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I used to be a matron but as a patient I was treated worse than an animal. That was one of the headlines in yesterday’s Sun. I do mean headlines, too. Jean Emblen’s account was not top story but it was right up there among the footballers’ wives. The editor of the Sun thought the readers would go for a story criticising nurses.
When did that happen? When I was a kid everyone was all soppy over nurses. It was considered quite shocking when a 1970s BBC soap opera called, tellingly, Angels depicted them as less than angelic.
We can’t simply attribute this loss in esteem to the NHS. For round about the first half century of the existence of the National Health Service, nurses continued to be loved by all (it is only fair to say there are plenty of people, including those with recent experience of the NHS, for whom that has not changed; a huge amount depends on the individual hospital). So what has caused it? Does it reflect reality – are nurses really not as good as they used to be – or is it just fashion, a last ripple from the wave that knocked politicians over in the 1960s and teachers in the 1970s?
One possible explanation is that nurses are no longer paid that badly. There is nothing like low pay for calling forth guilty affection. Once the pay improved people no longer felt they needed to make up the shortfall with love.
However my impression is that the downward trend on the nurse popularity graph best tracks the increasing moves for the nursing profession to become more… professional. It’s all “nurse practitioners” and degrees these days, and being more like doctors. No one ever had any trouble hating doctors, once the thermometer went down. People think that nurses these days think themselves too grand to change a bedpan.
Is this charge fair? Lucky me: I don’t know. You tell me. All I can say is that it would not surprise me if there was a tendency for both human contact and the dirty but necessary jobs to be de-emphasised in modern nursing, and maybe I can find a way to blame the NHS after all. It is what I would expect to see from an old command economy. Compared to most command economies, the NHS in its early years had a huge amount going for it: a sense of mission was in its collective blood. But as time as passed the blood has thinned, or done something else old and dry and sad that I lack the medical knowledge to build into my metaphor. (The blood of armies dries up in the same way, but then a war comes along and de-mummifies them. Or replaces them. ) An old and somewhat ossified organisation instinctively prefers its staff to have measurable, academic and relatively high status skills rather than unquantifiable, physical and and traditionally low-status ones. But no one was ever loved for academic skills.
In the US, I learn, there has been a similar move from plain old nurses to nurse practitioners, but if the American equivalent of the Sun has started on the anti-nurse stories then I had not heard about it. This might be because US healthcare is, for the moment, not provided by the taxpayer. At least, a lot of it is, but not so visibly. My impression is that the extravagant love for nurses in the past and the extravagant annoyance with them now are both British phenomena.
A simply astonishing story from Alex Deane of Big Brother Watch: Smokers harrassed – with the encouragement of a school, and the co-operation of the police
On one perfectly reasonable reading of this story, “harrassed” is too mild a term. The correct word is “assaulted”. I am no lawyer, but this looks to me as though it could involve multiple crimes – not just assault but also theft, and encouraging minors to commit assault and theft, if those are separate charges.
Outrageously the fagins here are not underworld characters but the Hundred of Hoo Comprehensive School in Medway (cute name, shame about the Special Measures), Kent Police, and something called “A Better Medway”, described as “a joint initiative between the council and NHS Medway that encourages healthy living”. “A Better Medway” part-funded the project, paying for filming equipment.
According to This is Kent, quoted by Alex Deane, the first few filmed attacks featured stooges and then they went on to “other people”. I can’t quite figure out whether or not the”other people” were members of the public who participated voluntarily as “extras” in an admitted fiction or whether they were real victims. My spidey-senses are a-tingle with the suspicion of some hasty re-writing of history after hostile attention; the comments to the sycophantic This is Kent piece are gratifyingly hostile. Also, the video admiringly profiled in Kent Online has now been removed by the user.
Irrespective of whether the videos are real or fake, videos that show apparent assaults in an approving manner incite others to commit similar assaults on smokers for real.
