Article: The Quest for Excellence – Healthcare

In my last blog I highlighted that by tweaking our way systematically and methodically out of a crisis we can collectively reach greater efficiency and major overhauls. Health and social care is no exception to this principle but when they reach a point of crisis there is undoubtedly extra pressure to do it quicker as lives are at risk.

Historically the NHS and current benefits (formerly National Assistance) came about to alleviate suffering from illness for every man, woman and child here in the UK.  A noble and bold move. Many causes of serious illnesses were identified as having simple solutions by way of basic housing, dental care and the introduction of free milk and meals for children at school. The funding for which was available because our nation was not as sophisticated in its needs and following two world wars were of a mindset to help each other out. Whereas in the 20^th century people were grateful for any help at all they received, at the beginning of this century people seem to be more inclined to criticise what it hasn’t the capacity to deliver... yet.

I sometimes think we have become like a truculent child never satisfied with what we have got and unaware of how much it helps to keep us safe and healthy.

It would appear that no one in government or in the NHS or Social Services predicted the effect of a massive growth in population or the rate of technological and medical advances. The result now seems to be that both have a demand from patients that far exceeds the supply of staff or facilities to cope with it at the rate that we, the public demand that it should. There are log jams everywhere for while there are many aids to the disabled and chronic conditions it is very much a lottery as to who will have access to them. In some cases it is down to your postcode, in others it is simply down to a lack of investment to roll it out at all which is incredibly frustrating for the medical science that works so tirelessly to find such solutions. It is also frustrating for doctors who are duty bound to constantly keep up to date with what might be possible but most of all frustrating for sufferers themselves desperate for that solution that has been reported in the media. It can be like placing a meal in front of a starving man but banning them from eating. We are all part of the problem and the solution at the same time.

We, the public, have become very adept at making ourselves unwell and disfigured. Professional dancers and sports people in their quest for excellence actually deform their bodies, people cripple their feet by constantly wearing high heels (occasional use doesn’t have this effect), thrill seekers and speeding drivers often end up in serious accidents as do those who would rather ignore or forget safety measures in the workplace to do things their way. We damage our livers with alcohol, our lungs with smoking, our brains with drugs, we eat too much or too little, do too much or too little exercise and most significantly of all make ourselves anxious and irritable about everything. Some even knock out their immune systems by striving to eradicate all germs which help develop them. Hermetically sealed homes are hardly likely to be a solution.

More people than ever attempt to self diagnose without any training by latching onto one or two symptoms and looking it up only to assume they have something terminal. Most commonly we panic that a simple symptom is an early sign of cancer. Early intervention is vital and yes you should talk to a doctor if you are concerned but the reality is that one incident of constipation is not likely to indicate a serious condition of any kind. Many such symptoms could just as easily indicate something very easy to remedy by tweaking your diet or exercise levels and by not leaping to the worst case scenario in the first place.

Quite a few serious conditions arise from anxiety and worry including heart conditions and mental health problems. In short we can help ourselves by not assuming the worst as an immediate response to one or two isolated symptoms. We can instead talk to a local chemist or phone NHS Direct – it can save many an unnecessary sleepless night.

Your GP is an Operations Manager for your well being

When you consider how many disabilities, ailments, accidents and illnesses the human body could suffer from, aren’t you rather grateful that your GP takes several years to train to learn about as many of them as they can? When you consider how many treatments there now are, aren’t you grateful that it you have a GP has the knowledge to alleviate so many by themselves AND direct you to specialists when required for further tests and treatment? Aren’t you glad that we have consultants that specialise in every area of medicine to get you well?

Your GP is responsible for the whole of your health both mental and physical so when they refer you to someone else, I recommend you go unless you want to get worse instead of better. Given how complex the human body is it is perhaps not surprising that in some cases it can and does take weeks and months to track down the root cause of illness, and likewise to get the treatment right. The important point to remember is that they try their best - if they didn’t there are safeguards in place for them to get suspended or sacked. When a GP does not refer you to specialists they do not so out of malice but most commonly because you do not need it, yet I have come across some who will not accept that. A large percentage of the time the GP is right but of course there are exceptions.

