BBC booze bill shocker

The shocker is, it's extremely reasonable:

The Corporation stated that the figure related to 'non-production related and production related spend'.
It added: 'The total spent on alcohol for the period 1st October 2013 to 26th October 2014 with the BBC's single preferred supplier Majestic Wine PLC was £43,000.'

I'm not the greatest fan of the BBC's compulsory TV licence, but I really don't think that this is worthy even of a Daily Mail throwaway article:

• Use of bulk supplier for savings: check
• Cost per employee per year: £2 , eminently reasonable, no reason to think this is taxpayer-funded employee booze
• Cost per day: £130 over all channels and events. That's about 3 bottles of Veuve Clicquot NV at Sainsbury's prices. Assuming the BBC allocates half a bottle per top echelon (MP, MEP, sleb) guest, that's 6 top echelon guests per day which sounds about right.

It comes as up to 50 MPs called for the licence fee to be scrapped and replaced with a voluntary subscription service in its place.

Talk about tenuous connections. This is possibly one of the strongest signals of thrifty BBC spending there is, and you're linking it to a call for licence fee repeal? Your logic is not like our Earth logic, Daily Mail.

Now CASH are going after beer

Dear little green apples, it seems that our beer is too sugary:

Cardiologist Dr Aseem Malhotra said: ‘The levels of sugar in some of these drinks is quite staggering.
'There's nothing wrong with the occasional drink but unfortunately we are consuming much more than is good for us.' Dr Malhotra said alcohol-related ill health is costing the NHS £3.3 billion a year.

Nine teaspoons of sugar in a pint of real ale, apparently. Whoop de doo. That's about 36 grams, or two and a half tablespoons. And on the (unsourced) £3.3 billion, I note that alcohol duty is £10-11bn so it would seem to be more than covering its alleged costs.

Who is cardiologist Dr Aseem Malhotra? Oh look, he's listed as one of Action on Sugar's medical advisors:

Dr Aseem Malholtra, Cardiologist and Science Director of Action on Sugar

And yet, he doesn't publicise any academic connection unlike most of the Action on Sugar advisors. How curious. He's a HuffPost contributor who identifies as "Cardiologist and writer with a special interest in improving the nation's diet". A bit of digging indicates that he's a cardiology registrar at Croydon University Hospital. I'm sure he's a perfectly good registrar but, let's face it, CUH is not known as one of the great medical research establishments. Even his BMJ article is "Observations", not a research paper.

So CASH/Action on Sugar's science director seems to be a rather second-rank medic. Shallow calling unto shallow, I guess.

The business of tipping

The has been a marked contrast between restaurant service in Britain and restaurant service in the USA - and by "the USA" I mean "pretty much any randomly-selected location in the entire United States of America" - at least as long as I've lived, and I suspect a lot longer than that. The general impression you get in a UK restaurant is that you're intruding on the waiting staff's quality time; to be fair, this has become less apparent recently as East European staff have proliferated in London and other major cities. I hope that the irony of British people in a restaurant hoping that their server comes from Tallinn, Riga or Wroclaw instead of Bristol or Derby is not lost on Nick "Chubby" Griffin. American restaurant and diner waiting staff can't, in general, do enough for you. This is clearly due to the tipping culture in America where good service is rewarded with good tips, and bad service punished with derisory tips. (Giving no tip could mean that you're a complete asshole, or just a furriner who doesn't know what's expect). Simple enough, yes?

Even in that seminal California film "Reservoir Dogs", tipping is intimately dissected by the participants:

Mr. White: You don't have any idea what you're talking about. These people bust their ass. This is a hard job.
Mr. Pink: So is working at McDonald's, but you don't see anyone tip them, do you? Why not, they're serving you food. But no, society says don't tip these guys over here, but tip these guys over here. It's bullshit!
Mr. White: Waitressing is the number one occupation for female non-college graduates in this country. It's the one job basically any woman can get, and make a living on. The reason is because of tips.
Mr. Pink: Fuck all that! I'm very sorry the government taxes their tips, that's fucked up. That ain't my fault. It would seem to me that waitresses are one of the many groups the government fucks in the ass on a regular basis. Look, if you show me a piece of paper that says the government shouldn't do that, I'll sign it, put it to a vote, I'll vote for it, but what I won't do is play ball. And this non-college bullshit you're givin' me, I got two words for that: learn to fuckin' type, 'cause if you're expecting me to help out with the rent you're in for a big fuckin' surprise.

