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Archive for the ‘Business’ Category

Sunday
Mar 11,2012

My excellent webmaster, Jon Worth, has written a blog post about his experiences earlier today with security on the Eurostar from Brussels.

He describes the pointless inconveniences that were introduced to plug the holes in an already leaky system.  The extra measures in place on his journey were presumably intended to plug the Lille loophole, described in the Telegraph today.  Yet the “solution” provided hardly seems cost-efficient or particularly effective.

The Sunday Telegraph explains the problem as follows:

“The loophole centres on the Schengen agreement signed between a number of European countries, including France and Belgium, which allows people to cross borders without passport checks.

The UK is not in the agreement can therefore check the passports of passengers travelling here.

As a result there are two gates for Eurostar trains in Brussels, one for those going to Lille, which does not have passport checks, and one for the UK, which does.

It means an individual could buy two tickets and then pass through the Lille gate but stay on the train to London without having their passport examined.”

Jon Worth describes the extra checks which took place on his train (no doubt as a result of this morning’s article in the Sunday Telegraph):

“Then today when the train called at Lille for more passengers to alight and board, we were told on the public address system in the train that there would be additional checks in the train between Lille and Calais. These checks were carried out by a team of 7 French rail police carrying guns and batons, but just checking tickets (and not passports). I asked the policeman who checked my ticket why he was doing so. “Parce-que c’est comme ça” (because that’s the way it is) he replied. I pushed him further, saying that of course I had to have a valid ticket, because how otherwise could I have actually got on the train? “C’est contre la fraude” (it’s against fraud) was the best I got out of him before he moved off.”

So that wouldn’t have prevented anyone with evil intent slipping into the UK.

However, today there was an additional check at St Pancras:

“Then upon arrival in St Pancras, not announced to passengers on the train, all passports and all tickets were being checked by UK Borders at the exit. Which – quite frankly – seems to render other checks superfluous. Why bother having a UK Border check in Brussels, and French police check in the train, if you’re then going to check in London too?”

Excellent –  apart from the extra costs of the unnecessary and ineffective security checks beforehand.

But what about the impact on passengers?  As Jon Worth points out:

“due to the small terminal exit and a few hundred people streaming off a train, the checks are not swift in London.”

This means at peak time there will either be terrible delays or – as happened with other border controls – the extra checks will be lifted.

The problem is potentially serious and it is amazing that the Home Office seems so relaxed about it.

Wednesday
Mar 7,2012

Yesterday there were five votes in the House of Lords on the competition sections of the Health and Social Care Bill.  The amendments were all defeated by the Government and, despite all the LibDem huffing and puffing over the last few weeks, not a single LibDem Peer voted for any of them.

The first amendment which would have placed a duty on the Secretary of State in respect of standards of adult social care was defeated by 261 votes to 203 – with 66 LibDems voting with the Tories against the amendment.

The second amendment which would have protected the NHS from the worst effects of competition (and was originally moved by a LibDem peer) was defeated by 275 votes to 188 with 66 LibDems voting with the Tories.

The third amendment which would have retained Monitor’s role as the independent regulator of NHS Trusts was defeated by 255 votes to 183 with 65 LibDems voting with the Tories.

The fourth amendment which would have tried to limit “anti-collaborative” behaviour in the NHS was defeated by 221 votes to 171 with 58 LibDems voting with the Tories.

The fifth amendment which would have enabled NHS commissioners to determine the most effective way of delivering NHS services without necessarily putting them out to the market was defeated by 203 votes to 157 with 52 LibDems voting with the Tories.

In none of the divisions did a single LibDem vote with Labour to protect the NHS.

Saturday
Mar 3,2012

On Friday, when Parliament was not sitting, the Government published 68 amendments to the Health and Social Care Bill changing the status of local HealthWatch organisations (the local bodies that are intended to protect patient interests in the new Tory/LibDem vision of the Health Service), as I predicted a few weeks ago.

The amendments are very complex and difficult to follow – they amend amendments to Part 14 of the Local Government and Public Involvement in Health Act 2007.  And they are scheduled to be debated next week during the House of Lords Report Stage consideration of the NHS Bill.

