises over Emeryville Marina, perhaps to salute my (minor) triumph

My achievement, I admit, hardly rivals his, but by my scale of things, it was quite satisfying enough. And at least it didn’t leave me bleeding to death at the foot of Pompey’s statue.

Fiddling while healthcare burns

It has been a fascinating experience to spend 25 years – what am I saying? knocking on 30 years – working in healthcare information.

Throughout that whole time, the field has been marked by two powerful and constant trends. The first of these is a growing capacity to deal with more and more diseases. Whether it’s breakthroughs in pharmaceuticals, in surgical techniques, in equipment and consumables, or simply in approaches to care, the number of conditions that can be diagnosed, treated and cured has steadily increased.

And the second trend has been a reflection of the first: a steadily ageing in population, at least in the developed world. People are living longer and that is a tribute to the success of healthcare progress.

Unfortunately, the two trends come together to reinforce a third and much more worrying development: uninterrupted grown in health expenditure. When I started work in this area, healthcare expenditure in Britain represented around 6% of GDP, and in the United States, around 9%. The figures today are over 9% and, staggeringly, over 16% respectively.

Now nobody has ever worked out the maximum an economy can spend on healthcare. We know that on current trends, the US is heading towards 100% of GDP going on healthcare by the end of the century, which is obviously crasy. But what if costs were halted at 50%? That does seem a bit high.  What about 25%? Could a society stand that? Could it still spend enough on education? On roads? Or, given the tendency of both Britain and the US to intervene in other countries’ affairs, on the military?

What is clear is that somewhere there must be a limit. And it’s equally clear that the two great forces that have marked the whole of my career both push that limit: as populations age, they tend to require more healthcare, and they require it for longer; as technology improves, it allows more to be done, but generally at higher cost, at least when innovations first appear. So we have a conundrum.

However, it’s not all bad news. Because one of the effects of improving technology is that in the long run it makes it possible to reduce, rather than increasing, costs. By doing things more effectively, we can avoid certain forms of expenditure. And there tends to be a tipping point in all technology developments: there comes a point where things become cheaper because they become more efficient – we’ve seen it in cars, that have improved massively in efficiency and therefore in cost. And we’re seeing it in healthcare, where for example keyhole surgery techniques have reduced the cost of care substantially because patient recovery is so much quicker, without any great increase in the cost of the operation as surgeons have become more proficient and comfortable as the techniques become routine.

That’s why so many procedures that used to involve several days in hospital can now be performed on a day case basis. A striking example is cataract extractions. Even more serious surgery, such as open heart operations, have so evolved that an otherwise healthy individual may be ready for discharge within four days, where in the past it might have taken twelve.

These examples are a clear signpost of the way forward: use evolving technology to improve care delivery. In particular, use it to limit the time patients spend in hospital: hospitals are nasty, dangerous places, full of sick people and the longer you stay in one, the greater the chances of picking up a nasty infection and leaving in a worse state than you came in. They’re also about the most expensive places in which to receive treatment – anything we can do to get treatment carried out in a GP’s surgery, or even in a hospital on an outpatient basis rather than as an inpatient, is likely to be a benefit to the patient and a saving of money for society.

Vital when needed, but best avoided if you can. And very expensive...

Now all this has been known for decades. The trick is to start doing it. Start cutting out the unnecessary treatment, or at any rate the unnecessarily expensive treatment.

But that means taking clinical decisions, deciding what is the most intelligent and appropriate approach to delivering care.

So why instead of tackling those issues does government after government instead try to find economies in the area of healthcare management? The British National Health Service spends around 3% of its money on management. Just how much can you save from that?

And are the savings real anyway? If you take out the administrative support staff, the administrative work still has to be done. So who does it? Why, the front line staff themselves. The nurses and doctors. That diverts resource from healthcare, and is also far more expensive: most nurses and certainly most doctors cost a great deal more than most administrators.

But governments do worse than that. In my time, in Britain alone, I’ve watched the Griffiths reforms bringing in General Management. I’ve watched the idea of ‘Hospital Trusts’ being introduced, and later ‘Foundation Trusts’. I’ve seen the creation and abolition of Area Health Authorities, the setting up of Primary Care Groups and then their replacement by Primary Care Trusts, now just over a year from abolition themselves, if the latest legislation goes through.

In other words, I’ve watched government tinkering with the organisation, fiddling with the structure. Andrew Lansley’s proposed NHS reforms are probably going to cost about £1.2 billion – all in the name of seeking out economies. And all the time the real savings, which at the same time can generate real improvements in patient care, need clinical reform, not managerial change.

