BALL THE WALL

He was brash, fast, bombastic, a sort of prototype Mohammed Ali ('I'm just the same as ever - loud, electrifying, and full of personal magnetism'), and right through the middle fifties he was second only to Elvis. Most of his records sold a million each: 'Long tall sally,' 'Lucille,' 'The girl can't help it,' 'Keep a knocking,' 'Baby face'. They all sounded roughly the same: tuneless, lyricless, pre-neanderthal. There was a tenor sax solo in the middle somewhere and a constant smashed-up piano and Little Richard himself screaming his head off. Individually, the records didn't mean much. They were small episodes in one unending scream and only made sense when you put them all together.


'I used to lose half my audience right at the start, when I came up screaming out of my coffin,' he said. 'They used to run screaming down the aisles and half kill themselves scrambling out of the exits. I couldn't stop them. In the end I had to hire some boys to sit up in the gallery with a supply of shrivelled-up elastic bands, and when the audience started running, my boys would drop the elastic bands onto their heads and whisper 'Worms'.


Long-time Rock fans have always been bitterly divided about him. He wasn't a hard core rocker, being too gentle and melodic, and this eccentricity can be construed either as back-sliding or as progression. Even ten years after his death, it isn't an academic question; I have seen Rock preservation meetings reduced to brawling knuckle-dusted anarchy about it. On the wall of a pub lavatory in Gateshead, there is a scrawled legend: 'Buddy Holly lives and rocks in Tijuana, Mexico'.


Eddie Cochran was pure Rock. Other people were other kinds of Rock, country or highschool, hard, soft, good or bad or indifferent. Eddie Cochran was just Rock. Nothing else. That's it and that's all.

NHS PLC

A wag has imagined how Andrew Lansley's NHS bill might be presented if it was a proposal for research:

As there is no overwhelming evidence in support of the proposed changes to the NHS as detailed in the governments' recent white paper, ethically the proposed changes can only take place in the form of a trial. I ask you to consider favourably the following study proposal which I submit without permission on behalf of the UK government.

Title: Reorganisation of the NHS in England

Background: The National Health Service in is its 63rd year. It is suffering the same demographic and technological challenges as all high income countries, specifically ageing of the population and increasingly expensive new technologies. These are major problems that we seek to address.

We also have concerns about outcomes in the NHS when compared with other countries. France spends more on healthcare than the UK, has fewer deaths from heart attacks than the UK, and will shortly be overtaken by the UK in this mortality measure. We determine from this observation that the UK healthcare system is not delivering as much as it should and must change, but not to be like France in funding or structure, and hopefully not in the trend in heart attack deaths. We do not consider this to be an ecological fallacy, and we do not consider any other differences between the populations of France and England.

Study design: Immediate full scale roll out without control or comparison group.

What this study adds to the current evidence: We offer no global, systematic appraisal of current evidence, and take no account of quality of evidence. As lawmakers evidence in the legal sense is our primary concern: oral and written statements from individuals and organisations, and we do not distinguish this from higher quality evidence. We are confident that this study will accrue a substantial body of similar (grade 5) non-evidence with which to inform future reorganisations.

Study population: The entire population of England, of all ages, is served by the NHS, with the exception of the most wealthy, who will be exempt.

Interventions: 1. A market based healthcare system; open to all willing providers. 2. GP based commissioning and the closure of primary care trusts. 3. Transfer of public health to local authorities. 4. Providers that cannot generate enough profit will close, whereas those making the largest profits will succeed, irrespective of the clinical performance. Taxpayer funding will continue, allowing successful firms to become a conduit of money from the many to the few.

Comparison group: None

Outcomes: No a priory health outcomes are specified, although multiple testing, case studies and post hoc analyses are planned by all political parties for election purposes and generation of low grade evidence.

Ethical considerations: No ethical approval has been sought. We acknowledge the risk associated with changing the health service, and are aware that small changes in important health outcomes can cause or prevent thousands of deaths. As we are certain that our approach is correct, we have no stopping criteria.

Consent: Population level consent sought and an election almost won on the basis of: "No top down reorganisation of the NHS". No consent sought on the specific interventions.

Costing: Estimated £1Bn to £3Bn, with potential future savings. Taxpayers are the sole funders.

Potential conflicts of interest: None declared although newspapers report the secretary of state for health has received £21,000 from the chairman of Care UK to fund his personal office.

