Wednesday, January 31, 2007
Wednesday is the day for the TPA's regular Our Money slot on 18 Doughty Street, including The Bloke's 5 minute Waste Watch video. Technical difficulties nearly caused a blank screen today, but after a De Mille style epic, the vid was eventually produced. It's on the £6.5bn pa dti (see also this blog):
Normal blogging service resumes tomorrow.
Tuesday, January 30, 2007
Along with a number of like-minded- if somewhat younger- enthusiasts, the Bloke went down to Westminster this morning to do a spot of direct promotion among our rulers. You can see what happened here:
This is the first in a series of such ads produced by 18DS. The idea is borrowed from successful US experience, and it is aimed at challenging the political consensus on a whole range of issues where the mainstream parties currently fear to tread- 18DS Director Tim Montgomerie explains more in his Times article this morning.
And they're looking for our ideas. the next will be on state funding for political parties and you can post your suggestions here.
Monday, January 29, 2007
You know things are really bad when Doc Reid not only has to renovate his house all on his tod, but also grant an interview to Humphrys.
The prison places debacle has happened because for all the usual pie-in-the-sky reasons, Straw, Blunkers, and Clarke systematically ignored their own Home Office forecasts for prison numbers. Naturally Reid kicked off his shaky tenure by blaming them. But now- just like them- he's turned to blaming the judges:
"Projecting the prison population is never an exact science. Independent sentencing guidelines laid down that tougher post-release supervision of offenders should be balanced by a 15% reduction in sentence length. This has not materialised."
In other words, his predecessors didn't actually ignore the forecasts at all: they simply instructed the judges to reduce sentences to fit the availability of places. Which of course is exactly what Reid reiterated to the judges last week.
No wonder he's so pissed at being singled out for ridicule by the Sun etc. They've all been at it.
We have to build more prisons, obviously. But are there any quick fixes?
We could start by noting who's actually in prison right now.
In summary, we've opened 20,000 extra places since Labour came in- largely the result of M Howard's prison building programme- and they've all been filled. To find out how, I've taken a look at some HO stats (as always you have to take the stats you can actually track down on the HO's abysmal website).
In 1996 there were 55,000 prisoners in England and Wales. By December 2005 that had increased to 74,000. The most obvious thing that jumps out is that of the extra prisoners, fully half were from non-white ethnic groups, even though they only make up 8% of the overall population.
Today, non-white ethnics are more than four times more likely to be in prison than whites. Most of the difference is driven by blacks, who make up only 2% of our population, but 15% of our convicts: they are nearly 10 times more likely to be inside than whites.
So much, so BNP. But when you probe further, you find that a big chunk of that growth has been driven not by British blacks, but by foreign nationals.
6,000 of our extra convicts are foreign nationals, who now comprise 14% of our total prisoner numbers.
Now, obviously we don't go in for national, racial, gender, or any other form of crude profiling here on BOM, but I wonder if you can guess where those 10,000 unwanted guests of Her Majesty come from. Here's the top 6:
- Jamaica- 1564
- Nigeria- 890
- Ireland- 649
- Pakistan- 444
- Turkey- 294
- Somalia- 284
But the action point is surely this. None of these people are British citizens, and as convicted criminals who've abused our hospitality, there's absolutely no reason why they should continue to enjoy it. We owe them nothing.
British prisons are not only full, but at £40 grand pa per head, are ridiculously expensive. For foreign prisoners, there's no reason not to do that subcontracting deal with the Russians.
As the Major has been arguing for months, Russia has extensive and underutilised penal facilities, and would surely be grateful for both the employment and the foreign exchange. It would certainly be cheaper and easier than building new prisons here, and would immediately give us 10,000 places to use for home-grown cons.
It's pure win-win-win.
Sunday, January 28, 2007
Well, actually, as I pointed out to him, it's only a short heavily edited segment. Plus, they sort of imply he's a batty old bloke with far too much time on his hands.
But there's no stopping him now. He reckons he's the new Natasha Kerplunski.
In the news this week:
£60,000 for asylum trapeze lessons- "ASYLUM seekers are to benefit from TRAPEZE lessons funded by taxpayers’ cash. A UK touring theatre company is spending £60,000 in grants helping teach circus skills to the youngsters — to improve their confidence.The group also lays on free transport, refreshments and interpreters in Arabic, Farsi, Kurdish Sorani and Kurdish Kurmanji. The Big Top skills, creative writing and drama workshops are offered by BandBazi Circus Theatre, a Brighton-based multicultural performing arts company." (Sun 23.1.07)
£470,000 on obesity drugs- "BLACKBURN and Darwen health bosses have spent £470,000 in four-and-half years on drugs that stop obese people feeling hungry, it has been revealed. The spend, by the borough's primary care trust, has been labelled "phenomenal" and a "waste of money". Coun Tony Humphrys, chairman of Blackburn with Darwen Council's health overview and social care overview and scrutiny committee, said: "It is a phenomenal amount of money. It is a waste of public money. People have to take responsibility for what they eat, especially parents." 15 per cent of males and 20 per cent of females in East Lancashire have a Body Mass Index over 30- meaning about 8,000 men and 5,750 women could be eligible to get the drugs on the NHS. Taken together, the survey showed one in two people are overweight or obese in the borough... official figures from the NHS show expenditure on these drugs went from £31.2million in 2002 to £34.8million in 2006." (Blackburn Citizen 26.1.07)
€107,890,098,965.56 Euro black hole- "Every public company in the EU must present its annual balance sheet according to strict rules, yet the EU itself produces accounts that break all the rules it imposes on everyone else. They don't use double-entry bookkeeping; tens of billions of euros float in and out of the books without explanation, and year after year the EU's Court of Auditors refuses to approve the accounts, because they are riddled with "material errors" and "irregularities". Andrew Hamilton, an Edinburgh accountant... decided to download the 139 pages of the EC's 2005 accounts and the accompanying 228 pages of the Court of Auditors' report. Although, with implausible precision, they gave the EC's operating revenue for the year as €107,890,098,965.56, it was impossible to discover where most of this money had come from or gone to, because the accounts do not use the double-entry system used by every corner shop. They are just a maze of meaningless figures." (Sunday Telegraph 28.1.07)
Another £325,000 construction overspend- "LEISURE boss Mark Smith is to face stiff questioning over why the final bill for the revamped Devizes Leisure Centre was £325,000 more than planned. Cash strapped Kennet District Council is trying to keep a close eye on its budgets and all senior officers have to monitor their budgets and submit quarterly reports. The plans were initially priced at £1.5 million... Councillors then agreed another £370,000 for the work, to bring the estimate to £1.87 million... In 2005 the council revealed the final price agreed with Devizes builders Gaiger and Son for the work was £2.4 million." (This is Wiltshire 25.1.07... and I'm not sure how This is Wiltshire's numbers precisely add up either)
Total for week- £71,207,855,000
Saturday, January 27, 2007
We blogged the Stern dodgy dossier climate report when it first came out (here and here). But it's now being given another run round the track at the Davos ego-fest (see the International Herald Tribune's lib agenda puff here).
The difference now compared to last October is that the people who actually know about climate change- as opposed to the propagandists- have now waded through the Review's 700 pages. And they've pointed out it's got even more holes than Blackburn, Lancashire.
