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Though perhaps inevitable for a doctor trained and employed within the NHS, David Kerr’s answers are all about the system: shift resources into primary and local care; clinical leadership; improve systems for patient information and choice; better data and information systems for improving clinical outcomes; benchmarking. What does this mean in reality? It means more reorganisations; more expenditure on technology; more consultancy fees. Cantankerous won’t argue against Kerr’s demands for greater clinical leadership, but the vast majority of doctors have shown themselves utterly disinterested in leading the NHS. Most of the managers in the NHS are former nurses. Doctors don’t run the NHS because doctors have jobs that are too financially and intellectually rewarding, too busy and too important. Doctors enjoy complaining about ‘people not as clever as them’ – bureaucrats, nurses, social workers and politicians – running the NHS but they don’t, and won’t, do it themselves. For an experienced but battle weary nurse, the promise of a £60K management job is almost irresistible. But why would an experienced consultant or GP earning more than £100K voluntarily accept a pay cut, lower social status and less job security to do a mundane administrative job? In any case, it isn’t the NHS part of the system that doesn’t work: it is the patient part. For all the reforms, NHS patients don’t behave like customers so NHS markets don’t function efficiently. Adam Smith’s Invisible Hand cannot perform its magic without patients behaving like demanding consumers. Isn’t it remarkable how little fuss there has been about MRSA and Stafford Hospital? Cantankerous has watched patients die due to lack of proper medical care in an NHS university teaching hospital, yet the patients’ families have not complained. Why did patients not complain when the quality of out of hours care they received dropped dramatically when simultaneously their GPs were handed huge pay rises? The reason why the NHS is the home of the Gallic shrug is straightforward; it is the same reason why the Australian, French and German insurance based health systems are so much better than the NHS. It is because exchanging cash changes behaviour significantly. People don’t complain about the NHS because it is free at the point of delivery. Patients feel so grateful for the free service that they do not complain and do not act like proper consumers. What we see instead is that shrug and ‘they did their best’. Paying money, even if largely refunded as is often the case abroad, completely changes the dynamic of the relationship: it becomes a transaction. Would the GP or consultant contract fiascos have happened if prices for appointments had increased by 50%? It is an awful thing to say, but would families continue to shrug at the unnecessary deaths of their relatives if the corpses had large invoices attached? And the impact on individual behaviour of real money changing hands, even if refunded later, is not merely anecdotal: there is a great deal of economic research which confirms what we already instinctively know. So, if the solution is obvious, why isn’ t the flawed system changed? Quite simply, because bureaucracies, professions and politicians hate decreasing their own power, and introducing money into the NHS would increase the power of those who pay: patients. In Stafford, patients paid with their lives: the solution is to let them pay with cash.  Voter-friendly? The general election is going to be tough and the Conservatives cannot afford to make it harder for themselves: the electoral map of Britain is already drawn in Labour’s favour. Tony Blair understood only too well he needed to appeal to the middle ground and secure the votes of some of the natural supporters of his opponents. This is the reason why Blair paid placed such emphasis on Mondeo Man and trying to woo the readership of the Daily Mail. Cameron doesn’t need to woo the readers of the Mail. Rather he needs to woo a significant proportion of the readers of the Guardian and the Independent. These voters have natural liberal tendencies and they need to be mollified. They have seen the waste and incompetence of New Labour; they know that they are living on Fiscal Fantasy Island. However, they fear a Conservative Party serving the few or the extreme. They worry about a Conservative Party of toffs and bigots, living in the past. So, given this, Cameron’s electoral alliance with the Ulster Unionists Party (UUP) is perplexing. The UUP is a partner which obliges George Bush to call David Cameron to ask him to use whatever influence he has to moderate the UUP’s extreme position which threatens the Northern Ireland peace process. Any moderate listener who heard the former UUP MP, Lord Maginnis, ranting on Radio 4 this morning, is hardly going to feel that the UUP is an appropriate partner for a mainstream British political party. You can listen to Lord Maginnis here and make up your own mind.