Thank you for consideration of our proposal.

josephlee@doctors.org.uk

Dr Lee's tongue-in-cheek summary of Lansley's Health & Social Care Bill is right on the money. For all the Department of Health's talk of evidence-based medicine, no evidence has been offered to back up what is effectively the privatisation of the NHS. A few random, decontextualised and sometimes woefully out-of-date statistics about the UK's mortality rates in some areas than other Western societies have been cynically forwarded to justify full marketisation of the health service.

The NHS, we are told, simply cannot stay the way it is. Reform is essential, and this much at least is true. To meet rising demand, arising from the ageing population and higher expectations from patients, the NHS must adapt and grow. But if the DH chose to look at the evidence (in other words, if it chose not to be so blindly ideological), it would discover that opening the NHS up to the market increases the risks of poorer patient outcomes and higher costs.

A report from the grand dame of health economics, Allyson Pollock, and David Price dissects the legislation with clinical precision. It spells out the following headlines:

- while the public will continue to fund the NHS through taxation, there will be no accountability for how this money is spent. Health services will be commissioned by general practitioners, often via private companies, and provided by independent Foundation Trusts. The direct line of accountability to the secretary of state (and hence to us, the people who pay for and own the health service) will be cut.

- GP consortia, which will commission for their local areas, have the power to decide which health services they wish to purchase, and for whom. The duty to provide comprehensive healthcare will no longer apply.

- This creates a risk that some people - especially "expensive patients" with chronically poor health, or those who cannot pay - may not be covered by the health service. A "safety net" in the legislation states that these people will fall under the "provider of last resort," i.e. the Local Authority. Local Authorities, unlike the NHS, charge for services on the basis of means-testing.

- The power to charge for some health services (e.g. prescriptions) currently lies with the secretary of state. Under the proposals, this power will pass to consortia. Consortia has been given a general power (under section 7, part 2h) to charge for services, and the limits placed on hospitals on the proportion of private patients they can take on will be removed.

- Funding will be allocated to individual consortia on the basis of aggregated patient lists. Given that practices will be able to compete for patients, it follows that some consortia will be left with a less attractive and efficient group of patients. In mitigation, consortia can pool a portion of their budgets in order to share risk; however, the costs of administering such an arrangement is high, and not guaranteed to solve the problem.

- The legislation encourages the opening out of healthcare commissioning and provision to "any willing provider". Commissioning budgets are unlikely to be controlled directly by GPs, but by private corporations. Clinical decisions and referrals will become increasingly influenced by corporate business plans, most notably the need to deliver a profit to shareholders. Similarly, healthcare providers (particularly hospitals) will become independent of the NHS, and they will be regulated on the basis of promoting competition, not patient care.

- If commissioners and providers are allowed - nay, encouraged - to drift away from the NHS, what will be left of the NHS? Nothing more than a brand name, a mechanism for passing our money into the hands of corporate providers.



The RCN's overwhelming vote of no-confidence in Andrew Lansley this week marks the Government's lowest point to date. The Government has announced it will "pause" and "reflect", claiming that it has failed to effectively communicate its message. This is nonsense. Doctors, nurses and patients are quite clear about what this legislation means. It's just that until now, the media has turned a blind eye or failed to analyse the Bill's implications. Cameron's immigration speech on Thursday aimed - rather successfully as it turned out - to deflect attention away from the Government's woes.

But with the majority of doctors and nurses opposed to Lansley's proposals, and the public now starting to pick up on them, the storm is unlikely to die down. Lansley will probably have to go, if only so that Cameron (who, unlike Lansley, clearly has no understanding of the NHS and has looked very out of his depth in the last week) can regain control. It has become the new pub game: what will be the Coalition's poll tax moment? Last week, the privatisation of the NHS took poll position.

VERDAMMT DAZU, EWIG ZU WERDEN, NIEMALS ZU SEIN

We returned over a fortnight ago, but I’m still a bit stuck for conclusions about Berlin. We all know more about the recent history of this capital city than any other (and if there’s anything you need to brush up on, every Berlin street corner has a helpful noticeboard or diagram to explain what happened, when and where), which makes it difficult to experience Berlin in the here-and-now. Wherever you stand, you feel compelled to think “what did this place look like in 1989?” or “am I in East Berlin or West Berlin?” It wears its history with some pride (we came through all this and survived), but you wonder if Berliners view it as something of a millstone round their neck. As someone who cannot get enough side-by-side, then-and-now photos of urban life, I guess I found Berlin seductive but resistable.