No wonder the controversy about the latest proposals is so intense. It deserves to be. The new initiative represents a huge expenditure to address completely the wrong issue. Not because trying to control healthcare expenditure is wrong, but precisely because it’s so badly needed: Lansley's legislation would waste money and fails to address the real problem.

When it comes to hare-brained government initiatives, it has to be right up there with the very best of them...

Land of surprise and curiosity

Amazing how one can become passionate about, or at least interested in, something to which one was previously pretty much indifferent.

Here I am opposite San Francisco, surrounded by colleagues who live here, and who almost universally support the 49ers. Who are the 49ers, I hear you ask, where by ‘you’ I mean practically anyone who lives outside the USA? Well, they’re the local team in the grand old game referred to in this country as ‘football’ and more or less everywhere else in the world as ‘American football’.

I can make no claim to any kind of expertise in this sport, although funnily enough after a childhood spent despising any kind of professional game, the first match of any kind that I ever attended happened to be an American football game. It was between the New York Giants and the Cleveland Browns. Practically the only thing I remember about it is a man in a brown scarf jumping up and down and chortling wildly when the Browns scored. He was silenced by a single, quiet scowl, probably because it was being directed at him not by one man by about 50, sat all around him.

Coincidentally, it was the same New York Giants who were playing the 49ers yesterday. The San Franciscan team hadn’t, apparently, been enjoying much success in recent seasons, so when they scored a dramatic, dying gasp win over the New Orleans Saints last week to qualify for the semi-finals of a prestigious championship against the Giants this week, it was a moment for jubilation throughout the City and among my colleagues.

That persuaded me to watch the game yesterday, and I found it surprisingly enthralling.

The first thing to say about the experience was that it was extraordinarily long. If you take a standard rugby game, say, the eighty minutes of actual playing time plus ten minutes of half-time break, usually takes about 100 to 110 minutes to complete. During the Six Nations Championship, for instance, you can be pretty certain that you can safely start a second game a couple of hours after the first without much danger of their overlapping.

An American football game only lasts sixty minutes, not the eighty of rugby. But yesterday’s match ran from 3:30 to after 7:30. It takes four times as long to complete as the playing time. 

What’s more, in a rugby game, the great division in a side is between the forwards and the backs. The forwards tend to be bigger and heavier and their major role is to drive the ball forwards, while the backs are lighter and quicker and their major role is to run with the ball. But they’re all on the field at the same time and part of the beauty of the game is how these two divisions mesh with each other.

In addition, when the forwards aren’t driving the ball, they’re trying to prevent the other side driving it back the other way, and when the backs aren’t running with the ball, they’re tackling their opposite numbers to stop them breaking through their lines. In other words, both divisions play both in attack and in defence.

In American football, although each side only has eleven players on the field at a time, it can actually be made up of 53. You get a group that specialises in attack, or as they like to call it here, offense, a group that specialises in defence, or defense as they call it over here, and a group that specialises in specialisation (I kid you not: you get a ‘specialist’ team). This means that every now and then, a whole team will leave the field to be replaced by a whole other team specialised in different skills.

Together with the fact that the play stops every few seconds for another set piece - both sides line up against each other, offense against defense, and pause before the side with the ball launches another brief flurry of frenetic activity - it’s not in the least surprising that it takes forever to get through sixty minutes. In the course of yesterday’s match I even had a brief siesta and a bath and managed not to miss any of the actual scoring action.

On top of that there are commercial breaks several times an hour, to make sure you don’t get too engrossed in the action.

Despite all these layers of sophistication, the whole match ultimately came down to that simplest of events, the bane of teams in every imaginable sport, the defensive blunder. And not just one but two of them - by the same player. Spare a thought and a little compassion for poor Kyle Williams from the 49ers, a beginner or, as they like to say over here, rookie who twice let in the other side - once to take the lead, the second time to win the match and qualify for the finals. What a morning he must have woken up to today!

Whoops! Williams spills the ball in his second match-losing error

Amazing the game hasn’t caught on around the world. What could be better in our bankrupt economies than to play a sport that requires 53 players to field eleven? If it got popular enough, it could actually seriously dent the unemployment figures.

Postscript: French at the wheel. The United States is not particularly celebrated around the world for its mastery of foreign languages. I always remember a Louisiana senator some decades ago announcing ‘if English was good enough for Jesus Christ, it’s good enough for me,’ one of the more delightful examples of the kind of captivating wit that makes it such a pleasure to visit this country (and which compensates for some of its less attractive features).