Cantankerous frequently condemns the wastefulness of the British state. However, Sir Martin Sorrell’s actions are clearly deeply unpatriotic and ungrateful and would be condemned as such without hesitation in other major economies such as France, Germany, Japan or the United States. While the size of the UK state is in urgent need of reduction, we still face a fiscal crisis, in part as a result of the huge state-funded stimulus package of which WPP has been a significant beneficiary. Sir Martin Sorrell knows all about financial crises from the near-collapse of WPP. The UK needs to maximise its income and minimise its expenditure. Sir Martin Sorrell has ensured that WPP will be contributing to the cost of Irish roads, schools, courts and banking system bailout when Ireland has invested virtually nothing in his, or WPP’s, success. In earlier times, such behaviour would have been called treason, and the Knight would have ended his life in the Tower of London. Today, we need to remember how to condemn such behaviour. Sir Martin Sorrell should be stripped of his knighthood and ostracised for his betrayal. Sir Martin Sorrell’s treachery should be as unacceptable as that of Anthony Blunt who did lose his knighthood. Sorrell’s actions have real consequences – life-saving treatments unavailable, decent equipment for the armed forces unaffordable. He should not be able to appear on the Today programme without being challenged. Why is the BBC interviewing the Chief Executive of a Jersey registered company domiciled in the Irish Republic in any case? Let RTE do the job instead. Shame on you, Sir.  Ben Bradshaw Commenting on the plans announced by Mark Thompson, Director-General of the BBC, to close BBC Radio 6 Music, Ben Bradshaw, the Culture Secretary, said: “I welcome that the BBC is thinking hard about what it does and where it should focus in future, but politicians should avoid compromising the BBC’s independence by giving a running commentary.” Bradshaw was not nearly so reticent when he was one of the leading attackers of the BBC during the Dr. David Kelly affair. His highly partisan, petty and unpleasant actions played an important part in outing Dr. David Kelly and driving the gentle man to his unnecessary, untimely and early death on 17 July 2003. Cantankerous finds this outing particularly ironic given the highly personal and homophobic election process Bradshaw himself had to endure to gain entry to the Commons in 1997. The attacks of Bradshaw and the Labour Government culminated in the resignation of the last competent Director-General of the BBC, Greg Dyke, and the last head of the supervisory board of the BBC capable of withstanding government pressure, Gavyn Davies. Whether you like Andrew Gilligan or not, there can hardly be an intelligent person in the country, perhaps excepting Lord Hutton himself, who today believes that the claims the Government made about Iraq’s weapons of mass destruction weapons were not made ’sexier’ as Gilligan so accurately stated. It wasn’t even Bradshaw’s job to get involved: he volunteered to, as this transcript of an interview on the Today programme makes clear. At the time Bradshaw was a Minister of State at the Department of the Environment – hardly a relevant role for attacking the BBC over its now proven allegations that the claims about weapons of mass destruction were exaggerated. Of course, Bradshaw is a former BBC journalist. We will just have to assume that he must have been pretty unpopular at the BBC and wanted to get his own back on the organisation which trained and paid him. You can see the hectoring Bradshaw’s disgraceful contributions to the process which resulted in the death of David Kelly and the emasculation of the BBC as a result of the Hutton whitewash here. You often reap what you sow and the Labour Party and Ben Bradshaw will pay a high price for their actions, even if they gained some short-term advantage – Bradshaw was, of course, promoted to the Cabinet. Firstly, Labour alienated an important part of its core vote, including a significant part of the previously sympathetic media which will play an important role in deciding the outcome of the next general election. Secondly, Labour greatly weakened the BBC’s autonomy: cantankerous expects Labour MPs in opposition will not feel too happy about this when the BBC is forced to dance to Rupert Murdoch’s tune by a Conservative government. Finally, Bradshaw’s Exeter seat is looking decidedly dodgy. As dodgy, indeed, as those dossiers. Let us hope enough of the voters of Exeter have realised what a deeply unpleasant, partisan and dishonourable Member of Parliament Ben Bradshaw is and sack him. Cantankerous doubts that the BBC or the liberal media will be queuing up to offer him alternative employment. Jonathan Ross’ agent has announced he won’t be seeking to renegotiate his contract with the BBC. Although Ross claimed his decision was ‘not financially motivated’ this is an important lesson for all senior managers who often accept without question what remuneration consultants tell them: if you pay an employee you value a ridiculous £18 million over three years the employee will no longer need to work having received the equivalent of several lottery wins. For years the BBC operated on the basis of ‘treat them mean, keep them keen’ until the executives realised that remuneration consultants (Towers Perrin et al) would give them, as well as the stars, an excuse for massive pay rises. Many years ago, when he was still cheap financially rather than with his gags, Canon used to have Jonathan Ross host corporate events. They didn’t think he was talented but loved the way he pronounced ‘Rank Xerox’. He still isn’t talented, but we can agree that Ross and Mark Thompson, misguided Director-general of the BBC, are both ‘Rank’.