Maybe I’ll post more substantially in due course, maybe not, but in the meantime, here is a little photobook of highlights.



Each day, the Raspberry and I left our flat armed with itineraries and lists of buildings to look at. I’ll get onto the buildings later (many of them left me rather cold), but this one called out to me from nowhere. It’s near the Hackescher Market and I still don’t get it – how did that rather classical looking collonadey thing get to be cut out of an International Style curved corner? I can’t find anything on the internet, and it’s probably not really important, but it intrigued/s me.



Norman Foster’s dome was closed, so we didn’t go into the Reichstag. The Platz der Republik felt a bit like a festival, but without the beer and homegrown – the architecture obviously has the same effect of dulling the senses.



The Holocaust Memorial doesn’t quite work. But how could it ever work? And what do we even mean by “work”? It is composed of thousands of ‘stelae’ – columns which traditionally commemorate the dead via long inscriptions. Each of the Holocaust Memorial’s stelae is blank – actually more than just blank, smooth and bland and hard-edged. Its opponents have criticised it for not mentioning the dead by name. But a memorial to the victims of the Holocaust must surely recognise that the Holocaust was more than just a genocide against individuals – it was the attempt to annihilate an entire race. The Nazis destroyed the records of many of their victims, so complete list of people killed exists. Its architect, Peter Eisenman, wanted visitors to feel the disorientation felt by the jews during the Holocaust – on this basis, it plainly fails. Maybe it fails for the same reason some of Berlin’s modernist architecture fails – it has the cool air of being slightly too pleased with itself. Shortly after it opened, Easyjet notoriously filmed a fashion shoot there for their inflight magazine. Some people are also upset by the opportunities it affords for clambering, for jumping from column to column, or for playing hide and seek. There’s no doubt – it does encourage playfulness. This disturbs us, but we can also see that it is irresistible. It reminds me of a Zizek passage where he talks about cinematic portrayals of the Holocaust. After considering Schindler’s List and Life is Beautiful, he concludes that the Italian farce Pasqualino Settebellezze (“Seven Beauties”) is the most apt...





Anhalter Bahnhof was, in the time of Bismarck, the largest railway terminal in Continental Europe, linking Berlin to Frankfurt, Munich, Dresden, Prague, Vienna and Italy. Like St Pancras, it had a grand hotel attached to it (the Excelsior) via an underground tunnel; and like St Pancras, it was an almighty piece of architecture, perhaps the most startling in scale that Berlin then possessed.



Under the Nazis, thousands of Jews began their journey to the death camps from Anhalter Bahnhof. The deportations continued until March 1945. Nevertheless, Speer’s plans for Germania did not include Anhalter Bahnhof, which he planned to turn into a massive swimming pool. In the end, the station, virtually destroyed by Allied bombs, clung on until 1960 when it was demolished, except for the facade which survives today next to an astroturf football pitch.





Karl and Friedrich have been temporarily moved from the middle of the park on Karl Liebknecht Strasse, and are currently sheltered under some linden trees, protected by metal fences. It’s difficult to tell whether they’re pleased with this development or not. Engels has that look of a man who is constantly put upon – it looks like frequently sweeps his hands through his hair in frustration.





This is an original Bruno Taut siedlung – the Wohnstadt Carl Legien in Prenzlauer Berg. Taut was Weimar Germany’s answer to Berthold Lubetkin – defending his opulent housing for working people, he said "we want to bring the lower levels of society higher." Carl Legien was the first chairman of the German equivalent of the TUC, and the flats named in his honour are quietly lovely: colourful and oriented to their copious back gardens. It occurred to us that it rather strange that decent, artistically designed housing for the masses becomes a tourist attraction. Maybe it’s not really a tourist attraction, but it seems sadly part of another world when today’s governments are not interested in providing their people with good, secure places to live.





An image from the East Side Gallery, the largest surviving portion of the wall, now covered with murals by artists from around the world. Ms Raspberry took this photo; I was in a mood that day.



Peter Behrens’ mighty turbine hall for AEG. More of this later.



Mies's Neue Nationalgalerie, with a reflection of the state library (the latter a far superior building to my mind than the former).