Chaos requires anaesthesia

‘A little poison now and then: that maketh pleasant dreams. And much poison at last for a pleasant death.’

Former Auditor General Sir John Bourn has given us a sketch of what a mediocratised civil service looks like.

Too many schemes today are like the structures children build with toy bricks — unbalanced, constantly wobbling, complicated to shore up and only too likely to come tumbling down — as in the arrangements for child support, and in the recent ill thought-out schemes for capital gains tax and the taxation of non-domiciled residents, which had to be amended even before they were put into operation ...

The machinery of government is in constant turmoil — new departments and authorities being set up and older ones shut down or amalgamated. Such churning costs millions of pounds and is largely irrelevant to the programmes and projects that have to be implemented ...

Time and again, the rapid movement of officials between widely differing jobs — often every two or three years — means that the wheel has to be reinvented repeatedly.

Contemporary government seems to be obsessed by presentation and the resulting need for continual rebranding. In other words, it suffers from the same style-over-substance syndrome that we see in contemporary high culture and academia. But does anyone really care?

In mediocracy what matters is what the majority thinks, or what it can be manipulated into thinking. Social consensus is the only criterion of reality. Since society sees what is presented rather than what is behind the image, appearance becomes more important than substance. Naming and labelling are social activities; their significance therefore outweighs the question of content.

Mediocracy is essentially an ethos of stasis. However, it needs to wage constant war against those who might threaten this stasis. Paradoxically, the struggle to maintain stasis is aided by undermining stability. Chaos in the social realm is helpful; it is loss of control in the cultural realm which must be avoided.

* * * * *

The LA Times’s Meghan Daum on the cultural journey from Sixties to Noughties:

If we're looking for a yardstick to measure how people's feelings about consciousness have changed over 40 years, we could do worse than to consider the enormous philosophical gulf between LSD and, say, Prozac. Whereas one purports to expand the mind, the other belongs to a class of drugs whose phenomenal success rests largely on their ability to keep the mind from expanding into uncomfortable places ...

No wonder no one does LSD anymore! It's utterly incompatible with the contemporary American lifestyle. You have to make time for it, you can't multitask while you're on it, plus it might be unpleasant. Ecstasy, on the other hand, is known to offer a one-dimensional, blissfully brainless high ...

Antidepressants, which, according to the Centers for Disease Control, are the most widely prescribed drug in the country, might not make people love the world, but they can be highly effective in keeping them from hating it.

Anaesthesia is important in keeping the citizens of a mediocracy sufficiently mindless, in order to avoid potential discomfort turning into criticism. (Though the few unwilling to be doped — whether by means of chemicals or mind-rotting pseudoculture — will find that the platforms of distribution available for the dissemination of their criticisms are confined to those despised by the elite.)

The well-adjusted individual in a mediocracy does not concern himself with the question of whether the changes that are happening around him are desirable. He is sufficiently mature and sophisticated to appreciate that the people in power are trained experts, who know more about the relevant issues than he does.

Certain phenomena, which might once have been experienced as alarming, need to be seen as inevitable signs of modernisation. These include such things as lying by officials, dumbing down, dismantling of civil liberties, increasing aggression, and the redefinition of terms and concepts.

Car parks & other weak links

Good organisation means paying attention to detail, and aiming for the highest standards, even if you don't always reach them. But what if you have a culture in which it is regarded as correct to have a relaxed attitude to detail, and in which high standards are seen as conflicting with an egalitarian ethos? (Aiming for high standards may go with trying to be better than others, or even — heavens forfend — feeling superior.)

From the discussion forum Grumpier Old Men here are two stories, from different individuals, about the British state medical service — the one which Michael Moore would like America to emulate. Via GP Dr Crippen, who says "It is not exaggerated. I see it every day, day in, day out."

