Rigging the System

[Demolition Squid]

For about six months I wound up working in the NHS. One of the many Commissioning Support Units, in fact. Whilst there, I was linked to this video as an explanation to help me understand where I fell in the NHS structure.

I wasn't there long, but I saw enough. Its one thing to know in theory that bureaucracy is massively wasteful. Having glimpsed into The Machine, I was horrified by it. But what was even more horrifying to me was the attitude taken by these people. Most of them had worked in the NHS for decades, and all of them had been fired from roles doing the exact same thing in the structure that came before - then rehired with a 40% or higher pay increase when the government realized that they hadn't actually accounted for the work they were doing before. Everyone knew that the bill to the NHS had increased hugely, that the majority of their time was spent trying to navigate authority that nobody really understood, and that the actual, fundamental and important work was the least part of their time.

More hilarious was when important work simply couldn't be done because nobody had the resources to see it through. I can't name names, obviously, but when a doctor's surgery lost all their records due to a server fault and it was found the backup systems they had in place weren't working, everyone at the table laughed at my suggestion we ought to try and send someone out to make sure backups were being taken elsewhere. Maintenance was supposed to be the responsibility of the surgery; emergencies were ours. So we couldn't take steps to prevent emergencies, we could only try and pick up the pieces when they happened.

Not a single person at the CSU believes that the current setup will stay in place past the next election. Basic systems - like project methodology, sharing data, and authorizing payments - are not standardized, all of them are handled differently by different teams within the organization, and the effort to try and get one common way of working had seen three heads (with three different approaches) before I joined. After three months, a new head of service was announced and she brought in an external consultancy to deal with it. They had not made much headway.

At first I thought all of this was just down to incompetence. The fact is, though, that the NHS delivers some of the best value for money of any national health service in Europe. We pay a comparatively small percentage of GDP (9.8%) for one of the top services. There's a massive amount of waste, definitely, but mostly because people are scrabbling to play catchup and maintain continuity of projects which have run for years after the government came in and threw it all up in the air.

Why would they do that?

Well, this blog gives a little insight.

225 parliamentarians have recent or present financial private healthcare connections
145 Lords have recent or present financial connections to companies or individuals involved in healthcare
124 Peers benefit from the financial services sector
1 in 4 Conservative Peers have recent or present financial connections to companies or individuals involved in healthcare
1 in 6 Labour Peers have recent or present financial connections to companies or individuals involved in healthcare
1 in 6 Crossbench Peers have recent or present financial connections to companies or individuals involved in healthcare
1 in 10 Liberal Democrat Peers have recent or present financial connections to companies or individuals involved in healthcare
75 MPs have recent or present financial links to companies or individuals involved in private healthcare

Fairly soon, The Transatlantic Trade and Investment Partnership will be coming to a head. This will probably open the NHS up to even more privatization - it is worth noting that the NHS already has to go through a rigorous open tender process - which is part of the reason the CSU exists in the first place. It is also worth noting that the people I spoke to about this were convinced that when the NHS just had it all in-house, it saved them a lot of money, because the process of ensuring that the tender for new medical treatment is fair and open to all private companies is itself a huge drain on resources.

But by throwing everything up in the air, slashing funding, and throwing in a whole raft of new areas where the NHS suddenly has to work with local government and community support agencies (where none of these organizations were used to working with anyone else before) the possible points of weakness multiply many times over. You are far more likely to get people losing patient information when it is suddenly being shared with many more people, only some of whom are used to dealing with sensitive information like that at all. You've muddied the waters of authority so much that decisions don't get made, so services have to work with older machines and resources because they can't get the approval needed to buy the new ones. In short, you rig the system so that over the next few years, as everyone struggles to find their footing, the architecture of the NHS begins to look very outdated and in need of modernisation.

Just in time for the private investment to swoop in and save the day.

It isn't about corruption, exactly. Nobody needs to be bribed or to have the explicit goal of forcing the NHS to fail - although I genuinely believe that many of those MPs with financial interests in private healthcare do have the explicit goal of seeing more of it sold off on ideological grounds. Instead, they just demand that it transforms itself into something totally new and - when it doesn't - they sell it off to people who say they can make it 'fit for purpose'.

