The TaxPayers' Alliance - Better Government

Threatening Schools Week

Apparently it is Threatening Schools Week.  Yesterday the Charities Commission threatened to remove charitable status from private schools they didn't think were doing enough to help poorer students.  Today the Telegraph reports that Gordon Brown is threatening to close schools that don't reach a sufficient standard in GCSE results.

This is another in a long line of tired and obviously failing measures designed to try and beat schools into better performance from the centre.  It is supposed to complement the only other kind of measure this government understands - showering public services with taxpayers' money.  It won't work.

This creates an incentive to improve GCSE results but no direct incentive to improve educational standards.  If all we wanted was improved GCSE results all we'd need to do is further increase the pace of grade inflation.  What we're really after is a system where young people receive a broad and useful education.

Schools facing a powerful incentive to improve grades can focus on teaching to the test at the expense of improving the education of a broader range of students (those who will never pass and those who will pass anyway are pretty much irrelevant to GCSE pass rates) and providing a broader education and set of skills.  Politicians who don't want to make the hard choice to follow through on Brown's threats can lean on the notionally independent QCA to weaken exam standards.

There's nothing wrong with schools being held accountable and there may well be a need for bad schools to close.  However, instead of making schools still more accountable to politicians why can't we make them accountable to parents?  Why can't we make closing a school not a decision for politicians but the result of parents, having been given the freedom, choosing a more successful establishment or getting a new one set up?

Threatening private schools - the last refuge of defenders of unreformed state education

The Telegraph reports that the Charities Commission are threatening to get tough with private schools who they believe don't provide sufficient benefit to poor students:

"Charity officials may carry out snap inspections of independent schools to make sure they are benefiting poor pupils, it has emerged.

They will have the power to strip schools of their charitable status – collectively worth £100 million a year – if they fail to pass the new test of "public benefit".  Other schools failing to comply could have their trustees suspended or bank accounts frozen."

This can't be separated from a political pressure from the Government that has seen private schools complaining that over-regulation is undermining their independence.  During the Labour deputy leadership race many contenders argued that they would like to see tougher conditions or a complete removal of charitable status from private schools.

A key rationale for giving charities tax breaks not available to other organisations is that they provide a service that, without the charity, government would need to provide - lifeboats are a great example.  Private schools clearly fit into this category as if their were no private schools there would be a significant number of additional pupils that the state sector would have to cater for.  There is no good reason to single out private schools for ever more onerous demands for additional public benefit.

Politicians should be spending their time trying to sort out an education system with massive problems.  From the Better Government Position Paper (PDF):

• 11 year-olds: 25% leave primary school without sufficient ability in reading and writing to tackle the secondary school curriculum.
• 14 year-olds: almost 30% do not reach the expected levels in English, Maths and Science to tackle GCSEs.
• 16 year-olds: almost 60% do not achieve a GCSE grade C or better in all the three core subjects of English, Maths and Science.
• After 11 years of state education at a cost of over £75,000 per child, pupils are leaving school functionally illiterate, innumerate and unskilled:
• 40% do not achieve at least a C grade in GCSE English.
• Some seven million adults in England cannot locate the page number for plumbers in an alphabetical index to the Yellow Pages.
• 47% would be unable to achieve a grade G at GCSE maths.
• The OECD finds that Britain has the second highest level of low-skilled 25-34 year olds in the 30 countries of the OECD – twice the level of Germany or the USA.

None of those problems are the fault of the roughly 7% of children who are educated privately.  Real reform of the education sector with politicians getting out of management should be the order of the day rather than class warfare politics.

