The truth about the monster hospitals

Today's new research which shows that one in ten people going into hospital are harmed by the experience is actually not a surprise. It confirms almost identical research elsewhere. The problem is that it is unlikely to become the political issue that it ought to be because political parties don’t know what to do with it – which of their various complaints and campaigns does it relate to, after all?

Actually, this is a key element of any non-technocratic campaign against the corrosion of our public services. The research was carried out in a large teaching hospital in the north; it would be good to compare it with a human scale institution. My guess is that the findings would be very different there.

Because the tragedy of our hospitals is that they are far too big. They rely on creaking technocratic systems, you never see the same doctor twice – which is not the ‘choice’ most people would make – and the whole system gets by without the very relationships between doctors, nurses and patients which make change happen.

The same corrosion and ineffectiveness is happening in our factory schools, merged police forces and struggling probation service. Because the technocrats at the heart of New Labour think these things are unimportant, whereas actually the ability to forge relationships is what makes professionals effective.

These monstrous hospitals have been driven partly by the need to sell off sites for capital gains, partly by the pride of consultants for ever bigger fiefdoms, partly by an unproven belief in the efficiency of big systems. There are economies of scale, of course, but they are bought at the cost of these hideous inefficiencies – mistakes, bugs, over-ordering and the sclerosis that happens when relationships are replaced by IT systems.

If you want to find an issue that really affects people’s lives, look no further.

Hustings angst

I was perched up in the gallery for the hustings, the first one I've actually managed to go to, and was excited by the sheer competence of the speeches. But in the end, as someone said in the pub afterwards, Chris talked about the same issues in the usual language, but Nick talked about new issues in an inspiring way - and, heavens, we badly need that.

It is true that there could have been more in the way of potential solutions, but at least Nick was framing the questions in exciting new ways.

Then there were the questions and answers, and I have been worrying ever since why I found these so dull. Am I wrong to be involved politics at all, if I feel that way? It isn't that the question of poverty and inequality is unimportant -I just don't believe the old Fabian mantras any more.

Again, it isn't that redistribution isn't important - of course it is. It is the technocratic terms in which the answers are trotted out, tweaking the tax and welfare systems as if people were rats in a laboratory. We have spent broadly 20 per cent of national income on welfare and defined broadly 30 per cent as poor now for two centuries (amazing that 20 per cent was spent before the New Poor Law Amendment Act in 1834, but it was - just distributed by parishes), and through a century of brutality and a century of the welfare state - Beveridge's giants are still with us. Something else is needed.

And if we don't face this head on and come up with a non-technocratic alternative, then the only alternative on offer is going to be Wisconsin-style brutality. So we had better get on with some radical re-thinking.

How is this relevant to the leadership issue? I don't think I can bear to go through another general election feeling that our manifesto was almost as irrelevant as our opponents'. I may be alone in this frustration with the way we cling to the old Fabian technocracy, but - speaking entirely personally - I desperately want us to choose a leader who will think, who will face up to the real questions and lead us into developing Liberal alternatives.

Listening to them both at Friends Meeting House, so articulate and polished, I felt Clegg was more likely to fulfil that role. It isn't certain - it's difficult being Lib Dem leader, especially a thoughtful one - but he gives me a reason for hope. Which is a relief, because I've already voted for him!

The real economics of nuclear

At long last, there is a study by an economist of the likely effects of the government's exhumation of the nuclear industry, and it is worth a read - especially by the nuclear enthusiasts who appear to be running some kind of campaign in the letters page of Liberal Democrat News. It's at:

http://www.theleaneconomyconnection.net/downloads.html#Nuclear

David Fleming is the economist behind tradeable energy quotas and what he writes about nuclear energy seems to me to clinch the argument against:

1. The remaining uranium ore in the world is now so depleted that the nuclear energy will itself run out of resources, to the extent that it will not be able to generate the energy needed to clean up and store its own waste - it will therefore be a net user of energy.