Sadly there are instances of malpractice, of abuse and of misdiagnoses but they are exceptions and what I fear is happening is that overall there is a mindset that takes these examples as being the norm when they are not. Statistics back this up. In all cases it is better to not cross bridges until you come to them. Better to find someone you feel you trust for your health care than to trust no one at all. The majority of health care professionals are safe and trustworthy. They entered the profession precisely because they want to help alleviate and cure suffering.

The reality is that not everything is curable, but where there is no cure the medical profession as a whole work to help manage symptoms and help us to adjust to that reality. The truth is there can never be a cure for everything as we inadvertently create new conditions and nature itself comes up with new things too. However, when we consider what astounding things are possible today compared to 100 years ago, I think we’re keeping pace rather well.

The Government’s part

Successive UK governments, just like the medical profession mean well but over the decades government invention often has had a detrimental effect. Just at that critical point when a patient is about to make significant progress a local facility gets closed, or there is less funding for tests as the priority from government is to deal with the increased instances of a different disease which is deemed to be more life threatening or on the increase.

It is an extremely difficult equation to get right as without early intervention people’s health conditions tend to have a habit of deteriorating. Economy drives in the form of services which are cut depletes morale in health care professionals which in turn can lead to increased stress which can lead to an increase in mistakes. Even managers get confused by edicts from government;  access for funding for one area of medicine gets switched back and forth all the time in reaction to demand. Procedures get changed, priorities get changed particularly when it comes to administration necessary for record keeping. The effect is that staff often have to adapt instantaneously to radical changes in both finding information and recording it. This leads to delays and further confusion and sometimes missed elements vital for diagnosis and treatment. In effect the changes insisted upon by government can and have added to stress levels, confusion and errors in my opinion. This is not unique to this parliament/government. This is a recurring pattern no matter which party is in office.

I believe this to be avoidable by the simple expedient of analysing what works first and why in as much detail as we do when there is a fault. In my opinion the best place to start to look for trends in ailments is from those who have the greatest level of objectivity in the medical profession, i.e. those who co-ordinate access to all treatments – our GPs. I can think of no other position in the health profession that is more aware of the most common ailments, and of what is likely to become more common either. If we want to stop being reactive and start being proactive to anticipate future demands it’s best to get the most relevant information we can as a starting point isn’t it?

Change is necessary

With increased awareness of illness come increased demands upon health care. With the mandate to prevent illness demand increases as it does with an increase in population; all come with added need for funding, more administration, more staff and higher levels of training requirements. Most of all it results in a greater need for more facilities – not less.

Like the government the NHS is responsible for just under 60 million people’s health in the UK regardless of those who can afford private health care, because it will mostly likely be an NHS A&E department you will be taken to first in an emergency and most commonly in an NHS ambulance. Even if you have private health care the standard of excellence in some areas of the NHS is such that it is their professionals that you will get referred to for treatment in their facilities. I think it only right that it is the NHS itself that dictates to government what its priorities are, but it can only stand a chance of properly assessing that if it has a chance gain the head space to enter into that process of diagnosing its shortages itself first.

In my opinion it desperately needs to stabilise what is already working first for the sake of its hard working staff and their health, but more crucially for the sake of the health of its patients. No private health care provider in the UK has the remit of looking after the health of 60 million people other than the NHS. Therefore no private health care provider could possibly have experience on how to do it. That is not to say there are not brilliant ideas to learn from private health care though. 

It is nothing short of a miracle that the NHS has and continues to cover so much. It puts me in mind of scientists trying to work out why a bee can fly as for years they were baffled by it. Bees seemed to defy all known laws of aerodynamics and yet they flew. So perhaps it is to science and mathematics that we should turn to find out how the NHS manages as if we understood that it would help to build upon its already marvellous achievements.

Do not stop seeking help when ill from the NHS, but do try to be (pardon the pun) patient. When any of us are ill it is often the hardest thing to do, but hard never means impossible. I’ve never worked for the NHS, but I doubt I would be alive today without it. When seriously ill, I have made matters worse sometimes, been demanding, angry and frustrated. It is very much the nature of us all to do so when we are at our most vulnerable, but by working with my medical team instead of against them my health improved. We can always help each other to improve everything we value and nothing on this Earth is as valuable as our own health. Cherish it, and above all take good care of it. 