Have a heart attack, I did on Thursday night ... I needed an Angioplasty, and a stent. Because Milton Keynes Hospital did not have an on call surgeon to perform the op, I needed to be moved to the JR hospital in Oxford, about 40 miles away ... Some bright spark decided that time was crucial, and asked my wife if she would help save time at the other end by shaving my groin in preparation for the angioplasty ...

Then the hospital needed to provide an ambulance with a member of staff trained on the defib machine to take me to Oxford ... after 45 minutes of listening to a matron drone on about needing to check protocols and ensuring that all risk assessments were complete, they drove me to Oxford. For 45 minutes my heart was being damaged but nobody moved because of the [health & safety] mafia ... Finally got to Oxford, and the 40 minute operation took two and a half hours, but I came out ok.

At 7 am, after a stressful night, my wife went back to the car in the car park in the JR hospital. When she [had] arrived at 3 am, all the barriers were up and no ticket was issued. After 6 am, you need to pay with a ticket to get out. Because she had no ticket, she could not pay. Because she could not enter the car park, she could not get a ticket. No parking staff were available until 9 am. For an hour she was trapped in the car park, until someone else who was trapped measured the gap and found she could just fit along the pedestrian pathway and leave illegally ...

Then Milton Keynes hospital said they did not want me - sorry, no bed available. I was kicked onto another ward, and kicked out after two days. Never did get back to MK, never did get the proper cardiac debrief session from a doctor. They needed me out of the bed, so I went to the transfer lounge, and waited for my five packs of pills. Four hours later, I finally got my pills.

and

[Friend with broken ankle] arrived in an ambulance, no wheelchairs availaible on arrival to casualty. Eventually they found a swivel office chair on wheels. They wheeled her in. She waited 4 hours to be seen, after having spent 2 of them desperate for a wee! Yep think its broken you need to go to xray!! No porters availaible. She phoned a friend, friend arrived to push her on office chair to xray! Yep its broken you need to go back to casualty. Friend wheeled her back ...

Back in casualty waited another hour to be told she had to go to fracture clinic. Friend had to leave to pick up children from school. Still no porters, arrival of a neighbour who took over portering duties and wheeled her to fracture clinic. She was impressed as to the choices of colour of cast she was given!

Back to casualty (again!). OK you now need crutches so you have to go to physio dept. Neighbour had to leave to see to her and friend's children! Still no porters, by this time she had seriously lost the plot!! She had arrived at 9.45 and it was now 5.30, nothing to eat or drink, no feedback as to after care. Eventually a porter was found, crutches distributed, pushed back to casualty, had to contact a taxi to take her home. Time now 7 pm. She arrived home and pulled herself through the front door depressed at the thought she had to return the next day to have cast replaced!!!!!

I wonder whether there are any illuminating parallels with the Terminal 5 fiasco, where small mundane things such as car parks again turned out to be important in the scheme of things.

Almost 300 flights in and out of Heathrow Airport were cancelled during the first five days as teething problems at the new Terminal 5 caused chaos ... The problems appear to be due to a combination of factors. Some were technical, involving glitches with the sophisticated new baggage set-up, which is designed to handle 12,000 bags an hour.

But other issues were more mundane. Employees arriving for work, for example, could not find their way to the staff car park ... The first warning signs came as early as 0400 GMT on Thursday when passengers began to arrive, only to be confronted with the same problems as the staff in trying to find somewhere to park. The road signs were apparently not clear outside the terminal, and people said they were given wrong directions once inside.

But that was only the start of their problems. All the check-in desks were apparently closed at 0400 GMT, leaving passengers no option other than to form a queue. (BBC News)

No matter how many training courses, checklists and other safeguards you institute, the underlying ethos and motivation will show through. Lower people's interest in standards and, sooner or later, you are likely to get lower standards. And attitude to standards is probably not unconnected to how one feels about doing things for other people.

