Sometimes I look at an article and am surprised by the  amount of outrage and personalised vilification that hits the reader. Usually, with this amount of vehemence,  there is a barely concealed sub text aimed at another subject. The language used is an obvious indication and I will give you a small selection of words and phrases used in an Opinion Piece that recently appeared in the Irish Times. Let’s give you a quick sample: rats in a sack, rabid English, buffoonish mindgames, ‘secretive, toxic, nationalistic protectionism’ and sh*ts. You and I have seen worse but it does warn you that perhaps this piece is written by someone venting their spleen rather than writing from their head and heart. I am referring to an article written by Kathy Sheridan, entitled ‘UK vaccine rollout success facilitated by EU’. It is a commentary on the ongoing issue of the supply of the Oxford Astra Zeneca vaccine. If you took out all the invective and extraneous material you are left with the EU narrative that the UK is being unfair in the distribution of the vaccine. By the way, I must give a joined up example of the sort of invective that threads its way through her argument. When criticising Britain for not solving EU problems, her analysis is as follows, “First dibs to the British prime minister who let the virus rip, presided over a new British variant, ate all the vaccines and now piously frets that Europe’s third wave “will wash up on our shores as well” because – wait for it – “we’re all facing the same pandemic, we all have the same problems”. But . . . but the third wave IS the Britain strain”. By her logic do we train our sights on the Italian’s and blame them for the first wave? Is she really saying that Boris has some hidden Wuhan  type laboratory or bat caves, whichever theory you favour and has deliberately unleashed a new variant on the EU? Has Boris ‘eaten’ all the vaccines? Pfizer, Moderna, J&J, even the Sputnik jab? I would also take issue with some of the other comments in that paragraph but you can see how the whole piece is argued.

Let us try to strip out the salient points and see if there is any merit in them. We can first look to the development and contracting arrangements  for the Oxford Astra Veneca vaccine. I use the full title to acknowledge the fact that this  drug was developed outside the EU and only one of four production units resides within the EU. As reported by the Express, Matt Hancock acknowledged this in his address to the House.

He said he was “proud” AstraZeneca had agreed to produce the jab at cost price in order to ensure it was affordable around the world. The Oxford AstraZeneca vaccine was developed because of UK taxpayers putting the funding into the science, to the development, to the clinical trials,” he said in the Commons this afternoon. Matt Hancock addressing the House of Commons

The second point to note is that the research and development was not funded by the EU but the US and UK tax payer and this may have been reflected in the British contract with the British/Swedish company. Sheridan has a conflicting view on the rule of law and thinks that a contract is only valid if it satisfies her view. As she says, “Principle matters, and the rule of law. If decency and reciprocity are seized on as EU weaknesses and used to harm its people, should the gun be fired to prove strength? ”  Her ‘Principle’ in this case, seems to be that because the EU ‘dropped the ball’ with the negotiations that the rule of law can be overturned by brute force. Neither side have revealed the terms of the contract but according to a BBC report, quoting from the Politico website, the UK had negotiated,” … a clause in the UK’s contract which says the government “may terminate the deal and invoke what appear to be punishment clauses” if there is a delay in supply. According to Politico, the EU waived its right to sue the company in the event of delivery delays. The European Commission says it is now involved in a “dispute mechanism” with the company.” 

The one thing that Sheridan believes in is interdependence and reciprocity, as she says, “The interconnectedness of the world, always a subject of derision to Brexiters, was never more exposed. Arguing against the EU’s proposed export ban, Taoiseach Micheál Martin pointed out that 280 materials go into making up the Pfizer vaccine, involving 86 suppliers and 19 countries.” I think that she misread Micheál Martins point. He was warning against arbitrary non legal action by the EU by highlighting the fact that so many countries are involved in the production of any vaccine. He may have been thinking of the essential ingredient in the Pfizer vaccine, produced by Croda International in the UK.

Pfizer has warned the EU to back down from its threat to block vaccines to the UK because the firm needs crucial ingredients shipped from Yorkshire

The Telegraph reports, “Pfizer has warned the EU to back down from its threat to block vaccines to the UK because the firm needs crucial ingredients shipped from Yorkshire.”  Or perhaps it was in relation to the production of Novavax which is thought to be very effective against the South African variant and will also be produced in the UK. I think the subtext to Micheáls comment that should be understood by Sheridan is that if the EU “pulls the trigger” people on both sides will be hurt, not just those of her enemies.

I am really not sure how Sheridan’s claim that the EU ‘export’ of 41million doses of the Pfizer drug supports her argument. I will take it on trust that 10 million doses were sent to the UK but I don’t see how the EU was demonstrating any good will with this transaction. In the absence of any other information in the article, I would assume that this was a normal supply of a drug from a US Pharmaceutical company, shipped from it’s EU plant. Have the EU demanded the return of the other 31 million doses from the other Pfizer customers? Perhaps there was some other noble part to this export. Was the EU sending the doses to some less fortunate country at cost, as is the case with the Oxford Astra Zeneca vaccine? If not, it just seems like any other transaction, apart from Brussels attempts at strong arming the UK.