More on superbugs

Margarent McCartney's article in the Financial Times on superbugs is well worth reading.  In particular, this section gets at how the inexperience and lack of subject knowledge associated with political management is crucial to the failure to control hospital infections:

"Politicians are tackling MRSA with campaigning zeal. Gordon Brown has pledged to instigate a “deep clean” of hospitals to reduce hospital-acquired infection such as MRSA. Health secretary Alan Johnson is setting up a committee to look into the issue and has also said healthcare staff should be unclothed below the elbow. Unfortunately, there is the delicate issue of evidence for these politically inspired “initiatives” which is not so apparent. Johnson’s statements on uniforms seem to contradict a publication from his own department, “Uniforms and Workwear”, which says “there is no conclusive evidence that uniforms pose a significant hazard in terms of spreading infection”.

[...]

Lack of handwashing might seem an obvious culprit, but at a lecture I attended recently, the futility of pursuing this as a cure-all was made apparent. “Handwashing does make a difference,” says Dr Stephanie Dancer, a consultant microbiologist in Glasgow, “but think. The doctor washes his hands and then pulls close a curtain. The curtain is covered in MRSA. Or he touches the bedside cabinet. That’s not been cleaned recently either. And there you have it, the transmission of MRSA.” Dancer says that while cleaners do a sterling job in tackling all general surfaces and floors, they are not responsible for cleaning lockers, bedside tables and curtains. “In addition”, she says, “there aren’t enough cleaning hours and there are problems with recruitment of domestic staff. The latter is understandable when you look at pay. You could go and stack shelves in a nice clean supermarket for more.”

Unlike most politicians, Dancer is an expert on the subject. One thing is for sure, none of us is sterile. We are all covered in millions of bacteria and shed thousands of them with each step we take. “Probably 5 per cent of us carry MRSA. But where there are outbreaks of MRSA, it doesn’t seem to be the ‘staff’ strains that usually infect patients,” says Dancer. Many factors affect how and where bacteria are spread. Ward design is crucial and inadequate maintenance can make them hard to clean. Open doors or windows create “more turbulent airflow and the possibility that MRSA could be lifted from surfaces and blown all over the ward,” she says. “Fans, very popular in hot wards, are very effective in shifting MRSA around.”

Truancy rises again

Still-rising levels of truancy, reported today by the Independent, are a result of the failure of an education system under political mangement.  There are a few key failures at work here.

1)  Children haven't learn to read

Poor literacy standards mean that a child will often find the rest of their education nothing but a humiliation.  Under a more flexible system the schools would not want to press vainly on trying to teach a child Shakespeare when they can't read the Sun.  A decentralised system where schools respond to the priorities of individual parents rather than the constant flow of central government diktats could be more flexible.

2)  Teaching to the test

We've noted before that it is becoming very apparent that schools teach what is needed to pass the many public examinations to the exclusion of a broader and more meaningful education.  That has to make things less interesting which will feed a desire, on the part of children, to avoid school.

3)  Focussing on those who can make the 'C' grade

Teachers face a big incentive to focus on making sure that the central "% Grade A*-C" number looks good for their school.  Students playing truant often won't be anywhere near that standard.  While good schools will do their best for every student many will accept the reality that they have to meet the political standard and focus on boosting as many students as they can over the line to grade C.  That undermines efforts to make combatting truancy a priority.

Both workers in the Health Service and people in deprived areas would be better off with real NHS reform

The Telegraph reports statistics from the ONS showing that middle class professionals are outliving builders and cleaners by as much as eight years:

One of the factors that the report cited as possibly affecting a person's life expectancy was interesting:

"But the nature of people's jobs also has an effect. If you have autonomy and control over what you do, you tend to be in better health."

This logic implies that reforms that give public sector employees more autonomy and control over how they provide services, with accountability for outcomes to the public instead of to politicians, are very much in the professionals' interests.  This is possible within public services.  A study, Good people, good systems (PDF), by the Serco Institute found that when public services were managed by the private sector the staff found they had much greater freedom to act on their own initiative.  Here are some quotes from professionals who had moved from the public to the private sector (still working for public services):

‘Implementing change is much quicker.  In the private sector, you have the capacity to change quickly and to react almost instantaneously.  But it is left to individual [contract units] to react to the changing pace of the [customer] – head office is behind on these development most of the time.’

