"Should not"

There was a bizarre reader's letter in today's Metro:

Whether or not you accept the NHS needs reforming (Metro, Mon) or repeated assurances from both the Tories and Lib Dems they have no plans to privatise the NHS - something I don't believe - there's another issue to consider.

Anyone who can recall the disastrous consequences of the internal market introduced into the NHS under the Thatcher government will remember any form of competition in this area will lead to disastrous results, such as hospitals and GPs competing with each other.

More importantly, health provision should not be based on whether one company is better than another at providing a service.

Dave Reardon, London.

Is this letter tongue-in-cheek or is he operating on a completely different level of reality?

Never, never on a Sunday...

We can have some fun with numbers with this one:

People have a ‘significantly’ higher risk of dying if they are admitted to hospital at weekends, new evidence reveals. Patients are 16 per cent more likely to die if they are admitted on a Sunday than a Wednesday, and 11 per cent more likely to die if they are admitted on a Saturday...

The analysis covered all planned and emergency admissions – more than 14.2million – to hospitals in England during 2009/10. It looked at 180,000 patient deaths within 30days of being admitted.

It's not clear if they made the obvious adjustment to the figures: "Another factor could be that seriously ill patients are more likely to be admitted on weekends. If they were less ill, they would have had their admissions postponed until a weekday.", and we aren't told how much lower admissions are on a weekend, so we'll have to work with what we've got.

a) 180,000 deaths out of 14.2 million admissions = 1.27% chance of dying.

b) Assuming same number of admissions every day (for lack of anything better), that can be split up into:
Mon - Fri = 1.22% chance of dying.
Sat - Sun = 1.38% chance of dying.
Check: (5 x 1.22) + (2 x 1.39) = 8.88, 8.88 ÷ 7 = 1.27.
Check: 1.22% + (13.5% x 1.22%) = 1.38%.

c) So your additional chance of dying if you are admitted on a weekend is only 0.17%.

Then there's the question of what-is-to-be-done?

Reduced staffing, fewer senior doctors on duty and poor access to diagnostic tests on weekends could have an effect, said researchers... Health secretary Andrew Lansley has said more could be done to increase the number of senior doctors working weekends.

What's the point of that then? It is clearly the case that it is far more expensive getting people to work at the weekend, because they want to be paid overtime etc (call it time and a half for sake of argument). So for a fixed salary budget, a hospital could employ ten fewer people Mon - Fri and seventeen extra people Sat - Sun*. There would be a modest reduction in deaths at weekends, but this would always be lower than the additional deaths during the week, so there'd be a net increase in deaths, end of discussion. So the answer is, just keep muddling along as best they can.

* Check: 10 people x 5 weekdays = 50 days' normal pay. 50 days normal pay ÷ 1.5 = 33.3 days' overtime pay. 33.3 ÷ 2 = 16.7, round it up to 17.

Andrew Lansley

WHO makes these silly rules? (2)

By signing the imfamous Article 8 of the FCTC, the UK agreed to:

"... recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability."

On this basis we agreed (emphasis mine):

"Each Party shall adopt and implement in areas of existing national jurisdiction as determined by national law and actively promote at other jurisdictional levels the adoption and implementation of effective legislative, executive, administrative and/or other measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places."

So different nation states implemented different smoking bans. Some, like the UK, went the whole hog other took a more relaxed approach, much to the annoyance of WHO. So the 2008 guidance on implementation of Article 8 sought to clarify what WHO really meant: (again, emphasis mine)

"[Article 8] creates an obligation to provide universal protection by ensuring that all indoor public places, all indoor workplaces, all public transport and possibly other (outdoor or quasi-outdoor) public places are free from exposure to second-hand tobacco smoke. No exemptions are justified on the basis of health or law arguments. If exemptions must be considered on the basis of other arguments, these should be minimal. In addition, if a Party is unable to achieve universal coverage immediately, Article 8 creates a continuing obligation to move as quickly as possible to remove any exemptions and make the protection universal."

Pesky thing this national law, isn't it? Luckily, Andrew Lansley hasn't been ordered to ban smoking in private homes and cars. The guidance states:

Public education campaigns should also target settings for which legislation may not be feasible or appropriate, such as private homes.

So Lansley's 'Tobacco Control Plan' proposes the following 'Big Society' solution:

"We will encourage local areas to create networks of local smokefree ambassadors at a community level to encourage people to make their homes and family cars smokefree."

So no big government snoopers, just 'Big Society' busybodies.

