Tuesday, 31 August 2010

Murdoch, Dave and the BBC

James Murdoch -
a second after remembering the size of his bank balance

With the Tories stepping up their attacks on the BBC - something that will please their media allies (not least BBC-basher-in-chief, James Murdoch) - Ash Atalla has warned against the complacency of its allies:

Meanwhile BBC Director General Mark Thompson pointed out what should be glaringly obvious - that the BBC, unlike Sky, actually invests in original British programming.

Ultimately, though, it's up to the Tories (sorry, 'the Coalition'), what will happen when Licence Fee negotiations start next year.

UPDATE JAN 2011: Looking back at this post again, it seems that Atalla's concerns were proved depressingly accurate.

Saturday, 28 August 2010

Government to close NHS Direct

... and replace it with a cheapo option, 1-1-1. The difference, media reports suggest, will be a dramatic reduction in medially-trained staff. NHS Direct employs 1,400 nurses out of a total of 3,400 staff.  

 If the NHS is a protected area of spending, the it's looking bleak for the rest of the public services in October.


PoliticalHackUK has, rightly, pointed out that this announcement is the latest in a rash of closures of public bodies that have been announced to the media first, in many cases before the employees of these organisations were informed.

Meanwhile, a petition to save the service has been launched here.

Friday, 27 August 2010

It was nice while it lasted...

The rise of the internet, for a while, looked to herald a bight future free from the staggeringly malign influence of every idiot's favorite paper, the Daily Mail.

Alas, as the dribbling fools that constitute its core readership base finally learned to master a keyboard, things have now started to change, and the paper is now consolidating its lead as the most-read online UK newspaper.

However, that was until I discovered a previously unreleased piece of research* that analysed its online readership and concluded that vast numbers of its readers don't in fact read the mindless drivel that passes for current affairs in the paper. In fact, the following percentages of people over the past year visited for these reasons:

  • 78% of visitors clicked on the pictures of bikini-clad women on the right-hand side of the page, at the same time as shaking their head in disgust at the moral decay of modern society;

  • 56% of visitors typed "hilariously offensive/predictable Mail stories about asylum seekers/biscuits that give you cancer" into Google and subsequently emailed said stories to their latte drinking, Guardian-reading metropolitan friends, so that they could all chortle about it over a glass of prosecco in the evening after work and talk about how wonderful Ben Goldacre is;

  • 22% of visitors wanted to find out which object / foodstuff / leisure activity was likely to give you a major disease and/or cure cancer that day;

  • 11% of (men) wanted to cut-and-paste a Mail story about women's true place in society (i.e. "Helen was a high-flying city lawyer on £11,000,000,000 per second, but then realised she was actually 750% happier behind the sink in the kitchen") with the specific intention of annoying their (non-Mail reading) girlfriend, who then angrily repeated said Mail story to the blank, expressionless faces of her female friends, 75% of whom do read the Mail and don't get what all the fuss is about, partly because they ignore all of the political stories and instead stare at the pictures of cellulite on celebrity x, age-lines on celebrity y or zit on celebrity z.
*I would post a link to this research, but I can't as I've just made it up.

Thursday, 26 August 2010

IFS on the Budget

After a detailed (and impartial) analysis of Osbourne's June Budget, the Institute of Fiscal Studies have concluded that it was "clearly regressive as, on average, they hit the poorest households more than those in the upper-middle of the income distribution in cash, let alone percentage, terms".

This has, for obvious reasons, upset Nick Clegg - the Lib Dems, rightly, are getting increasingly worried that their deal with the Tories is reflecting badly upon them in the eyes of many of their core supporters.

In response to the report, Clegg came up with this gem:

"You cannot measure poverty with a snapshot because people’s lives last longer than a single second... the question to ask about government policy is what its dynamic effects are... across the generations".

Now, following this logic, someone who is materially poorer shouldn't complain, because in 50 years time, their kids might be financially better off. That must be a comforting thought for them...

Wednesday, 25 August 2010

NHS Reforms Challenged

The magnitude of the reforms to the NHS announced in July by the Coalition have now begun to sink in.

The Muscular Dystrophy Campaign are one of a number of health groups that have expressed serious concerns about the impact of these changes. The Muscular Dystrophy Campaign have particular concerns (which they term potentially 'devastating') about the scrapping of Primary Care Trusts, and the potential loss of co-ordination that these bodies bring:

"It's shocking that the future role of essential, specialised services for people living with very rare conditions has been almost completely absent from the debate following the publication of the White Paper. At the moment, Primary Care Trusts collaborate regionally to commission specialised services for people with rare conditions. Will the new NHS Commissioning Board have its own budget for these particular services, or will the new GP consortia contribute part of their budgets towards specialised services?"