Indeed, they incite others to commit any other type of assault that the attackers may deem is good for the victims. The law, of course, forbids people to rip the veils off Muslim women who go about swathed – though at least as many people the veils offensive as find cigarettes offensive, and there is a reasonable case to be made – as reasonable as the case for doing good by force being made by the Ciggy Busters – that having their veils ripped off might do them good in the end and help them kick the masking habit. The law also forbids incitement to such assaults. If I were to make a “burqa busters” video the police would be round in an instant, and the defence that everyone involved was only acting would cut no ice with the Crown Prosecution Service.
Why should not that law also apply in this case?
… so I would advise anyone of an even vaguely libertarian inclination who gets stressed easily to read no further.
This article by Felicity Lawrence, Nanny does know best, Andrew Lansley, displays the ideology of the Nanny State in an unusually pure and unapologetic form:
Can it be too that Lansley is not aware of all the literature about how individuals’ “free choices” are shaped by marketing and advertising. Perhaps we should recommend some urgent remedial reading for his homework, starting with…
The Andrew Lansley for whom Felicity Lawrence is setting homework is the Secretary of State for Health. The fact that he consents to hold this position means that he too must be something of a statist, but nonetheless he recently said, “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.” It is a measure of how deeply Nanny’s rule has been accepted that even this pragmatic, rather than principled, objection to government health lectures aroused fury.
Now I am usually harsh in my criticism of the National Health Service and indeed I wish to see it abolished entirely… but credit where credit is due. This was a very, er, uplifting example of ‘Enterprise Thinking’ by the NHS.
Carry on, Doctor!
I am going to say naathing specific about this, but the best response to this sort of thing is for everyone to immediately make private copies of all the associated information and stash them somewhere.
The Internet is Forever, but some folk are just too dense to figure it out.
A quick entry from me: take a look at this item via Reason TV spot about the monster of a healthcare bill that passed at the weekend in the US. (I love the Incredibles-style music in it, by the way). As Gillespie puts it, the government underestimates of spending on things like health is not a bug, but a feature. The message that comes through, of course, is one that applies to governments worldwide. Do we honestly expect that politicians who are capable of the sort of accounting tricks surrounding building projects like the Olympic Games in London can be trusted to give accurate, costed predictions on things like healthcare spending, or education, or defence procurement?
Bear that in mind as we read the latest performance by UK finance minister, Alistair Darling, today.
“Congratulations, Democrats. Beginning now, you own the health-care system in America. Every hiccup. Every complaint. Every long line. All yours.”
– Kathryn Jean-Lopez.
I wish that were true. Here in Britain, where filthy wards in NHS hospitals, for example, have been a regular staple of the UK newspapers, the standard response is usually to demand even more money, more rules, and so forth. If you challenge the model of tax-funded healthcare free at the point of delivery, then you are political dogfood. And Mr Obama and his allies know that. As Mark Steyn has been putting since before Mr Obama’s election, Mr O. is counting on what the UK politician Sir Keith Joseph once dubbed the “ratchet effect”: ratchet socialism a little more, and make it harder and harder for anyone to push back.
Of course, sometimes this argument will be proven wrong. I do get the impression that a lot of Americans, including those middle-of-the-road voters who gave Obama a chance in 2008, are now very alarmed at the huge debt that his administration seems to be encouraging. So it may be that Mr Obama is a one-term POTUS. But his legacy might take a lot longer to reverse.
On a more philosophical line, here is what I wrote a while back about the bogus nature of healthcare “rights”.
Policy Exchange has just published a “research note” purporting to show that the tax on cigarettes in the UK should be increased, and that “that every single cigarette smoked costs the country money – 6.5 pence each time someone lights up.”
If you read the paper [pdf], you will find it is an astonishingly dodgy dossier. Here is how the figure is made up:
Taxation of tobacco contributes £10 billion to HM Treasury annually; however, we calculate that the costs to society from smoking are much greater at £13.74 billion. Every cigarette smoked is costing us money. These societal costs comprise not only the cost of treating smokers on the NHS (£2.7 billion) but also the loss in productivity from smoking breaks (£2.9 billion) and increased absenteeism (£2.5 billion); the cost of cleaning up cigarette butts (£342 million); the cost of smoking related house fires (£507 million), and also the loss in economic output from the deaths of smokers (£4.1 billion) and passive smokers (£713 million).
The notion of “cost to society” is a pretty weird one.
