Wednesday, 10 February 2016

In which we are reminded that the NHS management don't understand economics


It starts with this:

‘Collectively and cumulatively [these actions] and others like them will help shift power to patients and citizens, strengthen communities, improve health and wellbeing, and – as a by-product – help moderate rising demands on the NHS’

This is the rather ghastly sounding 'Health as a Social Movement' line in the NHS's vain attempts to pretend that preventative medicine will 'moderate rising demands'. What is most striking here is that, yet again, the basic economics of all this are overlooked (although given they've appointed the risible joke of a think tank, New Economics Foundation, it's pretty clear they're not remotely interested in actual real economics).

Unless the project is about improving productivity through these community-focused actions then the only impact - assuming they do improve health and wellbeing - will be to increase the long-term demands (and hence costs) on the NHS.

The report ...projected that people with Type 2 diabetes who participated in a disease management program to prevent serious complications would cost the federal government slightly more money over 25 years than they would have without any intervention.

If you stop and think about this for a second, the reason for a healthy community being more expensive is pretty obvious - most of the costs in the health system (and the care system too) are directed towards older people so if more people live to a ripe old age there are more of those 'end of life' costs.

To use a big example, we've seen a massive decline in the numbers of and in survival rates from heart attacks - since 2002 the mortality rate has more than halved. In simple terms this means there are double the number of long-term heart 'patients' compared to the old days when they all died of a heart attack. This absolutely brilliant and a credit to doctors, pharmacists and the health benefits of a bigger, richer economy. But it's costing the NHS a fortune.

And it's not just heart attacks but every sort of disease, from childhood infectious diseases through to cancers, that has seen declining mortality rates. And this means it's pretty normal to live into your 80s, not unusual to make it to 90 and increasingly common for folk to make it to 100. So when we act - quite rightly - to prevent disease and reduce mortality rates the result is more and more old people and more and more demand for the NHS services that are under so much strain.

The challenge for healthcare is to improve productivity - to reduce unit costs for operations, for providing care, for dispensing medicines, for all the vast array of stuff health care does. And spending money on "health as a social movement" only does this if it means that the allocation of NHS resources to these communities is thereby reduced. So long as we focus on simple prevention as a demand management tool, we will find no benefit in higher productivity and a pile more demand-led costs for the system.

This is, of course, what you get if you believe that NESTA, the RSA and New Economics Foundation are the sorts of organisations that are able to guide the NHS towards greater efficiency and higher productivity. A load of left-wing cant and absolutely no moderation of rising demand.


Quote of the day: Why doctors shouldn't strike


Nothing to add to this:

When a country operates under a healthcare monopoly, its citizens are fundamentally at the mercy of the provider. That provider has an ethical responsibility to show up to work every day and look after its patients; if they don’t, no one else will.

Absolutely spot on. It's unethical for doctors to strike.


Tuesday, 9 February 2016

Quote of the day - how the NFL is a corrupting enterprise that exploits its players and its fans


It happened. We all got terribly excited about the Superbowl. Even in England where we have rugby league which is the same game but without armour, forward passes or endless delays to fit in advertising.

Anyway here's Matthew Stevenson on the NFL:

The National Football League runs on backhand payments to athletic organizations, sweetheart contracts, and monopoly pricing, in addition to screwing over its fan base by moving teams around. Its reward for urban price fixing isn’t prosecution for collusion under antitrust laws (it is exempt). Instead, it is awarded a national day of reverence, Super Sunday, during which 30 seconds of ad time costs $5 million, and the strategic national stockpile of guacamole is severely threatened.

The owners don’t actually own teams, but are general partners in a football trust, which allows them to share equally in all television revenues and collectively 'bargain' with concussed players, who are only free agents after five years of indentured service. By then, most are broken men. The league's attitude toward the declining mental of health of its retired players could be summarized as “So sue me”.

Yes, a few stars make big money, for a while, but teams are rarely on the hook for long-term guaranteed contracts and salaries are “capped,” they say, “in the interest of competition.”

No words being minced there and a stark reminder to those fans of proper football who call for salary caps, pooled income and other madatory controls on the operation of the game. Be careful what you wish for.  And read the whole article in New Geography - it's worth it.


Looks like it's only the mad dogs left...

At least if we follow the latest guidance from the Church of Public Health:

There is no safe or healthy way to get a tan from sunlight, new guidance from the National Institute for Health and Care Excellence (NICE) has warned.

The health watchdog's latest guidance also says an existing tan provides little protection against sun exposure.

It recommends using at least factor 15 sun cream, with adults urged to use 6-8 teaspoons (35ml) per application.

Benefits from building up vitamin D from the sun have to be balanced with the risks of skin cancer, it adds.

