Olympics Opening Ceremony Wasn't Political

Friday's Olympics Opening ceremony was a great spectacle. Many have drawn attention to the £27m price tag and suggested that such largesse could hardly fail to provide success. Well, perhaps, but then I'd point to the Millenium Dome as an example of even greater expenditure that wasn't so well received.

But the real value we get from that expenditure is derived from the international attention the ceremony gets. The whole show portrayed a positive, some might say romantic, view of Great Britain and that can only benefit us in terms of international trade and tourism. This is important at a time when the Euro Zone (which currently repesents almost 50% of our current international trade) is lurching from one crisis to another, weakening our trading opportunities. We need to build a strong brand image across the globe to make up for Europe's slump. And of course a boost to tourism in this country won't go amiss either.

Watching the ceremony on the television was very enjoyable. Normally Twitter adds an extra dimension as people share their observations either witty or critical. However, on this occasion I found it significant detracted from my enjoyment. This was one event I was hoping could bring people together and certainly wasn't expecting party political point scoring. However, the inclusion of three letters in a set peice was enough to ignite an explosion of party political animosity that I foolishly failed to ignore.

Mention the NHS to any normal person and they'll think of hospitals, GPs, illness, cures, the birth of a child, the death of a loved one, a whole range of thoughts and emotions both positive and negative. People don't genially think of Tories or Labour socialism, centralised state provision of localised private provision, free at the point of use etc. No, but politicos do.

As soon as those letters appeared, left wing politicos erupted with claims that this ceremony proved, beyond doubt, that they were right about everything and Britain was really a socialist nation after all. "The best Labour Party political broadcast ever" claimed one Labour MP. Right wing politicos reacted similarly, that this was a left wing ceremony portraying Britain as a socialist state. Then, the lefties attacked the righties for politicising the ceremony. If there's one thing you can always rely on the Left to deliver it is hypocrisy. And enormous national debt, obviously. But I digress.

I may be in a minority of one, but I don't see any justification for party political point scoring. Yes, the NHS was mentioned, but such is the political consensus, there is no lack of commitment from the leadership of either party to a free at the point of use health service available to all.

The left want you to believe otherwise about the Tories. But that is because their idea of the NHS is fundamentally idealogical. All services must be provided by the state and all employees must be state employees. This ideological stance isn't even shared by everyone on the left or in the Labour party. The Blairite wing has long since worked out that a centralised Brobdingnagian organisation can't deliver the services required at an affordable cost to the nation. The Governemnt's NHS reforms were aimed at ensuring the concept of a national health service providing free care to all can survive in the coming decades of pressure on the public purse, by allowing GPs real choice in who provides the services they prescribe for their patients. This is an anathema to those with truely left wing beliefs as it could lead to charities, not-for-profit organsiations or even, heaven forfend, private providers, servicing patients, if they can provide better care and value for money. And so, they paint the Tories as anti-NHS. What they really mean is they are anti-reform of the NHS.

But whether you are pro or anti reform of the NHS, the ceremony wasn't making a political point. It was celebrating British institutions, including the monachy, hardly an institution close to the heart of your average lefty. It's a shame us politicos can't sometimes put politics aside and just enjoy a national spectacle when we see one.

 

Posted with Blogsy

Health Inequality And NHS Funding

Labour claims that a small change in the way Primary Care Trusts are allocated funds is designed to transfer money from "Labour" to "Conservative" areas of the country.

Labour point to a report by Public Health Manchester. Unsurprisingly, Manchester comes out as a victim of this evil Tory conspiracy. Of course, their conclusions are totally unbiased and deserving of the weight Labour have given them. But even if you believe that, and the figures are true, is this method of allocating cash to areas of the country really that sensible?

The change being suggested is to reduce the amount of additional money allocated to areas of considered to suffer from "health depravation". On first look that sounds sensible. They'll have more issues so need more money. This money is intended to be spent in more preventative activities such as encouraging healthier lifestyles and sexual health etc. Again, that sounds like a sensible thing to spend money on in places with such issues. But there is something fundamentally wrong with that approach.

One sign that something is wrong is that the money is always targeted at the same areas. Year in year out. In other words, the money is not buying preventative services that are making any significant difference. No doubt there are the odd examples of success here and there, but no overall relative upward trend in general health in these communities is discernible.

