Archive for the ‘NHS’ 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.

Red Brick blogs on the new regulations regarding council tenants who want to take over control of their estates. Their view is that this will be much more likely, and therefore that the campaign to prevent the London Borough of Hammersmith & Fulham demolishing a lot of homes in order to redevelop Earls Court has taken a big step forward. Perhaps. LBHF, as Boriswatch has repeatedly shown, is a bit of a happy hunting ground for really weird Tories, and the final word is with the Secretary of State, aka Bradford’s second-worst political product Eric Pickles. Good luck with that.

But there is an interesting point here. I would argue that re-election is not really a concern for the Tories. They have fully internalised the so-called “50% + 1” model dear to Karl Rove. The point is not to “win the centre ground” by triangulating, it is to scrape in by mobilising the base and demobilising the other lot. Then, one tries to change the conditions by making deliberately excessive and maximalist demands on the basis that whatever you ask for, you’ll probably get less, so it makes sense to shoot for the moon. Eventually, you’ll lose, but in doing so you will have pissed off the right people and hopefully changed the character of the terrain. Further, the new integrated Atlantic market for bullshit means that being a minister is no longer a life’s work, but rather an apprenticeship for much better rewarded punditry.

Think of it as an approach that isn’t about manoeuvring over the landscape, it’s about changing the landscape itself.

As a result, there is no strategic focus in terms of policy. Instead, there is a focus in terms of time. The point is to have a lot of things happening simultaneously in the hope that this will confuse the enemy – that’s you – and also in the belief that some of the bombers, or perhaps the bulldozers, will get through.

I see two responses to this. One is assymetric reaction – for example, throwing the kitchen sink at the Murdoch wars. There is no direct link between the NHS and Leveson, but you bet the sale of the News International papers would make it far easier to repeal the NHS Bill. This is why my blog is so obsessed by it. It’s an opportunity to change the terrain.

Another is total defence. If the attack is meant to be decentralised and localised to the NHS trust level, the defence can be as well. This is why you must read this seminal, classic post from Richard Blogger now and act on it. You can get a list of NHS foundation trusts whose membership is nationwide here. I just joined the one that covers my local mental health service – a likely early target – and now I am the NHS candidate for governor. Oh, yeah, and my local acute/general hospital. Go, read, work through the checklist.

(Title taken from faintly Orwellian-meets-Hazel-Blears but remarkably apposite Singaporean Ministry of Defence website. They used to have one that said “Total Defence. What will YOU defend?”, which is on point as well.)

So, I was at today’s NHS demo. Somebody had to be – I was shocked by how many people weren’t there. The streets were full of people who weren’t there. And there was a pretty standard demo pitched up on the pavement outside the Department of Health at Richmond House, 97 Whitehall. Speeches. Depression. Workers’ Liberty tried to sell me a paper. The last time I met that lot, they wanted to explain why the lesson of the Paris Commune was that you needed to be nastier to the Muslims. Anyway.

After a while some people from Occupy London and a couple of other orgs turned up to join in. Not long after this there was some sort of interaction with the police (I heard later that they asked us to leave the pavement), and as a result the demo moved onto the street and formed a block across it. Very quickly, a couple of carriers appeared from the Parliament Square side with TSG cops aboard (one of whom, presumably in charge, was out and about talking to the ordinary bill). After some parley – I don’t know the details – they suddenly moved off towards Parliament Square. I expected them to re-appear behind us, but it didn’t happen. Instead, traffic was diverted at each end of Whitehall.

So we stood and sat there, singing our songs and waving our banners. There was more police coming and going, but no real change. Occupy started to work through their standard occupying procedure of holding a meeting and getting a human microphone going.

About 1530, a police carrier appeared from the direction of Trafalgar Square and delivered a slack dozen TSG men, who formed a line across Whitehall between the levels of Richmond House and Downing Street. The demo, which had been facing towards Westminster, swung around to face them. At this point I was seriously worried that the next move would be a line moving up from Westminster to form a kettle. The police deployment was quite thin and extended, whether because this lot were the first to arrive or because they deliberately wanted to filter people through the line.

At 1536, I tweeted (so probably a little earlier), the demo started moving towards Trafalgar Square, partly pushing forwards and mostly moving around the flanks of the police line. (This is a fair characterisation, I think, as is this.) The police moved back towards Downing Street and then towards the Women’s Monument, and there was some sort of outbreak of shouting on the Downing St side in front of the Cabinet Office, where a lot of people were trying to get by between the police line and the buildings. I passed by on the other side close to Alanbrooke’s statue (my twitter feed says this was 1600). This is the widest point of Whitehall, and the police line now had demonstrators on both sides.