These days, Spanish is pretty ubiquitous but other languages barely get a look in. So Danielle and I were amazed to discover in three cab rides that our driver was French-speaking. On one occasion, we were a little offended by the taciturnity of the man behind the wheel, who answered our polite comments in monosyllables until he overheard us talking French to each other. At that point he revealed himself as Algerian and chatted to us cheerfully all the way to our destination. Of the other two, one was also from North Africa, the second from Guadeloupe. 

Not what I’d have expected in the US. But then one should never underestimate this country’s capacity to surprise.

Prayer, miracles and wonders

It never snows but it pours. All of last week we were wondering when the snow would finally reach Lake Tahoe. In the end, with our departure due the next day, we travelled up to the ski slopes on Friday to take our chances on the man-made snow, since the natural variety just wasn’t showing up. No sooner had we got there, though, than the real kind started to fall, so we had our day’s skiing under grey skies and with tiny, wet snowflakes stinging our faces as we struggled through the wind. 

We were even told, in the café on the slopes where we stopped for lunch, that we’d ‘timed that pretty damn’ well’, as they were going to shut immediately after our orders, having just been told that the ski-lift was closing down. One of the ski patrol people did tell us, with a charming smile (the friendliness and warmth of everyone we met was in stark contrast to the bitterness of the weather), ‘sure, you’ve got the time to eat your sandwiches, but don’t hang around, and if you look like being the last out, make a move for the door’.

By then the blizzard had got well under way, and all we could do was leap on the lift just before it shut and ski back down to the main station. It was a great day all the same, but truncated. Which made me think with wry amusement of the sign, we’d seen in the café where we had our lunch: ‘pray for snow’.

Faith invoked to overcome the drought

By next morning, the prayer had been miraculously answered, and the place was under a good blanket of snow, right down to the lakeside. We even had to fit chains to be able to drive away. Of course, for us, a day earlier would have been no bad thing. Timing is so important, isn’t it? A day’s skiing on fresh snow would have been a delight; instead we got to drive through it, which is much less fun.

Even so, I’m not complaining. We had a great time, however difficult the conditions and however short the day. And it was a relief to see some snow whenever it came, after so long when it looked like there’d be none. I even have to admit that, despite the lousy performance of most weather forecasters, who just kept pushing their prediction of snow back by a day each day, making me feel justified in thinking that one might just as well flip a coin, the local crowd did really well: right from the beginning of the week they said the snow would come on Friday, and they were bang on. They at least got the riming right. And showed me up for maligning them so mercilessly as I usually do (and no doubt will again).

An answer to a prayer - and vindication for a forecaster

Postscript. I loved the sign in the ski station, at the stop for the shuttle back to town: ‘Shuttle Bus to Gondola’.

A miraculous metamorphosis that would have been a wonder to behold

Now that’s a transformation I’d have loved to have seen. Would the driver have turned into an Italian with a fine tenor voice? Would his wooly hat have turned into a straw boater? Would his fleece-lined coat have turned into a stripy shirt? He might have been horribly cold, in the conditions.

But I never found out. We were in a hurry to get away. Timing again, you see. I had to be satisfied with miracle of snow falling in answer to a prayer. The even more miraculous conversion of a bus into a gondola was a wonder I would simply be denied.

Post-postscript. When we got back to the San Francisco Bay Area, I was struck by a pair of road signs: to the left ‘Ex’pression College’, with that apostrophe, for which I can think of absolutely no meaning; to the right, the ‘National Holistic Institute’. 

‘Yes’, I thought, ‘we’re back in the San Francisco area.’ All it would have needed to complete the picture was a few chanting monks in saffron robes. 

That evening Danielle and I went out to Japantown, which we'd never previously visited, travelling as we have on every occasion in this visit, by cable car. At our age, behaving like complete tourists no longer embarrasses us, so we can just let ourselves go and enjoy the pleasure. As well as a pleasant Korean meal in Japantown (yes, yes, I know, we thought it was Japanese until we were inside), we were delighted by the many people we met on the way back, who were all heading for an Edwardian evening.

Wonders of the San Francisco streets

A wondrous sight, and just what one might hope for from that great city, it provided a good way of wrapping up Danielle's visit here. I stay on for another six days.

Strange emeralds and ill-advised signs

Our stay in the Lake Tahoe region continues to provide constantly renewed pleasures. Some of my satisfaction comes in the form of mild irony, but hey, there are few things I appreciate as much - why would I complain?

For instance, the justification for being here at all is to get on with some work. That was supposed to reach its end early this morning, a time marked by splendid sunshine, warming us as we stepped outside, sparkling on the lake below us. But we overran and because, really, genuinely, we’re not hear on holiday (sorry, vacation: this is the US after all), we conscientiously ploughed on until we’d finished our agenda. By which time the clouds had come up, the temperature had fallen, a bitter wind had begun to blow and, before we got to the local beauty spot of Emerald Bay, the snow had started to fall.

