'Culture of Continuous Improvement'

The Conservatives have announced that under their leadership, the NHS will be transformed into a free market of competing hospitals, driven by a new focus on performance targets.

I was practicing my shorthand today as Jeremy Paxman was interviewing the Conservative Shadow Health Secretary Andrew Lansley on Newsnight. The title quote was said as Lansley was responding to Paxman's questions about the danger of removing traditional hospital targets.

People would be able to choose which hospital they want to be treated in, Lansley says, by looking at the success rate, the waiting times, or the experience of the hospital in treating major illnesses such as strokes and cancer, rather than just the waiting time.

Waiting times are being fiddled, supposedly; doctors keep appointment slots free during the day so that they can always see patients within 48 hours, and ambulances are left parked outside A & E when it's busy if the staff think that they'll blow the four hour waiting time limit.

Adding a competitive element, the Conservatives think hospitals should improve as they fight for patients. The Tories say that their strategic replacement of hospital targets for the NHS will save 100,000 lives a year.

But how does knowing these 'top- down' targets of a hospital really empower the patient?

What if I lived in London and, unhappy with the waiting time projected to me at my local hospital, I decided to be treated in York? What if my treatment then required frequent and increasingly debilitating visits? I probably couldn't keep going up there and I'd return to my local practice- to the hospital with a worse mortality rate, resigned to the targets.

The reason there isn't a huge, single, centralised hospital in the middle of England that can deliver every single treatment to every single patient in the country under its roof like an enormous supermarket, is because ill people need hospitals nearby.

People want to be near to their homes and families. No- one wants to travel far when they're ill, they just want the local hospital to treat them attentively and to high standards. It's unfair to actively force patients to stimulate hospital improvements through this 'competition'.

The proposed top- down targets will result in a transparent service, but it won't improve it. People will be resigned to the fact that their local hospitals are slow, or badly managed, or offer a bad experience.

Perhaps instead hospitals will replace the school as the new property value stimulus. People will pay more to live in an area with a great school- now they might be looking for great hospitals too.

Social Norms, how the media promotes drug use, and Only in Ibiza.

In my earliest article, I referred to the increasing normality of cocaine use in bars, homes and work- places as a drug acclimatisation process.

I wrote that it was powered not by celebrities, but by the inherent propensity for sadness that humans have, as Huxley once wrote. Peer pressure, familiarity and celebrity usage intensify it, but it's the emptiness of people that are drawn to a drug- any drug's- numbing effects.

Much has been written on the subject, and it seems like everyone is doing it.

That line, incidentally, embodies the essence of 'Social Norms.' People are easily influenced by others. If they think that many people are doing something, they are more inclined to do it themselves.

I recently visited Ibiza for a birthday, where drug use is deemed acceptable as part of the scene. There were a few times that young people we met told me it was 'only in Ibiza' that they took Class A's. I particularly remember hearing it in Pacha from a group of newly qualified dentists. Back home drugs weren't a necessity of lifestyle for them.

So what changed?

I think that the people we met were submitting to a pre- conceived social norm of the island, a norm that has been carefully manufactured by the clubs and bars.

These clubs and nights have titles like 'Amnesia', 'HedKandi' and 'Es Paradis' (the last one is for real). CD's are released called 'I Got Mashed in Ibiza', and drinks are so expensive in the clubs (16 euros each) that it actually seems logical to some people- logical, bear in mind- to take ecstasy or MDMA instead, at 5 euros each.

These clubs still make money from the drug use by offering bottles of water at 8 euros each.

The article I read on social norms was written by the brilliantly- named Daniel Finkelstein, and it said that if a person feels like everybody else is doing it, they will be psychologically more inclined to take the drugs themselves.

This is where media commentary on drug use can be unwittingly damaging in the fight to curb drug abuse. Finkelstein provides the (unsubstantiated) example that as more was written on teen binge drinking during the 2006- 2007 tabloid focus, binge drinking established itself as socially normal, and the figures went up afterwards.

It is contentious whether binge drinking went up as a result of people reading that everyone else was doing it, or at least believing that everyone else was doing it, but it can't be denied that billion pound industries like advertising and fashion are reliant upon herd mentalities and persuasion techniques.

I didn't have a name for it in my first article on cocaine use, so I called it an acclimatisation process, but now I'd band it under the idea of social norms.

Cocaine use is rising: There were 740 incidents of overdose in 2006-07 compared with 161 in 1998-99, according to official Government data.

