Friday, January 18, 2008

Some rather weak responses to the TPA report on NHS performance

Cross-posted from the TaxPayers' Alliance blog

Here at the TaxPayers' Alliance we're used to rather unconvincing government responses to our reports. Tessa Jowell produced the memorably meaningless argument that it "is a mistake to view 2012 as a cost, rather than an investment" - as if investments don't have costs. The DFID managed to completely contradict their own press release in a response to our study on hate education in the Palestinian Territories.

Today we've had some equally lackluster responses to our study Wasting Lives: A statistical analysis of NHS performance in European context since 1981.

The King's Fund, quoted in the Guardian, were good enough to acknowledge that our basic methodological approach is valid. Unfortunately, they then tried to diminish the conclusions of our study by placing them in a completely inappropriate context.

Even if the statistic that total mortality is between 750,000 and 1,000,000 is accurate that isn't the correct number to compare with our estimate of 17,000 deaths from poor NHS performance. Most deaths occur either from a condition, or at an age, that they should not be considered amenable to healthcare and therefore have a limited part to play in any discussion of the ability of the NHS to save lives.

The proper comparison is with total amenable mortality and that comparison is contained in our study. As the Times noted "mortality from [amenable] conditions is 26.9 per cent higher in the UK than the average in the four European countries, and 48.6 per cent higher than in France, the best-performing country." This is a very significant difference. We only cited the number of lives lost more prominently as we didn't want the human tragedy to be lost in a fog of more esoteric statistics.

If the King's Fund don't think that 17,000 deaths is a high number then why do we concern ourselves with deaths on the road or deaths related to alcohol? Neither are nearly as lethal as poor NHS performance.

Health Minister Ben Bradshaw responds for the Government with a quote in the Guardian. First, he said that the gap between EU peers and the UK has been narrowing. That was clearly acknowledged in our study. However, it has been narrowing at pretty much exactly the same slow pace since 1981 despite a huge cash injection since 1999. There are probably several trends underlying that pattern, technological change that erodes established advantages is probably particularly important. There is a lot of analysis of the trend in our report but, suffice it to say, Bradshaw has to explain how exactly his government has spent so much more, £34 billion, and got exactly the same results.

He follows that with a meaningless ad hominem. Hopefully Guardian readers will be open minded enough to know that calling someone "rightwing" is a poor substitute for being able to point out how they are wrong.

Finally he accuses us of admitting that our figures are "more than three years out of date". We did no such thing. The data used in our report is the very latest available mortality data. It describes deaths in 2004 for the simple reason that mortality statistics for more recent years just don't exist yet. 2004 isn't that long ago and is five years after the cash injection whose effects we wanted to study. Almost all statistical analyses have to look a certain distance into the past thanks to the time taken, by the relevant organisations, to produce the statistics that they analyse. If Ben Bradshaw isn't willing to accept any study that does so you have to wonder how he understands health policy at all.

A new TaxPayers' Alliance report - Wasting Lives: A statistical analysis of NHS performance in European context since 1981

A report I have written, Wasting Lives: A statistical analysis of NHS performance in European context since 1981, examining NHS performance and putting it in context with an examination of trends in Europe was released today. It has done rather well in the media and will hopefully provide a new clarity to the healthcare debate - illustrating both the huge stakes and the failure of recent strategy.

The empirical method used, mortality amenable to healthcare, was obviously inspired by Nolte & McKee's 2003 study of amenable mortality, which was cited in the Better Government position paper (PDF). However, the analysis was inspired by this graph, and others like it, from the Department of Health (PDF):

Look at the pattern for England compared to the EU-15. Premature mortality from circulatory diseases is definitely falling - and converging on the EU-15 average. But its been falling pretty steadily since the eighties. If you look at that graph its very hard to spot what has happened to massive additional spending since 1999.

Replacing this graph of one condition with no filtering for conditions amenable to healthcare with the aggregate mortality amenable to healthcare numbers in our study was an enormous empirical task. It required exporting the numbers for a given gender, in a given country, in a given year from the raw World Health Organisation database to a spreadsheet. That spreadsheet filtered for conditions amenable to healthcare and then turned those numbers into an age-standardised rate. This had to be done for each gender, each year and each country. It was a big process but it gave us an aggregate measure of healthcare progress in Britain and the European countries studied.