The real problem is there for everyone to see and is  shown in the following graph. The one on the left shows the number of vaccinations administered per 100 for Israel, the US, the UK and the EU . Israel leads the group with the US and UK following at a much lower rate  with the EU trailing far behind. There  were many problems for the EU in trying to co ordinate an effective vaccination program with 27 countries. These include, inter alia, a slow bureaucracy, national antipathy, lack of confidence in vaccines, lack of confidence in the Commission and energy expended  refighting the last war. If we take one element, that of the time taken to approve the Oxford Astra Zeneca vaccine we can see delay after delay whilst the UK fast tracked the process. At the same time the vaccine was being tested, a huge campaign was launched by the NHS to ensure the public had confidence in the product. Oddly enough, you could take the words from a critic of Astra Zeneca and apply it to the EU roll out. Just imagine ‘EU’ in place of ‘Astra Zeneca’ as the subject in the following extract from a BBC interview with Mr Lamberts MEP, in which he states “They commit, they de-commit, they de-commit on new commitments without any warning.” Of course he was talking about the rollout issues and Astra Veneca’s difficulty in resolving them but the quote sums up the companies problems dealing with the EU. In short, the European Medicines Agency (EMA) approved the Oxford Astra Zeneca vaccine, after some delay, in January. Some EU countries were not happy with the statistics for the older age groups and restricted it’s use for the over 65’s. By March, France and Germany approved it for the 65 -74 age group but delayed again over fear of people developing blood clots post vaccination. EMA reassured them that there was no evidence to support these fears and distribution restarted with France restricting use to the over 55’s. Now, Germany has again stopped vaccination despite assurances from the EMA and the Commission. The absence of trust in the EU institutions and seemingly non scientific bias locally has created mistrust in the vaccine as seen in the graph from the Economist, below.

This rather hesitant approach by the EU nations seems not  to chime with Sheridan’s apocalyptic  picture of the  experienced on the continent, ” This is not about frozen sausage meat. People are dying, battling long Covid and mental illness in the embers of crushed economies.”  Perhaps, Sheridan could persuade the EU to use up the vaccine held in storage, presumable as a result of nations stop start approach to roll out. On this subject we should return to the BBC interview with Mr Lamberts, “Mr Webb interjected: “All of that would sound more cogent coming from the European side if it was not the case that there are literally millions of AstraZeneca doses that are available in Europe but are not being used and just stored.” The Belgian MEP replied: “There you have a point, I will make no dispute about that.”

“All of that would sound more cogent coming from the European side if it was not the case that there are literally millions of AstraZeneca doses that are available in Europe but are not being used and just stored.” The Belgian MEP replied: “There you have a point, I will make no dispute about that.” BBC interview with Mr Lamberts MEP

To summarise, if our “hovering Martian” that opened up Sheridan’s article, could see the full picture, what would they conclude? Simply put, they would see one vaccine produced by a combination of a UK University and Pharmaceutical company, financed by the UK’s taxpayer. They would also note that most of the orders placed for the UK are produced by the UK factories at Oxford and Keele  They would see that the UK rapidly changed the approval system and with “roaring success”  (Sheridan’s words) became the lead European country to vaccinate it’s population. In contrast, what do we see from the EU? We see an extended and bureaucratic approach to the contract with Astra Zeneca. UK took the risk of underwriting any liability and the EU demurred, at the expense  of it’s citizens and their economy as described by Sheridan. Then the EMA delayed approving the vaccine and struggled to gain the trust of national governments to accept it’s leadership, as discussed above (an example of nationalistic protectionism?).

We have seen that the Commission, under Ursula von der Leyen has come under fire for it’s lacklustre performance. To some degree, the targeting of the UK is an attempt to divert attention from  it’s inability to lead and adjust to emergencies. For once, Sheridan is justified in the use of her unflattering descriptions in describing the EU Commission as, “a bunch of flapping mackerel right now.” However, she is wrong in somehow attributing their response to Brexit. If that was the case the logic of her argument should be that the EU, having been liberated from those awful Brits, should have outperformed them. We seem to have reached the sub text of her article. All those references to ‘toxic nationalism’ and ‘rabid English’ and so on reveal the fire that drives her disordered diatribe. The key sentence in all her writings is, “Johnson’s programme is in jeopardy because he failed to co-ordinate and co-operate with Europe.”

“Johnson’s programme is in jeopardy because he failed to co-ordinate and co-operate with Europe.” Sheridan, Irish Times

If only those Brits hadn’t left the EU then they would have looked as incompetent as the rest of the Union.  That Boris and those football hooligans, that drove all those nice Oxbridge people out of the Union,  shouldn’t be able to tie their own shoe laces let alone organise a ‘roaring’ successful vaccination program. There may be plenty of opportunities in the future for Sheridan to register  her glee at Britain’s problems but not this time. Britain has left the EU and is not responsible for resolving the EU’s problems. Perhaps, Sheridan should retrain her sights on to the real problem, that of the EU itself and leave Britain to make it’s own mistakes.