"Keep calm and carry on caring!"

Operations File: The Art of Tweaking - 10 Steps to Efficient Working

There is no question in my mind that the smaller an organisation the easier it is to review, assess and analyse faults and identify inefficiencies. The fewer parts there are in any machine or system the fewer points of failure it can have or develop. It becomes a relatively quick process to fix a problem, to reorganise a system, to develop it or add and expand it.

Faults, spanners in the works, inefficiencies can only be in a limited number of places in the smaller enterprise operating in isolation. For larger concerns (including government departments and banks) such challenges become ever more complicated to nail down to just one cause as several factors are always in play at any one point. Put simply, problems multiple proportionately according to complexity of the systems devised. This situation is exacerbated when prior expansion plans were not thought through or could not predict excessive demand and no contingency plan was considered.

Leaving aside health and social care (the subject for a future blog) this blog outlines the basic principles for any other organisation. The reason to separate health and social care is because the effect of changes are far more complex as real lives are at stake and the entire history of such services has to be taken into account. It merits a more detailed understanding.

Signs of overload

Hands up all those who have encountered difficulty getting through to the right person in the right department to resolve a problem; from supplies of raw materials to contractors and delays in applications for funding, loans, getting repairs done and all manner of bureaucratic tick boxes to wade through – all hold us up in our endeavours. This is nothing new, the only thing that has changed is our lack of patience. I am no exception to this at all though I do try to be.

With increased demand comes a higher risk of inefficiency, mistakes and delays exponentially speaking. With increased inefficiency comes an increase in frustrations, complaints and overloading systems and ultimately... collapse. The solution is to calm down. The expedient to deploy is forward planning.

However when a crisis occurs forward planning is not the priority and if no contingency plan has been anticipated for any particular situation it can result in a recipe for disaster. The only way to cure inefficiency is to work methodically through all the following steps.

10 Steps to Cure Inefficiency

Step 1: Identify areas of high risk of overload – they are your priority.

Step 2: Identify specific labour intensive, time consuming tasks – they are areas that need attention.

Step 3: Look at the whole system to see if some faults are occurring everywhere – if so do they have the same root cause?

Step 4: Identify where and how duplicated effort occurs and why – opportunities to simplify should start to become self evident.

Step 5: Identify what still works efficiently and why – you’re going to need to protect it to continue to work.

Step 6: Research ways in which to simplify tasks and reduce duplicated effort that will suit your workforce and its way of working – there’s no point trying to get staff to work in a way that causes stress or worse, disinterest – and discuss options with all staff.

Step 7: Propose a 3 phase plan of action to the workforce and amend according to priority of need for each and every department.

Step 8: Finalise plan of action and set target dates for each phase.

Step 9: Monitor, review and adapt each phase as it is being implemented.

Step 10: Start planning how the new system can be modified and developed for expansion and don’t forget to design a contingency plan to prevent panic should it need to downsize – it substantially reduces risks of stress which enables people to adjust more easily.

All this sounds simple but in practice it requires the full co-operation of everyone, patience and commitment. Just a surgeon wishes to avoid snagging a lung when operating on a heart, success depends largely on NOT disturbing what works as little as possible. The key steps I find that commonly get glossed over or totally ignored are Step 5 – identify what does work and why, and Step 6 – research and discuss with staff. You can delegate or take the first 5 steps in any order it you like, but ensure you do them all thoroughly. 

In one overhaul of systems the instruction came to me to “change everything!” This came from staff and managers alike. What followed was the eradication of duplicated tasks by different departments, increased access of information that anyone needed to do their work. This didn’t mean all information was made available, merely that which was relevant to each department with the addition of overviews from other departments.

During the transitional period staff found that they had to relinquish some responsibilities and take up new ones, but by asking staff beforehand this was achieved amicably so that it all worked out rather well. It did so because things were not such much overhauled as methodically, systematically tweaked into working at every stage of the process across the whole operation at the same time. The result was an overhaul. Everyone was behind it because they totally understood both the risks and the benefits throughout the process.