Are the customs and police getting worse at detecting it, or is it that people are adopting an 'Ibiza mentality' more closer to home?

What seems challenging to the theory that media focus increases the normalcy of drugs, and thus its prevalence, is that the majority of articles denounce its use, and attempt to expose the harm drugs cause.

This appears not to matter. Supposedly we, the UK, are the worst offenders for cocaine use in Europe. On the surface, this is an incredibly negative article. The title bands the whole nation at the top of a deeply derogatory list.

But think of the solidarity that banding us against Europe creates- perhaps only subconsciously- and perhaps only in the current climate of the Lisbon Treaty.

I'd also question the motivations of the European Monitoring Centre on Drugs behind a report that portrays the UK like this. Why is it necessary to release a report like this?

On another note, I'm annoyed with the executive director of the United Nations Office on Drugs and Crime, Antonio Costa, who, despite his position, immaturely refers to cocaine as the 'white lady.' (This article really did frustrate me.)

I might be wandering away with my ideas here, so I'll end the article at this point. My original intention was to attribute the idea of drug acclimatisation under the less clunky name that I'd christened it, and I think the theory of social norms fits quite well, so I'm stealing it.

Finkelstein's 'social norm' theory provides another powerful indictment on the strength of the media in guiding public behaviour, even when the news is entirely negative.

Finkelstein suggests its political and socially helpful uses, so read the article and see how, for example, if people were told that everyone else were giving to charity, donations would increase as a result.

I'm still more inclined to believe that the idea of social norms are inextricably linked to a selfishness. I think that these norms may catch on easier when the people deem it beneficial to their lives, cocaine, holidays or going out.

Its a positive thought though, and he wants to raise £1 billion a year.

We'll see Finkelstein, we'll see.



http://www.timesonline.co.uk/tol/comment/columnists/
daniel_finkelstein/article3359660.ece

Baseball bats, knives and scissors

Five kids are circling each other on a street. They're about 13 years old, except the tallest one, who's about 15. He's telling one of the kids, in a calm voice, to put the bat down.

He says it another three or four times, until two of the younger kids set on him. The older boy and one of the larger kids have locked arms together as they grab each other's tracksuit tops.

They're both getting in hits to the head as they keep each other standing. The one with the bat is dancing around them, desperately swinging the bat again and again against the older lad's arms and skull.

A girl starts screaming and the older kid rips himself free and runs away.

There's an argument now between the woman who screamed at them to stop and the kids with the bat. She tells them they only used a bat because they knew they wouldn't beat him in a fight: 'Yous'll get fucked up when he comes back for yus.'

A minute later the street is quiet again. Everyone has walked off.

We watched this through the living room window of a terraced house in Liverpool last Sunday afternoon. It's a student house, but it's not in a particularly bad area. We stepped outside when we heard the noise, and when I looked down the street there were two or three other people stood on their doorsteps.

I'd have thought twice about watching them or going outside if it were adults, but these were young kids, and none of us wanted to watch a kid get his head split open on the street outside.



Last week, Gordon Brown held a meeting to organise the governmental reaction to the recent spate of knife crimes amongst teenagers. Only 16 MP's attended, and the culmination of that meeting was a statement. It was a statement quickly dismissed as 'gesture politics' by the former head of the Youth Justice Board incidentally.

Brown said that youths would be treated more harshly than previously by police officers if found with a knife, and could expect to end up in court.

Ken Jones, president of the Association of Chief Police Officers and also in attendance at the meeting, specified the new police guidances more clearly than Brown. From now on, officers will use common sense in every search, but will be less inclined to issue cautions when knives are found.

A youth will face a charge, even with no previous convictions or aggravating factors.

The meeting coincided with the introduction of a national advertising campaign aimed at deterring youths to carry knives. The message is that those who carry knives are themselves more likely to be hurt and killed in knife attacks.

There's a similar statistic in America about guns, and it has done little to deter gun crime there.

With this logic, if you are a country with the capacity to engineer nuclear bombs, you are more likely to be attacked by a nuclear bomb from a country with similar nuclear bomb- engineering abilities. It does make a lot of sense.

The Cold war was balanced for decades on this premise of irrational counter- thinking. Likewise Iraq, North Korea, Pakistan represent the modern- day, global examples of how carrying a weapon for protection puts you at risk from being hurt by the very possession of that weapon.

The psychology is straightforward: no- one wants to turn up to a gun fight with a catapult.