‘I am free to manage with greater autonomy, most certainly.  But that freedom comes with a price.  If you get it wrong – I’ve always accepted that if I’ve made a mess of my job I will be called to account at some stage.  It doesn’t have to be a nasty falling out; it’s just that if I run this contract and it doesn’t go well – either because we lose a lot of money, or the client is permanently unhappy with us, or we have a terrible safety record – it’s quite right that I should be called to account.’

Another factor contributing to poor healthcare outcomes among the poorest is that they tend to get let down most by the poor quality of British healthcare.  Dr. Thomas Stuttaford writes for the Times:

"In many deprived areas high blood pressure is still grossly underdiagnosed and treated poorly. Hyperlipidaemia – raised cholesterol levels – is ignored and few NHS patients know that their low-density lipoprotein levels are an essential indicator of possible trouble ahead. Breast screening, when compared with that of the rich, is too infrequent, discontinued too early and can even be desultory.

The average NHS practice still does not carry out or organise worthwhile cardiovascular assessment. It doesn’t measure blood sugar levels and renal function routinely, or determine the PSA levels of men so that it can diagnose prostate cancer in time for worthwhile intervention, or even understand the cardiac implications of progressive impotence.

Once a potentially lethal disease has been discovered, the quality of care that money can buy either in this country or abroad when compared with the standard NHS treatment is deeply worrying."

MPs and their skills

The Mail reports today that MPs are struggling to find employment on leaving work:

"The study said employers have little use for former MPs - and some take more than a year to find a job.  Those who do manage to find work often complain that they do not earn as much as they did in Westminster.

[...]

A careers advice company cited in the report warned that a high percentage of former MPs 'were commercially unemployable at senior management level'.

[...]

A high proportion of those who do find work get places on quangos."

It is pretty clear that in the private sector MPs, with little management experience or really detailed knowledge of a subject, cannot find senior management level employment.  They tend to find jobs by staying in the, less discriminating, public sector.

The top tiers of management in public services are taken up by politicians.  They don't have the right skills and experience for senior management in the private sector, is it any wonder they fail in the public sector?

More secrecy and failure in the NHS

Following on from the widely-reported failues of the NHS to tackle hospital superbugs comes the news that one in three NHS trusts is struggling financially. How is this possible? The NHS now consumes around £100 billion a year, a threefold increase in the last decade.

We can only repeat that this failure is not surprising given that the NHS is run by politicians who lack management experience and detailed knowledge of healthcare and who are in their posts for too short a time to make a real difference. Health Secretary Alan Johnson is the fifth Health Secretary in ten years, and, as Patrick Barbour pointed out on ConservativeHome last week, has no experience of heathcare at all. The problems in the NHS are therefore not going to go away, no matter how much money the service continues to receive.

At the same time, the NHS's culture of secrecy shows no signs of abating. Maidstone and Tunbridge Wells NHS Trust, which was at the centre of the recent hospital infections scandal, has just refused to disclose how much it has given its chief executive, Rose Gibb, in a payoff. This is the same payoff that Health Secretary Alan Johnson has ordered be suspended pending a police investigation into whether Miss Gibb, and other senior managers and board members in the Trust, should be charged with manslaughter over the superbug outbreaks.

What a disgrace.

Fewer than half of pupils gain good GCSEs in core subjects

Yet more evidence of the failures of the state education system have come to light today:

• Fewer than half of 16-year-olds this year achieved five A*-C grade GCSEs including English and maths;
• Only a quarter achieved five A*-C grade GCSEs including English, maths, science and a foreign language;
• One in five teenagers failed to get a single A*-C grade GCSE - for boys, the figure was one in four.

The full government figures are available here.

