Yesterday morning we had nothing in particular planned but after we had got Meg up and breakfasted, we made a trip down into town. The weather was still pretty cold but not quite as cold as the day before so the walk down was relatively pleasant. We we were delighted to bump into one of our friends who was engaged in some gardening and to learn that another friend, and near neighbour, had received some medical results that had been received the day before and that indicated that nothing had actually worsened. We were pleased to hear this news and then proceeded along the High Street where we bought some cosmetics and relieved an ATM of some of its cash. Then we made our back up the hill to have a warming cup of soup when we returned home, after which the carers called for their pre-lunch call. We had some fishcakes for lunch although the amount of actual fish inside them these days is so miniscule that having thrown away the batter, not much actual fish remains. This afternoon I contemplated getting the front lawns cut but this may have to wait until tomorrow when I have to ensure that Meg is in her wheelchair and can accompany me outside. So our afternoon TV viewing, we watched the concluding episode of 'Tess of the D'Urbervilles' with the final scene being where Angel and the sister of the just-hanged Tess make their way up West Hill outside Winchester which is where the University of Winchester at which I used to teach is located. Following on from this on the BBC iPlayer was a film called 'Jude' which said it was based upon the Hardy novel of 'Jude the Obscure' but it seemed to depart quite a lot from the novel as I remember it. The film was 'dark' in the extreme with the couples three children ending up dead whilst Jude and Sue were wracked with remorse and guilt, feeling the killing of the children was God's vengeance for the fact they were living with each other as man and wife whilst actually being married to other partners. To be honest, we were pleased when the film had ended and the two carers came along to give Meg her teatime call and the two of them will return later in the evening to put Meg to bed.
We heard on the news yesterday that Wes Streeting, the Health Secretary, was going to introduce a policy of grading hospitals so that they form a League Table and, presumably, those at the bottom of the pile would have their Chief Executives removed or be subject to other forms of sanction. More than 120 NHS trusts in England will be scored on their waiting times, patient care and spending in what is being labelled as 'Football League' type reforms. Members of the general public might think that this is a good idea to improve the NHS and it is evidently something that politicians, even Labour ones, think is a good way to inject a degree of managerial efficiency. But it is important to say that this type of measure has been tried before and did not yield the anticipated results. In the late 1980's there was an idea to rank all hospitals and this policy was carried out. But I remember that, at the time, a hospital possibly in Lancaster was ranked as the lowest in the country when it came to outpatient waiting times (a research interest of mine) But when reporters descended on the lowest ranked hospital in the land, the patients that they interviewed were satisfied with the level of service that they received and evidently did not have the ability to attend any hospital other than their local one. But this league table approach has been found to be severely wanting because of what social scientists interested in quality management have termed the curse of the 'perverse indicators'. When targets like these are set, then managers will do whatever is necessary to achieve the target and other important but unmeasured work will either not get done or be degraded. So the setting of targets can, and often does, drive down the overall quality in the system as senior managers reorient their organisations so as to meet the guidelines. The whole of this type of debate formed the backdrop to a series of papers which formed the backdrop to my PhD (on the subject of quality in the health service) so this explains my interest in the subject. But another question raises its ugly head, which is why this approach which had been tried before and shown not to work was being re-implemented? I think some of the must lie in the time scale of changes and those who implement them. It is now some 35 years since this approach was tried before but those responsible for implementing and pursuing the League table policy of the late 1980's and early 1990's will have retired. So there is no organisational memory that this approach has been tried before with minimal impact. Was there anybody in the Department of Health (or even the Labour Party) to tell Wes Streeting that this previously tried policy had not really worked. Did Wes Streeting even know this approach had been tried before - and, if he did, did he commission any papers to inform him why the policy had failed and what lessons should be learnt for the future? i think there are some parts of the Whitehall machine that attempt to learn from past mistakes (and I suspect that the Defence ministry is fairly good at this as it attempts to learn the lessons from each conflict in which the country is engaged) But, if I were to make a guess, it would be that there is a failure of collective memory in the Department of Health and so we shall probably go ahead and repeat the mistakes of the past.
The media has been full of the meeting between President Biden and President-elect Trump as they meet in the White House to agree and cement the transition details between one presidency and the next. At least Biden extended a cordial welcome to Trump if only for the sake of the cameras, a courtesy that Trump did not extend to Biden four years ago at the change of presidency. The transfer of power in the UK political system is swift and sometimes even brutal with removal vans drawing up at the back entrance to Downing Street the day after an election but the USA takes a lot longer over this process until the inauguration in January.
© Mike Hart [2024]