From this point on, the demo moved fairly quickly up Whitehall. Ahead, I saw a police 4×4, possibly a senior officer’s vehicle, parked in the middle of the road, which suddenly moved off with squealing tyres. That sounds dramatic, but in truth the pace was little more than a brisk walk, and nothing violent had happened so far.

Approaching the top of Whitehall, a choke point where the street narrows before entering Trafalgar Square, I looked back and saw that beyond the demo, and the police, and the demonstrators who were on the other side of the police, many more police had arrived. I think I saw between five and eight carriers.

At the top of Whitehall, the demo started to pass into Trafalgar Square. I was one of the first in the retreat at this point. Due to the demo, and to an “event” in the Square, there was very heavy traffic on all the streets around it. As we emerged from Whitehall, the next vehicle to move forwards from the direction of the Strand and Northumberland Avenue was a police van, specifically one of the red Transit minibuses used by Met Diplomatic Protection and anti-terrorist branch units. (Wail Qasim identified them as such at 1606.) It was, for the record, in the traffic jam rather than parked off the street, and everyone was inside with the doors and windows shut.

One of the Occupiers immediately lay down in front of the van, I think to stop it or any traffic blocking the exit from Whitehall. Other demonstrators gathered around it. There was a hiatus as they realised that they had kettled the cops, and the cops realised that something unusual was going on. Then, one of them got out of the vehicle, with his H&K rifle slung, apparently intending to talk to the people. It can only have been at this point that the now-famous photo was taken. Like everyone else, as far as I can make out, my first thought was “Er, armed police?” (as my Twitter feed records at 1604).

Nothing very much happened. I was one carriageway from the van, and I don’t remember that anyone raised their voice between the police or the protestors around their van. However, I presume they radioed for help, as the first TSG unit now caught up in a real hurry, eventually forming a line (very tight and concentrated this time) in front of the van.

People now began to gather on the mini-roundabout facing them, which seemed to me to practically invite the creation of a kettle around it as more and more police were still appearing. As a result, this didn’t last and the demo moved on across the Square and into the Strand. By the level of Charing Cross, I had the impression that the demonstration had melted away, which struck me as a smart move. In fact, according to Twitter, some of us pressed on up Aldwych and encountered quite rough treatment from the police.

So that was my experience. Everyone seems to be furious that armed police were seen on the demo. I’m not sure that they were used, and I wouldn’t want this to detract from getting after, for example, this bloke or this one.

However, I think the real reason for this is that the Met usually has a group of armed officers and their vans based at Charing Cross nick, as it’s close to various ministries, the Palace of Westminster, Buckingham Palace, and some embassies that get armed police protection. The van could have either been coming from Charing Cross to start a shift, or perhaps on the way back via Northumberland Avenue. They didn’t seem to be particularly aware something unusual was going on, and they were sitting in a van in a traffic jam rather than being deployed in any tactical fashion. My twitter feed records this view at 1608, as do some others.

Well, ha ha. But I do think we should note that David Cameron’s appointment as Prime Minister was greeted by the markets with a dramatic spike in the price of gold, not usually seen as a vote of confidence. Here’s the data, at Felix Salmon’s; as he points out, trying to map events in consensus reality to market charts is a sucker’s game (although I did once have to explain that the giant V-shaped downspike in MTN stock on the chart was the day when half the management team died in a plane crash).

In other post-election cleanup, YouGov did some polling about the public’s preferences. The only group of people not to be consulted about the coalition – that’s us! – broke 20% Tory, 33% Unholy Alliance, 39% Lib-Lab. Anthony Wells, like a good Tory, points out that this means 53% of the public wanted Tories in government, but doesn’t mention that by the same token, 72% wanted Liberals in government. Ah, the times when we were the nation’s least despised option. Also, how many people would have wanted a Labour minority government?

Hopi points out that the key lubricant in the coalition is money, and that both parties have agreed to give money to each other’s pet clients. Interesting contributions in comments from Alan Beattie and Dan Paskins, babbling idiocy from others.

Computer Weekly is interesting on the future of the NPfIT debacle. Also here.

Healthcare volunteers in Kenya: it doesn’t work. Turns out you need to “pay” people to “work” in “jobs” if you want to achieve anything lasting.