WHO makes these stupid rules! (1)

Just a few days after Call Me Dave declared war on red tape and threatened to drag bureaucrats that make stupid rules into his office for a stiff talking to, his Health Secretary proudly announced the commencement of stage 2 of the WHO war on smokers governments new 'Tobacco Control Plan for England. In 2012 Tesco will be forced to hide their fags under the counter, by 2015 Mr Patel will only be allowed to display a small written list of brand names and prices in his newsagents. Nightclub vending machines will be a thing of yesterday by next year too.

Something the politicians and media never like to mention is who actually makes these rules, that's because WHO, part of the UN, do. Ever since the UK and around 100 other nations (including many dictatorships) signed up to their Framework Convention on Tobacco Control in 2003 we agreed to eradicate tobacco (well to hand the lucrative trade in tobacco over to foreign criminals).

It works like this. WHO publish a rather subjective treaty urging signatories to protect people from the perils of tobacco smoke. For example, have a look at Article 13:

"Each Party shall, in accordance with its constitution or constitutional principles, undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship. This shall include, subject to the legal environment and technical means available to that Party ..."

In 2003 do you think anyone read that as fags had to go under the counter? Well, it is subjective isn't it, so WHO helpfully publish 'Guidelines for Implementation'. In 2008 they instructed the world:

"Display of tobacco products at points of sale in itself constitutes advertising and promotion. Display of products is a key means of promoting tobacco products and tobacco use, including by stimulating impulse purchases of tobacco products, giving the impression that tobacco use is socially acceptable ..."

They continue:

"To ensure that points of sale of tobacco products do not have any promotional elements, Parties should introduce a total ban on any display and on the visibility of tobacco products at points of sale ... the ban should also apply in ferries, airplanes, ports and airports."

Vending machines?

"Vending machines should be banned because they constitute by their very presence a means of advertising or promotion under the terms of the Convention."

There you go, that is how it works. Politicians who are soft in their implemention of the FCTC are targeted by the lobby. The more draconian you are, the more the FCTC people like you, the more they laud you and the more you get to ride the WHO gravy train. The UK is actually putting many tyrannical dictatorships to shame!

More to come on the FCTC and Lansley's other plans for smokers over the next week or two.

NHS Reform - I don't think so

While leafing through the Sunday Times last weekend I came across some job ads for senior monitoring and other positions connected with the NHS. In the light of the coalition's aim to "reform" the NHS, I couldn't help noticing what is required of those to be appointed.

In addition to the usual diversity bollocks, candidates must have "significant board level experience in a complex, high-profile organisation and the stature to be effective in the Whitehall environment" or "a public or health sector background, with some knowledge of personnel and pay issues and an appreciation of the policy and financial constraints on pay decisions affecting the public sector". They should be committed "to the NHS and its values with the ability to apply their skills and experience to the advancement of the Trust’s business and strategic goals".

The message of the ads is clear. The NHS, despite a cursory nod in the direction of the parlous financial state of the country, wants more of the same: only apply if you have a bureaucratic mindset (honed in large private or, preferably, public sector entities), won't rock the boat and will commit to business as usual. I don't think "reform" quite catches the flavour of such appointments: perhaps "stasis" is more accurate.

This behaviour is not restricted to the NHS. Every similar position in every part of the public sector draws from the same well of smug, already generously-rewarded, uninspiring apparatchiks who have risen without trace in a multitude of non-jobs in dysfunctional organisations. As living examples, each time a scandal erupts in a public sector organisation you will find a senior sinecure holder blinking in front of the TV cameras telling the mugs – again - that "lessons have been learned".

To a lesser extent Big Corp is also a victim of this plague. The same slimy reservoir was apparently dragged to land the non-executive (and many executive) members of the boards of RBS, Northern Rock and Lloyds before these outfits disappeared into the taxpayers' arms. It is no surprise that the FSA – another pit of expensive non-talent – asserted that there were no corporate governance issues involved in the debacle at RBS. Even so, the private sector, generally speaking, has to deliver something consumers want at a reasonable cost and, more to the point, can go elsewhere to obtain. Accordingly, in theory anyway, a minimum of efficiency and executive competence must be achieved or the enterprise will go bust. Nevertheless, the business wing of the political class protects its own. Thus, for instance, in memory of his distant glory days at ASDA, Andy Hornby - despite bankrupting HBOS at minimal financial or, incredibly, reputational cost to himself - was appointed to run Boots.

