Archive for the ‘action’ Category
So, that Total Defence plan. Not long after blogging about the weird way becoming an NHS Foundation Trust member is mostly about the staff discounts, my Google Alert tail-warning receiver lit up. Specifically, it caught the fact that the Haringey Clinical Commissioning Group was going to have a public meeting, so off I went with a little notebook of talking points.
My first impression (as I was on time) was the usual depressing one – they’re all 117 years old, there’s four of them, and Christ, they’re odd, and one of them’s reading something called God’s Word Made Plain. Why did I volunteer again? But the room filled up, and then filled up some more, and eventually we counted up 53 MOPs who turned out.
The original agenda was all about “how the CCG can communicate with the public”, but when it got communicating, the message from the public was that the public wanted no part of that. It turned out that the local “Patients Panel” hadn’t met for years. An effort was made to explain the new NHS structure, and at this point, astonishment and disbelief set in as the CCG vice chair and the (existing) NHS finance director tried to draw the organisation on a flipchart. (It reminded me of the enchanted PowerPoint presentation in one of Charlie Stross’s novels.) So, GPs were meant to commission everything, and the PCT and SHA had been shut down, with 54% cuts imposed on their staff, but to keep the wheels turning, they were reorganising as a cluster in the meantime. Then, the GPs would take over, but the GPs themselves couldn’t be in a position to commission their own work, so they would be commissioned nationally, while some other services would be carved out of local commissioning.
One of the CCG doctors said of the re-org that “in terms of human pain it’s quite remarkable – managers are people too, you know”. Before the CCG took over, it would be allowed to have a “shadow budget” but no actual money, because it didn’t have an accountable finance function. And before it did, everyone would be sacked again. The national commissioning board would replace the SHAs, but would have four or possibly more regional branches that might be quite a lot like them.
The questions kept coming and eventually they abandoned the agenda in favour of just standing there fielding. It turned out that there was a 93 page national test that the CCG would have to apply, but nobody had seen a copy and nobody was clear about who set the test or how. There was a Joint Strategic Needs Assessment, carried out by the cluster and the local authority, but how that fed into this process was a mystery.
On the question of specialist services that would be carved-out of local commissioning and reserved to the national level, the chair had to be told that it wasn’t right and it wasn’t OK to say that “normal people” wouldn’t need to know about it because a lot of them are psychiatric in nature. It turned out that they represent 40% of the budget. The service-user activists got angry. As well as a Health and Wellbeing Board, whose makeup a Lib Dem councillor told me was still being debated, there is a Mental Health & Wellbeing Board, but the GPs have yet to deign to meet them because after all they’re only nutters (I paraphrase, but not much).
It turned out that the NHS organisations being butchered have a variety of huge databases of information vital to the commissioning process. Nobody seems to know what will happen to this.
The specialist/local interface seems to be enormously crucial, and a completely undemarcated frontier. The GPs are hugely keen on “continuous follow-up”, but it’s far from obvious why anyone would want follow-up by someone who has no specialist knowledge of their condition.
The FD confirmed the following figures in my talking points: the Government has budgeted £25 per head per year for the CCGs and the Commissioning Support Organisations. Of this, the NHS North Central London cluster says it can do the CSO job for £15/head/year, which leaves £10*225 kilocitizens in Haringey or £2.25m a year in funds flowing to the CCG as such. The CCG plans to have CSO staff co-located with it, and in fact to rely on the CSO for pretty much all its day-to-day functions.
Apparently the Government arrived at the figure of £25 by halving the existing Londonwide figure and dividing by the population.
Anyway, my take-home points: CSOs are crucial (although we knew that). Status of staff – are they civil servants? Who has responsibility for the public money flowing through them? What happens to this database? Further, the frontier problem between central and local is important. And I’ve got to get on to some of these assorted boards.
I was really pleased by the turnout, and the degree to which the crowd were intelligently angry. A surprising number of people had evidently taken the time to brief themselves in advance.
More of a scratch pad for me than anything else.
It’s not like your friendly local Clinical Commissioning Group would have a web site. Is it. Anyway, there is a list of names in this PDF.
Chair / Central Lead Dr Helen Pelendrides*
Vice Chair / North East Lead Dr John Rohan*
Borough Director Andrew Williams
West Lead Dr Peter Christian*
South East Lead Dr Muhammad Akunjee*
Central GP Member Dr Sharezad Tang*
North East GP Member Dr Simon Caplan*
North East GP Member Dr Gino Amato*
West GP Member Dr Dina Dhorajiwala*
West GP Member Dr David Masters*
South East GP member vacant
Sessional GP member Dr Rebecca Viney*
Borough Head of Finance David Maloney
Director of Public Health Dr Jeanelle de Gruchy
Non-executive Sue Baker
Non-executive Cathy Herman
Patient Representative (West) Patrick Morreau
Patient Representative (East) Ivy Ansell
Haringey Council Mun Thong Phung
Haringey Council Councillor Dogus
There’s going to be some sort of public meeting on the 17th of April.