That means that these amendments – slipped out without proper warning or explanation (a normal courtesy of writing to those Peers with an interest in a particular matter doesn’t yet seem to have happened in this case) – will not receive proper Parliamentary scrutiny.  They have never been considered by the House of Commons (and, if passed in the Lords, will now only be taken there as part of the truncated Consideration of Lords Amendments procedures).  In the House of Lords, they have not been subjected to detailed scrutiny at Committee Stage and will essentially have to be debated on a take it or leave it basis when they are eventually reached probably some time late on Thursday.  That will be the only opportunity for any  discussion on what these amendments mean.

So what are these amendments about?

The biggest change is to remove Clause 181 and Schedule 15 of the Bill.  These established local HealthWatch organisations as statutory bodies with a defined local membership (appointed in accordance with regulations) that could employ staff, would meet in public etc.

Instead, local authorities will be expected to make “arrangements” with a body that “a person might reasonably consider … acts for the benefit of the community in England”. And these bodies will then be able to sub-contract the patient representation work further.

The role of the national body, HealthWatch England (which the Government still want to be a sub-committee of the heavily-criticised Care Quality Commission) to advise local HealthWatch organisations is also being diluted with their power to give “advice” being changed in another amendment to a weaker role of giving “general advice”.

Presumably as a sop to people like me who had complained that there was nothing to require local authorities to provide an adequate local HealthWatch organisation (or even to spend the money allocated for local HealthWatch for that purpose), there is an amendment that gives HealthWatch England the power to give a local authority “written notice of its opinion” that the services expected of a local HealthWatch organisation are not being provided properly.  This gives HealthWatch England the power to write a letter, but that is all.  There is not even a requirement for a recalcitrant local authority even to respond to the letter.  I am sure they will be quaking at the prospect!

The Government acknowledges that there may also be a conflict of interest between a local HealthWatch organisation and the local authority that is responsible for setting it up and funding it (for example, if a local HealthWatch criticises the quality of the social care provision provided by a local authority).  They are therefore putting forward an amendment saying that local authorities “must have regard to any  … guidance on managing conflicts” that the Secretary of State may issue.  Again, not much of a safeguard.

The amendments also seem to envisage that a local authority may get different contractors to provide the various functions of local HealthWatch organisations, so one contractor may “gather information” and “make recommendations”, another may be responsible for “monitoring” services with the power to “enter and view” them, a third might provide advocacy services and a fourth might be responsible for “influencing commissioning”.  This is hardly a recipe for an effective structure.

And there is another strange amendment which suggests the possibility of imposing a requirement that  in any area “Local HealthWatch contractors (taken together) are representative of people who live in the local authority’s area”.  This acknowledges that there are likely to be several sub-contractors providing patient representation services in an area, but also opens up the possibility that the sub-contractor providing one service may not be representative provided the other subcontractors compensate for the first’s unrepresentativeness.

Without these amendments, there would at least have been some clarity as to what a local HealthWatch organisation might look like – even though they would be hampered, possibly shackled and potentially starved of funds by being subservient to the local council in their area whose social care provision they would be monitoring.  However, with these amendments local HealthWatch organisations are likely to be fragmented and will lose the authority they would have had by being statutory bodies.  What is more by deleting the schedule that would have specified membership arrangements and governance they will now be shadowy and unaccountable structures.

The net effect of these amendments will be to make it more likely than not that the new local HealthWatch organisations will be ineffective and that there will be no proper and coherent structure of patient representation at local level.

One can only speculate as to why these amendments have been brought forward in this way at this time.

One possibility is that some obscure unit in the Cabinet Office charged with dismantling the public sector suddenly realised that there was a bit of the Health and Social Care Bill that did not facilitate privatisation and instructed the Department of Health to change it.

Another is that Department of Health Ministers have realised that the changes they are making to the NHS are so unpopular and are likely to have such a damaging effect on patients that they simply cannot risk having an effective mechanism for patients’ interests to be represented.

I don’t know which is the real reason, but it is difficult to conceive of any other rational explanation.

Friday
Feb 17,2012

There is an excellent article in the New York Times that explains the behavioural psychology that is now linked to supermarket loyalty cards and on-line shopping patterns to target and personalise adverts and offers.

It describes an incident in a Target store (a major US chain) as follows:

“a man walked into a Target outside Minneapolis and demanded to see the manager. He was clutching coupons that had been sent to his daughter, and he was angry, according to an employee who participated in the conversation.