Even the BBC, which filled its airwaves bigging up the Review in October, has now felt obliged to broadcast a programme rubbishing it. You can listen here, or read a report here.
I especially like the verdict of Prof Richard Tol (both Hamburg and Carnegie Mellon Universities) who is one of the world's leading environmental economists, and so important, the Stern Review itself cites his work 63 times:
"If a student of mine were to hand in this report as a Masters thesis, perhaps if I were in a good mood I would give him a 'D' for diligence; but more likely I would give him an 'F' for fail. There is a whole range of very basic economics mistakes that somebody who claims to be a Professor of Economics simply should not make."
Excellent stuff (you can read a full commentary by Prof Tol here).
PS Over on The Fisk I elaborate on the BBC's U-turn. And the role of abysmal BBC Business Editor Robert Peston, who almost certainly hadn't read the report before opining on it, and who allowed his eco prejudices to run riot. (Peston- surprise, surprise- turns out to be the son of abysmal Labour Peer Maurice Peston).
Friday, January 26, 2007
This week it's the Home Office back in the headlines. But it isn't alone. Right across Whitehall, large parts of the government "machine" are in melt-down.
Some of the very worst problems are to be found among the so-called Executive Agencies. These are the supposedly arms length "independent" bodies set up by government departments to take responsibility for executing some specific task. They hardly ever work, and here on BOM we are forever reporting on the latest agency shambles (see posts on the Highways Agency, the National Patient Safety Agency, the Child Support Agency, etc etc).
It's especially important to understand why this happens, because our politicos- fed up to the back teeth with having to explain away the endless results of their own bungling- are desperate to set up even more of such arms length bodies.
The idea was set out in some detail by Tony's fave think tank the ippr last summer. We blogged their report here, contrasting their proposed flakey new "governance" structure for government, with the way that Tesco- along with every other successful real world operation- works.
As you may recall, the key element of ippr governance is to split policy-making from execution. It's a world where the politicos are only responsible for deciding policy, and it's civil servants who are responsible for everything else.
Of course, you only have to reflect on the idea for a couple of minutes to realise how daft it is: politicos would come up with even more ludicrous impractical policy ideas than they do already, and would be able to walk away from the inevitable fiascos that followed. It really would be "not me Guv" government, and we taxpaying voters would have even less control over the whole wobbly edifice than we have now.
Tesco shareholders always know exactly where the buck stops. Sir Terry Leahy can delegate as much authority to his managers as he likes. But he can never delegate responsibility for the results.
Last week we got a worm's eye view of exactly how differently things work in the world of executive agencies.
Johnston McNeill is the former Chief Executive 0f Rural Payments Agency. That's the agency that was responsible for the appalling cock-up in farm support payments (see previous blogs, here and here). It cost us taxpayers hundreds of millions, and it eventually cost him his job.
Last week he gave evidence to a closed session of the the Commons Environment, Food and Rural Affairs Committee, and they grilled him about the whole disaster. For supporters of Tesco government, the transcript makes fascinating reading (if you've got a spare hour or so).
The bottom line is that he was made to carry the can, even though most of the critical decisions that caused the disaster were taken by ministers:
- It was ministers who decided the RPA should cut staff numbers from 3,500 to 1,900 at the same time as introducing the brand new untried untested EU "single payment system" (SPS). Even though they were warned in writing by the Defra Permanent Secretary that it was a "bridge too far" (Question 1140)
- It was pretty clearly ministers who imposed RPA's disastrous new "task-based" work scheme rather than the old "claims-based" system (Q 1142). What that meant was that staff lost the capability of working through all aspects of an individual support claim, and were simply doing their own bit of a process driven workflow. In other words, jobs at the RPA were deskilled in a crude attempt to save money, and the old emphasis on "clients" was lost. Consequently, when the new computer system failed to work, there was no manual fallback. (If this all sounds horribly familiar, it is- our old friends the consultants at PWC designed the new task-based work system, and our old friends at Accenture designed and built the unworkable IT system. Strong shades of the NHS supercomputer, and the current goings on at DWP and HMRC).
- It was ministers who decided that SPS should be implemented using the so-called "dynamic hybrid model", absolutely the most complicated of all possible approaches, and the one most EU members avoided like the plague.
- It was ministers who imposed a tighter timetable than McNeill wanted
- It was ministers who decided to press on with this crackpot scheme, even though they had been told there was a 60% chance of failure (Q 1195)
So despite the fact that the RPA was nominally an independent agency, it was ministers who took all the key decisions on the road to disaster.
There are other shocking revelations. To start with, McNeill never wanted the job in the first place. He could see it was a total snakepit, and quite sensibly did not apply for it. Unfortunately for him, he allowed himself to be cajoled and flattered into accepting, a decison he must now bitterly regret and which should stand as a stark warning to public servants everywhere.
Then, despite the high risks of disaster and the fact that the RPA is responsible for dishing out £1.5bn pa of public money, McNeill only ever met Defra Secretary of State Margaret Beckett twice in his whole time as CEO. And the second time was when he was made to confess personally to her that the entire project had blown up. In reality there seems to have been virtually no contact between the important people up at Defra's plush Whitehall offices and the poor bloody infantry slugging it out in the trenches. Or in this case, an office block somewhere in Reading.
McNeill lost his job. The politicos who should have been shot (pic above) fared somewhat better. The horse woman is our National Embarassment Foreign Secretary, Little Ben is still at Defra, and Beardman Knight is now screwing up our schools. Only Morley aand Bach have had to settle for the rigours of the backbenches.
As we've said many times. We don't want yet more expensive thickets of "independent" quangos, agencies, and general buck passing operations. We're not interested in sham arrangements designed to relieve politicos of responsibility for delivery.
We need Tesco government.
And we need it now.
Thursday, January 25, 2007
So once again we're clean out of prison places, and as a direct result we're having to turn convicted sex offenders loose on the streets.
Are you a betting man/woman/goat? OK, without the benefit of hindsight, what odds would you have given that we could have a straight run of four Home Secretaries quite as whimperingly incompetent as Jack Straw, Bonkers Blunkers, Smiler Clarke, and Doc Reid? Just like that- one after the other.
Obviously, if you were dealing with any other walk of life, the probablity would have to be vanishingly small. Some self-limiting feedback law of nature would have kicked in long before now to stop it happening. For example, a company managed like that would have gone bust.
But in politics it's the norm. And somehow we just seem to accept it.
Think back to the so-called Great Home Secretaries.
Er... umm... can't name any, huh?
The usual answers are Michael Howard and Woy Jenkins.
Howard- roundly excoriated by the Labour and the lib media throughout his tenure- was the man who forced through a big prison building programme, and who actually got recorded crime numbers heading down. The only time that has ever been achieved by any Home Secretary in modern times.
Jenkins was the "great reforming Home Secretary" who gave legislative expression to the swinging sixties, a decade when Britain's recorded crime rate doubled (at this point, we would have previously referred to schh-you-know-what, but because of this, we can't).
So from where I'm sitting, I think we've only actually had one post-War Home Secretary who was any good. And it wasn't Woy.
Looked at that way, we can all see the last four clownish incumbents follow a long and dishonourable line. We should not be at all surprised they have failed to plan for the continued growth in prison numbers.
