Sunday, February 26, 2006

Good manners in public life

Various comments from council meetings at the opposite end of the country in the past few days have set me to thinking about the importance of civility and good manners in public life.

There is always a temptation for someone considering a current problem, to compare it with some real or mythical past age when such problems supposedly did not exist, and conclude either that the younger generation is dreadful or that the country is going to the dogs. I will resist that temptation, because I can remember when I first got involved in politics at the age of 17 I heard some pretty extreme examples of rudeness between politicians, and older councillors lamenting that there was much more hostility between the parties than when they were younger. Come to that, as a small boy I remember hearing my mother tell my father that there were “a lot of babies running the country” after an exchange between Ted Heath and Harold Wilson which concluded with the leader of the opposition saying that “an insult from the Prime Minister is a compliment to any self-respecting member of this House.”

But although I am not convinced that the overall standard of manners in public life is getting worse, I am entirely convinced that it could and should be better.

What started this train of thought was a council meeting marked by several instances of gross incivility. One councillor responded to a motion I had moved seeking to limit the amount paid in councillor’s allowances, not with a real discussion of the merits of the case, but with a personal attack on myself which was nasty enough to draw a rebuke from the mayor. Those people who have seen the way the three political parties operate will not be at all surprised to learn that the individual making this attack was a Liberal Democrat.

The last time I had been on the receiving end of a similar piece of venom, also from a Lib/Dem, was about seventeen years ago, and on that occasion the then Mayor was sufficiently upset to tell the councillor concerned to finish speaking. I have no criticism of the current Mayor for not doing that to the person who attacked me this week; it is a matter of judgement how severely to respond. If the threshold were set at the level which required such a response he would have had to terminate speeches from one Conservative, one Labour, and three Lib/Dem councillors. Indeed, the Mayor did order one member of the council’s cabinet – yes, a third Lib/Dem – to sit down and stop speaking after he responded to a question from a member of the public by cross-examining the questioner.

At the other end of the country, there was a very unfair attack on the current Mayor of Copeland following a meeting of Cumbria County Council. The National Code of local government conduct requires councillors who serve at more than one level of government, such as Borough and County, to reconsider an issue each time it comes up and to do so from the viewpoint of the whole area covered by the body they are currently sitting on. In other words, County Councillor Norman Clarkson is not just encouraged but required to avoid being influenced by the fact that he is also Mayor of Copeland while voting on an issue at the County Council. I was very disappointed to see him criticised in this week’s local papers for not breaking ranks with his county group on a difficult issue affecting Copeland. If the attack on Councillor Clarkson was meant to imply that he should have given special treatment as a county councillor to Copeland, he was effectively being attacked for not doing something which the code of conduct signed by all councillors specifically forbids.

I wish I could say this was the only time I had seen the mayoralty of a Borough or City dragged into politics, but sadly it happens too often and has done throughout my time in public life.

But if we want to make politics relevant to a greater range of people, then politicians of all parties must make more effort to treat one another and the public with more politeness. Even – to use a current buzzword – with respect.


Giving birth can be both one of the most wonderful and one of the most agonisingly painful experiences any human can have. No man can completely understand what the women we love have to go through to bring our children into the world, but you don’t have to experience it first hand to know that even a straightforward and quick labour with no complications is a shattering experience and a bad one is beyond description.

I have always found it amazing that some “natural birth” fanatics try as hard as they do to persuade women not to use pain relief during birth. Where there are genuine medical concerns about particular methods of pain relief I understand it. But people who argue against anaesthetics on the grounds that they stop people from having the whole experience of birth completely horrify me. It is the sort of argument you would expect from the Marquis de Sade on acid.

I am strongly opposed to the proposal from Education and Research Committee of the National College of Midwives to charge women giving birth in NHS hospitals for epidurals “unless there is a medical need for them.” Like many proposals which at first sight appear to be completely insane the arguments for and against this are more complex than is immediately apparent. But although there is a real issue this proposal absolutely is not the way to address it.