 A true professional Adam, Isabel, You have certainly provided you client Trafigura with such excellent advice. I am sure you must both take great professional pride in your jobs and enhance your firm’s reputation suppressing reports like this:
http://88.80.16.63/leak/waterson-toxicwaste-ivorycoast-é2009.pdf
Leading directly to this:
http://en.wikipedia.org/wiki/Trafigura
and this:
http://www.spectator.co.uk/alexmassie/5417651/british-press-banned-from-reporting-parliament-seriously.thtml
and this:
http://order-order.com/2009/10/12/guardian-gagged-from-reporting-parliament/
and this:
http://richardwilsonauthor.wordpress.com/2009/10/12/the-parliamentary-question-carter-ruck-and-trafigura-dont-want-you-to-see/
and this:
http://www.northumbrian.org.uk/2009/10/the-trafigura-question-carterruck-dont-want-you-to-see/
and this:
http://www.pressgazette.co.uk/story.asp?sectioncode=1&storycode=44460&c=1
as well as a guaranteed front-page in the Guardian and other newspapers when the injunction is inevitably overturned, followed by leading billing on Channel 4 news and Newsnight.
It is rather fortunate that we have ethical, fair-minded lawyers like you sleeping happily in their beds knowing they have helped prevent injustice and safeguarded hard-won freedoms rather than those other materialistic solicitors who might chase high-paying clients. I recommend that you give a talk at your children’s schools telling them about your poorly-paid jobs championing what is right.
I am sure Balliol and Jesus must be very proud that they have produced lawyers such as yourselves, and given the excellent publicity you have generated for both Carter-Ruck and Trafigura, I am sure students of such renowned academic institutions will be queuing to join your illustrious organisations.
Again, I am sure Trafigura will be delighted at the results of the high-quality media management advice you have provided, which I am sure was exceedingly good value for money.
Regards.