Sources

Irish Times, 24/03/21, Kathy Sheridan, UK vaccine rollout success facilitated by EU

UK vaccine: ‘AZ offered to world at COST price’ Hancock erupts at EU games on jab | Politics | News | Express.co.uk

Where is the Oxford-AstraZeneca vaccine made? – BBC News

Exclusive: Pfizer warns EU to back down on Covid vaccine threat to UK (telegraph.co.uk)

EU news: Philippe Lamberts dismantled as ‘MILLIONS’ of AstraZeneca doses wasted by bloc | Politics | News | Express.co.uk

Covid: What’s the problem with the EU vaccine rollout? – BBC News

It is with some reluctance that I approach my latest essay, not with my usual heightening blood pressure or, a sense of righteous indignation but with a sense of sadness and despondency. I am writing about their Royal Highness’s the Duke and Duchess of Sussex. I hardly know where to start but I suppose the event that forced them to my attention was the Oprah interview. For a couple that wanted to step away from all the media attention and make their own way in the world, they seemed to have taken a wrong turn in appearing on prime time television. It is quite obvious that a quiet retirement was never an option and I am pretty sure that we will find it difficult to avoid them as they tell their ‘lived experience’ of Royal oppression to a gullible Oprah audience. I had formed my opinion of the Sussex’s character some time ago and felt that with the move to Canada the divorce between them and the Monarchy suited both parties and the country.

However, I knew that given their lack of character  that it wouldn’t stop there. I think that there is more than a casual similarity with the Edward and Mrs. Simpson story especially with the personalities of the people involved. I think that Harry is like Edward in that he is fragile, lazy, wants to be the centre of attention but doesn’t want to do the work. He is attracted to a dominant figure that promises to release him from the boredom and suffocation of his duties. Meghan is a ‘B’ list actress who wants to be a media ‘A’ list star and made the same mistake as Wallace-Simpson by thinking that being a Royal will give her that exposure. A bit harsh do you think? You only have to look at the carefully choreographed interview, with the Diana look and the focus on the victimhood of  The Little Mermaid.  The Little Mermaid! 

There were so many questions that Oprah didn’t ask, that to an unbiased observer, the whole story crumbled for lack of any context or, substantiation. The claim that Meghan did no research into the Royals is beyond belief. But once they had connected, did Harry not bring her up to speed? Did he not brief her on his own misgivings about the job  or the supposed Royal racism? Did he not discuss his version of his mothers story? Where was he when his wife was feeling suicidal? Who was it who made that comment about Archie? This predictable playing of the ‘race card’ was typical of the whole miasma of tales that only served to support the fantasy of the poor American innocent who was ruined by those evil Royals. By the way, it is interesting to note that Harry, having witnessed  the production of the race card, then refuses to support it “That conversation I am never going to share,” Really, …. watch this space. Where there were facts they were either wrong or conflated in support of the narrative. For example, the implication that Archie was barred from being a Prince because he was non white. This was intended for an American audience who wouldn’t know that the issue of granting this title was decided by George V in 1917.  Again, this story was delivered by a couple who wanted to step back from the ‘Firm’ but wanted to keep all the advantages, including financial support from Charles.

There is a fundamental misunderstanding about the role of the Monarchy in the British Constitution. As a result of the interview I heard a lot of commentary on both sides of the Atlantic  about how the Royals have no power, how they exist only to  shake hands and open factories but that is to miss the central role they have in modern political life. Yes, they take part in colourful and quaint ceremonies like Trooping the Colour. But note that it is the Queen’s Colour that is being trooped by the Queen’s Guards. It is not Boris or  a Government Minister who takes the salute but a member of the Royal family. When you receive your tax demand through the post, the envelope is marked with the legend, ‘On Her Majesty’s Service‘ (or in the case of James Bond, ‘On Her Majesty’s Secret Service’). Judges sit on the Queens Bench, that tax demand is delivered by The Royal Mail, the policeman’s helmet is surmounted by the Royal cypher and so on. Is this just a hangover from the past with no relevance to today? Well, yes and no. It is a fluid connection to the past and a confirmation as to what it means to be British. It represents tradition and good practise but it also performs a subtle but essential delineation of political power. At the opening of Parliament each year, the Queen delivers the Queen’s Speech outlining her government’s program for the coming Parliament. This takes place in the House of Lords and the Queen sends her official, Black Rod, to summon the M.P.’s in the House of Commons to attend. The door of the Commons is slammed shut as Black Rod approaches and he/she has to knock three times before he/she is allowed in. A quaint piece of colourful drama, even down to a little heckling of Black Rod as he/she delivers the Royal summons? Yes but also a marker to show the supremacy of Parliament over the Crown and of the  Commons over the Lords. This, fully costumed vignette, encapsulates British Constitutional development  of the past 150 years. The Monarchy occupies the spaces where a potential challenger to Parliamentary Supremacy would develop.