Still, if you can bear to, it is worth refreshing your memory on the key facts (see this blog):
- In deciding how many new prisons to build, the HO has failed to follow its own prison population projections: eg in 2002, they forecast a range of possible requirements for this year, ranging from 86,700 to 100,700. Yes that's right, somewhere between 7,000 and 21,000 more places than they've actually built.
- Unlike his immediate predecessors, Reid did promise to build another 8,000 places; but with Gordo having frozen the HO budget, it still isn't clear where the money's coming from.
- Although there's constant whining about how you can't produce these places overnight, PFI prisons can be built and opened in as little as 22 months: Reid's already had 8.
The current top-down, too big, too incompetent for purpose Home Office needs a radical shake-up. We can all see that.
But simply splitting it in two to grab some headlines off Gordo, won't achieve anything. If anything it will worsen the silo problems that have lain behind several of its more spectacular cock-ups over recent years.
Law and order is far too important to be left any longer in the hands of our bungling Big Government politicians. Just like the police, prisons should be made the responsibility of locally elected sheriffs. It's the only way we taxpaying law-abiding citizens can even hope to get traction over this mess.
We blogged the fiasco of the government's anti-child obesity programme when the NAO report on it was published last year (see here). It's a classic case of policy dithering and shambolic organisation, with at least 26 different goverment bodies all sticking a finger into the mechanically recovered meat pie.
The Public Accounts Committee has just published its follow-up report, with its redoubtable chairman Edward Leigh commenting:
"It is lamentable that long after the target was set there is still so much dithering and still so little co-ordination."
Lamentable indeed: we estimated it's cost taxpayers £1bn, and it's achieved SFA (see previous blog).
Yesterday, BOM's engineering design correspondent, IK Brunel, drew our attention to a specific instance of how the waste happens. For once, this one isn't down to fit minister Caroline Flint, but notoriously bearded Schools Minister Jim Knight (see here and here):
"Children who attend primary schools in deprived areas of England are to be given pedometers in an attempt to encourage them to be more active.
The £494,000 scheme will see 45,000 pedometers, which measure the number of steps taken, handed out in 250 schools."
Mr Brunel- who, as well as constructing God's Wonderful Railway and the Great Eastern, has some considerable experience in the pedometer business- tells us:
"Electronic pedometers all get made in Taiwan and never cost more than two or three dollars (and the three-dollar ones will be making the tea and giving soothing massages while they read your horoscope).
If I wanted to, I could almost certainly supply the government with 45000 cheapo electronic pedometers for about 100K dollars.
Even ignoring the irony in giving presents to the lazy using money appropriated from the hardworking, one can't help wondering what the other £450,000 is being spent on?"
We couldn't have put it better.
Another triumph for Britain's Simple Shopper.
Wednesday, January 24, 2007
A few months ago I spent an afternoon in a Charities Commission office. It was as quiet as the grave, and for some reason I got the distinct impression nothing much was going on. I even started wondering what they actually did for all the taxpayer's money they get.
Let's face it, that kind of thing can be slightly awkward for management. I mean, you can't necessarily get the workers working if there's no actual... er, work to do, can you. Yet if they just sit there, it can give the wrong impression. Which would never do.
Well, now help is at hand:
"Thriving Office is a CD laden with the sounds of an office buzzing with activity. Aimed squarely at the growing millions who work from home, the disc features two 37-minute tracks, titled (seriously) "Busy" and "Very Busy." Each features ringing phones, barely intelligible conversations, closing file cabinets and other noises meant to drown out the inevitable home-office soundtrack (screaming kids, barking dogs) as well as convey to callers they've reached a hotbed of productivity."
Now, why didn't any of the government's many thousands of expensive consultants think of that?
Or maybe they did.
Listen very carefully next time you phone a government office.
The facts- as the Cuture Media and Sport Committee reminds us today- are that the basic cost of staging this madness has already increased from £2.375bn to well over £8bn. That's a tripling, compared to the doubling in Sydney and the quadrupling in Athens (see BOM cost primer here).
But... and these are BIG BUTS...
First, those overspends for Sydney and Athens were the final figures, once it was all over. We're still more than five years away from our final conflagration.
Second, that £8bn only relates to the basic cost- the figure that we were originally told would be £2.375bn. In addition to that we've still got at least £7bn of transport infrastructure costs, and a further £2-3bn of other costs elsewhere (see BOM primer).
So the final total remains well on course for our £20bn guesstimate. All to be funded by you-know-who.
The only real question is whether this fiasco is down to sheer green wet-behind-the-wossnames blithering incompetence on the part of Bliar, Jowell, Ken, Seb et al? Or whether it was just an out-and-out salami slicing lie?
Personally, I score it fifty-fifty. Clearly they put all the original numbers together on the back of a subsidised Royal Opera House ticket during a private champagne party.
But they also lied to us all in not publically acknowledging that huge extra block of financial iceberg beneath the water.
Tuesday, January 23, 2007
Despite the fact that they themselves prefer to stay comfortably ensconced in the capital city, our politicos have long been keen on relocating bureaucrats out to bleak industrial estates up North or maybe the roundabout at the end of the M4.
And in theory it's a good idea. Why pay London pay rates and London rents for civil service work that could be done somewhere much cheaper? The taxpayer could save money both directly, and indirectly by getting people off those expensive regional dole queues... sorry, Incapacity Benefit registers.
But as always, theory's one thing, practice something else again.
All too often such moves have a horrible tendency to end up actually costing us more. For example, we recently learned that the BBC's partial move up to Salford will require more taxpayers' money than leaving it in London.
And this morning we hear of more such nonsense from Scotland:
"HUNDREDS of civil servants are being paid extra to travel to work under the Executive's flagship relocation policy.
More than 3,000 workers have been relocated under the controversial scheme to move public-sector jobs out of the capital. Under civil-service rules, however, they are entitled to receive extra cash for the excess cost in travelling to new locations for work.
Yesterday, it was revealed Transport Scotland, which has been moved from Edinburgh to Glasgow, was spending £2,000 a week on fares for 57 of its 250 staff to commute. Audit Scotland has estimated the Scottish Public Pensions Agency, which moved from Edinburgh to Galashiels, will spend more than £92,000 in excess fares over five years.
The Executive was unable to calculate the cost to some 30 other agencies forced to move, but it is expected to run to hundreds of thousands of pounds.
Civil servants whose commutes have increased because of moves are also taking advantage of flexible hours to include travelling time as part of the working day."
How mad is that?
Why, you'd almost think the politicos were engineering these relocations not to save taxpayers' money, but to shore up electoral support in favoured constituencies.
Monday, January 22, 2007
The Scotsman reports:
"ONLY one in three civil servants in Scotland actually trusts the government they work for to make good use of public money.
A staff survey found only 28 per cent of government employees believe the Scottish Executive and its agencies make good use of their financial resources... The statistics were just as bad when civil servants were asked if the government had a culture of good financial management. A total of 28 per cent said no, only 28 per cent said yes."
Yes, it's Scotland. But we'd be prepared to bet that the results would be just as bad if the government ever had the nerve to conduct such a survey here.
PS The Scotsman report also reminds us of some of The Scottish Executive's most jaw-dropping lunacies. These included spending £300,000 and many months employing marketing agencies to find the best symbol for Scotland, only to settle on the national flag the country has used for centuries.
