Wednesday, 30 November 2011

For the want of a ruddy shoe

Tomorrow I shall be turning up for a hospital out-patient appointment with a Consultant Orthopaedic Surgeon. I don’t particularly want to, but I have no choice.
Why do I not want to go? Quite simply because its a waste of my time and more importantly a waste of the surgeon’s time and a waste of NHS resources.
Why do I have no choice, but to go? Because the bloody stupid system says I have to.
You see, I need supportive shoes for my foot deformity –childhood poliomyelitis but that’s a long story. The upshot is I have a limp and without strong supportive footwear to correct the talipes equino-varus of my right foot, I am unstable and can slip and fall - as indeed I have, many a time.
Many years ago I saw an orthopaedic surgeon who tried half-heartedly to offer me corrective surgery. Risky venture I thought to myself. The trade-off for me was between my present state (pain free, but with a slight limp that is hardly noticeable with the correct footwear) and the risk of surgery going wrong with the possibility of some but by no means guaranteed improvement in the stability of my right foot. I
No, thanks, I decided, opting instead for corrective footwear. So off I went to a very nice orthotics expert and over the years I have been one of their more satisfied customers, turning up every autumn to ask for a new pair of shoes made to my measurements with the right shape and support for my right foot.  They offer to make me 2 pairs but each time I decline, on the basis that I can only wear one pair at any time, but to be honest feeling somewhat guilty that I am getting a free pair of shoes.
Fast forward then to Oct 2011, Andrew Lansley in charge, Health and social care bill going through Parliament, 20 billion to be saved. I ring up the orthotics dept. ‘Please can you order me a new pair of shoes; my present pair is getting worn and losing its grip, I am sure you have all my details with the measurements and the correction needed.’
‘Ah yes indeed we have your details but things have changed, we can’t order  a repeat pair without a new referral from the oprthopaedic surgeon’, says the nice orthotics dept receptionist. The system had changed, someone in management decided that people were turning up with alleged deformities and getting shoes made for free without clinical need. After all some deformities do get better with a couple of aspirins. Maybe the human foot has acquired the organic ability  to grow back into the normal shape.
Anyway, there was no point arguing, it wasn’t her fault, she was just doing as she was told. 
I rang the Orthopaedic secretary, repeated my story to her. She was really sorry, she understood the situation, she said,  but (sounded ominous that 'but') she was equally helpless; the orthopaedic surgeon was not allowed to refer to orthotics without assessing the patient, and she couldn’t make an appointment for me to see the surgeon without a fresh referral from the GP. In fact they could only make so many follow up appointments before needing a fresh referral.
Again no point arguing, it was the system you see. You can argue with an unreasonable person, you can even reason with an argumentative person, but there is only one thing you can do with a stupid unreasonable obstinate system. Give in and go along with it.
So I sent an email to my GP; you see ever since I wrote an editorial in the BMJ about telephone follow up, I have been a fan of e-comunication if it saves the time of busy professionals.
My GP, being an independent contractor and basically a sensible chap able to decide how he works, was not under an obligation to a silly system. He could so easily have said that he could not make a referral without seeing me and my allegedly deformed foot. No, being a sensible chap, he referred me to the Consultant Orthopaedic Surgeon.
And so that’s how I am reluctantly turning up to clinic tomorrow. I have no doubt we’ll have the same conversation as we had all those years ago (its not the same surgeon you see, so I'll have to repeat my story), we’ll come to the same conclusion (its the same foot, the same deformity, the same disability and so I can’t see how we can reach a different conclusion, unless the clever lab boffins have found a way of growing a whole foot from a toenail); I’ll be sent off to the orthotist who will finally order a corrective shoe for me.
Meanwhile I shall be off with my old pair to Timpson’s in the High Street and explain to the friendly fellow there why I want him to put a double thickness sole on the right boot but only a single thickness sole on the left shoe. That should last me for a few months.
Saving costs is an expensive business. 