The reason why some midwives are arguing for a reduction in the number of epidurals is that studies suggest women who have this particular form of pain relief may spend longer pushing the baby out of the birth canal and are up to 40% more likely to need some other form of intervention. For example they may need a forceps delivery which can bruise the child’s head. So there is an argument for encouraging wider use of alternative forms of pain relief.

However, discouraging epidurals by charging for them is an appalling idea which would be both unjust and utterly counterproductive. For a start, wealthier patients would pay for anything which they perceived as reducing pain no matter how much it costs, and this policy might actually encourage those women with incomes above the poverty level to think of an epidural as a powerful form of pain relief and ask for one. On the other hand, those vulnerable women who are affected by poverty might be afraid to ask for pain relief even if they really needed it for fear of being charged for an “unnecessary epidural.” Any policy which might result in the poorest members of society going through agonising pain while being afraid of the cost if they ask for help would be outrageous and utterly unacceptable.

Whether pain relief is provided and of what kind is not just the responsibility of the mother, it is also a matter on which the taxpayer is paying for the professional advice and expertise of the midwife and at least two doctors, the anaesthetist and obstetrician. If there are medical issues affecting the form of pain relief to be used it is the professionals’ responsibility to ensure that those issues are properly taken into account. They can, should, and in my experience, do explain to the expectant mother the advantages of the various different forms of pain relief available.

Recent surveys by Mother and Baby magazine found that only 5% of women have a “completely natural” birth with no intervention or pain relief: 23% have a planned or emergency caesarean. 38% of women have an epidural. These percentages did not change between surveys in 2002 and 2004. I have seen it suggested elsewhere that the percentage of births with an epidural is about 20%. Either way it would appear that a very substantial proportion of mothers do ask for pain relief but go for one of the other options rather than an epidural, and the proportion given an epidural does not appear to be increasing.

If, and I repeat if, there is convincing evidence that large numbers of women are asking for or being given epidurals without medical need – then procedures for advising on and deciding on pain relief should be reviewed. But it would be wholly wrong to put the blame on the mothers or to introduce charging.

Tuesday, February 21, 2006

From Two jags to Twenty-Two jags ...

I was most amused to see on the front of the News and Star the other day a quote attributed to the Deputy Prime Minister to the effect that he felt a right twit.

Had someone slipped John “Two Jags” Prescott a truth drug ? Had he realised how daft it is to bulldoze thousands of houses in the North while simultaneously forcing councils in the South to build vastly more houses than the local infrastructure can support ?

Has he finally realised how daft it is to waste millions of pounds on unelected Regional Assemblies when the only area of the country he offered a chance to say whether they wanted an elected regional assembly voted massively against “more politicians” ?

Was he referring to the fact that he as minister for council tax had not paid his own ?

Was he referring to the fact that while he is proud of having two jags himself, his department’s policy of restricting the parking places provided with new houses means that anyone else with two cars will have trouble finding a house where they can be parked off the street without cluttering up the road and blocking emergency vehicles ?

No, he had merely had a slightly embarrassing accident while visiting a Cumbria school’s sports events. Oh well. Perhaps having admitted to looking a twit in one area he might eventually realise how he looks in the areas where he is doing real damage. The frightening thing is that such a man is not the most disastrous minister to serve in a government which has also included Margaret “foot and mouth” Beckett, Steve “pants on fire” Byers, Patricia Hewitt, Frank “dead-head” Dobson and Geoff Hoon.

And after two-jags, we now have twenty-two jags, this being the number of cabinet ministers who are offered an official jaguar. To be honest, if this decision had been made by government which was not so fond of bashing the motorist I probably wouldn’t object. But from advocates of “Modal shift” who are trying to persuade the rest of us to give up our cars it rather looks like “Do as I say, not as I do.”


(Or, "Why Cumbria should keep our own police force."

At one stage it looked as though the proposal that Cumbria should lose our own police force, as part of a rationalisation into huge regional police forces, would go through without much of a fight.