* * * * *

Consider the post office closures. I realise there are all sorts of arguments about market forces, whether you should have subsidies, whether there are bureaucratic obstacles, and so forth. But look at the ultimate outcome. We have a government that seems willing to spend freely on schemes which are supposedly in various people's best interests, but which as far as I'm aware have not resulted from the electorate's urgent demand for them — e.g. food education programmes, citizenship classes, "ethnically diverse police mascots". Yet this same government appears to have little interest in maintaining a service which a large number of people clearly find highly desirable. As usual, market arguments are applied selectively. *

In a mediocracy, the concept of service has been redefined. This is because the idea of one individual doing useful things in accordance with the wishes of another is considered too threatening. People are taught to find it demeaning to be useful. They are encouraged to believe that they should not have to do simply what other people want, and to feel instead that they have a right to exercise their judgement and creativity. Ironically, this ethos is described as 'individualism'.



* Interesting, incidentally, that Simon Jenkins ("stop wailing") seems to have changed his mind: he now appears to be in favour of retaining village post offices. Also, he uses the word "Orwellian". Flattery indeed.

How many deaths will it take?

The story about Maidstone Hospital shocked and appalled even me, cynic about state medical services that I am.

For some time I've been in little doubt that eventually, a medical system such as ours — without any effective consumer power — would descend to the level at which patients are left to lie in their own filth. I was however surprised last week to find that the NHS has in part already begun to reach that level.

In my opinion things can only get worse.

Consultations, reviews, reports, admonitions, penalties, more training, change of management, increased funding — none of these things can overcome a basic absence of incentive. Once a culture of efficiency and diligence has declined in a particular corporation or profession beyond a certain point, nothing can retrieve it. It basically has to be dismantled and you have to start again.

I wonder how much worse things will have to get before the penny drops, and people overcome their fear that without a nationalised medical service they will be at risk of receiving no decent medical care. And start considering the possibility that the risk is higher with a nationalised service.

Here are some highlights from the Report of the Healthcare Commission's investigation. ("CDF" = Clostridium difficile, the hospital-based pathogen responsible for 90 deaths at Maidstone Hospital and Kent & Sussex Hospital during 2004-2006.)

[In one-third of the 50 CDF cases which were investigated] the medical records did not indicate that doctors had regularly reviewed patients’ CDF infection after it had been diagnosed. ... In at least five cases, we could find no mention of CDF in the notes after it had been diagnosed. This was despite evidence of continuing symptoms from the infection, for example, diarrhoea or abdominal symptoms. [p.32]

In 22 cases, neither a microbiologist, infection control nurse, outreach clinician, nor gastroenterologist was involved in the care of the patient. In six of these cases, CDF infection was considered definitely or probably the main cause of death. [p.32]

35 patients were started on antibiotic treatment within two days of a positive result; five patients three or more days after the result became available; and 10 were not started on antibiotics, either because the diagnosis came too late, or for reasons not clear from the notes. In 12 cases there had been a delay of over one week between development of symptoms and starting antibiotic treatment for CDF. [p.33]

On at least two occasions, the reviewers concluded that a delay in starting treatment had occurred because of an initially negative microbiology result that was not repeated for several weeks despite persistent diarrhoea. There was evidence of serious deterioration in a manner consistent with CDF infection during this time in one of these patients. [p.33] [Moral: if a medical expert says you definitely haven't got a particular ailment, perhaps you shouldn't necessarily take their word for it.]

In general, there was little evidence that, once CDF had been diagnosed, patients were routinely and actively monitored for signs of severe CDF infection, particularly colitis. [p.34]

In at least seven cases, the reviewers were concerned that patients had not been managed in accordance with their resuscitation status. This was because these patients were recorded as being for “full active treatment” ... but did not receive fairly routine interventions such as nasogastric feeding or an abdominal X-ray, where it appeared that these were indicated. [p.35]

The overwhelming majority of relatives and patients who contacted the Healthcare Commission were not happy with the nursing care received at the trust. Words used by a few included “despicable,” “sickening,” “appalling,” “chaotic.” [p.39]

One family were very concerned that after the sister on the ward had reprimanded a nurse for a further error in giving medication to their relative, they were seen “laughing and joking” together five minutes later. This gave the impression that the matter had not been taken seriously. [p.39]

