People who shouldn't be allowed to drive 1

Amazing how many drivers feel the need to look at their passengers while they are driving.

Here's a tip: if you have something to say to your passenger so important that you need to watch how they are taking it, save it for when you aren't doing 70 on the motorway!

NHS money-wasting 1

Whose brilliant idea was it to spend £8,000 on a handbook to advise nurses on climate change?

NHS ruined by its own obesity

Only a few weeks ago, MPs, including Gordon Brown, were queuing up to defend the National Health Service from its detractors in the USA; now it turns out that the government has commissioned a consultancy report on the NHS, which has recommended excising 10% of its budget.

Last week, a report by the Patients Association revealed that many supposed professionals don't think nursing is about looking after sick people at all. This week's consultancy document lists a raft of ways in which the NHS could save money, including not bothering to perform hysterectomies or varicose vein surgery. The study identified "staff productivity" as a major problem area where improvements could save £2.4 billion.
The Times says that "Productivity is notoriously difficult to measure in an organisation as large as the NHS", although it is not clear whether this statement is a paraphrase of something in the McKinsey report or the viewpoint of the journalist. Either way, it's not actually accurate: it's not the size of the NHS that makes "productivity" difficult to measure, but the hugeness of what McKinsey & Co would probably call "units", but normal people call "hospitals".

Time was when hospitals were smaller, much much smaller. There were also more of them, located in places that patients and staff could get to easily, and by public transport. In smaller hospitals employees all knew each other. They worked directly for the hospital, not agencies, and everyone from consultants to cleaners felt a sense of belonging and possession. Smaller hospitals meant fewer security issues: there weren't so many entrances and anyone unfamiliar was quickly noticed. In smaller hospitals, patients — that's what they were called then: no faffing around with surveys considering whether the sick might prefer to be known as "clients" or "customers" or "stakeholders" — could find their way around. Smaller hospitals had (just) enough staff and of the right sort: a sufficiency, but not a plethora, of managers; nurses who wanted to nurse and who treated patients like individuals not statistics. MRSA was unheard of in smaller hospitals: the cleaners gave a damn — after all, they ate in the canteen and lived in the nurses' home too — and Matron went round the place every day to check that everyone's job was properly done. (Admittedly, the title did need changing to accommodate a new generation of male nurses, but the point about duties remains.)

At Chelsea Hospital for Women (1916-1988), the average waiting time for routine surgery, major or minor, was about six weeks. No-one, but no-one, got past Doreen on switchboard during the day, or Nick the chief porter at night, without proving legitimate purpose. Christmas was wonderful and the good will lasted all year. Every department hosted a party, each with its very distinct character (the engineers had theirs in February to cheer everyone up) and everyone went to as many as they could and socialised together: doctors, nurses, clerical and managerial staff, cleaners and porters. It made staff feel part of a community in which they were keen to reinvest. On the rare occasions a patient died, the whole place mourned.

But in the 1980s the accountants started taking over the world. It was inevitable that they would look at hospitals and decide to amalgamate them into megahospitals. Matrons became administrators, managers first instead of nurses, rebranded as Chief Nursing Officers who grudgingly allowed a single Christmas party and were apparently incapable of understanding that community was the glue keeping the NHS together. Smaller hospitals were pulled down to make way for enormous concrete complexes, with lots of technological equipment, but fragmented and segregated departments. The NHS sacked its cleaners, and cleaning — a quite important function in a hospital — was taken over by the agency with the most competitive tender (small was beautiful there, apparently), its rootless staff paid peanuts, and problems reported via a double chain of command too distant to be effective. In those circumstances, MRSA was just waiting to happen. In the megahospital security is a nightmare. In physical terms, violence has escalated to an all time high; and patients' digitized records are vulnerable to a range of problems: breaches and losses (including that perennial favourite, the unencrypted and mislaid or stolen laptop), hacks and crashes.
A few small hospitals still exist, but it's a struggle, even though there is much they can offer,. The bloated NHS is so busy with bureaucracy — KSF, health reforms, targets — there's barely time for patient care. No wonder nurses have given up actual nursing. No wonder "productivity" is problematic.
Megahospitals are simply too big to be workable, too huge to achieve the sense of community required to provide a service and job satisfaction, too enormous for individual patients to feel they matter much. However many "managers" the NHS employs — and some out there who would say it's far too many already — these monstrosities have become unmanageable.