There is no doubt that there is a serious problem with health inequality in Britain. It ends up costing the tax payer more and more as the issues go unaddressed. So there certainly is a case for spending money on it. But what is the best way of allocating funds?

We can easily turn Labour's claims round and point out that they originally ran a system that benefitted Labour areas at the expense of Tory ones. But this shouldn't be a party political issue. Instead we should think about the best way to fund activity that will improve health across the nation.

I would argue that funding for preventative health initiatives should be linked to outcomes. Where one initiative produces success it should be given funds to expand its activities to other areas etc. And it shouldn't matter if the initiative is state run, charity of private. The most successful provider should attract the most investment. But the current system just rewards failure. As long as an area keeps its "deprived" status its PCT can rely on some more money. The money fails to improve anything so they need more next year and such is the story of NHS spending over the decades.

The original idea behind setting up the NHS was a (typically deluded central planner's) view that it would cost less and less as the health of the nation improved. Instead we've spent more and more of our national income on it and have barely kept up with our international competitors in terms of overall national health. In some cases outcomes are woefully behind.

The NHS reforms go some way to at least lay the foundations for more effective funding of health care in Britain. But they have been watered down too much and much more is needed to transform the attitudes of NHS staff and users so that they are less resistant to change.

But a good first step would be to show real progress in addressing health inequalities by rewarding success in this area rather than failure and ignoring politicians who want "their" people funded more than the "other's".

The Khan Academy, Philanthropy and The Big Society

It gets 2 million hits a month but I've only just heard of Salman Khan's Online Academy, and it's very impressive.

The free resource, provided through the effort and commitment of Khan himself with philanthropic backing from the likes of Bill Gates, has gone from strength to strength since he started tutoring his niece in maths (or math as our American friends insist on calling it). The 2 million visits a month are to over 2,300 separate tutorials covering subjects not just limited to mathematics (which includes everything from simple arithmetic to calculus) but also several science subjects (biology, physics etc), history and finance.

For all those who snort in derision at the concept of the Big Society and the idea that people may give up their time to pursue worthwhile projects (albeit voluntary work is only an element of the rather nebulous concept), this is an excellent example of how it can work (at least in the US). Salman Khan was a hedge fund analyst before developing this idea. He now commits all his time to it relying on donations to continue development, and to live.

Admittedly, philanthropy is much more common and engrained in US society. But it would be nice to think that we too could develop a similar culture of giving amongst the better off in this country to support the bright ideas and efforts of others. But before that happens we have to remove the attitude and, in many cases legal and commercial obstacles, that discourage or stop private individuals or organisations from contributing in health, education and other public services.

Recent events point to a lack of political will to drive the agenda forward. I hope this has been just pragmatic, tactical manoeuvring and that the strategy remains alive and well. Because I'm sure there are just as many great ideas and people in this country that could complement public services and improve our quality of life without having to rely on the approval, control and largesse of the state.

Who Was Most Influential On NHS Reform?

After all the threats and brouhaha that the Lib Dems put up over NHS reforms following their poor local election results, they must be disappointed with this finding in today's YouGov poll for the Sunday Times.

Who do you think is most responsible for influencing the change in the Government's policy regarding the NHS? (%)


Mind you, not as disappointed as Labour must be. They are clearly seen as complete irrelevant and ineffective by voters currently.

Angry Doctor vs Cameron & Clegg

On one level I sympathise with the consultants anger at journalists not following the correct hygiene regime but mostly I find the arrogance and rudeness sadly typical of the self important, jumped up little hitlers that are all too evident in our health service, especially at consultant level.



If you listen to what he's actually complaining about, it's not that the hygiene of the ward is at risk from the tie wearing journos, but that "we", as in him and his colleagues, have been made to remove ties etc. (whether he means just for that day or always is unclear). In reality, he's offended by the presence of the prime minister and his deputy and outraged that his entourage should be allowed to break a rule.

One has to wonder why he didn't take this up with the ward sister who is responsible for hygiene on the ward and who asked Cameron and Clegg to remove their ties but not the journalists. I suspect he just wanted to show how much more important he was than the visitors he had on his ward and the staff running it, despite the great publicity they were bringing to his hospital (until he turned up).