It cannot be repeated often enough:

• The state education system is failing to provide enough children with a good, rounded education.
• The state education system is particularly failing poorer children, who perform far worse than the average.
• The state education system is failing despite education spending doubling in the last decade.
• Without major change the state education system will continue to fail no matter how much money is spent on it.
• The state education system is failing because it is managed by politicians who lack experience of managing large organisations, lack detailed knowledge and experience of education and are in their posts for too short a time.
• Returning control over education to civil society, as is done in Sweden, the Netherlands and others, will improve outcomes, especially for the poorest children. Politicians should set high-level education policy, such as the level of taxpayer funding and the number of years of compulsory education, and leave the rest to parents and teachers, who will make a much better job of it.

Quarter of hospital trusts fail to meet basic hygiene standards

Coming just a few days after the superbug scandal at the Maidstone and Tunbridge Wells Hospital NHS Trust and the admission that 20 hospitals have worse infection rates than Maidstone and Tunbridge Wells is the lastest in a series of revelations about the sub-standard level of care in the NHS.

The Healthcare Commission has just published its Annual Health Check, and the findings make grim reading. As the Times points out, the report finds that one in four hospital trusts across the country is still failing to meet basic standards of hygiene and infection control.

On ConservativeHome, Patrick Barbour rightly argues that political management has failed the victims of superbugs. He writes:

"Imagine if a care home in the private sector had over 90 deaths due to negligence.  But will anything happen here, where the NHS is run by ever-changing politicians, who lack management experience and knowledge of healthcare?

"The Secretary of State, the three Ministers and two Parliamentary Undersecretaries have made up the top three levels of the NHS over the last 10 years.  Yet they have virtually no management experience, no in-depth knowledge of the NHS and they frequently change their jobs.

"Alan Johnson, the current Secretary of State for Health, is typical.  Before becoming an MP he worked in the Communication Workers Union, a position for which no healthcare expertise was needed.  Since he was first appointed to a ministerial position eight years ago he has been a minister at the DTI and at the DfES and a Secretary of State for Work and Pensions, the DTI and the DfES before moving to the Department of Health.  That’s more than six jobs in eight years, in four very different departments.  How does any of this equip him to run one of the largest and most complex organisations in the Western world?  It doesn’t.

"We will continue to have a Health Service which is ranked as 18th out of 19 developed countries by the British Medical Journal as long as politicians continue to manage the Health Service."

State schools are failing the poor

A damning Ofsted report has revealed that the state education system is failing the poorest children in our society:

Just 51 per cent of secondary schools were judged to be good or outstanding;
34 per cent were merely satisfactory;
10 per cent were inadequate;
Only 12 per cent of 16-year-olds in care gained five or more A*-C GCSEs;
Just 33 per cent of pupils entitled to free school meals gained five or more A*-C GCSEs;
61 per cent of non free school meals children gained five or more A*-C GCSEs;
More than 200,000 young people aged 16-18 have left school with no qualifications at all.

This record is a national disgrace. A system of state education that was originally designed to remove education inequalities has managed to entrench them. No matter how much extra money the state education system receives from taxpayers, it will not fundamentally improve unless politicians, who lack experience of managing large organisations and lack detailed knowledge of education, are removed from its management.

More evidence that the scandal at Maidstone & Tunbridge Wells wasn't an isolated incident

Alan Johnson's attempt to fool the British public into thinking that the tragic deaths at Maidstone & Tunbridge Wells NHS Trust are an isolated case becomes more disingenuous by the day.  A new scandal has now emerged at the Royal Blackburn Hospital in Lancashire's neonatal unit.  Six babies have tested positive for an aggresive form of MRSA.  The hospital covered it up and, as a result, one mother caught the disease from her baby and had to be hospitalised.

The Government's argument that their broader health policy has not failed is also looking increasingly tenuous.  Nurse of the Year Justine Whitaker has quit saying:

"Sitting in meetings we are constantly being told 'We're going for this cheaper option with this bandage; we're going for that cheaper option with that dressing; we need to be mindful of resources'.

"I'm absolutely fine with that - I run my household like that - but what I see as a waste of resources is when I'm sitting in a big meeting and as a clinician I am the cheapest person there at £35,000 a year and decisions are still being put off to another meeting."