2. Uranium shortages will cause interruptions of supply before 2019, which will then get worse.

3. Every stage of the nuclear process except fission itself produces carbon dioxide, and even more so as the richest uranium is used up - especially because of the large amounts of uranium hexafluoride (10,000 times more powerful a greenhouse gas than carbon dioxide) which is used in the process of uranium enrichment.

Heathrow doublethink

There really is something sick about the idea that we can boost the UK economy by concreting over six schools and one whole village, and demolishing at least one twelfth century church.

Only in the peculiar looking-glass world of Treasury economics can that path lead to 'wealth'. By that route we will have no schools, concrete wastelands punctured by planes landing every thirty seconds, and without historic or natural features, yet we will be wealthy beyond our wildest dreams. It is a prime example of what Ruskin referred to as 'illth'.

For me, there is something fundamental about the coming battle over Heathrow's sixth terminal and third runway, after all the assurances last time that they had been ruled out. No government can possibly back the idea and remain credibly concerned about global warming. This really is a line in the sand: a No Pasaran moment.

In the meantime, it ought to be worth calculating whether allowing the world to change planes in multinational retailer heaven, or making it easier for Britons to spend their money abroad, will actually boost the UK economy - however narrowly defined.

The real leadership issue

I’m not sure I’ve got the hang of this blogging business yet. There is so much to respond to – people even ask me what I think and I never get round to replying (yes, James Graham, you’re absolutely right!).

The problem, I suppose, is that I ought really to have instant reactions. I do, but they’re often complete rubbish. Which is my excuse for writing something about the leadership debate on Question Time a full 36 hours after it happened (mea culpa)

I thought it was an impressive, civilised debate. I thought Nick Clegg won, but only by a whisker, but then all that seemed to be up for debate was the candidates’ abilities to articulate identical responses.

Yet there is an issue in this leadership contest, it just isn’t one that can be spoken entirely openly – so this is, inevitably, an interpretation of it. The issue is this: will the Lib Dems continue with the same basic tactics and strategy but better, or will they re-think precisely why they want to achieve power and how? Will they stay a tight, slightly inward-looking band of initiated enthusiasts, or will they reach out and find new ways of knitting together a Liberal coalition?

This is also – surprise, surprise – the key issue for me. I approach the candidates with the following questions:

• Will they renew the intellectual basis of Liberalism (we’re still living off the ideas from Grimond’s leadership four decades ago)?

• Will they articulate a new approach to politics that is capable of pulling opinion formers behind the party (or will they just assume, as we have done, that most of them are simply ‘against us’)?

• Will they update, renew and deepen our community politics heritage so that helping people ‘take and use power’ is at the heart of our strategy (or will they carry on assuming it’s just about leaflets and elections)?

• Will they engage with the ferment of new ideas outside the party (or will they fall back on the tried-and-tested way of expressing things that has served us well since 1979)?

• Will they stitch together an innovative platform capable of providing political leadership for the voluntary sector (as we did successfully in the 1960s)?

Since this is inevitably not part of the public debate, we have to read the code. But I take it from Clegg’s description of the last two years of the party as ‘inward-looking’ and his urge to take the party “out of its comfort zone” that he realises how much we’ve got stuck, and is prepared to do something about it.

Huhne may feel the same; I might be wrong. But the careful tailoring of his message to the defensive fears of activists leads me to believe it isn’t so high up his agenda.

That’s why I’m backing Clegg. Because I believe he will be bolder and more thoughtful on our behalf, and boldness and thought are what we need more than anything else right now.

The Golden Age that isn't

I went to see Elizabeth: The Golden Age last night, a rare night out from the toddlers. Cate Blanchett is extraordinary and clearly the days of the film epic have returned. I enjoyed it, but kept my fingers crossed.

I happened to hear a radio report just before about Gordon Brown’s attempt – abortive so far – to come up with a ‘motto’ for Britain. This is an interesting, but probably doomed idea, to somehow distil the meaning of what has always been a massively diverse nation.

New Labour has no sense of history whatsoever. As arch-modernists, they don’t see the point, and consequently find themselves repeating history (usually as farce) all over the world. Any motto stitched together by marketers without a sense of history is liable to be as vacuous as, say, Newport City Council’s mission statement (the usual bollocks about 'excellence').

