"Why are we doing this?"

"I need the exercise and you won't go for a run. Come on, hurry up, I haven't got a lot of time. "

We set off without the dogs and head down the lane. It is early afternoon, just before 2 o'clock. A late lunch break from work. The weather is dull, misty with a slight drizzle possibly low cloud. We walk quickly, the clock ticking before I need to be back at my desk.

"This is nice," said the Webmaster, "a benefit of working at home."

"Even in this weather? Does it make up for all the cups of tea you feel obliged to keep making for me?"

We walk fast.

"Ha ha. That's all you want. Cups of tea."

"Not true." The drizzle is heavier now as we walk briskly up the lane skirting the hill. "The Student won't miss this weather."

So what's the latest status on the bag?"

"Still not located. I'm going to call the UK customer services and see if they are any more help. When she calls the US number it recognises her number and puts her through to a pre-recorded message telling her they are aware she has reported a lost bag and they are still trying to locate it. If she tries speaking to another department they put her through to lost bags and she's going round in circles."

"How can they not have tracked it down and provided a status report after three days?"

"Don't know. Just seems that they don't care. On their website it just says to send in a form BY POST if you haven't heard from them after FIVE days."

"I'm not getting a good feeling about this."

"I don't know why the Americans have such a good reputation for customer service. So far the Student's experience is that it is worse than here."

"Maybe it's the smiles and 'have a nice day'; superficial."

"Well maybe where people rely on tips it's better, like in restaurants and hotels but shops, banks, airport, airlines seem to be worse. Let's see."

We are at the brow of the hill. The view across the Potteries is hazy with the mist. The Welsh hills to the west are shrouded in cloud but Mow Cop castle appears to be holding up a band of heavy cloud, leaving a ribbon of clear sky over the ridge on which it stands. We don't have time to stand and look. We hurry on down towards the village and along the narrow lane to Fiddlers Bank. An ambulance coming up out of the village passes us."

"I wonder where that's going," says the Webmaster.

"Looks like the first responder service. We used to know the local first responders, they came out to Andy quite often. One was the father of a friend of either the Lawyer or the Student. I can't remember which one, the Lawyer I think."

"He might have retired by now. If the news is reliable, a lot of doctors are taking early retirement and maybe the paramedics are too. The medical profession seem more upset with Hunt and the teachers were with Gove and I thought that was impossible. How can he be so bad?"

"A cynic would say he isn't. Run it down and sell it off. No one in their right mind would try to turn the NHS into an American style service if their primary aim was accessible, quality health care for all rather than business opportunities for the few."

"We seem to have it in for Americans today," the Webmaster sounds concerned.

"Well how can it be right that people can't afford health care and insurance companies can refuse to cover to people who need it? It's purely a commercial model, and not in anyway a public service for the individual and collective good."

"I can't understand why so many are against the Obama reforms, what harm does it do anyone?"

According to my US boss, who approved of it, but then he is partly Italian, it's effectively extending the cover that the young and elderly already have."

"Someone Tweeted to Trump asking him not to repeal Affordable Care Act which he hadn't realised was the same thing as Obamacare when he voted. He was getting a lot of abuse back. People calling him an idiot and telling him he deserved what he got for being so stupid."

"Stupid or not he should be able to get health care services."

We climb up the stones and over the stile. The field is cut up and muddy where the horses have been standing, but there a no horses in the field today.

"If Hunt was supposed to be running the NHS for the benefit of the patients he would have been sacked by now. He can only meet his targets by reducing them. A bit like your suppliers."

"We don't let them do that. And don't be rude about my suppliers. There's no comparison. Hunt's using a well known ploy. When he's knackered the NHS he'll claim the only solution is to sell it off and by then people will think it can't get worse. Like the railways in the 80's. Everyone is making a lot of noise about it but too many still vote for the Tories and UKIP."

"Most UKIP supporters I know want the protect the NHS."

"Well they voted for the wrong party then. They're like the guy in the US who voted for Trump you were talking about a few minutes ago."

"Shhh, this is Brexit central around here."

We make our way through the fields and over the stiles and come out onto the road just as a bus passes.