You have certainly provided your client Trafigura with such excellent advice. I am sure you must both take great professional pride in your jobs and enhance your firm’s reputation suppressing reports like this: http://88.80.16.63/leak/waterson-toxicwaste-ivorycoast-é2009.pdf Leading directly to this: http://en.wikipedia.org/wiki/Trafigura and this: and this: http://order-order.com/2009/10/12/guardian-gagged-from-reporting-parliament/ and this: and this: http://www.northumbrian.org.uk/2009/10/the-trafigura-question-carterruck-dont-want-you-to-see/ and this: http://www.pressgazette.co.uk/story.asp?sectioncode=1&storycode=44460&c=1 as well as a guaranteed front-page in the Guardian and other newspapers when the injunction is inevitably overturned, followed by leading billing on Channel 4 News and Newsnight.  Isabel Hudson: What a lawyer It is rather fortunate that we have ethical, fair-minded lawyers like you sleeping happily in their beds knowing they have helped prevent injustice and safeguarded hard-won freedoms rather than those other materialistic solicitors who might chase high-paying clients. I recommend that you give a talk at your children’s schools telling them about your poorly-paid jobs championing what is right. I am sure Balliol and Jesus must be very proud that they have produced lawyers such as yourselves, and given the excellent publicity you have generated for both Carter-Ruck and Trafigura, I am sure students of such renowned academic institutions will be queuing to join your illustrious organisations. Again, I am sure Trafigura will be delighted at the results of the high-quality media management advice you have provided, which I am sure was exceedingly good value for money. Regards.  Fraudster Madoff Bernie Madoff was today sentenced to 150 years in prison for defrauding thousands of innocent victims. When his Ponzi scheme was rendered unsustainable by the financial crisis, the exposed Madoff admitted his guilt and stated he was too ashamed even to seek his victims’ forgiveness.  Gordon Brown Yet Madoff’s theft of £40 billion ($65 billion) over two decades is amateur in comparison with Gordon Brown’s masterly and on-going heist. In May 2009 alone, Gordon Brown’s government managed to spend £19.9 billion more than it received in income. At that rate, every two months Gordon Brown’s government will steal more from future generations of British taxpayers than Bernie Madoff managed in twenty years. Gordon Brown’s government spent more than £26.75 million more than it received in income in each and every hour of May 2009. That is £331 for every adult, every pensioner, every child in the UK. In just May alone. Whatever happened to the abolition of boom and bust which Gordon Brown proclaimed ad nauseam as our ‘prudent’ Chancellor of the Exchequer? Gordon Brown was as qualified to be Chancellor as Bernie Madoff was to be Chairman of NASDAQ. Yet Gordon Brown and his Ponzi-scheming Cabinet continue to claim that taxes will not need to rise and that government expenditure will not need to be cut despite the dire state of the public finances. Worse still, he tries to smear all of those who acknowledge the truth. Gordon Brown’s United Kingdom is rapidly becoming Fiscal Fantasy Island. Gordon Brown and his Party are dishonest. They treat the electorate with contempt, like idiots indeed. Perhaps we were idiots to believe their lies three times. But, we now know the claims to have abolished boom and bust were ridiculous. We know that prudent governments have to balance their books. We know we can’t afford to go on holiday to the USA or Europe because the pound is so weak. We know that the rich have become richer and the poor have become poorer. We know that huge, vast, enormous sums of money have been wasted on non-jobs and quangocrats. We know that the OECD is forecasting that the UK economy will contract by a massive 4.3% this year. At least Bernie Madoff had the decency to admit he was a liar and a fraudster. The Grand Jury of public opinion will almost certainly convict Gordon Brown and his accomplices at the General Election. And, even if Gordon Brown manages to hoodwink the electorate, he will not be able to deceive the financial markets: watch the pound plummet if the global markets even imagine that the Fiscal Fantasy Island Fraudster could be at the helm of UK plc for another five years. Hard to see the idea of holding an inquiry in public ‘whenever possible’ as undesirable, isn’t it? Unless of course, the war was started by your party contrary to your party’s and public opinion. And if the British public was misled about the intelligence justification, purpose and legality of the war. And if the war was a total strategic failure which destabilised the region, split key alliances and demoralised and overstretched the UK’s armed forces. And if the war has cost the UK taxpayer more than £6.44 billion. And if the war made us hated as Bush’s poodle, not just amongst the Muslim masses but also amongst our allies globally and our Muslims at home. And destroyed our reputation for defending civil liberties and opposing torture. And saw us fail to oppose rendition. And, most importantly, the war cost the lives of 179 British troops and thousands more Iraqi civilians with, of course, the loss of homes and limbs of thousands more, Iraqis and British alike.  