The practicalities of tweaking is more of a specialism of the staff than managers in practice but only when managers are on top of the whole picture so that they can highlight pitfalls to avoid and reinforce the long-term objectives. They co-ordinate the whole, but it’s the staff that make it happen. Regular updates are vital during any transitional period so that no one department races ahead before others are ready to. If one department is lagging behind to achieve its targets, the others who are waiting for them should help by teaming up with them which increases unity in any workforce.

Efficiency to me automatically means less stress in the workplace and always entails empowering all parties to utilise their skills to their full potential. Collectively we can and do devise solutions that benefit all. In isolation we can only devise systems that will suit a few.

Hard work need never be devoid of fun so enjoy the Art of Tweaking your way to a less stressful and more successful stress free future!

A comedy sketch

A sketch that didn't make the cut for 'The Tourist's Guide to an United Kingdom'. Enjoy. It is meant to be funny but only you can decide on whether it is or not.

A Composite of Errors 

Characters:

Members of a Democratic society (MoDs), Rocker (a media presenter) and...

a Government Official or spokesperson (Gov Off).

Rocker: Hello and welcome to Big Answers, the show that debates the topics that are trending the most and top of the agenda this week is “Do any politicians do what the people elect them to do?” With me tonight are highly opinionated members of the public and our so far unheard of obligatory Government Official. Well what do you expect when we have to economise on production costs? Who would like to open?

MoDs 1:               The answer to that is no.

Gov Off:               I really cannot agree with that statement because I think the evidence speaks for itself. The electorate always vote for change and whichever government is elected actually always delivers on that and always has in fact.

MoDs 2:               Yes, yes that’s true. I think I’ll vote for you again!

MoDs 1:               Oh do behave, we didn’t ask for this magnitude of cock-ups did you.

Gov Off:               Well as a matter of fact, in a way you did.

MoDs 3:               No I flaming well didn’t! I never voted for you toffs to cut benefits, cut social and medical services, cut legal aid, cut education, cut emergency services and the armed forces and I think I am right in saying no one else who voted did either!

Gov Off:               Ah well, you see you didn’t explain that beforehand you see and not being endowed with the powers of telepathy we after due consideration and many a debate decided to go with the changes you did ask for.

MoDs 2:               You see I told you they listened. If I may, I would like to elaborate by a way of a brief recap on what we did ask for, then we’ll see if the government did as we wanted.

Gov Off:               Oh please do, I have a dinner meeting before collecting my new rubber stamp from the requisitions department, who also supply red tape in abundance. My old rubber stamp has simply worn away with over use recently. I can’t fathom why. It’s prompted an enquiry as to whether or not we should review the materials used for such items as their life expectancy, as it were, is woefully below expectations and falls short of what current demands are for such a device.

MoDs 2:               Oh really? How distressingly annoying for you. I can hear my heart dripping as it bleeds for you.

Gov Off:               Yes it is rather. Never mind though, in true nationalist spirit we soldier on. Do continue with your explanation of what we’ve achieved for you all even we politicians get frayed by constant criticism and little praise you know. We are but human after all.

MoDs 2:               Aww bless you, you poor things. And thank you for this opportunity to speak for you. With a bit of luck it might persuade party members to consider me as a candidate for party membership. Here goes nothing.

MoDs 1:               You said it, love.

MoDs 2:               We asked for there to be economies to combat this financial economic crisis, so this government made cuts. We also asked for a reduction in foreigners being allowed in and this government is doing its best by making it as unpleasant as possible for them to enter our country unless they work like stink for less money than we are prepared to do and... we asked for benefit scrounging to stop and benefit fraud to stop too and I must say I am thoroughly delighted with how well poor people are now being forced into thinking about actually earning a living instead of expecting to get a free meal ticket for doing nothing for this country. And you’ve even gone as far as forcing the ill into work too before they get addicted to the idea that they have to be fit to work before trying for it. I think you’re simply marvellous. I really do.

Gov Off:               Quite. We couldn’t have put it better ourselves and indeed haven’t it would seem. So you see, far from being unreasonable, uncaring people we, in government are merely doing exactly – absolutely nothing more and absolutely nothing less – than you, the electorate have requested. So it does come as rather a shock to all members of parliament, across all parties that so many of you are er... how does one put this, dissatisfied with the result. After all it’s not as if many of you were particularly interested in how we effected these changes that you put us in office for. Those that expressed an interest we did our best to listen to but with 60 million people to consider it at times, if only occasionally proves to be a tad confusing as to how to come up with policies, laws and legislation to win the popularity I mean approval of everyone at the same time.