Snow. All week we’d been hoping for snow so that we might get a little skiing in before heading back to the big city on Saturday, and not a single snowflake had fallen. It chose instead to start coming down once we’d decided on a hike.

Emerald Bay remained gorgeous place, but it had some trouble living up to its name. Unless of course there is a breed of emerald that is a fine slate grey trending towards jet black (do emeralds have breeds? Not that it matters - I’m sure they don’t have this one.)

Lovely spot. But emerald?

As it happens I nearly didn’t make it down to the lakeside. As we started out on the hike (or gentle country stroll to use the term we prefer in England) I came across a warning sign.

A whole mile? Bad news for health conditions apparently - whatever the condition.
In any case, aren't they lying? We surely are being advised. By this very sign.

Do I have a health condition? Well, of course I do. The condition of my health is, mercifully, pretty good. But it’s certainly a condition.

Should I have stayed in the car park (sorry, parking lot)? Perhaps in the van itself, with the heater on? It would have protected me from the cold and the snow, certainly, but can you imagine? I would have missed the unique experience of seeing grey emerald waters.

In the end I decided that I couldn’t deprive myself of that pleasure and headed down the path. But not without gratitude to the Park authorities for showing such solicitude for my wellbeing.

Thanks, guys.

A place of beauty and a game of chance

There are places which, at every first sight, immediately strike you as belonging to the world's great sitees of natural beauty. Danielle and I are at Lake Tahoe, and it's right up there with what's  most outstanding. A mountain lake stretching into the misty distance, with snow-covered peaks gazing down on all sides, the slopes covered with age-old woods extending as far as the eye can see.

Well, when I say ‘snow-covered’, they ought to be at this time of year, but today all they show is some pretty impressive rocks with odd patches of ice. The snow is only striking for its absence. Bad news for the villages clustered around the lake and which depend on the winter sports: they’re having a bad time of it.

As for us, we’re having to resign ourselves to not skiing, but it hasn't been hard. We're here because a group of my colleagues invited us along so I could join them for some discussions on product strategy, and they've been invaluable. Those colleaguese are also excellent company. So Danielle and I are enjoying spendign time with them, there’s plenty to eat and drink, and the setting is glorious.

Besides, as well as being beautiful, the setting has features than can conjure up a smile.

We happen to be in Nevada. We got here from California. And how did we know that we’d crossed the State Line? Just before we turned off the main road, we came across the infallible sign that we had moved into Nevada: a casino.

The landmark for our arrival in Nevada: the Heavenly Village Casino
But we lost the bet on snow

It’s in the same village, but a different state. On the California side, you can live in virtue with no contact with the corrupting influence of gambling. But if you’re tempted – well, just a few minutes walk will take you into the hands of the fiend and you can gamble your heart away.

Give me virtue. But only when I don’t feel like sinning. As a commandment it may seem a litte pragmatic, a true game of chance dependent on where the line between two States was drawn. That won't satisfy someone who believes that morality should be, well, a little more absolute than that. But at least a rule that flexible seems to take human nature more fully into account.

And it's probably a lot easier to apply to life.

Enjoying the present, reliving the past

In a memorable line, the Comedian Eric Morecambe assured his audience that he was ‘playing all the right notes, though not necessarily in the right order.’

We've never been that good at getting the order of things right. When the judge granted Danielle, then married to her first husband, her divorce, he took a look at her belly and said ‘I expect you’d like me to reduce the time lag before the decree becomes absolute to the minimum.’ He took it down to a week from the normal six, and as a result Danielle and I were married just eighteen days before our son Michael was born.

With Danielle’s first son David with us, and Nicky showing up not that long after Michael, there was no way we have a honeymoon at the right time - i.e. then. So instead ten years later, with a business trip to San Francisco in the offing, I suggested that Danielle come along and take the opportunity to have a delayed honeymoon. Better late than never, after all, and we would enjoy it all the more for having waited so long.

And we did enjoy our trip to what quickly became Danielle’s favourite city anywhere. We stayed at a hotel which boasted a penthouse which was more a pentshack: a wood and glass construction placed on the roof, with breathtaking views of San Francisco Bay, the Golden Gate Bridge and the city, where we were woken in the morning by the sea lions barking and could watch a flock of parakeets flying past our windows.

When, nearly twenty years on, I again got the opportunity to take a business trip to San Francisco, Danielle announced ‘I’m coming along.’ It struck me as a good idea, so she’s at my side as I write this.

