Friday, July 03, 2009

Triumphs Of The Commissariat

Where Commissars fear to tread

We really shouldn't keep knocking the Commissars. After all, they're only trying to give us A Better World. A world that is ordered, and fair, and peopled with... well, better people. It's entirely our fault that we keep letting them down.

Take schools. This morning we heard about another selfish parent attempting to circumvent the Gosplan allocation protocol for state school places. In this case, she used her mother's address in an attempt to get her son into a good school, and quite rightly, she was sent to a heavy labour gulag for intensive re-education prosecuted for fraud.

How many times must we be told? Everybody must know by now there are far too few good schools to go round, and it simply isn't acceptable for non-Commissariat parents to insist on priority for their own children.

Indeed, as Commissarette Fiona Miller told us this morning on the state broadcasting network, it's also unacceptable for petit-bourgeois elements to move house simply in order to get into the right school catchment area. She herself knows of a couple who moved in just down the road from the very dacha she shares with our ex-Information Commissar, specifically to gain access to the same excellent local school the young Miller-Campbells attend. Can you imagine such disgraceful behaviour!

And then there's the latest attempt by reactionary counter-revolutionaries to undermine the achivements of our glorious People's Health Service.

According to the so-called Commons Health Select Committee, one-in-ten NHS hospital patients is harmed as a result of the treatment received:

‘Tens of thousands of patients suffer unnecessary harm each year and there is a huge cost to the NHS in consequence... Government policy has too often given the impression that there are priorities, notably hitting targets, achieving financial balance and attaining Foundation Trust status, which are more important. This has undoubtedly, in a number of well-documented cases, been a contributory factor in making services unsafe.’

This is preposterous. Don't these idiots realise what a triumph the Commissariat targets have been? And when it comes to patient safety, you've only got to glance at the official chart to see how brilliantly things are going:

As everyone can surely see, in the last five years reported safety incidents at NHS hospitals have soared! It's a triumph of targeting, and a triumph of Commissariat planning.

Now why can't we all give credit where credit is due?


So just how dangerous are our NHS hospitals?

As regular readers may recall, Tyler's Mum was a nurse in a pre-NHS flagship hospital (the Royal Devon and Exeter - now sadly down the NHS plughole). And as she always used to tell us, hospitals are dangerous places. The fact that people sometimes get harmed is not hugely surprising.

What we really need to know is whether things are getting worse or better - especially given all the cash government has been pumping into patient safety - and whether NHS hospitals are better or worse than industry norms?

And on those vital questions it seems we have absolutely no idea. As the Commons Health Committee says:

"55. The evidence... both in England and internationally, indicates that the extent of medical harm is substantial, even on a conservative estimate, and that much is avoidable. International studies suggest that about 10% of all patients who are admitted to hospital suffer some form of harm.

Judging how far patient safety policy has been successful requires more reliable data regarding how much harm is done to patients. Unfortunately, neither the NPSA nor the DH was able to provide us with that. Government estimates of avoidable harm and the attendant financial costs are extrapolations from old, very limited, data; and no attempt has been made to produce reliable up-to-date figures."

So there we have it. We are spending many tens - possibly hundreds - of millions on patient safety programmes and monitoring systems: the National Patient Safety Agency (NPSA) alone costs us £30m pa. Yet the reams of figures they produce are virtually useless.

It's yet another example of top-down tractor production management. Yes, there are always plenty of targets and numbers, but they are so distorted (in this case by self-reporting bias), they are meaningless and often downright counter-productive.

So how could we manage hospital safety?

Answer: copy the system we have with commercial airlines.

I know nothing about the technicalities of airline safety, or how it's delivered. But I do know that some airlines have been much safer than others. And those are the ones I fly with.

Once again, we need the good old market. Where the Commissars struggle, choice and competition would soon weed out any operators perceived to be dangerous. Yes, OK, we would also need some minimum safety regulation as well. But that could be achieved for far less cost than the massive and useless NHS "safety" bureaucracy we currently have in place.

Another one for George's List.

PS Tyler's flabbers were well and truly gasted by the tale of Tereza Tosbell (pic above):

"A patient was so disgusted at the "filthy" hospital ward she was being treated on that she forced herself out of bed and cleaned it while still attached to a drip. Tereza Tosbell, 48, who works as a cleaner, became angry as she watched hygiene staff at work and claims their brief visit left the room as dirty as they found it. So she tracked down cleaning materials and attacked the sink, radiator and curtain rail she said had not been wiped by the official cleaners in Colchester General Hospital. "It is shameful that the cleaners just wiped the basin with a paper towel and totally ignored the taps which are the most important part. The radiator was filthy, there were cobwebs on the curtain rail round my bed and you could write your name in the dust on the windowsill," said Miss Tosbell."

And what did Colchester General Hospital have to say for itself?

"We have had a number of unannounced hygiene and cleanliness inspections by the Healthcare Commission and all wards inspected have been found to have a good level of cleanliness and maintained in good general repair. In the annual health check ratings for 2007-2008 we scored maximum marks for safety and cleanliness."

Maximum marks huh? Do we believe the Commissariat tractor stats or the customer? Tricky.

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