However, all the police authorities have refused to meekly submit proposals for their own abolition by the required deadline. And I am grateful to Simon Jenkins in the Guardian for the most damning quote opposing the regionalisation of police forces in England and Wales.

A very prominent politician once described the idea of scrapping the existing 43 police forces and replacing them with larger regional forces as "the most determined and least popular attempt ever made to centralise policing in Britain, to give ministers unprecedented control over the way that the police do their work, and to undermine police independence. It is driven not just by short-term cost-cutting, but by an ideology that resents local freedom, and has an aversion bordering on paranoia to local government." Anyone proposing such a policy should be put "in a padded cell with his arms stuck behind his back while he was examined by a range of psychoanalysts".

And who said this ? Tony Blair, as shadow Home Secretary in opposition back in 1994, referring to a similar (but less extreme) proposal to the one his own government is promoting now.

Yesterday the airwaves were full of talk of the government’s “respect” agenda, with various new powers and offences. But most of the types of anti-social behaviour described are already criminal – the problem is enforcing the laws we already have. If I thought making the police less local was likely to help this I would be all in favour of it, but I really can’t see that.

One of the strengths of British policing is that it is local. I remain convinced that policing a community in a way which relates to local people and reflects their needs is easier if you are accountable to someone sufficiently near to be accessible than in a system where everything is controlled nationally.

None of the 43 police forces complied with the government’s deadline to submit plans for mergers. And anyone who is concerned about good policing in England and Wales should welcome this - including those who consider that the present structure of 43 police forces may not be perfect.

Keeping the local link is particularly sensitive in rural areas such as Cumbria. We have just lost or are in danger of losing our own regiment, our local fire control centre, while both our community and District General Hospitals may be adversely affected by health reviews. Being forced to merge our local police force into some huge organisation covering most of the North West would fit into the same pattern of continuing loss of local control and accountability, if not an actual run down of services.

From the statements made by the Association of Police Authorities, I have the impression that some police authorities think the mergers which Charles Clarke is trying to push through are a bad idea, while others are not necessarily opposed to the principle but want more time to come up with good proposals. Obviously all have agreed that none of them would meet the deadline: if some authorities had submitted proposals at the time requested this would have made it easier for the Labour government to use “Divide and Rule” tactics to pick off those who refused.
By refusing to meekly ask “How high?” when the government says “Jump!” the police authorities have shown a welcome independence and made more likely a proper debate.


In December, along with about 150 other people, I attended a meeting organised by the leagues of friends of the community hospitals in Cumbria. The following week about a thousand people marched in Penrith in support of local hospitals. Local residents from Millom, Keswick, Workington, and all over Cumbria joined the demonstration to make the point that our local community hospitals provide a vital public service and should be protected. There is nothing which galvanises a community as much as when their hospital is threatened.

I was very impressed by the arguments which I heard at the public meeting, and I do not believe that the case for reducing the role that community hospitals play makes sense.

Last year, when reviewing the services provided by the main Acute hospitals at Carlisle and Whitehaven, the local NHS Trusts in West, North, and East Cumbria suggested that a closer relationship could be built between the District General Hospitals and the community hospitals, which might involve using the community hospitals more to support and enhance the services offered by Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven. I always had some reservations about how that might work in practice, but in principle it is one of the trusts’ better ideas. Yet it is beyond belief that the Community hospitals could play that role if some of the proposals which were floated over the past few months – such as closing them overnight – were put into practice.

The Health Secretary recently took time off from making herself a national laughing stock over legislation to restrict smoking and instead talked about the need to boost the role of Community hospitals. If the government is to do this then they must ensure that local trusts fund these hospitals properly.

Make no mistake – the fact that consultation on the trust’s proposals have been deferred does not mean that the Community Hospitals in Millom, Keswick, or anywhere else in Cumbria are safe. We must continue to campaign to support them. But it does appear that the realisation is dawning on both the trusts and the government that they cannot treat our community hospitals as expendable cannon fodder, and on that the government is finally realising that all is not well with the health service in Cumbria.

We must keep up the battle – and we can win.