With a sense of history, you can’t help feeling that they ought to come up with something related to Elizabeth’s speech in the film to her council about the Armada: “They carry within their bowels the Inquisition; God forbid they should land on these shores…”

This mythos may not be fair or rational or modern, or even accurate, but there is an extraordinary paradox that runs through English history – and it is English history we’re talking about here. On the one hand, there is this constant, ill-prepared standing alone against continental tyranny. On the other, it is always an immigrant, polyglot England that fights the battle.

It is, in short, a Liberal thread that runs through our history, though one with a Whiggish tinge which constantly threatens to collapse into an xenophobic little England that is not Liberal at all.

So driving back from the film, I wondered whether we were destined to repeat this pattern again. Whether at some point, in the not-too-distant future, after the slow impoverishment of the United States, we will withdraw from the international financial tentacles that are sucking what remains of our institutions dry, and stand alone again, with only our own resources to fall back on, and those of all the nationalities that shelter with us.

That is unlikely to be a Liberal future either, and lodged in a profoundly illiberal world. Perhaps we ought to start discussing more directly how to avoid it.

Oh my God, I think it's chicken pox!

Of all the risks that keep me awake at night about my children, I can’t say I have ever felt the fear clutch my throat and say: “Oh my God, perhaps they’ve got chicken pox!”

I’m not claiming that chicken pox can never have complications, just that – if taxpayers are going to spend millions tackling childhood risk – they might look elsewhere first.

Let’s not set out in too much detail exactly who profits by the suggestion, in a report 48 hours ago, that chicken pox vaccine should be added to the controversial MMR. But no doubt we will be subjected to the usual barrage of public relations from the pharmaceutical world, explaining how chicken pox is a major risk to us all that we have never noticed before.

But there are two other very odd things about this. Why is it that successive governments have been so fixated about the risk to babies, and overwhelm newborns – or pre-borns – with advice and care, but then let children grow up in hideous concrete Bastilles, bored out of their brains by New Labour ersatz education, fed on chemicals and additives? Strange, isn’t it.

The other peculiar aspect is about immunity. I’m not a scientist, still less a doctor, but I can recognise a mega-trend when I see one, and something funny is going on about human immunity. I don’t just mean Aids or ME, but other variants of faulty immune system like asthma (one in seven children now), eczema and allergies.

I don’t know whether this is a result of more chemicals in the environment, or whether it has something to do with overloading the immune systems of babies by multiple inoculations directly into their bloodstream. I don’t know, but I’d feel a good deal happier if the government was asking the question too, instead of just bullying people into getting the jabs.

Both my children have had them. There are good reasons for that, though I wonder about MMR. I told the health visitor about my crisis of immunity theory and could see the irritation and shock on her face. The next thing I knew, the head of immunology for Croydon was phoning me up at home to remonstrate (she didn’t agree either).

But I know other doctors who are asking similar questions. I daren’t provide any clues to their identity, because I fear the government’s health police will track them down. But I’m glad at least that somebody is asking, before we add another unnecessary jab to the already potent cocktail.

Could the National Trust become a political party?

Whatever happened to political parties? Their combined membership amounts to little more than the circulation of a modest-sized celebrity magazine. In ten years time, well, they probably won’t manage more than the readership of the New Statesman.

I’ve been on the look-out for years for something that might replace the insititution, at least in the UK. Then I open the Times yesterday, and find that the National Trust is going head to head with the government over their housebuilding plans – threaten to buy up green belt land to prevent them.

I have wondered for some time, without taking the thought very seriously, that the National Trust could transform itself into some kind of political party. Its membership is around five times any rivals. It stands for a set of coherent ideas about conservation, green futures and good management – and for ideas (whether you like them or not), about the nature of Britain.

It has recently adopted something approaching an economic policy – local purchasing, rebuilding local money flows – and the latest news looks as if it is moving towards the next stage. What comes next? Candidates?

