Ash Wednesday

I usually blog on this with a painting – Goya, Bruegel, Spitzweg (genius) and more. I was prompted today to look at Rembrandt’s** late work, The Return of the Prodigal Son, which, if you know the parable, is highly apposite for Lent. Wikipedia is good on this. Kenneth Clark called it “a picture which those who have seen the original in St. Petersburg may be forgiven for claiming as the greatest picture ever painted” –  a fairly high bar, I’d say.

Henri Nouwen had a more overtly human and religious take on it, expressed very poetically: “Rembrandt is as much the elder son of the parable as he is the younger. When, during the last years of his life, he painted both sons in Return of the Prodigal Son, he had lived a life in which neither the lostness of the younger son nor the lostness of the elder son was alien to him. Both needed healing and forgiveness. Both needed to come home. Both needed the embrace of a forgiving father. But from the story itself, as well as from Rembrandt’s painting, it is clear that the hardest conversion to go through is the conversion of the one who stayed home”

We’ve all been there, and we will be again.

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Rembrandt, The Return of the Prodigal Son, 1668. The Hermitage, St Petersburg

 

**The Knife is in awe of a few painters, Rembrandt is one of them: 1, 2, 3, 4

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“Brava, la Fallaci. Brava.”

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…she even made selfies look cool…

Eight years ago, in one of the earliest pieces in this blog, I wrote what was effectively a fan’s homage to one of the great women of our time, writer and journalist, Oriana Fallaci. I think it still reads well. Fallaci was something of a prophetess, of an uncompromising and ballsy kind, who could write and argue with great vigour and effect. She was a populist in the tackling of difficult (and dangerous) issues, such as Islamic terrorism. Here is Christopher Hitchens’ profile of her, in some ways a kindred spirit.

She died of cancer in 2006, happily dismissive to the end, of some early social justice warriors who were trying to get her prosecuted.

The people who use the word ‘populist’ in a contemptuous way now, would likely hold Fallaci in contempt too. I doubt though, that they would express it to her face.

All this is a preamble to an excellent piece by the Fallaci of our time (sort of), the tireless Douglas Murray, in the enduringly excellent magazine for the brainiacs of Western Civilization, Standpoint. Feel free to read my blog post too, but here, describing one of her most famous encounters, is Murray:

In the early 1970s she had conducted an interview with the Shah of Iran, in which he discussed the visions he believed he had received. The resulting piece was so damaging that when Ayatollah Khomeini came to power he granted Fallaci the only interview that any Western journalist would ever get with him. They met in Qom in 1979, where the Ayatollah discovered that just because Fallaci disliked your enemies it did not follow that she would like you. When the Ayatollah claimed that the Iranian revolution which he was heading was animated by love she replied, “Love or fascism, Imam? It seems like fanaticism to me, the most dangerous kind: the fascist kind.”

The full version of the Khomeini interview remains one of the greatest pieces of reportage of the 20th century. Not just for the scoop, or the intricately revealing lead-up to the encounter, but for what Fallaci did during it. Forced into a chador in order to enter the Ayatollah’s presence, she ended up in a row about why women should be forced to wear such a garment, and became so enraged that she stood up and ripped off “this stupid medieval rag”, letting it fall to the floor “in an obscene black puddle”. At which “like the shadow of a cat . . . he rose so quickly, so suddenly, that for a moment I thought I had just been struck with a gust of wind. Then with a jump that was still very feline, he stepped over the chador and he disappeared.”

It should be noted though, that the newly labelled fascist fanatic Khomeini later reappeared and finished the interview.

She certainly had something.

Knifonomics (part 39): we’re all the same

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I haven’t blogged in this area for more than a year. What is there to say, other than Trump’s tax cuts will be interesting to watch, given the positive precedents of Kennedy, Reagan and Thatcher .

However, public spending brings out the worst in politicians, in terms of pandering to various interest groups – at all points on the political spectrum – and the persistent inability to cut back. Cutting back, not because of a desire to hammer ‘the poor’ etc, but more because the fabled future generations will be saddled with the potentially unpayable bill.

The can is always licked down the road (see also NHS management techniques).

