Dishonesty in making peace

The Treaty of Versailles reneged on the terms of the Armistice. This dishonesty in making peace directly led to the second world war and indirectly to many conflicts following it, with the loss of millions of lives. Dishonesty in making peace is a dangerous precedent. 

No matter how abhorrent the crimes of John Downey and other criminals who were given what appears to be an amnesty (notwithstanding that these agreements may have been made in less than transparent circumstances), to renege on these agreements is treading on very thin ice.

Lean methodologies, KPIs and the NHS: A recipe for trouble?

The concept of lean originated from Toyota and is founded on a model of continuous product and process improvement and the elimination of non-value added activities. The value adding activities are simply only those things the customer is willing to pay for; everything else is waste, and should be eliminated, simplified, reduced, or integrated.

One of the significant aspects of lean is that of key performance indicators (KPI). The KPIs by which a plant/facility or organisation are judged will often be driving behaviour, because the KPIs themselves assume a particular approach to the work being done.

In the NHS, KPIs are used to examine and compare performance across NHS organisations. These indicators focus on areas such as length of stay, costs per episode of patient care and number of staff employed. Many assess efficiency within the service, whilst others examine clinical performance. The intention is to define a service and judge its effectiveness and KPIs also provide benchmarks to implement incentives and sanctions in an effort to improve overall quality. However, there is little or no evidence of what sorts of incentives and sanctions actually work to drive up quality.

For example, a Child and Adolescent Mental Health Service (CAMHS) that has approximately 100 referrals per month, has KPIs that define service levels with regard to how referrals are managed. Urgent cases need to be seen within 24 hours, with a follow up within a week. Another KPI is that young people who require assessment but are not urgent will be seen for a routine assessment within three weeks of the referral being made. There are also limits imposed regarding the number of cases not appropriate for specialised CAMHS who can be signposted to other services, for example local authority family support.

In terms of sanctions, if a young person is not seen within that period, the service will be penalised with a reduction in funding of £30,000. In a team that is already undergoing budget cuts and staff losses, it is hardly surprising that meeting KPIs dominates the management of the team, and leads to an emphasis on getting though as many assessments as possible. The downside of this emphasis is less attention being paid to the actual interventions and therapies provided for young people and their families; caring for desperately troubled young people has become simply a matter of meeting targets.

It is important to recognise that these KPIs were established by the commissioners of the service, and agreed by the senior managers of the service, none of whom have any clinical experience of working within CAMHS. This process also provides an insight into a significant flaw in the artificial ‘internal market’ of the NHS; those specifying and agreeing services may have little knowledge of the service and often do not consult with the practitioners.  

Another KPI specifies a DNA (did not attend for appointment) rate of 10%, so not only is the practitioner's time wasted at a cost to the service, but the service is punished by financial sanctions if the DNA rate goes over 10%.

One of my concerns with the lean culture is that it pays little attention to the wider impacts an organisation can have on the context in which it operates. For example, by ordering parts’ just in time’ from external suppliers, the external suppliers are bearing the costs of uncertain revenue streams and fluctuating demands, which may tempt them to cut costs in other ways; perhaps by employing staff on fixed term or temporary contracts – thus shifting uncertainty down to the workers themselves.

Other criticisms of lean are that lean practitioners may easily focus too much on the tools and methodologies, and fail to focus on the philosophy and culture of lean, or that management decides what solution to use without understanding the true problem and without consulting shop floor personnel. As a result lean implementations often look good to the manager but fail to improve the situation.

Whilst many hold up Toyota as an exemplar for lean working, it might be borne in mind that earlier in February, Toyota announced it is recalling 1.9 million of its Prius hybrids, 30,790 of which are UK-registered, because of a computer problem that could cause the vehicle to stop. This follows a series of recalls over many years as listed below:

Sep 26, 2007 – US: 55,000 Camry and ES 350 cars in "all-weather" floor mat recall

Nov 02, 2009 – US: 3.8 million Toyota and Lexus vehicles again recalled due to floor mat problem, this time for all driver's side mats.

Nov 26, 2009 – US: floor mat recall amended to include brake override and increased to 4.2 million vehicles.

Jan 21, 2010 – US: 2.3 million Toyota vehicles recalled due to faulty accelerator pedals[ (of those, 2.1 million already involved in floor mat recall).

Jan 27, 2010 – US: 1.1 million Toyotas added to amended floor mat recall.

Jan 29, 2010 – Europe, China: 1.8 million Toyotas added to faulty accelerator pedal recall.

Feb 08, 2010 – Worldwide: 436,000 hybrid vehicles in brake recall following 200 reports of Prius brake glitches.

Feb 08, 2010 – US: 7,300 MY 2010 Camry vehicles recalled over potential brake tube problems.

Feb 12, 2010 – US: 8,000 MY 2010 4WD Tacoma pick-up trucks recalled over concerns about possible defective front drive shafts.