Some patients and families told us they thought that the trust was unwilling to acknowledge that patients had the infection, particularly in the early months of 2006. ... Some families were concerned that signs and notices relating to infection and isolation were inconsistent or missing. [p.40]

We observed 29 wards during our visits to the trust. Twenty wards at the trust were observed as having basins that were hard to reach or obstructed, either on the wards or in the utility room. There were mixed male and female patients on 15 of the wards we visited and three had unisex toilet facilities. Even when patients of the same sex could have been grouped together in a bay, this often did not happen. It was particularly unfortunate for patients with CDF infection to be with patients of the opposite sex, since they often had diarrhoea many times a day. [p.43]

Not only were there were very few hand basins on many of the wards, but some of these were difficult to use because they were next to beds. In 2004, the existing basins were replaced on the Nightingale wards at Kent and Sussex by mistake. The intention had been to add extra ones. This therefore led to no overall improvement in the number of hand basins. ... At Kent and Sussex Hospital the average space between the centres of beds was 2.3 metres, with some as narrow as 2 metres. [p.44]

We observed eight bedpan macerators (machines for the destruction of disposable bedpans) to be in a poor condition on eight different wards. They were dirty, rusty and leaking. These posed a potential risk as leaks could soil the environment ... On an unannounced visit in April 2007 we found bedpan washers at the Kent and Sussex Hospital that were not working, resulting in bedpans that had been washed still being visibly contaminated with faeces. [p.45]

Judging by this blog reaction*, the medical profession is in semi-denial about this scandal. How can it be the highly trained professionals who are at fault? To suggest so would be to raise the possibility that their motivation might not be as driven by lofty concepts like duty and sacrifice (as opposed to financial considerations) as they would like us to believe. Which would undermine their claims to be allowed to have power over patients on the basis that they alone are suited to judging 'best interests'.

I note from the BBC report that the Commission "began its investigations amid a string of complaints about cleanliness, and was particularly alarmed after the trust claimed no-one had died from the condition despite admitting there had been hundreds of cases. This seemed highly improbable given that the average death rate is between 6% and 7%." No doubt the trust thought it best not to generate unnecessary panic, or unhelpful scrutiny.

So do you still want to "trust your doctor" (or other health care professional)? Even though he/she is not really working for you, but on behalf of society?

* via The Last Ditch

Vulnerable models - a selection

Front page of Friday's Financial Times:

Questions over the competence of the Financial Services Authority moved to the fore yesterday ... Some of the UK's leading institutional investors, speaking on condition of anonymity, also turned on the FSA. One said ... "Northern Rock has fallen foul of the dislocation in markets. But the model was always vulnerable. Why wasn't that spotted?"

Possible answer: Because under mediocracy, the paradigm role for managers in the regulatory sector — as in most other sectors — changes from (a) taking responsibility to (b) applying rules. So long as no specific rules are contravened, an official can be considered to be discharging his or her responsibility. Conversely, the enforcement of rules becomes paramount, and trumps the application of individual judgement.

Here are some more vulnerable models. When these lead to failure, do/will people wonder why their particular flaws weren't spotted?

• free university education for everyone ( → free university education for no one)

• guaranteed state pensions for all ( → guaranteed state pensions for none)

• free medical care for all ( → rationing and refusal)

• university admissions meritocratic and evenly distributed among social classes ( → university places by quotas and/or lottery)

• safety net and liberty for all ( → health authoritarianism)

• education without market forces ( → pupils cannot read, write or add up)

• perfect egalitarianism and fairness ( → spin, concealment, and a new elite)

Mediocracy in banking: the mess spreads

Further to this, the current credit crisis is still expanding rather than contracting. The commercial paper problem has not gone away. There is something odd going on with German banks. And now we have the first British bail-out: Northern Rock.