We could then look and find out two things. First, we could get an estimate of the human cost each year of the poor performance of the NHS. These are mortality rates and it is easy to lose sight of the fact that they represent a staggering number of lives lost. Innumerable tragedies, a significant number of which, over 17,000 by our estimate, could have been avoided if we matched the performance of European healthcare systems.

Second, we can see whether massive increases in funding post-1999 have had been effective. It appears they haven't. There is no discernable effect of the additional funding in the mortality numbers. If we want to get the kind of performance in healthcare that people in Europe expect and receive we need to learn lessons from how they organise healthcare: we need to decentralise, encourage competition and end political management.

Barry Sheerman's ironic accusations (via ConservativeHome) reports Barry Sheerman accusing David Cameron of turning the Commons into a brawling house:

"In an podcast, the chairman of the education select committee said: "Can I just say, there was appalling behaviour by the leader of the Opposition today.

"He has been around in Parliament long enough to understand the rules of Parliament.

"He used the word 'you' shouting across the despatch box six times. He wasn't reprimanded by the Speaker, which I think was unfortunate.

"If someone is going to turn this place into a sort of brawling house, I am going to do anything I can as a senior member of Parliament to stop him."

Asked whether he would be seeking action on Cameron's interventions, Sheerman said: "He's got the behaviour of a hooligan in the chamber.

"As someone who wanted to get away from 'Punch and Judy', he is dragging the House of Commons down into a pit that I don't want to see it in."

What's brilliantly ironic is that this is the same Barry Sheerman who got in a drunken fight with Bob Marshall-Andrews, from the Times:

"Barry Sheerman, the senior Labour MP and chairman of the Commons Education Committee, happened upon the scene and attacked Mr Marshall-Andrews for talking to his “friends” in the Tory party. Mr Marshall-Andrews shouted back at him and suggested that Mr Sheerman might have taken drink.

At that point Jim Dowd, the pugnacious Labour MP for Lewisham West, arrived to begin haranguing Mr Marshall-Andrews, who insulted him and again implied that he was the worse for wear. It was too much for Mr Dowd, who grabbed his foe by the lapels and began pushing him across the lobby, finally pinning him against a wall.

Fortunately, the Labour whips’ office is in the opposite corner of the lobby and they were quickly alerted. Tom Watson, the genial and rotund junior whip, raced to the fracas and pulled Mr Dowd away from his adversary.

Other whips — known as the Westminster “thought police” — appeared swiftly to surround the combatants and defuse the situation,fearful that the real police might have to be called in. Mr Dowd retired from the area and Mr Marshall- Andrews went back to his Conservative “friends”.

Later, with tongue slightly in cheek, Mr Mitchell described it as an “unprovoked and unpleasant attack on a distinguished senior parliamentarian. It was mercifully defused with speed and efficiency by the government whips."

What a hooligan!

Thursday, January 17, 2008

The DFID respond to the TPA study on Hate Education

Yesterday we released a report on how British taxpayers' money supports hate education in the Palestinian territories. The response from the Government is a little confused.

As I wrote on the TPA blog:

"Today our study on Hate Education in the Palestinian territories was reported in the Express. The report included a response from the Department for International Development:

"A spokesman for the Department for International Development said: “We don’t fund the Palestinian Authority directly and therefore don’t fund textbooks."

How strange, on the 11th of July last year they put out a press release titled:

"UK leads the way in resuming direct aid for Palestinian Authority"

The release continued:

"The UK has underlined its support for the Palestinian Authority with a contribution of £3 million to allow it to begin paying off its private sector debts, Douglas Alexander, Secretary of State for International Development, announced today.

A month after Hamas’ takeover of Gaza and the establishment of a new Government by President Mahmoud Abbas, today’s announcement makes the UK one of the first countries to resume direct financial assistance to the Palestinian Authority." [emphasis added]

Beyond that, the problem isn't just direct contributions, as the Express notes: "the TaxPayers’ Alliance said that, by funding worthwhile activities, Britain was freeing up funds which could be spent in more sinister areas."