Apr 16, 2010 – US: 600,000 MY 1998–2010 Sienna minivans for possible corrosion of spare tire carrier cable.

Apr 19, 2010 – World: 21,000 MY 2010 Toyota Land Cruiser Prado and 13,000 Lexus GX 460 SUV's recalled to reprogram the stability control system.

Apr 28, 2010 – US: 50,000 MY 2003 Toyota Sequoia recalled to reprogram the stability control system.

May 21, 2010 – Japan: 4,509, US: 7,000 MY 2010 LS for steering system software update.

July 5, 2010 – World: 270,000 Crown and Lexus models for valve springs with potential production issue.

July 29, 2010 – US: 412,000 Avalons and LX 470s for replacement of steering column components.

August 28, 2010 – US & Canada: approximately 1.13 million Corolla and Corolla Matrix vehicles produced between 2005 and 2008 for Engine Control Modules (ECM) that may have been improperly manufactured.

February 22, 2011 – US: Toyota recalls an additional 2.17 million vehicles for gas pedals that become trapped on floor hardware.

Russell Brand’s Revolution: A call for systemic thinking?

Russell Brand’s idiosyncratic but perceptive call for revolution is welcome.  I welcome it because it is one of the most public articulations of the need for us to think differently about our relationships to each other and with the planet.

Brand was invited to edit an issue of the New Statesman  and he outlined some of his ideas in a recent interview with Jeremy Paxman:

  
Not voting, from Brand’s perspective makes sense; voting to change the system maintains the system.  However, Brand’s revolution is not one of apathy, nor is it a revolution of bloodshed and uprising. It is a revolution in how we think.

This revolution has been slowly gaining momentum since Gregory Bateson outlined what he called a ‘cybernetic epistemology’; a way of thinking in terms of relationship, of recognising patterns, a way of thinking that also requires humility and an appreciation of the sacred.

 “What pattern connects the crab to the lobster and the orchid to the primrose and all four of them to me? And me to you?” he asks us to consider at the outset in Mind and Nature (p. 8).

This focus on both the content and relationship aspects of all messages invites us to think about pattern also in human relationships and how we create patterns that we live and that define us. And it is becoming vital that we heed and respond to this need.

Bateson warned us in his essay Form, Substance and Difference (in Steps to an Ecology of Mind, 1972):

“If you put God outside and set him vis-a-vis his creation and if you have the idea that you are created in his image, you will logically and naturally see yourself as outside and against the things around you. And as you arrogate all mind to yourself, you will see the world around you as mindless and therefore not entitled to moral or ethical consideration. The environment will seem to be yours to exploit. Your survival unit will be you and your folks or co-specifics against the environment of other social units, other races and the brutes and vegetables.

If this is your estimate of your relation to nature and you have an advanced technology, your likelihood of survival will be that of a snowball in hell. You will die either of the toxic by-products of your own hate, or, simply, of over-population and overgrazing. The raw materials of the world are finite.

If I am right, the whole of our thinking about what we are and what other people are has got to be restructured. This is not funny, and I do not know how long we have to do it in. If we continue to operate on the premises that were fashionable in the pre-cybernetic era, and which were especially underlined and strengthened during the Industrial Revolution, which seemed to validate the Darwinian unit of survival, we may have twenty or thirty years before the logical reductio ad absurdum of our old positions destroy us.


Nobody knows how long we have, under the present system, before some disaster strikes us, more serious than the destruction of any group of nations. The most important task today is, perhaps,  to learn to think in the new way”.

Unfortunately, there are the few who will not want to hear Bateson’s warning and challenge, for they have a vested interest in this status quo that in reality is a slow decline into more inequality and destruction.

Brand’s revolution is to reject this status quo in which the very few profit, and the price for this profit is paid by people who are starving, killed in conflict and sick.

Yes, we can reject this system by not voting. We can reject it by becoming critically aware of the propaganda spewed out of the mainstream media that services the needs of the few.

But this revolution is not just about rejection of an old, unfair and destructive system. It is about accepting others, about sharing ideas, engaging in dialogue, and re-evaluating our relationships.

Blaming the vulnerable

A 'terrorist' with Asperger’s, an abused mother with alcoholism who kept the corpse of her child that died of starvation for 2 years in a squalid home, a murderer who was not being treated for his mental illness....all symptoms of a 'broken society'; a society broken by a lack of resources for mental health and social care, a society where the vulnerable are castigated and the people who work at the front end are blamed for what are systemic failures. The Conservative conference tagline ‘for hardworking people’ and Cameron’s closing remark "Together we'll build a land of opportunity for all” are just empty sound-bites to keep the faithful happy while all the while, the rich carry on getting richer and richer. I am beginning to despair. How many people are suffering right now? How more people and children have to die before we see some real change?

Addiction to power

When only the 1% are left, there will be no more profit. They will own a barren world created by their addiction to power.

