I am sure that Joan Errington, the English teacher at Brighouse School in Death of a Nightingale, would approve if I borrow the words that Shakespeare used to describe the 7th age of man to describe one of the things wrong with UK plc today.
The Mid Staffordshire Hospital Scandal is just the latest example.
Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
As Shakespeare traces the seven ages of man, those are the famous closing lines of ‘all the world’s a stage’ in”As You Like It”. His characters are still around today, appearances a little different, natures very much the same and the parody unsurpassable.
If you want to know why civil servants get it wrong so often, keep wasting vast sums of taxpayers’ money, give bad advice to government – or fail to give good advice – create or perpetuate jobs that do little more than bolster unemployment figures – and it matters not one jot which political party is in power – then let me use Shakespeare’s words lamenting life’s closing days, “sans teeth, sans eyes, sans taste sans everything” to describe all those who serve on bodies whose remit it is to provide accountability in the system, but very rarely do. In particular, “sans teeth”.
Read on. You will see that the same is true of the NHS. You will understand why the Government refuses a public enquiry into the Mid Staffs hospital scandal.
In my last post I wrote of the mandarin, James Harrington, in Death of a Nightingale ” … you would not expect to see him on the Clapham Omnibus. The person exercising authority does not need to be reasonable; effective and competent, yes and, in a much better world than ours, accountable … “
In this post, I want to pick up the proposition that mandarins should be accountable. A news item in the Times last Tuesday, 18 February is still fresh in my mind. You will find it on page 18.
Baroness Young of Old Scone told the Times that she had decided to resign as chairman of the Care and Quality Commission, the newly formed “super regulator of health and social care”. She said that “her notion of what was required of an independent regulator sat uneasily with the Department of Health… Rugged independence is not what they are looking for; they are looking for something much more emollient and collaborative.” In short, sans teeth …. Pity she didn’t stick it out, but that’s another matter.
No wonder the Mid Staffordshire Hospital scandal. And there are many more scandals where that came from.
By way of another illustration, a doctor I know with a serious heart problem realised, as most patients would not, that a hospital nurse dispensing warfarin to him was giving him the wrong coloured pills indicating an excessive dose. He was able to correct her.
The Baroness, IF ONLY SHE HAD STUCK IT OUT, might properly have asserted the need for two nurses always to be involved in dispensing medication as a core discipline. No wonder so many patients claim damages against the NHS and many who don’t!
Official Figures
In 2008/09, 6,080 claims of clinical negligence and 3,743 claims of non-clinical negligence against NHS bodies were received by the Authority, up from 5,470 claims of clinical negligence and 3,380 claims of non-clinical negligence in 2007/08.
£769 million was paid in connection with clinical negligence claims during 2008/09, up from £633 million in 2007/08.
The Independent
Sunday, 13 July 2008
NHS: 60,000 medication blunders in 18 months. Every year, 24 patients die as a result of being given the wrong drug or the wrong dose.
By Brian Brady and Nina Lakhani
Never mind the cost. What about the suffering?
Mid Staffordshire hospital is not alone to get it wrong.
Does “a better world than ours exists anywhere in the world”? Whether it does or not, that is not to say that it ought not to. The absence of accountability may be the same the world over, but in a country like China there will be absolutely no need for a time wasting and costly charade to make it seem as though it does.
Here is an illustration from the Global Edition of the New York Times on January 11. Thomas L.Friedman writes “We applied for a US Department of Energy loan for a 92 megawatt project in New Mexico and in less time than it took them to do stage 1 of the application review, China signs, approves, and is read to begin construction this year on a 20 times bigger project!” It’s worth reading the whole article on page 7 headed “Who’s sleeping now?”
Just think about this. The one thing that ought to give Western democracies their cutting edge over authoritarian regimes should be the accountability of the system. Instead Western democracies waste so much time trying to pretend that it exists when it doesn’t, that they actually put themselves at a disadvantage.
Why do Governments continue to allow this? It’s very simple. Every four or five years they are held to account. They are answerable to the public for the mistakes that are made, and therefore it is best that voters do not know too much about them. MPs protect their seats. Civil servants protect their jobs. There is a name for this – symbiosis, more colloquially, “I’ll watch your back if you’ll watch mine.” In short – the cover-up.
In the UK here are just a few public bodies that are supposed to provide the checks and balances in the system; there is OFSTED, the Local Government Ombudsman, the Audit Commission, and all those Commissions of Enquiry. There are also Parliamentary Select Committees, hand-picked by the Party Whips. And MPs themselves should have a role here. And there is now the Care & Quality Commission.
There is no shortage of velvet gloves, but no sign of an iron fist in any of them, or steel in the backbone for that matter.
Oh for a permanent Paxman fist in even one of them!
If you want to understand read Death of a Nightingale and see a case in point. Special Educational Needs is now a disaster zone for many children with special educational needs. Some academics who advocated Inclusion as dogma in the 1990′s would have you believe otherwise but, if you don’t believe me, read the growing evidence of it at the end of the opening page of this website.
And read for your light entertainment “Alice in Blunderland” a parody that I include in post 15 here. See it all in virtual reality and in surreal reality too. Once you know the way in which the system operates, the world is never quite the same again.
