Opening up the NHS?

"Death rates of patients undergoing major surgery at NHS hospitals are to be published on the internet.

[...]

Death rates are expected to be at a disproportionately high level in hospitals where fewer operations are performed and surgeons have less opportunity to improve.

The government believes publishing the figures will mean badly performing trusts will have to improve standards or halt areas of surgery where they are lagging behind."

This, from a report in the Telegraph, is great news. If patients can make an informed choice then that should put pressure on the acute trusts to up their standards. In fact, this is long overdue:

An inquiry into the deaths of children at Bristol Royal Infirmary a decade ago showed how poor practice persisted because mortality rates were not disclosed.

The effect will be limited though as - within the NHS - patients only have a limited amount of choice. While the trusts could compete with each other to a certain extent they are protected from new entrants to the market, a restriction that will severely limit the ability of patients to take advantage of this new information.

Beyond that, the structure of the NHS will restrict the ability of the trusts to respond to quasi-market pressures introduced by this new source of information. The NHS is essentially a quango of quangos. It is made up of a combination of the primary and acute trusts, strategic health authorities and a maze of central quangos. In our report, Wasting Lives: a statistical analysis of NHS performance in European context since 1981 (PDF), we set out how the central quangos control many of the most important NHS decisions:

"The NHS has a large number of local bodies, the Primary Care Trusts, NHS Trusts and Regional Strategic Health Authorities. However, these are all both legally non-departmental bodies answering to the Department of Health and effectively part of one organisation. Most have only a very limited ability to act independently:

• Their decisions over which drugs to buy are expected to conform to guidance from the National Institute for Health and Clinical Excellence.



• IT expenditure is mostly handled by Connecting for Health which runs the National Programme for IT , the largest single information technology project in the world.



• Staff pay, the largest item of expenditure, is determined nationally by the NHS Pay Review Body.



• Amounts of funding are also set nationally according to a weighted capitation formula. This became very controversial in 2006 when the Government were accused of manipulating the funding decision for political advantage."

This information will be a valuable resource for NHS patients. It would be so much more valuable if our healthcare system were liberalised more broadly.

Cross-posted from the TaxPayers' Alliance blog.

"Democracy, freedom, subsidiarity - federalism, the solution we've got!"

They're young, lyrically imaginative and enthusiastic for the European Project!

Lipdub Europe United par les Jeunes Européens - France
Uploaded by JeunesEuropeensFrance

This gave me rage blackouts.  I defy any Briton of good sense to watch it and not want to quote Nelson's advice to a midshipman aboard the Agamemnon.

P.S. If this has been posted by someone else already, and I missed it, then apologies.

Glorious Isolation

Zoe Williams, at Comment is Free, is confused by our lack of friends that might support a bid for Eurovision victory:

"But still, two questions: first and most obviously, why have we got nobody to vote for us? Everybody goes on about eastern Europe and their bloc voting, but this is not some ex-communist curiosity that we in the hyper-individualised west will never understand. Everyone has chums: the Scandinavians vote for one another; Cyprus votes for Greece; and Andorra, Portugal and Spain stick together."

Well, the answer's obvious, isn't it? Humans are angry, tribal killer chimps.

Europe's other nation states aren't very stable. Most have them have had their borders redrawn endlessly and have even ceased to exist several times pretty recently. All sorts of people aren't in the nation they started out in and have tribal loyalties elsewhere. Even when no one is being conquered a land border is far more porous than a watery one. All this means that most European countries have human ties to others in their proximity.

We're just as tribal. In fact, Anglos of one kind or another have been - for some centuries - the biggest, baddest tribe on the planet. Not only do we keep our own borders steady (the last battle on our mainland was in 1746) but we also conquer the others and take their stuff. However, we generally haven't taken territory in Europe (too high maintenance) but in the rest of the world.

If it wasn't Eurovision but Worldvision (World Vision might be peeved if it were set up) then our Anglo cousins and Commonwealth buddies would be in play. We'd do fine. The best evidence available suggests that we would do extremely well, that we are the world's favourite nation.

Our relationship with continental Europe has defined our history and frog-bashing has become a dull cliche best left behind. However, there is no reason to get wound up in a fit of teenage self-consciousness just because the continentals won't vote for us at Eurovision.

Cross-posted from CentreRight.com.

The decline of the traditional family - the sixties or Thatcher?

I've written a response to a post by Unity addressing that subject. Unfortunately it is a bit too heavy on the graphics to easily copy over here so you should go to CentreRight.com to read my argument.

Taking responsibility

Great post by Pub Philosopher:

"But there is another similarity between both these tragic stories. Khyra's and Victoria's fathers were not living with their daughters and were out of the UK when they died, yet they displayed their grief for all to see and launched tirades of criticism at the British state for its failure to look after their children.

[...]

Much of this disproportionate response resulted from a mind-set which assumed that the state must take all the blame for Victoria Climbie's death. Anyone who suggested that, perhaps, her father should bear even a little of the responsibility for entrusting his daughter to inappropriate carers was drowned out in the chorus of "something must be done".

[...]

I'm not saying Birmingham's social workers are blame free. They should have asked questions when the child had been away from school for so long. If they were unaware of this, then that is a system failure too.

