#AmericanEmbassyLondon

Just a short blog - maybe just a bit of tittle tattle - ha!

A couple of weeks ago President Trump announced he was not going to come to London to participate in the opening celebrations for the new US Embassy at Nine Elms. His reason - he was embarrassed by the new embassy which he tweeted as follows :

"Reason I canceled my trip to London is that I am not a big fan of the Obama Administration having sold perhaps the best located and finest embassy in London for “peanuts,” only to build a new one in an off location for 1.2 billion dollars. Bad deal. Wanted me to cut ribbon-NO!"

4:57 AM - Jan 12, 2018

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First of all - the previous US embassy was in Grosvenor Square - in perhaps London's most prestigious area - Mayfair. I agree with Trump - it was a building of real status in a superb location consummate with what many would see as the US status in the world - and particularly to represent what is oft referred to - the USA UK "special relationship". 

Yesterday I had to visit the new US embassy at Nine Elms to obtain a visa to visit the US - so I am in a position to comment on the new building - ha!

The area of London Nine Elms is south of the River Thames. Nine Elms was / is most known for the location of London's largest fruit and veg market "New Covent Garden Market". It is a utilitarian area - and I would best describe the new US Embassy as on a "ring road" - an inner bypass - a far cry from the green and beautiful Grovesnor Square. The area definitely does not have the status of the former embassy site and it is certainly not as well served by transport connections. (The nearest tube - Vauxhall - is a 10 minute walk away).

However I guess the explanation lies in utility - not status. The new building is purpose built - so it should be fit for purpose - and I suspect easier to keep secure ( a very important consideration). On that point there were quite a number of special police armed with machine guns evident.

I attach a couple of photos I have taken of the exterior of the new building- admittedly close. Please make your own mind up about it's visual status. I have also downloaded one from the north of the river - it does look more impressive I think.

Just a quick comment on the visa I was seeking. A tourist visa would not do for my purpose. I need a higher status one as I will be arriving in Seattle by sailing boat. (The Chinese requirement - for the port of departure - Qingdao - is similar to the US - a visa and substantial fee). The procedure for getting the visa required supplying comprehensive personal information in the form of an online application followed by a subsequent face to face interview (the procedure at the embassy takes about 3 hours). It struck me by contrast how casual we are in the UK with who comes to our country - with the nonsense of free movement of people. I whole heartedly want a Brexit that gives us full control of our borders again with an ability through visas and passport control to monitor and control in purpose, character and numbers - who can come to our country.

The old - US Embassy Grovesnor Square - now sold to a Middle East business to become a luxury hotel.

The new - Nine Elms - south of the River Thames

#NHS privatisation or privatisation? - oh - & PFI (Private Finance Initiative)

It is in everyone's interest that when issues relating to the NHS and its future are discussed it is done without misunderstanding or knee jerk reaction. Unless we can do so there can be no rational debate - a debate that allows the best solutions emerge for the very complex challenges the modern day NHS faces.

A key term and one that is often used is "PRIVATISATION" of the NHS. Usually it is used when referencing the threat or perceived threat to the NHS posed by the Conservative Party - ie the Tories are/want to "privatise" the NHS.

There is a problem. "Privatisation" is a loose term. It means different things to different people. Unless it is possible to agree what it means or not mean we will have a problem moving on objectively and collectively - something we need to do desperately.

Here is an attempt to get the terms of reference for a debate about the future of the NHS on a clear footing.

The starting point :

Our National Health System (the NHS) has 3 core principles set down over 60 years ago when the NHS was formed. They are :

1. that it meets the needs of everyone.
2. that it be free at the point of delivery.
3. that it be based on clinical need, not the ability to pay.
   

In relation to those core principles what does "privatisation" mean. There are two possibilities and they are often conflated. They must be separated.

PRIVATISATION (Meaning 1) It means getting rid of the NHS as defined above and replacing it with another system - most likely an insurance based scheme as used in the USA and many other countries. (private health care). People who advocate this do so because they believe the NHS is inefficient, too costly, possibly too big to control and too unwieldy to meet future challenges and needs. Their conclusion is it is unsustainable and needs to be replaced by a better system. That better system will be paid for by individuals out of their own money - probably with the benefit of tax relief on premiums paid. For some it might simply be they see the possibility of making a great deal of money out of a new system.

PRIVATISATION (Meaning 2) It means the core principles of the NHS above are fully retained ie free to everyone based on need rather than the ability to pay but with the private sector (funded out of taxation) providing some/all of the services and treatments offered by the NHS.