However, here in Western Europe, there is a view that the USA is different, and that greedy capitalists have failed to apply a welfare state type of safety net. Not so however. Virtually everything in this passage on the new bipartisan US budget deal applies to pretty much all developed economies in Europe and North America. Singapore, not so much.

Of course, last week’s agreement has some virtues. You can’t spend so much money and get nothing in return. We may be spared another government shutdown over the budget, because the agreement sets spending levels for two years. Similarly, the agreement suspends the federal debt ceiling — how much the government can borrow — through early 2019. This presumably postpones another self-destructive debate over whether the government should default on its debt, damaging its credit rating and flirting with a financial crisis.

In truth, much of the spending authorized by the agreement is desirable. Future deficits have been wildly underestimated, because projections for defense and non-defense “discretionary” spending were unrealistically low. On defense, Obama’s budgets reduced readiness, left the services too small and made it harder to counter new technological threats, most notably cyberwarfare. There was a similar squeeze on many vital domestic agencies, from the Internal Revenue Service to the National Parks.

To some extent, the new agreement represents a catch-up from this stringency. Meanwhile, so-called “entitlement” programs such as Social Security and Medicare — for which people automatically qualify — were largely untouched. They represent about 70 percent of federal spending. Together, costly entitlements and expanded discretionary spending produce enormous deficits, exceeding $1 trillion a year, as far as the eye can see. 

That’s a huge gap — roughly 5 percent of our gross domestic product — to close or shrink. Most politicians are can-kickers. They want nothing to do with the necessary tax increases or spending cuts, including possible reductions in Social Security, to curb the out-of-control deficits.

Ignoring them seems to involve few economic or political costs. The extra borrowing caused by deficits hasn’t sent interest rates sky-high. Indeed, after the Great Recession, deficits helped the economy recover. Now, despite our political and social problems, foreigners still seem happy to hold U.S. Treasury securities as “safe” financial assets. In general, the public doesn’t seem aggrieved by big deficits, especially when compared with the alternatives.

How many people know that 70% of US federal government spending goes on social security and healthcare? I’m not sure exactly how the two compare, but in the UK it’s half that, 34%. The single biggest chunk is on pensions, of course. And the public, by and large, are happy with it.

We are indeed, all in the same boat. Except Singapore.

 

Twattish comments: an occasional series – Gerry Adams

How do you intend to remember famed terrorism enabler, liar and hypocrite, Gerry Adams, as he heads for an overdue retirement? Here is Gerry’s own take:

“I am a very good dancer, I sing extremely well, I am a half-decent cook, I have written a wee bit, I like walking, but I’m comfortable in my own skin and I am surrounded by some wonderful people, a great family, my wife, people who love me.”

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A walk down memory lane with Gerry might take you to Omagh

In fact, Gerry’s only positive achievement is probably that he once made Eddie Izzard seem funny, for the first and last time:

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…he has a point…

 

Great Landscapes: when near Rome..

Thomas Cole was an American painter of the famous Hudson River School, though slightly bizarrely, he was actually born in Bolton, Lancashire. Famous and successful in his day, he did the obligatory Grand Tour to Italy in 1842, six years before he died at the age of 47. He had the requisite technical skills, certainly, but if you had to pin down what made him special, it was, I think, a sense of grandeur and otherworldly numinosity. A kind of large scale American version of Caspar David Friedrich, with a touch of the classicism and ethereal light that Turner and Claude Lorrain had mastered.

To a degree he is the victim of the kind of snobbery that relegates him to second tier status in the art world. If you were to dilute him down to the most basic elements, you might end up with someone like the gifted commercial sentimentalist, Thomas Kinkade.

In any event his Italian paintings are terrific, and here’s one of them:

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Thomas Cole, Ruins of Aqueducts in the Roman Campagna, 1843. The Wadsworth Athenaeum, Connecticut

Which came to mind when I stumbled upon a magnificent landscape by Edward Lear, ‘nonsense author’, of the pyramids at Giza. I had no idea what a great artist he was. Having explored his stuff a bit, I found this:

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Edward Lear, In the Campagna Near Rome, 1844

I’m not sure where it’s held these days, but note that it’s almost contemporaneous with Cole’s work. Lear had a long life and spent about 5 decades travelling on and off, mainly in Europe, at a time when that was obviously a bit more arduous than today. Both paintings are magnificent.