Sunday, 20 November 2011


I have just come back from a visit to my local town centre; depressing and enjoyable in equal measure.  Enjoyable because it was a bright, if somewhat cold, and it felt good to be among people busy with the routine excitement of a Saturday outing.  Depressing because of the forced jollity of the seasonal decorations that far from being a reason for good cheer somehow seemed to remind you that we needed it if only to counter a general mood of economic malaise.  

And so to shopping – not for the essentials but for those other things that allegedly brighten the day – gifts.  

Conventional wisdom has it that gifts are a wonderful thing. The recipient and the giver are both blessed, or so it is often believed. And buying gifts definitely benefits the retail sector and therefore  the economy. (Though as far as the economy goes, what’s important is that people spend their money on buying things. The giving of whatever has been bought as a gift is not necessary for any economic stimulus – unless it is a battery operated thingy, in which case it is good for the battery trade.

But conventional wisdom is subject to the corrosive effect of convention.  Routine and custom gives rise to perfunctory duty rather than joyous spontaneity in much the same way that familiarity breeds contempt.  Expectation of a gift leaves the recipient vindicated rather than fulfilled if the gift materialises at all and disappointed if it does not.  A sense of obligation to give converts what might have been a voluntary and joyous act into a reluctantly discharged duty.

In A Thousand Splendid Suns Khalid Hosseini describes the gifts that Jalil makes to his illegitimate daughter as ‘half-hearted tokens of penance, insincere, corrupt gestures meant more for his own appeasement than hers..’; ouch!

With marriages, anniversaries, birthdays, Divali, and now Christmas, not to mention special days like father’s day, mothers day and the soon –to-come new year’s day presenting not-to-be-missed opportunities for giving and receiving , the potential for trouble is immense. The appropriate gift must be chosen, bought, packaged and presented with the right element  of generosity. The recipient has to show the right degree of surprised pleasure taking great care to hide any disappointment at the choice of gift. 

Altogether too many opportunities for getting things wrong with serious consequences for 
social and family relationships.

A few of us discussed this over dinner one day and came up with a set of Rules of Gifts (based loosely on Isaac Asimov’s rules of robotics). I propose that universal acceptance of these rules  will promote harmony, reduce conflict and enhance relationships.
Rule 1. The potential Giver has the right but not the obligation to make a gift.
Rule 2. Once a Gift has been given, the Recipient has sole rights over its fate.
Rule 3. The Receiver has a duty to accept the gift in the spirit in which it is given but has no further obligation to the Giver.
Rule 4. All other parties are irrelevant to the transfer of the gift from the giver to the receiver.

And that is my gift to the thorny problem of gift-giving.

Thursday, 13 October 2011

The liberty that we take for granted

While researching something completely unconnected to this topic I came across these fascinating quotes from James Madison. He was the 4th US President, but it's not for his presidency he is best remembered, but rather for his work and contribution to the US Constitution.

Among the many volumes he wrote about liberty, the role and place of the State and the responsibilities of the people are these gems.

"I believe there are more instances of the abridgement of freedom of the people by gradual and silent encroachment by those in power than by violent and sudden usurpations."

and then this masterpiece;

"It is a universal truth that the loss of liberty at home is to be charged to the provisions against danger, real or pretended, from abroad"

 and  further;

"If tyranny and oppression come to this land, it will be in the guise of fighting a foreign enemy."

Could Madison have been thinking of 9/11 and the infamous Patriot Act?

A.C. Grayling presents a tremendously powerful defence of liberty in his book Liberty in the age of terror 

Sunday, 11 September 2011

9/11 Ten years on

I haven't blogged for some time now.

It's the 10th anniversary of the 9/11 attacks on the World Trade Center and the other two terrorist attacks on US targets.

