NHS horror stories, my life as a Twitter fogey, and cricket’s robot generation

Peter Wilby's "First Thoughts" column.

Horror stories about the National Health Service come thick and fast, conveniently for a government that wants to hand it over to private capital. One week, it is chaos in A&E; the next, substandard care at 14 hospital trusts and old folk being ushered to an early grave by the Liverpool Care Pathway (LCP). We should treat these stories with scepticism even when they are apparently validated by official inquiries.

With all the talk of “excess deaths”, you would think that our hospitals had become killers. Yet, as the NHS medical director for England, Bruce Keogh, observes in his report on the 14 “failing” trusts, overall mortality in hospitals has fallen by about 30 per cent over the past decade.

Inquiries, however, rarely conclude that the problems they were set up to address don’t exist and they would be dismissed as whitewashes if they did. Given the emotion and fears surrounding serious illness and particularly death, it’s easy to find allegations of medical neglect. Julia Neuberger’s report on the LCP is replete with phrases such as “some people”, “many people” and “all too often”. There are no references to randomised sample surveys. The inquiry invited submissions from the public (it received 483), talked to 113 people at meetings and looked at hospital complaints. Such evidence should not be ignored but it is naturally biased towards those who suffered bad experiences.

No institution is perfect and anything involving medicine, which is as much an art as a science, will be more imperfect than most. What we don’t know is whether a health service run by private providers would be better.

I offer this snippet: in 2010, the US health department’s inspector general reported that 13.5 per cent of Medicare hospital patients suffered “harm” from “adverse events”, nearly half of them because of care failures. British newspapers love to highlight cases of “wrong-site surgeries”, in which ovaries are taken out instead of the appendix, for example. The United States has 40 of those a week; the UK has about 60 a year. The NHS has failings but they seem relatively few and, by international standards, very cheap.

Guilt by association

What’s in a name? The Neuberger report acknowledges that “many relatives” of patients on the LCP felt their loved ones had had “good deaths”. Yet it recommends dropping the term. “Pathway”, it argues, suggests patients being speeded directly to their coffins. I wonder if “Liverpool” isn’t the greater problem. Thanks partly to the Sun and Boris Johnson, the city has acquired negative associations in the past 25 years. Mention Liverpool and people think of poverty, unemployment, riots, too much drink and a declining football team.

Seen but not heard

The BBC’s director general, Tony Hall, says that he intends to stop actors muttering in the corporation’s dramas. If so, he will be performing a service to theatregoers as well as TV viewers. Actors, it seems, are no longer being taught to articulate their lines clearly and “throw” their voices, largely because the big money is now in TV, where authenticity is thought more important than audibility. Being deaf, I nearly always buy front-row seats at the theatre, but in the West End recently, we sat in the grand circle and my wife, whose hearing is perfect, complained that she couldn’t hear, either. Theatregoers should start a campaign and, at an agreed signal, stand in unison and shout: “Speak up!”

Social outcast

We hear much about how social media companies hold extensive databases on us that could be exploited by governments and corporations. We also hear about their inadequate controls over insulting comments. But I have not noticed discussion of their arbitrary power over users. I returned from holiday to find my Twitter account “suspended”, without warning or explanation. After a polite, emailed inquiry, I was told to look at the rules. I replied I couldn’t see how I had broken them. Two weeks later, someone at Twitter emailed me, saying, “It’s been awhile since we’ve heard from you,” and that “hopefully” the matter had been resolved. It certainly hadn’t, I replied. The account was restored a few days later, still without explanation or apology.

Being an old fogey, I use Twitter spasmodically and was not greatly inconvenienced by its loss. To some users, however, it has become an essential working tool. In a telling example of how technology can restrict rather than widen choice, many feel they must use it because their professional peers do so. We should know more about the Californian geeks who run social media and what redress they offer to those arbitrarily blackballed.

