Latest diary entries

Ramblings about cats, games and miscellanea.

Love the NHS, we'll miss it when it's gone

The NHS is in meltdown, and nobody with any modicum of power seems to care. I've been meaning to have a rant about where the NHS is going for some time, but the trigger for finally writing this was the second story on the BBC front page this morning. It was titled "NHS trusts with deficits rise to 39", and it goes on to say that "18 of 147 trusts missed a target that 85% of suspected cancer patients started treatment within 62 days."

To anyone with half a brain cell, it would be pretty clear that these two things are linked - the trusts are being starved of cash, so they can't treat the patients. However, it goes on to quote a Conservative health spokesman as saying "we do not accept that delivering safe and compassionate care in the longer term costs more money." Really?

I don't know what would be more upsetting - that the people in charge of the NHS are clueless, or that they know exactly what they're doing.

The NHS provides this country with one of the best healthcare systems in the world. If someone falls ill, they will receive treatment regardless of whether they are young or old, rich or poor. I'm biased, and you should be too - it is a unique and precious thing, one which has saved or significantly extended the lives of millions of people. It saved my dad's life last year, gave my mum an extra 10 years to see me grow up and go to university, and helped my gran live to 105. But everything we hear in the media makes it sound terrible - and our politicians seem to be doing everything they can to make that the reality.

This government, as those which went before, have set a lot of targets for the NHS - financial targets, waiting list targets, hygiene targets - and at face value, that may seem to some like a reasonable way to do things. After all, successful businesses have targets and budgets, so why not use those techniques to get the NHS's spending under control and to improve the quality of its care?

Because the NHS is not a business. That's why.

People bring money into businesses, but take it out of the NHS. That's why businesses advertise to reach more people, whereas the NHS advertises to avoid them. A hospital has no control over how many new patients come in through their doors on a given day, nor how many in their catchment area get cancer or need hip replacements. That means that they ultimately have no control over how much money they have to spend, so saying that they are a terrible organisation for going over their budget is insanity.

Trusts in deficit should be assessed for efficiency and quality, and then praised for doing their job. Throw money at them, give everyone a bonus. But that doesn't happen. Regardless of what politicians say, the reality of the NHS is that it's being starved of cash while costs are going up. Several years ago trusts embarked on a process of reducing their staff through "natural wastage" - a lovely way of saying that when critical front-line staff leave, they aren't replaced and their colleagues have to pick up the slack. This inevitably forces corners to be cut, and patients suffer.

At the same time, the odious administrative structure soaks up vast amounts of financial resources while issuing directives and making changes to services without any idea of the implications for those actually doing the jobs, nor any thought to the effects on patients. Pencil pushers who never leave their comfortable offices in administrative buildings miles away from the hospitals end up making decisions about patient care based on nothing but the numbers.

The trusts have their budgets cut at one end, targets and fines raised at the other, and the staff and patients are caught in the middle. This can only lead to one outcome: management lose sight of what the hospital is there to do, staff are pushed past breaking point, patient care suffers, and we have more Mid Staffordshire scandals. If anyone thinks that trust was the only place this has happened then they're living in a dream world.

Recent and current governments have forced a culture in the NHS of putting money above all else. A trust gets a certain amount of money at the beginning of the year. If a waiting list time limit is breached, it is fined, regardless of the causes. If more than n patients on a ward have C. Diff, it is fined for poor hygiene, despite the fact that it spreads in the community and they probably all had it before they came in. And these aren't trivial fines, they're tens or hundreds of thousands. But to make up the shortfall, a hospital can sell its services to other NHS bodies, or private healthcare.

Ah, private healthcare. I remain convinced it's a con. Some private patients will be treated in private hospitals, will have nicer accomodation and shorter waiting lists; sure, those are nice, but they don't fix what's wrong with you. Say what you like about the NHS, but thanks to its qualification requirements and training programmes, the staff skill mix in its hospitals are miles ahead of the private sector. If a doctor in a private hospital isn't a moonlighting consultant, chances are they're there because it's the only job they could get. But not all private patients are treated in private hospitals; some are lucky enough to go directly to the NHS hospital in the first place - where they'll end up on the same wards as NHS patients, being treated by the same staff with the same drugs. It's just they're paying for it twice.

This leads me back to what I alluded to at the start - the mismanagement of the NHS could just be incompetence, but it's increasingly clear that successive governments are deliberately causing budget deficits and missed targets so they can point at them as proof that the NHS is in meltdown, implicitly encouraging people to opt for private healthcare while "improving services" by opening up more and more opportunities for private companies to get a bite of the NHS pie. It's not just the current government - both they and Labour have allowed or forced the NHS to outsource logistics, catering, cleaning, parking, legal services, and actual treatments. They're even turning into landlords, letting hospital space to Boots and Costa. And don't get me started on Labour's PFI deals or the Tory's insane GP reforms.

What I can't understand though is why. Do the politicians genuinely believe that a private sector model is a good fit for the health service? Do they really look at healthcare in the USA and aspire to bring that to the UK? Can they really be that stupid? Why does the mainstream media only ever focus on the official line that the NHS is terrible, and not do anything to fight to protect it?

Healthcare is not a business, and patients are not customers - they are our sick friends and relatives, and we should do everything in our power to support them and those who look after them. Instead we let our politicians and media bicker about budgets and targets while they conspire to run one of humanity's greatest achievements into the ground. This isn't healthcare - it's insanity.