The lymphoedema nurse, who has 14 years of clinical experience, added: "There is no sign the red-tape is being reduced. It all leads to more bureaucracy, which all leads to more form-filling and paperwork.  But as a nurse, I just want to nurse, I want to look after patients. "

The Sun gets it right:

"But Justine is not alone. Top doctors and consultants are also leaving in droves.

They cite the same problems — indecision, waste and non-stop Whitehall meddling.

Despite extra billions, the health service is in crisis."

Chairman of the Maidstone & Tunbridge Wells NHS Trust quits

James Lee, chairman of the Maidstone & Tunbridge Wells NHS Trust, has resigned following the Healthcare Commission's report on an outbreak of C. difficile there that has claimed over ninety lives.  The Telegraph have seen his letter to Alan Johnson.  He wrote: "We had to be concerned about finance because this trust has been struggling with a state that is pretty close to bankruptcy.  We knew that the Treasury was pumping money into the NHS, but quite frankly none of this seemed to be getting to the 'coalface'."

He added: "It has become clear to the members of my board that the NHS is run on the basis of command-and-control. I personally have never experienced such centralised or detailed control. I doubt whether it can ever work.  This way of managing things is fundamentally incompatible with the whole concept of independent trusts with non-executive directors."

In some ways Lee is quite right.  His letter exposes the extent to which the NHS is managed by diktat from demanding politicians.  Hopefully Lee would support a new system with managers of decentralised services held to account by customers who can vote with their feet.  I worry that he would rather just not be held accountable by anyone.

In other ways he is passing the buck.  While the Trust may have been under financial pressure you only have to look at their Annual Report for 2006-07 (PDF) to see that they had a questionable sense of priorities.  It shows that the number of nurses fell by 123 while the number of admistration and estates staff only fell by 65.  While hospitals do need to be organised and the Trust's estate would obviously need planning, particularly with a new hospital on the way, it appears that these staff were prioritised over the front-line staff who were needed to prevent the horrors discovered by the Healthcare Commission.

Lee is right that the Maidstone & Tunbridge Wells NHS Trust's problems are driven by broad problems beyond the Trust itself but for him to be so unwilling to accept personal responsibility for such a tragedy taking place on his watch is deeply unimpressive.

MoD homes 'scandal' not being fixed

It might be easy to think that once a real crisis like the poor housing that armed forces personnel are provided with breaks, with a furious reaction from the public and in the media, politicians will finally get on the job and ensure it is fixed.  However, today the Liberal Democrats have unearthed that by the Government's own figures they will take half a century to bring armed forces housing up to standard:

"In a written answer to Willie Rennie, the Liberal Democrat MP for Dunfermline and Fife West, Derek Twigg, the defence minister, said that the MoD had spent £16.4million of its housing budget upgrading existing stock to the highest level — called standard one.

Previously the MoD said it would cost £750million to bring all its houses up to standard, meaning it would take almost 46 years at last year's spending rate."

This is another problem with political management.  Measures don't need to be effective, they just need to be enough for the minister to be able to pretend they have responded to the issue.  Exactly the same thing happened with old council houses, before the Thatcher government allowed their occupants to buy them, councils didn't properly maintain them.

If members of the armed forces have to wait 46 years for acceptable housing they won't really be waiting for the funds they'll be waiting for the slow wheels of a politically managed bureaucracy to turn.

Twenty hospitals have worse infection rates than Maidstone & Tunbridge Wells Hospital Trust

Remember Alan Johnson telling us that the Maidstone & Tunbridge wells scandal was an "isolated incident".  We thought this was unlikely at the time:

"Mr Johnson told BBC Radio 4's Today programme this morning that the Kent outbreak was an isolated incident."

He is either fudging the issue or outright lying.  While the scale of the outbreak in Maidstone & Tunbridge Wells is exceptional the scandal of hospital infections is not confined to that NHS Trust."