Analyse this

How could Ashton Agar, a 19-year-old cricketer playing his first Test and batting at No 11, make 98, the highest score of Australia’s first innings against England at Trent Bridge? The answer is that, since Agar had played only 16 unremarkable first-class innings, the England coaches, lacking videos of him, could offer bowlers no plans for getting him out. International sides now analyse opponents exhaustively. They produce pie charts, spreadsheets, graphs and other statistical paraphernalia, searching for a batsman’s weakness as assiduously as physicists searched for the Higgs boson. Even the best modern bowlers are robots, programmed by back-room boffins. Without the usual input, they malfunction.

What redress does Twitter offer to the arbitrarily blackballed? Photograph: Getty Images

Peter Wilby was editor of the Independent on Sunday from 1995 to 1996 and of the New Statesman from 1998 to 2005. He writes the weekly First Thoughts column for the NS.

This article first appeared in the 22 July 2013 issue of the New Statesman, How to make a saint

Photo: Getty Images
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The future of policing is still at risk even after George Osborne's U-Turn

The police have avoided the worst, but crime is changing and they cannot stand still. 

We will have to wait for the unofficial briefings and the ministerial memoirs to understand what role the tragic events in Paris had on the Chancellor’s decision to sustain the police budget in cash terms and increase it overall by the end of the parliament.  Higher projected tax revenues gave the Chancellor a surprising degree of fiscal flexibility, but the atrocities in Paris certainly pushed questions of policing and security to the top of the political agenda. For a police service expecting anything from a 20 to a 30 per cent cut in funding, fears reinforced by the apparent hard line the Chancellor took over the weekend, this reprieve is an almighty relief.  

So, what was announced?  The overall police budget will be protected in real terms (£900 million more in cash terms) up to 2019/20 with the following important caveats.  First, central government grant to forces will be reduced in cash terms by 2019/20, but forces will be able to bid into a new transformation fund designed to finance moves such as greater collaboration between forces.  In other words there is a cash frozen budget (given important assumptions about council tax) eaten away by inflation and therefore requiring further efficiencies and service redesign.

Second, the flat cash budget for forces assumes increases in the police element of the council tax. Here, there is an interesting new flexibility for Police and Crime Commissioners.  One interpretation is that instead of precept increases being capped at 2%, they will be capped at £12 million, although we need further detail to be certain.  This may mean that forces which currently raise relatively small cash amounts from their precept will be able to raise considerably more if Police and Crime Commissioners have the courage to put up taxes.  

With those caveats, however, this is clearly a much better deal for policing than most commentators (myself included) predicted.  There will be less pressure to reduce officer numbers. Neighbourhood policing, previously under real threat, is likely to remain an important component of the policing model in England and Wales.  This is good news.

However, the police service should not use this financial reprieve as an excuse to duck important reforms.  The reforms that the police have already planned should continue, with any savings reinvested in an improved and more effective service.

It would be a retrograde step for candidates in the 2016 PCC elections to start pledging (as I am certain many will) to ‘protect officer numbers’.  We still need to rebalance the police workforce.   We need more staff with the kind of digital skills required to tackle cybercrime.  We need more crime analysts to help deploy police resources more effectively.  Blanket commitments to maintain officer numbers will get in the way of important reforms.

The argument for inter-force collaboration and, indeed, force mergers does not go away. The new top sliced transformation fund is designed in part to facilitate collaboration, but the fact remains that a 43 force structure no longer makes sense in operational or financial terms.

The police still have to adapt to a changing world. Falling levels of traditional crime and the explosion in online crime, particularly fraud and hacking, means we need an entirely different kind of police service.  Many of the pressures the police experience from non-crime demand will not go away. Big cuts to local government funding and the wider criminal justice system mean we need to reorganise the public service frontline to deal with problems such as high reoffending rates, child safeguarding and rising levels of mental illness.

Before yesterday I thought policing faced an existential moment and I stand by that. While the service has now secured significant financial breathing space, it still needs to adapt to an increasingly complex world. 

Rick Muir is director of the Police Foundation