Advocates of the private sector playing a part in the provision of NHS services and treatments might argue any of the following :

• It can offer choice.
• It can be more flexible.
• It can be niche.
• It can be more efficient ie the NHS becomes the customer rather than the provider. As such it can determine the contract and what it is prepared to pay for. This can encourage/require the provider to offer excellent service/results.
• It can sometimes offer better value for tax payers money than the NHS can provide for the same money.
• The private sector is often more innovative.
• The private sector can be more efficient and offering volume treatments such as immunisation injections - flu jabs - screening etc.
• It can be a way of the NHS obtaining new capital investment albeit indirectly. 

However there is plenty of opposition to this type of privatisation. Arguments against might be any of the following :

• For some it is emotionally and/or politically unacceptable to introduce "private" (and therefore profit motive) under any circumstances into the NHS.
• It is the thin edge of the wedge - a slippery slope. Those advocating Privatisation Meaning 2 are actually aiming for Privatisation Meaning 1 in the longer term.
• It must cost the NHS (tax payer) more because some money is being taken out of the system as corporate profit.
• Private puts profit before patient interest.

OBJECTIVITY NEEDED - MY ASSESSMENT (a personal  and lay opinion).

1. I do not believe any of the major political parties - including the Conservatives - want to Privatise the NHS as in Meaning 1 above as part of their manifesto or even hidden agenda. Apart from anything else it would be political suicide. 
2. However ALL parties faced in government with running and financing the NHS quickly realise how challenging it is to both fund and to meet public expectation.
3. Those that advocate everything provided publically (without profit motive) is good and everything provided by the private sector through Meaning 2 must be bad because there is a profit motive are being doctrinaire rather than objective.
4. The NHS is still almost entirely over (95%) outright public in its provision but bad care happens (South Staffs). Mistakes happen. Waiting lists happen. Targets aren't met. Over bloated management happens. Money is wasted - paying too much for drugs etc.
5. Some argue that 4 above is entirely because the NHS does not have enough money - or even - money should not even be a consideration in healthcare.
6. However resources come from taxation and are therefore finite. Choices have to be made about what is spent where. A terminally ill cancer patient can be given a very expensive drug that might extend life by 6 months to a year. That money could be spent on providing an extra nurse for a year and would help many patients. What is the right thing to do?
7. It is well documented and understood by the baby boomers (of which I am one) that the "public sector" can be very inefficient and wasteful. They are usually both monolithic and monopolistic - and as a result can be unresponsive to customers - badly managed - complacent and self serving. Not a panacea. We have experienced it first hand
8. As a result, past Labour and Conservative (and with the Liberal coalition) have seen there is a place for some limited privatisation under the NHS public umbrella. GP's and dentists are effectively "private businesses". Hospices are businesses albeit charity based ones. Many outpatient clinics are now run by private contact (such as Virgin) - for which the NHS pays and of course so are many support services - like IT, cleaning and catering. It is happening and by and large it works very well and there might be scope and reason to do more.
9. For me (8 above) is not an issue providing the NHS sets the clinical/medical standard. The important thing is not whether a particularly service is carried out by the Public or Private sector providing any private contract outsourced by the NHS - is paid for by the NHS and is free to the public based on clinical need rather than an ability to pay. Surely the most important focus is the quality of the service provided and not really who provides it.

So in summary I think the NHS is too big and the issues too complex for a one cap fits all mind set. The NHS must continue to challenge itself - find the optimum way of doing things - and the public would be irrational to be dismissive of private providers if they can offer a quality and cost effective service (for less money.) There is no doubt in my mind Public owned businesses can be wasteful and complacent and in some situations private business can do a better job.

A quick word about PFI contracts for those that do not know much about it. Private Finance Initiatives are very much in the news at the moment. Broadly these contracts/schemes started when Blair/Brown were running the Government. 75% of all existing PFI contracts were signed by a Labour Government. What are they? The Labour Government decided they want to provide new hospitals, schools and roads. However they do not want to pay for it by raising taxes. They could borrow the money - but that looks bad too. So what do they do? They find a private company to build the hospital, or school or motorway. The private company pays for it all before handing the completed building over to the NHS/Government. Look voters we have provided you with a brand spanking new hospital - vote for us! The deal is then the NHS/Government repay the private company over say a 30 year period. However now the penny has dropped - or been exposed - which is why it is in the news. Billions are outstanding to PFI companies and is costing a fortune to service. The tax payer will be paying through the nose for years and it is the Governments fault. There should be a lesson here for all those that want to consume now and pay for it later. Sooner or later the sh-t hits the fan. Better to try and live within your means. Morally better to live within your means than dump the liability on the next generation (your kids!)