“My daughter got this in the mail!” he said. “She’s still in high school, and you’re sending her coupons for baby clothes and cribs? Are you trying to encourage her to get pregnant?”

The manager didn’t have any idea what the man was talking about. He looked at the mailer. Sure enough, it was addressed to the man’s daughter and contained advertisements for maternity clothing, nursery furniture and pictures of smiling infants. The manager apologized and then called a few days later to apologize again.

On the phone, though, the father was somewhat abashed. “I had a talk with my daughter,” he said. “It turns out there’s been some activities in my house I haven’t been completely aware of. She’s due in August. I owe you an apology.”

I suspect these systems are now so sophisticated and analyse so much data about individual’s behaviour that they far surpass even the databases held by the most anti-civil libertarian governments.
But for some reason you don’t hear so many complaints ….
Thursday
Feb 9,2012

After the excitement of the Government’s defeat in the House of Lords yesterday afternoon by a margin of four votes (with the Convenor of the Liberal Democrat Peers, Lord Alderdice,voting against an amendment he had both signed and spoken in favour of) on the principle of mental health issues being given greater priority within the NHS, the rest of the days proceedings might have been a bit of a damp squib.

However,the later debates illuminated what a dog’s breakfast the whole Health and Social Care Bill has now become.

For example, at one point I tried to elucidate what would be the mechanisms to drive up quality in local healthcare provision and how would health inequalities between commissioning group areas be addressed, saying:

“My Lords, I support the amendments in this group because I believe that it is important that we look at the mechanisms that will be embedded in the Bill, assuming that it eventually receives Royal Assent in some form, and that will in practice drive change in the direction that we all want. That includes improving the quality of the care offered, and it means addressing the issues of health inequality to which the noble Baroness, Lady Tyler, referred.

One of the omissions from the Bill is that, apart from placing some general duties on the various bits of the NHS, there is very little about demonstrating how those duties will then be exercised or creating a mechanism for assessing that. The amendment, which talks about reporting annually to Parliament on the progress made, seems an essential first step in making sure that that happens.

The reports on inequalities will be increasingly important in this area. However, Amendment 112, dealing with CCGs’ annual reports on how they have discharged their duty to reduce inequalities, raises another question, and this comes back to the issue of what will be the catchment areas of individual CCGs. Unless there is far more central direction than I have understood—and perhaps the Minister can reassure us on that—it seems likely that there will be, to use an unpleasant term, ghettoisation in some CCGs.

In some local authority areas, the easier bits of the patch will have one CCG and another will cover the others. That is likely to mean that the areas covered by those two different CCGs are rather more homogeneous than might otherwise be the case. If one CCG covered that area, the duty to make progress on health inequality would be clearer. If we are talking about smaller populations served, it is more likely that they will be homogeneous and that there will therefore be less inequality to address. The question will be whether there will be enough pressure within the system to ensure that the inequalities in health outcome between different CCG areas will be addressed. It is all very well to place a duty on a CCG which covers, say, the people of Tottenham in north London, where there are tremendous problems of health status, life expectancy and so on, to report on what it is doing to eliminate health inequality in its patch, but if the nature of that patch is such that it is already deprived in terms of both economic indicators and health outcomes, what will be the driver to ensure that the inequality of that area compared with others is addressed?

Who will own the strategy within regions and parts of the country to address issues such as health inequality and clinical standards? If the answer is that that this will all be done by the NHS Commissioning Board, that is a wonderful answer and tells us what an important body the NHS Commissioning Board will be. How will that be operationalised? What mechanism will drive that? Before you know it, you are talking about a regional and area infrastructure no less baroque than anything we have seen in the past. Otherwise, it cannot happen. What will be done to operationalise the drivers to make the improvements happen? It will not be sufficient to place a duty on everyone to report on what they have done, although that is valuable and worth while in itself. What will be the duty to address issues between localities? You can address all the inequality you want within those areas, but if the outcomes are already much lower in those areas, will there be enough infrastructure around the NHS Commissioning Board to address the problem of the inequalities between the different areas?”