"I'm not having it", he exclaims as he is ushered away by mortified managers and more level headed colleagues. Any normal concerned professional would have been asking questions of those very same managers and ward staff as to why the rules were allowed to be broken. The ward sister must be furious. It's her domain of responsibility after all. Now, if Cameron was suggesting what kind of operation the patient should have on his leg, then fair enough. The senior orthopaedic surgeon would have been rightly outraged at such temerity and impertinence. But instead he's lost his rag over the apparel of some journalists.

I think this illustrates something I've observed in my dealing with the medical profession and, to varying extents with other professions. That is the almost total and unquestioning respect and deference these people receive from those around them for achieving the position they have. While most deserve the respect and don't let it go to their heads some, like this chap, truly believe they are above everyone else, not just in terms of attainment, which is often true, but they actually believe they are better, more important than all those around them. In this case, he believes he's better than the managers, the ward sister and the prime minister and his deputy.

It can't be healthy when such deferential treatment produces such utter arses. It's certainly been my experience that NHS consultants are not infallible. Given their mistakes can cost lives, a bit of humility might not go amiss and may even make them better healers, as well as people.

NHS Reforms. What's Changed?

Good summary of the NHS reform changes, from The Times...

Muscular Liberalism or Lack of Leadership?

I always vowed never to subscribe to The Times when it disappeared behind a pay wall. But then I began to miss some of my favourite columnists such as Giles Coren, Hugo Rifkind, Daniel Finkelstein, David , Rod Liddle and Matthew Parris.

But Saturday's column by Matthew Parris hits the nail on the head on the subject of NHS reform.

He imagines a Britain where our agricultural system is run like a Soviet collective. Everything is controlled by the state, everyone involved is employed by the state, all supplies are directed centrally. He then develops this crazy fantasy. The government decides on reform to allow farmers to choose between suppliers. He describes the response to this suggestion as follows...

"Now picture a special conference called by the farmers’ trade union to debate the proposals. Here is an extract from a union leader’s speech to the conference. He is railing against a duty, in the proposed legislation, to promote localised competition . . .

'I want proper controls nationally considered, not locals trying to sort things out . . . I want politicians of every stripe to understand that we do not need competition to run Britain’s food production. It creates duplication that is wasteful — and why give state agriculture’s money to private shareholders? What Britain’s food production needs to improve quality and efficiency is collaboration and co-operation across [all] sectors, [not] different materials being delivered by different providers in order to try to get a cheaper deal — fertilisers in one place, feedstock in another, veterinary services in another and follow-up somewhere else.

'Which brings me to one particularly unacceptable idea in the Bill: performance-related bonuses ... otherwise known as the ‘quality premium’. The idea is that farmers’ groups that ‘purchase well’ — ie, save money — will be given some money to hand out to their members . . . this idea stinks.'"

Only Parris doesn't have to imagine this response. These quotes are taken from a keynote speech by a Doctors leader at a British Medical Association conference in London last week. All Parris did was change references from healthcare to food production.



It highlights the perverse sentimentality we have in this country about maintaining a Marxist style healthcare system despite all the evidence that things could be so much better if a degree of competition, even if it is only in the supply of certain services or supplies, were introduced.

But the main point he makes is how today's Conservative party is failing to champion capitalism. Nothing illustrates this more than the backtracking on the NHS reforms we're seeing now. Many will put this down to the influence of the Lib Dems but the truth is that it is also a symptom of the Tories desire not to re-contaminate their brand. The simplistic messages put about by socialists is far easier to get across in soundbites on the telly and in newspaper headlines than some theory associated with free markets. Free markets that many people associate with selfish pursuit of profit by "fat cats".

A leader must make and keep his party electable. Cameron has gone some way to detoxifying the Tory brand (although not far enough to win a majority, it has to be said). However, sometimes public opinion needs to be led, not followed. Tragically, the case for reform has not been made effectively enough, so a dilution in the proposals was inevitable. But that doesn't mean the case for change shouldn't continue to be made and made strongly, one might say muscularly. A case that, given enough effort, would convince a sceptical public that a free at the point of use health service doesn't have to be totally provided by the state working to some monolithic central plan. That real responsiveness and quality improvements can be achieved through providers competing to be chosen by GPs and patients rather than there being only one option.