Meanwhile, it is clear that private companies are going to have a major role in the commissioning of services - potentially opening up massive conflicts of interest and driving commissioning (and therefore ultimately service provision) decisions out of the public sector altogether.

Now Unison has decided to go to court to attempt to put the brakes on a reform that, as well as potentially meaning the end of the National Health Service in its current form was, incredibly, not even mentioned before the election by either the Conservatives or their butlers the Liberal Democrats.


Do Unison have a case? Well, in 2006 the NHS Act was passed, and included section 242 which applies to:

• strategic health authorities;
• primary care trusts;
• NHS trusts; and
• NHS foundation trusts.
Section 242 explicitly states that:
“Each relevant English body must make arrangements, as respects health services for which it is responsible, which secure that users of those services are, whether directly or through representatives, involved (whether by being consulted or provided with information, or in other ways) in –

a) the planning of the provision of those services
b) the development and consideration of proposals for changes in the way those services are provided, and
c) decisions to be made by that body affecting the operation of those services. “

The duty applies if implementation of the proposal, or a decision (if made), would have impact on -
a) the manner in which the services are delivered to users of those services, or
b) the range of health services available to those users.

Tuesday, 24 August 2010

Lib Dem defects to Labour

Ok, so he's not an MP or anything... but Ian Jobling is the first such post-election defection. Despite endless rumours, no MPs have so far done the same (yet).

Public support for the coalition evaporates (especially for the Lib Dems)

The latest YouGov polling shows that the leaderless Labour Party are now only 2% behind the Tories (on these figures, the former are up 9% on their general election share). For the first time, overall positive approval of the coalition government has disappeared - the proportion of people approving and disapproving of the government is now neck-and-neck.

The Lib Dems, meanwhile, have equalled their 12% score that they polled at the end of July, which was their lowest score since 2007, in the immediate aftermath of the exit of Menzies Campbell. They are now more than 11 percentage points down on their election score.

Sunday, 22 August 2010

NICE, drugs and the (sort of) National Health Service

Will the spate of reforms in health care see a reduced role for the right-wing hate figure that is the National Institute of Clinical Excellence (NICE)? 

The British Medical Journal are certainly hinting that that may well be the case, and pre-election comments by Andrew Lansley suggest that its key role in assessing the 'value' of medical treatments may be on the way out. This will no doubt delight many in the pharmaceutical industry.

NICE, the original target of many of the hysterical 'death panel' stories circulating in the US, plays an important role in ensuring that drugs purchased by hospital trusts are medically effective - in essence helping to prevent drugs companies from profiting from the sale of treatments that have little in the way of proven efficacy.

Currently the system allows for purchasing decisions on licenced drugs to be made initially at a local level. However, NICE makes nationally-binding recommendations where there is uncertainty in the apparent value of a medical treatment.

If health service commissioning is fragmented, and NICE loses its key role in influencing the purchasing decisions of NHS Trusts, then there is a huge danger that the balance of power will tilt in the direction of private drugs companies, driving up costs for UK patients. 


Equally importantly though, is what the current government will do when the current Pharmaceutical Price Regulation Scheme (the agreement between the Department of Health and the major pharmaceutical companies over prices and other related regulations of licenced drugs) expires in 2014. It looks likely that the system will end - the question will be what takes its place?

Now, there is no doubt that the huge bargaining power of the NHS has not been best used in the past. If a new pricing system can redress this deficiency, then all the better.

The question is, will a Coalition government that has planted its flag firmly in deregulation territory be willing to fight hard to get a good deal for the NHS (or whatever it is that British health care system will be in 2015)?

Back to the 1990s

There maybe arguments as to whether it is a result of economic necessity or merely ideology, but this government is practising, as one commentator puts it, 'laissez-faire government in the purest sense'.

In the name of austerity and of promoting 'freedom' for professionals, step by step the Coalition are slowly dismantling state-delivered public services. In health care, one of the biggest early assaults has been on methods to measure (and encourage) high-quality, timely service to NHS patients. The government will argue that this is in order to reduce bureaucracy, but sceptics will argue that removing performance monitoring is all too convenient, and scrapping safeguards to prevent NHS patients being disadvantaged is an indication of an government relaxed  about the consequences of such an outcome.

So, waiting time and service delivery targets are set to be dropped, caps on private hospital incomes will be removed, NHS Professionals is the latest outfit rumoured to be under threat of privatisation (although it appears that, in line with many other public bodies, those actually working there are left in the dark). Most recently, it has been announced that Clinical Excellence Award Schemes are now 'under review'. These awards, incidentally, are designed to give financial recognition to consultants 'who perform over and above the standard expected of their NHS role'.