I would further like to point out that we have made significant inroads into economising by making redundancies in the all our government departments by sacking, I mean sadly making redundancies in the Civil Service. Successive governments have done this in order to cut down on the volume of paperwork we would otherwise have to wade through.

Rocker:                 I see. So how does that work then?

Gov Off:               Well, it gets filed in the appropriate department.

Rocker:                 Who files it?

Gov Off:               A Civil Servant of course.

Rocker:                 Do these documents get read, summarised and acted upon?

Gov Off:               Well, er... yes I believe so.

Rocker:                 You believe so, but don’t know.

Gov Off:               Why would I know. I am only a token spokesperson after all.

Rocker:                 Do you have any idea about who actually deals with these files then?

Gov Off:               By whoever is appointed to do so during any parliament of course.

Rocker:                 Who appoints these people and are they Civil Servants or Ministers?

Gov Off:               In accordance with the democratic process we elect people to appoint. Sometimes it is more appropriate to appoint a Civil Servant, sometimes a Minister or their Private Secretary. The elective process is very simple, we drop random names in a hat and whoever loses gets appointed. With the streamlining of Civil Servants it actually increases the chances of an MP getting the appointed with this role. The point is that these files are always to hand in each department and are never lost for ease of reference.

Rocker:                 Without breaching security of course can you give us a rough idea as to where they are filed or how.

Gov Off:               Er well let me see now. Yes, I think I can although I’m it’s not my personal area of expertise. Each department, as I understand it files all reports, correspondence and memos etc in especially designed and dedicated receptacles. They are called BINs for short.

Rocker:                 Bins?

Gov Off:               Yes, it’s an acronym for Bureaucratic Information Notifications I believe.

MoDs 1:               That explains a lot. Allow me to translate this time. They mean they file everything in with the rubbish which let’s face it is the only area of expertise politicians specialise in!

Gov Off:               Oh come, come that’s hardly fair. Governments never throw anything away for fear of legal action against them! Governments may make laws but they still have to seem to abide by them at all times.

MoDs 1:               Hang on a minute. Just how many honest workers in the Civil Service did you make redundant.

Gov Off:               To be quite candid with you, I’m afraid I don’t know. I do however know that the target is to get it down to only have one Civil Servant.

Rocker:                 For each department?

Gov Off:               Ultimately for being responsible for the entire administration of all government departments. A response to calls for not wasting so much time and money in bureaucratic red tape and a means to ensure that long term only elected MPs will be responsible for admin. Frankly the current batch care little as they have no intention of reading every email whatsoever, instead they take samples by dipping in and out once a week though there are rumours this will be reduced or streamlined down to once a month. But to answer your question as accurately as I can, I believe the current figure for the total number of full time government administrative Civil Servants is about 200. This has been achieved thanks to the marvel of automated systems which are programmed to back up all correspondence so that nothing is ever lost as it might be useful one day.

Personally in response to the demand for further savings I am only on an apprenticeship scheme earn the same amount per week as anyone else is despite having a weekly allowance from my extremely wealthy parents which amounts to the equivalent of what some people currently will earn in an entire year. The principle of my being paid something for my work was deemed politically correct and in order to appease my father who for some reason developed a nervous condition involving his eyes rolling every time Mama and I entered into conversation, I can’t fathom why. When one has a job to do, one has to abide by the boundaries of that remit. Next year I might well find I have the opposite remit to perform. Not having a crystal ball one finds one really can’t comment further on that except to add that one can always try to choose a job that one enjoys. I happen to enjoy paradoxical and conflicting roles which makes me rather employable.

Rocker:                 Well what do you know, an honest spokeperson for the government. I have a feeling your employment status will be changing rather rapidly after those revelations.

Gov Off:               I look forward to it. I rather enjoy variety of experiences don’t you?

Rocker:                 Well I think your wish will be granted on that one. Leaving that aside for this debate, but I’m sure it’s a subject for some Parliamentary Ombudsman or other to debate with if not the UN and a psychiatrist, let’s get back to the question for today. Do the people think that our government do what we elect them into power for?