As Willem Buiter writes,

It is clear that the conditions for a justifiable bail out ... were not satisfied. ... I can only conclude that the Bank of England is a paper tiger. It talks the ‘no bail out’ talk, but it does not walk the walk.

Talking the talk, but not walking the walk. Also known as 'style over substance', or 'appearance over content'. A key characteristic of mediocracy.

How dare you say the Emperor has no clothes

One thing that is crucial in sustaining a mediocracy¹ is to protect it from criticism, and to conceal its underlying deficiencies as far as possible. Even if it isn't possible to conceal problem areas from the people who actually come into contact with them, we can make it impossible for their observations to receive a platform. The media, in particular, must preserve the myth that nothing is fundamentally wrong. (The only section of the British media which doesn't quite play according to this rule is the Daily Mail. Which is probably why it's so despised by the establishment.)

At the same time, the dissatisfaction and restlessness produced by the deceptions and repressions of a mediocracy¹ need to be directed at a suitable target, though obviously not the government or the statist machinery. What is left, then, is the commercial sector and private individuals.

So we get a kind of double standard for "whistleblowing" (insiders drawing attention to dishonesties or shortcomings). Where the private sector is concerned, it is encouraged; when it is the state that is exposed, it is punished.

Another way of looking at the issue is that it's a consequence of mediocratic phoneyness. A misplaced pseudo-egalitarianism means that things have to look as if they're more open and democratic, and as if ordinary people can make a difference vis-a-vis entrenched power groups. In practice, the 'egalitarianism' is driven by a top-down pro-state elite which cannot tolerate rival power groups or, indeed, any kind of dissent. Hence the 'paradox' that New Labour, marketed in terms of opennness and accessibility, has been one of the most dangerous British administrations to be on the wrong side of since the Cromwellites.

In Monday's Telegraph, Admiral Sir Alan West advocated snitching on your neighbours if you suspect them of being terrorists. (Funny how the problems of terrorism — arguably created by the state with its paradoxical mixture of (a) failing to stand up to authoritarian threats from certain minority communities and (b) a gung-ho approach to military intervention in other people's countries — are generally to be solved by making the lives of private citizens more uncomfortable.) This follows hot on the heels of Home Office plans² to require council workers, charity staff and doctors to tip off police about anyone who they believe could commit a violent crime.

On the other hand, consider what happens to those who blow the whistle on possible defects in the state apparatus:

the late David Kelly — thrown to the wolves by the Ministry of Defence for questioning pre-war propaganda;

Jack Lemley — rubbished by the government for daring to reveal the fiasco behind the London Olympic project;

Rita Pal — smear campaign by the General Medical Council³ for drawing attention to illegal practices in Midland hospitals⁴;

most recently, Angela Mason — suspended for filming the reality of life in inner city comprehensives⁵.

¹ Applies equally well to communist or other authoritarian regimes
² h/t Not Saussure via Shuggy
³ As the principal body behind a professional monopoly remunerated predominantly from state sources, the GMC is effectively an arm of the state.
⁴ h/t Devil's Kitchen
⁵ See also Educational Conscription

Oh no, logo

"The most unpopular logo in British history" - David Smith, The Observer

"A puerile mess, an artistic flop and a commercial scandal" - Stephen Bayley, Design Museum

"Vicar on a motorbike syndrome" - Ian Jack, The Guardian

"Variously compared to a broken swastika, a smashed window, and two characters from The Simpsons engaging in a sexual act. ... 22 epileptics experienced seizures after watching an animated version of the logo; another viewer vomited at the very sight" - The Week

Why use many words, when one word (beginning with the letter M) will do?

The new betamax?

I remember when video recorders came in. (Yes, Dr T is that ancient.) Anyway, there were two rival formats, betamax and VHS. (Wiki it if you're too young.) All my highly educated, thoughtful friends — well those who were geeky enough to have a view — were sure that beta would win the competition.

Fast forward ten years: beta is dead. If you have any beta cassettes (weddings, rare movies) you can play them until your beta player packs up. After that you've had it.

