Friday, 26 January 2018

Closure of the Royal Alexandra Hospital Children's Ward

The First Minister of Scotland has endorsed the closure of Ward 15, the Children’s Ward, of the Royal Alexandra Hospital citing as the main reason the advice of clinicians. Basically they have resorted to flying in the face of the well worn maxim that advisors advise and Ministers decide. But this is a Government decision and there’s no hiding behind expert advice can disguise that. I don’t decry the role of experts in helping form Government decisions but if government slavishly accept their advice and form policy only on that basis I have to ask myself why we bother to have politicians and we don’t just let the experts run things.
What has been sadly overlooked is that clinicians have vested interests in these decisions. They would not be human if, when asked whether they would recommend moving to a shiny new facility they would reject the idea. It’s almost like a promotion and who would reject that? Why would they want to stay in a facility that despite there being no plans to close it only 2 years ago has been run down so quickly that a mere 2 years later it is portrayed as virtually derelict and unfit for purpose? Why would they want to stay and fight for better facilities at the RAH Children’s Ward when the plan of the Health Board and the Scottish Government has clearly been to run it down at a helluva pace? Little wonder they are demoralised and want to move.
The clinician advisors are experts and when patients are presented to them they are very good at what they do. But they have no interest in how those patients get to them and are extremely vocal about late and missed appointments. They are not experts in transport infrastructure but just expect that patients will cope, and they don’t really care how. The new hospital is very poorly served by public transport but that counts for very little because people who have to use buses can’t really be experts. Can they? Well they’re experts on buses but nobody really cares about that.
Clinicians are also not experts in social cohesion and the type of local services that form a network which is the basis of a community. That isn’t their problem. They deal with patients as individuals as they should, but someone, and that someone should be the First Minister, should be looking at the bigger picture and taking responsibility for keeping communities alive. Localised health provision is a large part of that. The Government shouldn’t be guided only by clinicians in this respect. Investment in local health facilities is an essential part of what defines a community and this closure is a cut in local provision. It’s not a reorganisation. If you start with 2 facilities and end up with 1 then that’s a cut by any definition. People in our poorest communities are the real experts in the effects of cuts but that kind of expertise is neither wanted nor needed. They’re dependent on local services so they must be poor. Their expertise doesn’t count.
Much is made by the SNP of the proximity of the new facility to the old one. I live about 4 minutes from the RAH and I know that it takes at least 20 minutes to get to the new hospital from the RAH. A month ago they were telling me it was about 15 minutes from the old one to the new. Maybe in light traffic that could be done. Last week they were saying it was 7 minutes and now they’re telling me it’s just 5 minutes down the road. So maybe I worry too much. At the present rate I reckon it’ll be at the end of my street in about a month. But I think that might be a bit of misplaced optimism.
I hope the Scottish Government will think again, take into account the views of the other experts I have identified, and reverse this cut.

Thursday, 25 January 2018

The Offensive Behaviour at Football Act.

Can I just put in my usual disclaimer. these views are entirely my own and I do not purport to represent any organisation, even those of which I might be a member.

Back in my lost youth Government introduced the Litter Act.  Litter was becoming a problem but it was never the intention to fill the jails with people who had dropped a sweet wrapper. Seat belt legislation was never intended to fill the jails with people who had forgotten to put on a seat belt. Similarly it was never the intention of the proposals to ban parents smacking their children to fill the jails with stressed out parents.

The point of all of this legislation was to try to effect a social attitude change.and to change public behaviour so that there was a consciousness among people that acceptable behaviour had changed, and that they should seriously consider and modify their conduct. It wasn't to criminalise people. It was to send out a signal of a broad societal change and back it up with penalties for the sake of society and which would only be imposed if the signal was ignored.

In the case of the OBFA it's beyond doubt that there is offensive behaviour at football matches which doesn't occur in most other sports, so to that extent the specificity of the Act could be justified. It's not impossible but it's difficult to defend the right to be offensive. I suppose there are issues of free speech but I think we're grasping at straws with that defence so I won't try. Offensive baviour at football is a stain on the fabric of our society but half a dozen police were never going to be able to jail 3 or 4 thousand chanting football fans so I think the act is best viewed, like the others I've mentioned, as a signal that a specific problem exists and needs to be addressed. It should be an indicator to young fans that the ancient bigotries of their elders, who want to be sure that their bigotries live on after them, has to change. The object of the act isn't to jail people, it's to make them conscious that society has moved on and certain things which were acceptable are no longer so. The object is to stop people being gratuitously offensive and I can't see how that is a bad thing.

There are however questions around how the act is policed. There is a mis-trust of the police, not always unjustified, among certain sections of our community and over enthusiastic policing only makes it worse. The real answer to that is that people shouldn't indulge in offensive behaviour and should get as far away as possible from people who do.

I know that there is very little in the OBFA that isn't addressed elsewhere in law by breach of the peace or other public order legislation but they lack the specificity to deal with this specific problem and send this specific signal.

But one thing is certain in my mind. If I'm right and the act should be treated as sending a signal then repeal of the act sends a much worse signal to our whole society.  Amend it by all means so that the offence is much clearer and people know where the boundaries are, but don't repeal it unless you can replace it.