Now, it is true that many senior consultants have lucrative contracts, but the history of the NHS has been one of using financial incentives and generous contracts (particularly so in the large reform and investment programme in the early 2000's) to encourage key senior medical professionals to maximise their work in the state sector - of risk leaving them doing the bare minimum for the NHS in favour of more lucrative private work.

Whatever the decision on the Clinical Excellence Award Schemes are, it is clear that major efforts to encourage professionals not to prioritise private work to the detriment of NHS patients are now a thing of the past. In this area, the government is taking a step back, and it looks highly possible that Britain is heading back to the 1990s.

Wednesday, 18 August 2010

Free Schools (Part II)

Steve Bell © 2010
 Was it just Toby Young and his friends that wanted one?  It was one of the Tories few well-trailed promises pre-election, but it certainly doesn't look like the world is queuing up to set up Free Schools.

Lord knows why - they are ideal. Why place inner-city plebs in modern buildings with adequate facilities when you can bang 'em in an office block?

"Ethos", we are told by the government, "is more important than landmark buildings"... although you try telling that to the pupils here.

So, the dream of getting that pesky state out of the way might take longer than Gove thinks. The vanguard, meanwhile, will no doubt be religious groups desperate to persuade everyone that science is a load of tosh, companies pretending to be 'concerned citizens' who are simply planning to bide their time until the rules are changed to allow them to make a profit... and the ranks of the Disgusted from Tunbridge Wells, one of whom writes:

"I realy wont to set up a free School. I am fed up of goverments like NuLieBore and the EUSSR telling us what too do in this Great Country. We need a return of Christian Values, the cane and no Political Correctness and immigration. I am going to set up a school to teach this and also to help with making sure that Our Children learn proper subjects like Grammer and not islam and homosexuality".

Still - probably for the best that there isn't a mass move towards the idea, as:

a) there's no money for it; and

b) the pioneers of the scheme don't like it at all anymore.

Tuesday, 17 August 2010

100 Cuts

Bus services, charity grants, school maintenance... the list of cuts even in advance of the October Comprehensive Spending Review gets ever larger. The Independent recently produced this list of 100 of them - one for every day of the coalition government:


Interesting how many charities and voluntary organisations - supposedly the vanguard of the Big Society when all the scrounging, lazy civil servants and public sector workers are out on their ear - are on the hit-list.

Monday, 16 August 2010

Government announces an end to something that has already ended

In a minor change of tactic, the coalition has made an announcement that isn't, for once, about how much they are going to slash and burn. Instead, they are going to announce the revolutionary step of closing mixed-sex wards.

All well and good, except:

It is estimated now that only around one-in-10 hospital wards are still mixed sex. Labour eventually concluded it would be impossible to abolish all of them - because of the disproportionate costs involved in converting some of the older Victorian hospitals.


Two years ago, Lord Darzi, an eminent surgeon who was made a health minister by Gordon Brown, concluded that the aim of providing single-sex wards across the NHS was an "aspiration that cannot be met"

Still, this way, the Coalition can do a 'Boris', and announce something that has already been done and brand it as their achievement.

UPDATE: A commentator points out that I might be being unfair here. But by announcing something that they clearly have no intention of properly resolving, the Coalition government can't expect a pat on the back for this... if an NHS with plenty of investment couldn't achieve 100% single sex wards, then how will an NHS in decline?

Sunday, 15 August 2010

Tumbleweed TV

Off piste, this one, but I wanted to share this jaw-droppingly bad attempt at 'satire' from some members of the right-wing loony-bins that are the US Tea Party movement. It's unintentionally laughable rather than witty... which certainly ain't what they were planning.


The example above is a case study that illustrates two very simple (and accurate) premises:

A) That right-wingers are rubbish at comedy and satire... because they are too angry and self-absorbed to be witty. Case for the prosecution: Daily Show (funny) versus Fox's Red Eye (about as funny as a fire in an orphanage).
B) That a Tea Party gathering makes your average UKIP convention look like a cluster of well-adjusted human beings. They are absolutely bonkers, mad and in many cases dangerously deranged people. Don't believe me? Go on to YouTube and type in "Tea Party" and have a look at some of them... sigh.

"Welcome to the Carling East Dartmoor"

The list of potential privatisations of British assets grows longer by the day, with the Met Office and England's nature reserves the latest to join the hit-list.