It's here David Cameron still has to prove himself. Will he lead a muscular liberal coalition that brings true liberalisation to Britain's public services and with it much improved service and efficiency? Or will he allow the left's preferred definition of the word liberal to prevail, an option that pollsters would tell him would be the best option. In which case we'll miss the greatest opportunity for decades to setup the high quality and high value health service that we need.

UPDATE
This article on the ConservativeHome website by Paul Goodman (@PaulGoodmanCH) covers the liberal/pragmatist debate really well. Definitely worth a read.

Private Provision Of Social Services

From The Economist

The recent stories in the press, and on TV last night, exposing abuse in care homes for the mentally ill and elderly along with the news that Britain's largest care home provider, Southern Cross, is in financial difficulty, have caused much concern about the role of the private sector in the provision of social care.

My last blog post extolled the virtues of the market in the NHS, much to the annoyance of an anonymous commentator. Predictably, these private sector failures were used as examples of why any involvement of the private sector in social care is a bad idea. I replied in kind but subsequently have read an excellent piece in The Economist, published today, on the same subject. You can read that article here... When carers fail: Southern Cross’s problems are a business failure, not a policy failure.

It's worth a read if your interested in the implications of increased private provision in our social services.

NHS Reform and The Evil Market Boogyman

There is no doubt that the government's proposed NHS reforms have proven to be controversial. Originally backed by Lib Dems, Andrew Lansley has now lost their backing as the party descends into panic mode after the poor local election results. Without the support of the Lib Dems the reforms stand little chance of getting on the statute book.

It seems the main sticking point for the Lib Dems is the extent to which the market will play a role in the provisioning of a free-at-the-point-of-use service.

But, what is this evil market that is threatening our fantastically efficient and effective NHS, in the minds of the left anyway? If you read the Guardian or watch the BBC you'll be under the impression it is some kind of malign mechanism that is designed to sap whatever is good out of anything that comes into contact with it. A diabolical agent of the right wing, whose only purpose is to destroy the NHS and replace it with a US style health care system, where only the rich can afford decent treatment and the poor will be left to die in agony on the streets (because they'd have sold their homes to pay for what inadequate treatment that could pay for).

It suites those on the left, the statist planners and advocates of entrenched public sector interest, to characterise the market as a thing, a device, usually portrayed as an ideological paragon at the heart of the plans of frothing mouth right wingers hell bent on suppressing the poor and enriching their banker mates in the city. But, if you haven't already dismissed this as ridiculous (genuinely) idealogical nonsense, think on a bit more.

What is "the market"? It is nothing more than the choices made by you, me, our neighbours, their friends and family, in fact everyone. It's not an extraneous body with an agenda of it's own. Why shouldn't our needs as patients be put at the heart of our health service?

In Britain we have come to expect a free-at-the-point-of-use healthcare system. There are some powerful moral arguments for it and it appeals to our sense of fairness, that everyone, regardless of ability to pay, should receive the best healthcare available. We call the system the National Health Service and we are all very attached to the concept. And quite right too.

Free at the point of use it maybe, but cost free it certainly isn't. The cost to all us tax payers runs to over £100 billion a year. It has the income of a small nation but with the burden of expectations of a very large, complex and demanding one. As multiple reports over the years prove (including this one), the NHS is neither efficient or effective in delivering the standard of care we expect. As someone who has had a love one almost die of malnutrition on an NHS ward, I know for a fact that reform is needed.


The model we use currently is predominantly based on services being delivered by state owned entities and staff. New Labour's early reforming zeal attempted to introduce a more modern and competitive environment but met the same seemingly immovable forces of self interest in the form of public sector unions and others, such as the doctors' union, the BMA, who mobilised to scare the general public and the Prime Minister of the day into believing change was too risky. Old Labour fifth columnists like Gordon Brown and Ed Miliband made sure these voices were heard and moved to scupper all subsequent attempts at reform that threatened their friends and party funders and (as they saw it) loyal Labour voters in the public sector. Sadly, history may be repeating, with Cameron replacing Blair and Clegg replacing Brown. Cameron may not be worried about upsetting Labour voters in the public sector but he is worried about re-contaminating the Tory brand with the poisonous idea, no matter how untrue, that he wants to privatise the NHS.