Beta probably was the superior format. It was smaller, for one thing. But VHS won out, presumably because of some historical advantage (sorry but this is so boring I can't be bothered to wiki it myself to check) compounded by the network effect.

Moral? Markets aren't perfect. Well, whoever said they were? I, for one, not. All I ever say is: markets are the least bad option.

To get onto the real point. I wonder whether Typepad is the betamax of blogging.

When I started blogging, a certain well-respected blogger, fairly high in the blogocracy, advised me to use Typepad. "Far far better than Blogger", she said. "Be aware that blogger.com will let you down sooner or later." And what she said seemed to be confirmed by online commentary, and by the fact that among the most highly regarded quality bloggers, there did seem to be a distinct bias towards Typepad. Plus by one or two teething problems when I started using Blogger. For example, the image upload facility was extremely dodgy. "It's okay in Firefox," the "help section" helpfully advised. (Isn't it ridiculous the way many current help sections take a "can't be bovvered" approach, and leave it to the victims to form mutual error support networks? And that's how I came to use Firefox for posting, though not for browsing. Technical note: the mediocracy blog is best viewed in IE7.)

However, for some time I have taken a very defensive approach to technology. Don't try to be clever. Don't be the first to try something sexy and new. Do what everyone else does; follow the crowd. I used to slightly look down on people who took the "you can't go wrong with IBM" approach. Now I think it's the best thing you can do. And it's not just a question of age. It's simply the safest option in a world becoming dominated by mediocracy. (BTW, thanks to those who left comments on Mediocratic Microsoft. It's possible I will be forced to try Linux or Apple at some point, but meanwhile I'm staying as put as possible.)

Typepad may well have been the better choice, even as little as six months ago. But the trouble is, we live in an increasingly monopolised, big-players-only world. (So much for the phoney "end-of-competition", "lots-of-little-players" fairy tales from techno-utopians such as James Moore or Don Tapscott.) That's why I stuck to Blogger, because it seemed to be the slightly more dominant player.

And I'm starting to see slight signs of a crack-up. Just little things so far, nothing major. One or two Typepad sites that don't load properly, or load slowly, or don't load at all.

I don't want to alarm anyone, and I certainly don't want to accelerate anything already in progress. And I'm not saying it's the right thing to happen. I don't know if Typepad is "better" or not, it probably has some pros and some cons.

More importantly, I don't think it's at all healthy if the duopoly collapses into monopoly. Unfortunately, web stuff — and software generally — has a distinct tendency to do so. Trouble is, there are relatively few diseconomies of scale for a business that is purely technological. The efficient size for such a business may well be equal, or nearly equal, to the total size of the market. Unless you get a natural division into two distinct markets, as has happened with IBM/Microsoft vs Mac. But that's the exception to the rule.

Sooner or later, one side will start to dominate, and that is likely to be the beginning of the end. Unfortunately, purely on the basis of current economic strength, it is likely to be Blogger.

Talking out of my hat? Please use the comment function.

Mediocratic Microsoft

My experiences with Microsoft products have mostly been fairly good. Although the company (like many others) has a tendency to do updates more often than necessary, and to add more bells and whistles than is optimal.

However, I wonder whether Gatescorp is succumbing to the mediocratic virus.

I've been helping a colleague get used to her new PC, which came bundled with Windows Vista, the latest version of Microsoft Windows. Her previous PC had Windows XP. Two things (so far) have struck me as pretty damn unsatisfactory.

1) Her Hewlett Packard printer/scanner, which is a fairly recent model, wouldn't work with Vista. When I tried downloading a driver, I was told by the HP site "Driver not yet available. Should be available March 2007." (It was March 2007.) Now surely MS shouldn't release a new version of its operating system until it has ensured it's downwardly compatible with all existing products, especially those from major suppliers such as HP?

