Thoughts on Spending 31 Hours in a NHS A&E with a 87 year old

What, I wonder, would the various denizens of the blogosphere have been saying if they were sitting there with me and my ailing Mum?

The rabid right-wingers would have blamed the incentive-free state bureaucracy I suppose. But they would be wrong there; I really don’t think it had anything to do with the governance arrangements or lack of a direct profit motive. The people, from the consultants down to the porters and cleaners , did seem genuinely open, friendly and willing to help.

Most of my comrades on the left might have muttered about still catching up with years of underfunding, and there were certainly evident staff shortages , though mainly, as far as I could see, unpredictable ones as at least two nurses went off sick in that 31 hours. It’s hard for any organisation to deal with that.

My blogroll’s resident HR expert might have had something to say about the composition of the staff team though; to be frank I thought there were too many doctors and not enough nurses. This may seem an unusual complaint. It only makes sense when one realises that the doctors appear to operate in separate little kingdoms of medical specialism. About a third of our wait was simply down to the A&E team referring some x-rays to the orthopaedic surgeons for a second opinion on whether there had been a fracture. And whilst we waited for that second opinion nothing else happened, no temporary admission could be made because the separate specialist kingdoms hadn’t decided whose kingdom (i.e. what kind of ward) Mum was going to be admitted into. I believe this is called silo working in management speak. Meanwhile the nurses on A&E were doing their A&E thing which, when it comes down to it, is basically triage. So if someone is marked as awaiting a second opinion they just move onto the next case unless there is some urgent call from the bed which has been parked in this triage operation. No thought beyond basic feeding and toileting is given to the cases not identified as urgent. If there had been more nurses the various doctors’ instructions might have taken effect rather quicker – and more holistic care might have actually been provided. Also, I’m not certain why it would have been such a great disaster to get Mum somewhere comfortable, even if it did prove to be the wrong ward and meant her having to be moved the next day.

My blogroll’s representative Spiked-influenced commentator and general enemy of the risk adverse culture would also have passed a few harrumphs about the reason for the final section of our wait – the seeming impossibility of assembling two spare members of staff to push the bloody bed containing my Mum to the ward. First we got a single porter; then we got a cleaner but no porter, and finally, 4 hours after the consultant had instructed an early transfer to a ward, we got both. Of course I pleaded and pleaded to be allowed to help to push the bed myself – but, no it was ‘against the rules’, 'not procedure' there were Health and Safety concerns and so on. So Mum sat waiting, immobile and in semi-public view, in A&E till two people could be assembled, one to push the bed and one to simply open the doors and push the lift button.

But most of all I reckon Boffy will be slowly and sympathetically nodding his head and biting back the urge to say, "I told you so - the left has got to be about more than just knee jerk defence of the NHS" . & so he did. Several times.

The Challenge of Avoiding Junk Food

Don't like McDonalds? But they're hard to avoid- each dot of light on that map above represents a branch. The answer says Weather Sealed is to move to South Dakota:

.... McDonald’s cluster at the population centers and hug the highway grid. East of the Mississippi, there’s wall-to-wall coverage, except for a handful of meager gaps centered on the Adirondacks, inland Maine, the Everglades, and outlying West Virginia.

For maximum McSparseness, we look westward, towards the deepest, darkest holes in our map: the barren deserts of central Nevada, the arid hills of southeastern Oregon, the rugged wilderness of Idaho’s Salmon River Mountains, and the conspicuous well of blackness on the high plains of northwestern South Dakota. There, in a patch of rolling grassland, loosely hemmed in by Bismarck, Dickinson, Pierre, and the greater Rapid City-Spearfish-Sturgis metropolitan area, we find our answer.

Between the tiny Dakotan hamlets of Meadow and Glad Valley lies the McFarthest Spot: 107 miles distant from the nearest McDonald’s, as the crow flies, and 145 miles by car!

Say what you will, Anglo American capitalism has always been great at providing choice, I'm sure you'll agree...

Via

Seven Deadly Sins: Their Distribution in the US

Yes, I've got John B's range of problems plus a few more, but once my family sorts itself out I'll start blogging properly again. Meanwhile check out Angie Androit on Sociological Images:

Some geographers at Kansas State University recently did an analysis of the spacial distribution of EVIL in the United States. Which part of the country is most afflicted by sloth? Lust? Greed? Envy? Wrath? Gluttony? Pride?

That’s right, folks – these geographers have operationalized sin, quantified it, then measured and mapped it. Pride is the aggregate distribution of all other sins, since it is supposedly the root of all evil (though one could also make a good case for apathy). Here’s how the sins are measured (and here’s a good view of the maps):

• Greed: Average incomes versus total inhabitants below the poverty line
• Envy: Total number of thefts (robbery, burglary, larceny, and stolen cars)
• Wrath: Total number of violent crimes (murder, assault and rape) per capita
• Lust: Sexually transmitted diseases per capita
• Gluttony: Number of fast-foot restaurants per capita
• Sloth: Expenditures on arts, entertainment and recreation versus rate of employment
• Pride: An aggregate of the six other sins

There are clearer maps over at Flowing Data.

Best Pitch Invasion Ever

A Question

The Problem

My mother is very old and very frail. She has various chronic medical problems which mean that she has severely restricted mobility and stability, so there have been a number of recent falls. She has lost the effective use of her right hand which means that she can’t cook or even cut her own food up. I call these problems ‘medical’ in the sense they each have at least one medical name – but, truth be told, I don’t really see them as separate ‘medical’ problems. Mum is just old. & she lives alone. She's also poor: she lives in a ground floor privately rented flat and gets full Housing Benefit.