Whatever the coalition does, I’ve a feeling this story will determine how it ends up – on China’s property bubble, banks, and the coming blowout of the government deficit as it inevitably bursts and lands on the government’s books. As Doug “always up to no gooood” Henwooood would say, he believed in the collapse of capitalism until he realised the power of a good bailout. When the Chinese banks blow up and get bailed out, will American right-wing nuts blame that on black people?


Quietly, as the election campaign goes on, the NHS IT programme has gone from “heading for the rocks” to “sailing into the cliff”. Has NPfIT put us back 10 years? asks the NHS chief in Rotherham, who’s taken the recently announced option to bail out of the project and deploy something of his own choice. He’s also chosen to do a soft-launch rather than a monster all-or-nothing go-live – so he’s probably worth listening to.

A key problem, apparently, is a lack of the right skills – people have simply drifted away from the project as the reek of zombiedom has become ever more intense. It’s somehow awe-inspiring that it was possible to spend £12bn without attracting hordes of the talented and the merely opportunistic.

The guy who got out earlier – the Paul Allen figure – speaks, and says that the project was doomed because the clinicians didn’t support it. Where have we heard that before?

A safety critical bug emerges.

Some areas have suspended uploading patient data to the Big DB; weirdly, it turns out that the official business case for the summary care records was never approved.

Even weirder, many of the trusts that sent out letters to millions of people, red-alerting NO2ID into action, weren’t actually planning to upload – they just did it because some budget became available for publicity, and hey! budget! Thus accidentally throwing a giant NO2ID demo at the taxpayers’ expense.

Something interesting about the NHS NPfIT project. During my recently completed two-week conference binge, I spoke to people from a British telecommunications company who were fresh, if that’s the word, from tangling with the NHS IT Zombie, and had apparently escaped before it ate their brains with a spoon. I also heard people from a French telecommunications company who had been working in the same field speak.

They agree on this; national healthcare institutions are too complicated for any one organisation to build the kind of comprehensive, end-to-end workflow system that NPfIT envisaged. This is partly because of the incredible complexity of their business processes; an episode of care can span anything from a GP appointment that ends by the patient being told there is nothing the matter with them, or an immunisation being administered in a single visit by a nurse, to 20 years of treatment for a cancer and subsequent surveillance. There are a hell of a lot of other organisations that interact with the NHS, and who aren’t part of the project.

In fact, if they were, the scale and scope of NPfIT would increase to the point at which it encompassed most of the public sector; it would have to integrate with the social security system, and because of all those benefits that are delivered as tax credits, with the Revenue as well, and (because the NHS provides the armed forces’ medical care) with the MOD’s personnel system and even with tactical communications systems in the RAF, because Selly Oak receives casualties direct from the war. Of course, it no doubt already needs to talk to the Treasury’s systems. You might as well just ask the ghost of Stafford Beer to build us a Cybersyn for the whole economy.

But that wasn’t the worst of it. The real problem, according to my source, was that the designers of NPfIT believed that there was an organisation called the NHS. In fact, this was a bit like modelling a blue whale as a homeogenous sphere to make the maths easier. The killer wasn’t that medicine is complicated; it was that the NHS isn’t a monolithic organisation. It is, of course, an institution – a set of social, political, and economic expectations and relationships, a recognisable culture, a way of understanding the world. But it’s far from being a single organisation.

Instead, it’s an ecosystem, made up of many organisations that sometimes play similar roles (it’s a hospital; it’s a GP practice) but differ dramatically in their internal structure, rather as a dolphin and a Humboldt squid are both social, pelagic, fast-swimming predators in the subtropical ocean. However, only one of them is even a tetrapod, and only a real idiot would assume they were both sufficiently described by the concept of “shark”. And the interactions between the creatures in this ecosystem are deeply complicated.

In that sense, it’s quite a lot like the Internet. That, too, consists of a grab-bag of diverse organisations that cooperate with varying success on the basis of a few rules and a rough common culture, which is often honoured more in the breach than the observance. That also has a lot of odd emergent features that arise from its complexity, and would almost certainly be impossible to design as a single organisation. Indeed, an old staple of Internet-related mailing lists is the question of what the word “Internet” actually means.

Cue facile libertarian woofing. Yadda yadda Hayek privatise the BBC. Spare me. Neither does this mean the NHS is disorganised; it may well mean that it’s better for its geographically and functionally diverse components to work differently. It would be surprising if they all shared a single optimal strategy. Of course, there is a perfectly good paradigm for building effective information systems in circumstances like these (and another one). What’s really deeply depressing about this is that after all the blundering about and the money, there’s still not the key element that makes a Web-like approach possible – standard data formats and interconnection procedures.