Screwing over waitresses (I chose that word deliberately, and you should read about tips, sex and power at some point) is not done by anyone who regards themselves as a civilised human being. My median tip when eating out in the USA is 20%. Average is probably the same. Outliers are 25% (for really good service) and 5% (extremely rare, for British-quality service); if I'm anywhere near the latter, I'll be asking to speak to the manager in most cases. So everything's working as expected - or so I thought...

Back in 2008, San Diego restaurant owner Jay Porter decided to try an experiment: eliminating tipping in his restaurant and replacing it with a fixed (18%) service charge. So how did this work out? Conventional wisdom would suggest that the lack of incentive for better service would lead to a general lowering and flattening of the quality of service curve. After all, if removing tips worked well, wouldn't every restaurant do it?

The results make fascinating reading. Jay Porter's series of blogs on the results are compelling, and a rare case of actual data supporting the facts. What I found particularly interesting were the worked examples. I'd forgotten - because I've never waited tables - that the waiting staff are only part of the restaurant team. The problem is that, if you pay all your staff minimum wage (which is all the average restauranteur can afford), the waiting staff benefit strongly from tips but the kitchen staff do not, despite contributing just as much to the dining experience. Hence the approach in some states (e.g. NY) to pay the waiting staff much less than minimum wage, expecting the wage to be made up with tips, and redistribute that money to the kitchen staff; the waiting staff still do pretty well, but the curve is at least flatter. In other states (e.g. CA) you're not allowed to pay waiting staff less than minimum wage, so there is a customary "tip out" where the waiting staff share some of their tips with kitchen staff, but it's still ad-hoc and prone to abuse.

Porter's approach was to charge a fixed service charge and forbid tips. The service charge gets distributed reasonably equally around waiting and kitchen staff. Now I (and most economists) would have expected this to reduce overall quality of service, but in fact Porter claims this doesn't happen - good waiting staff don't pay much attention to tips throughout the service period, since they're too busy actually serving. It also removes an interesting perverse incentive on a server to maximise his or her tips at the expense of overall restaurant income; read the blog for the full details.

Equally interesting is the case where substituting a service charge for tips doesn't work - tips in a bar:

n a crowded bar, bartenders are expected to just say the price of a drink order to a guest — we wouldn’t present physical checks. And it was during the presentation of the physical checks that we could best explain the service charge/no-tipping concept. The check also had the policy explained on it, so guests had a pretty good chance of understanding what was going on.
[...]
Given that the line item service charge seemed like a lost cause, we switched to building the service cost into our pricing. This is known as service compris, and a lot of people advocate for it, but it wasn’t a success for us. With service compris, an $8.50 cocktail became a $10 cocktail on the menu, and that was a huge psychological leap for our market

Note that the factors which made tip elimination in a bar painful were to some extent due to this being a very unusual situation in a bar. One wonders how it might work out if a state or city banned tips all together in bars in favour of a service charge.

I'm still not convinced that Porter's service charge approach would work as proposed across the huge range of restaurants and diners in the USA, especially in dubious establishments where one or two really good waiting staff keep the business afloat. Still, he makes a compelling case that the conventional wisdom about tipping is not completely supported by the available data.

Insurance as a legislative aid

I've just found this article from late 2012 (after the Sandy Hook shooting) where the Daily Beast's Megan McArdle examines the proposals for making gun owners carry insurance. Given the increasingly puritanical calls from the BMA about alcohol / fat / tobacco / salt and making their consumers "bear the cost" of their indulgences, it's instructive to examine how well this approach works for gun owners.