This time we did everything much more by the book. The first evening we were in China Town to indulge ourselves in truly superior Chinese cooking. The next day we had a walking tour through part of the city, enchanted but shivering through weather that had turned to bitter winter overnight. To warm up we headed to a vegetarian restaurant, Green’s, where we had an excellent meal against the background of yet another view of the bay and the bridge.

Our first visit to San Francisco had left me with only one regret: we’d had a remarkable breakfast at the famous Cafe Roma, sitting in the tiny back terrace area, under vine leaves through which the surprisingly warming October sun was shining. But I chose not to wash down the meal with mimosa, the combination of orange juice and champagne that would have been the perfect complement to my scrambled eggs and smoked salmon.

So I took great pleasure in correcting that omission while I was at Green’s, and we had mimosas there - though as befits the constant innovation that marks the city still, this one was made with pomegranate juice rather than anything so pedestrian as mere orange.

Ready to enjoy mimosas and correct an old omission
Pomegranate, no less - my dear, the style, can you imagine?

Then we set out to find our hotel with the pent shack again, which was not as straightforward it sounds, since we couldn’t remember the name let alone the address. But we tracked it down, and found the San Remo unchanged, and still endowed with its jewel of a pent shack.

We also travelled round the city by the most appropriate means, cable cars, even hanging on for dear life to the outside on a couple of occasions. That was a mode of transport we’d disdained first time, this trip has really seen us being quite exemplary in ensuring we did things properly.

The right notes in the right order, for once. And the notes themselves are pretty special, they resonate with us. San Francisco remains Danielle’s favourite city. 

And I have to say that I too find it hard to imagine one to prefer to it.

The wonders of private healthcare and of Scottish government

In Britain, a very small proportion of healthcare is delivered by private hospital


These are organisations that provide healthcare for profit, or at least try to (anyone can run a business badly). As a result, they only do what is referred to in the trade as ‘cold surgery’ - in other words operations carried out on a planned basis rather than in response to an emergency. 


These can be relatively low-key operations such as a hernia repair, or something more substantial, like a hip replacement. But what they all have in common is that they are carried out on patients who are, broadly speaking, in good health: they obviously have the condition for which the surgery is needed but otherwise they’re well - they don’t have anything likely to turn into a nasty heart attack, or a major neurological problem such as a seizure or, even worse, a stroke. 


It will come as no surprise that this is the kind of case that is most likely to generate a profit. 


Partisans of private hospitals argue that by handling this kind of work, they relieve the NHS of having to do it. What that argument leaves out of account is that what’s left is the more difficult cases that are likely to be the most expensive. What it leaves even more out of account is what happens if things unexpectedly go wrong, as they have a tedious way of doing in healthcare. 


What if, against all the available indicators, a patient has a heart attack while in the private hospital? 


I came across exactly such a case some years ago, though I won’t mention the private hospital involved, because why should one embarrass the guilty? What happened was that reception staff called for an ambulance. When it arrived, NHS paramedics took the patient into their charge at being shot of all further responsibility for him. 


Because that’s what the private sector does. It cherry picks the easiest cases. And it avoids any of the huge infrastructure costs associated with building centres capable of dealing with the serious problems, with the life-threatening conditions. No wonder the private sector can aim at profitability. 


Why is this important today? 


Because the latest reorganisation of the NHS aims to make it possible for ‘any willing provider’ to deliver healthcare. That form of words led to a bit of a storm of controversy so now the government is saying, ‘well, yes, of course the provider as well as being willing also has to be suitable, properly qualified, and shown to be capable of delivering quality.’ If only they’d said that from the outset I’d have less trouble believing them. But suitable or not, these hospitals are still going to be creaming off the most lucrative cases while avoiding the burden of the difficult ones - for which they’ll have to turn to the public sector for support. 


Anyone in Britain questioning that suggestion need only look at what’s happening in connection with the latest healthcare scandal: breast implants provided by a (now-bankrupt) French company, PIP, using industrial-grade silicone. That’s a bit like putting a load of diesel oil in your body and being told, ‘don’t worry - there won’t be a problem unless the pack leaks.’ Inspires confidence, doesn't it?


And guess who did 95% of the operations? Private hospitals, of course. And who picks up the tab if things go wrong? Oh, yes, you guessed it: the public sector. The private cosmetic surgery companies reckon that they just can’t afford to do the work of removing the implants themselves - it would cost too much. Why, it might wipe out their profits. So they expect the rest of us to cover them for them. 

Leaking industrial grade silicone - just what every woman wants inside her
The private sector can fit them. To take them out, just turn to the NHS

Oh brave new world that has such people in it! 


What a wonderful, liberating experience it’s going to be having all those ‘willing providers’ helping out the NHS. 