Indy whitewash We should learn the lessons of the Hutton Inquiry into the events surrounding the death of David Kelly. Any thinking person knows now that Kelly was right when he said the intelligence was sexed up, and that Gilligan was acting in the public interest to report it. Yet the report cleared the government and castigated the BBC and Gilligan, forcing the resignation of an excellent Director-General and Chairman, contrary to all the evidence. How could this whitewash happen? Hutton claimed that the public would interpret ’sexed up’ as meaning an outright lie rather than exaggeration, and hence what Gilligan reported was ‘untrue’. Talk about splitting hairs for government advantage. No wonder the Independent ran a blank front page headlined ‘Whitewash?’. Why does this matter for the new Iraq inquiry? Well, the author of the Kelly whitewash, Lord Hutton, made his career in Northern Ireland, that province of the UK where the intelligence community, the judiciary, courts without juries, internment without trial, the police, the military, the SAS and dirty tricks and politicians merged into a dirty primordial soup. Lord Hutton was made lawyer for the Northern Ireland Attorney General in 1969. Hutton defended Britain in the European Court of Human Rights when it was found guilty of torturing internees without trial in 1978. Lord Hutton represented the Ministry of Defence during the Bloody Sunday inquiry. Can any of you spot a pattern? The Guardian summarised Hutton’s past best when it quoted the republican Danny Murphy on the Hutton whitewash:
So, where does this lead us? What relevance does this have to the new inquiry into Iraq? Question: Who is the chairman of the new Iraq inquiry? Answer: Sir John Chilcot Question: Past form regarding Iraq? Answer: He was a member of the Butler Review, boycotted by the Conservatives and the Liberal Democrats, into the handling of the intelligence used to justify the war. The Evening Standard called it Whitewash (Part Two). Question: How did Chilcot make his name? Answer: As Permanent Under-Secretary of State at the Northern Ireland Office, in the primordial soup referred to above. Question: Any other interesting things about Chilcot? Answer: Chairman of the Police Federation, Staff Counsellor to the National Criminal Intelligence Service, Staff Counsellor for the Security and Intelligence Agencies. Conducted reviews of Royal and VIP security (1999) and the Castlereagh Special Branch break-in (2002-3). Question: Where is Castlereagh? Answer: No surprise,it is in Northern Ireland. So, let’s just wait for Whitewash (Part Three). It looks inevitable. An extremely well-informed source within a leading NHS trust has spilt the beans to cantankerous on how NHS trusts, and the NHS in general, have managed to hide the fact that the number of managers in the NHS has been growing out of control. Here is how the statistics are manipulated: when compiling the number of administrators and managers within the NHS, it is considered routine to exclude personnel who come into any clinical contact with patients. However, many of managers in the NHS have transfered into management from nursing and often wish to maintain their professional registrations, as a personal safety measure should the wheels fall off the NHS gravy train. So, they see patients for perhaps a few hours per week. Yet many NHS Trusts are counting them as 100% clinical staff. Why does this matter? Well, because the Department of Health sets targets for manager:clinician ratios. Claiming that managers are actually clinicians increases the number of 100% non-jobs that can be created. Does this make a difference in practice? Cantankerous can provide an example which shows how it does. A ‘top-performing’ NHS Trust recently asked managers to cut costs. An admirable manager went back to the Trust executives with a plan to cut unnecessary managers. However, she was told that the Trust was ‘undermanaged’ and that it needed more managers to achieve Foundation status; whilst she might have been expected to be congratulated on her efforts, she was in fact berated. Quite disgracefully, as happened at Stafford Hospital, the Trust Board was more interested in achieving Foundation status than maintaining high quality standards: the manager was told to sack nurses instead, irrespective of the impact on patient care. For the Trust Board it is statistics and their status that matters, not patient care. The way that the