Megan McArdle argues that mandatory liability insurance for gun owners won't work out quite as people intend:

Accidental death and injury rate from guns is fairly low, compared to both other gun incidents, and other categories of accident: 14,000 injuries and 600 deaths in 2011. This sounds like a lot, but in a population of 300 million, a lot of people die each year from almost anything: dozens of kids a year drown in buckets.

The focus of this law must clearly be homicide. Except - wait! people who commit homicide with guns don't often legally own the gun, and therefore will have at best a "relaxed" approach to owning insurance for the device. Many people commit suicide with guns, but again it's hard to imagine that they're going to be overly concerned about buying and keeping that insurance; and to whom would the insurance pay out? It also turns out that even for really obvious and easy-to-police items, it's hard to ensure that owners have insurance:

One in seven drivers in America is uninsured. That's despite the fact that they are driving a large, hard-to-conceal object which is regularly inspected by the fleet of parking and traffic enforcement professionals hired specifically by governments for this purpose.

You can view the idea of "mandatory liability insurance for gun owners" in two main ways. One is as a subversive attempt to make gun ownership more expensive, in order to reduce the number of law-abiding gun owners. The other is to provide a fund to compensate the victims of gun crime.

It would be interesting to apply this approach to other indulgences. I understand that there's a certain problem with criminal damage and assaults arising from drinking in British town and city centres. So let's only allow adults over 18 years old to buy alcohol from pubs and clubs if they can present proof of alcohol liability insurance. The insurers will look at age (under 30 years of age indicates disproportionate likelihood to cause trouble), gender (males more likely to cause problems to others than females), previous criminal convictions (of course) and presumably employment status - full time employees are less likely to get pissed and commit acts of violence because come Monday morning they'll be lining up with other unemployed people. Maybe there would be different levels of insurance; the lowest level lets you order a glass of wine, then progressively higher levels of insurance are required to be allowed to order strong lager, tequila shots, and the top-end insurance would allow you to drink vodka + Red Bull. In the event of alcohol-caused criminal damage, your insurance would pay out to cover the costs of the injured parties.

Perhaps I shouldn't give people ideas.

Too much Olympic spirit?

Congratulations to an anonymous 34-year-old Londoner who exemplified everything that makes Britain what it is today when he attempted to swim the Atlantic as a tribute to the London Olympics:

The lifeguards called out a helicopter and a diver dropped into the sea and explained to the man that it was not a good idea to swim across the Atlantic and advised him to head back towards France.
He replied that he was a strong swimmer and felt up to it.

What a heartwarming tale, and what a can-do attitude. This man is clearly one to watch for the 2016 Olympics.

Sour grapes at Diageo

Apparently, having a craft beer company winning 'Bar Operator of the Year' didn't go down too well with the Diageo reps at the British Institute of Innkeeping (Scotland) awards:

A representative from Diageo, who has not been identified, was allegedly overheard threatening to withdraw the drinks giants' sponsorship from future BII awards if BrewDog was declared the winner.
Sources at the dinner at the Grand Central Hotel in Glasgow claimed the trophy had already been engraved with BrewDog's name and judges were shocked when another bar, Behind the Wall in Falkirk, was announced the winner of the category.

The judges were shocked? I'm shocked that a giant of the drinks industry would stoop to such behaviour. Oh, my mistake, it wasn't an official policy or anything:

Diageo said in a statement: "There was a serious misjudgment by Diageo staff at the awards dinner on Sunday evening in relation to the Bar Operator of the Year Award, which does not reflect in any way Diageo's corporate values and behaviour.

Yes, because the fact that Diageo employs and promotes people like that has nothing to do with Diageo as a corporation. Umm. And by "serious mistake" you just know that the spokesperson means "got caught".

This is what really grips my chaps about the Borg-like FTSE and Dow giants. On the occasions where staff members do something dementedly tyrannical (depressingly frequent) and get caught (depressingly few) the company points to its policies and "values" training and says "hey, nothing to do with us, we condemn behaviour like this." But anyone with experience of their working environments and the practicalities of promotion and advancement within the company structure can see that bullying, arrogant and borderline sociopathic behaviour is disturbingly effective at helping one to rise to positions of power. I'm sure no-one sat down and designed the company that way, but that's how it turns out. That which you reward, increases.