"If you work for a business then whatever your role you are part of the team delivering the services of that business, so a cleaner who works for the NHS would be part of the success or failure of the health care provided. If you are a cleaner working for a cleaning company then you are working for the success of the cleaning company, not for the success of the health service."

"What's the difference, surely the cleaning company only gets the business because they clean properly? They'd lose the contract if they didn't."

"Contract terms, Service Level Agreements, scope and profit. And define 'properly'! Once the contract is awarded, possibly to the lowest bidder, the service company will want to ensure its margin and so it won't want it's staff providing services the client didn't agree to pay. After all, the cost may have been kept down by bargaining on service levels. Why would they do it for free? 

Isn't that the fault of the people making the contract?"

"Maybe, but it isn't easy and I bet the focus is on the cost. Unless you are buying physical items that can be weighed, measured and tested for compliance with engineering type specifications there will be a lot of grey areas. I wonder if any hospital cleaning or catering companies have healthcare outcomes and targets in their service agreements. I bet they don't. It would be too difficult to measure and hold them to account."

"So you're claiming a contract cleaner isn't as effective as an in-house cleaner?"

We turn left and walk past the pub. It is quiet. 

"They may be just as good at actually cleaning, but it will be harder for them to be 'part of the team' and I think that makes a difference. If everyone is in silos just providing their own services you can lose the communication and networking. You're not part of a health care team, you're just a cleaner. And you have to follow your own boss's instructions and they will be trying to meet the cleaning company's targets."

We walk through the car park towards the path up and over the hill. There are no cars. The heavy clouds which had early appeared to be propped up by Mow Cop have dropped and the castle is no longer visible. The mist is thicker and the view more limited than on our outward journey. It is only mid afternoon but the gloom is making it like dusk.

"For someone who makes a living from outsourcing you don't seem very keen."

"I think that's a bit of an exaggeration. Depends what and how you outsource, whether you know why you're doing it and how you are going to ensure accountability. It can be done well or not well. Just like anything else. Not all outsourcing is bad. Some is good."

"Why would anyone outsource if they don't know why they're doing it?"

"Common problem. Muddled reasons. Some say it is to buy in subject matter expertise from specialists to improve quality, others say it is to save money, others so they can focus on core business and strategy and lots more reasons, but the way you go about it will vary. Problem is that in many cases different parts of their management team have different reasons and they fail to get any of them."

"Like they pay more for a worse service."

"In too many cases, but carefully defined metrics can be useful."

"So you wouldn't outsource cleaning from the NHS?"

We are at the summit of the hill. To our right we can see someone working in a field and we can hear a couple of dogs barking although we can't see them.

"I don't know, but I'd say it can be argued either way that it is or isn't part of the core services. If you consider only the actual medical staff to be core then you probably don't take much notice of the cleaning and award the contract to the lowest bidder. 'Cleaning is cleaning is cleaning' and the person procuring probably doesn't understand the first thing about cleaning anyway. Far too important to do cleaning themselves!"

"Catering is another area where things can go wrong with direct impact on healthcare outcomes, but they outsource that."

"Yeah and look at all the complaints about food in hospitals, and people who need special diets going hungry. Whether you think it should be outsourced of not that is very bad."

"What about buildings. Apparently people work better if they are in well maintained buildings and if it's nice surely it will be more pleasant for the patients."

"Most people probably wouldn't want the NHS to employ its own architects, builders and joiners etc, but do you mean outsourcing the management and maintenance of all the building facilities  or just contracting a building firm when work is needed, or something in between?"

A runner comes up the path towards us and we step to one side to let him pass.

"Is that the bloke we saw before?" asks the Webmaster.

"You mean the one who we followed up Hough Hill in the dark?"


"No. He was older and a lot slower than that guy."


"We need to start running again. We did a few runs before Christmas but nothing much since. How am I going to do that race?"

"You'll manage."

"Easy for you to say. I can't just turn up and run a race when I haven't done any running for months apart from an occasional jog round the lake."

We turn down the track and back to the lane.

"What time is it?"

"Just after half past."

"Good, plenty of time. Just about the right distance for a lunch hour walk but next time we should run."