Before them both though, in 1826, was Camille Corot, with a much simpler style, but the same magical effect:

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Jean-Baptiste-Camille-Corot, The Roman Campagna with the Claudian Aqueduct, 1826. The National Gallery, London

 

You can of course still see this scene, at the Parco degli Acquedotti, only a few miles from the city centre. The Roman engineering of the Aqua Claudia and associated structures is astonishing, but the photographs can’t compete with painters.

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The statue of Christ being transported in the opening scene of Fellini’s La Dolce Vita
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The Porta Maggiore in 1896, the Aqua Claudia is the upper channel
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The Aqua Claudia in the Campagna

 

How to write (an occasional series: 2)

A nice profile in the FT, of a writer that I’d never come across, Denis Johnson, who died last May. Sounds like his stuff is worth a try, but I’m quoting his description of a writer’s life here. A lyrical ode to his modus operandi. Sounds kind of fun, and blogging is, perhaps, its pale imitation:

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Denis Johnson

“Writing. It’s easy work . . . You make your own hours, mess around the house in your pajamas, listening to jazz recordings and sipping coffee while another day makes its escape . . . Bouts of poverty come along, anxiety, shocking debt, but nothing lasts forever. I’ve gone from rags to riches and back again, and more than once. Whatever happens to you, you put it on a page, work it into a shape, cast it in a light. It’s not much different, really, from filming a parade of clouds across the sky and calling it a movie — although it has to be admitted that the clouds can descend, take you up, carry you to all kinds of places, some of them terrible, and you don’t get back where you came from for years and years.”

It seems appropriate to add a little jazz.

1001 things wrong with the #NHS (998): Committees

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Pretty simple, and universally applicable

The Knife has done lots of formal hospital management, though on the principle of ‘quit while you’re ahead’, I voluntarily stepped down quite a while ago. I don’t hate it, usually, but I prefer clinical work by far, and if I leave this earth having done any good, it’ll be in the latter sphere, by a long way. If you step too far away from the clinical stuff, you start to act and think differently, ego takes over and your peer credibility dies.

That’s guaranteed.

That said, it’s an interesting milieu, not least because of the subterfuge, inconsistency and indecision that abounds, usually combined with declarations of ‘caring’. The much hated private sector – which happens to constitute most of the healthcare in the developed world – would never tolerate the crap that goes on. (For the record, I do no private work.)

And today, as it happens, was one of the most gruesome** management meetings that I’ve ever attended – I won’t bore anyone with the details, but it was actually depressing. It was an absurdly large group attempting to share a process that neither needed it, nor was amenable to it.

Where to go for solace, some reassurance that my negative feelings are in fact appropriate?

Well…….

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….the author is talking about restructuring the playing season for American football. The key quote is “committees are what insecure people create in order to put off making hard decisions”. It’s nice to be inclusive, if possible, but it’s no surprise that the phrase ‘design by committee’*** is never used in  complimentary way.

Even worse than that is that such large unwieldy groupings always contain people with nothing to lose, no axe to grind, and indeed no expertise worth having. As any endocrinologist will tell you, a negative feedback loop is an essential regulatory part of a well functioning system. You need people with what Black Swan author and polymath, Nassim Nicholas Taleb calls ‘skin in the game’ (1, 2). I don’t want my clinical practice parameters decided by a committee of people without skin in the game. Nor would they, if it was their area, and nor would my patients want it.

What’s the answer to this?

Well, here is the same author. I agree wholeheartedly with it, not least that it’s coming on the back of a riff about the uselessness of management consultants (who should be barred from the NHS)…

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…for money, read clinical practice.

You can guess the author, I would imagine

 

**if you want to know how gruesome the NHS can be, this vivid account (spoiler: bad language), gives a fair appraisal of a bad spell. I did not write it!

 

***As advertising pioneer and author of Confessions of An Advertising Man, David Ogilvy said: ‘Search your parks in all your cities. You’ll find no statues of committees.’