In reply, the Minister, Earl Howe said:

“The noble Lord, Lord Harris, asked me about clinical commissioning groups and referred to their geographic coverage. He will know that each CCG will be accountable for the outcomes that it achieves against the commissioning outcomes framework, which is under development. The CCGs will be supported in their efforts to improve quality by the NHS Commissioning Board, whose job it will be to issue commissioning guidance, informed, among other things, by NICE quality standards.

I do not agree with the noble Lord that CCGs are likely to be ghettoes. Across many clinical areas, they will collaborate to serve the needs of patients over an area wider than that of just a single CCG. What is not stated in the Bill but I hope is implicit in all that the Government have said is that there will be transparency in all this. Once you measure results, there is, ipso facto, an incentive to improve those results.

The noble Lord, Lord Hunt of Kings Heath, asked me how a CCG can influence improvement in primary care when it is the board that is commissioning the primary care. I simply remind him that CCGs have a duty under the Bill to support the NHS Commissioning Board in its quality improvement functions with respect to primary care. Indeed, one of the key benefits of CCGs as we see it—and we know this from a practice-based commissioning which has been in place for a number of years—is the ability for peer review and peer pressure to drive up quality.

The noble Lords, Lord Harris and Lord Hunt, asked me who will lead the local strategies. Health and well-being boards will be the bodies that will produce a joint health and well-being strategy, and that will be designed precisely to address issues such as health inequalities, which involve different services working together. CCGs must have regard to these strategies in addition to reporting annually on health inequalities, as through the amendments in this group.”

Shortly afterwards, I intervened to try and clarify the point and this was the exchange:

“Lord Harris of Haringey: I just want to make sure that I understand the point that the Minister is making. Let us compare two localities in London. I mentioned Tottenham, so compare that with, say, the residents of Totteridge. They are very different socioeconomic groupings with very different health outcomes. What is the mechanism for addressing health inequalities between Tottenham and Totteridge? Who will be responsible for addressing inequalities between areas that are just a few miles apart but which have very different characteristics and very different social outcomes? The health and well-being boards are borough-based. Tottenham is in the London Borough of Haringey and Totteridge is in the London Borough of Barnet—neighbouring boroughs that are very different in composition. What will be the overarching structure that addresses those inequalities?

Earl Howe: Localism lies at the heart of our approach to these issues. Although I have no doubt that conversations and comparative analyses will take place between different health and well-being boards and different local authorities, in the end it is the responsibility of health and well-being boards to look to their catchments. As I said, the outcomes that are published, both in terms of the NHS performance and public health and social care, will in themselves incentivise improvement, if the local authority and the health and well-being board work together as they should. This is a joint enterprise between public health, social care and the NHS.

We shall no doubt experience the effect of comparative work between local authorities once the early implementer groups have bedded down and begun their work. Both the board, however, and the Secretary of State will have duties in relation to inequalities. They overarch everything that happens and I suggest that that will ensure that a system-wide and strategic approach is taken, for example, through setting objectives in the board’s mandate in relation to inequalities. These could feed down very easily to CCGs through commissioning guidance issued by the board. I hope that that gives the noble Lord a summary, or at least a flavour, of how we envisage this working.

Lord Harris of Haringey: May I just clarify? Will there be nothing between the board at national level? Will it look right across the country and say, “We will address these inequalities”? Will there be nothing, for example, at the London level, to address inequalities between different parts of London or will it simply be driven nationally? That is a recipe for not necessarily making the best decisions in particular areas.

Earl Howe: The noble Lord will know, because the NHS Commissioning Board authority has published its proposals, that the board will be represented sectorally. There will be field forces in all parts of the country. My vision of this, and that of Sir David Nicholson is that in the areas in which the board operates it will take a view across a region and look at how outcomes vary between local authority areas. The board will be very powerfully placed to influence the kinds of inequalities that the noble Lord has spoken of. It is important for noble Lords to understand that the board will not be a collection of people sitting in Leeds. The majority of its staff will be a field force. I hope that that is helpful.”

So the NHS Commissioning Board will have an army of staff, active in every region and locality “influencing” local Commissioning Groups.  (This army will, of course, be anonymous and unaccountable – except at national level through the NHS Commissioning Board and the Secretary of State will try to imply that none of what happens is anything to do with him.)
A later exchange on another amendment amplified the point:
Baroness Jolly: Before the Minister sits down, will he clarify whether the same processes that he has just outlined would apply to people in receipt of specialist services that are commissioned by the NHS Commissioning Board, not by local CCGs?