I'm glad to see that BrewDog, the real winner, isn't a meek and mild organisation though:

The group has also riled health campaigners by producing high strength brews such as "Sink the Bismarck", which at 41pc is believed to be the world's strongest beer.

You just know that they'd bring a keg of that along to a brewing festival in Munich, don't you?

The canonical Daily Mail food article

The story of Sara Agintas and her weight gain is truly wonderous to behold.

• Unemployed layabout: check
• Parent of many children by several fathers: check
• Overweight: check, check, check
• Drinking to excess: check ("it's fine to drink 50 units per week while pregnant, I just dilute it with ice")
• Housed at taxpayer expense: check
• Bonus marks for falling through the stairs of her house and requiring the council to reinforce them
• Spending huge amounts of benefit money on food: check
• Teenaged mom: check (first pregnant at 17)
• Demands large amounts of taxpayer money for medical treatment: check

'I can’t afford a personal trainer or weight-loss surgery – I need help from the taxpayer. I know it's my fault I'm fat, but my pregnancy cravings meant I couldn’t stop eating,' she told Closer.
Read the full interview in this week's Closer magazine on sale now

News article trailing a magazine feature: check.

There's no direct link to rising house prices, to be fair, so I think it's still just possible for another Daily Mail article to top this; however, it will be hard to beat.

Looking at the photo in the article, I can't help but feel sorry for that sofa.

Blog of the day: Minimum Knife Pricing

Over at Mr. Wadsworth's, a wonderful spoof on minimum knife pricing:

Ministers say the proposal would not affect responsible restaurants or diners. But they predict that it could significantly change the behaviour of those who cause the most problems for hospitals and the police, by making it more expensive to stab somebody.

Go read the whole thing.

A modest proposal to the FSA

The UK Financial Services Authority has been on the receiving end of a fair amount of abuse over the past few years, much of it justified. Being a kind-hearted soul, I have a modest proposal to get my mate Hector back in the good books of the public and government.

You may be surprised to learn that the strict standards in the railway safety industry (if your company is on a contract for Network Rail, they can turn up at your workplace and demand you submit to drug or alcohol testing) do not apply for FSA-registered individuals. Banks may tell their FSA-registered employees that they are subject to random drug or alcohol tests, but I assure you that this doesn't happen in practice. Heck, why would it? If as a bank you feel you can adequately monitor an individual's trading performance, why would you want to rock the boat by testing that employee unless he's making a loss and you're looking for additional grounds to fire him?

So let's have the FSA declare that a random drug and alcohol testing regime will apply for FSA-registered individuals at any UK-located branch of a financial institution with over 25 registered employees in that location, from Jan 1st 2012. The testing unit turns up having given 1 hour notice and get witnessed (yes, watched wizzes) pee samples from randomly selected 2% of the registered employees. The employer gets the results. Anyone with significant intoxicant samples goes straight to a board where they can appeal the pending loss of their FSA registration. Operating costs come out of existing FSA operational funds, so no additional operating costs to existing firms with unintoxicated employees.

The FSA gets to do something useful and popular; the programme gives a significant boost to the UK drug testing industry in time for other events; the government gets to point at something concrete being done to counter the drug-addled dipshits depicted in popular culture renditions of the City; the City gets something to point to and deflect such future criticism of their employees. What's not to like?

[It may strike the reader as incongruous that we don't similarly test Civil Service and Government members engaged in decision making of equal import compared to the railway and financial services domains. Your correspondent can only invite the reader to draw the appropriate inference for future action.]

24 hours in A+E - the end-of-the-road edition.

Now we have Saturday afternoon to Sunday morning. Should be a corker.