Now it turns out that the hospital isn't even exceptional.  It is twenty-first on a list of the hospitals with the worst infection rates.  Kettering General Hospital has nearly twice the infection rate.  Hospital infections are a national scandal not an isolated tragedy.

Oxbridge giving up on the A-level

With the ongoing weakening in standards and concerns that schools are teaching to the test the A-levels are becoming less and less useful for universities trying to assess students for entry to university.  Oxford and Cambridge universities are responding by setting up their own tests.  The Telegraph describes a range of new tests that are being introduced and new exams (such as the Advanced Extension Awards) that are being recommended in an attempt to provide some replacement for A-level grades as a standard that universities can use to tell students apart.

This looks like a private solution to the problem of exams responding to the needs of politicians, for yearly 'good news', instead of the needs of universities and business, which are interested in more rigorous tests.  The government has set out plans to improve the situation by replacing the Qualification and Curriculum Authority (QCA) but it appears likely that any resulting improvement will be distinctly underwhelming as politicians will remain in charge.  If the mainstream examination system isn't reformed more and more universities will have to find their own solutions.

Patients pulling their own teeth due to shortage of NHS dentists

The Telegraph reports that patients are taking to pulling their own teeth as they are unable to find an NHS dentist.  There have been massive increases in the NHS budget, often more than 7 per cent annually, in recent years.  That there should still be such basic, and worsening, shortages in certain areas points to a colossal failure of management.  The money has not translated effectively into improved services as bureaucracy has increased and productivity fallen.

We're still getting more, empty promises of improvement.  As highlighted before on this blog, politicians are only talking about trying to address shortages in NHS dentistry now after it was promised that it would be made a priority a decade ago.  If we're going to pay so much for the NHS we should expect a decent service.

Management in the Health Service and hospital infections

The first three tiers of management in the NHS: the Secretary of State, the Ministers and the Parliamentary Under-Secretaries are all politicians.  As politicians their careers have been spent honing their media skills and their public speaking.  Few politicians have any experience of managing significant numbers of staff.  The current Secretary of State for Health, Alan Johnson, entered politics after a career in the unions.  He doesn't have any experience managing large organisations to prepare him for the challenge of managing the 1.3 million staff in the NHS.

Equally, they only have a limited knowledge of the healthcare sector.  Alan Johnson worked in the postal union but is placed at the top of the NHS chain of command.  While he will have plenty of advisors and civil servants, some of whom may have experience of the sector, he will find it impossible to properly understand their advice or choose between conflicting advice, without experience in healthcare to guide him.

Inexperience at the top is matched by poor management practices further down the organisation.  There were first problems with organisational stability at the Maidstone & Tunbridge Wells NHS Trust, at the centre of the recent controversy over hospital infections, the Healthcare Commission said:

"The lack of organisational stability with numerous structural changes over the last three to four years, meant managers could not settle into roles and focus on the key issues. The high turnover of executive directors and senior managers caused instability and left gaps in leadership as the trust grappled with its very busy agenda. Many staff felt the degree of change had been damaging and had contributed to the lack of clarity on accountability."

The figure at the centre of the problems in Maidstone & Tunbridge Wells NHS Trust is Rose Gibb.  She was the Chief Executive of the Trust, an organisation with a budget of £243 million and 4,527 staff and she was paid between £140,000 and £150,000 per year.  The Commission described an autocratic senior management that failed to build managerial and leadership capacity throughout the organisation.  There was little delegation.  This failure, built on a failure to properly give responsibility to junior staff, is the hallmark of leaders who are uncomfortable in a management position so try to do everything themselves.

Also, Mrs. Gibb is described as difficult to challenge.  All it would have taken is one effective challenge to her repeated assurances that the infection problem was being controlled for the Trust to accept that it had a major problem, after that it could start to do something about it.  Lives could definitely have been saved.

Management in the NHS needs to be improved if we are to avoid more tragedies like the one the Healthcare Commission has just uncovered.