Contacts (for all the North Central London CCGs) are here.
The proposed commissioning support organisation (that’s the bit Lansley wants to give the yanks – a technical term, I agree) prospectus, from the existing NHS organisation, is here. Interesting detail:
Our services will be affordable. Our offer will enable you to run your CCG effectively and to deliver commissioning support within your £25 per head allowance. Our working principle is to provide a core offer for £15 per head, with additional or enhanced services available at additional cost. We believe that this meets current CCG expectations that internal CCG running costs will cost up to £10 per head.
There are 225,000 people in the London Borough. That’s £2.2 million in “internal CCG running costs” split between whichever people in that list get to draw a salary from it. Fuck me, no wonder Saint GP likes it.
Back in the summer, as the News International scandal (well, beyond the scandal of its very existence) cranked up, we had a look at how the government buys newspaper display advertising and made an effort to reach out and touch the people in charge of it. I see no reason not to go round the buoy with this for another try. Back then, the Central Office of Information still existed, with a sword hanging over it. Now, we have Novated Frameworks. What?
Well, rather than having its own media-buying desk, the government has contracted the job out, via the Government Procurement Service. Some details about novatin’ a framework are here. Although it does seem that the end of COI is sliding right, there is a contact for the supplier here. Presumably, though, every agency now contracts with them on a per-project basis, thus saving literally thousands of pennies.
So we did the Stag & Dagger festival. This translated into the following facts on the ground, which I propose to review briefly.
Toro y Moi, at XOYO
This lot could be interesting – if they stopped, ugh, jamming. EDIT. Ended up back in the bar with the house’s DJ. Venue is pretty great, too – fantastic sound, disturbingly reasonable drinks prices and surprisingly nice people. Even though I spotted someone holding a pint in their teeth to facilitate tweeting with both thumbs. Quote: “You’ve really done that skinhead look haven’t you – is that, er, deliberate?” No, I fell under a barber’s shop.
YBAs at the Old Blue Last
If you like vaguely punky, you’ll like this, but there’s a lot of it about. Also, could people stop pretending to be the Jesus & Mary Chain? This was the second act of the night I would have dropped in favour of the house’s DJ like a shot.
Wire at Village Underground
Legends, but ruined by terrible sound in the cavernous railway arch.
James Yuill at City Arts & Music Project Basement
This is going to be harsh, but stop trying to be Jarvis Cocker, especially as you’re a DJ. No-one dancing. Beer prices the highest I’ve seen anywhere in the world. I also refuse to believe that their basement really looks like this and suspect that decorators spent serious money making it look that cheap.
Star Slingers at Queen of Hoxton
This lot sounded interesting and they got the floor going, but for some reason we didn’t like them much. Don’t remember exactly why, probably because they were the last act of the night. And they kept pointing a laser at me. Prices appalling (I brought Daniel Davies here once and even he jibbed), not much point if you’re not on the roof terrace. Handy for the office.
I forget who played at the Hoxton Bar & Kitchen but we couldn’t stand the gaff for more than 30 seconds at a time, so the only way to take part would have been to take turns to duck in and out like Soviet submariners during a nuclear accident.
At my local gym on Friday, I was accused of abusing steroids. Just like that – I’d finished my weights session and moved on to the abs, when some random guy approached me and said “Here – are you on gear?” No. “I mean, are you on gear?” No, I’m not on steroids. [Cancel the maniac, please] “I mean, you’re lifting heavy for your physique, man.”
All the while, I couldn’t stop thinking of the Geoff Wode scene in Withnail & I. “Look at him! Look at Geoff Wode!” Recreational steroid users and people who know most of the W&I script are probably two groups with a minimal intersection set.
OK, so as well as the big demo, currently standing at 578 coaches and counting, there’s going to be a day of action on the NHS on the 1st of April – April Fool’s day, surely someone can make something creative out of that. So I thought I’d open another flank. Flipchart Fairy Tales has already covered the issue as well as anyone will, but the point is quite simply that they’re all lying to you about public pensions.
That’s a chart of the forecast cost of the entire public sector pensions system as a percentage of GDP, with a sensitivity analysis showing what happens to it if you change various parameters like life expectancy, productivity growth, and such. The coloured area each side of the line on the chart (the central projection, showing what the forecasters think is the most likely scenario) shows the range of possible outcomes if those assumptions are set to different values, to take into account the uncertainties involved.