Leave that aside for a moment. Add up costs and revenues to the state, which might be one semi-logical way of determining whether the smoking in some sense “runs a deficit”, and using Policy Exchange’s own figures you get a big surplus for the Treasury. Even if you assume all house fire costs are borne by the state and not partially by insurers and householders, and there are no errors in the headline figures, then you can only get to £3,549 million. (Have you noticed how public policy research generally involves implausible numbers of significant digits, and at the same time utter absence of error estimates?) On that basis smokers are contributing roughly £6Bn annually towards public spending.
But what are we to make of the suggestion that counting “lost output” is meaningful? To my mind the idea that an economic aggregate represents a collective wealth that may be politically attributed and redistributed is repulsive even if it is coherent (which I doubt). The state’s royal We, which Policy Echange is channelling here, may in turn choose to impersonate you and me and everyone else, but it only controls the taxed margin of other’s outputs. Output and taxation are apples and oranges. It is meaningless to add them together. Unless you want (or deserve) a punch.
And even were it not meaningless, there’s an accounting fraud here. If you count output putatively lost to smoking, then you must also count the gains. There is the output of the tobacco industry, distribution and retailing in the UK to consider. Imperial Tobacco alone had a gross profit for the year ending September 2009 of approximately £5.3 billion. The CTC industry consists of tens of thousands of small shops. Honest research, however dubious its theoretical basis, would attempt to estimate the value-added, too. It would also be clear – without referring to a paper cited in the footnotes we cannot tell whether the cost-of-illness measure used in determining those “lost outputs” also includes the gains to third parties in pensions unpaid and public services unused by people dying early. If you are going to add apples and oranges, you should also tell us explicitly whether you have subtracted pears.
But what set me off on this chase was actually just one of those headline figures. Most of the margin of costs over gains in this strange sum is covered by the £2.9 billion allocated to the “output lost to cigarette breaks”. How do they know? “[A] number of studies have investigated workers taking breaks in order to smoke, and have tried to quantify this time at between £915 million and £3.2 billion per annum.” Hm.
Read through to p13, and you discover that the number of studies was… two. Er, no. It was one… Or some sort of strange interpolative hybrid… I cannot decide. Make your own mind up:
McGuire et al. estimated that £915 million annually is lost on the basis that average smokers spend tenminutes a day smoking, while light smokers and part-time workers would use approximately half of this
time. The Royal College of Physicians (RCP) used similar initial assumptions on average smoking time to
calculate that some £2.6 billion would be saved through the introduction of smoke-free legislation. Using
McGuire’s estimates of 5.2 million working smokers, with the RCP’s estimates of ten minutes a day smoking
reveals an intermediary figure of £2.9 billion.
I think that is ‘intermediary’ in the sense that a magician is an intermediary between a rabbit and a hat.
However they get there, if someone thinks that cigarette breaks ought to be a determining factor in public policy, rather than a matter for negotiation between employer and employee, then I suggest that it would be a good idea if they are kept as far as possible from the levers of power. This lot are said to be influential on the presumptively incoming Cameron team. Oh dear.
The new enemy is salt. Here is an interesting example at an early stage of how calls for legislation leap from study to implementation. A survey has looked at salt.
In the paper, Kirsten Bibbins-Domingo and colleagues, from the University of California, San Francisco, USA, undertook a computer simulation showing the effects of population wide reductions of dietary salt intakes in all adults aged 35 to 85 years in the USA. Reducing dietary salt intake by 3 g per day (1200mg less sodium per day) could result in 60,000 to 120,000 fewer cases of heart disease , 32,000 to 66,000 fewer strokes and 54,000 to 100,000 fewer heart attacks.