Hospital infections at Maidstone & Tunbridge Wells NHS Trust

The news from Kent is truly shocking.  In the face of financial problems and in an effort to meet government targets a clearly incompetent management presided over hospital infections that the Healthcare Commission say directly killed at least 90 patients and may have contributed to the deaths of 331 people.  Some of the anecdotal evidence is, perhaps, even more shocking:

"Nurses did not have time to wash their hands properly, and left patients to lie in their own excrement because they had not been able to assist them to a commode.  The report found that shortages were so dire that nurses told patients to "go in their beds"."

An undercover reporter found:

"On my first day as I emptied bins, swept and mopped I noticed old blood stains ingrained on the floor.

I also saw unlocked sharps bins containing used needles lying in corridors - I was never told where to store them or how to handle them.

Clinical waste skips, which contain bags full of old dressings and bodily fluids, were left open in corridors used by visitors and patients, even though the hospital's own policy says they should always be locked.

The clinical waste skip I had to use also filled up quickly so rubbish bags had to be left on the floor - when I asked a supervisor what to do with them I was told to leave them beside the skip.

In A&E's operating theatre, a blood-stained gown was left on a trolley for 24 hours and used medical instruments were discarded in a sink for a day."

There are two things we need to understand when considering the meaning of this shocking story.  First, when the Health Secretary, Alan Johnson, says this:

"Mr Johnson told BBC Radio 4's Today programme this morning that the Kent outbreak was an isolated incident."

He is either fudging the issue or outright lying.  While the scale of the outbreak in Maidstone & Tunbridge Wells is exceptional the scandal of hospital infections is not confined to that NHS Trust.  In 2000 the National Audit Office estimated that 9 per cent of hospital inpatients have a hospital acquired infection at any one time.  That number is probably even higher today.  In recent years, the number of deaths from C. difficile infection has spiralled, as this graph from the Office of National Statistics shows:

Even these shocking numbers, way above the 540 who die each year from - for example - drink driving, may well be an underestimate of the true scale of the problem.  In the case of Maidstone & Tunbridge Wells the Trust was clearly either genuinely clueless or outright dishonest about how it presented the statistics.  The Trust told the Healthcare Commission that no deaths had definitely been caused by C. difficile between April 2004 and March 2006.  The Healthcare Commission did a quick sample of 50 patients who had died and had contracted C. difficile and found that in 26 per cent of cases it was definitely or probably the cause of death and in 78 per cent of cases definitely or probably contributed to the patients' deaths.

With 55,364 per year being infected by C. difficile the true number of deaths caused by the disease could easily be higher than that shown in the graph above.  The graph also only shows C. difficile and not other, sometimes lethal, hospital infections such as MRSA.

Broader questions should also be asked about the implications of such a massive a disincentive to go to hospital when a large part of Britain's poor cancer survival rate, for example, is blamed upon late diagnosis.  Is part of that due to an unwillingness to go to hospital and run a big risk of contracting a new illness while you are there?  If they are contributing to people delaying a visit to hospital when they feel ill the true number of deaths caused by hospital infections could be even higher.

Second, we need to understand that these problems stem from the way the NHS is organised.  The health service has had huge increases in its budget - the problem is not a basic lack of money.  Political management contributes to the problem of hospital infection in two key ways:

There have been five Health Secretaries since 1997 (Frank Dobson, Alan Milburn, John Reid, Patricia Hewitt, Alan Johnson).  This lack of long-term leadership, which leads inexorably to a myopic management culture, explains how Rose Gibb, chief executive of Maidstone & Tunbridge Wells NHS Trust was able to get away with repeated public assurances that she had the problem under control over a period of four years.  Instead of insisting that rapid progress be made in reducing the number of patients killed by their hospitals each Health Secretary since at least 2000 (when the National Audit Office found hospital infection on a massive scale) has passed the issue on to their successors.