She is now in a care home for a spot of respite care after her most recent fall, and I'm trying to sort out the necessary services to allow her to return to her flat - aids, adaptations, meals on wheels and so on. As a woman who was 8 on the formal abolition of the workhouse - and only 26 when they really ended - she views residence in any kind of institutional 'care', from hospitals down, as a sort of shaming personal disgrace. And I live two hours drive away in a house with no downstairs bathroom or spare bedroom. My only sibling lives abroad and Dad is dead.

The Question

Mum is going to die at some point in the probably not-too-distance future I know. But it is her chassis and wheels that are failing, not the basic engine - her heart and lungs - so this might take a number of years. I want her to have a good ending.

I invite all all you lefty - or even perhaps not so lefty - bloggers to explain how your particular take on politics and the world might help achieve this. Or are there things about the nature of welfare and old age which are just beyond politics as we currently understand it?

& it's OK, I'm not asking you to solve my problem let alone my Mum's. It's not that personal. I just want to see how the left can attempt to connect its formal politics to lived experience. I don't want to 'tag' anyone formally, but I'd be interested in responses from anyone, especially anyone on my blogroll.

On Anniversaries

The last fortnight or so has been a time of anniversaries: the outbreak of WW2, 9/11, the collapse of Lehman Brothers. All of them lovingly covered in depth in the Press and on TV. After all, it's easy copy. You don't have to do the spadework of a real news story, just gently remind everyone of what happened in Event X, list the plans to commemorate it and get a few talking heads to intone on Event X's significance. Happily for our media friends you can usually rely on a new someone or other each year to come forward with a different perspective. So this year we've had 'WW2 -The Polish Version' in the mainstream media. (I'm as one with B& T on that one by the way).

Except the Credit Crunch/Financial Crash of course. We haven't even agreed what to call that, much less decided what it means. Peter Clarke expands on this point in the Guardian today with the help of a variety of the allegedly Great and Good: Skidelsky, Keynes biographer, says Keynes is back; Peston admits he thought things would change faster; David Hare wants to know why no politician has thought all this through as yet; Fay Weldon gives us a plug for her new book. And so on. Meanwhile Wiliem Buiter in the FT says, almost in the style of Manuel from Fawlty Towers, that he knows noooothing, albeit in a very erudite way. Krugman in the NYT says the whole economics profession got blindsided - but other economists seem to believe that their profession didn't pay enough attention to their own nostrums. The Crash is certainly a Great Event, worthy of an anniversary - but no one has a convinicing narrative, there is not yet an established Myth to reinforce or to attempt to knock down.

It is, in short, as yet a Phoney War that no one quite knows how to characterise at the moment - because it isn't finished and may yet have barely begun. Who knows if we're about to bounce, 'V' style, into a sunny upland future of a new Long Wave upswing or be seduced by a false dawn ? What will come to be seen as the defining moments of the financial crisis have yet to occur. Sure, unemployment has risen. Sure, some familiar firms have got belly up. Nonetheless, we're told that on all sides that the formal conditions that indicate a technical end to Depression are looming on the horizon. Perhaps. The real story - the anniversary signifier, the thing our children will remember it for, the Dunkirk, Barbarossa, Kursk and D-Day of this economic crisis as it were - lies ahead.

I can't help but believe that this story, when it emerges, will focus on the three re-negotiations of power:

• The inevitable one that will occur in my lifetime between the 'West' as we have traditionally understood it and the BRIC countries, especially China. People who make things aren't going to put up with not getting anything but a fraction of the fruits of their labour for ever and a day;
• The renegotiation of power we need and which I hope for, but which may never materialise - the one between the merchants of relentless growth, and the planet. This can only be done through re-distribution - because, as Chris points out, just stopping economic development per se kills babies. But more babies - and toddlers, and other children, and adults - will die unless we act to stop the potential for runaway climate change. So redistribution is key;
• The renegotiation between state and civil society and the organised power of Capital. This is the most complex of all in some ways - and perhaps even less likely to happen than a coherent response to climate change. But we need such a renegotiation if all this is not to happen again.

Happy anniversary.

That Wire Analogy (Yet Again)

So I get back from whatever it is I've been doing to find the long shadow of my favourite TV show still bugging the blogosphere - and indeed mainstream journalism. Chris Grayling's comparison of inner city Britain to the version of Baltimore peddled in the Wire is the gift which just keeps on giving.

He's been given such a hell of a kicking on all this that I thought it might be fun to try to sketch out some ways he might, inadvertently, have stumbled on something. Not, obviously, in terms of crime. The local Manc paper dealt with that :

"[Baltimore], home to about 600,000, was blighted by 234 murders last year. That compares to 35 in Greater Manchester, which has a population of around 2.5m."

No, the real comparison is about how our lives - like the lives of The Wire's drug dealers, police, dockers, politicians, schoolkids and journos - are haunted by an imbalance between agency and structure. Or just by structure, actually.

The whole series could have been written by Talcott Parsons or Louis Althusser: no one, or almost no one, escapes their circumstances for any length of time. Structures call forth successions of individuals - Avon, Stringer, Marlo - to fulfill essentially the same roles. People change in all-to-predictable ways: just as Daniels, who makes Commissioner, has a guilty secret from his time on Narcotics, so Carver, originally a kind of joke, puts his days of petty corruption behind him and rises up the ranks as a reliable officer. But you just know he won't leave his past behind, any more than Daniels manages too. Individual initiative is, ultimately, crushed, be it Bunny's Hamsterdam or Carcetti's new broom in City Hall. Even the great symbol of individualism - Omar - loses, and I reckon we see in Michael's trajectory a proto Omar in the making, so even the individualism at the heart of the American Dream is structurally produced.

Yeah, that strikes me as being quite like Britain today - even before one gets into in business of 'public service reform', performance targets and the near universal 'gaming' of these things. There is no real social mobility, no real opportunity for individualism. Chris Grayling is right, inadvertently.