Postscript: they order these things better north of Hadrian’s Wall 


This week David Cameron, Prime Minister of the United Kingdom, decided to confront Alex Salmond, First Minister of Scotland, a major part of that same United Kingdom. 


Salmond wants to hold a referendum on independence for Scotland. But because he’s a wily old fox and he know time’s on his side, he wants to hold it in 2014. And, because he knows he might lose the referendum, he wants it to include an alternative possibiliy - maximum devolution, with Scotland running all its own government except for foreign affairs and defence (often the same thing these days) which would be left to the residual UK. 


Now Cameron is calling him out. The referendum must be held in 2013. And, he maintains, it can’t contain the maximum devolution question. 


So Cameron is taking on Salmond head on. Cameron. Self-confident to the point of brashness, indolent when it comes to preparing his ground, convinced that success is his due. Against Salmond. The smartest operator in the UK today. 


I’m looking forward to watching the contest. Cameron might best him. But I won’t be putting any money on that.

Cameron, left, looking for an idea. Salmond looking as though butter wouldn't melt
I know who I'd put my money on

Happy anniversaries and an affectionate feline

Marking memorable moments 

A former boss once asked me, ‘David, you know the best way of ensuring you never forget your wedding anniversary?’

‘No,’ I dutifully fed him the reply he wanted.

‘Forget it once,’ he told me.

Funnily enough, our marriage hasn’t been like that at all. For the first 22 years, Danielle forgot the anniversary each and every year, and in all but one of them I alone remembered. So year after year I’d turn up with a bunch of flowers, and Danielle would say ‘oh - is it today?’

Seven years ago that all changed with the birth of our granddaughter Aya, coincidentally on the very day of our anniversary, 11 January. At least, I hope it was a coincidence, because otherwise I’d have to start accepting the intervention of supernatural forces that I’ve always found it more comforting to deny.

Anyway, with something really important by which to remember the day, Danielle’s never forgotten it since.

So tonight we celebrated our twenty-ninth anniversary. And Aya’s seventh birthday, of course.

Well, not exactly celebrated,though Danielle’s potato salad was outstanding. We marked it, at least. We’re saving ourselves for next week in California when Danielle will be out every day on the ski slopes above Lake Tahoe, while I’ll be indoors discussing product strategy.

And how’s that not an appropriate way to celebrate?

29 years - the moment deserves celebration

Mixed messages from Misty.

A strange transformation has come over our cat Misty. He has taken to coming and lying on my lap, even at one point abandoning Danielle’s to choose mine. He stops to greet me when I let him in, instead of just pushing past to get at his food, protesting if there isn’t enough. 

He treats me like a human being, even sometimes like a fellow cat.

It’s actually quite troubling. I mean, I’ve known for years that he’s a worryingly talented cat, something that can have quite disturbing effects. For instance, as the three of us were standing on our doorstep once, while Danielle was opening the front door, I casually commented that Misty was putting on a little weight. Up went his tail and his nose, and he stalked away. For the next 24 hours, he’d have nothing to do with me.

I’m concerned now that from an understanding of spoken English, he’s now graduated to reading the language too. In a recent blog, I made some comments about his attitude towards me which he may have regarded as hurtful. Perhaps he’s putting all this effort into showing me that he deserves my affection.

Misty, you don’t need to. Very nice to have you lying on my lap from time to time, to have you purring beside me, but you don’t need to force things. I liked you even when you treated me with contempt and bit me when I didn’t jump to do your bidding. 

Relax. Be yourself. That’s the way I like you anyway.

Coming down to earth

If Christmas is a family time, we did it right this year. We saw my mother and my brother; we had our granddaughter with her parents in the run up to Christmas; and at various times over the Christmas and New Year period our other two sons and one of our charming daughters-out-law.

It was only on Monday that our daughter-out-law left, to start a new job in Madrid, proving that jobs can be found in Spain despite the much trumpeted unemployment. One son went on Wednesday, the other on Friday, so the wind-down after Christmas has been tapered, not brusque, making the transition back to work, which I found painful this year, easier than it might have been.

Now, though, we’re back to our own devices, with little to show for the festive period but a large number of bottles for recycling and some kilos to lose.

One lasting legacy of the family visit is a recommendation my son Michael made to listen to a great podcast series: The History of Rome by Mike Duncan. This is the internet at best: somebody who has nothing to gain by it has simply prepared and delivered a history of Rome in dozens of bite-sized episodes, with just the right level of detail to be informative while remaining entertaining. 