What Lansley and others in the coalition should do is take a day off and read Antony Jay's Management and Machiavelli. One of the major lessons taught by Machiavelli and highlighted by Jay is that, if you want to reform anything, don't ask those with a stake in the existing set-up to manage the changes required . Needless to say no-one in the coalition would be interested. They'll blunder on and the apparatchiks currently on the payroll – together with those to be appointed per the ads in the Sunday papers - will hold on until Labour returns to re-reform the NHS and, while it's about it, shower them with a new splurge of other people's hard-earned money.

Umbongo

University Tuition Fee Tomfoolery

David Cameron, in today's Evening Standard:

Unlike our predecessors we won't patronise the public by pretending there's a bottomless pit of money we can dig into. There isn't, and that means difficult choices need to be made. The public subsidy for higher education is massive — this year the Government will spend around £5 billion on teaching costs in English higher education alone — and in the context of spending restraint it cannot be exempted from cuts.

A lot has been said in recent weeks about what is in the interests of students, but this government is also responsible for the interests of taxpayers — and at a time of real financial hardship, a time when we have no choice but to make cuts across public spending, I don't believe it is right that we ask those on low incomes to pay taxes to prop up an unaffordable university funding system that they are not benefiting from directly.

Seems fair enough to me, sure, soften the blow by paying students a grant or a Citizen's Income, give them low interest loans so that people from poor families etc can go (which is sort of what the Lib-Cons are doing).

But that '£5 billion' figure reminds me of something else I read today, what was it.... ah... here we go:

Schools, employers, the food and drink industry and communities themselves are being urged to do their bit to make the nation healthier. Ministers said they wanted to tap into the potential of all of society in setting out their public health plans. Projects being promoted include everything from bike training in schools to voluntary cuts in salt and fat content by food manufacturers.

Councils will get a ring fenced budget to coordinate the push in England. This pot, which will be handed over from the NHS, will total at least £4bn a year from 2013, the government's public health white paper, Healthy Lives, Healthy People, said. It will be accompanied by the transfer of local public health directors from the NHS to local government.

It's funny how the money has run out for something half-way sensible, like universities, but there's plenty left over for these entirely made up schemes. As a taxpayer, I'm not keen on over-subsidising other people's university courses, but I'd rather pay for that (which does have some overall benefit to society, and maybe my kids will benefit from it) than this quango shite which is clearly of no benefit at all to anybody apart from the quangocrats running the scheme.

"Councils in charge of healthy lifestyle drive"

It's amazing to think that some people thought the Tories would be any different to Labour, although bansturbatory policies probably go down very well with a small majority of voters or whatever political persuasion. From the BBC:

Councils are to be put in charge of encouraging healthier lifestyles under plans to be unveiled by ministers.

Local public health directors will be moved out of the NHS and into local government as part of the shake-up. The government believes the wider remit of councils in areas such as housing, transport and leisure puts them in a stronger position to tackle smoking, drinking and obesity in England.

And so on an so forth ad infinitum.

Getting your priorities right

From The Metro:

... in a written reply to accusations by former health secretary Andy Burnham that he was ‘rowing back’ from previous statements, [Andrew Lansley] said: ‘I have announced plans to phase out the NHS Direct number. I am aware that some people are claiming, incorrectly, that NHS Direct is to be shut down.’

Mr Burnham said: ‘This is a welcome climbdown and great news for the staff who work for NHS Direct and all of us who rely on it.’

PS, I must cheerfully confess I have no idea what 'NHS Direct' is and have certainly never relied on it.

I am a child abuser: official

It appears that Prof Steven Field has deftly picked up the baton from "Sir" Liam Donaldson and is spouting the time-honoured drivel:

"Unless parents exert more control over their children's diets, they are risking a lifetime of health problems, and even premature death - death before their parents, which is almost too sad to contemplate," said Prof Field (1)

His harshest criticism was reserved for parents who put their children at risk by smoking in front of them and he suggested they "are committing a form of child abuse".(2)...

His warning comes after Andrew Lansley, the health secretary, called for people to take more responsibility for their own health and behaviour, instead of relying on state intervention. (3)

1) Not true. The wholly unsubstantiated scare story is that this generation of children will have a shorter life expectancy than their parents, but seeing as a) there is a long term trend for life expectancy to increase by one year every decade; b) parents tend to be thirty years older than their children (so will tend to die thirty years earlier); and c) parents who feed their children Unhealthy Food will probably eat it themselves as well, the idea that such parents will outlive their children is fanciful in the extreme.

2) Guilty as charged, Your Honour. Take me down.

3) He seems to have entirely missed the point. Lansley actually said that all this nannying and hectoring was at worst counter-productive and expensive and pointless at best.

UPDATE: see also Health Minister Dick, Longrider, Gawain Towler; JuliaM.