statistics on management within the NHS are compiled really matters. PS Cantankerous would really like to know what ‘undermanaged’ means. Cobra Beer, owner of the lager brand marketed as ‘less fizzy’ and thus somehow more suitable for curries, went bust at the end of May. As Cobra struggled to survive around 100 staff lost their jobs. Cobra owed unsecured creditors a staggering £75 million. The brewer Wells & Young’s, which manufactured the ‘Indian’ beer not in India but Bedford, was owed many millions of pounds. So, given some expectation of natural justice, we would expect Cobra’s owners and investors to lose control of the business they failed to run properly; the business to be sold to new owners who might have the skills and strategy to make it a success; the trade creditors who made, distributed and promoted the beer to get whatever value remained to recompense them for their work. Life is not that fair, and certainly not in the world of the ‘prepack administration’.  Karan Bilimoria gets his hands on liquid gold Cobra Beer was controlled, until the end of May, by Lord Karan Bilimoria. Bilimoria was nominated for his CBE in the same 2004 Queen’s Birthday Honours List as the infamous Sir Fred Goodwin, who ran Royal Bank of Scotland into the ground. Subsequently upgraded, the now Lord Bilimoria seems as adept as Goodwin at ensuring his own personal enrichment at the expense of his employees and creditors. The phoenix Company that has risen from the ashes of Cobra with indecent haste is 49.9% owned by a certain Karan Bilimoria, with the remainder purchased by Molson Coors. Meanwhile, the people who ran the adverts or bottled the beer are left without payment, as the sacked employees are left without jobs. Lord Karan Bilimoria always seemed to run Cobra Beer as a personal promotional vehicle. Bilimoria appeared to spend more time on speaking engagements than running the business, and the judgement and emotional security of any person willing to become Chancellor of Thames Valley ‘University’ must surely be questionable. When cantankerous examined the Cobra balance sheet, a few years ago now, there wasn’t enough surplus cash to pay a telephone bill. The last, truly last, set of accounts showed that the Company lost a staggering £15.9 million on a turnover of £34.1 million; growth isn’t hard to achieve if products are sold for half the amount that needs to be charged to break even, never mind make a profit. That a company voluntary arrangement (CVA) was vetoed by the credit insurer of Wells & Young’s, which actually did the work of brewing the beer under licence, indicates that legal action may be likely. It is hard, at first glance, to see how Cobra was not trading while insolvent or how its auditors, PWC, managed to repeatedly give it clean bills of health. As an aside, cantankerous could never understand the point of attempting to turn Cobra into a global brand when the US rights were owned by a rival. While the discussion of moral hazard is often restricted to economic principles and banks, and while everything should be done to salvage businesses, what happened with Cobra Beer can’t be right. Yes, trading partners should not have been so foolish as to allow themselves to become so exposed to a company with such woeful financial performance, but when businesses are restructured it cannot be appropriate to reward incompetence at the expense of suppliers and employees. What was Cranfield School of Management thinking when it awarded Bilimoria its 2008 Entrepreneur Alumnus of the Year award? And cantankerous really can’t understand why Molson Coors would want a businessman with the record of Bilimoria to own 49.9%, and be Chairman, of a business in which it has invested £14 million. Lord Karan Bilimoria wins the June 2009 Waster of the Month award for wasting:
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David Kerr, Professor of Cancer Medicine at Oxford, writes a 
Sir Martin Sorrell is Chief Executive of WPP, the largest advertising group in the world. Today, WPP announced profits of £663 million. This morning, Sir Martin Sorell pontificated in an interview on BBC Radio 4’s Today programme. With WPP’s headquarters and main listing in London, you would expect these results to be great news for UK plc. But they are not. Sir Martin Sorrell moved WPP’s domicile to Ireland for tax avoidance purposes in 2008. The move will cost the UK £185 million in 2010 and, most likely, more than £1 billion over the next decade. Of course, Ireland will benefit to the tune of £82 million, but Ireland did not provide Sir Martin Sorrell with his knighthood for ‘commercial services’, his Cambridge education, the professional and financial services infrastructure which allowed him to make his name with Saatchi & Saatchi, or the education, healthcare, transport, legal and social security systems on which his Company and its employees depend.