Listening to this excellent series I was particularly struck by the history of Etruria. It was the home of the Etruscans, a nation of extraordinary wealth and culture. And indeed power: in the early years of the city, Rome was ruled by Kings and the last of these were Etruscan.

Many centuries later, in a struggle with another and equally ruthless imperial power, Benjamin Franklin would tell his fellow revolutionaries, ‘We shall hang together or we shall hang separately.’ The Etruscans were hanged separately. They wouldn’t bury their differences and they paid the price. 

Take Veii, once their wealthiest city, their jewel, not ten miles north of Rome. Never heard of it? Nor had I, or if I had, I’d forgotten. Today it’s part of a village in the Rome municipal area. With some fine ruins. 

I can imagine the scene, just before the slaughter of the population when Veii fell to the Roman siege (the soldiers broke in through the sewers, demonstrating that for all their love of honour, Romans valued success still more). I picture a worthy citizen, not realising that he would meet a violent death within a few hours, declaring ‘Veii has always stood proud and wealthy, the greatest of the Etruscan cities, and we’re certainly not giving up our independence to them, far less to those upstarts from down the road who’ve had the temerity to send an army against us.’

The rest, as they say, is history. Etruscan has vanished as a language. The people of Etruria were completely assimilated into Rome, speaking Latin and playing their own part in Roman life within a few generations.

Veii: not a lot left. The price of standing aloof?

Over the Christmas period, the British Conservative Party moved ahead of Labour in the opinion polls. 

That statement may seem unrelated to what came before, but bear with me: I shall explain.

That Conservative lead is particularly bad news for Labour. In mid-term, an Opposition needs to be building up a good lead in the polls if it’s to win the next election: there tends to be a swing back to the incumbents in the final stages, so the Opposition needs a cushion. Being behind is pretty desperate.

What caused the Conservative surge? 

On 10 December the Daily Mail referring to a historic moment the day before, told us ‘Defiant Cameron stands up to Euro bullies...’ This was the historic moment when Cameron vetoed changes to EU treaties so that the whole organisation could get behind attempts to solve the Eurozone crisis.

Others less inclined to see Cameron as a latter day Titan taking on the erring gods have taken exception to the word ‘veto’. Usually a veto, as they point out, stops something happening. This veto meant that 26 countries would go ahead and do it anyway, but without Britain. 

I sometimes wonder whether Cameron only realised that afterwards. Because as soon as he’d cast his vote, he told our EU enemies, sorry partners, that they couldn’t hold their discussions in EU buildings - you know, ‘if you’re not going to play by my rules, I’m taking my ball away.’ Later on, Britain backtracked from that position - civil servants, who are professionals after all, probably pointed out that this might not be the best way to make friends and retain some influence among people whose support we might need again some day.

But the virulence of Cameron’s initial reaction does rather suggest that he caught himself by surprise, doesn’t it? I can see him saying ‘well, you can’t do that because I’m saying ‘no’, so there, now what you are you going to do, eh, don’t look so clever now, do you? What do you mean? You’re going to go ahead and do it anyway? What without us? You’re going to ignore my veto? Well - if that’s the way you want to play it, you can’t use these nice offices then...’

In Britain though we tend not to think about the after effects of this kind of gesture but prefer to concentrate on the gesture itself. People loved it. ‘Standing up to to the Euro bullies’. Wonderful stuff. And it got him a tick up in the polls. Ahead of the opposition. Brilliant.

That got me thinking of other times in history when people have struck out on their own and told their partners to get stuffed. The Italian city states, for instance. Our daughter-in-law, when our granddaughter’s family came to stay with us, gallantly stood in a queue at the National Gallery for four hours so that we could all go and see an exhibition of paintings by her long-time favourite, Leonardo da Vinci. 

I particularly liked the pair of fabulously beautiful portraits of Ludovico Sforza’s wife and mistress. I often wonder how each of them must have felt about the other picture. And I can just imagine Sforza saying ‘Milan isn’t just an Italian city. It’s a proud and powerful centre with a long history of its own. We’re not going to be sucked into some kind of bogus unity with the rest of the peninsula.’ But while Leonardo was there, the French turned up and sacked the place, and over the next few centuries, Italy was regularly the playground of invading armies.

Leonardo's Lady with an Ermine: Ludovico Sforza's mistress
Culture, wealth, sophistication - but they were no protection against the French

One of the places I particularly liked in Alsace, where we used to live, was the Haut Koenigsburg, a fine castle beautifully and inaccurately restored by the German Kaiser Wilhelm (Alsace is like that: what country it’s in depends not just on geography but also on history). Why did the castle need restoring? Because it had been overrun a Swedish army. Swedish for crying out loud. Why the Swedes? Because until all those little German princedoms finally got together and sank their differences, Germany, like Italy, was a wonderful place for other countries to fight their wars.