#NHS Health service 'haemorrhaging' nurses, figures reveal

Too often I find myself frustrated by wilful inaccuracies or editorial political bias in BBC news but the link below is to an accurate and important article. For once it is an objective article about nurse numbers (there will be a similar trend with doctors) in the NHS and not a sensationalist and inaccurate one - laying the problem on Brexit or privatisation.

http://www.bbc.co.uk/news/health-42653542

The public - the nation should be very concerned about what is happening in the NHS. It is on a downward spiral. Why is it happening? It is happening not because the Tories are not committed to the NHS but because they have offered shocking and inept leadership - primarily in the person of Jeremy Hunt.

Jeremy Hunt is the worst type of leader. He is duplicitous. He lies. He uses weasel words. He is gloss without substance. He is loathed and despised by the workforce and there lies the problem. He has broken the workforce. His propaganda has been too good.

Doctors and nurses know decisions made have not been in patient interest - and therefore not in theirs - because they are not sustainable - but he has forced them through and many of the public (who believe they can have it all) have supported Hunt. The inevitable - the sh-t is now hitting the fan.

Here are two examples of what has gone wrong :

1) In a stretched NHS Hunt forces Junior Doctors to accept the principle of 7 day elective care. They know it is unsustainable because the NHS is already struggling to offer 5 day elective care. Hunt forces it through by battering Junior Doctors into submission. He lies. He says Junior Doctors are being misled by their union - that they do not understand what is on offer. (a ridiculous and insulting thing to say to some of the countries most intelligent, talented and vocationally caring young people). But he wins. He forces the new contract on them. But it is a pyrrhic victory - because the junior doctors and all the other NHS workers - nurses, paramedics and consultants who supported them - were right. 7 day elective care was and is unsustainable - unsafe - dangerous - because the resources are not there - cannot be there in the short and medium term.

At the time of the Junior Doctors dispute and every time since Hunt says he is going to provide 1000's of more doctors and nurses. Those in the NHS know this is impossible - why? - because the trained people do not exist. It takes 6 or 7 years to train a doctor! Of course Hunt's team have been plundering the world trying to buy in foreign doctors and nurses but there are language and qualification issues. It is also expensive. It turns out there are retention problems too for the same reasons our own doctors and nurses are leaving. It has not been the answer and it is probably immoral anyway.

2) CQC - and the inspection regime. Inspections are no longer primarily about observation but about a paper trail. The CQC mantra - if it is not written down it didn't happen. Nurses are continually filling out charts - fluids, food, pressure etc etc. This is very time consuming. It gets in the way of actual care. It is demotivating when you are working hard - long hours - trying to do the right things as a vocational carer - but being told you care is no good because you haven't filled in a chart. How do you think nurses feel? PS - when you think about it what does a tick in the box prove - other than the box has been ticked. Does it prove real considered care. The accumulated time taken up with ticks in boxes for every patient every hour of the day must be manifest.

So what has happened. The commitment of doctors and nurses through their professionalism and vocational calling has been abused by Hunt and to a large extent by the gullible public. (the public praise doctors and nurses for the job they do but they do not listen to what they are saying).

Most doctors and nurses do have a vocational calling  - they do not do what they do just for the money. But everyone has a breaking point.

• Many doctors and nurses are demoralised - even broken - because the NHS is not providing them with the time and resources to offer the good care they are desperate to provide. 
• Many doctors and nurses have a shocking work life balance. The hours they are being required to work and intensity of it - might be manageable over the short term - but it is not the short term. It is day in and day out and they do not believe Jeremy Hunt will help them. They believe he lies and exploits them for political reasons only and they see no end to it.
• All this would be hard to take for doctors and nurses - but it is made worse because they said it was going to happen with Hunt's 7 day elective obsession. It has happened and they are the ones left trying to handle the self inflicted carnage.
• To top it all health care professionals are aware of the bloated management structure carried in the NHS - for ever in meetings and on fat salaries. Reading there will be more specialist HR courses to aid recruitment and retention of nurses just shows how much is wrong in the NHS. The NHS does not need more HR or more managers. 

Consequently breaking point is reached. People start leaving. Staff start going on the "bank" because they can establish a more tolerable work life balance. Experience is lost. New recruits do not have the experience and leadership to cope. The ones that remain are worked even harder. They start to leave. Care implodes. This is what is happening.