MoDs 2:               Yes!

Rocker:                 Wow, someone who actually believes they do. Who’d have thought it eh? Is there anyone else or are you a lone voice in the wilderness of a hurricane set to blow your delusions away?

MoDs 4:               Yeah this government is ok cos I want a return to the good old days where you can be racist, sexist and as prejudiced, abusive as you like without any meddling from the knob heads in government. So long as you’re not caught bothering anyone, what business is it of anyone else’s anyway, eh? I mean that’s what our illustrious leaders have always done anyway innit?

Gov Off:               I don’t think that’s in any democratic party’s manifesto yet, but if that’s what the majority of the people of this country want, your wish is very much our command as it were. I’ll make a note of that for MPs to debate when next in session. Never let it be said that we in government are not open to radical ideas.

MoDs 1:               You ignorant, short-sight prats, of course it’s not what the majority of people want!

MoDs 3:               Hear, hear! Heaven forbid that we return to those days. We need progress not regression.

Gov Off:               Oh really? What a pity I thought we were onto something easy to achieve for a change. How disappointing because you see the crux of the problem that you plebs, I mean the proletariat... I mean the electorate don’t seem to grasp is this. To fulfil your ever louder demands for change, ever more rapidly, for things like more money in your pockets, for being rewarded so that everyone can be millionaires (at which point, I can assure you as I speak from personal experience, you won’t want to pay 40% income tax) there have to be sacrifices along the way. Money you see does not grow on trees. At least not yet, but your government, already anticipating that request has already allocated billions to try and make it do so.

MoDs 1:               You’re off your trolley you are! All of yer are! Stark raving mad!

Gov Off:               Be that as it may, and may I point out that the electorate voted us into power unlike in communist countries where they largely accept that someone has to lead for better or worse and therefore just leave them to it, sort of. They have just as many extremes from bright ideas on what’s best overall for their people but without the encumbrance of voting who leads them into chaos. As I was saying, I feel compelled to repeat a former statement. Money as yet does not grow on trees so in a democratic nation the electorate quite simply have a choice on what they would like their chosen government to spend limited funds on. If the voters don’t like the changes we have brought about they are at liberty to express that by voting for different changes, but no matter who gets into office next time, that government will do exactly what you demand of it, though probably not in any way you would wish it. We thought by now you might have evolved wit enough to have worked out that this is how all governments work and have worked since democracy began, but apparently you haven’t. The reason for this style of leadership is very simple and comes in the form of a well known maxim that you might of heard of “you can please some of the people some of the time, but you cannot please all of the people all of time.” All democratically elected politicians do is try to please enough of you enough of the time to vote them into office. And like lambs to the slaughter you always vote for personality above content, for who speaks more eloquently above what they are actually planning.

MoDs 1:               Well I know what changes I will be campaigning for before the next election then. I want a change in bleeding attitude from politicians for a start.

MoDs 3:               I quite agree, but would you mind not swearing please.

MoDs 1:               Sorry darling, but they fair make my blood boil they do. I want progress not a return to previous centuries when it became a topic for debate about what to do about the stench from unsightly poor people cluttering up the street, quite aside from the nasty diseases they spread. Did the 20^th century not happen or something? Was the last 100 years for nothing then?

MoDs 3:               Well put old bean! Bravo! Well put! I mean surely it is better to spread what little funds we have more evenly and to use it more prudently after all we are an innovative nation are we not? We’ve still got pluck enough to do this haven’t we? And instead of radical changes with every new government, couldn’t we just tweak things more gradually? I mean one never knows whether one is coming or going these days, does one?

Gov Off:               Dear lady, you encapsulate the dilemma of many a government with that statement but the reality of going with sensible measure such as you propose is that they are never popular enough to win enough votes.

MoDs 4:               Nah, why bother when you know dam well it won’t last. History love, repeats itself. Let chaos ensue, dog eat dog. That’s the natural order of things and mankind has simply meddled too much. High time you accepted it and your rightful place as a chattel to your masters and betters.

MoDs 2:               Good grief, who let him in? It’s like some throw back in time.

Gov Off:               If I may interject again to reinforce that last point...

Rocker:                 Oh must you? Lord how they like the sound of their own voices. Try and be brief pal.