The TV coverage is extensive, sombre and occasionally reflective, but for the most part it makes painful harrowing viewing. It was a dramatic, deliberate and deadly attack, so utterly successful in meeting its malign objective of spreading fear and provoking a response.

What can I add to the thousands of hours of media debate on the aftermath of 9/11?

Did it change the world? Was America's response right? Are we safer now after all the violence unleashed by American forces in pursuit of their arch enemy, after all the missile and drone attacks, in Afghanistan, Iraq and Pakistan, the bloody pursuit of non-existent WMD in Iraq, after regime change in Iraq?

Who knows? Every politician's answer to these questions merely reinforces their prejudices. No one wants to admit they got it wrong, everyone seeks to justify, however tenuous the logic, the decisions they took at the time.

But whatever we may think of the long term effects of the 9/11 attacks, they cannot be fully disentangled from the consequences of the particular policies pursued by the US and its allies in their attempts to guarantee the security of the homeland. By one reckoning the hundreds of thousands of deaths added by the wars of the last decade to the 3000 of 9/11, were all worth it - justified by the fact that there has not been a repeat of 9/11. By this reckoning we at least know the relative value of a human life in different parts of an unequal world. After all the dead of 9/11are being remembered and commemorated today; the others are statistics remembered fleetingly, namelessly in blogs like this one.

By another reckoning, US actions following 9/11 made a scary situation terrifying; the war on terror heightened the risk of terrorism worldwide even as it made it harder for another attack on US soil. Arguably 10 years of war and trillions of dollar expended on a military response against whole peoples, accompanied by debt, and the near collapse of the financial system in 2007 and the subsequent recession, have left America  weakned to the point where the only positive claim it can make for the last 10 years is that there has not been another attack by aliens on US soil.

What a calculus of terrorism and counter-terrorism, attack and reprisal!

What a legacy for the true victims of 9/11! Avenged, yes but future enemies deterred? Lessons learned? The world a happier, better, more peaceable place?

Maybe not.

It all depends on what you mean by security and how that translates into living in safety.  One way to gurantee security is to have friends, the other to have better defences and more guns than your enemies. The one prevents attacks, the other at best lets you thwart an attack at the cost of infringeing your own liberties, and at worst, gives you a half decent  chance of going after your attackers should they breach your defences. The one is based on equality, and respect for others, the other on a stubborn belief of inherent superiority over everyone else.

There were a few voices back then in 2001 calling for a different response to the 9/11 attacks than the one we got, but they were unpatriotic, cowardly appeasers who deserved vilification by the press until they were muted. Like Susan Sontag's whose essay in the New Yorker is reproduced here in full:

Susan Sontag's essay:

The disconnect between last Tuesday's monstrous dose of reality and the self-righteous drivel and outright deceptions being peddled by public figures and TV commentators is startling, depressing. The voices licensed to follow the event seem to have joined together in a campaign to infantilize the public. Where is the acknowledgment that this was not a "cowardly" attack on "civilization" or "liberty" or "humanity" or "the free world" but an attack on the world's self-proclaimed superpower, undertaken as a consequence of specific American alliances and actions? How many citizens are aware of the ongoing American bombing of Iraq? And if the word "cowardly" is to be used, it might be more aptly applied to those who kill from beyond the range of retaliation, high in the sky, than to those willing to die themselves in order to kill others. In the matter of courage (a morally neutral virtue): whatever may be said of the perpetrators of Tuesday's slaughter, they were not cowards.