So Andrew Lansley would abolish the government's centralised health targets for waiting lists etc:
"We have reached the absurd situation where waiting-time targets are being turned into a minimum wait so you have got local NHS bodies telling the hospitals that they cannot treat patients before, say, 20 weeks because they cannot afford to pay for it and because the waiting-time target says they should be seen at 20 weeks.... One-size fits all targets are not the right way forward."
Quite right too. Tractor production targets simply do not work.
But his alternative is also riddled with obvious problems.
Under his plan, GPs would once again become proper fund-holders, would be given back more of their discretionary power as "gatekeepers", and relieved of all those counterproductive targets and box-ticking duties. Instead of being paid to tick boxes, they would be rewarded for "outcomes"- eg how many of their patients survived five-years after a cancer diagnosis (five-year survival being a international standard measure).
Fund-holding GPs would thus have both the scope and financial incentive to use their professional judgement in deciding the best treatment. The focus would be on final results, not on process. Much better all round.
Sounds intuitively very appealing, doesn't it.
Or does it?
Look, I'm a GP. But unlike the Doc say, I'm a Goldman Sachs style GP, with big red £ signs constantly flashing in my eyes. I look at Lansley's new system and I say "aha," I say, "aha, this means I only want healthy patients."
So I look at my list and I start by chopping all the smokers. Then I start on the fat chavs. I hire Mr Gomulka's dog-team to visit them in their homes with the message to loose 5 stone within a month, or piss off. Drink problem? Chopped.
Then I start on genetics. Obviously anyone with a family history of heart disease or cancer would be shown the door.
New applicants for my list would have to fill in a 30 page health and lifestyle questionnaire, provide references, and undergo- and pay for- a detailed health screen. And just like life insurance, any porkies which subsequently come to light would be punished by immediate exclusion.
I might go further. I might find ways of encouraging any of my patients who got say a cancer diagnosis and looked like they weren't going to make 5 years to move elsewhere. I could envisage arrangements with "partner practices" specialising in such cases. For an appropriate fee of course- fees driven directly by the the DoH pricing tariff itself.
And then of course there are all those old people. Very expensive at the best of times, and frankly anything can happen. An outcomes tariff would need to be pretty juicy for me not to chop the lot... er, resettle them with a specialist partner provider.
Speaking as a 56 year old who's clocked up just under four years of post-cancer survival, I'm nervous.
As a public service, BOM plans to launch a new website where you- the ordinary members of the public- can name and shame underperforming Health Commissars.
To be called the Wall of Shame, it will be modelled on the Department of Health site being established to name and shame GPs. Both will draw on the wealth of valuable management experience gained in the PRC during the Cultural Revolution.
Now you will be able to respond properly to stories such as this latest news on the NHS Supercomputer:
"Leading healthcare IT experts have warned that the NHS's troubled £6.2bn system upgrade is costing taxpayers substantially more than it should. They claim the same functions could be delivered for considerably less outside of the national programme for IT, dogged by delays and software setbacks.
Phil Sissons, a former executive at the software group Torex - now part of iSoft - and an ex-consultant to the NPfIT, said: "Publicity from the national programme was that they got some good deals because of the buying power of the NHS.
"But I don't believe they reduced the cost at all. There are multiple margins being added to the process each time there is an extra layer of management or another company involved."
Doug Pollock, managing director of software supplier Cambio, who has also worked within the national programme, said these multiple margins were sometimes "scandalous".
In this shameful case, the NHS has already paid £119m for patient administration systems (PAS), off-the-shelf items that should have only cost £30m. Four-times over priced.
Our all-new Wall of Shame will allow you to name not only the Husky Killer, but also the running dogs who actually "negotiated" such abysmal terms.
PS As the Department of Health's campaign to demonise Britain's doctors gathers pace, the Doc continues to strike back. And many congratulations to him for winning not one but three Oscars in the worldwide Med Blog awards- including Best Med Blog. Fantastic achievement for one so unopinionated. If only we could find a Home Office insider to give us a similarly robust counterview to all that demonisation they get from J Reid et al.
Sunday, January 21, 2007
In the news this week:
£400m for 2012 cost consultants- "The House of Commons Culture, Media and Sport select committee will this week express dismay that the cost of 2012 has already risen from £2.4bn to £3.3bn and could easily go even higher. The cross-party group will ask why the original budget produced in 2004, which ministers and London mayor Ken Livingstone insisted was robust, so quickly proved to be an underestimate... It will point out that the cost of employing consultants CLM to control costs and project manage the array of 2012 building schemes rose from £100m to £400m in three months." (Observer 21.1.07)
£10,300 for new name- "HEALTH chiefs have been attacked for wasting taxpayers' money on finding a new name for a health trust. Officials at Doncaster and South Humber Healthcare NHS Trust spent £10,300 on employing consultants to give the organisation a more user-friendly image. The consultants spent a year dreaming up a new name – eventually settling on the Rotherham, Doncaster and South Humber NHS Foundation Trust- DASH." (Yorkshire Post 5.1.07)
£280,000 overspend on theatre- "Redditch Council officers had to explain to its executive committee on Wednesday why there was an overspend of more than £280,000 on the Palace Theatre facelift... Borough Director Chris Smith said: "It was very complicated." Councillor Colin Macmillan said: "The fact it was complicated is not an excuse. If a situation is complicated, then we should be geared to deal with it. This is not free money and shouldn't be treated as such." (Redditch Advertiser 16.1.07)
£11m Manchester Council overspend- "Manchester city council has racked up a expected overspend of nearly £11m. The projected overspend, for the financial year 2006/07, is the equivalent of a council tax rise of about 10 per cent. And, unless it can be reduced, the difference may have to be taken from the town hall's healthy cash reserves - or passed on to the taxpayer." (Manchester Evening News 5.1.07)
Total for week- £411,290,300
Saturday, January 20, 2007
Another day older and deeper in debt.
As Gordo's borrowing binge continues, the official National Debt now exceeds £500bn for the first time ever.
But as regular readers of BOM will know, the real total- including all those Enron off-balance sheet items- is getting on for £2 trillion (see here for latest summary and ITBA video). In fact, you can even argue it's as high as £9 trillion (including future state pension payments).
And even in terms of those fudgy Golden Rules, the wheels are coming off: the Times has a good quote from Gordo's 2001 Budget speech:
“From the unacceptable level of debt we inherited — debt at 44 per cent of national income — I forecast debt in the coming year will fall to 30.3 per cent and in the following years I project 29.6, 29.7, 29.9 and 30 per cent successively. . . putting Britain in a far stronger position to deal with the ups and downs of the economic cycle”
But his Enroned National Debt is now 38.1% of GDP, and heading North at a rate of knots (40% being his tediously repeated Golden Rule maximum).
PS A few days back we blogged the lies told by the Blessed leader about how our inflation problem simply reflects a global problem. Guido has now posted the splendid Daily Politics interview where Brillo- armed with some facts- smashes the self-satisfied Ed Balls to a pulp. Well, actually, sadly, after Balls has fallen to his knees and acknowledged Brillo's brilliance and all-round superiority, he's let off. Disappointing. What do we pay our telly tax for if not to see government ministers humiliated?
Friday, January 19, 2007
Several interesting pieces from correspondents.