Just one study and even then, dietary recommendations are notorious for lack of reliability. But the recommendation follows like day after night:
A reduction in dietary salt of 3g per day, the authors went on to say, would have approximately the same effect on reducing cardiac events as a 50 % reduction in tobacco use, a 5% reduction in body mass index among obese adults or the use of statins to treat people at low or intermediate risk for CHD events. Furthermore, reducing dietary salt intakes by 3g per day would save $10 billion to $ 24 billion in annual health care costs
Precise, costed benefits that bear little resemblance to reality, but a comparison with the other devils of public health is utilised to define a ‘collective benefit’. Thus the call for legislation by the European Society of Cardiology:
While individuals may use salt sparingly at home, around 75 % of the salt we eat is already in the food we buy. This, says the ESC, underlines the need for legislation to lay down guidelines. “The reality of international food production in Europe means that such public health initiatives need to be tackled on a European wide basis, rather than an individual country basis,” said [Professor Frank] Ruschitzka.
Throw in a publicity week and the NGO for good measure:
Salt will again be on the agenda with World Salt Awareness Week 2010 , which runs from February 1- 7 (3). The week is being run by World Action on Salt and Health (WASH), a global group that works with governments to highlight the need for widespread introduction of population based salt reduction strategies
Add salt!
Helen Evans, who runs Nurses for Reform, a campaigning organisation dedicated to free-market options for healthcare in the UK, got to meet Conservative Party leader David Cameron a couple of weeks ago. The Daily Mirror [here, here and here] and the Daily Telegraph found out about the meeting and offered their own take on it.
Broadly, I agree that the proposals are in the right direction, although I have concerns about some of the tactics suggested and their formulation, which I deal with later. The bit that was not previously familiar to me was the idea that a barrier to entry should be at least lowered, by amending local planning rules to make it easier to open a new healthcare facility. I’m told the Conservative Party already favours this for schools, so the extension to clinics should not be difficult.
Having read the briefing document presented to the Leader of the Opposition, I disagree with one element of the strategy being proposed, specifically this passage: “the [National Health Service] NHS should be renamed the National Health SYSTEM and that under its auspices patients should benefit from a universal right to independent hospital care and treatment.”
A “universal right” is something that a government could be justified in declaring war to defend, like “freedom from slavery” or freedom from the use of confessions extracted under torture in criminal trials. It could certainly be a pretext for new taxes, a new bureaucracy, more regulations, and the restriction of other “non-universal” rights. Sadly, this call for declaring that privately-provided healthcare is a right could become the very instrument for imposing regulations (such as US Medicare-style price controls, or French-style government control on where doctors can practise [link in French]) that violate patient and physician freedom. To give a specific example: could a private clinic be fined for not providing 24-hour accident and emergency access? I would expect a government agency to do just that. Meanwhile, of course, government facilities which operate “in the public interest” would be excused.
A second concern comes in a later paragraph: “health censorship must be outlawed and patients must be empowered with greater access to information.” Outlawed? Must be empowered? By what agency, regulation, funded by what taxes or levies, with what powers of inspection and control?
These may seem like quibbles, but the law of intended consequences suggests that the wording of reforms can be as important as their spirit. Consider the US Constitution’s First Amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.
Does it say that Congress cannot give money to the Food and Drug Administration to hunt down anyone making claims about the alleged benefits to cancer patients of drinking grapefruit juice? No it does not. It means it, I think, but can I prove it to the US Supreme Court? Probably not.
It might be more boring to do, but the best way to remove censorship would be to revoke the clauses of those laws and regulations that allow it. As for “empowerment,” if this comes from the government it will mean a Department of Truth in Advertising demand for a quarterly report from all private providers as to how they inform the public, with fines for not reaching a wide enough audience.
On the positive side, Nurses for Reform finds that the ownership by a government department of most of the UK’s hospitals is a potential conflict of interest. There is the temptation to hide problems, to restrict information about alternative (often newer) treatments, the cozy relationship between the government employees in the NHS and those of the Department of Health who are supposed to watch them.
Dr Evans is therefore absolutely right to suggest the immediate transfer of ownership of NHS hospitals out of “public ownership,” and she is also correct that the “Secretary of State for Health must no longer have any say over when or where hospitals are built, opened or closed.”
On the issue of advertising, or freedom to communicate with the public in general, the major benefit would be that people could get an idea of which were the better brands (either cheapest, or best quality, or best balance between the two). If we think of how Aldi and Lidl can co-exist with ASDA, Tesco, Sainsbury, Waitrose and independent grocers, we can see how variety of branding can lead to beneficial competition: new treatments, more options and probably less queues.