My discussion of the place of the Monarchy in modern Britain is less than comprehensive. The role is complex and encompasses  economic, cultural, constitutional and political aspects of Britain’s past and present. It is firmly interwoven into the constantly changing fabric of society and has had to accommodate many Harry and Meghan moments and has survived. My concern is the erosion of the sense that with rights come duties. With our obsession with living vicariously via social media and the values of vaguely defined social justice. The Queen and her father, George VI, set a moral standard for a Head of State that is unequalled anywhere else. Their example encapsulates the virtues of honesty, hard work, fairness, duty, common sense, loyalty, respect and personal responsibility. This is in contrast to the shallow lives of the Edward and Wallis Simpsons and the Harry and Meghans of this world who want celebrity status without sacrifice and claim victimhood when their demands are not met.

 

 

 

 

 

 

 

Cartoon from the Mercury News

 

 

 

 

 

 

 

 

 

 

 

 

I was saddened to see the riot and attack on Capitol Hill last Wednesday (6/01/21) and especially the loss of life that occurred.  A note of caution before we go any further. We should learn our lesson from the past few months and not jump to the conclusion that these four people were ‘killed’ as a result of the riot, as was reported by CNBC (07/01/21) . We see from the same report that three deaths are provisionally listed as ‘medical emergencies’ and at the time of writing there is an investigation into the deaths of Ashli Babbitt and subsequently, Officer Sicknick.

Having said that, the President has lost the opportunity to leave his mark as the person who changed the political dynamic in the States by standing up for common sense and country. The Glitterati, led by George Clooney, say that his name will forever be linked to “insurrection” and the Democratic press will make sure of that. I think that history will take another view. When all the articles from the legacy Press have faded and the Chat Shows have been forgotten the President’s Legacy will be that he challenged progressivism , forged by the elites of the press, the Arts, the Universities, Big Tech and the Democrats.

Though the Left would love nothing more, Trump supporters are not going away. The same bill of complaints leading to Trump’s ascension remains. Trump didn’t arise in a vacuum, and the Left’s mission to fundamentally transform America that gave birth to Trump and Trumpism is not only alive and well but is even more dangerous now that Democrats have captured control of the two political branches of our government.. David Limbaugh

I have to pause to highlight the sheer opportunism  of Chuck Schumer comparing the riot with the attack on Pearl Harbour which was noted in a report from News 24/7, ‘The Senate minority leader’s flair for melodrama is so well known that in a city full of publicity-hungry politicians, it’s an old joke that “the most dangerous place in Washington is between Chuck Schumer and a TV camera.”‘ If we accept that this wasn’t a second Pearl Harbour or 9/11, it is serious enough to give the President’s enemies enough ammunition to compromise all the work he has done in the last four years and make the choices for the GOP more difficult going forward.

What I find interesting amongst all the talk of this being the greatest threat to the constitution is the conflation of the , rather exotically dressed leaders of the riot/ mainly peaceful  protest, with all those who disagree with the liberal establishment. David McWilliams wrote a piece in the Irish Times subtitled, ‘The white working class is slipping down the US and global pecking order.’ (9/01/21) The article can nearly be summarised in following quote, “In absolute terms the “deplorables” are not much worse off than they were 30 years ago, but relative to the brown and black people who used to do their laundry, they are sinking.” He manages to introduce the Hillarian elitist term, “deplorables” early in the diatribe but doesn’t really define who he means. They are white, of course and male perhaps the above picture could serve as an identity kit to mark out his targets. Most of the support for his contention that these ‘deplorables’ are entitled and resistant to change seem to be rooted in the 19th century. One of the few modern examples he uses refers to the high success rate of West African immigrants in employment. He produces no evidence that the white working class, have demonstrated against any immigrant who would contribute to the common good. Was he saying that this demonstrates the high level of education in Africa that will fuel the increased competitiveness of the continent with the U.S.? If so, that will affect everyone and I would suggest that given the education levels in different ethnic groups that the white working class will not be the most impacted.  I would add that it wasn’t the ‘deplorables’ who discriminated against Asian immigrants who wanted to access higher education but the Harvard elites.

What do we make of this sort of stereotyping ? The first thing to note is that the left have learnt little over the last number of years. If we take Brexit as an example the Remainers created a straw man of the typical Brexiteer. He was white, male, probably an ex football hooligan with a Union Jack T Shirt and aggressive tattoos. His only political belief was that immigration was bad and that you couldn’t trust foreigners. The Remainers continually called the Brexiteers ‘racist’ and reiterated the Clinton line, “it’s the economy  stupid”. What they hadn’t noticed was that the debate had shifted and the question was now the same one that Maggie Thatcher posed, who is running the country? Cummings had found disenfranchised voters who knew that their voice wasn’t heard by those in power. The issue was now cultural, political as well as economic. As with the Clinton (Hilary this time) election the left in the UK was shocked to see the collapse of the ‘Red Wall’ and suffered a resounding defeat. David McWilliams may be correct in his economic forecasts, although perhaps he could tone down his glee over the demise of the U.S. but empires rise and fall and he is right that change is the natural order of things. What I don’t see is half of the voting public in the picture he has drawn. Statistically some of that number has to be non white. He refers to the, “…. brown and black people who used to do their laundry.” Does he know any working class people? Is he suggesting that the working class own or, ever owned slaves? He mentions that soon women will have more wealth than men, does the working class not have a few women amongst them?