 

Earl Howe: My Lords, where a service is commissioned by the NHS Commissioning Board—and let us imagine that it is a specialised service—the patient’s recourse should be to the board. However, of course, the board will be represented at a local level rather than only centrally, and we expect that the board will be represented in health and well-being boards and in the discussions that take place there. It would therefore be possible for a patient to address their concerns, in the first instance, to the health and well-being board, which would have the ability and power to communicate directly with the NHS Commissioning Board, if that was felt to be appropriate. However, as I said, the patient would be able to go straight to the board in those circumstances.

Lord Harris of Haringey: I appreciate that this is very bad manners, given that I missed most of the debate. The Minister has just said—although perhaps I misinterpreted him—that the NHS Commissioning Board will have a representative on every local health and well-being board. If so, how will those individuals be known or accountable? Is that not the most extraordinary bureaucracy? He seems to have made a most extraordinary statement.

Earl Howe: My Lords, we are at Report stage and I hope that the noble Lord will forgive me if I do not reply at length. The point I was seeking to make was not about representation on the board but involvement in the health and well-being board’s wider deliberations. It is entirely open to a health and well-being board to invite a member of the Commissioning Board to be a permanent member, but I am not saying that we are prescribing that.’

So there will be – or at least can be – NHS Commissioning Board staff “influencing” or even sitting on local Health and Wellbeing Boards.

By now I was becoming even more curious about the extraordinary reach of the NHS Commissioning Board and in a debate on the proposed duty to encourage “autonomy” for local NHS bodies I pursued the topic again:
“My Lords, every time I look at Clause 4—[Laughter.] I cannot understand what my noble friends find so amusing, but every time I look at this particular clause—if that makes it easier for them—and particularly listening to the remarks of the noble Lord, Lord Marks of Henley-on-Thames, I have been confused as to what problem the Government think they are solving by the clauses on autonomy.There is apparently a concern about micromanagement. There is a desire to have local innovation, flexibility and local responsiveness. What is it about the current arrangements in the NHS that necessarily prevents local innovation, flexibility and local responsiveness? Why are we having these discussions? If there is a concern from the Government that they are micromanaging, they have a solution—they stop micromanaging. Again, what are we trying to do here?However, once you include,

“the desirability of securing, so far as consistent with the interests of the health service”—

or whatever form of words you choose to have—this principle of autonomy, you are setting up an automatic conflict. If the form of words that the Minister and the noble Lord, Lord Marks of Henley-on-Thames, have put their names to was in the Bill, does this mean that the Secretary of State will be intervening when there are clear cases of postcode lottery? That presumably is the implication. Or is the Secretary of State now going to say that in fact a postcode lottery is what this legislation is designed to create? We should be clear what these clauses are trying to prevent. What is the problem that they are trying to solve?

The noble Lord, Lord Marks of Henley-on-Thames, was moving in his description of how the Secretary of State would weigh these difficult issues of the possible conflict between,

“the desirability of securing, so far as consistent with the interests of the health service”,

autonomy and the priorities of the fundamental role of the NHS. This is a balance that has to be weighed. He talked about this line of accountability that will exist between the NHS Commissioning Board and the CCGs—these tentacles that the NHS Commissioning Board will put throughout the NHS. They will be unaccountable and anonymous, and individuals will be operating at regional or at local level.

There will be an army of people operating as the tentacles of the NHS Commissioning Board. They will be informing the Secretary of State so that he can exercise his judgments about the balance between autonomy and meeting the principles of the NHS. I wonder whether the Secretary of State is creating the most extraordinary bureaucratic monster to solve a problem that could be easily solved simply by resisting his tendency to micromanage.”

And this prompted further exchanges:

Earl Howe: My Lords, the noble Baroness, Lady Thornton, has spoken to Amendments 10 and 52, which, as she has said, would remove altogether the autonomy duties on the Secretary of State and the board. The noble Lord, Lord Harris, asked me what the problem is that the Bill is trying to solve in this regard. The duty is intended to promote a culture of fostering local autonomy rather than to outlaw specific practices; but without a focus on autonomy, it is possible that the mandate from the Secretary of State to the board or the framework document from the board to CCGs could impose disproportionately burdensome requirements on the system. The Government believe that local operational autonomy is essential to enable the health service to improve the outcomes of care for patients, provided that autonomy is within the framework of clear ministerial accountability.