In order to measure and understand progress in overgrown, bureaucratic public services politicians have to use simplistic statistics.  These are the targets which form the basis of politicians' demands for results.  Too many weak-willed managers bow to the pressure for certain targets, such as the reduction of waiting lists, to be prioritised and this leads to the exclusion of basic measures like ensuring proper hygiene.  No manager wants to risk the ire of politicians who see them failing to make progress on key targets.  The Healthcare Commission describe how the target that no patient should be in A & E for more than four hours had taken priority over controlling infection even during outbreaks of C. difficile.

While politicians might be able to improve the NHS' record on hospital infections if they make that the new obsession for the target culture only fundamental reform of the NHS will lead to the balanced management priorities that the service needs.  While it might be possible to stop Rose Gibb's generous severance package without accountability at the top the NHS will remain slow to respond to new problems.  Only when politicians get out of management and the health service is put back under the control of patients will we see real improvement in British healthcare.

Almost all children are victims of crime

The Howard League for Penal Reform have released figures, reported in the Guardian, showing that almost all, 95%, of 10-15 year olds are victims of crime.  72% were hit or kicked, more than half threatened with violence, almost a fifth have had things stolen outside of school, 11% have had money stolen and almost 10% have had a mobile phone taken.  The Howard League survey also suggests that there is also a widespread fear of crime among young people.

The correct conclusion to take from this isn't that we need to send the police, sirens flaring, into schools.  Instead, it's another reason why we need schools to be both free to properly impose discipline - for example with the freedom to exclude disruptive pupils - and answerable to parents who can insist that discipline be imposed by voting with their feet if a school isn't under control.

Junior doctors

The Telegraph reports that the failed computer system for recruiting junior doctors to training posts is to be scrapped.  An inquiry headed by Sir John Tooke has found that those running the system failed in two key ways:

• The IT systems were full of errors and did not keep applicants' data secret and secure.  Apparently it was obvious from as early as March 2006 that there could be problems with the online system.
• Senior civil servants were told that the 2:1 ration of applicants to places was a "red risk" - a massive and pretty obvious problem - months before the crisis but that nothing was done to ensure that as few expensively trained doctors as possible would find themselves without a training post.

Once again civil servants and politicians prove unable to manage a major project.  Management inexperience is combined with the slow-moving culture of the civil service and results in a system which doesn't respond promptly even when given ample warning that a project faces big risks.

Crossrail gets the go-ahead

With an expanding population and economy improving London's infrastructure is definitely a good idea.  Anyone who has faced overcrowding on the tube in the morning can see that.  However, with the project expected to cost £16 billion, more than the Olympics and Heathrow Terminal 5 combined and the record of big government projects - one third over budget on average - which the TaxPayers' Alliance discovered it is hard not to feel a certain sense of foreboding.

Hopefully when this project is set up the lessons of the TaxPayers' Alliance report "Beyond the Dome:  Government projects £23 billion over budget" will be taken into account:

• Public sector officials fail to properly specify what is needed from a project at the outset.
• Public officials and contractors underestimate the cost of a project in order to gain approval in the knowledge that projects are rarely cancelled when they later go over budget.
• Fixed-price contracts are not foolproof.
• Politicians and civil servants lack management experience and subject knowledge and change posts too frequently.
   

For more detail and evidence of these problems read the report (PDF). If politicians learn lessons from past mistakes we, at the TaxPayers' Alliance, might not have the sad task of forming 'Crossrail Watch' in a few years time.  Here's hoping.

The Health Commission Wales fail a patient and taxpayers

Channel 4 news reports another story of structural failure in the NHS today.  Doctors told a woman in South Wales that she needed a scan to discover whether a lump on her lungs was cancerous.  The application for a scan was rejected on the grounds that it would be too expensive.

This might sound like just another story of brutal rationing within a service that wastes so much of its budget.  It's worse.  The scan would not only be less invasive and dangerous than the thoracotomy that the Heath Commission Wales recommended it is also less expensive.

That's right.  The Commission made the decision because that would mean the cost coming out of another NHS body's budget.  Insanity.