First up, our clubbing correspondent is pleased to note the BBC are still pretty with it, as regards the views of young folk. The "BBC News Youth Panel" reckons unanimously that the increase in Telly Tax is totally cool, and that the BBC is A Good Thing Ltd. Funny. Wonder how the panel got selected. And wonder how they'll feel when they're actually old enough to pay the Telly Tax.
Andy and Tom have hacked into the government's top secret Quango Nomenclature Protocol. This link takes you straight into the heart of the beast, where you can literally create your own quango. Mine is the Dolphin Development Discussion Trust, and I'm taking the chair with immediate effect.
Meanwhile, a very interesting post from Keith McMahon over at Telebusillis. Keith is a telecoms industry vet, and makes an important point about the Telly Tax settlement. He points out that with household numbers expanding by around 300,000 pa, the actual increase in revenue the "British Bolshevik Corporation" (excellent) will get from the settlement is much greater than the 2-3% annual increases we've all seen quoted.
He's crunched the numbers and reckons the average annual increase is about 5%. Which is obviously a much more comfortable settlement than the BBC bosses have let on. Still Keith reckons they've blundered big-time in accepting responsibility for the digital switchover. Take a look at his post here .
Whatever else she lacks, the Commissar's got more sauce than Lea & Perrins:
"If we anticipated this business of GPs taking a higher share of income in profits, we would have wanted to do something to try to ensure that the ratio of profits to the total income stayed the same and therefore more money was invested in even better services for patients. Neither the Government or BMA anticipated how much GPs would do in response to performance-related pay."
Translation- if we'd actually understood how those new GP contracts were going to work, we'd have capped their pay.
Right. But what the rest of us want to know is wtf you ever imagined you were capable of managing such a huge upheaval in the first place? As your "esteemed" colleague My Lord Warner whinged just before Xmas, those grasping GPs "kept their eye on the ball" while the Department of Health... er... ummm...
And wtf don't you draw the clear conclusion- from IT systems to pay, you lot are totally incapable of ever getting taxpayers a good deal. We can all wring our hands, and wallow in the pain of regret, but what we actually need is action to stop this stuff happening all the time. As we've said many times, we'd all be a lot better off if you just got out of the way.
And railing against doctors- doing your very best to make them the villains of the piece, launching a guided Gerry Robinson, and generally slagging them off (see the Doc on this)- simply doesn't do it. In fact, it's highly likely to backfire, not just in terms of their general morale, but also in terms of driving them piecemeal into the private sector (cf the large swathes of Britain that are now NHS dentistry-free zones).
Yet somehow the Commissar still reckons things are cool:
"GPs in England are doing more for their patients in terms of prevention and giving support for long-term conditions than almost any country in the developed world."
On Monday I went for my annual medication review (don't ask) with my GP. She is the same GP who twenty years ago saved one of the young Tylers from an early exit- I would literally trust her with my life.
In the past, the review has always been pretty straightforward, taking about 6 or 7 minutes. This time it took closer to 15.
Why? Was it perhaps because she was was giving me a far more thorough inspection than ever before?
It took 15 minutes because she had a whole new load of boxes she had to tick. Well, not just tick. She had to fill in various new sections on her computer screen. Eg:
"Has your cancer made you depressed?"
"No. The increase in taxes to pay for NHS cost inflation- that's made me depressed. But not the cancer, which got sorted. On BUPA. Why are you asking?"
"Well, because I have to fill in this information for our PCT or we don't get paid. The only problem is I can't find the right bit on your form..."
Phones practice manager. "Right... right.... OK, so I tab across to the second screen... and then what?"
It would be grossly unfair to say she was following a call-centre style computer script, but I certainly caught a whiff of my experience with NHS Re-Direct.
As she said when I commented on how ludicrous the new system was, "yes, the Department of Health simply had no idea what a great deal they had with GPs".
They certainly didn't.
We can all argue about what GPs are "worth", and as we've said before, only the market can really decide that. But what we know for absolute double-definite, is that we taxpaying consumers are getting a much worse deal now than we were before the Commissars' latest brainstorm.
As even Hewitt admits, they've unambiguously moved us in the wrong direction.
Thursday, January 18, 2007
The biggest single factor determining whether a school is successful is the head teacher.
That's common sense, isn't it. The head has to organise and inspire the school, hire and fire the teachers, and most important, provide that magic leadership stuff.
Which means that the head has to understand the business of teaching, inside out. And the only way of getting that is by working at what used to be called the chalkface.
So it's unsurprising that all the headteachers in Britain's top private schools have worked their way up from the classroom. Even media headmasters like Anthony Seldon (headmaster of Wellington College) have put in the time with 5c. Without that experience, they would never have the necessary knowledge and skills to do the job well: they certainly wouldn't have the necessary credibility with staff or more importantly, the paying customers, aka the parents.
To be sure, they probably employ a bursar who brings business rather than teaching experience, and who takes care of all the tedious financial and operational details. But the Big Buck stops with a professional teacher.
Sadly, in our beleaguered state schools things aren't so simple. There, the customers are not the parents, but the Commissars. And as everybody knows, Commissars are much less straightforward than parents.
To begin with, they never really know what they want, and are constantly flip-flopping from one harebrained scheme to the next. Then, they think they know more about education than the teachers themselves, so keep forcing the heads to follow this or that current fad as the mood takes them. Then, they want lots of paperwork and general box-ticking so they can assess performance against their contextualised equality skills social outreach matrix. Then... well, we all know the score.
The upshot, as we've blogged many times (eg here), is a crisis in headteacher recruitment and retention: would you want to do a job where you had to answer to the likes of Alan Johnson and the amazing Jim Knight- neither of whom has any education experience- telling you what to do and how to do it? No wonder headteachers are leaving in droves.
As it happens, Mrs T used to be a teacher and we therefore know a number of state school headteachers. Except that now it would be more accurate to say we know a number of ex- state school headteachers: they're all taking early retirement as quickly as they can manage it, often with stress related illnesses.
And the vacant posts can't be filled. According to the National Association of Headteachers 1200 state schools in England alone were without a permanent head last year. It is scandalous.
So what are the Commissars doing about it?
What do you think?
Yes, that's right- they hired consultants to come up with a solution.
And education ahem experts PriceWaterhouseCoopers- at the cost of goodness knows what fee- have duly delivered the answer.
According to them, you don't actually need a professional teacher to run a school: you could hire someone from industry. Maybe a consultant even. You just need someone who can organise stuff and get the forms filled in on time.
Now you know that's rubbish. I know that's rubbish, and perhaps more importantly, the teachers know that's rubbish.
But none of that counts. Ando obviously, the parents won't get a say.
The desperate block-headed Commissars will decide, and I think we already know how that will go.
Still, at least there's one silver lining: the money we've paid across to those PWC consultants should help pay a few of their own private school fees.
Amidst all the BBC hand-wringing over the "disappointing" increase in its funding, we ordinary mortals are livid at still having to pay £20bn of tax over the next six years simply for owning a telly.
The best broadcaster in the world, huh?
How much BBC do you actually consume? For me it's R4 Today (at least up until it sinks beneath the trivia waterline at 8.30), various other bits of radio news, and Newsnight two or three times a week. That's it. BBC TV news is now so dumbed down and lefty, it's best to steer well clear.