If you really want the belly laugh, though, here's the kicker. I had lunch with a guy whose job is to make sure that there's acceptable coverage for all the major illnesses and injuries and so forth in the county. He explained that private hospitals LOVE the NHS, because it lets them have a safety net for their patients. They don't bother to provide all the equipment and training to their low-level staff that the NHS does - they can only handle things that go entirely according to routine. If something goes wrong, or it turns out you need care that the private company aren't set up to deal with... they just dump you on the NHS and leave you to it. Emergency surgery to patch up the mistakes or situations that arise from private surgeons who aren't equipped to deal with them are increasing across the board, and play hell with the schedules.

I can't wait to see that kind of cost-saving approach applied across the board. 

[Cain]

Yup.  The NHS has severe problems with spending in terms of overpaid bureaucrats and expensive, failed projects (not least due to the lack of transparency in how it spends its funds, plus nearly a decade of Gordon Brown purposefully hiding as much information as possible from the rest of the government on how the Treasury was allocating funds to the NHS), but Parliament and the government in particular have a vested interest in not fixing this fundamental problem, and instead using it as a cudgel to allow for private health reform.

I don't forsee a good end to this, but then as far as I'm concerned, I don't see pretty much anything to do with the economy having a good end as things stand.

[Faust]

I can't wait to see that kind of cost-saving approach applied across the board. 

From what we're seeing of the education system they are marching to the same beat.

[Demolition Squid]

They told the police to prepare for a 25% cut in funding too, which they said would fall largely on front line officers.

I'm expecting G4S to pick up the slack.

Its like the politicians have decided that the time is ripe to stick their face in the trough. I suppose, compared to institutionalized child rape, cash for you and your buddies doesn't really register.

[Cain]

I suspect there's also an element of revenge in the police decision as well.  Deciding to bring down a Chief Whip in some sort of twisted political power play (Leveson related?) was not their brightest move.

Still, I can't say I enjoy the prospect of G4S having any more say over security issues.  While I don't think they're actually much worse than the UK police, in terms of conduct or accountability, they will likely end up costing three times as much.

[Junkenstein]

£5 on G4S taking over "Community support officers" or somesuch other ineffective do-nothing bullshit.

Can then be used to leverage police powers to corporations after they are able to do fuck all for a few years.



More to come, the OP is magnificent.

[Demolition Squid]

I'm not sure if it is still the case, but for a period, you had to be a community support officer before you could become a front line police officer.

If so, that'd be very valuable to G4S. Get their method and culture in the door at the ground, bring in consultants higher up to help guide the inevitable restructuring the cuts will need, and they are well on their way.

And thanks! 

[Junkenstein]

I think there's two things in that list that deserve a mention before I go on.
http://socialinvestigations.blogspot.co.uk/p/key-facts-of-lords-and-mps-connections.html
Firstly :

124 Peers benefit from the financial services sector

Secondly:

All were able to vote on the Health and Social Care bill (now Act), despite having a prejudicial interest, which would not have been allowed at local council level

Emphasis mine, and I say warranted.

The first relates to how the system operates. Financiers grease wheels and that is certainly a substantial percentage of people involved. The immediate direct implication is that these ideas in general have been and currently are being applied to the financial sector in some form. Setting rules enforcing a "Zero risk culture bank" in such a manner that one buckles and dies allowing for "Sweeping radical reforms to get the economy moving" wouldn't surprise anyone. Name a thing that various financial institutions, alone and in various cartels and collusions haven't fucked with. Try. Stop laughing, this is serious.

So the number is substantial and now we look at healthcare, to start. Dare we think that some of these financial chaps be involved with healthcare? I think we fucking dare. Because if they're not they are at best working colleagues and at worst old college chums. Friends, various relationships, old school buddies bribes, corruption and smiling faces in the right place at the right time clearly make all kinds of legislation occur for better and worse. Every so often the system is declared FUBAR and something more complex (Not the same as better) is shoved in to create new jobs, raise the economy and boost the average pay in a certain sector or use the budget right up in another. Policing budgets are cut yet there's a shiny new post of "police and crime commissioner". Etc. Etc. E.Fucking.tc.

This leads me to suggest that the process (or at the least a trial version of it) is already under way in many such ways. Consider how much involvement certain firms have now, and have had despite fucking up all the time. My go to whipping boy is Capita but G4S are easily as incompetent and likely involved in similar levels of corruption. Healthcare being incrementally chipped away at until the axe can fall seems inevitable. I suppose if you did it fast people might object and a paranoid man might think about Boris buying those water cannons.