Engaged

I'm very pleased to announce that I asked Leela to marry me, and she said yes!

For those interested in the details, it was her birthday last Monday, and each year we take a few days off to do something - day trips to local towns and cities, visits tourist attractions, films at the cinema, that sort of thing. I also cook her a meal, usually macaroni cheese and strawberry crumble, as those used to be the only two things I could cook - but this year I also gave her a chocolate mousse, an apple and ginger syrup sponge, and a ring.

Despite the fact that this Saturday we will have been going out for 10 years, Leela was very surprised - instead of answering, she repeatedly asked me if I was joking. To be fair, I was proposing with a party ring. After I had assured her that I was entirely serious, she agreed, and we haven't stopped grinning since.

My fiancée and I (tee hee!) haven't set a date for the wedding yet, but given we both enjoy travelling to distant places, and there is no better excuse to travel than a honeymoon, we're thinking the date will largely depend on flights...

Boxes

My house has been invaded by boxes. They're everywhere I look - the spare room, the downstairs toilet, my office, the halls - we can barely get around the house. When my gran went to a home and my dad sold our house in Kent about 8 years ago, I spent several weeks going through everything; I started well, but as the weeks dragged on I ended up throwing most stuff into boxes to sort out later. My dad had a bit of storage space, so the boxes sat there until now; I can't keep them there any more, so I'm finally being forced to go through and sort out what to keep and what to get rid of.

Enter ebay. I've got a lot of random crap which I was pretty sure nobody would want, but which I couldn't bear to throw in the bin - minidisc players, a portable analogue tv, an old digital camera, an hp pda - you know, the sort of tech junk that you use for a few years before it gets replaced and goes in a drawer, never to be looked at again. Well, it turns out that there are people who want this stuff, and they live on ebay.

I have sold 11 items now, and made a grand total of £100 - which sounds nice, until you factor in the many hours I have spent writing listings, packing and weighing items, printing postage, and dropping parcels off at drop-off points for the various couriers I chose. Pretty sure once you factor that in, I've actually made a loss - but at least the things have new homes and didn't end up in landfill. I'm just not sure I can bring myself to list the hundreds of other things I need to get rid of.

The other thing I'm going through is a box of VHS tapes. Thanks to family friends with cameras, I have several tapes of me as a child, which I'm in the process of ripping to my computer to delay data rot. It stirs odd feelings of nostalgia and loss - hearing my mum's voice again, seeing my dog running around in the garden, remembering things about my childhood which I'd forgotten. One thing is abundantly clear though - I now understand why I was so mercilessly mocked and bullied at school: I was really, really annoying.

I'm thinking I should forget ebay and set up a kickstarter, where for each goal reached I release a new video on youtube of me as a child, each more embarassing than the last. There's enough cringe-worthy gold here for me to retire by christmas.

In other news, I've done a new version of the TCMI (although nobody else seems to be using it this year, which distresses me greatly), I've been migrating all my sites and services to new servers (I really hate puppet, I'll blog about that at some point), and I decided not to run the new advent calendar this year (it needed a bit more work, and didn't make sense to start in the middle of December). I'm still chugging down through my to do list, gradually approaching "Finish software and put it on sale" - a fairly critical one for an independent software developer, but one which is taking a lot longer to get to than I had hoped. 2014 - that will be when I finally sort things out. Yes, 2014. But until then: back to puppet.

A New Website

It has finally happened - I've updated my website! It's got a new design, a new blog, and a new back-end - yes, I have at last ditched the 15 year old perl includes in favour of a django site. I've put it straight into its new Christmas theme - it's a work in progress, since I've got a few more things planned for it this month, including a new improved TCMI and a new advent calendar which is not quite ready.

The main change to the new site is that I've split my diary in two. There's now a new blog section for tech stuff, and the old diary has moved into the new personal section of the site and will mostly be about cats. I'm doing this because I've always felt the tech stuff got in the way of stories about cats, and vice versa, which has led to my all-time-low of 3 entries in 2013. This will now change.

If you're reading this on the old RSS feed address, you'll get both the diary and the blog - but if you don't want to read one of them, there are now separate feeds.

Yarr - Yet Another RSS Reader

I've released a new project: django-yarr, a Django-based RSS reader for people who want to self-host.

I'd been hoping to have my new site up and running before I started releasing things, but we'll have to make do, because the Google Reader Apocalypse is Nigh.

I'm a big fan of self-hosting, so when Google announced on March 13th that they were killing Reader, I started looking around for a replacement to drop into one of my Django sites. There were a few around, but they didn't seem to be heading in the direction I was looking for - basically a clone of Google Reader - so I started Yarr on March 14th.

I was aiming for an 8 hour project, to release that week - I made it 4 hours in before the phone rang, and I've been distracted with more pressing matters ever since. Never mind - with less than 24 hours to go until the Reader switch off, Yarr is now ready to start taking over as my RSS reader.

I won't lie - it's still a work in progress. Most notably, although you can import your feeds from the OPML in a Google Reader Takeaway, once they're in there you'll have to use the admin site to manage your feeds - although you can expect that to get fixed in the next couple of days.

If you're looking for a google reader replacement and have a django site handy, please give it a try and let me know what you think.