How much would it have cost to sponsor an effort to fix that, coming up with an XML standard or a Semantic Web ontology and some NHS standards, setting down for example where the canonical data would live and who could get at it in what circumstances?

obligatory NHS post

Something worth remembering, from comments at Making Light:

Back before she became a vice-presidential candidate, Sarah Palin proclaimed a “Healthcare Decisions Day” in Alaska, when Alaskans would be encouraged to discuss end-of-life care with their physicians. Just last month Newt Gingrich wrote an editorial for the Washington Post praising “community-wide advance care planning”.

They’re faking it, of course. It’s just another alternative truth; the post-modern politics package is what they do.

But I wondered: what is the special impact of maintaining a system that wastes about a trillion a year, compared to the cost of the same performance elsewhere? Even if there’s $80bn of profit in there, surely any system or elite that was even minimally sane couldn’t accept something the size of the war-swollen budget deficit going down the toilet every year.

As far as I can see, there are a couple of ideological/aesthetic effects of the healthcare system that may explain (or expalin – freudian!) it. The first one is something which I’ve noticed thanks to the blogosphere: Americans talk about health insurance the way drug people talk about drugs. Indeed, it’s the drugs that vary. It’s all about waiting for this, trying to get that, coming up with schemes to get hold of that despite not having such-and-such – a combination of dependency and fascination, on the one hand, and bitter, whining resentment on the other. The system is so complex, and its motivations so mean, that the good ol’ fundamental attribution error makes it impossible to avoid imputing will and whim to it; I’m waiting for my man, indeed.

British conservatives tend not to get this bit, the degree of insecurity it provides; they imagine that you pay a bill every month and it just works. This is of course because of the NHS; if your employer stuck to the premiums, you’re still covered anyway, and the private healthcare biz is limited in how far it can go in “medical loss management” because of the system’s existence.

And insecurity is deeply political – whilst you’re desperately trying to score the next month, what aren’t you thinking about?

The second: The desperate insufficiency of negative liberty. Another thing which always comes up – sticking to some crappy job to get health insurance. This raises an interesting point. What kind of a huge X-inefficiency must that be? Further, if you believe in liberty, what kind of an infringement of it is this? One of the great achievements of the NHS is that you never need to think about it, or rather, that you can think about it in rational, public terms rather than under constant personal and private insecurity.

This is a crucial point about libertarian ideas of liberty – if, as they usually maintain, we need freedom in order to be creative, innovative, and enterprising, why does this usually get delivered in the form of making it as dangerous as possible to be any of those things? It’s almost as if…there was a complete disjuncture between the top layer of ideology and the operational code that makes it all happen!

And thirdly, the flip side of being obsessed with health insurance is being obsessed with health (self, quackery, etc).

No wonder they’re so keen.

Which reminds me; while the transatlantic bit of the whole palaver played out, my grandfather was waiting for the results of an NHS case conference as to whether they could carry out a procedure to place a rather special stent at the very top of his throat, in order to re-open it, without the tumour interfering with his breathing. He’s over eighty, he’s been ill for some time, he’s already had several rounds of radiotherapy. And, of course, he’s not Stephen Hawking, but an old sailor and former GEC Marconi electronics engineer, an orphan who was a communist from the Depression until he got to know Yugoslavia in 1945. The procedure is complicated; they need the respiratory specialist to be present at the same time.

They provisionally scheduled it for Friday after next.

The NHS is perhaps the definitive creation of democratic socialism in Britain…

So what is wrong with Daniel Hannan? To understand this Tory of the Week, it’s worth looking back to this post on the role of the Daily Telegraph in the world media ecosystem. Specifically, it acts as a sort of reflector attack for nonsense, picking up propaganda that can’t be released directly into the US press and rebroadcasting it straight back. Once published by a newspaper of record, no-one has any problem printing it again.

There are two things here; one is the continued attraction of the US’s well funded rightwing infrastructure. Dan Hannan, being an MEP, doesn’t have to publish very much in the way of a declaration of interest – in fact, in the past he’s been pretty strident about this. At the same time, hard-right politicians throughout Europe are well known for funding their party organisations out of EP expenses, and Hannan is doing the reverse; rather than using EP funds for party purposes, he’s using his status as an MEP to go on the speaking circuit in the States and bask in wingnut welfare.