What he and his elitist colleagues have done is to draw a very narrow picture of anyone who opposes their narrative. He has created a straw man, a member of the ‘American Honky-Tonk Bar Association.’ complete with cowboy boots and AK47. After applying the racial, gender and classist filters to conservatives there are no women, no people of colour, no one with any education, no one outside this imaginary group. He accuses the working class of feeling entitled but I would suggest that they are not looking for a hand out, as are the various lobby groups of the progressive left but rather a hand up. They are not afraid of work, something he might discover if he ever actually talked to anyone outside of his bubble.  At the beginning of the First World War the British Army was called “Contemptable” by the Kaiser and they happily adopted this name and became the ‘Old Contemptables’ that eventually defeated him. By the same token I am happy to become one of the ‘deplorables’ and look forward to the return of common sense and respect to all my fellow country men/women. There are two effects of applying the Goebbels principle; one has been amply demonstrated over the past four years where you repeat something untrue like, ‘Trumps is a Russian Agent’ and through sheer repetition the base start to believe it. The second effect is that you start to believe it yourself.

 

 

 

 

 

 

Sources

David Limbaugh, 8/01/21,www.dailywire.com/news/limbaugh-trumps-agenda-must-survive-his-presidency.

Four Dead After Pro-Trump Rioters Storm Capital Jennifer Elias, Kevin Breuninger, Marty Steinbergw.cnbc.om/2021/01/07/four-dead-after-pro-trump-rioters-storm-capitol.htm

Capital rioters can’t stop the economic forces undermining their tribe., David McWilliams, 9/01/21,www.irishtimes.com/news/world/us/us-election/david-mcwilliams-capitol-rioters-can-t-stop-the-economic-forces-undermining-their-tribe-1.4452498

If nothing else, the current Corona virus pandemic has focussed us on the need for data to assess risk and to inform policy. However, it is one thing to produce data and another to weigh it’s validity and to interpret what the underlying message is. It is with this  in mind  that we must be very careful how we judge how well our decision makers have performed in the current crisis. The real test is that of a historian who will ask whether any other course of action was viable given the  background ‘noise’ and ‘chatter’ and contradictory expert advice.

Having said that there was one set of data that caught my eye as it touched on not one but two of my previous essays (see below). In an article in The Times, Kat Lay had reported that the doctors in the NHS were concerned that patients were holding off attending A&E because they were afraid of catching the Corona virus. For English hospitals, the number of attendees had fallen by 57%, comparing April 2020 with April 2019. In whole numbers, that means a reduction of 1.2 million visits, month on month. “Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said the drop in A&E attendances was “a significant concern” and people’s conditions may have worsened as a result.
“This is a ticking timebomb in itself and it will be exacerbated by a myriad of other pressures in the coming weeks,” he said.”(The Times 14/05/20)

Of course there are some obvious reasons for the decline in numbers mentioned in the article and referenced on the graph opposite. Working from home means that there is far less traffic on the roads and partly for this reason there were 27,000 fewer ambulance calls y-on-y. What is missing from the article and the medical references, is voiced in the comments attached to the article and was the subject of my earlier essays (see below). It is the elephant in the room. Let’s take a couple of comments that give a flavour of the frustration of readers with the journalist, for not asking the obvious questions.

Willie Deadwilder: Surely this is to be expected. Fewer drunks on the streets means fewer admissions to A&E plus fewer people at work means fewer workplace accidents. It’s not rocket science.

Lenny:Of course you are right. Why can’t our dozy journalists do some basic research or ask the right questions to A&E staff? It does not fit with the prevailing narrative of doom and gloom.

Paramaniac: I work in the Ambulance Service and all I can say is thank you lord, thank you so much for giving us a small break in the mind numbing incessant c**p we normally go to.
I realise it won’t be for long and once C19 is over we’ll be back to doing the incessant mind numbing c**p we do in the Ambulance Service but thanks for while it lasted.

What wasn’t discussed in the article was the effect of those who either attend A&E because it is free or, they can’t be bothered to go to their GP and those who attend because of anti social behaviour. Of course, there are a number of people who don’t attend, who should attend. There are those who feel that they shouldn’t bother the Health Service at this time  and stoically suffer on when they should seek help. There are those who are afraid of catching the virus, whose condition will deteriorate and they will be one of the ambulance calls that will become an emergency. What we don’t see in this article is the reason for the paramedics prayer of thanks in the Comments.

