The Bewilderness

The Brown Bust, 2010 and counting

The money ran out in 2010. So ran a note by a departing Labour Minister: one finale epitaph on that irresponsible administration. Some will call this a lost decade; but better to rename this: Brown's Bust. 

The Guardian sets out a series of welfare changes that come into effect in the next two months. These changes represent a reduction in the amount of benefits received and reduce the scope by which entitlements can be rewarded. This will not reduce the welfare bill; only its rate of increase. The article is entitled by Patrick Wintour, their political editor, as the day that the Coalition changed Britain. 

Rather OTT, as the alternatives are far less palatable. Reduce benefits in Irish or Greek terms and embrace destitution. That day may still come. Have Labour and its slavish press forgotten that the money to pay for their client state must be raised abroad and, if no money is raised, no benefits can be paid.

Labour opened the sluicegates of debt. All else is incidental detail designed to deal with the consequences.   

Creeping closer to prohibition

This government always oscillates between applying the work of professional nannies and arbitrary populism. Now that Labour is behind in the polls, populism (or accountability) gains a greater weighting in their search for votes. Hence, the latest reaction to Donaldson's sledgehammer approach: PROHIBITION. It didn't work in the US and is unlikely to do here. The Tories also rejected this policy balloon. Only the so-called Liberal party embraced the public sector professional:

The Liberal Democrat culture, media and sport spokesman Don Foster backed Sir Liam’s call. “The Liberal Democrats have long argued that the ridiculously cheap below-cost price of alcohol in some of our supermarkets and off-licences is a key contributor to the problem of binge drinking,” he said. “There is clear research showing that putting an end to pocket money-priced alcohol will influence drinking behaviour. While more work needs to be done on the details, we welcome Sir Liam’s intervention and hope that the Government will act.” 

The argument against is that a majority would be penalised for a small minority: responsible: the responsible paying for the behaviour of a minority binge drinking culture.

There will be times when this principle is reversd though it should be applied to many more areas such as tax.
 .

Skoolzanhospitalz: a national lottery

Post-easter, the political agenda returns to normal with both parties grappling  with electoral concerns: skoolzanhospitalz.  The Torygraph kicks off  with a n unsurprising article  about the postcode lottery on mortality. A number of hospitals have higher mortality rates, yet the Health Commission has refused to investigate, allowing for sleight of hand:

Nigel Ellis, the commission's head of investigations, said using more up-to-date data and a detailed analysis, Mid Staffordshire still gives "greatest cause for concern".

A statement from the trust said the problem was that administrators failed to include certain information, giving an artificially high mortality rate.

A spokesman for George Eliot Hospital Trust, in Nuneaton, gave the same explanation.

"The standardised mortality rate released last year related to the financial year 05/06 and was 147 per cent," he said.

"For the annual year 07/08 we are expecting our standardised mortality rate to be approximately 105 per cent, which is within the limits for a trust of our size.

Moving on to another statistical sleight of hand, we turn to inflation. The variation between personal inflation rates and the official figure has discredited the measure.

The Tories are using the news of the teachers' conferences to set out their new policy on education: removing all failing schools from local council control immediately and setting up charter schools. A step forward, though vouchers are better. And having to deal with a broken profession that remains the main enemy to a better education:

Speaking ahead of a motion to be discussed today, Mr Sinnott called for a return to the liberal principals of the early 1980s when some inner-city education authorities developed alternative reading strategies.

Under the motion proposed by the NUT's ruling executive, guidance would be sent to its members in primary schools, reminding them how to teach using a variety of literacy methods.

But the plans were condemned by the Conservatives, who pushed for a return to phonics and a rejection of "failed" reading strategies.

Nick Gibb, the shadow schools minister, said: "Teachers should use the methods that the evidence suggests is the most effective way of teaching children to read. All the evidence suggests that phonics - taught in the first years of a child's education - is the most effective way of reading. The 'look and say' method that the NUT is talking about here is very damaging, particularly to children from non-educated families."

National Health Secession

Professor Aziz Sheikh has called for the National Health service to provide separate (privileged?) services for Muslims to take account of their religious requirements. The Professor is of Muslim orientation and has written an article for the British Journal of Medicine, giving reasons for his argument:

Writing in the British Medical Journal, he said the NHS should record patients’ religion as well as their ethnic grouping. “It is absurd that we do not, for example, know the perinatal mortality or smoking prevalence among Muslims,” he said. Male infant circumcision should be available throughout the NHS, he added. Although some NHS trusts do offer circumcision, most parents are forced into the poorly regulated private sector, he said.

Aziz Sheikh is conflating two issues here: matters of public health and providing specialised services for particular communities. Whilst there may be problems amongst Muslim communities in terms of infant mortality and chronic illness, it is unclear why their status as Muslims should predispose them to these. Indeed, habits of smoking, drinking or living in relative poverty are widely acknowledged as better indicators for life expectancy and health. Therefore, these arguments may demonstrate that Muslims suffer from these problems, but that the causes are not specific to Muslims in particular, but are generally prevalent amongst the poor and immigrant communities.

It is not absurd that we do not gather statistics on the basis of faith, as faith is not a primary indicator for health, unlike social class, education or  the country of origin for your family. Aziz Sheikh has cited this argument to add ballast to his call for discrimination in favour of Muslims on the NHS.  This points the article away from a public health agenda  towards a medical version of the  'identity politics' that has hindered the effectiveness of other institutions.