The damned statistical lies of the NHS (hip replacement edition)

A quick observation. The ‘top nurse’ in NHS England, Jane Cummings, is quoted in today’s Times as follows:

A million more cataract operations or 250,000 hip replacements could be funded if the NHS did not have to pay for appointments that people failed to attend

Of course this is only the latest in many claims about the NHS which appear shocking, eye catching and as one might expect, either unprovable or simply untrue.

A few facts, assuming that Ms Cummings is primarily referring to missed outpatient appointments. Depending on your specialty, very few operative patients fail to attend:

a. Patients who fail to attend are very often patients who shouldn’t even have had an appointment. Many have got better. Many were given appointments ‘just to check’. There is lots of evidence that the clinical yield from an arbitrarily timed clinic appointment is minimal. Who is benefiting here? Do not assume that these appointments were necessary. The fault may lie with the hospital.
b. It depends if your outpatient clinic template already factors in DNA (Did Not Attend) patients. Mine used to. If your clinic is very busy then these absent patients are actually a great relief. If there is a factored in DNA factor and they all do attend, then it creates a real problem. In other words, it’s not always an administrative disaster, just as it’s not always (or ever) a clinical disaster – see point a.
c.  The claim that these DNA’s mysteriously add up to a quarter of a million hip replacements is a classic piece of pseudo-statistical rubbish. It probably emanates from an NHS head office algorithm built on crazy assumptions, or on the specious views of overrated NHS parasites like the oft-quoted ‘charity’ The Kings Fund. The Times article states:
At an average cost of £120 per slot, this indicates that doctors’ time worth about £950 million was wasted last year.

In the real world, in the unlikely event that your clinic finishes early, then you probably do one of the following valuable things: speak to colleagues (including non-medical ones), have lunch, conduct a ward round, review investigations, write to GP’s, make necessary phone calls, answer emails, complete training dashboards online, speak to management and much much more. All necessary parts of the job. What this unexpected ‘spare’ time does not, and cannot equate to is knocking off a quick hip replacement.

Oddly enough it might, if in a parallel universe the NHS had spent a bit more of its already colossal budget on meaningful infrastructure, like operating theatres. There is no shortage of patients who can come in at short notice, and NHS admin staff are now often superbly responsive at  getting hold of patients in a hurry. That is the sort of NHS of which Nye Bevan and William Beveridge would approve. The NHS desperately needs to factor in some free space in both its physical and administrative infrastructures, if it wants that kind of flexibility. I think it should.

Ms Cummings is describing a made up situation that is misleading at best. It appears to be part of a national drive. Some Scottish health boards, for example, are claiming that these DNA’s cost an unlikely £4 million a year, based on back of an envelope calculations.

If, however, you want to save millions of actual cash payouts for work not done, generally speaking, try rescinding the increasingly absurd and profligate New Deal contract.

There’s a suggestion for 2018.

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….it’s actually a bit more complex than this

The SNP: decline and fall (16)

As 2017 ends, this long running saga is drawing to a close. It’s been 3 months since the last episode, and in truth, not much has happened. Not much in Scotland, that is, although events elsewhere have conspired to put a further dampener on the whole SNP raison d’etre (unless you cynically believe that such a thing is in fact the mere fact of clinging to power and the associated trappings, with independence merely a Scottish avatar). So….

51. Ozymandias Salmond

Although Shelley’s paean to fallen grandeur and the passage of time had a certain romantic majesty, it’s difficult to claim as much for the fate of Alex Salmond. Not only does he seem to think that a gruesome chat show on the amusingly barefaced bias of Russia Today is some sort of positive career move, he’s in trouble for blatantly lying in his opening episode, so short was he of ‘material’.  In keeping with no. 49 in this series, there’s a bit of unhappiness between Eck and Ms Sturgeon on this one, which is strange given they’re one big happy family. Talking of which, the ubiquitous Tas has been both getting exposed to Eck’s undoubted sartorial flair (see pic), and being punted (by Eck) as a fashion guru herself to deal with the…um…shortcomings of middle class legend SNP MP Mhairi Black. To quote Ms Black:

He then said that the last time he’d had this conversation it was with a young woman called Nicola Sturgeon.