How does this article and it’s omissions connect with my two essays on the subject. The first one, entitled Minister for Health  (03/09/18 see below) described my reaction to the unveiling of a new health plan entitled Sláintecare. I suggested that a plan cannot be a plan without costings otherwise it is merely the Ministers aspiration. I went further to suggest that there appeared to be a dearth of management information that would serve as a platform for making plans. For example, at the time there was a lot of heat being generated about people on trolleys in A&E. However, there seemed to be very little light in the way of in depth verifiable data on the subject. We just about knew the number of people involved but even this was a source of dispute between the HSE and A&E Unions but beyond that, very little. My second article Addendum to the ‘Minister of Health Article  (01/03/20 see below) followed up on the first one by commenting on the statistic that in 2018 the HSE conducted a survey of 293,976 hospital discharges and found that 33,929 (11.5%) patients were discharged the same day and 55,510 (18.8%) were discharged within 24 hours. There seemed to be a curious lack of interest as to why this was the case. The lack of Junior Consultants at night was one guess that was hazarded but there appeared to be no real effort or, ambition, to discover how many of those discharged within 24 hours should have been there in the first place.

We can sense a theme running through these observations with similar characteristics. First of all and most obviously there seems to be a dearth of detailed information in relation to Health issues. The issue of under resourcing A&E has been a long running story for a number of years but we only see a large scale survey being made in 2018. I have yet to see a comprehensive breakdown on these numbers that would be the basis for solving the problem. Secondly, part of the reason for lack of any cohesive logical response is the quality of reporting. In the case of the current Times report perhaps Kay Lay should take Lenny’s advice in the Comments section and do a follow up article based on an interview with Paramaniac or, one of his/her colleagues. Thirdly, as mentioned in my first essay, there is no responsibility for value for taxpayers money in the Health service. The Children’s Hospital is a prime example of this. For one of the most expensive capital projects in the health service there was an incompetent  political and managerial oversight of the project. There has to be far more transparency and ownership of all parts of the health service. In my essay I suggested that there should be an independent internal audit section that would publish its findings on a regular basis and make clear who is responsible in cases of failure. Fourthly, an outsiders view of the Health Service is that it is being run mainly for the benefit of employees and not the patients. I hasten to add that frontline staff are heroically trying to perform miracles in an environment that seems to be in constant crises. However, when the budget is increased there never seems to be any question of making efficiencies, for example reducing administrative staff in favour of front line and medical support staff. Instead, what we see is a form of internecine warfare to make sure that everyone in the industry gets their share. Perhaps that is too harsh a criticism at a time where frontline staff are risking their lives but I think on reflection there is a feeling that they are, ‘Lions led by donkeys’. Lastly, the poor old politicians must share in the ‘Donkey’ category. They have distanced themselves from the management of the service and are reluctant to get bogged down in any attempt to make it more efficient and up to date. The inmates run the asylum and react very strongly to any attempt to change the status quo.

Having said that, there is much to treasure and we see, on a daily basis, the commitment and self sacrifice that  health workers are prepared to undergo in their service to others. It is the system and management, both political and operational, that need to change to match this level of service.

 

References

The Times, 14/05/20, Kat Lay, Coronavirus: A&E visits plunge to lowest on record,

Minister for Health

Addendum to the ‘Minister of Health Article

Now and again you come across an report or, some data related to an article you wrote at an earlier date. Such an article appeared in the Irish Times, under the heading, “30% of admitted patients discharged within 24 hours is ‘absolutely crazy'”. It seems that in 2018 the HSE conducted a survey of 293,976 hospital discharges and found that 33,929 (11.5%) patients were discharged the same day  and 55,510 (18.8%) were discharged within 24 hours. In times where health service resources are stretched the first question that comes to mind is how many of these patients should have presented at the hospital at all. The article did go on to give some context to these number and in the absence of any published detail we have to be careful about drawing conclusions. For example, a percentage of patients would have been discharged from one hospital to be transferred to another for specialised treatment. Also, the consultants are quick to point out that often junior staff are left to cover the out of hours shifts and do not have the training, experience or, confidence to discharge patients and so they are given beds until a more senior colleague can make the decision.

I wouldn’t think for a moment that Simon Harris follows my Blog but it is coincidental that the survey was conducted in the same year that I wrote an article about the importance of getting the raw data together and analysing the numbers before tipping even more taxpayers money into the Health industry money pit. (See the link to the 2018 article below) In the absence of any other published material I can find, I find it astonishing that the survey was conducted as late as 2018 and that the conclusions are only reported in 2020. I assume that further investigations are being made into the type of health issue presented and whether HSE resources were being used in the best way.

I hope that what we are seeing is like the proverbial duck above water whilst all the activity is below the waterline, soon to be released to an unsuspecting public. I say ‘unsuspecting public’ as nothing approaching a set of clear management accounts has emerged from Simon Harris or, the HSE and I think that the tax payer would be astonished if something like a sign of good management and governance should appear in the near future. In the recent election I saw many promises of extra expenditure on public services but very little mention of getting value for money. Just throwing money at a problem solves nothing. There is no alternative to understanding the fundamentals  and drivers of the Health Service but what has filtered through to the public is very disappointing.