But Mr Zaire has some cheek to blame just about everyone else when, it appears, he had very little involvement with his children. "

Re: Overclass values created the underclass

Tim links to a blog by Melanie Phillips who attacks the Guardianista crowd. She accuses them of being responsible for many of today's social problems through an attack on the social institutions that are often called "traditional values".

If you haven't read it before, Theodore Dalrymple's The Frivolity of Evil, a piece for City Journal, is a superb introduction to this subject and one of the best articles I've ever read. The effects on the 'underclass' of the dangerous combination of the welfare state and the moral equivalence that pervades our culture and institutions is a subject Dalrymple has spent a huge amount of time discussing and if you want to read more his archive at City Journal is well worth a browse.

I think Phillips is wrong on one point. She suggests that "the supercilious overclass" has "the money to get itself out of trouble". It does have the money, education and other advantages to largely avoid the kinds of problems that afflict the underclass. That doesn't mean that it has got out of trouble. Allan Bloom's landmark book The Closing of the American Mind sets out the harm that relativism - emerging out of a frivolous nihilism - has done to the Western elite. It is a hard book to sum up within a single post but here's what I wrote when I first discussed it on my own blog:

"Bloom's masterpiece is hard to precis. It begins discussing his students and how relativism has closed their minds; how a doctrine of 'openness' has perversely undermined serious dialogue between different opinions and cultures. It then goes on a tour of Western philosophical thought illustrating the struggles that brought us to where we are now. My understanding of his critique is that we have lapsed into nihilism without taking the condition seriously. We cannot take seriously old visions of the good life and have broken the processes and destroyed the environments in which new visions might flourish. He sees this as a broad problem for Western civilisation but sees the crucial centre of the problem in the decline of liberal education within the Universities.

[...]

Dalrymple's work is excellent but if you only read Dalrymple and look at the problems of the poor it is as if you are studying an oceanic earthquake by measuring coastal waves and understanding the misery of those they make homeless. You need to understand the problem at its source. The source of the awful problems Dalrymple describes is in the elite and their intellectual decline. A philosophical decline in the West. Hopefully Bloom can provide a valuable first step in understanding that source of our problems."

That's pretty inadequate but this is a hard subject to get your head around. It is worth the time though as it is the thread that connects so many problems the modern Right should aim to confront. A relativist distaste for morals, nations and individual free will can be found at the root of a host of less esoteric problems.

The class card

This article by Nick Cohen has an interesting explanation of why Labour's attempt to play the class card backfired so badly in Crewe & Nantwich.

Of course, in some sense it is easy to explain why the "toff bashing" went poorly. It was done badly. They didn't have enough else to say, Edward Timpson isn't a "toff" in any meaningful sense and Tamsin Dunwoody is part of a political dynasty. However, it does seem to have been particularly ineffective and it might be worth thinking about whether there is a broader weakness in appeals to class.

My normal thesis is that the British people never respond the way class warriors expect them to and just don't think in classes. Ever since the First World War nationalism has proved itself just one group loyalty among many more potent than class. When Prescott said that Labour are "always better fighting class" he was clearly wrong. They got hammered by Thatcher when it was socialists versus capitalists in the eighties, the supposedly post-class Blair did far better. Marx was just wrong, at least in Britain and probably elsewhere, and class really isn't a good way of understanding political struggle.

However, Cohen might have a better explanation. He essentially posits a subtler understanding of class - i.e. class can have a significant effect on politics but it isn't just some lever a left-wing party can pull at will. The contemporary Labour party has no credibility attacking the ex-Bullingdon Club types as they are themselves just another tribe within the same elite:

"You will find part of the explanation the next time you read one of the 'when I was at Oxford I hated the Bullingdon Club' articles, which have taken permanent residence in the pages of the liberal press. You can guarantee that the outraged journalist or Labour politician was not at Oxford because they were working on the assembly line at Cowley. When they say 'I was at Oxford', they mean they were living in the same colleges and listening to the same tutors as Boris Johnson and David Cameron. They just moved in different social circles.

Freud's narcissism of small differences can power great hatreds and I have no doubt that the rage at the return of the Etonians is sincere. I feel it myself, while realising that these are tensions within a tiny and privileged part of British society.

[...]

Indeed not. Labour has been marching through the institutions for 11 years. With the exception of the armed forces, it has not allowed one state body to stay in the hands of natural conservatives. The Church of England, the BBC, the judiciary, the senior Civil Service, the trusts, agencies and quangos all have a pinkish hue. Even chief constables sound like Harriet Harman.

You can't run as an anti-elitist when you are part of the elite. You can only argue that you and your kind are best qualified to govern the country. Labour could make their case when Mrs Blair was gloating and Britain was booming. When hard times come, voters blame the people in power for their troubles, not 'the people on the grouse moor'. The old ruling class has been out for so long it no longer frightens voters, while Labour's jeers strike them as a cynical distraction from the enveloping economic crisis."

His casting of Thatcherism and the right-wingers who reacted with fury at attacks on grammar schools as representing a middle class, meritocratic (for better and for worse) anti-elitism within Britain's conservatives suggests that class distinctions are complex on both sides of the partisan divide. The most obvious expression of anti-elitism within the contemporary Conservative Party is, perhaps, Direct Democracy. That movement could be understood as an attempt to make elites more accountable to the popular will.

It seems plausible that the fate of the 'pink hued' elite, with values that might best be described as 'tranzi', that Cohen describes could come to dominate our politics in the coming decades.

Cross-posted from CentreRight.Com.