Inequality

In the UK, the public sector is continually being squeezed with demands to improve performance.

Performance is measured by achievement of targets. A focus on ticking boxes rather than thinking about patient's needs led to the appalling Mid Staffs situation.

Why did this happen?  Because ticking boxes keeps the commissioners of services happy.

Who are these commissioners? Believe it or not they are also NHS employees, but they are the purchasers in the ludicrous ‘internal market’ that is the ‘modern, efficient’ NHS.

Why an internal market? Because politicians and ideologues did not like doctors deciding what was best for their patients.

Recent evidence published in the Lancet indicates that health in the UK is lagging behind other countries. The response from Jeremy Hunt (the UK Minister for Health) is "For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking underperformance around."

Translated: ‘We need more boxes to tick’

He wants more people to go for regular health checks to spot diseases earlier and he is calling better joining up of NHS services so that patients don't get lost in the system.

Well, no shit, Sherlock.

He also says that many deaths happen because the NHS is not good enough at preventing people getting sick or because treatment does not rival that seen elsewhere in Europe.

So let’s blame the NHS, shall we, Jeremy? It makes a change from blaming the population, I guess.

Here is something to think about.

The health of the population in the UK is contextual.

People eat crap food full of corn fructose, starch and horse meat because food producers manufacture cheap, crap food to keep the prices down.

Lots of people in the UK are poor and have little choice but to buy cheap food sourced by supermarkets (who incidentally screw producers to keep costs down – after all, supermarkets are ultimately about profits and dividends)

People drink and smoke too much too. That could be because lots of people in the UK are unhappy.

The context of health (and other issues like crime and education) in this country is that, like in the US, around 40% of the wealth is owned by less than 1% of the population.

We all know politicians lie or are ‘economical with the truth’ and that many politicians represent the interests of the elite.

But the even bigger lie is that politics makes any difference. Even having the vote makes little difference as far as the gap between rich and poor is concerned; nothing has changed in hundreds of years.

Mainstream politics is a sideshow, a diversion from the reality of inequality in our society, and it is this inequality that needs to be addressed.

Anything else is just a distraction, like taking an aspirin to treat a cancer.

Porn: The banality of evil in the 21st century.

Nine men have been jailed in Rochdale for their part in the grooming and sexual exploitation of five females aged between 13 and 15. One of these young women was forced to have sex with twenty men in one night.

I suspect that if these young women had been aged 18 to 20, the story would not have made headlines.

Hannah Arendt wrote about the banality of evil; how ordinary people could be involved in committing atrocities because they accepted the premises of the state, and assumed that their actions were, therefore, normal.  There seems to be a greater likelihood that acts that could be considered evil are more likely to be committed when a group is involved, as in Rochdale or in Abu Ghraib. Perhaps peers encourage each other, and people who ordinarily would not commit evil feel able to, or pressured to do so. The peer group normalises such behaviour.

Pierre Bourdieu wrote about the learned, fundamental, deep-founded, unconscious beliefs, and values, taken as self-evident universals, that inform our behaviour which he describes as 'Doxa', and suggests that this knowledge emerges from and reinforces another concept, the 'Habitus'. Habitus could broadly be taken to mean the internalised assumptions that arise from living in a particular culture.

I remember seeing Passolini’s film ‘Salò’ and being horrified by the increasing degradation and torture that was perpetrated on the victims of the men of power.

The film ended with two young soldiers, both of whom had collaborated in all of the prior atrocities, dancing a waltz together. The banality of evil captured.

Now this film is pretty much freely available for anyone to see; yet when I saw Salò in the late 1970’s it could only be shown with a Home Office licence. And this leads to a wider point.  The current ease of access to a film like Salò is hardly surprising in the context of the massive amount of pornography that is freely available.

Pornography represents another dimension of the banality of evil. Much pornography involves the degradation of women, be it anal penetration, double penetration, ‘air-tighting’ (where mouth, vagina and anus are simultaneously penetrated) or the insertion of objects that painfully stretch the vagina or anus. Oral sex typically involves deep, painful penetration, and the male usually ejaculates over the woman’s face. Some porn (bukkake) involves multiple men ejaculating over a woman’s face, another type of humiliation.

Imagery of this type is creating a habitus not only for those who access it, but for the partners of those who access it. Assumptions that this type of degradation and violence is normal lead to men expecting that sex will be like this and women internalising negative views of themselves as sexual objects. All the while, billions of dollars are made (typically by men) who profit from the sex industry.

We need to change the way we think ; the way we think about relationships and gender, and challenge this habitus that reinforces stereotypes and limits the possibilities for intimacy.

References

Arendt, H. (1963). Eichmann in Jerusalem: A report on the banality of evil. New York: Penguin

Bourdieu, P. (1990). The logic of practice. Stanford, CA: Stanford University Press. 

Further information:


www.antipornography.org/

http://www.object.org.uk/