The noble Baroness will be aware, because I have said it before, that we are aiming to free those closest to services to take decisions that are right for patients, free from central micromanagement by either the Department of Health or the NHS Commissioning Board. The amended duties, with the caveat that the interests of the health service take priority, achieve the right balance between autonomy and accountability. Without the clause, a future Secretary of State could choose to ignore one of the fundamental principles of the Bill, which is that those closest to patients are best placed to take clinical decisions. Without the clause, a future Secretary of State would be free to use his extensive powers to micromanage the NHS. The autonomy duty is a necessary part of the Bill, placing a duty on the Secretary of State to consider the expertise of those in the health service while recognising that there will be circumstances—

Lord Harris of Haringey: My Lords, the noble Earl seems to be saying that you cannot trust your own Secretary of State not to micromanage unless they are effectively forbidden from doing so. We have all talked of the Secretary of State’s accountability to Parliament. Surely the principle is that an accountable Secretary of State will be under enormous pressure from Parliament not to micromanage. If it is such a central issue of policy, Secretaries of State should simply be told not to do it, rather than requiring an Act of Parliament.

Earl Howe: I challenge the noble Lord to think of one Secretary of State, with the distinguished exception of my right honourable friend Mr Lansley, who has not succumbed to the temptation of micromanaging the NHS. No Secretary of State has been able to resist that temptation because, frankly, Parliament expects them to do it. That is what the system has expected of the Secretary of State. This is a burden on commissioners and clinicians, and, in the end, it does not well serve the interests of patients. It is all very well for the noble Lord to say, “Well, just stop”, but the system encourages it and the duties on the Secretary of State are there to encourage it.

Baroness Thornton: I cannot resist saying that the noble Earl’s right honourable friend Mr Lansley has dabbled and intervened on at least 12 occasions since the Bill started. He is on the record as saying on one of those occasions that certain managers should be sacked. Is the noble Earl saying that that will cease when this Bill is on the statute book?

Earl Howe: I am saying that the Secretary of State will not have the ability to micromanage the health service as he does at the moment. Whether the examples cited by the noble Baroness constitute micromanagement, if my right honourable friend is just expressing a view, I rather question.

 …

Baroness Jay of Paddington: The noble Lord may be surprised to hear me ask this question because, as he kindly said, I have been very determined that the provisions on accountability and parliamentary responsibility et cetera should be strengthened in the Bill. However, I listened to what my noble friend Lord Harris said about what he described as the “increasing tentacles” of these links between the various providers and the Secretary of State. Is the Minister not becoming concerned—as I would in his position—that all this new accountability and these links undermine the basic policy positions of the Bill? That is why, for example, my noble friend Lady Thornton suggested that it would be cleaner—if that is the word—to remove the whole of Clause 4 from the Bill. The complexities that are being set up and strengthened, as the Minister has agreed, make the whole thing so incredibly complicated and bureaucratic that the underlying policy positions are being totally distorted.

Earl Howe: I do not share that view at all. I do not think that the autonomy and accountability arrangements are as complex as the noble Baroness seems to suggest. Autonomy and accountability are two sides of the same coin; one confers autonomy in exchange for accountability. That is the model that we have adopted and the one that I would hope that Parliament would wish us to adopt, given that substantial sums of public money will be at the disposal of commissioners throughout the NHS. I therefore do not see that the metaphor of tentacles employed by the noble Lord, Lord Harris, is actually very appropriate. It implies that there is an organisation holding those in the health service in a grip. That will not be the case. The role of the board is to support local commissioners; it is to be there as a resource to promote guidance, supported by the quality standards that we were debating earlier. It is not—I repeat not—a replica of the kind of line management that the NHS has seen to date.”

The reality is that the mechanism to micro-manage will be there – through the personnel (tentacles) of the NHS Commissioning Board – but presumably the micro-management will be deniable by the Secretary of State.
What a way to run a Health Service. 

 

 

 

 

Monday
Jan 30,2012

At the end of last week, I reported that Andrew Lansley was planning to change the status of the new local HealthWatch organisation so that patient representation could be put out to competitive tender.