I’d welcome it myself, even vote for it, if it wasn’t for the damage they might wreak on the Lib Dems – unless the Lib Dems can learn some of the lessons now about the slow and unremarked radicalising of Middle England.

Which brings me finally to the housebuilding issue. Once again, this is about centralisation.

Because the UK remains so debilitatingly centralised, corporate headquarters flock to the capital in a way they don’t feel the need to in the USA or other European nations. Consequently, because of the miserable metropolitan snobbery at the heart of UK politics, so do other businesses. So do people.

So we find ourselves in a situation where we are demolishing homes in the heart of northern cities, while we have to queue to leave London underground stations in the evenings (I queued 20 minutes to get out of Leicester Square station a little while ago).

The Liberal response to the housing crisis ought to be (a) Massive decentralisation of power to regional centres, (b) Strengthen regulations about how much money people can borrow for mortgages – the real driver of house price inflation, (c) Proper, civilised homes with gardens, in new garden cities – many of them in the north.

Let’s be tough about this, and maybe we won’t have to canvass against National Trust candidates in the future.

What radicalism means?

Simon Hughes coming out in support of the Clegg camp is significant. I don’t know why, as party president, he’s allowed to support either side – but the fact that he has done means something, to me at least.

Simon was elected in 1983, just a few years after I joined the Liberal Party. In the years that followed, especially while he was such a brilliant and innovative environment spokesman, he came to symbolise what radical Liberalism was all about. For me and many others.

But some misunderstanding about what Liberal radicalism means has crept in since then. As if it meant ‘social liberalism’ or more public spending or more enthusiastic support than ever for local government power. It might imply any of those, but not by themselves – for me, radical Liberalism means a greater commitment to change, to being on the side of people not institutions, to handing power back to people, to making them independent.

I’ve always regarded myself as a radical – but realise only too well (I can tell by the puzzled looks in the policy committee when I open my mouth) that this may just be my interpretation of the way things are. On the other hand, with Simon joining the Clegg camp, I have a feeling of reassurance that my brand of radical Liberalism is shared more widely.

Maybe it’s also about to undergo an exciting revival.

The trouble with those Blair brothers

In Alan Bennett’s play Forty Years On, he imagines running into the Berlin brothers in the 1920s – Irving and Isaiah. Perhaps someone in a future play about the early years of this century might imagine running into the Blair brothers, Tony and Ian – brothers, at least, in their inability to realise they have to take responsibility for disaster by resigning.

They may have done their best. Their motives may have been pure. That isn’t the point. When you lead an organisation found guilty of endangering life, and when one innocent man was shot dead five times at point blank range – through a failure of management – the man at the top has to resign.

In the same way, when the policy you have personally forced through as prime minister turns out to be one of the biggest foreign policy disasters in British history, massively undermining our security in the process, and you don’t resign – then what circumstances could ever force anyone to resign?

Both disasters, rather indirectly, are also failures of Whitehall’s obsession with centralised power. Britain could never have invaded Iraq if the prime minister hadn’t over-ridden every check and balance the constitution allows. Reading the details of the misjudgement at Stockwell tube station in 2005, it also becomes horribly clear that what led to the shooting was a failure of communication.

The control room did not fully understand, or trust, the judgement of officers on the ground who were tailing the suspect. If they had been on the spot, the shooting would never have happened.

You thought this was a blog about resignation – or Irving Berlin? Actually, it’s about centralisation and just how ineffective it is – and about the Lib Dem leadership race. Because, in small ways, throughout public services, the same failures are taking place every day. Frontline professionals have knowledge of individuals before them, but they are countermanded and controlled by distant managers without access to the same information.

One reason I’m backing Nick Clegg is my sense that he understands what is missing from the current Lib Dem platform. Centralisation is the narrative of our time, but we have yet to unpack it properly, research its real costs and implications, find a language for a genuinely local politics that shifts responsibility. That’s what we need to fulfil the role it seems to me that history has assigned to the party – to localise Britain.

Yet every day, there is a new example of failures in public life that need to be re-interpreted through this new Lib Dem lens. If I ever manage to summon up the energy to continue with this blog, I hope that is going to be its central theme.