Fun Online Polls: NHS reform & Alternative Vote

Andrew Lansley's suggestion that GPs be given more control over NHS budgets received a very lukewarm nod of approval in last week's Fun Online Poll. Full results as follows:

Giving GPs control over NHS budgets is...

A small step in the right direction - 36%
Indifferent unless there are loads of other reforms - 31%
A step in the wrong direction - 25%
Other, please specify - 8%

So now we know. Thanks to everybody who took part.
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As to electoral reform, my original preference was "first past the post with top up seats" (which is UKIP's preferred option - David Campbell Bannerman refers to it as "AV-plus" here), but a lot of people don't like party lists and/or MPs without a constituency link, so having weighed up all the options, my current preference is "multi-member constituencies" (explanation as to how this could work here).

But never mind all that. They have now published the AV referendum question for next May: "Do you want the United Kingdom to adopt the 'alternative vote' system instead of the current 'first past the post' system for electing Members of Parliament to the House of Commons?", which I have chosen as the question for this week's Fun Online Poll.

Vote here or use the widget in the sidebar.

Fun Online Poll: Andrew Lansley's NHS reforms & heat wave

I suppose I might as well shut down yesterday's poll, because people will probably have forgotten about the mini-heat wave at the weekend now that it's started drizzling again. The results were:

Did you spend less time blogging when the weather was so hot?
Yes - 12 votes
No - 9 votes
Other, please specify - 1 vote (trying to repair car and/or buy new one).

Thanks to everybody who took part. I was firmly in the 'yes' camp on this one, in case you're wondering, and just being nosy about everybody else.
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Andrew Lansley's plan to give GPs control over NHS spending seems like a small step in the right direction to me, i.e. towards a taxpayer-subsidised health system with competing, non-state owned providers, like in most European countries. The high street doctor is just a referee between patient, provider and insurer, but seeing as most people have a pretty good idea what is wrong with them, they go straight to a specialist high street doctor anyway and there are few 'general practitioners'.

But I haven't given it that much thought. These chaps have, so if you haven't already made up your mind, read up for entirely opposite points of view:
Adam Collyer is enthusiastically in favour (beware: he is true blue Tory, so might be a bit biased - but what he says makes sense).
Obnoxio The Clown thinks that the only people less trustworthy than bureaucrats are GPs.

Or if you want the depressed-to-the-point-of-suicidal view, why not try Auntie Melanie?

Cast your vote here or use the widget in the sidebar.

"Actually, where do we end up with this?"

Our Heath Secretary gives us some examples of the Law of Unintended Consequences, as reported by the BBC:

"If we are constantly lecturing people and trying to tell them what to do, we will actually find that we undermine and are counterproductive in the results that we achieve," said the health secretary...

He said the TV chef's approach to school food had not had the desired effect - the number of children eating school meals had gone down instead of up. "Jamie Oliver, quite rightly, was talking about trying to improve the diet of children in schools and improving school meals, but the net effect was the number of children eating school meals in many of these places didn't go up, it went down. So then the schools said 'It's OK to bring packed lunches but we've got to determine what's in the packed lunches, we've got to decide what's in the packed lunches.'

"To which the parents' response was that they gave children money and children are actually spending more money outside school, buying snacks in local shops, instead of on school lunches." He said then people had said shops near schools must be banned, adding: "Actually, where do we end up with this?"

Doubleplusgood! Cost of alcohol plummets!

A few days ago, a committee of MPs solemnly announced that the "total cost of alcohol to [English] society has been put at £55 billion".

Yesterday, according to Tory health meddler Andrew Lansley MP (who doesn't appear to realise that "one unit" of alcohol, in this country, is already defined as "one centilitre of pure alcohol"), the cost had dropped to a mere £20 billion.

Maybe he didn't get the memo?

"Average NHS wait up under Labour"

Lots of fun-with-numbers on the statistics that show average waiting times in NHS are up marginally over the last ten years, from 41 days to 49.

What I like best is where Ben Bradshaw MP (Lab, Exeter) abandons all hope of doing the mental arithmetic to somehow prove that average waiting times are shorter and goes for a couple of bare-faced lies instead:

"Under the Tories is was not uncommon to wait 18 months or more for an operation. Tackling long waits leads to a short-term increase in the average wait as the backlog is cleared - this can be seen in the data."

Er ... so ten years later is a 'short-term increase', is it? Is he admitting that they haven't cleared the backlog after ten years? Are there people who have been on a waiting list since 1997?

Let's not forget that the nominal cost of the NHS has nearly trebled from £34.7 bn in 1997-98 to £94.3 bn in 2007-08 (planned - see page 7)