Saturday, February 18, 2006

When Clever People Do Stupid Things

Yesterday a court quashed the disciplinary action taken by the General Medical Council against Professor Sir Roy Meadow, one of the most distinguished children’s doctors in the country. Professor Meadow had acted as an expert witness in the trials of many women accused of killing their own children: unfortunately his greatt knowledge of medicine and convincing air of authority as a witness was matched by a gross ignorance of the principles of statistics which would have been unacceptable in a Lower VI former studying for Maths A-Level.

Professor Meadow convinced first himself, and then the juries, that at least three innocent women who were already suffering the agony of having lost their babies, should be jailed for murdering them. He told the trial of Sally Clark that the chances of her having two children lost to cot deaths through natural causes were one in 73 million, and the trial of Donna Anthony that the chances of her two children having died from natural causes were one in a million. This evidence was based on a fundamental misunderstanding of statistics: other studies by doctors who do understand mathematics suggest the odds are more like one chance in 77.

By overturning the finding that Professor Meadow was guilty of serious professional misconduct, the judge has effectively ruled that it is acceptable for a highly skilled professional who is being paid by the state to give expert evidence in one area of knowledge to neglect the basic mathematical understanding required to understand that knowledge. I think there are three implications for our society of this decision.

1) The stupid mistakes which do the most damage are rarely made by stupid individuals, but by intelligent ones – stupid people are rarely in a position to do as much damage as intelligent people.

2) Our society needs to recognise that expertise in one area often does not translate into expertise in others

3) It is high time we ensured that all lawyers, judges, expert witnesses, and juries had access to some basic training in statistics.

The classic example of a brilliant man who caused a major disaster with a stupid mistake that no stupid person could have made was Admiral Sir George Tryon. He became Commander in Chief of the Royal Navy’s Mediterranean Fleet, then the crack force of the most powerful and professional navy the world had ever seen, and did so purely on ability. His powers of intellect enabled him to best in argument any other officer who ventured to disagree with him. And more than eighty years after the accident in which he died I have met people who still believe that he was not responsible for that accident.

But there is no doubt that Tryon caused the collision which sank his flagship, HMS Victoria, drowned 357 officers and men, and made the world’s most formidable fleet look like idiots, with a basic mathematical error. Tryon was commanding two columns of battleships. Each column was formed in “line ahead” with one ship behind another, and the two columns were heading in the same direction, side by side and six cables or 1,200 yards apart. The turning circle of these ships was 1,600 yards. Tryon ordered the two columns to turn towards each other. Nobody will ever know exactly what he meant to happen, but as one of his officers pointed out, the two columns of battleships would have had to have started more than 1,600 yards apart to carry out any such manoeuvre safely.

At least four of Tryon’s officers, including the captain of his flagship, HMS Victoria, which was leading one column, the fleet’s second in command in HMS Camperdown at the head of the other column, and two staff officers who queried the orders, realised that they were likely to result in the collision of the leading ships.

Faced with an apparently suicidal order, these officers reacted in different ways.
The only person to come well out of the disaster was Commander Thomas Hawkins
-Smith, who initially pointed out the problem and then queried the order twice. Tryon at first accepted the point, but unfortunately he then apparently forgot that he had done so, brushing objections aside. The captain of HMS Victoria is on record as saying that “Open criticism of one’s superior is not consistent with true discipline”, and said nothing to Tryon until a collision was inevitable. However, he probably saved some lives by asking for and getting permission to put the engines into reverse and by closing the ship’s watertight doors.

The Second-in Command, Admiral Markham in the Camperdown, saw the problem but didn’t know what to do, and while he was trying to make up his mind the entire fleet was heading for the Syrian coast on which they would all go aground unless something was done. While he was dithering, Tryon sent the signal “Why did you not obey my order?” and then Markham followed Tryon’s instructions, with the inevitable consequence that the Victoria and Camperdown collided. Ironically, just after the collision, Tryon was handed a note with Markham’s reply, “Because I did not quite understand your signal.”