Gov Off:               Sadly unless the people of this great nation choose by democratic majority to abandon or at least streamline what they demanded of their government previously to change tack again  to reverse what has been done in this parliament, and unless the majority of the public vote for such sensible measures as investing in all services more evenly it isn’t likely to happen. Indeed thus far, if memory serves me correctly, the electorate never have made such a demand of any government in the entire history of mankind so I am pretty confident it won’t do so before the next election either.

MoDs 1:               Oh I see, it’s our fault! I knew it. I just couldn’t figure out how.

Gov Off:               Oh it’s your government’s fault too in equal measure I think, but there is another factor which tends to upset the apple cart with tedious regularity and that is the unforeseen. From hostile acts from other nations to natural disasters and calls for our assistance from many desperate people aboard – all require considerable amounts of time, energy and money, tact and diplomacy to safeguard this great country from all manner of threats including the threat of diminishing its reputation and investments beyond its own shores. Unless and until we can nationally and globally agree to kerb our appetite for our own betterment at the expense of others it will always entail that others go without unless of course everyone chooses to voluntarily donate as much as possible to the less fortunate among us. Governments could tax you more heavily but all you do is vote them out when they do that. The overwhelming evidence suggests that you don’t want that and that’s why we in government do our utmost to follow your example and your wishes. We happen to be rather better at it than you because we’re in power and you’re not and have the advantage of knowing how to wangle systems or change them to suit our personal interests rather favourably. It’s a career path I highly recommend assuming you can the last the distance of continual criticism that is goes with the territory along with all manner of slur campaigns to discredit you from the media, sometimes justified, sometimes not. The perks long term don’t tend to be bad and just like any of you who wish to be remunerated handsomely for the level of responsibility for others you undertake, we are no different. But, take heart for this government has been investing on your behalf in all manner of automated systems and environmental safeguards to make the threat of the demise of the human race and indeed the entire planet is as pleasant as possible. For example we have given a shockingly large amount of money to science in the hope that through research and development money will one day actually grow on trees. There was a proposal to change the format of cash into apples and other fruit but the feeling was that there was a high risk of fraud thanks to the arrival of genetically modified foods and the advent of 3D printing so the idea was squashed and made into a smoothie instead as a result of a recycling pilot scheme your government thought it would test drive.

Rocker:                 Are you serious about that? I mean, you didn’t seriously consider that proposal did you?

Gov Off:               Well we are obliged to consider even the most unorthodox ideas at times, never more so than in a financial crisis or when we happen to be caught up in a World War or two.

MoDs 1:               You’re sick you are. In the head.

MoDs 3:               I fear I have to agree, you’re all as sick as parrots and squawk just as much.

MoDs 1:               No, it’s worse than that it’s more like a disease that spreading.

Gov:      The cause being the electorate.

MoDs 1:               Bollocks it being our fault, you’re like, like... I dunno, like poisonous toadstools pretending to be healthy mushrooms. We just want enough stability to get on with our jobs but you can never leave well enough alone for anyone to do anything sensibly without changing everything. You know it well enough alright but just won’t admit it is all. You’re crazier than a box of frogs.

Gov Off:               My dear chap, I think you’ll find we all are now. Who is more insane, those who are crazy enough to attempt to lead in the way that we do or those who vote known mad people into power? say we interfere with your work, well frankly the electorate dictate through continually meddling in ours. I would recommend adopting the attitude of “If you can’t take a joke, you really shouldn’t have joined.” It’s a mere palliative of course but it does allow one to continue in ones obligations according to our respective remits. Or to put it another way become a fungi! Oh I say, I think that’s rather good.

Rocker:                 And a very old joke.

Gov Off:               Oh is it? What a shame, I thought I’d become a wit at last. Never mind, practice makes perfect. One day I might become a fungi indeed I could quite possibly do so if I get buried when I pop my clogs.

Rocker: Indeed. Well that really does give everyone plenty of food for thought I think. I’d like to thank our contributors for their candour (that’s honesty to ordinary folk). Remember you heard it all here first, but that’s all we have time for tonight. Next time on Big Answers we debate vegetables – smarter than us or more stupid, and should they have the right to vote? My opinion is they already do. I hope you can join us. Good night.