Leaving aside minor quibbles about yet more corporate branding of anything and everything, the question is whether selling off important sites of biodiversity will lead to poorer maintenance and possible loss of the land to development.

Tuesday, 10 August 2010


As the economy stalls, yet another private company relying on public sector business reports a gloomy outlook, the Ministry of Justice becomes the second major government department, after Culture, Media and Sport, to announce details of its spending reductions and consequent job losses.

...Hearty chortles and back slapping all round at the Carlton Club tonight then...

The cuts will apparently be front-loaded - the question therefore rises as to whether the government is favouring the political expediency of having cuts early on in parliament (rather than just before an election), over a more nuanced approach to avoid tipping the country back into recession.

Meanwhile, it's apparent that the so-called ring-fencing of health funding isn't translating into protecting services... begging the question as to how much money will be lost in the Lansley's restructuing plans.

Wednesday, 4 August 2010

Healthcare - inefficient, expensive and bureaucratic... welcome to America.

It comes to a pretty pass when the residents of Daily Mail Island are getting anxious about the removal of the cap on private income in NHS hospitals. 

The NHS restructure itself is - unsurprisingly due to its haste - a confusing mix of decentralisation and privatisation... with the creation (ironically) of a raft of new quangos thrown in for good measure. Consequently, no-one is quite sure what to make of it all, although many people could be forgiven for believing this is just part of a general privatisation of the public sphere.

In the light of this, it's worth pausing for a moment to consider the main calls from the Coalition for the very large changes being forced upon the NHS. These are familiar - that the NHS faced a large deficit, is unwieldy and is inefficient. The free market and private sector, by contrast, will be its saviour - lowering costs, offerering choice and improving standards. It is then worth looking abroad to the systems that the political right aspires to, to see just how much greener things are on the other side. The answer, predictably, is not very...

An ageing population, demographic changes and increased demands from patients has left just about every health care system in financial trouble, whether it is the crippling deficits that the very well-funded, social insurance-based French health system has been facing for years, or the huge costs of the private insurance-based US health system.

The latter system is particularly expensive, with health spending running at more than 15% of GDP [2008 figures], compared to around 8% in the UK, even after New Labour's dramatic funding increases. The expense is such that even though huge costs are absorbed by patients themselves (or their employers) in the form of private insurance and co-payments, the government - ironically - spends sums on subsidising the system matching those on a per-person basis that are spent in the public funding of the supposedly commie-socialist-fascist (delete abusive term as appropriate) UK system.

Meanwhile, the France continues to wrestle with a key problem of employer-funded social insurance systems- what happens when employers start to balk at the costs of paying for insurance for their workers?

Despite its huge costs, the US system is manifestly unfair - something that all but the most blinkered Republican or Tea Party member would acknowledge. Prior to the Obama reforms of 2010, only 80% of people under 65 were covered by medical insurance and  - crucially - even among those with insurance, many have insurance plans flimsy enough that they will fail to cover many medical costs, to the extent that 85% of those with insurance aren't covered for the costs of prescription medicines. As the latter are, unlike in the UK, unsubsidised and are not subject to regulatory controls on costs, these can be hugely expensive (this is for another post, though). The reforms themselves will do little to reduce these costs, as compromises have meant they are in essence a large subidy by government for the multi-billion private health industry.

As well as being unfair and expensive, US healthcare falls short in health outcomes when compared to other developed-world health systems. The independent Commonwealth Fund has consistently found the the US system has these deficiencies:

"Despite having the most costly health system in the world, the United States consistently under performs on most dimensions of performance, relative to other countries... Compared with six other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives."

The report above (the third edition of a comprehensive measurement of these systems going back more than half a decade), also contains a fact that will be news to most UK newspaper readers - that the UK NHS is the most efficient of all these systems. The UK also ranks in the top two for the effectiveness of care, safety, equity and cost-based access [click on picture to open]:

Mind you, what's a comprehensively researched, quantitative and qualitative academic review of health care systems when you can have simple ideology, eh?

Tuesday, 3 August 2010

Some considered views on British healthcare

Whilst the Tory (sorry, Coalition) government ponders how it can best use next year's BBC licence fee negotiations to eviscerate the corporation, it's worth, for a few moments, taking a short e-trip over to the USA, where we can get some examples of balanced, impartial, well-considered commentary on the NHS in their media.

My personal faves include the following gems:
It's a sad fact of the US that its media culture is utterly dominated not only by loony outlets like Fox News, but countless 'independent' think tanks and so-called academic research institutions like the Manhattan Institute... a torrent of right-wing noise punctured once in a while by the occasional (often milder) voice of reason.