Props to the Filipino nurse looking after Ted and Irene - the man was very smooth. Ted was on his way out with a cancerous tumour in the bladder, knew it was there but was very stiff-upper-lip about the whole thing. Irene was apologising for calling the sister over - I don't know what the opposite of 'entitled' is, but Irene feels it in spades. Ted and Irene were stretching to try to see the bright side of life in very trying circumstances. As sister Maria said, you don't always get the privilege of spending time with people like that.

One young chap, Ian, was skateboarding while drunk and broke his ankle. Two components of the pisshead triad at minimum. The exact circs of the breakage may remain a mystery. Ian hated needles, but clearly not enough to offset his like of beer.

Emergency technician Amanda caused my teeth to grate somewhat. Does this make me a bad person? The ambulance crews call her "Peggy Mitchell" so it's not just me. She must have loved kicked-in-the-face patient Duncan as he could barely talk, so she got all the air time.

A patient came in with a heart attack - the team was administering CPR, which is already a pretty bad sign. Sure enough, the consultant called it a day. To be fair to Amanda she was up on the man's chest pumping away like a good'un.

"Every year 7 million people have accidents at work". I'd bet a considerable sum that there may be 7 million reported accidents at work, but there are a good number of those people who have multiple accidents. The example shown to us was a hedge trimmer vs finger; a Polish gardener shooting the breeze with Roman his German doctor. Roman has had to adapt the typical German direct approach to the British patient. "Will it hurt?" "Oh, yes!" gets the nurses telling him off. He sounded not a little irked with a British GP telling a patient with splinter-in-the-thumb from a month ago to come to A+E. I can see his point. God forbid that the GP should actually have to do anything tricky.

70p for a Bounty in the vending machine? Talk about captive audience pricing.

When the resus sister Sharon is saying "Oh my God, this is ridiculous" as the phone rings again, you know it's a good night. From one point of view. "So Stuart, what were you doing up the tree?" He doesn't remember. Alcohol, stupidity, gravity, kerching. Stuart likes to live life on the edge, but is afraid of his mother finding out. You couldn't make it up. "You're silly and you do stupid things" as his girlfriend observed, cutting to the heart of the issue.

A week later, Ted passed on. Stuart and Ian are, unfortunately, fine.

Next week: a 16 year old with query stroke. WTF? A different patient has a history of 74 previous suicide attempts. Let's be honest, she's not really trying.

24 hours in A+E - the mandoline slicer edition

The vignettes from tonight's slice of life at Kings A+E:

• "Fall from a tree? He's probably absolutely trolleyed." I'm not taking that bet. We also saw from a maimed carpenter that electrical tape is just as good as, if not better than, Elastoplast.
• A good friend is one like Patrick who will hold a bowl under your jaw while you vomit into it, while he is completely sober. Such friends are rare, treasure them. He even bigs up your past heroic deeds to the nurse who's about to stitch up your nose.
• Oh, another stab victim (left side upper abdo). Didn't see much of him beyond ten seconds just before the ad break, and there was no narration about his injury but it was a small but obviously deep isolated wound to the front of the abdomen. I got the message.
• The poor sod who got stuck between a cherrypicker and a car was, nevertheless, painfully lucky. He just wanted to go home but, as the consultant pointed out, his pain relief choices were between paracetamol at home or morphine in hospital. After that kind of squash, I'd take all the opiates that were on offer.
• Unknown male with a head injury; fall from a ladder onto concrete (height unknown), intubated with severe traumatic brain injury. He had a mobile phone but it's locked - who can unlock it? Turned out to be a chap called Nicholas who, it appears, was very near to biting the big one. He's still a long way from fully recovered but a light year from the state he was in after the accident. Good job by the neuro guys and all the rehab team.
• When the A+E nurse is acquainted with your model of vegetable cutter (a mandoline) it's a sign that you should change to a different one.
• Ironic that Darren who fell through a window while cleaning it, saw his arteries spurting blood over the walls and ceiling, and wrapped his arm up in a towel to control the bleeding, didn't feel he could watch the nurse sticking him with a local anaesthetic. There's no accounting for taste. Incidentally, that's why you shouldn't clean your windows.

The trailer for next week's episode showed an ominous red stain halfway down the ambulance trolley when the patient was transferred off it.