The Department of Health has form on this: the organisations acting as “hosts” for Local Involvement Networks were selected following a competitive tendering process in 2007 and bids were sought from throughout the European Union and here, so I am told, is the text of the advert in the Uzbechistan Times:

Gloucester: health and social work services

Takliflar

Umumiy ma’lumot
Davlat: ??????????? ???????????
Shaxar/axoli punkti: GLOUCESTER
Kontrakt yoki xabarnoma raqami: eu:281809-2007
Chop etilish sanasi: Noy 30, 2007
Amal qilish muddati: Yanv 7, 2008
Xaridor: GLOUCESTERSHIRE COUNTY COUNCIL
   
Original matn tili: ??????????
 
Bog’lanish uchun ma’lumot
Manzil: GLOUCESTERSHIRE COUNTY COUNCIL
GLOUCESTER , Gloucestershire
??????????? ???????????
Veb-saxifa: http://www.gloucestershire.gov.uk/index.cfm?articleid=14857

 (I am afraid the cyrillic script doesn’t come out very well in WordPress.)

The fact that the previous Government allowed this function to be tendered doesn’t make it right for the proposed new system, particularly as Ministers have complained about the cost of administering previous patient representation structures which were based on this “hosting” principle.

All in all it looks like “dogma gone mad” with no regard to the cost or to whether it will deliver more effective patient representation.

I have this afternoon tabled two Parliamentary Questions on the subject:

“To ask Her Majesty’s Government:

    1. What would be the cost of requiring local authorities to put out to competitive tender contracts to run local HealthWatch organisations?
    2. What was the cost of putting out to tender contracts to act as hosts to Local Involvement Networks?”
Sunday
Jan 29,2012

John Naughton in today’s Observer has an interesting article on the proposed new EU data protection directive and the way in which Facebook is getting “its retaliation in first”.  The proposed “right to be forgotten” is likely to conflict with Facebook’s newish “timeline” facility.  And the retaliation?  This is how John Naughton puts it:

“The day before the commission made its announcement, Facebook’s chief operating officer, Sheryl Sandberg, gave a speech to a technology conference in Munich. Her menacing subtext was neatly summarised by the New York Times thus: “Concerned about privacy? Maybe you should be concerned about the economy instead.” Translation: mess with us, Eurotrash, and we’ll screw you.

Sandberg’s speech was revealing because it exposes the line of argument that Google, Facebook, et al will use to undermine public authorities that seek to control their freedom to exploit their users’ identities and abuse their privacy. The argument is that internet companies create lots of jobs and are good for the economy and European governments shouldn’t stand in their way.”

Apparently, to back this argument Facebook referred to a report that they had commissioned from Deloitte which concluded that Facebook had  indirectly helped create 232,000 jobs in Europe in 2011 and enabled more than $32bn in revenues.

John Naughton is sceptical pointing out that Facebook itself only has about 3,000 employees world-wide and he continues:

“Inspection of the “report” confirms one’s suspicion that you couldn’t make this stuff up. Or, rather, only an international consulting firm could make it up. Interestingly, Deloitte itself appears to be ambivalent about it. “The information contained in the report”, it cautions, “has been obtained from Facebook Inc and third party sources that are clearly referenced in the appropriate sections of the report. Deloitte has neither sought to corroborate this information nor to review its overall reasonableness. Further, any results from the analysis contained in the report are reliant on the information available at the time of writing the report and should not be relied upon in subsequent periods.” (Emphasis added.)

Accordingly, continues Deloitte, “no representation or warranty, express or implied, is given and no responsibility or liability is or will be accepted by or on behalf of Deloitte or by any of its partners, employees or agents or any other person as to the accuracy, completeness or correctness of the information contained in this document or any oral information made available and any such liability is expressly disclaimed”.”

Although Deloitte is normally regarded as a respectable organisation, these caveats plus the rather tendentious conclusions should raise alarm bells.

Or as John Naughton puts it:

“The sole purpose of “reports” such as this is to impress or intimidate politicians and regulators, many of whom still seem unaware of the extent to which international consulting firms are used by corporations to lend an aura of empirical respectability to hogwash.”

Yet reports like this with sensational conclusions seem a particular feature of commentary on the internet.