The second quote relates to another part of the nature of the system - You cannot advance (Line your pockets above a certain level) unless you are willing to collude with others. The way that some "local council" rules, laws and regulations are used are almost entire petty, personal and (locally) political. The fact that similar standards are not applied at the levels where the highest levels of corruption are possible should be surprising, but hey, it's the UK. If you're in the club you're golden.


My third and more general point relates to what has previously referred to as "Waste". In the "Ooh there's so much waste to be cut". What we are really talking about here is corruption. With every increase in level of people to influence with spending money, tenders and managing budgets you inherently introduce the possibility of bribes and other possibilities for deal making, whatever that deal might be. The reality behind "Cost saving exercises" is that you're cleaning the table of all current deals and offering a new one. A smart man might do that when he's got a timetable in mind and the "perfect people" for the job well informed of what's to come out and what kind of way they might want to present themselves to it, if they happened to be so inclined.

"Waste" is a fancy term for "Bribe" unless you show me otherwise. Because let's be clear, there's plenty of ways to consider what a "bribe" really is. A cushy do-nothing job to brown envelopes with filthy lucre, it's a giant list of shit that flows around all industries in some form.



That all said, with various police cuts, I bet a few more MP's come to our attention for improper activities. Tit for tat and that.

[Demolition Squid]

Well.

I just found out that as of 2015, probation services throughout England and Wales will all be privatized. I haven't heard anything about this in the media, and I can't look for sources right now myself, but I'll throw something up when I get home.

Disturbing how quietly this is happening.

[Cain]

Sadiq Khan (who is fairly sensible so long as you don't let him near anti-terrorism legislation) has spoken out about - and against - this.

But I think anyone expecting Labour to try and sort out this mess is living in a bubble.  I'll admit, Miliband has had a hard time with a press who are primed and ready to smear and character assassinate him given the smallest chance.

But by the same measure, Miliband has been a weak opposition leader.  The Brownite milieu he gained his political credentials in was mostly good at 1) Keeping information from the Cabinet 2) not upsetting Gordon Brown and 3) leaking shit to the press.   He hasn't got the media presence or the political skills to sustain a broad attack on the government - on any of the public services.  And this is one issue that Labour should be united on - Blair's reforms were a key aspect of his government legacy, and whatever one may think of the man, certainly better than what is coming down the line from the Tories.

But given Labour's general morph into "rich boys club for those who don't hate gays or Muslims", even that may have changed.

[Demolition Squid]

Yeah. There have been a few times when Milliband has spoken up and not sounded totally useless... but he is terrified of saying anything which can be construed as anti-business. Or he's just genuinely incompetent at getting his message out. ... Or he has no message to get out at all. It is difficult to tell.

Either way, I don't have any faith that he'd fix this or any other problem. The best I can say about Labour is that they don't seem as actively evil as the Conservatives. That may just be because they don't get enough airtime to show their colours; their support of the RIPA legislation is enough to make me wary.

It is disappointing that there isn't even a single leader who comes across as competent right now. I don't even have to agree with what they say (although that would be nice). I just get the impression that all of them are completely out of their depth, none of them have any idea what to do in a 'Big Picture' sense. Mostly, they all seem to be peddling different brands of doom.

There's actually some vaguely interesting ideas on Labour's website, but I have no confidence they'd actually do them because their whole strategy seems to be 'repeat soundbites until the gormless public catch on'. They are just as disdainful of their voters as the Conservatives, just in a different way.

Its almost worth voting UKIP just out of spite. But there's a good chance they'll actually take my constituency and that would be horrifying.

[Cain]

Yeah, in one sense I look forward to UKIP getting some power as, at long last, the spiteful portion of the British public will get the government they asked for.  But in every other sense, it will be horrifying, especially with what follows (since UKIP are destined to fail, while it's voting constituency will not die out).

In regards to Labour...I think at least half of the problems go back to the Blair years.  The Blairites were pretty scummy at times...but they were also media savvy, and fairly ruthless when dealing with the Tories.  All through Blair's leadership, the Tory Party rarely had him on the back foot, and quite often the situation was Blair had them running scared.