The youth that doesn't carry a knife gets mugged or beaten, and loses his possessions, or the confrontation itself. The youth that carries his knife with him is challenged, pulls his knife from his pocket, and one of a lot of things may happen in those tense seconds.

One: ideally for the victim, the attacker flees, and the victim walks away.

Two: the attacker, or attackers, wrestles the knife from him, and he is robbed and possibly hurt by his own knife. The victim could also use the knife on his attacker, forcing the consequences of carrying a knife upon himself.

Three: the aggressor pulls out a bigger knife, or another weapon, or someone sneaks up behind him and hits him, or he falls over, or he is challenged to use it, or someone jumps between them, or the police arrive, and so on.

These situations are based on the assumption that the youth is carrying the knife passively; there is no known vendetta against him, or that he himself has no issue against anyone else. He's carrying it in case he's mugged, or attacked, or walking through an area he's scared of, and amongst these kids, the new threat from Brown to prosecute kids with knives may deter many from leaving the house with a blade.

These aren't the youths needing to be targeted though. At some point in childhood, many children develop a fascination with knives, or fire, or ninja stars (I'm imagining my childhood friends here).

They may all be easily accessible in the house- including ninja stars, incidentally- and a few kids may take it too far, bring them to school one day, and get excluded.

But these youths, and the ones with knives in their pockets in case they get mugged, aren't causing the real trouble.

It is the youths in the opening story that will provoke the cycle of violence that surrounds a fatality. The kids are fighting in the street, and one of them has the misguided presence of mind to realise that he cannot beat his enemy with his fists, so he carries a bat with him to attack him.

I doubt I'll see them again- I wasn't really concentrating, just watching the whole scene, so I can't know how it will continue to escalate, or even if it will.

But a boy willing to bring a weapon in the first place has already beaten through the psychological barrier of carrying and using weapons. When someone is intent on violence, as the kid we witnessed last Sunday was, any weapon is a danger.

He'll be fearful of retaliation, limited only by the imaginings of his own fear, and it may spur him to carry something smaller, better hidden, to protect himself.

The older boy may reason the same thing, or he may now be intent on violence as retaliation. He might also decide that a knife is necessary, to protect himself against this younger boy and his friends. The situation is a tightly- wound coil of fear and retaliation that really could end up with one of the youths seriously hurt, or dead, or in prison.

The majority of the recent attacks seem random, but all involve a situation where a youth is single- mindedly intent on violence, just like the kid with the bat was.

The last few I've heard occurred on a dancefloor, in a case of mistaken identity, outside a club, when friends tried to intervene in a separate fight, and in a bakery, when a youth told to leave attacked a customer.

The last case raises a point of capital significance that has not been addressed by the government and police. The teenager was slashed to death with a shard of glass that was broken in the shop seconds earlier. There was no weapon involved, only the intention to cause violence on anyone around. The teenager had been asked out of the shop for a fight by his attacker beforehand.

With a focus on knife crime, youths with vicious intent in their heart can continue to carry bats, scissors, screwdrivers, penny rolls, or use bottles or glasses in the vicinity to attack people. The police can't charge someone with a pair of scissors in their pocket unless there is cause for alarm, its the reason many muggers carry them instead of knives.

When I was a little younger, an acquaintance of mine was arrested for being abusive to a police officer. He had a beer bottle in his hand which was taken off him. After he was charged and released, he received a letter telling him that, at the guidance of the police, the offensive weapon had been 'destroyed', like it was a gun.

A beer bottle is just a container until someone intended or threatening violence wraps his hand around it. Similarly, a knife, a baseball bat, a screwdriver or a bundle of keys are all just objects comfortable in everyone's home, until they are picked up by someone with the intent to cause violence.

In Gordon Brown's proposal to prosecute those that carry knives, the attempt has been made to remove what his team has ascertained to be the cause of knife crime from the streets. But the actual cause of knife crime is not the number of knives on the street, its the number of people willing to use weapons, like the teenager with the bat.

An understanding as to why certain people are intent on violence when they leave the home should be addressed, but it'll be too difficult for a government to analyse something as psychologically variable as that, so they'll carry on with the adverts and the posturing.

With violent intention, there will nearly always be a weapon to hand, so the police shouldn't fight the number of weapons on the street.

Once again, like prostitution, like drugs and like alcohol, they have to investigate what's going on underneath it all, the inner motivation.

Knife crime will drop when the issues at the heart of street violence are addressed, if ever. Until then, expect more stories.