“I thought, ‘oh, very good’ and I just left the awkward silence hanging when he asked me if I wanted him to arrange it with Taz. I’m like, ‘I am never going to be told how to dress, especially by a man.’

Still, the good news is that Eck’s flagging TV career may only last as long as his overpaid yet now apparently defunct journalistic one.

Look on my works, ye Mighty, and despair!

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“Is anything worn under the kilt, Alex?” (I’ll stop there)

 

52. Catalonia is still part of Spain

No need to reprise the whole Catalonia secession thing. Suffice to say that despite the ignorant and rather pathetic urgings of various SNP lackeys, neither the glorified opinion poll of  October 2017, nor the actual national elections of last month, lead to anything like independence, nor is there any hard evidence that it would be popular.

In fact the Spanish have lead the way on this by issuing various arrest warrants, such that the floppy haired Salmond manqué (and talk show guest) Puigdemont, ran away from the heat and is now in exile.

Oh, and the SNP’s beloved EU backed Spain to the hilt on this. As any sane observer would expect them to.

53. Tax the ‘rich’

The SNP, having avoided using their tax raising powers for a long time (with good reason), have now caved in, and courtesy of the ‘limited’ Delboy Mackay, their Finance Minister, have decided to punish the middle classes.

It may please the zoomer base, but as a general observation, these things never end well. Interestingly, it coincides with Trump’s bold application of Laffer Curve principles in the USA. We’ll see how that works out as the year unfolds.

54. Reflections on the Revolution in Scotland

(misquoting Edmund Burke).

The Knife has continued to be impressed by the resemblance (1, 2) of the intolerant zealots of the SNP to their French predecessors, the Jacobins of the French Revolution. In keeping with their bizarre attempts to take over the rearing of the nation’s children, and to impose a monoculture on debate within their masses, I was struck by the similar mood music of the Law of Suspects, which the National Convention of 1793 passed in France:

“1. Immediately after the publication of the present decree, all suspects within the territory of the Republic and still at large, shall be placed in custody.

2. The following are deemed suspects:

i. those who, by their conduct, associations, comments, or writings have shown themselves partisans of tyranny or federalism and enemies of liberty;

ii. those who are unable to justify, in the manner prescribed by the decree of March 21st, their means of existence and the performance of their civic duties;

iii. those to whom certificates of patriotism have been refused

…and there’s more. I’m not saying it’s going to happen, although a stroll round SNP Twitter might persuade you otherwise, it’s just that there’s a certain doctrinaire flavour that keeps cropping up…

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…wishing the voting age was even lower

 

To close, over to a better and more measured writer than me, Euan McColm, with his New Year observations:

Nationalists now growing impatient with the First Minister over her hesitancy will, I think, be further disappointed in the year ahead.

Sturgeon is understandably keen to maintain the myth that she is in control of when another referendum takes place but the power to make this decision lies with Westminster and, after the general election showed a majority of votes for unionist parties, the UK government would have no hesitation in rejecting the First Minister’s proposal. This, I suppose, might play into the SNP narrative about a Scotland forced to bend the knee by the Westminsters (which is what we must now call the English) but no matter the grievance dividend, it will not get Sturgeon the referendum she says she wants.

The challenge for the First Minister in the months ahead is to keep her hardcore supporters happy with just enough constitutional meat while winning back the trust of unionist Scots who were previously happy to back the SNP in Holyrood elections but who are now weary of and frustrated by the nationalists’ obsession with another referendum.

Quite.

 

 

Christmas, again

There are so many great takes on Christmas carols and related songs. Here are a few that cropped up in the past year.

The wrecked hedonist chic of English maverick Peter Perrett meets Silent Night:

…and the ragged genius of Tom Waits does the same:

…Ed Harcourt’s unique and awesome take on In The Bleak Midwinter:

Happy** Christmas!!

Here is the favourite Christmas image of the estimable @BeardyHowse – Joseph minding the baby while Mary reads in bed

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Fitzwilliam collection, 15th century

 

**…although if you’re from the Guardian…

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That’s the true spirit of Christmas