I'd be quite happy to drop Newsnight, in which case, the following BBC chart suggests I should pay no more than 13 quid. And chopping Wogan and Wossy would bring that down to about a fiver:
And while Mrs T has an unhealthy addiction to Desperate Housewives and a certain other soapy substance, that's all provided tax-free by the commercial channels. Plus of course, the Desperates are the product of that supposedly hopeless market-driven US system.
At some stage over the next six years I'm hoping that internet telly will have developed enough for us to slip the surly bonds of aerial/satellite telly altogether. The young Tylers assure Mrs T she could already download the latest episodes of DH gratis within hours of their first US screenings. And 18 Doughty Street will surely have surpassed Newsnight in significance long before then.
PS Talking of public service broadcasting, I think we can all see what a service Big Brother is providing. Remember although C4 gets no overt tax funding (yet), it does get a public subsidy in the form of free use of analogue spectrum. Can't find a serious estimate of what that's currently worth, but since the value of spectrum freed up though digital switchover has been estimated at between £2bn and £5bn, you'd have to guess the value of C4's bit is £200-£500m, translating into an annual subsidy of say £20m. And that's after the decline in its value as digital TV has exploded. Of course, the BBC gets an even bigger spectrum subsidy, on top of the telly tax.
Wednesday, January 17, 2007
A couple of weeks ago we looked at some US waste watchers, and noted how much of their effort is directed against pork-barrelling. That's the practice whereby US Congressmen divy up Federal tax dollars among themselves to pay for pet projects back in their constituencies. The general idea is to buy continued electoral support back home, although there have also been plenty of cases where more direct financial considerations are involved.
Some have argued that such things could never happen here because... well, we have a national government that acts in the interests of the entire nation, not just favoured bits of it.
Last autumn we had the scandal of the electoral "heat maps", which Commissar Hewitt uses to decide which hospitals to let close- ie those in Tory areas- and which to protect- ie those in Labour marginals. In fact, as we later discovered, since 1997, 70% of new hospitals have been built in Labour constituencies.
Then last weekend - blow me down - we learned that exactly the same thing has been happening with schools. Under Labour's Building Schools for the Future programme, 27 out of 38, or 70% of the projects, have gone straight to Labour authorities.
And today we hear of yet another case, this time involving the oldest pork barrel of all- defence.
Regular BOM readers will recall the case of St Athan, the MOD's aircraft maintenance facility in South Wales. Just before Christmas, MOD tried to bury the bad news that the base was to lose its maintenance contract, threatening thousands of local jobs.
Not surprising they wanted to bury it because St Athan is slap-bang in marginal Labour country, with the local MP, John Smith, sitting on a horribly wobbly majority of 1800.
What to do? What to do?
Ah yes. Easy. Simply close some other bases in Tory or Lib Dem constituencies and transfer their work to St Athan.
Which is exactly what's happening today. Des Browne has announced that St Athan is to be Britain's new Defence Training Hub, and that training will stop at Blandford Camp in Dorset, and at RAF Cosford in the Wrekin, terminating thousands of local jobs in both places.
And yup, both Blandford and Cosford are in Tory constituencies.
I think the appropriate expession is oink, oink.
PS We can't blog pork barrelling without just mentioning once again a few of the all-time US greats. This list includes $219,000 to teach college students how to watch television, $100,000 to study how to avoid falling spacecraft, and $144,000 to see if pigeons follow human economic laws. Remember: the US is the future.
A few days back we gave thanks for Bank of England independence, and yesterday we found out just why they'd been forced to jack up interest rates so suddenly. The fact is, they've been quite as shocked by the spurt in inflation as most outside forecasters.
As the FT reminds us this morning:
"Back in late 2004, when it was setting interest rates to hit its 2 per cent consumer price inflation target two years hence, the BoE monetary policy committee calculated there was only a 12 per cent chance of CPI inflation exceeding 2.5 per cent at the end of last year. The following August it was almost cocky, putting only a three per cent probability on that outcome and suggesting there was no chance of inflation rising above 3 per cent.
So great has been the surge in inflation, however, that what was once thought almost impossible is now reality. CPI inflation hit 3 per cent in December, the highest in 11 years; the fourth quarter CPI inflation rate rose to 2.7 per cent; retail prices index inflation at 4.4 per cent was at its highest rate for 15 years; and RPIX inflation, which excludes mortgage interest payments and was the Bank’s target measure before 2004, rose to 3.8 per cent."
Now we can all make mistakes- even those brainy people at the Bank. But at least they've recognised their mistake, and they're taking firm action to put it right.
Contrast that with the Blessed Leader. Yesterday, he was asked about the inflation situation at his monthly press conference. This is what he said:
"Look, inflation has risen not just in this country but in most of the major countries because of rising energy prices, rising oil prices which have doubled, tripled, over the past few years. That however is expected to come down in 2007 and we expect to come back to the 2% inflation ... it is worth pointing out for example that if you take America on the same measurement of inflation they went over 4%, Europe went up to 3.3%.
This is a very common issue. It is driven by these rising energy prices and it will fall as the energy prices fall."
Interesting. You wonder why those dunderheads at the Bank didn't know that. They're clearly inflicting interest rate pain we don't need to suffer. They'll be pulling the wings off flies next.
Of course, one reason the Bank didn't pick it up, is that it isn't actually true. In fact, not for the first time, Blair was telling the most monstrous family size porkies.
According to the official CPI release from the Office for National Statistics, our CPI inflation has increased over the last year from 1.9% to 3% (12 month rates, December 2005 compared to December 2006).
According to the same document (table 7), over the most recent 12 month period available- November to November- comparable CPI inflation in Germany fell by 0.7%, in France it fell by 0.2%, and across the Euro area as a whole, it fell by 0.4%.
And America? For some reason the ONS release doesn't include the US, but it is included in HM Treasury's Pocket DataBank. And there, table 16a tells us that US CPI inflation fell from 3.5% in November 2005 to 2.0% in November 2006 (latest figures).
Just to nulabour the point: as well as being the Bank's target, the CPI is the internationally accepted comparable measure of retail price inflation across economies. And it shows that whereas Britain's inflation has taken off over the last year, in most major economies- including those specifically named by Blair- it has fallen- despite the increase in energy prices. We are an outlier with much worse performance than other countries.
Now we all know about damned statistics, and I'm sure Blair's spinners might be able to find some bizarre statistical artefact to support what he says. But the rest of us just aren't interested in his bullsh*t any more- what we need to know is what's actually happening in the real world. (Sadly predictable that none of the assembled lobby journos questioning him yesterday were on top of the facts).
And the moral?
Once again we can see precisely why politicos could never be trusted with the management of monetary policy.
I wonder why we still think they can be trusted with the management of all that other stuff?
PS I'm not the only one to pick up on Blair's inflation commentary. Over on Rightlinks, my old colleague from DDFL days, the excellent Serf, points out a fundamental flaw in TB's point about energy prices. Also, somebody called Tyler posts a spookily similar article to this one over on TheFisk.com, the brand new 18DS site edited by Sam Coates.
The government's CIO Council - founded in 2005 - has just published its first annual report. Chief Information Officers are the guys who actually run those troublesome government mega-projects, and naturally most of their report comprises their latest triumphs in tractor production (eg it hails the achievements of the dire NHS Re-Direct). But there are a couple of interesting snippets:
£12.4bn total spending in 2005-06- This includes about a billion apiece for DWP, HMRC, and MOD- appalling money pits all. It also includes £1.1bn for Connecting for Health, which seems light for the NHS supercomputer. However, the report records another £1.4bn for the NHS, and another £0.1m for the Dept of Health, so the true total is clearly much higher.
