Health Minister Andy Burnham disgraced himself this morning on the radio. Subject is ‘patient choice’ (BBC item), which is to be expanded. In my view, generally a good idea to put the patient and their adviser (usually the GP) in the driving seat – if money follows the patient then suddenly patients matter more to eveyone in the NHS. Whatever anyone says, the NHS is a bastion of producer interest and its staff quite capable of treating you as if you don’t exist. There’s lots that can go wrong of course, but patient choice is right should be doable. Burnham’s disgrace was to fudge the critical question: what happens to places patients choose to abandon? He came up with some weasel words about support from the centre for hospitals that were struggling. But choice will only work if there is a credible exit strategy for places that aren’t chosen. Vast sums of money and growing share of national income are at stake – see chart (click to open larger version). Ministers have to be much more careful than they have been about who gets to spend it and how that is decided.
Just back from an excellent break in the Lake District, but had cause to reflect on the reasons for Britain’s poor record on economic productivity compared to the US. I’m convinced it’s little to do with the rise of China taking all our jobs, the failing biotech revolution, poor R&D spend or any of the other reasons usually offered. No, it is something much closer to home: the underperforming British consumer is to blame.
The basic reason is that Brits too easily put up with rubbish service or products or are too undiscerning to notice that’s what they have been offered. The consumer is the problem… Continue reading “The under-performing British consumer”
Another solemn cheque-signing [BBC report] and confirmation that, at €10 billion, the International Thermonuclear Experimental Reactor (Iter) will be the second most expensive experiment of all time. Fusion scientists are pulling a fast one playing on gullibility and vanity of politicians… in return for hugely expensive and enjoyable research spend they are offering the empty promise of endless energy, allowing us to fill that mental void marked “answer to world’s energy problems” with something looking suitably futuristic. There’s a (lame) joke about fusion and its constantly shifting promise of jam tomorrow: “did you hear that the fusion research programme has discovered a new fundamental physical constant – and it is equal to 40? As in “40 years from now”.
Should the NHS fund complementary medicine? Some top medics say ‘no’. Scientists are often too quick to dismiss treatments that work outside their own paradigm – and we need to stay open-minded about this stuff. But the question is, as always with the NHS, should someone else pay? The NHS is based on an implicit ‘contract’ between net beneficiaries (typically the old, sick and poor) and those that are net payers (young, healthy and rich). Those paying in are entitled to expect that NHS treatments have been shown to effective and cost-effective, and that they are not funding New Age fads. The NHS already has NIHCE to tell it what interventions are good value for money. I suspect that we will find that there are valuable therapeutic benefits from some of these treatments – but unless there is evidence, people wanting unproven alternative treatments should expect to go it alone.
An article in the Independent on Sunday picks up the Environment Agency’s approach to the Energy Review – and uses it to challenge Tony Blair’s pro-nuclear posture. A much better way would be to design a technology-neutral market that properly rewards low-carbon technologies and see which technologies are competitive. Nuclear might be the right answer. But it might not.
Just received a slightly irritating letter from Thames Water cheerfully suggesting: “Let’s beat the drought together”. At no point in the letter do they suggest that customers should ask to have a free water meter installed. Yet when people actually pay for the volume they use, they do actually use 10-20% less on average. Even in the advice on saving water section on their web site they decline to suggest it. But meters are essential for fair charging for water, efficient use and sensible tariffs. Continue reading “Thames Water – why water metering needs to be mandatory”
It’s hard not to dislike intensely Professor Sir Roy Meadow – the ‘expert’ witness that consigned Angela Canning to gaol and her family to utter misery on the basis of completely incompetent statistical assertions designed to shore up his idiosyncratic theories about sudden infant death syndrome. And he has never even apologised.
So good news today to hear that the General Medical Council is to appeal against the High Court ruling denying its right to stike him off. And the GMC will be supported by the Attorney General. [BBC item]. The High Court’s ruling was a disgrace, effectively protecting experts from the professional consequences of outrageous failure with extreme consequences for others.
The most famous claim with which Meadow mislead a jury was that there was a 73 million to one chance of two ‘cot deaths’ in an affluent family. There are two childish flaws in this statistical claim: Continue reading “Professor Sir Roy Meadow”
I’ve just done up my garden, including the purchase of a new garden table. I went to crocus.co.uk and ordered on-line…. and here it is pictured on-site. I was of course worried that this may be a table made of tropical hardwood – so I took some comfort from the Crocus’ hardwood guarantee, but was I right to? Continue reading “Is this a Garden Table of Death?”
At the CBI dinner, the PM says nuclear power is back with a vengeance. An odd choice of words… like it’s pay-back time and a lot of people are gonna to get hurt.
This determined winner-picking pro-nuclear stance based on the PM’s gut feel and advisers’ hunches shouldn’t really surprise anyone – he’s been saying it for months. The trouble is that it is quite difficult to actually do this, even if it is what the Prime Minister wants. At least not without completely upending the energy market as currently designed – and that may take rather more time than the PM has. Continue reading “Blair backs nuclear plans – but…”
The European Court of justice has just found that the NHS must fund treatment on the continent if the NHS waiting time is deemd too long. The ruling on case of Yvonne Watts (see BBC) effectively creates a single European health service with open ended obligations and removal of one of the very necessary approaches to rationing health care. Continue reading “EU judgement on hospital reimbursement goes way too far”