Old Lad

Here is a message for my local authority battling with flooding today. For thousands of years there has been a season called Autumn. During Autumn leaves fall off the trees .In the midst of this leaf drop and towards the end of October we get heavy rain. The leaves have now blocked the drains and culverts, so the roads flood with what the Met Office describes as surface water, causing disruption and sometimes flooding to property. So how long will it take the local powers that be to realise that leaf fall has predictable consequences! When I was growing up the drains in the street were regularly cleaned out by one of those wonderful vehicles that sucked up debris and then washed the drain through.. have you seen one on the roads in recent times? Me neither!

As I grow older it seems that actions are being taken across all public services and nobody appears to predict the consequences. We are now heading towards an economy based on electric power – vehicles, home heating, large data centres to cope with the internet and Artificial Intelligence. The consequence of this is that we need to generate more electricity and fast. And yet the Government and Politicians dither and argue about sources of power. Living in a part of the world that was the first to generate electricity from nuclear power the consequence of closing down ageing nuclear plants before new ones had been built seemed blindingly obvious..

My old employer, the NHS is a master of introducing systems without any thought of the consequences. Consider the never ending saga of hospital Accident and Emergency Departments (known in my day as the Casualty Department). Most A&E departments now resemble a battlefield clearing station reminiscent of MASH – although I recollect that 4077 MASH was more efficient at coping with demand .In my view the current A&E debacle stems from two major driving forces. The first is a major change in the way people are admitted to hospital. In my day (not an expression I like using) if I as a GP felt a patient needed to be in hospital I would ring the doctor on call for a specialty, make the case for admission, and then the patient would be sent straight to the ward. As a result of the closure of beds in the last 30 years the NHS decided that all admissions should go via A&E. So this unholy mixture of people with serious illness, the walking wounded and victims of major trauma all funnel into departments that physically are not big enough and without sufficient staff. Consequences! The second major driver – and I have spoken about this before – is the restrictions in getting a GP appointment with complex systems being put in place by Practices to filter requests, including the dreadful 111 system.. So out of frustration the public default to the only bit of the NHS which has open doors 24/7 – A&E. So patients who really could be dealt with by a GP are added to the mix. The frustration here is that about 30 years ago some of us could see the consequences of these policy changes, and I remember research showing the value of a GP being stationed in A&E departments, and also the concept of an admissions unit separate from A&E. But it never caught on.

Lack of planning for consequences goes right across the board. Replacing high street shops with takeaways makes us get fatter. I recently visited a town in Lancashire where there were 5 takeaways all next door to each other. Do planners think of the consequences? Our rapidly shrinking Royal Navy will soon be at the stage where it could fit into a Boating lake (I exaggerate of course) but we are an Island Nation dependent on shipping which requires protection. Consequences again.

I was always a great fan of C Northcote Parkinson who promulgated Parkinson’s Law. He was also someone who wrote of the Law of Unintended Consequences. Perhaps this should be required reading for those responsible for our public bodies. Meanwhile each Autumn the leaves will fall, the drains will block and we shall have floods!