Let me put this argument another way. Visit Breaking the Magician’s Code: Secret of Knife throwing http://www.youtube.com/watch?v=oHCyNkixqs4. When you know why the magician doesn’t run out of beautiful models, the illusion is no more, never to return. The world is never the same again.
The following extracts from Death of a Nightingale may destroy some of your illusions. Mine were destroyed a long time ago and I am much the better for it.
Act One Scene 3
James Harrington, the mandarin from London, has just arrived at the regional office of the Department for Education. He is explaining to Judy Fotheringham in charge there how the system works.
JAMES HARRINGTON You really mustn’t allow yourself to be upset by the media. Whenever this arose my father – he was a wise old bird if ever there was one – he always said that the Pharaohs weren’t put off their grand design for the Pyramids by carping criticism in the Alexandria Times. I’ll tell you something else. Have you heard the Latin tag “Audi alteram partem”?
JUDY FOTHERINGHAM My Latin’s not very good these days. Doesn’t it mean something like “You have to listen to both sides of the argument”?
JAMES HARRINGTON Pity you didn’t have a classical education. In the civil service manual, “Audi alteram partem” is translated to mean that “you can drive your car on the wrong side of the road. ” Politicians watch our backs and we watch theirs. They provide the safety valve for the system. If we get it very badly wrong, they lose their seats. It works. Mistakes self-correct … in time.
David Harding, the Director of Education for Westborough, later explains how the system works to Margaret Williamson, head teacher of Brighouse School.
Act One Scene 8
This is the scene where David Harding, the Director of Education for Westborough, persuades Margaret Williamson to argue the case for the closure of her school to its parents.
DAVID HARDING It’s what we have to do. OFSTED will be on our backs if we don’t.
MARGARET WILLIAMSON I thought OFSTED was interested in standards and wouldn’t like what you are suggesting.
DAVID HARDING You misread it. They’ll turn a blind eye to it. They won’t put a black mark against you or your school while this is going on. And when they inspect us they’re only interested in whether we are delivering government policy and meeting government targets. That’s the way that things get done.
MARGARET WILLIAMSON And people get done, David.
OFSTED by the way is an acronym for Office for Standards in Education.
You can see the consequences in the final scene of the play.
Act Two Scene 6
Eileen Winterton, chair of governors, Margaret Williamson, head teacher, and Anwar Fawzi, a parent, look on as Brighouse School is demolished.
EILEEN WINTERTON Margaret, the problem’s not just here. It’s everywhere. Remember Enron when that big American energy company went bust and people lost billions. In Enron they had another name for it. They called it “rank or yank”. You were “ranked” if you played ball with them, “yanked”, sacked, if you didn’t.
MARGARET WILLIAMSON It probably explains why no-one blue the whistle on our credit crunch. Someone must have known about all that mountain of unpaid mortgages. They must have.
EILEEN WINTERTON There’s always a cover-up, every single time. That’s why they play “pass the parcel” with our complaints – you know pass the buck. Nobody’s held accountable when they boob. They make sure of that. That’s the real trouble
ANWAR FAWZI You’re right there. And they play games with us, those people. They play charades when it comes to consultation – they don’t really consult – they just want to make it look as though they do.
(Bulldozer noises continue in the background until the end of the scene.)
It is not as though no-one has seen the problem. It’s just that no-one ever does anything about it. Hence Baroness Young of Scone feels that she has to resign only five months after the Care and Quality Commission has started work.
Prologue
The recent Power Report pointed to “the weakening of effective dialogue between governed and governors” and “the rise of quiet authoritarianism within government.” …Sad to say, the report has already been allowed to gather dust as reports of this kind invariably do, and everything goes on as before.
The Power Inquiry was set up by the Joseph Rowntree Trust in 2004 to mark its centenary. It established a Commission under the chair of Baroness Helena Kennedy QC, to investigate why the decline in popular participation and involvement in formal politics has occurred, to provide concrete and innovative proposals to reverse the trend and to explore how public participation and involvement can be increased and deepened.
I flag this up even though the flag is at half mast.
You may or may not like Rudi Giuliani, but read his book on Leadership and you will see that he spotted the problem and he at least tried to do something about it. Not living in New York I wouldn’t know how far he succeeded.
Notes & Quotes
From Leadership by Rudolph Giuliani
The New York City school system was never really going to improve until its purpose, its core mission, was made clear. What the system should have been about was educating its million children as well as possible.
Instead, it existed to provide jobs for the people who worked in it, and to preserve those jobs regardless of performance. That’s not to say that there weren’t committed professionals at every level within the system. There were, and that’s the shame of it. Those with their hearts in the right place were the ones who suffered most.
Until I could get everyone involved to sit together and agree that the system existed to educate children, fixing little bits of it was symbolic at best. Band-Aid solutions can do more harm than good.
Does this sound all too familiar?
To conclude this post and to paraphrase Shakespeare – Something’s rotten in State of Western Democracy. The scandal of MPs expenses in the UK is a sign of it. It is, however, the least of it.
I’d cast my vote at the forthcoming general election for any of the three main political parties that looked as though it was seriously going to tackle it, not just pay lipservice to tackling it.
Termites, of course, not a chance.
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