"I ain't got drugs and I ain't got a gat in my car,
there's a baseball bat in my car,
but I use that to play baseball or I play rounders."
-Wiley, People Don't Know

Growing Cannabis on Cloudy Days

Two cannabis farms have been found in rented houses in my area recently. I know there are at least three more around that haven’t been discovered, because someone close to me was paid in ‘Columbian flake’ to re- wire the house for the drug farmers.

Typically, the timeline from finding a suitable unfurnished property to harvesting the produce is short. An estate agency will be approached by a couple, and a short- term permit will be negotiated. The agency will be in charge of the property, and will be contractually obliged to inspect it for damage during the tenant’s stay. It’s relatively uncommon that an inspection will be performed until the end of the residency, especially if a three- month rental is taken.

The next step is conspicuous, but again, usually easy. The equipment for harvesting the plants will be moved in. Fans, lights, tubs, fertiliser, electrical cabling and pipes for an indoor irrigation system will be set up. The paraphernalia of scales and pressing equipment can be brought later, when the harvest is ready to be sold. If everything is boxed up, there’s little risk of a neighbour challenging the new tenants.

The police will tell you that there are strong Vietnamese or Chinese links, but my contact has only ever dealt with local English people. They’ll tell you that every available space in the property will be used to cultivate the drug, but I’ve been told that in the houses he’s re- wired, they only used the upstairs area. They have a couple of people move into the ground floor, to protect the plants and decrease suspicion.

One piece of advice that the local police offered residents in ‘spotting cannabis farms’ was to be vigilant of properties recently rented, but with tenants that only visit at strange times in the day and night. Permanently covered windows were also marked out as suspicious. The truth is that properties are very carefully chosen to protect an investment of hundreds of thousands of pounds. Snoopy neighbours are probably considered.

With such an enormous risk, only the laziest or greediest dealers are walking out of houses with bin- bags full of fresh cannabis slung over their arm. The cannabis is dried and pressed into blocks on site, and then transported in smaller, less conspicuous bags.

As for the massive electrical cost to artificially recreate tropical climate with lights, fans and irrigation systems, that’s where my friend arrives. It is possible to disconnect the electrical wires from the energy provider’s meter, and bypass it with a small box, so as not to pay any electricity. The provider will ask for a reading at the beginning of the tenure, which will be given, and will then bill the residents after future readings.

There will be no change in the electricity meter dial. If a meter reading is asked for, the tenants tell them they’re too busy, or just getting in the bath (the bath’s probably full of soil at this point). No- one checks, and the weed is left to mature. No need to import it if it can be grown on a rainy day in Wythenshawe for free.

The Drug Acclimatisation Process

Saturday’s essay on the glamorous courting of drugs in our society was deeply flawed, and representative of an older populace completely out of touch with the reality of street drugs.

Connolly’s argument is convoluted from the moment he criticises the Home Secretary’s proposal to re-classify cannabis. Connolly offers the reader two situations of dope use. The first compounds it as a precursor to harder drugs and eventually death, the other use where a ‘formerly well- adjusted’ youth inexplicably spends months locked in terror after a single use.

Between these two stories, he writes that both the government advisors and police officers have expressed anger towards the reclassification attempt. Connolly then tells us that he’s on the sides of the parents of these unfortunate victims. He is telling us hysterical tales and asking us to ignore the objective viewpoints of scientists.

Do those against the re- classification want more people to die or exacerbate their mental illness, or do they simply recognise that a classification serves to inform the intended user of the risks, be they addictiveness, toxicity, psychological issues, or social harms?

Ignoring the anomalous instances Connolly uses, which I’ll return to later, it has to be understood that thousands of people in Britain smoke cannabis, and that some people smoke it every single day for many years. I know this because I’m seeing my friends do it now.

Presumably, when advisors write the reports that offer the classifications, they assess the risks based on information from heavy or regular users. We wouldn’t expect them to ignore a death directly linked to drug toxicity because they thought it might unrealistically distort the overall risk of the drug, we’d expect them to note the death and analyse the risk accordingly.

It would be improper for the researchers to use the two examples Connolly cites however. I mean no disrespect to the families, but Rogers, a drug user who dies during a heroin detoxification, cannot be linked to the dangers of cannabis. Equally, I insist that a teenager that kills himself, and I’m on shaky ground here because I know how it looks, cannot be used either.

Roger’s death would be recorded for research on the classification of heroin, not cannabis. And the suicide could have so many surrounding factors that it would be improper to blame it entirely on cannabis.