More fundamentally, the total mixes together apples, pears, and probably guava fruit as well. For example, some of the underlying numbers are capital costs, whereas others are just PFI "rental costs". And it isn't clear that the figures include associated knock-on costs, such as training staff in new systems and loading data, which we know is a large extra cost of the supercomputer.
The bottom line is that the true total is almost certainly much higher.
551 government websites to close- Anyone who has used government websites knows how awful most of them are. Even if the information is on them, you can't find it because the search functions are such pants. The CIO's response is to close 551 of them (out of nearly 1,000), and "migrate" their content to DirectGov or Business Link. Er... guys... they ain't a whole lot better.
Tuesday, January 16, 2007
The hopeless hapless Home Office continues to reel from one crisis to the next. Yesterday, its Permanent Secretary Sir David Normington was once again grilled by the Public Accounts Committee, and was forced to admit not only do his officials ignore the filing and cover up problems, they can't even count properly:
“Since the summer we have gone through 160 data sets and given them a star system from three to nought for their reliability. We are looking actively at the 30 data sets that are not up to scratch.”
Translation- even we have been forced to recognise that one in five of our published statistical series are complete and utter rubbish.
This is a very serious matter. Because these aren't just your usual run-of-the-mill government wibble stats on gender balance among hospital administrators, or community empowerment outreach initiatives. No, these are stats on important stuff like crime and immigration. Stats that are needed to guide vital policy areas and to allow the rest of us to see how the government is really performing.
Home Office statistics have long been a national scandal. From the British Crime Survey- the government's massaged opinion poll on the incidence of crime- though to its wildly understated immigration numbers, HO stats have long been little more than an exercise in political spin.
Obviously we can all understand why the politicos like it that way, but there's a price to pay: nobody believes any of them any more. Indeed, according to a survey carried out by the Office for National Statistics, only 17% of us believe government stats are put together free of political interference.
Ah, you may say, but surely that's why Gordo is setting up his new independent Statistics Commission Board . So they can take responsibility for all key national statistics, and ensure they are produced rigorously and well away from the corrupting hand of the politicos.
Except for one thing.
The key Home Office stats- like the BCS- are mysteriously being excluded from the whole exercise. Along with many other highly sensitive stats produced by Whitehall.
In fact, in the case of the Home Office, only 12% of their statistical output is actually covered by the National Statistics system.
The Statistics Commission itself says public trust will only be re-established in the integrity of the numbers if the new system ensures "that all appropriate departmental statistics are treated as ‘National Statistics’. The arrangements here must be seen to serve the public interest, not just the convenience of government departments."
Even the Home Office's own "independent" review of crime statistics, while tippy-toeing tortuously over the eggshells, pretty well says the stats should be handed over to ONS control.
Doc Reid can rage and fulminate against his officials as much as he likes. But we'd all be a lot more convinced if he took some real action. And I don't mean just suspending some patsy assisitant-sec on full pay. After all, that poor sap is probably so confused by all the political number massaging that goes on, he's probably forgotten what straight reporting actually looks like.
No. Reid should make a proper start on cleaning the stables by handing over the production and publication of all major HO stats to the ONS. Completely.
He could make the announcement today.
Monday, January 15, 2007
It's a funny thing isn't it. Britain's most successful customer service operator in recent years has been Tesco, about whom we have blogged many times. In the fearsomely competitive retail sector, it has been our leading mass market innovator, it has extended choice and cut prices for millions of customers, and it has generated massive profits for its shareholders. The other supermarkets have been forced to up their games or risk extinction.
And yet, for well over a decade Tesco has been condemned by the liberal media and politicians alike for exploiting the poor, destroying the fabled High Street, and even eroding the very cohesion of British society (don't believe me? Check out this wibble from the BBC this very day).
Later this week we'll hear how the Competition Commission is getting on with its probe into the £120bn pa groceries market, and doubtless we'll be treated to yet another wave of anti-Tesco hysteria. After all, they do have a 30% market share and it's growing all the time.
Now there's no doubt that Tesco is a very aggressive player. And there are clearly questions about its massive land bank, and other property dealings (see this Observer article for summary). And yes, you can bet its property execs are quite capable of skinning local authority planners alive.
But surely nobody can doubt the fundamental reason for Tesco's success: it gives its customers what they want.
How do we know that?
Because you see... and listen very carefully to this because it's quite technical... the customers wouldn't shop there if they didn't want to.
Which means of course that in delivering its service, Tesco always has to make sure customers come first- they're the ones with the money.
In contrast- and I apologise if I'm going to fast for you- our public services never have to put customers first. The ones with the money are not the customers, but the politicians.
So it's hardly surprising that public service customer service tends to verge towards the sh*te. Always and everywhere, you just need to follow the money.
I was reminded of this simple fact when I stumbled across that quite wondrous Hazel Blears Tesco video on YouTube.
In fact, I was so struck that I drew it to the attention of The Bloke, who immediately stapled some choice bits onto the end of a short vid he'd shot a while back outside Slough Tesco. See what you think:
PS Apologies for the quality of the Bloke's vid- he seems to have done this one on a £19.99 Tesco videophone.
Sunday, January 14, 2007
£2.5m on hand washing lessons- "Now, pay close attention. There are apparently 10 stages involved in washing your hands — so you need your wits about you. To help you with the timing, officials have suggested that you may want to sing Happy Birthday To You, twice in a row... In the same week Britain decided to resume space exploration, the Scottish Executive has just decided to spend £2.5 million on telling people how to wash their hands. A total of 14 health boards are to be given funding to employ a "hand washing co-ordinator", on a salary of £50,000, to promote the campaign. And a helpful website has been set up — www.washingyourhandsofthem.com." (Telegraph 13.1.07)
£290m pa wasted on R&D tax credits- "Half of the £580m cost of Gordon Brown's research and development (R&D) tax credit is wasted because firms are claiming the cash for research they were already planning to carry out, the Treasury has admitted. But survey results revealed under the Freedom of Information Act show, in the Treasury's words, that only 'half of respondents whose company had made a successful claim for the R&D tax credits said that it had had some impact on either their R&D spend or R&D projects.' The survey finding suggested that at least 50 per cent of the cost of the high-profile scheme was what economists call a 'deadweight loss', because it was paying for research that would have taken place anyway." (Observer 14.1.07)
£3m double payment for government air travel- "British taxpayers are to give £250,000 to a food factory in Thailand so that it can bury its rotting vegetables. The deal is part of a £3m government scheme to balance the carbon emissions created by Civil Service and ministerial air travel... The Government has estimated that it will be responsible for 300,000 tons of carbon dioxide over the next three years, and according to methodology used by Climate Care, the leading carbon offsetting company, this means that British ministers and civil servants are expected to fly more than 600 million miles every year... The Government spent £6.1 million on ministerial travel overseas in 2005/06, a third of which is attributed to Mr Blair and which is a 20 per cent increase year-on-year. Defra alone lavished £4.5 million on trips abroad for its employees, a 25 per cent increase on the previous year. In 2005, the Department for International Development spent £900,000 on air travel within the UK alone and a further £8.3 million on flights abroad. Many of the civil servants travelled business or first class." (Sunday Telegraph 14.1.07)
£243,000 golden handshake for NHS boss- "An NHS Trust that was £5 million in deficit paid off a former director with a £243,000 golden handshake. Iheadi Onwukwe, 41, was given the payoff when he left his post as director of public health at Eastbourne Downs Primary Care Trust after what is believed to have been a dispute with a senior colleague... after the dispute Dr Onwukwe was effectively paid to do nothing before he was finally paid off. The trust is carrying out a cost-cutting review that could lead to services at Eastbourne District General Hospital and Conquest Hospital in Hastings being downgraded." (Times 13.1.07)
£80,000 for axed quango head- "The former head of the Rural Payments Agency was paid more than £80,000 after he was removed from office last year, rural affairs minister Barry Gardiner revealed. Johnston McNeill continued being paid for more than eight months after his removal. He was effectively suspended on full pay and cost taxpayers £81,410.55 from the time he was axed on March 16 until December 1." (Guardian 12.1.07)
Total for week- £295,823,000
Saturday, January 13, 2007
There's a fascinating interview in the Times today with Professor Sir Michael Rawlings, who heads the National Institute for Health and Clinical Excellence (NICE), the commissars' notorious treatment rationing committee.