Like Veii and the other cities of Etruria, the proud little Italian and German States were hanged separately because they wouldn’t hang together. 

Well, the Conservatives have drifted back behind Labour again. Not by much, but still behind. It’s as though after the excitement of the veto that never was, cold reason has reasserted itself. Ater all, nothing has changed. The French and the Germans haven’t surrendered to us. The economy is still dire. Unemployment is still rising.

It’s a bit like us taking out our empty bottles and resolving to lose those extra kilos. After the warm glow of the festive season we’ve had to come back to earth. Reality once more exerts its sobering influence.

Charming traditions

One of the high points, or at any rate one of the points, of the recent Christmas break was that great English tradition of the Boxing Day hunt. 

On the 26^th of December, some hundreds of those who like to think of themselves as superior, turned out with pretty red coats and large horses to go careering across the countryside after a bunch of hounds, while some hundreds of thousands of people with no more sense but far less money turned out to support them. 

It seems that this year the supporters numbered about 250,000.

Oscar Wilde had it right. Fox hunting is the unspeakable in full pursuit of the uneatable.  

The unspeakable at play

Well, the uneatable has been illegal game since 2004, when Parliament decided that having dogs tear a fox to pieces at the end of a hunt wasn’t acceptable behaviour in the twentieth century, however much fun the unspeakable may have got from the process. And however time-honoured the tradition.

Of course, there have been a few accidents when hunts have actually led to the death of a fox but, hey, accidents happen. 

Remember Apartheid South Africa? They used to happen to activists who got too close to windows on the upper floors of police stations. 

What about these days in Russia? They happen to journalists who get to close to uncomfortable facts. 

At least in Britain, it’s foxes who tend to be the victims rather than people. Where Britain resembles the other two countries is in the fact that the police don’t waste their time or anyone else’s investigating these unfortunate incidents. Sorry, accidents.

So the unspeakable are still going strong, heavily supported, galloping around the countryside as though they owned it which, come to think of it, they probably do. And with their friends now in government, there’s some pressure to get the hunting legislation repealed.

It’s a curious business, that. I never liked the ban. Not because I’m fond of the unspeakable of lack sympathy for the uneatable. More because I just don’t like bans.  I reckon they ought to be kept to the bare minimum needed for a civilised society. 

So, murder: yes, ban it (much though I’d like an exemption made for certain individual victims I could name). in a week which saw the conviction, eighteen years on, of two of the men who killed the teenager Stephen Lawrence for daring to be black in a public place, it’s hard not to feel that certain bans are highly desirable. Ban rape, ban violence against the individual generally, ban burglary, theft, fraud, and so on. 

But can’t we keep bans down to the strict minimum necessary? 

Take cannabis, for instance. It seems that at least three million of my countrymen smoke it on a regular basis. That suggests that we have at least as many dope smokers as we have churchgoers. So just how useful is that ban?

It’s easy for me to oppose the ban on cannabis: dope doesn’t bother me. It’s easy to tolerate things I have nothing against. The real test of tolerance is when we have to apply it to things we don’t. It’s more of a challenge to oppose bans on things that make me uncomfortable. For instance, I don’t like the wearing of the niqab, the full face veil, but it’s not clear to me that entitles me to call for it to be forbidden?

Equally, I dislike fox hunting pretty intensely. But I’m not convinced it should be banned, principally because I dislike the idea that a majority, just because it is a majority, should be able to impose its will on a minority that is no threat to its wellbeing. 

What’s more, I’m less uneasy about hunting than I am about our knee-jerk tendency to reach for the statute book to deal with any problem. That’s another of our traditions in our great nations of the rule of law: faced with a problem,  legislate, if only to make it look as though the government is taking action.

I’d much rather see certain things wither away than be banned. Reading toxic newspapers. Binge drinking. Believing in things because a few centuries go someone claimed, without a shred of evidence, that they were the word of God.  

So where does that leave fox hunting?

Well, there’s pressure for the ban to be lifted. Will it be? No, it won’t. Polls show a hefty majority in favour of keeping it. No politician who wants to ensure his re-election is going to go out on a limb on this one.

So what will happen? Another great tradition will be respected: the unenforced law. On the one hand, the law will stay on the statute book, and those who loathe hunting will feel self-satisfied on that account. On the other hand, those who want to tear around tearing a little animal to pieces will go right on doing it knowing the police will do nothing against them. At the price of a little hypocrisy, everybody can get what they want. It’s win-win. Except for the fox, of course. 

Ah, traditions. Charming, aren’t they?