Personally, I see no point whatsoever in delaying the reform of NHS funding: it merely prolongs unnecessary suffering and provides more opportunities for opponents of change to mobilise, like Gorbachev’s “perestroika” versus the liquidation of the soviet system. Having little expectation of any progress under a new Conservative Party government this coming year, it would be a pleasant surprise if Dr Evans’ proposals came to fruition. But at least no one can now claim that the case was not made.
[UPDATE: corrected link for Daily Telegraph article]
As FA Hayek pointed out many years ago in his masterpiece, The Constitution of Liberty, if healthcare is paid for out of general taxation and delivered free at the point of delivery, then in a world of scarce resources – and healthcare is always constrained at any time by the supply of doctors, drugs, etc – then such care must be rationed by some form of bureaucratic/political rule. As Dr Hayek presciently warned at the time (1950s), any such rationing will put doctors, politicians or other people in power in the position of a god, in having the decision about who gets treatment for what, or whether life A is more “worth saving” than life B. For example, one such utiltarian consideration might be that it is more “cost-efficient” to save the life of a young kid with his whole life ahead than an 90-year-old. That is what happens when socialised medicine is established. It transfers key powers to people in ways that raise disturbing issues of accountability and control.
Now a socialist might respond that it is still better for health care to be rationed by some rule they consider to be “fair” than by the supposed lottery of the market, although in fact, as I would respond, there is, due to the benefits of competition and entrepreneurship, far greater chance that all but the poorest will get better healthcare under a genuine free market in health than under the system of centralised, state-provided healthcare. Also, if the possession of a large fortune is partly a matter of luck, then luck, being blind, cannot be either just or unjust. It just is. Some folk have access to better dentists or whatever because they are richer. That may annoy someone who cannot afford the whitest teeth, but that is not proof of unfairness, as such. To prove it, one would have to construct an ethical theory that says that humans have an apriori claim on their fellows to receive a certain amount of healthcare/watever as a “right”. But such “rights” are abuses of the term: one cannot have a right to X that requires that another be forced to provide X, such as forcing folk to train as doctors to serve the sick, and so on.
I was led to think about the latest twist in the US healthcare debate by reading an article by the US writer, Nat Hentoff. He totally bypasses the issue of how to deal with scarcity under socialism in ways that are fair. He rightly worries about the sort of brutal choices that state-rationed healthcare provides, but then does not see that any system of state-run, and socialised medicine, makes such issues of rationing unavoidable. Rationing by such tests of age, “need” and so forth is a feature of socialised medicine, not a bug.
(H/T: The Corner).
According to Radio Free Europe,
Rovshan Nasirli, a young Eurovision [song contest] fan living in the Azerbaijani capital Baku, says he was summoned this week to the country’s National Security Ministry — to explain why he had voted for Armenia during this year’s competition in May.
“They wanted an explanation for why I voted for Armenia. They said it was a matter of national security,” Nasirli said. “They were trying to put psychological pressure on me, saying things like, ‘You have no sense of ethnic pride. How come you voted for Armenia?’ They made me write out an explanation, and then they let me go.”
(Hat tip to Gene of Harry’s Place and Robert Wright of the The Daily Dish.)
In other news, Health Secretary Andy Burnham has accused Tory MEP Daniel Hannan who said on US TV that the US healthcare system was generally better than the NHS of being unpatriotic. Senior figures from both the Labour and Conservative parties have denounced Hannan and demanded an explanation.
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Who Are We? The Samizdata people are a bunch of sinister and heavily armed globalist illuminati who seek to infect the entire world with the values of personal liberty and several property. Amongst our many crimes is a sense of humour and the intermittent use of British spelling.
We are also a varied group made up of social individualists, classical liberals, whigs, libertarians, extropians, futurists, ‘Porcupines’, Karl Popper fetishists, recovering neo-conservatives, crazed Ayn Rand worshipers, over-caffeinated Virginia Postrel devotees, witty Frédéric Bastiat wannabes, cypherpunks, minarchists, kritarchists and wild-eyed anarcho-capitalists from Britain, North America, Australia and Europe.
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