The NHS should be more accommodating to the religious needs of Muslims. Many Muslims would prefer to see a same-sex doctor for reasons of modesty, but this was often not possible, despite the increasing number of female doctors in the NHS. More information about drug ingredients should also be available to allow Muslim patients to avoid porcine and alcohol-derived drugs.

If a patient who is Muslim wishes to receive treatment that is compatible with his religious inclinations, the National Health Service is unlikely to meet their answers. The rationing of healthcare is resolved in a mediocrity of outcomes based upon the equality of all - though contact with NHS personnel or class will often result in a better quality of care.

Aziz Sheikh's call for services in line with the Muslim faith could be interpreted as the natural demands of a  community that has found its feet and  started to  request  personalised treatment, in line with the  oft-quoted rise of  consumer expectations in health. Some could also see this as the  further development of separatism within the Muslim community, demanding special treatment for itself.

The common factor is the state monopoly in health.  It encourages communal responses to health issues, allowing professional leaders to make calls for particular treatment, with the corresponding balkanisation and backlash that we would expect from those who perceive that they have been missed out in any sharing of the tax spoils. Hence, the unedifying advance of 'white welfarism' in the leafy suburbs.

This would not be reported if health was a choice of individuals purchasing their requirements in a free market. The particular institutions would cater for those who wished to  apply these requirements, and  one would expect multi-faith alliances to obtain the critical mass that health provision often requires.

The problem is not Islam, it is the National Health Service.

Data Protection Undermines Public Health

The Academy of Medical Sciences is a professional body that operates within the mainstream activities of government funding and science based medicine. The  group acts as a vehicle for professional researchers and their latest complaint focuses upon the difficulty they have to access  medical data.

They note that the onerous bureaucracy  of the data protection act , and  its variable interpretation by public bodies, has led to a swift decline in their access to date for epidemiological and other public health studies. It is not clear that the trend towards increased control over the use of personal data had to lead  to a   decline in the use of such data for a public good. With such laws. a simple exemption would have sufficed to maintain access to this data on an anonymous and aggregated basis, with voluntary 'opt-outs' for those who did not wish to participate in such programmes.

Instead, arbitrary interpretations of the data protection regulations, has prevented access to medical records just as databases are proving more useful at aggregating and mining data for public health purposes. This is another example of complicated regulation causing unintended and pernicious consequences.

Yet, there is one theme that can be teased out of this affair, apart from the larger narrative of poor regulation. The professional classes enjoyed a paternalistic relationship with state structures, acquiring funding, status and power over the poor bloody infantry, or as we know them, the consumer. They did not have to take account of individual concerns over data when they were conducting their programmes.

The report, Personal data for public good: using health information in medical research', can therefore be broadly welcomed, for arguing that public education and engagement are necessary in order to place such studies within an ethical context. The danger is that, just as regulation has caused the problem in the first place, faux consultation from designated self-identified consumer or patient groups will be used to justify public health programmes without ensuring that the final mile is achieved: the permission of an individual to  allow their data  to be used in  public health or other studies.

The danger, as future posts will map, is that  states will use  consultation exercises and focus groups as alternative  channels to representative institutions, in the name of deepening or widening democracy and popular participation. We should consider the Napoleonic joys that participatory or deliberative democracy may bring....
 

An Acceptable Level of Death

The National Health Service has entered a deepening financial crisis as increased expenditure has raised wages without a corresponding rise in productivity. Additional burdens such as the working time directive and reserves for possible lawsuits have outstripped the rise in spending. Patricia Hewitt, Health Secretary, wrote in a memo leaked to the Observer that operations should be delayed so that trusts could curb their debts. Funds on public health were also frozen.

Centralised micromanaged organisations cannot manage their financial resources. The failures of Labour's NHS reforms ripple through the institutional economy, decreasing supply since resources are more restricted and allowing demand to increase by lengthening the wait of patients. Some of this demand will tail off as desperate patients obtain relief from private sector providers or die from a lack of clinical treatment.

For the government, this is an acceptable level of death.

Public Spending Cuts are here again?

If you cast your mind back three years to the last round of NHS reorganisations, the government established   Primary Care Trusts in order to act as a purchasing authority for general practitioners, where they could buy in hospital services. It was a belated recognition of the 'internal market' with which the Major administration attempted to restructure the health service.

The Primary Care Trusts acted as an extra layer of bureacracy and cost 63 million pounds to set up in 2003. Now, Sir Nigel Crisp, Chief Executive at the Department of Health has requested the 28 Strategic Health Authorities to reduce the number of Primary Care Trusts from 302 to 150 or less. This policy has been developed as part of the 'efficiency programme' in government, known as Gershonisation after the Gershon review, and will result in compulsory redundancies.

Crisp said that cutting the number of trusts could save £250m over the next few years. "These funds can then be redirected straight to front-line services," he added. The reduction in the number of trusts will raise questions about their creation, a scheme that cost more than £63m.

The cuts are expected to result in thousands of job losses and the department has begun talks with civil service trade unions The department said last night: "We are committed to reducing the excess bureaucracy in the management of the NHS. It is far too early to be talking about the number of job losses. There will be a reduction in the number of top management teams and back-office units.

This emphasis upon a reduction in headcount, against a backdrop of Strategic Health Authority deficits and potential cuts, may herald a renewed squeeze in government expenditure. Has Gordon tired of wasting money?