Our leaders are bent on convincing us that everything is O.K. America is not afraid. Our spirit is unbroken, although this was a day that will live in infamy and America is now at war. But everything is not O.K. And this was not Pearl Harbor. We have a robotic President who assures us that America still stands tall. A wide spectrum of public figures, in and out of office, who are strongly opposed to the policies being pursued abroad by this Administration apparently feel free to say nothing more than that they stand united behind President Bush. A lot of thinking needs to be done, and perhaps is being done in Washington and elsewhere, about the ineptitude of American intelligence and counter-intelligence, about options available to American foreign policy, particularly in the Middle East, and about what constitutes a smart program of military defense. But the public is not being asked to bear much of the burden of reality. The unanimously applauded, self-congratulatory bromides of a Soviet Party Congress seemed contemptible. The unanimity of the sanctimonious, reality-concealing rhetoric spouted by American officials and media commentators in recent days seems, well, unworthy of a mature democracy.
Those in public office have let us know that they consider their task to be a manipulative one: confidence-building and grief management. Politics, the politics of a democracy—which entails disagreement, which promotes candor—has been replaced by psychotherapy. Let's by all means grieve together. But let's not be stupid together. A few shreds of historical awareness might help us understand what has just happened, and what may continue to happen. "Our country is strong," we are told again and again. I for one don't find this entirely consoling. Who doubts that America is strong? But that's not all America has to be.

—Susan Sontag

Friday, 24 June 2011

India the emerging superpower! Or is it???

Every week adds its own stock of stories that tell of India's rise to economic superpowerdom.

This week, Indigo - a relatively new domestic airline placed a huge order for 180 or so Airbus A320neo passenger planes, second only to AirAsia's order for 200 planes.

But also this week the Economist published a remarkably clever interactive map of India, replacing the names of the various states with their nearest country equivalents in annual GDP terms. So Uttar Pradesh for example - that huge (94,000 sq miles, 243,000 sq Km) and populous (2011 popn 200 million) is, in population terms, bigger than Pakistan, or even Brazil; but in GDP (103.5 Bn USD) terms the nearest equivalent is in fact tiny oil rich Qatar, population 2 million.

Carrying on in this vein, Andhra Pradesh becomes Slovakia, Maharashtra is Singapore, Madhya Pradesh is Guatemala, Tamil Nadu is equivalent to Angola.And the industrial power house state of Gujarat, with the worlds largest petrochemical complex, is in reality the equivalent of Angola.

Fascinating stuff. The map is far more impressive than dry statistics of GDP per person.

No doubt India is advancing economically at a pace only just overtaken by China, but that growth is nowhere near fast enough, or sufficiently evenly spread, to lift the vast bulk of the poor out of poverty any time soon.

A sobering thought.

PS. The GDP figures are based on Purchasing power parity conversions of rupees into dollars.

Wednesday, 22 June 2011

Striking out on your own

I left paid employment recently and decided to set up on my own.

I am lucky. Lucky to be at a stage in my career where I don't exactly have to worry about keeping up the repayments on the mortgage. 

Lucky also in that I can look forward to a decent final salary defined benefit pension scheme.  

The recent changes in public finances and the consequent public sector cutbacks led to my employer offering an early release scheme and though it meant a serious dent in my income, I decided to take the plunge when I still had the energy and the enthusiasm to do something different. 

So I set up on my own.

I am now familiar,  if somewhat daunted, with such matters as company filings, P&L statements and HMRC returns. 

Should I get an accountant? Do I need a fancy website? Do you have the keep the paid up company share capital in a steel box under the bed? What are the pros and cons of buying such things as a computer and printer on the company account. 

All very interesting questions and there is lots of material to consider. But it all takes away from the core task of going out to get the business, deliver what the client wants, and keep up the level of skill and knowledge needed to work in what is after all a knowledge business. 

Without that there isn't going to be the profits out of which to pay the tax. 

Lots to do,  much to learn. 

But the key thing, I am fast discovering, is that its takes discipline to work on your own without the warm (if sometimes stifling) embrace of a large organisation that provides the wherewithal of everyday work - a desk, telephone, computer, blackberry, meeting rooms. I miss also the office camaraderie, and yes also the strangely welcome annoyance of stupid emails, mandatory training to tick some health-and-safety-gone-barmy  box, and the maddeningly inane organisational newsletter. 

Better get back to the business of growing the business!