And especially so in respect of information security, last year the UK Government published figures saying UK cyber crime was costing £27 billion per year and not to be out-done Symantec suggested that the global figure was $388 billion.  The reality is that all these figures are unverifiable – and whilst I am quite clear that cyber-crime is a very serious problem for the world economy these estimates are, to use John Naughton’s word, “hogwash”.

Spurious precision – whether it is Symantec’s $388 billion or Facebook’s 232,000 jobs in Europe – should always be treated with caution.

Friday
Jan 27,2012

I am hearing a most bizarre rumour – even by the standards of bizarreness fostered by the Health and Social Care Bill.

Apparently, Ministers have instructed civil servants to draft an amendment to the Health and Social Care Bill (which begins its Report Stage in the House of Lords on 8th February) to change the status of the proposed new local HealthWatch organisations.  These are the local structures that are being set up to protect the interests of patients in the brave new world of the “reformed” health service after the Bill is passed.  (I have already warned that the proposals for HealthWatch are flawed.)

I am told that under this amendment, local HealthWatch organisations will no longer be “statutory bodies” but will instead become “bodies carrying out statutory functions”.  This sounds – as, of course, it is meant to – like a trivial semantic point and the amendment will no doubt be presented as a technical change of no significance.

The reality is very different.

In fact, the change of status is important.  It implies a downgrading of local HealthWatch organisations and they will need all the clout they can muster if they are to be effective.  Some of that clout would come from being a statutory body in their own right.

But the real reason behind this change is that the local councils who are to set up the local HealthWatch organisations will now be required to put out to commercial tender the work of HealthWatch.  (You cannot tender for a statutory body, but you can tender for a body to carry out statutory functions.)  And as each individual HealthWatch organisation will have a budget above the level at which EU competition rules kick in, the tender will have to be advertised across the European Union in the Official Journal, so that firms and organisations from anywhere in Europe can compete to provide local consumer representation services.

I hate to think what these multiple tendering operations will cost and I fail to see how it is likely to lead to better quality local patient representation.

If this were some new health and safety requirement or some equal opportunities expectation, no doubt the newspapers would be wheeling out the “This is political correctness gone mad” headlines.

In fact, this is another example of the Health Secretary’s privatisation-mania, so all together now:

THIS IS PRIVATISATION GONE MAD.

Sunday
Jan 22,2012

The Government’s e-petition site has rejected an e-petition calling on the Government to improve “the flow of passengers through busy London Underground stations” by installing slides in place of escalators.  The e-petition also suggests that:

“Small prizes should be available for those reaching the bottom in the fastest time. These would be paid for out of the savings of not having to maintain and operate down escalators.”

The e-petition has been rejected because this is a matter for a devolved authority – in this case the Mayor of London – and therefore it is for the Mayor of London to consider this proposal.

Tuesday
Dec 13,2011

Telephone message received: “Please call Geoff in Lord Strathclyde’s office as soon as possible. He would like to have a meeting with you before the Christmas break if at all possible.”

I have to admit to being intrigued.  This would be the first time that Thomas Galloway Dunlop du Roy de Blicquy Galbraith, 2nd Baron Strathclyde, Leader of the House of Lords, has ever asked to see me. And before Christmas …..??!!

I dial and speak to Geoff:

“Hello, this is Lord Toby Harris.  I had a message to ring.”

“Oh yes. Thank you Lord Harris.  Tom Strathclyde was keen to have a meeting with you and Lord Kirkham  in the next week or two before the Recess.”

This was even more intriguing: I have never even spoken to Lord Kirkham, the South Yorkshire billionaire, founder of the DFS Furniture Company and Chairman of the Conservative Party Treasurers.

“Are you sure you’ve got the right Lord Harris?  What’s the meeting about?”

“Oh, fundraising, I think.”

“What sort of fund-raising?”

“I guess, it is for the elections next May.”

“I think you have got the wrong Lord Harris.”

“Oh, err, are you sure?”

“Yes, I think you want Lord Harris of Peckham.”

Of course, Lord Harris of Peckham is not quite in the same league as Lord Kirkham: he is only worth £285 million and he only does carpets.

Still, it is good to hear that the Leader of the House of Lords and the Chancellor of the Duchy of Lancaster is doing his bit for the Conservative Party coffers from his Parliamentary office with the support of his civil servants ….