Admiral Tryon appears to have realised his mistake just too late – his voice was almost a whisper as he gave permission to put the engines “full astern” to slow down the ship. In his last minutes he made no attempt to deflect responsibility for the disaster: his last recorded words were “It is all my fault.” He made no attempt to save himself and went down with the ship.

Admiral Tryon and Professor Meadow had in common that both were brilliant man at the head of their respective professions and internationally respected in their fields. Both made basic mathematical errors with grave consequences. Professor Meadow wrecked three lives where Admiral Tryon ended more than three hundred. But there are lessons we need to learn from both.

The first is that the more eminent you are the more you need to listen to others. If Admiral Tryon or Roy Meadow had been less eminent, both they and others might have been less inclined to assume they were always right.

The second is that we should be much more careful about assuming that knowledge in one field carries over into another. Angela Cannings, one of the innocent women who was wrongly convicted on Professor Meadow’s evidence, was surely right when she said yesterday of expert witnesses that “It’s when they are approached about areas outside their expertise that they should look up and say ‘Sorry, I can’t deal with this’ and step back.”

That principle has much wider application. Let me give just one example. I am an economist by profession and a regular churchgoer. I have heard priests and bishops give sermons in which they talked about spiritual matters, theology or human motivation and I immediately recognise that they are vastly better informed than I about such subjects and I have things to learn from them. However, when the subject turns to matters on which I have professional knowledge, it readily becomes apparent that neither theological college nor biblical study gives any insight into such matters as the relative merits of competing economic theories or tax rates. It pains me to say it, but when bishops for whom as pastors and theologians I have immense respect are invited to talk about government economic policy they often reveal themselves to be as misguided outside their field of expertise as Sir Roy Meadow was outside his.

I have also heard Bishops say very intelligent things about politics and economics. But nine times out of ten, when this happens the idea or concern which is being raised has been put as a question. In other words, the most intelligent contributions often come from a speaker who is acutely aware of the limits of his or her expertise.

The same applies when politicians talk about football, or when successful football managers are invited by the media to talk about business, or when TV soap stars talk about politics, or successful authors are invited to talk about the law. In a democracy we are all entitled to a view about any subject but we should avoid the trap of assuming that an expert in one subject is certain to have valuable insights into another.

My final comment is that, to avoid the risk of sending more innocent people to prison, we must significantly raise the level of statistical expertise available to the courts. Expert witnesses who think they understand maths but don’t are not a problem unique to cases of cot death. Another example is genetic fingerprinting. This is an immensely powerful tool and there is no doubt whatsoever that it has sent many guilty people to justice. But statements of probability in relation to genetic evidence can sound more powerful than they really are unless there is corroborative evidence.

Let’s give an example. Supposing there is a crime for which there are no surviving witnesses, and the police have recovered genetic material which they are absolutely confident belongs to the perpetrator. They trawl through the genetic database and find a villain whose DNA has a sufficiently good match that there only one person in five million would have a fit as good as better. They haul the suspect in, and find that heh could have been in the right place at the right time and has no convincing alibi.

I hope and believe that most British police forces would do more work than this before bringing a prosecution, but let’s suppose for the sake of argument that we have a rare sloppy example, and they don’t. You are on the jury – you are told that the accused had the opportunity to commit the crime and that genetic fingerprinting suggests it is five million to one that he did it. Do you find him guilty?

If you said yes, I hope you’re not on the jury should I ever be wrongly accused of anything. Five million to one odds means there are about eleven people in Britain with an equivalent match, including about three or four adult males of an age to be strong and fit. I would want to have far more evidence against the accused than just the statistics before I would be confident that we had the right man. Genetic fingerprinting evidence on its own would only be sufficient to be certain we were convicting the guilty person if we had the ability to rule out all other potential suspects with an equally good genetic fit, and any system of government with enough information to do that would be dangerously close to a police state.

If we want to avoid such miscarriages of justice, we need to provide lawyers and judges with more training in statistics – and perhaps also provide more support for Juries. How about a handbook, “Probability for Jurors” ? You read it here first.