 

 

 

 

Article: Minister for Health September 2018

The Irish Times, 24/02/20, 30% of admitted patients discharged within 24 hours is ‘absolutely crazy’, p1, Paul Cullen

I have avoided writing a commentary on Brexit, partly because of it’s complexity and partly because the debate centres around fault lines rather than the underlying fundamental issues. I was sent the following article, written by George Friedman and it became clear that Charles De Gaul understood and predicted the current crisis. What it says is that you must understand what has happened in the past before you can explain the present. There are a number of things that De Gaulle got wrong but overall he put historical context first and this is what I think  the debate should be about.

Brexit and Charles de Gaulle’s Last Laugh

In many ways, de Gaulle foresaw the crisis Britain is now struggling to pull itself out of.

As we watch the British government tear itself apart over its relationship to Europe, it is useful to stop and consider the deeper origins of the crisis. They go back decades, to the long-standing tension between Britain and Europe, and in particular between Britain and France. Britain was not a signatory of the 1957 Treaty of Rome or any of the prior agreements that led to European economic integration. But in the 1960s, it applied to join the European Economic Community. At the time, Britain was economically weak, having never fully recovered after World War II, and saw the EEC as a free trade zone with relatively few complexities. The country had stayed clear of excessive entanglement with continental Europe but felt that having less limited access to Continental markets would help in its recovery.
But the British application to join the EEC was blocked by France in 1963 and 1967. French President Charles de Gaulle argued that the British economy was in many ways incompatible with the rest of Europe’s. He also argued that Britain had a deep-seated animosity toward any pan-European undertaking and would perceive a united Europe as a threat to its independence. De Gaulle didn’t view Britain as a fully European country, since its history ran counter to Europe’s history. Since the Norman conquests, Britain had been fencing with Continental powers, playing one off against the other to prevent any one power from becoming strong enough to storm the English Channel and conquer it. Whereas the other European powers were primarily land powers, forced by geography to focus on the threats posed by their neighbors, Britain was a naval power, whose primary response to Napoleon, for example, was to protect itself through a blockade that weakened France. From de Gaulle’s point of view, Britain fought World War II the same way – by shielding itself and abandoning France.
The British understanding of economic life, according to de Gaulle, was also incompatible with Europe’s. The British economy was driven by private investment, innovation and risk-taking. Continental economies had a much more intimate relationship with the state, which helped shape the direction of the economy and cushioned the impact of capitalism on workers. The state’s relationship to the market, therefore, was also very different. De Gaulle did not see the state as intruding on the nation but as the embodiment of the nation.
The European Union derives from the same tradition de Gaulle did. Neither objected to private property, but they believed in the need for state intervention in all aspects of life. The EU has a regulatory bent that is far more intense than the British, and sees its bureaucracy as having authority far greater than Britain’s.
De Gaulle had other bones to pick with the British. Britain’s relationship with the United States troubled him deeply. De Gaulle saw the U.S. as the logical and extreme expression of British ideology and strategy. The U.S. marginalized the state and, like Britain, was prepared to fight to the last European to block the Soviets. De Gaulle recalled the U.S.-British alliance in World War II, and the degree to which he had to resist having France reduced to a dominion of the United States and Britain during and after the war. The tension between Britain and the Continent didn’t end with World War II, and Britain’s relationship to the United States compounded it.
De Gaulle saw the alliance between the Anglo-Saxons as representing a multi-faceted threat to the Continent. In particular, he did not want Europe in a fixed alliance that committed the Continent to military action under certain circumstances. He didn’t want another war in Europe and was not prepared to take the same risks the U.S. was claiming it was prepared to take. He saw NATO as a threat to the EEC in many ways. He also saw the Soviets as a manageable threat, and the Americans as reckless. From de Gaulle’s perspective, then, if Britain were to join the EEC, it would act as a tool of the United States, and he was not willing to let that happen.
For de Gaulle, the cultural gap between Britain and a united Europe couldn’t be bridged. They were just too economically incompatible and their strategic interests too different.
De Gaulle’s goal in all of this, however, was not simply to build a European community. He wanted to build a European community that France could dominate, something that was still conceivable in the 1960s, while Britain remained outside the bloc. And in trying to achieve his goal, he actually anticipated the problem that would arise with the Maastricht Treaty, which established the European Union.
Britain has a very different economic and political culture than the Continent. It has a different history that gives it a different view of the Continent. Leaving other matters aside, it does not fit into Europe, and the attempt at bridging this gap has led to the worst political crisis in Britain since the fall of France.

There are, of course,  many other variable to consider when looking at the current situation. Globalisation, technology, urbanisation, environmental issues  have all changed the world since De Gaulle’s day but he identified key difference between Britain and the continent that still hold true. Most of them have a historical trajectory and you can see an example of  this by contrasting the constitutions of Britain and Europe. Most of the EU countries have written constitutions that has been forged after conflict, whereas Britain has a mainly unwritten constitution that has evolved over time and is  grounded in common law. This has evolved into the principle of parliamentary supremacy whereas, by revolution or war the continental systems have produced a stronger executive branch that can take unilateral decisions with much less constraint. We can see this in the way that Brussels, Germany and France  rammed Monetary Union (EMU) through on the back of the Maastricht Treaty to consolidate national currencies into one European currency. I can remember people saying that Britain’s refusal to join reflected her attachment to the pound and empire but what made more sense was that Britain and a few other states just couldn’t see how it would work. In the end they were proved right and the fundamentals of a stable currency have still not been resolved. What was seen to be an attachment to former glory was, in fact, a practical assessment of the EU’s plans which were the product of an ideological construct and the ambitions of a politicised bureaucracy.