He tells of the accounting formula NICE uses to decide which treatments- especially which pricey new treatments- it's going to sanction on the NHS.
"It is fiendishly complicated, but at its heart is its attempt to put a price on one perfectly healthy year (normal people call this a blessing, health economists call this a “quality-adjusted life year”, or QALY).
How much is this worth? Priceless, many would say, but NICE puts it at £30,000. Very roughly, if the extra cost of a new treatment to give one good year of health is more than that, there have to be exceptional circumstances for NICE to approve it."
Well, you think, maybe we've misjudged NICE. Maybe it is way more scientific than a crude matter of rationing. But why £30,000?
"The figure is, Sir Michael admitted, pretty arbitrary. Officially NICE does not take account of politicians, or the pockets of the NHS, but the figure is broadly pitched at what the country can afford."
Very interesting. Because that is not at all the way the economists who developed the QALY measure intended it to be used.
For those not versed in the dismal science, the QALY is merely the latest manifestation of a long-established tool in cost-benefit analysis. It was realised long ago that to make a comprehensive investment assessment of say a new public road scheme, you had to be able to assign a money value to the lives that would be saved from having a safer road.
So measures were devised. Initially they were based just on the economic value of the future output lost when someone got killed. But after a while, even dismal economists were persuaded that people are more than just the discounted present value of their future marketable output. So they started adding an arbitrary amount for grief, pain and suffering.
Later they came up with an alternative, somewhat less arbitrary approach, based on so-called "willingness to pay" (WTP). Typically, they'd analyse relative price data on choices that people were actually already making, to see what it revealed about the monetary value they assigned to risking their own safety. For example, you could compare the relative pay of different jobs, some very safe, like sitting in a Whitehall office making decisions about NHS rationing, some much less safe, like running the accounts department at the Baghdad General. The latter obviously pays much more, but for a good- and quantifiable- reason.
The upshot is that today we know for certain what a life is worth. Oh yes, we do. And here in Britain, it's...
Are you ready for this?
That's it. Simple as.
And it's an all-in figure, including £860,380 for the "human cost" (pain, grief, intrinsic enjoyment of life etc), and £451,110 for the output foregone from losing a drone.
Now stop squawking. I know you're priceless. But in terms of averages- as agreed by the Department of Transport no less- that's it. £1.3m.
So to translate that into a QALY- the value of one extra year of life with a good quality of health- you need to split it up into annual units. We won't go into the brain-deadening actuarial detail of how that's done right now, but it's not too hard, and you can find out here.
The key point is that the answer is not £30,000.
No, indeed. The snappily titled "Estimating a monetary value of a QALY from existing UK values of prevented fatalities and serious injuries" is a detailed paper just produced by an eminent team of academic health economists for the Department of Health itself. And they put the figure at £63,000 at 2003 prices*. Or twice the NICE figure.
So why the difference?
Going to have to hurry you...
Yes, absolutely right. If NICE used a figure of £63,000 there wouldn't actually be enough, er, money to go round.
So why bring QALYs into it at all? Whatever Rawlings might say about QALYs or quarks or anything else to make it sound scientifically objective, the figure of £30,000 is nothing more than a simple rationing device.
And there's more. Even setting aside the actual financial figures, how does NICE reach its QALY score for each of the treatments it assesses? Clearly I'm no Doc, but there are some big problems here. Not only must you assess the physical impacts of new treatments, you have to have a way of weighting together (valuing) the different impacts.
For example, suppose Treatment A sorted out your debilitating heart problem but left you blind, would you take it over Treatment B, which might leave you vulnerable to a heart attack but still sighted? No, huh? Well supposing it only left you deaf- would you take it now?
It's unclear exactly how NICE does this, but this paper suggests polling people to discover how they rate different health states. The following chart summarises what they found in terms of QALY values assigned by people to different possible bundles of health impairment:
Note for happy release fans: some health states are clearly viewed as being much worse than death (which by asssumption scores zero).
I must say I find the whole area very interesting, but sadly it's not going to help the NHS very much over coming years.
Because the main point of the Rawlings interview was so he could flag up loud and clear that the money has run out.
QALYs or not, the way forward is only too clear.
Rationing is back, and with our new jacked-up NHS cost base, this time there's absolutely no prospect of increasing the budget to resolve it.
*Footnote: The QALY study referenced does also produce some somewhat lower estimates for QALy (eg £45,000), but the figure consitent with the NICE approach is £63,000.
Friday, January 12, 2007
I'm truly shocked by the news of the school hammer attack outside Swindon:
"A 15-year-old boy was attacked with a hammer at his school by an Asian gang. The pupil was left lying in a pool of blood after he was set upon by a gang of at least four Asian men at the Ridgeway School in Wroughton, near Swindon, Wiltshire, at around 4pm yesterday."
I'm shocked for a number of reasons. First, because I know the school. It was the first purpose built comprehensive in Wiltshire, and thirty years ago I spent a term there as a student teacher. And it is inconceivable that such an appalling thing would have happened in this semi-rural school then. An organised cold-blooded attack of the utmost brutality carried out by a group of adults on a single fifteen year old boy in the school playground. You can hardly find the words.
Second, I'm shocked by the reaction of the school and the press. It's clear that their first instinct was to conceal the obvious racial dimension to the attack - which is self-evident whether or not it was "racially motivated". The headmaster's main concern was that "he did not want the attack to damage the reputation of his school", while most of the initial press reporting (such as the Grauniad here) simply failed to mention that the attackers had all been Asian and the victim white.
Sure, you can argue that it's better not to mention such matters in case it stokes up further tension. But does anyone seriously imagine that word didn't get round Swindon in hours? What's more, as witnessed by the crowd of angry white parents forcing an emergency meeting with a reluctant head, not talking about it racks up the tension even more. Why, people even get the impression the establishment doesn't care.
The local BNP is having a field day. They say they're "standing up for local people", and are calling on the head to resign for trying to wish the issue away.
The law needs to deal with the perpetrators swiftly and firmly. Because out among the real people this case has already confirmed an awful lot of prejudices.