2) Several emails in her inbox cannot be deleted. Windows Mail reports an "unknown problem" and directs you to the MS support site. Where someone, who appears to be MS-authorised, advises in one of the threads (which you have to search through to find the relevant one) that the solution is to use the command prompt and instruct your PC to reorganise the mail files. And that it probably shouldn't be necessary to delete all your mail files. What??? You have got to be kidding me.

Do you try to do things perfectly, or do you aim for "99% error-free"? Looks like MS have started to pick the mediocratic option. Let's hope for all our sakes other major corporate players like British Airways don't follow suit.

Smiling demned nurses

I didn't mean to blog today, but it's hard to resist an opportunity like this when it falls into the lap of the MEDIOCRACY prism.

PROBLEM

1) A state monopoly in medical care has resulted in the gradual loss of a professional ethic which was always ultimately inspired by the profit motive. With no financial incentive to behave nicely towards patients, many doctors and nurses have simply stopped doing so.

2) This lack of incentive extends to delivering medical services to a high standard of quality and efficiency. Why bother? Just so your colleagues will respect you? But their respect no longer depends much on this, and anyway peer pressure isn't sufficient to generate quality or efficiency, as we know from our experience with nationalised industries.

3) Because of an irrational fear on the part of most people that the abolition of the NHS would entail a complete loss of medical care, it has become impossible even to discuss this option. Tinkering at the edges by means of 'internal markets' and similar has simply made things worse.

4) For the foreseeable future therefore, we are stuck with a medical system which will get progressively worse, even with more and more money being pumped into it. Although patients are usually unable to assess the technical quality of what they receive, they are astute enough to notice whether they are being treated like (a) paying hotel guests or (b) prison inmates.

SOLUTION

Train staff to "smile" more at patients.

THE government is considering a new scheme to improve the National Health Service: encouraging doctors and nurses to smile at patients. The proposal was presented at Thursday’s cabinet meeting as the culmination of six months’ work by the brightest minds in Downing Street. A cabinet source said: “One of the things that came out of the focus group discussions was that they didn’t feel nurses and so on gave the impression that they cared enough. They felt, for example, that they should smile more.”

Ministers were told that a MORI survey had shown people remained dissatisfied with public services despite the billions of pounds Labour has spent on them. Ben Page of MORI told ministers the public wanted to see nurses smile more and to “give the impression of caring”. (Sunday Times)

Because, of course, what matters in a mediocracy is not caring, but looking like you care.

Update

Ben Page has left a comment saying the Sunday Times article is a calumny of the facts, and that MORI will be publishing the full report next month. I look forward to reading it, and will comment again when I’ve seen it.

Page says that “the public want to see tenderness and compassion in the delivery of public services”. No doubt patients would like to be treated with more respect and politeness, but the question is whether this can be achieved in the context of a state service, in which there is effectively no consumer power. It’s a little like saying: “parents want comprehensive schools to provide an environment in which their children can flourish”. Sure they do, but it ain’t gonna happen, however aware the government is of the problem.

2007: the Year when the merde hits the fan?

Here is my own humble contribution to "predictions for 2007".

First, a question. What happens if a country is run along mediocratic lines for one or more decades? By which I mean:

• quick easy-fix answers to everything

• "no brainer" solutions (i.e. not thinking too deeply about anything)

• style over substance

• equality more important than quality

• rejection of principles in favour of watered down pragmatism

• rejection of bourgeois hierarchicalness in favour of "do what you feel"

• pseudo-individualism i.e. "can't be bovvered".

Answer: everything will go on rubbing along after a fashion, by living off the previously accumulated reserves of capital, innovation, bourgeois forethought etc. That is, until there is a crisis which tests the system. At which point, depending on the severity of the crisis, you get either (a) red faces or (b) panic in the streets.

Here then is my Cassandra-like prediction. 2007 will be the year in which the British infrastructure gets severely tested and is found severely wanting. I don't know whether it will be the London transport system, the water supply, the "health" service, the state "education" system, the electricity grid, or the monetary system. Perhaps a combination of several of them.