This is not an article defending people’s right to take drugs. It is just that so much is damaged when newspapers allow articles like this to be published. It is terrible when the photograph of a fresh- faced child is positioned next to the photo of the gaunt, dark- eyed drug abuser he grows into, but it is not conducive to gaining an objective evaluation of the impact of drugs.

Weak- willed politicians listen to public opinion, and it seems to say that society is disgusted that drugs are killing people in our communities. The studied risk is ignored for the sensationalist risk, Class C becomes Class B, and police officers around the country are resigned to the new rules.

This is not an article denying that drug abuse is prevalent in our country. As stated earlier, regular cannabis users are my friends and associates. I’ll admit it takes ten minutes for a friend of mine to order and buy cocaine delivered to his door by a couple of 17-year- olds. But you know all this.

Aldous Huxley was writing about the relationship between the human psyche and drugs before the 1930’s. This was before Connolly’s youth incidentally, which is surprising because Connolly ‘didn’t know a single person who had ever tried drugs.’ Now, if I was pretty certain that Huxley had done some form of psychedelic drugs when I was only 12, I reckon that Connolly might be rose- tinting his memory of the early 60’s here.

Anyway that’s what he wrote in his article, and it helps him to promote his theory that the cult of the celebrity lifestyle is advertising the glamour lifestyle of drug- taking to young people, and that society has implicitly allowed it.

Huxley saw a crushing emptiness in humanity that explained the attraction of drugs. Chemical intoxication provided short- term happiness, comfort where there is none, or insensitivity from the unhappiness of life. Drugs affect people from all walks of life because the emptiness is inherent to us all.

Connolly uses Rogers as an example of how drugs permeate unstoppably into our society, and even take over angelic- faced middle class children like Rogers, but think what he is actually saying. He is implying that drugs should not have reached this one, that his proper upbringing should have kept him clear. Connolly surmises that drugs must be so powerful now that they are breaking down the social walls, from the lowest classes where they’ve always been, to our middle class children.

Look at it Huxley’s way, and in Rogers you just see an unhappy person looking for some help. The reason that it has always been so prevalent in the estates and slums is not because they don’t have the emotional protection that middle class kids have, its that a lot of the heartache occurs there, and drugs become an escape.

This may be hard to relay, but it forms the basis for my original proposal that perhaps Connolly and the older populace are struggling to understand that the prevalence of drugs has cultivated a new drug user. Unfortunately, there will always be the junkies that struggle to deal with the pain in their lives and that will abuse drugs until death.

A few might make the headlines if they began life middle class with some prospects, because why are they so sad? Most won’t, because they already live in poverty, are sexually or physically abused, or never had a chance. They’ll fit Huxley’s mold too, but people will expect it, and society won’t bat an eyelid.

This new drug user does not ultimately become Connolly’s dreaded poster boy for a life abstaining from drugs. This drug user takes drugs intermittently, maybe every weekend, maybe once a month, maybe on Tuesdays and Saturdays. They might go out to a club and take a few ecstasy pills on Friday, and the next night they might just get drunk.

They might go to a friend’s house for a small party with a bag of cannabis, and end up eating hallucinogenic mushrooms instead. If they’re in a club, and someone offers them cocaine in the toilet, they’ll snort a line. They might even smoke Class A opium on a holiday in South East Asia.

Connolly misunderstands the true effects of society’s hypocrisy when it comes to celebrities and drugs. It hasn’t caused starry- eyed Winehouse fans to inject heroin, and it’s unlikely to have caused girls that look up to Kate Moss to snort cocaine.

It’s bred familiarity.

Instead of denying that drugs did not exist in their youth, that they do now, and that celebrities are advertising them to impressionable youths, Connolly should note the ubiquitousness of drugs as the real problem.

The new drug user will take drugs when he feels like getting high for a while; he is the city banker at one in the morning finally finishing work, the lads on a stag do in Blackpool, the kids in the park popping pills on a balmy Wednesday evening in summer, and the public school children smoking weed at the end of the playing field.

The new drug user props up the drug economy, but its not celebrities that make them do it. Celebrities are people just as susceptible to the effects of drink and drugs, but they have more money and more time than most to play around, so it looks like they do it with more aplomb. Like drugs, the rock stars and comedians can have as many tattoos as they want, because they don’t need a real job and they have the time. The secretary from Newcastle had hers done on holiday, and she keeps hers hidden because work wouldn’t allow it.