Britain joined the EEC which was a common market that retained decision making at the national level. I  think that most British people accepted that, over time, as economies moved together so would the links between countries. The problem was that France and Germany wanted to keep up the momentum to expand the geographical community and the power of the EU establishment. The problem of keeping up the pace is that you can quickly create a disconnect between the people that you are representing and the governing body. It became very clear that the  Maastricht Treaty was treated with suspicion by many countries and to counter the fears of forced centralisation the concept of subsidiarity was established. The principle of Subsidiarity does not just state that decision making be devolved to the lowest competent authority but that it is the responsibility of the central authority to make the case that it is necessary to take it away from local jurisdiction.

Specifically, subsidiarity means that proponents of centralisation are the ones who have to prove that further integration is justified. If they fail to make the case, subsidiarity means that the powers should remain de-centralised. (Making Sense of Subsidiarity: How Much Centralization for Europe?)

The authors of the 1993 report, Making Sense of Subsidiarity: How Much Centralization for Europe? clearly saw the tension between “efficiency-enhancing centralisation and democracy-enhancing sovereignty.” It also identified the principle’s weakness in that it was not defined  in law and that any dispute was adjudicated by the ECJ, hardly a disinterested body. The inevitable consequence has been the expansion of Brussels at the expense of local decision making. To paraphrase Ronald Reagan, Brussels will never voluntarily reduce in size and the EU bureaucracy  is the nearest thing to eternal life that this earth will ever see.

If the trade-off that Europe has chosen cannot be explained and justified to citizens, consequences are unavoidable. The loss of sovereignty can easily turn into a loss of identification with the European project, and, as seen today, the missing identification can generate a dangerous democratic deficit, and a concomitant longing for the autonomy of the nation-state.

The problem, that was clearly seen by the authors of the 1993 report , has come about. The institutions of a European wide super state are all there. The flag, anthem, judiciary, executive, parliament, external borders, membership of the UN and the beginnings of an EU military are all there to see. But who will defend this super state? Yes, we can identify the economic benefits and for some the prevailing liberal ideology but the democratic deficit that the report identified has resulted in a return to identification with the nation state that can be seen all around Europe.

 

Liberal governments in Continental Europe saw the Nation State as the source of all modern wars and in the aftermath of the Second World War it seemed reasonable to look for a convergence of states that would lock them together so that there would be an end to international conflict, at least in Western Europe. This would seem a reasonable strategy especially between Germany and France who between them had produced a Napoleon, Kaiser and Hitler to terrorise the continent in modern times. However, the claim that the EU and it’s predecessors have kept the peace in Europe is only partially correct. As already stated, it has stopped two member states from repeating past adventures but has it secured peace from external threats? De Gaulle’s  belief that the Russians can be negotiated away have thankfully never been tested. The reason that the post war expansionist communist states were held at the western borders is NATO. De Gaulle’s nightmare had come about. It is the presence of those Anglo=Saxons that has prevented a nuclear tipped Russian advance into Paris not the EU. To be more precise, it is the presence of 60,000  U.S. troops in Europe, plus all the America military might, on call, that has held Russia in check.

De Gaulle was wrong on many fronts. Partly as a result of his humiliation during the war he incorrectly identified the main threat to post war Western Europe as being the Americans and British. However, his analysis of the differences between Britain and the continental Europeans can hardly be faulted. This means that, given the ambitions of Brussel and Paris, that the union was never going to work within the current framework. It would not fail on immigration, EMU or, the ‘great British sausage’ but on the impossibility of forcing a continental culture onto a British one. Whatever happens to Brexit the EU still has the same problems with the remaining countries and we can see the fault lines wherever you look. The problem with the model is that it attracts little loyalty from it’s citizens. Yes, we all identify as Europeans when we go through passport control but if asked where we come from we respond in national terms. We like the mobility and economic advantages when things are going well but have no accountability when things go wrong. We are told that that there is democratic control via the European Parliament but the electorate rightly sees through this myth and shows little enthusiasm for European elections. What they do see when they make a stand is that huge pressure is put on national governments to correct this aberration as happened when the Irish electorate rejected the Lisbon Treaty in the 2008 referendum. There are many things right with the EU but it is a house built on a shaky foundation and it is not clear whether this is accepted by the ruling elites or, whether they will ignore all the warnings and continue to build even higher in a desperate hope that the foundations will somehow hold.

 

 

 

Reference:

GPF, George Friedman, 2/04/19, geopoliticalfutures.com/brexit-charles-de-gaulles-last-laugh/

Jean-Pierre Danthine, Subsidiarity: The forgotten concept at the core of Europe’s existential crisis, 12/04/17, https://voxeu.org/article/subsidiarity-still-key-europe-s-institutional-problems