Jeremy Hunt has abused and insulted the intelligence and vocational commitment of the experts in the NHS - doctors and nurses. They are the ones at the coal face too. Hunt can talk about "our NHS" - the NHS "we love and believe in" but he has offered shocking  - crass - probably immoral leadership for political and career expediency. The NHS is sinking and that is terrible - for both staff and patients alike. It is very very worrying and disturbing.

The solution. Get back to basics. Easy said - but there needs to be a truthful and honest dialogue between the care professionals, the government and the public. Somehow politics needs to be taken out of the debate. The government and the public need to start listening to what doctors and nurses are saying. They are saying it because they really care - but everyone has a breaking point and they are entitled to consider their own health and life too. They do not do what they do to be abused on a daily basis. Give them the proper resources and a half decent structure to do their job. Respect their professionalism instead of paying lip service to it.. Then they won't leave. Simple.

PS. Many NHS staff believe that what is behind Jeremy Hunt's (Tory) leadership of the NHS is a wilful and political strategy to grind the NHS down into failure in order to be able to replace it with a US type insurance based system. I do not personally subscribe to that but it just shows how bad Jeremy Hunt's leadership has been. The staff think he wants to destroy the organisation he is meant to be leading.

#London & Brexit

Can I set the scene (especially for my overseas readership - ha!). I had to go to London for a half hour appointment to get a Chinese visa. The journey to central London from my home on the Isle of Wight takes 2 to 3 hours. My appointment at the embassy was at 11am and my return journey was booked for 15.30 so I had some time to use. Unusually I had no prior plan. What to do on this bright, dry and cool day?

Well I walked (dawdled) from The Royal Exchange at the junction of Threadneedle Street (location of The Bank of England) and Lombard Street - "The City" - (although much of the banking sector etc have now moved to Docklands to the Canary Wharf area) down Poultry, Cheapside, St Pauls Cathedral, Ludgate Hill, Fleet Street, Strand, Trafalgar Square and Whitehall, Admiralty Arch, The Mall, Horse Guards Parade, St James's Park, Buckingham Palace and Victoria. It is not far - an easy mainly flat walk.

I had plenty of time to observe, think and reflect. Here are some random pearls!

• I read somewhere - an observation - "London is a world class city in a 3rd world country". Discuss. Justify! Well this observation makes me smile - sadly. It obviously depends on your assessment criteria. I can see merit in it - but London is not where I would want to live or what I would want our country to be.
• Having said that every time I go UP to central London (you go up to London from the South and South West - down to London from the Midlands and the North) - I get a buzz. I think not because of what London is now - but because of its history. It is everywhere - everywhere you walk - every corner you turn - there is a famous building - a famous street name - a landmark - the Thames. It is wonderful in that sense. Samuel Pepys, The Tower - the Fire of London - the Black Death and then Dickens - legacies of Empire - the great Victorians - and Churchill and the 2nd World War. Amazing.
• I got to St Pauls Cathedral and sat down outside. The last time I had done so was when I came up to pay respects to Margaret Thatcher on the day of her funeral. Margaret Thatcher was a controversial figure. In my view she saved this country. She would get my vote after Churchill for the greatest British citizen. We owe a huge amount to her. (young people today should read their history and not fall for the cheap propaganda of the socialists regarding the Thatcher era.) If only Maggie was here now. Her commonsense, weight of personality, good values and energy and determination would sort Brexit out. I hoped Theresa May was going to be more like Maggie - but unfortunately she has fallen well short.
• It is then down Ludgate Hill where I watched Margaret Thatcher's funeral cortege go by. The crowds were massive that day and they were overwhelmingly respectful and moved. There was a lot of predictions about protesters. There where a handful. They were pitiful.
• Central London is prosperous. Every shop unit is filled. It is an up together place. It is good to see - but at what cost to community?
• There are a lot of anti terror precautions in situ - massive concrete bollards.
• I see a narrow road called Old Bailey. I walk up to the Central Criminal Court. You can go in the public gallery. I have done it before at the High Court and local Crown Courts. A fascinating free watch. But now the rules - no mobile phones and they will not hold them for you. So another day.
• I am now in Fleet Street - once where all the national newspapers were printed. A famous red on the Monopoly Board. 
• It is lunchtime. I rarely drink during the day but I love visiting interesting London pubs. Today it was The Old Bank of England. Here is their marketing blurb. It was very impressive inside. A pint of Fullers London Pride. Only down side. £4.80 per pint!
• In the 16th and 17th centuries, two taverns stood on the site of the Old Bank of England. ‘The Cock’ and ‘The Haunch of Venison’ were both demolished in 1888 to make way for the construction of the Law Courts’ branch of The Bank of England.
  
