Morning

A letter from England:

Simon. Thanks for your comments. Hopefully the blizzards will be gone by March but you never know, as for a strike not very likely, despite attempts at portraying unions as gung ho we are very compliant and malleable compared to our European cousins.
The big story here at the moment is Chris Huhne's fall from grace. Spectacular and depressing. Another nail in the coffin of trust in politicians There has been a very muted response to Burnham's announcement, perhaps a case of Be Careful of what You wish For.  Or perhaps just fatigue at the thought of yet another re-organisation of the NHS. It'll be interesting to see how this plays out.
I am fascinated at your experience of doing voluntary work. I agree with you that self-help and voluntarism can be very positive, and regrettably officialdom has made this increasingly difficult. We have to admit that the public sector is often paternalistic (despite genuine attempts at the opposite) and off-putting rather than embracing and partnership oriented. A sweeping statement I know and unfair  in some circumstances but there can be no doubt that excessive legislation and mindless bureaucracy has grown up, mostly piecemeal, over the years, often for good reasons but sadly a whole range of unintended and negative consequences have emerged which often lead to the experiences you so graphically describe. Underlying this there has grown up an almost pathological aversion to risk which stifles creativity and initiative at a time when we need them most. There is a tendency to respond to problems by adopting legal or bureaucratic means (sometimes these are necessary) rather than solving the underlying real causes which in most cases are cultural and behavioural.  These are more difficult to deal with and do not  easily fit into a climate of Quick Fix and Sound Bites peppered with blame games and finger pointing (very different to true accountability).
I can't remember last time I heard the phrase ‘Big Society’. It has disappeared from the political narrative I fail to see how (or understand ) the reduction of the public sector or the rolling back of the state will promote the Big Society. I think the government don't understand it either or can find any credible narrative for it, hence it has been allowed to fade away. It is more likely that the vacuum will be filled by economic interests and/or ‘intelligent’ criminals. Read some fascinating stuff about what has happened in Russia in the last 20 years and the conclusion the commentators come to is that it is a Mafia State ("where there is money there is organised crime") where it is impossible to distinguish between legitimate and illegitimate activities. In fact the distinction is meaningless, ditto for politicians and criminals. A rather frightening look into a possible (but not inevitable) future.
On a slightly different topic linked to my previous observation about inequality I have come across a commentator called Robert Reich, Harvard academic and member of both the Carter and Clinton administrations, so hardly a left wing loony. He has made a film called Inequality For All based on his book Aftershock which are attracting attention. I have not seen it or read the book but there was a comprehensive article about his thinking in the Observer last Sunday (see also). The statistics on inequality are eye watering (e.g. 400 individuals own half of the total wealth of the USA ) and merely confirms other statistics I have seen. Interestingly he is not opposed to inequality as such but identifies the point at which it becomes problematic (we are long past this point) and why, as well as offering some solutions (higher taxes will produce increased productivity! Osborne will have a fit). Reich claims UK's austerity as a ‘cruel hoax’ which simply does not work or will work. I suspect he will not be invited to the Tory conference but it may give some food for thought for Labour. The value of property in the ten richest boroughs in London is equivalent to the value of all properties in Scotland, Wales and Northern Ireland put together.          Have you seen the report on Mid-Staffordshire hospital? Depressing and a real eye opener. Clearly there is something deeply wrong in many parts of the NHS  and a reminder that being in the public sector is no guarantee in itself that there will quality and dignity in the services provided, but I remain convinced that the current changes are not the way to solve the problems which in my view are largely cultural and behavioural compounded by a large dose of managerial incompetence at every level of the NHS reinforced by a government (Labour) obsessed with targets and statistics. The patients did not get a look in. What is worse is the total contempt with which both patients and their relative were treated. Hundreds died prematurely often in traumatic circumstances. Surely some accountability is not unreasonable. A national scandal really but I have seen no evidence or heard any convincing arguments that the current changes (i.e. privatisation, fragmentation, competition, etc) will improve the service. I have heard plenty of ideology and political spin but it seems to me that cooperation, co-ordination, competence (the 3 Cs) are more relevant to success and despite paying lip service to these they are sadly absent, so is any attempt at accountability and democratic transparency. Just look at the make up of Commissioning Groups (e.g. local elected members are banned from being members). The proposed Well Being Groups have still to prove their worth (I still don't understand what they will actually do but I remain open to be convinced. Could easily become talking shops). I do however welcome the transfer of public health responsibilities to local authorities; but in itself it doesn't do anything but there is  the potential to be creative and use it as a springboard for additional duties when Andy Burnham becomes minister! Enjoy the Greek weather. Winter has returned here. Best Jan