Our report raises serious issues about how the UK contributes to the long-term prospects for an end to the Israel-Palestine conflict. It makes positive recommendations, modelled on longstanding practice in Northern Ireland, for how our aid money can encourage an end to radicalisation and hate education. The DFID should look at those recommendations instead of issuing nonsensical rebuttals."

Monday, January 14, 2008

"I have to believe that when my eyes are closed, the world's still there."

There are some massive and flawed assumptions underlying Justin McKeating's angry post about those opposing opt-out organ donation. This section is a prime example:

"‘It strikes at our relationship with the state,’ they say. Well get this: You can’t have a relationship with the state when you’re dead. You can’t assert ownership over your own corpse. Why? Because. You. Are. Dead. What other freedoms would you like to exercise after you’ve shuffled off? I take it you’ll be putting your favourite songs on your iPod to take with you as well? It’ll be as much use to you as your liver."

You clearly can and do have a relationship with the state when you are dead. It doesn't take very long to think of some examples:

  1. There is both a criminal penalty (I assume) and a massive social sanction to necrophilia.
  2. People frequently refight criminal trials after the person convicted has died in order to establish their innocence.
  3. A will has legal force.
  4. Even under Brown's proposed reforms we will legally respect explicit opt-outs.

We clearly believe that people are entitled to maintain some kind of dignity after they have gone. This requires that we respect their wishes. Assuming that they would be okay with us removing their organs, rather than leaving them be if we don't know, is a fairly major change in how the state treats the dead. If you assume some kind of continuity between a dead person's identity and a live person's - which you should if you support the use of wills - then it most certainly does strike at our relationship with the state.

Balancing the dignity of the dead against the interests of the living is the philosophical question at the heart of any reasoned consideration of this problem. Plenty of people get very angry at the idea that their autonomy over the final fate of their bodies is being limited. Justin's rant isn't going to win them over. It isn't designed to. Those who die for lack of organs are never really used as anything but a rhetorical stick with which to beat assorted enemies.

Such a debate would look at alternatives like reforming how the health services treats grieving families. The Department of Health reckon they could increase organ donations by 50 per cent by better managing that process. That isn't enough but throw in some inventive new ways to get people to consent before death and I think you'd be fine. Beyond that, there's always commoditisation. Wat Tyler has more on the various alternatives to Brown's initiative.

I find the idea of an opt-out system for organ donation alarming for the same reason I found the idea - floated a while ago - that the HMRC should be able to take money straight out of our bank accounts alarming. It will mean that when inevitable screw-ups take place it will be far more likely that someone will wind up having their organs removed against their wishes. Bureaucratic procedure tends to err on the side of the default position; it seems almost certain that scandals thanks to overlooked opt-outs would become commonplace very quickly.

I don't actually feel outraged myself - I'm blessed with a rather moderate temperament - but I absolutely understand those who just feel very affronted at the idea anyone would presume consent to take their organs. As Justin says, even many of those who will quite happily take a donor card are angry at the presumption. Just the way plenty of people will give to charity but wouldn't like to find the RNLI lifting their wallet. Our bodies are our own, even after our death our wishes over how our corpses should be disposed of are quite rightly respected, and having them stolen grates even if it is for a good cause.

Sunday, January 13, 2008

Canadian Heroics

This is the opening statement of Ezra Levant - brought up before the Albertan Human Rights Commission thought police - defending his decision, and freedom, to republish the Danish Cartoons. A real hero for our time.

There are more excellent videos on his website, from the actual interrogation, including his refusal to accept that his intentions should be a relevant matter, description of how these cases diminish journalistic expression and do more to contribute to racial animosity than the cartoons and finally how he refuses to answer to the state, rather than civil society, for his views.

You can donate, at his site, to support him in his struggle. A worthy cause.

Best of Blogpower 2007

There's an excellent set of self-nominated 'Best of 2007' blogs up at the Blogpower home. An excellent showcase of the variety the group has to offer. Go and take a look.

I nominated my post which set out, using some pretty simple statistics, why a clearly expensive survey by the British Council actually completely disproved the Tranzi line that we all need to think like 'global citizens' that they were trying to push.