  The Bank of England traded here for 87 years, until 1975, when the premises were sold to a building society. In 1994, London brewers, Fuller, Smith and Turner took over the lease and began a major refurbishment - with the aim of restoring the splendid building to its former glory.
  
  The Old Bank of England also has a more grisly connection with the past, for it lies between the site of the barber shop owned by Sweeney Todd, ‘The Demon Barber of Fleet Street’, and the pie shop owned by Mrs Lovett, his mistress. It was in the tunnels and vaults below the present building that his victims were butchered before being cooked and sold in the pies to Mrs Lovett’s unsuspecting customers.
  
  As the former branch of The Bank of England, the basement still contains the original vaults used to store bullion, and indeed some of the Crown Jewels during the First World War. Whilst two safes have now been changed to hold our cellars and kitchens, the main vault is intact – and still contains the huge steel bullion cupboards.
• On to the Strand - pass the High Court - Royal Courts of Justice. The frontage is very familiar - where so many case participants have faced the cameras for the news.
• London is relatively quiet today but still it is high pressure living. In to Trafalgar Square, across Whitehall - on to the Mall and into St James's Park (observe maybe the best fed squirrels and birds in the world!) As I have said before the place names are so evocative. Makes you feel you are participating in a living history.
• I get to Buckingham Palace. There are ALWAYS mass tourists there. Evidently Liz is not at home - no flag. It is a bland looking building - but she is not short of rooms - ha!

Anyway I am rambling. I spent a lot of time thinking about Brexit. The way it is playing out is driving me nuts - very frustrating - but you can sense why when you visit London.

London voted remain. In fact London has been described as a REMAIN island in a largely national sea of Brexit. Here is the vote analysis. http://www.bbc.co.uk/news/uk-politics-eu-referendum-36612916

London is a multicultural melting pot. Immigrant/migrant numbers have been huge and sustained. Tourism and student numbers are massive too. Put together the cultural mix is incredible and dominates. The capital is also the primary base for what might be described as the UK's "liberal elite establishment" - and left leaning "cultural" glitterati - the champagne socialists. Perhaps more than anything it is a honeypot for the wealthy and major international business - particularly service and financial based businesses - now much concerned about our trading relationship with the EU. It is not typical of the rest of the UK. I would go as far as to say London does not feel or act like it is part of the UK. It is anonymous. It is impersonal. It is devoid of collective community. It has its own disparate agendas with powerful pressure groups - all media savvy.  People are there for their own reasons - and much is transitory - opportunistic. London and the people that now live there see Brexit as a threat to its/their preeminence and consequently voted for and continue to agitate to stay in the EU - even if it flies in the face of our nations democracy.

Much of the Brexit vote in the UK was to resist becoming like London. To resist London's economic and cultural and political domination - to resist the self serving interest of London. London's agenda and its persona is not what the majority of people want for their country. They want to preserve their communities. They want to make their own rules and plan their own futures. They want to spend their money in the way they want and stand on their own two feet in the world. They are sick of conceding these things and all that goes with it to unelected bureaucrats, political elites - especially left leaning liberal elites and of course international business (only interested in growth and profit). It is not working for them. It is threatening their way of life. They want their nation to be free again even if there is a short term economic cost. There is now a battle - largely characterised as London remoaners against the rest. The rest must win - they have the democratic mandate.

London is great to visit as a tourist or maybe as a place to live for a year or two - but as a way of life - it is not what the majority of the people of the UK want and they have voted to leave the EU accordingly. Hopefully London will be taken down a peg or two in the pecking order and through decentralisation and reduction re engage with the rest of the UK on a unified and common UK agenda. It should mean it will no longer be a honeypot for the EU and that without doubt will be a good thing for the UK overall. Bravo.

Old Lady of Threadneedle Street - the Bank of England

Royal Exchange - Lombard Street - The City

Views of St Paul's

 

Old Bailey - Central Criminal Court

The Old Bank of England

The High Court

Looking back to Horse Guards Parade from St James's Park

Back of Whitehall and Downing Street

Views of Buckingham Palace and St James's Park

#Leadership PT4 Innovation (especially in sport) by Matthew Syed

About a year ago I wrote several blogs about my experiences relating to leadership.

This morning I came across this fantastic article written by Matthew Syed. I commend it to you - especially if you are an Arsenal or Manchester United fan - ha!

https://www.thetimes.co.uk/article/wenger-and-mourinho-failed-to-learn-from-ferguson-6qc6pg9vh