So, we're spending enormous sums on an organisation built on the 1940's concept that centralised state planning and provision is the only way to provide a national health service free at the point of use. This approach has failed to deliver consistently excellent service as expected. There's been much tinkering at the edges to attempt to improve things but nothing that has been in any way adequate. And now the money's running out. David Cameron is committed to maintaining real terms funding and is avoiding real NHS budget cuts. However, after a decade of fiscal incontinence that has seen the NHS's budget more than double, the organisation has lumbered from poor productivity to worse. Some, politically motivated performance targets have been met (especially around elective appointments) at the expense of professional medical judgement in many cases and overall quality of care has dropped.

What's needed is choice. For example, GPs should be able to assess the performance of local care providers and send patients to the most appropriate one dependent on their needs. If that happens to be a private outfit rather than a public one, so be it. As far as the patient is concerned, it is free. The only difference would be quality. Where appropriate the patient should be provided with adequate information to be able to make informed decisions of their own about where and how they are treated.

I think the proposals have been rushed out and not communicated to key stakeholders in healthcare or to he general public very well. Taking time to pause and refocus is sensible. But, if the reforms are watered down or delayed until the next parliament we will merely end up with an organisation that has grown to rely on massive year on year budget increases to achieve bare minimum standards, if even that at times, facing the prospect of budget increases at barely inflation levels only. It won't know how to adapt. Services will be cut instead of unnecessary bureaucracy, productivity will carry on falling, outcomes will continue to lag behind international standards, cost efficient prevention will still play second fiddle to expensive cure etc etc.

Those that oppose the market playing a larger roll in the provision of healthcare are opposing the NHS becoming more responsive to our actual needs. They prefer to promote their ideological belief that only the state can provide adequate healthcare, despite all the evidence to the contrary.

All that patients care about is that their treatment is of the highest possible quality and free. Who provides it is irrelevant.

Fear and Dishonesty Emerge As Labour's Main Tactics

We have been warned that this General Election campaign could turn nasty and at the end of the first week it has. The Times reports that the Labour party has targeted 250,000 women with leaflets suggesting that treatment for breast cancer will be inferior under a Conservative government. As if that is not appalling enough there is a question around exactly how these tawdry leaflets were distributed. And there have been widespread calls from leaflet recepients, the Tories, Lib Dems and SNP for Labour to apologise.

What we need to know is, who authorised this campaign? Was it Andy Burnham the Health Secretary who today defended the leadlets and did Gordon Brown know about it?

Even if Labour didn't illegally use private medical data to select their victims audience, as they claim, Labour sources confirm to The Times that they did use "socio-demographic research". They also have access to the Mosaic database from Experian, which includes "anonymised hospital statistics, including postcodes and the diagnoses of patients, to identify the likely addresses of those with particular illnesses". Along with all this, they used Tangent Communications to distribute the leaflets. Tangent are said to specialise in “highly targeted marketing”. Tangent Communications clients include the Department of Health and Cancer Research UK.

Of course, even if you believe that they didn't target sufferers of, and those vulnerable to cancer directly, the prevalence of the disease means there are few people who have not been affected by it in one way of another. Labour knows the fear it strikes into the hearts of millions and this is what they seek to exploit.

Labour's objective is to focus on the Conservatives intention to drop micro management by government ministers using politically motivated targets. They paint this as some kind of lessening of a commitment to quality healthcare that would adversely affect cancer treatment. In order to maintain that impression they need to ignore that fact that the Tories intend to replace these targets with a system that judges health care providers by far more relevant, measures focussed on actual outcomes. This makes more sense to me. I don't care how long whatever phase of my treatment, a government minister decides is important, takes if I know that the overall care I will receive maximises my chance of survival with as little adverse impact to my quality of life as possible.

Far from reducing information available to patients about health care the Tories pledge to increase it, and that pledge it pretty much central to their vision of moving to a more patient focused system where we'd have a choice where we go for treatment. If you want more detail on their plans, the Conservatives will be publishing their Manifesto on Tuesday. However, the Draft Manifesto they published earlier in the year sets out their plans as well. I suggest skipping the blurb at the start and jumping straight to page 8.

Now, you may not agree with this approach. Fair enough, that's a matter of opinion. The best way to deliver health care is a big question and there will be many different theories and proposals. But to suggest that your political opponents are setting out to deliberately damage health care is wrong and to target the fears of women about breast cancer is utterly contemptible.