However, the Brownites and Blairites alienated each other through their scorched earth tactics around 2006-8, and in such a way that I don't see anyone from that wing of the party, with a longer history of successful government and media relations, sticking their head out for Miliband.  Labour's a divided house, and until they sort out their internal issues, either by Miliband getting some actually useful political advisors or by the party picking a leader who is acceptable to both wings, nothing will change.

Which is sad, because for a PR man Cameron is terrible in terms of public image.  I can think of half a dozen ways to make him look like a prat, and that's just in PMQs.

Miliband has had some success at jerry-rigging Parliament in terms of procedure and debate times, so it's not all doom and gloom.  Expect a few nasty surprises for the Tories in any future large votes - like, say, on Europe - because Miliband is a political nerd and if there is one thing nerds do well, it is game complex systems to become completely overpowered.  But it's hardly sufficient, as a strategy to bring down the coalition.

[Demolition Squid]

There were some questions asked (and almost answered) about the probation selloff today. I followed as best I could but mostly got the impression that all decisions have been made and no serious criticisms were being pushed particularly hard. So pretty standard for parliamentary questions really.

What keeps striking me is that - although we are told we live in an age of superficial politics where style is all that matters ... most politicians are just bloody terrible at it. Take this quote for instance:

"I have to say that the trade union has on occasions put forward information in a way that has not given, I would have thought, sometimes context, and even the accuracy of the situation."

You can see what he meant, but it would be nice if people speaking on behalf of the government could actually speak coherently and in clear sentences. I don't feel like that is too high a bar. 

[Junkenstein]

You can see what he meant, but it would be nice if people speaking on behalf of the government could actually speak coherently and in clear sentences. I don't feel like that is too high a bar. 

I CAN'T STOP LAUGHING NOW.

[Demolition Squid]

Interesting article (part of a series) in the Guardian this morning.

http://www.theguardian.com/commentisfree/2014/dec/08/taming-corporate-power-key-political-issue-alternative

Ministers and civil servants know that if they keep faith with corporations in office they will be assured of lucrative directorships in retirement. As head of HMRC, the UK government's tax-collection agency, Dave Hartnett oversaw some highly controversial deals with companies such as Vodafone and Goldman Sachs, apparently excusing them from much of the tax they seemed to owe. He now works for Deloitte, which advises companies such as Vodafone on their tax affairs. As head of HMRC he met one Deloitte partner 48 times.

The key political question of our age, by which you can judge the intent of all political parties, is what to do about corporate power. This is the question, perennially neglected within both politics and the media, that this week's series of articles will attempt to address. I think there are some obvious first steps.

A sound political funding system would be based on membership fees. Each party would be able to charge the same fixed fee for annual membership (perhaps £30 or £50). It would receive matching funding from the state as a multiple of its membership receipts. No other sources of income would be permitted. As well as getting the dirty money out of politics, this would force political parties to reconnect with the people, to raise their membership. It will cost less than the money wasted on corporate welfare every day.

All lobbying should be transparent. Any meeting between those who are paid to influence opinion (this could include political commentators like me) and ministers, advisers or civil servants should be recorded, and the transcript made publicly available. The corporate lobby groups that pose as thinktanks should be obliged to reveal who funds them before appearing on the broadcast media; and if the identity of one of their funders is relevant to the issue they are discussing, it should be mentioned on air.

Any company supplying public services would be subject to freedom of information laws (with an exception for matters deemed commercially confidential by the information commissioner). Gagging contracts would be made illegal, in the private as well as the public sector (with the same exemption for commercial confidentiality). Ministers and top officials should be forbidden from taking jobs in the sectors they were charged with regulating.

Aaaand then he starts to veer wildly off into cloud cuckoo land, suggesting a world parliament, a global body to manipulate trade, the dissolution of corporate law...

... but you know, those first ideas seem pretty great to me. What he doesn't explain is how to go about enacting it given that it is against every current vested interest, and the major parties could ignore it with impunity. Getting the viewpoint 'shut down the gravy train' to be taken seriously seems about as challenging to me as 'wipe out all debt'.

But I could be wrong. If UKIP makes actual, serious gains that'll be evidence that an independent party with extremist ideas can get somewhere... and this seems like a good foundation for a hypothetical UKIP of the left.