But the most interesting feature of the chart is this: the peak cost is this year, 2011. This isn’t subject to very much uncertainty at all – we know very well how much public pensions will pay out this year. So, why on earth is anyone talking about cutting public sector pensions, when their cost is going to fall every year from here on in as far as, ah, the financial year 2059/2060, by which time we’ll either be hastily revising the budget to deal with the National Union of Robots or else scratching it on part of a ruined conference centre in Harrogate with a sharp stone as Chinese occupation troops armed with spears look on.
And it’s not some unusually lefty wanktank that’s come up with this through highly advanced ex ano analysis. This chart was dug out of horrible Blairite gargoyle John Hutton’s urgent report on why public sector pensions have to be slashed yesterday, and it was prepared by the Government Actuaries’ Department.
So, I’d like to find out exactly how many and which MPs have seen it, know what it means, and what they think as a result.
Here are some questions, with the answer in (brackets):
1) What do you think public sector pensions cost as a percentage of GDP, right now? (answer: 1.9%)
2) Is this rising or falling? (falling)
3) What do you think they will cost in 2020? (1.8%)
4) What do you think they will cost in 2050, in the Treasury’s worst-case scenario? (1.5%)
5) In the light of this, do you support cuts to public sector pensions? (left as an exercise to your representatives)
And tell me about it. (Apologies are of course due to Josh Marshall of Talking Points Memo fame.)
So what about that Public Data Corporation?
I think it should be opposed with full force. Why? Well, the fact they want to structure it as a “corporation” is suspicious in itself – it’s going to be tempting to declare it a trading fund and force it to make profits, even if only in the silly Tory sense of forcing other bits of the government to play at shops and pass bits of their budget to other budgeting entities. This would send us right back to 1996 – no access unless you’re rich, thanks. The model here is the Forensic Science Service; this was trading-fundised, so that money from the policing budget was sucked back to the Treasury with every DNA test, and has now been sold to the private sector. (Expect to need a DNA-driven innocence project within years two, I would.)
Further, the point of the exercise isn’t defined at all well. Sometimes, you might think this was an opportunity. If something is ill defined, there may be the opportunity to define it. However, it is hardly a controversial statement that the current government has something of a record of introducing ill-defined and poorly thought out wheezes that end up in a horrible mess. It’s therefore prudent to assume that this particular wizard wheeze is just as poorly thought out as all the others, and will end up in a horrible mess unless someone intercepts it. Just look at what they’ve done to some perfectly good projects. Hopefully, that’s “intercept” as in the way the air force do it – splash it in the North Sea.
Also, the current position makes sense; data.gov.uk lives in the Cabinet Office. The Cabinet Office’s core responsibilities are for the machinery of government and the Civil Service. Data disclosure and privacy issues are fundamentally administrative. The dossier is where it should be, and conveniently close to seriously influential people. Bumping it to some sort of thingy-wotsname quango based hundreds of miles from Whitehall would be a defeat.
Finally, the best reason to oppose it is that if we spend the next three months refining our response and debating the philosophical nature of privacy, whatever it is they want to do with it, they’ll just do it and the damage will be done. If it turns out to be a reasonable idea, it’s always possible to welcome it later. But the flip side of “working with” them to improve it is opposition. It’s the early no that buys later influence.
Say no to privatisation and the back to ’96 agenda. Say no to the Public Data Corporation. And if you’re working with government datasets, scrape and stash as much stuff as you can right now.
Things to do this week: withdraw all my savings from ING Direct and take them elsewhere. Seriously, read the whole thing.
We’ve seen plenty of this sort of stuff before:
These networks such as the UnCut movement or the student movement with outstanding micro-organisations such as the UCL Occupation (which has received over 60,000 hits on its blog in a little under a week) who have so dynamically organised yesterday, today and going forward will inevitably be more flexible and effective than organisations with generic ‘leaderships’ such as major businesses, the police or even the National Union of Students.
Well, if your benchmark of effectiveness is the NUS… Mere snark, though. This particular Internet prairie fire does seem to be spreading nicely and doing more than tweeting. However, whenever someone starts going on like this, I do tend to suspect what they mean is “…more flexible and effective than organisations with people with funny accents who are train drivers an stuff”.
I’ve said before, though, that I suspect that a lot of this network organising is structurally suited to negativity. Look at the ‘baggers, for example. The classic examples political science types use, like open-source software projects, tend to be very different to the implementations in politics – rather than trying to recruit masses of people, they’re usually driven by a hard core of the obsessed, or of people whose job it is. Order is difficult, mayhem is easy. Specifically, you can contribute significantly to mayhem by putting in an hour here or there.
On the other hand, though, it’s not as if we’re likely to run out of rage. This is ‘bagger lesson one. Negative tactics and the expression of inchoate rage are not without value. Nigel Stanley gets it right – it’s a false dichotomy. Getrennt marschieren, vereint schlagen, and we’ll all get there in the end.