You remember all those years ago when the merest glimpse of watery sunshine resulted in us stripping layers of clothing off to bask in its glory? When your mum, spotting the opportunity to get some peace and quiet threw you out into the garden with as few clothes on as possible (and sun cream - what is sun cream)? Those days are gone, the midday sun is left solely to the mad dogs.

What absolute frothing lunacy is this - rickets is on the increase and over 90% people with skin cancers survive but the Chief Medical Officer, NICE and the assorted fussbuckets prefer to scare us about cancer while not giving a damn about kids getting deformities from being kept in a dark room in case a ray of sunshine should accidentally splash onto an unprotected portion of skin.

The guidance goes into contortions that are more reminiscent of the hokey-cokey to describe how we can expose skin to build up Vitamin D with first one arm, then another exposed for a 'short period' to the evil rays or the dreaded sun.

It does seem that it's not the dogs that are mad but the entirety of the public health profession.


Saturday, 6 February 2016

Migrants on benefits, mosquitoes, arts funding and other links you'll like

Spooky Bradford

"I didn't even know I could get benefits" - a reality check on migrants and the benefits system

“And actually it doesn’t bother me, all this immigration debate. I’m too busy. I work full time; I have three kids. But nobody I know came here for benefits and I don’t think not getting them will stop anyone coming. Maybe one or two. There’s always someone. But I know many, many more British people who live on benefits than east Europeans.”


Kill all the mosquitoes

"Mosquitoes spread Malaria, Chikungunya, Dengue Fever, Yellow Fever, a variety of forms of encephalitis (Eastern Equine Encephalitis, St. Louis Encephalitis, LaCrosse Encephalitis, Japanese encephalitis, Western Equine Encephalitis, and others), West Nile virus, Rift Valley Fever, Elephantiasis, Epidemic Polyarthritis, Ross River Fever, Bwamba fever, and dozens more."

So exterminate them - all of them


So you don't do politics? Think again.

"Politics is omnipresent wherever humans negotiate over power and governance. We speak of “office politics” or “university politics,” and those phrases are not mere metaphors. Our negotiations with friends are a form of politics as well, as we figure out where to go out to eat or what show to see. Our romantic and familial relationships are full of similar negotiations about language, persuasion, power, and mutual consent. To say we “don’t do politics” is to have a narrow notion, in Ostrom’s view, of what constitutes being a citizen in a society where democracy is a feature of so many institutions."


Virtue signalling as conspicuous consumption.

"Rather than trying to one-up one another by buying Bentleys, Rolexes and fur coats, the modern social climber is more likely to try and show their ‘authenticity’ with virtue signalling by having the correct opinions on music and politics and making sure their coffee is sourced ethically, the research says."

...interesting and challenging


Nothing new about retailing as performance (ask any market trader) - and it's back...

One of the key themes emerging from the presentations was that creating face-to-face customer experiences is vital to retailers not only because of the value to audiences in-store but also because of the huge value of customers sharing their experience across social media platforms. Sophie Turton from eConsultancy, who spoke at one of the learning talks, noted that:

“Instead of creating content, retailers should be creating opportunities for content creation – instagrammable moments, inspiring experiences.”

The Urbanophile on Charles Taylor's 'A Secular Age'

"The creation of the buffered self had consequences, however. By disconnecting us from the world, and draining the world of meanings, the buffered self creates a sense of improverished existence. That is to say, it produces the pervasive modern sense of malaise long commented on by Freud and others. But whereas Freud saw malaise as the inevitable byproduct of the sense of guilt necessary to make civilization possible, for Taylor it is rooted specifically in Western modernity’s sense of the buffered self."

Fabulous stuff.


And how all the arts funding still goes to London:

The report also highlights that Arts Council England’s decision to move an extra 5% of Lottery funds outside London amounts only to an “improvement outside London of 25p per head”.

Its Rebalancing Our Cultural Capital report in 2013 also claimed that ACE was allocating more than five times as much spending per resident to London organisations as those outside the capital in 2012/13.


Thursday, 4 February 2016

Quote of the day - on virtue-signalling as conspicuous consumption


Excellent from the Adam Smith Institute:

Virtue signalling has made widely-held ideas like ‘keeping up with the Joneses’ and conspicuous consumption completely outdated, according to a new paper from the Adam Smith Institute. Rather than trying to one-up one another by buying Bentleys, Rolexes and fur coats, the modern social climber is more likely to try and show their ‘authenticity’ with virtue signalling by having the correct opinions on music and politics and making sure their coffee is sourced ethically, the research says.

A good read too.