The second is that the US political circuit is being used as a sort of substitute for British politics here. Hannan at least thought he could say things in the States that would get him in a good deal of trouble in either Westminster or Brussels; intervening in US politics is a way of positioning yourself in Tory internal politics, without showing your hand too much. To be publicly rightwing enough that you want to abolish the NHS is not career positive if it gets into the papers; he seems to have thought that the public wouldn’t notice as long as it happened beyond the seas, but that the sort of Tory constituency associations that could get him a Michael Gove-like seat for life would notice.

Interestingly, it seems to be the case that Conservative Party politics operates in a trans-atlantic world akin to “the isles” in recent British historiography – up until the 18th century or thereabouts, it was possible to play off Scotland or Ireland against London effectively, Scottish and Irish armies were deployed to England during the civil war as (mostly) English ones went the other way. Similarly, Conrad Black imagined himself kingmaker from Toronto. It’s happened before, too – here’s a fascinating letter about Saskatchewan’s NHS-like system, which faced a barrage of redbaiting and was eventually set up with the assistance of volunteers from the UK.

It goes beyond the mere intergovernmental alliance; tellingly, Atlantic Bridge in its current form was set up in 2003 to drum up support for the Iraq war, and it is chaired by Dr Liam Fox MP, one of the Tories who spent 2002-2003 arguing that the Blair government was not sucking up to the Americans enough. I’ve argued before that the Decent Left movement has succeeded, in that it’s found a home in the Conservative Party through figures like Michael Gove; Hannan is probably too much of a tribal Tory to be considered Decent, despite being close to Gove and wired up to the Iraq noise machine.

However, all this relies on the Atlantic as a semi-permeable membrane. It is crucially important that only the bits of your westward enterprise that you want arrive back in London. Access to the bridge must be strictly controlled. This appears to be what went wrong with Hannan’s propaganda tour; when the Guardian is one of the most read newspapers in the US, it’s much harder to achieve compartmentalisation, and the instigators of the #welovethenhs Twitter drive blew the seal so comprehensively that they forced David Cameron to join up and very publicly disown Hannan.

Marked out as a loose cannon, his chances of being parachuted into the Commons must now be considered poor. So you can expect a lot more wingnut chum from him, as he steps up his campaign for a sinecure at the Heritage Foundation.

Chris Dillow points out that perhaps, if we were to do it all over again, we might not design the NHS the same way. Well, maybe not. The really interesting bit, however, and the conclusive evidence that this was a content-free piece of Tory internal politics is that Hannan and Gove’s own proposals are essentially identical to Obama’s.

Both books call for the NHS to be replaced by a new system of health provision in which people would pay money into personal health accounts, which they could then use to shop around for care from public and private providers. Those who could not afford to save enough would be funded by the state.

So, personal insurance, with a public sector option, and Medicare/Medicaid benefits. West of 30 degrees, he agrees with people who think this is equivalent to Nazism; east of 30 degrees, he thinks it’s genius. The real content here is that Hannan wants to be considered a maximum rightist in two different political systems, and doesn’t give a damn for the actual content of anything he says.

Further, after the last post, BT futurologist says we’re living in science fiction. And what particular works does she mention? Blade Runner, Judge Dredd and Solyent Green.


In the world of Halting State, meanwhile, the Germans have had a wee probby with their electronic health cards. Partly it’s due to a reasonably sensible design; they decided to store information on the card, rather than on a remote system, and to protect it using a public-key infrastructure.

Data on the cards would have been both encrypted for privacy, and signed for integrity, using keys that were themselves signed by the issuing authority, whose keysigning key would be signed by the ministry’s root certification authority, operated by the equivalent of HM Stationery Office.

Not just any PKI, either; it would have been the biggest PKI in the world. Unfortunately, a hardware security module failed – with the keysigning key for the root CA on it, and there are NO BACKUPS. This means that all the existing cards will have to be withdrawn as soon as any new ones are issued, because they will need to create a new root KSK, and therefore all existing cards will fail validation against the new ones.

It’s certainly an EPIC FAIL, and alert readers will notice that it’s a sizeable chunk of the plot of Charlie’s novel. But it’s a considerably less epic fail than it might have been; if the system had been a British-style massive central database, and the root CA had been lost or compromised, well…as it is, no security violation or data loss has occurred and the system can be progressively restored, trapping and issuing new cards.

In that sense, it’s actually reasonably good government IT; at least it failed politely.