24 Hours in A+E - the violent crime edition

Ah, Saturday afternoon and overnight in Kings A+E. This is going to be a corker. If alcohol doesn't feature in 50% of the injuries, I'll be astonished.

One nurse noted "I had 'ping pong ball in anus' the other day in Trauma". That's got to chafe. "They had four and then noticed there were only three left". Thank goodness she left the detail to the imagination. Wonder what happened with the bats.

Oh, look, intoxicated students, injured after falling from a bar they were dancing on. Alcohol, stupidity and gravity; kerching - the pisshead triad. They were trying to look after each other, which was sweet, but doing so while four sheets to the wind made it a little futile. Amusing to see their friend assert to the nurse that their head injury wasn't serious. Glad that you've got CT-level vision there, sunshine.

Grudging respect to builder Colin who had his forearm opened up by a knife in an attempted cellphone mugging. He seemed quite happy scrutinising the injury which opened up around 10mm of flesh, and was concerned but not panicked about loss of sensation in his finger which likely indicated nerve damage. Had been drinking but that didn't seem relevant to the injury so I'll let that one pass. He seemed relatively relaxed about the docs prodding the injury, that's a man with a substantial pain threshold. This was confirmed by him removing his own stitches to get back to work sooner.

I have to confess to a growing respect to senior sister Jen, who has seen everything and is near-terminally laid back about an increasingly demented night shift. She knows biological facts that no-one should need to know, and confirmed the 50%+ alcohol-induced injury proportion for the key shifts. She handled combative patients and stressed relatives with aplomb combined with don't-screw-with-me-sunshine firmness.

Father and son brought in with "samurai sword" and blunt trauma injuries, though the son's holes didn't look that large to me (they were in dangerous places though) following gatecrashing of a family party.
A couple of predators decided they wanted to come in and "no" wasn't an acceptable answer. Wonder what their crime history looked like.

Catherine was a classic PFO who "started to feel unwell" after an evening out with friends. Drank enough to start inducing apnea, which caused no little concern. I'd suggest hot sweet coffee, p.r.. She claimed that "her drink was spiked". Mmmm...

Moral of the evening: if you need to go to A+E with an injury that will be treated in Minors, don't go on Saturday night; you'll be there until Sunday daybreak. And it's probably your own fault.

Stabbed but not slabbed

It's slightly indirect, but interesting reading the reactions of a response Police Inspector to the programme '24 Hours in A&E'. I've been following it since the start, and it's starting to become somewhat depressing. Filmed at Kings Hospital in South London we see a steady procession of knife victims come through triage. "Oh look, another teenaged / early 20's African-Caribbean guy. Shocker." It's so consistent, it's not even funny. Why aren't people shouting from the rooftops about this? Oh, I think I might know. Commentator VoiceOfReason in the comments notes:

“We all have to be so careful these days, you never know who’s listening and any suggestion that you are not ‘toeing the party line’ will kill your career stone dead.’”

Providing balance, there's an equally steady stream of pissed-as-a-fart agressive, obnoxious and barely intelligible white males in the same age bracket alternating between actual alcohol poisoning and the consequences of intoxication (falls, crashes, fights). This has already been the subject of any number of rooftop shoutings, but is equally depressing.

I'm hoping against hope that the programme makers have been focusing on the "entertaining" gangsta muppets and dickhead pissheads, ignoring a majority of peaceful accident victims and elderly acute cardiac events. But I'm afraid that my optimism is mis-placed.

There are an awful lot of people on that programme who need to be charged the full cost of their treatment, and (since they've already spent their money on booze, bling and clothes) be made to work it off. And a much smaller posse of medical staff (from porters through nurses to SHOs) who should get that money tax-free without any of it being diverted to the bean-counters or suit-wearers upstairs. Like that's going to happen. The Triage nurses in particular deserve canonisation, as the cartoon which used to hang in their room in Chester A&E noted:

The gates swing wide, the trumpets sound, the angels toll the bell. 

"Come in my dear, take up your harp; you've done your time in Hell".