A bad week for culture in Bradford (and The North)

It has been a lousy week for culture in Bradford. First we had the announcement that the Royal Photographic Society (RPS) collection of art in photography would be transplanted from Bradford to a new 'centre' somewhere in London. And then today we got a second bombshell as the National Media Museum pulled out of the Bradford International Film Festival.

My view of all this is that it underlines the utter and complete domination of arts and culture by a narrow, London-focused elite. The Trustees of the V&A are all based in London and it wouldn't surprise me to discover that many of them, while they've visited Paris, Venice and New York haven't visited Bradford, Gateshead or Wolverhampton. For this elite such places are for talking about - you know 'deprivation', 'poverty', 'the underclass', gritty Northern films on a left-wing theme - rather than visiting. For the London elite the best that can be said is that some of them consider the North somewhere to be patronised - not in a physical way but by appearing on late night arts shows and saying how important it for the North to be recognised culturally (just so long as we don't have to go there).

There's nothing new with this problem - it remains perhaps the biggest challenge facing England. We talk a lot about the imbalance between London and 'The North' - indeed the Arts Council spends most of it's briefing pages on funding trying to demonstrate that it really does care about 'The North' and that most of the money doesn't go to London. It remains the case that roughly twice as much money goes to London that to the whole of the North. And let's remember that The North's population is around double that of London. meaning that per capita Londoners get four times as much arts funding as Bradfordians.

More to the point, London is also much richer with more access to the private sector funding that being one of the world's great cities brings. And this means that the wider infrastructure of arts and culture - commercial theatre, art markets, music and so forth - is much stronger (or at least appears that way). So while the efforts of the Arts Council, Heritage Lottery Fund and others to redress the imbalance is welcome it doesn't get close to the heart of the problem.

This heart - the central challenge - is the assumption that major national institutions have to be based in London. This was the essential problem with the decision by the Science Museum to hand over the RPS collection to the V&A. Not that a new 'centre' for art in photography isn't a great idea but rather that the centre could only be created in London. It seems that the Trustees of the Science Museum Group, at their meetings in London, didn't even consider suggesting to their new partners at the V&A that locating the new centre in the North might be the right idea (we can't be sure because the minutes of this almost entirely publicly funded organisation are not public).

So the RPS collection goes to London, which is sad. But worse than this, there's nothing but a gap left behind. Bradford no longer has that inspiring collection and nothing will replace it (a new 'interactive gallery' at the National Media Museum doesn't work since it's not really new and isn't really culture). The decision is a narrow one driven by a combination of cost pressures on the Science Museum Group (mostly being resolved by cutting the budgets of its three Northern museums) and the in-built bias towards London.

The actual decision was taken - without engaging with stakeholders in Bradford so far as I can tell - back in July 2015 with the time since then presumably spent thrashing out the details with the V&A. I don't know when the second decision, sacking the Bradford International Film Festival, was taken but it's announcement in the same week at the RPS collection decision suggests either a similar timetable or else a desire to get all the bad news out in one week. And now the museum, from being to go-to place for the culture of photography, film and TV, has become a mere adjunct of the science museum proper, a place of buttons and levers dedicated solely to showing off science stuff rather than curating the artifacts and the content of these classic media.

What's missing - from the V&A as well as the Science Museum - is any sense of the damage these decisions are doing to Bradford as a city. London is awash with film festivals whereas Bradford had just three - all now gone or under threat. All killed off by the narrowing of the National Media Museum's focus and by the blind ignorance of that London elite running the museums. The closure of a gallery or reconfiguration of a museum in London may be agitating but it does little real damage to that city's arts and culture infrastructure. Here in Bradford - just as almost everywhere in the North - the decisions made by the Science Museum to withdraw from involvement in culture has left a raw, bloody gash in the UK's only UNESCO City of Film.

It's true that Bradford people will pick themselves up, will gather together and put what pressure they can on government, on the Arts Council on the museums. And maybe a few conciliatory crumbs will come our way as a result, doubtless loudly trumpeted by those London institutions as great news for poor old Bradford. Of a considered approach to that bloody gash in Bradford's cultural life there will be none. The big arts and culture institutions won't set up a group to work on mending the wound their decisions have made, instead they'll spin what little (and it is vanishingly tiny) they've done until such a time as the national media stop taking any notice.

Even more, without some sort of big stick from government there's no way for us 'stakeholders' in Bradford's culture to influence the decisions made by that rich London-based elite that makes the decisions about how England's arts and culture infrastructure should be developed. I'd like them to visit Bradford - let us ask some questions of them. Not just about why everything has to be in London but about how they can support those of us who want to create a cultural heart for the North of England, who want to see the arts infrastructure developed and who are fed up with being supplicants to grand men and women in London who have - as we've seen in Bradford - the power to thoughtlessly tear great chunks from the cultural life of Northern cities.