Is Mr Lansley About to be Toast?

LONDON, ENGLAND - APRIL 13:  Secretary of Stat...
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Andrew Lansley – Is He About to be Hung Out to Dry?

Labour have been attacking the government’s NHS reforms.

As the BBC puts it:

Labour said the reforms in England would introduce a “full-blown” market into the NHS and put hospitals at risk.

The Royal College of GPs say the proposals are “unravelling and dismantling” the NHS.

The Liberal Democrats, as ever, are stuck in the middle, vowing to be a “moderating influence” on the Conservatives in the Coalition – whatever that means.

I watched a little of the pointless debate by accident on the BBC News channel.

John Healey, for Labour, bemoaned the fact that under the Conservative proposals, NHS hospitals might actually go bust.

He did not dwell on what might cause an NHS hospital to go bust. That would only happen if it was run so badly that it did not attract any patients, and the patients were all choosing to be treated by rival hospitals. Mr Healey wants to keep open even failing NHS hospitals, because, you see, they are part of the sacred National(ised) Health Service.

Andrew Lansley, the Health Secretary, responded by saying

What matters is the views of NHS staff.

Yes, really he did say that. And by that little phrase, ladies and gentlemen, Mr Lansley laid bare everything that is wrong with the NHS. Here was a Conservative letting slip that what is important to him is not the views or interests of patients, but the views and interests of NHS staff.

There seems to be a wall of misunderstanding over health services. Tony Blair once said “The NHS is not a supermarket, for goodness’ sake!” And yet, without food distribution, we would all starve. Our food distribution network is every bit as essential as our health services – arguably even more so.

People seem to be able to understand that competition in food supply is a good thing. They understand that the interests of food consumers are best served by a free market in food distribution. Nobody, not even Labour, suggests that we should nationalise all Britain’s food shops otherwise some of them might – shock horror – go bust.

And yet, over health care, people come over all misty eyed. That dream of Socialist Utopia that the Labour government of 1945 created seems to be alive and well in people’s attitudes to the NHS.

We ought to be a bit more grown up.

NHS nurses are not “angels”. They are human beings doing a job. They deserve to be properly paid for it, and they deserve to be respected. They need to be managed and they need to be motivated. It is simply not enough to claim that their devotion to public service is enough to motivate them.

And the same goes for doctors, ancillary workers and everyone else working in British health care. They all need the discipline of the market and competition to motivate them to serve patients. Tesco only serves customers well because otherwise the customers go off to Sainsburys – not because its staff have a vision that they are stopping starvation on our streets.

Patients are the ones who matter – or who should matter. Mr Lansley’s NHS reforms go in the right direction. And as Labour seem not to understand, the reason they are right is, ultimately, because under his proposals, NHS hospitals might go bust.

In the 1980s, contracting out of refuse collection was highly controversial. People were shocked at the idea that private companies might make money by collecting our rubbish. Now, privately run refuse collection is commonplace. The ideologically driven debate of those times seems an anachronism. One day, the same will be true of this government’s timid attempts to introduce market disciplines into health care. One day, people will wonder what all the fuss was about.

The government either gets on with these reforms and defies its critics, or it backs down. Sadly, I fear that David Cameron may well end up hanging Mr Lansley out to dry as Mr Cameron runs for cover. After all, he can always blame a climb-down on Nick Clegg.

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What If Food Supply Were Organised Like the NHS?

First self service Tesco, St Albans, England
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Wikipedia

Would You Rather Have This or State Food Shop Number 1?

There has been lots of controversy about the NHS reforms, which are published today. Watching the debate has been like peering through a window into another gloomy world, in which nothing can work unless it is centrally planned and managed, and free enterprise is anathema verging on evil.

Just to bring home how unreal the whole thing is, let me take today’s article by the BBC on this and change it slightly. (This is no criticism of the BBC, by the way, who simply reported the comments of the parties involved.)

Imagine a world where the government ran all the food shops and food distribution, under a nationalised “Food Supply Service”. Everyone could get whatever food they needed free, provided their family cook wrote to the food shop asking them to provide it. Food shops would not deal with anyone unless they had a family cook’s referral.

Imagine people had died due to food poisoning in large numbers, and shortages of particular foodstuffs were commonplace. Imagine food shops were notorious for being filthy. Imagine the government was spending as much on food supply as other countries, but many people were still going hungry, and some starving.

And now, here’s that doctored BBC article:

Ministers seek to answer critics as Food Supply Service bill published

Ministers have taken the first step towards an overhaul of the National Food Service in England with the publication of controversial draft legislation.

The Food Supply Bill paves the way for family cooks to get control of most of the Food Supply budget from 2013.

Unions warn the plans could undermine the food supply service, while MPs say they have taken the Food Supply Service by “surprise”.

But the government argues the changes will improve the provision of food and accountability.

Speaking as the legislation was unveiled, Food Supply Secretary Andrew Lansley said modernising the Food Supply Service was “a necessity not an option”.

He said: “In order to meet rising need in the future, we need to make changes. We need to take steps to improve nutritional outcomes, bringing them up to the standards of the best international food supply systems, and to bring down the food money spent on bureaucracy.

“This legislation will deliver changes that will improve the supply of food and save the Food Supply Service £1.7 billion every year – money that will be reinvested into supplying food for hungry people.”

Pace of Change

The plans will led to more than 150 Food Supply Service organisations being scrapped and sweeping changes to the way food is supplied.

Family cooks will take on responsibility for “buying in” the bulk of food for hungry people.

In the process, all of England’s primary food supply trusts (PFSTs) and strategic food authorities will be disbanded.

Commenting on the bill, Dr Laurence Mynors-Wallis, Registrar of the Royal College of Food Delivery Experts, said the college was concerned about the pace of change.

“We are particularly concerned that in some areas the new structures will not have the skills or expertise to support bread buying,” he said.

“There is a danger that, in the new system, bread will be bought from the cheapest provider at the expense of quality.”

Betty McBride, Policy & Communications Director at the British Milk Research Foundation, said hungry people at “the sharp end of these reforms” must not be forgotten.

She said: “If the Government wants to make reducing hunger the measure of success, then these are exactly the issues they have to address.”

‘Disastrous’

Earlier, during exchanges at Prime Minister’s questions, David Cameron was accused of being “arrogant” for going ahead with the moves despite warnings from unions and food experts.

Labour leader Ed Miliband said food shop staff had warned of “potentially disastrous” consequences for food supply.

But the Prime Minister said the Government was “reforming the Food Supply Service so that we have got the best in Europe”.

The changes were first set out in a white paper published last summer. They apply solely to England – Scotland, Wales and Northern Ireland have different systems.

Managers working for PFSTs are currently responsible for planning and buying local food from bread to coffee, but under the changes consortia of family cooks will take on responsibility for this from 2013.

Pilots are already starting and once the process is complete, two tiers of management – PFSTs and the 10 regional food supply
authorities – will be scrapped.

The bill has been eagerly awaited by those in the Food Supply Service to see just how much power will be devolved to family cooks, how they will be held accountable and what safeguards will be put in place.

‘Extreme concerns’

In the lead up to its publication, fears were voiced by the
Confederation of State Food Shops that food shops could go bust as the plans include opening up the Food Supply Service to “any willing provider”.

Critics have also questioned whether family cooks have the experience and skills to handle such huge budgets – they will have control of about 80% of the budget.

On Tuesday, the Commons food supply committee criticised the scale and speed of the reforms, saying the Food Supply Service had not been able to plan properly.

A host of unions, including the British Association of Cooks and the Royal College of Washers Up, have expressed their “extreme concerns” that greater commercial competition in the Food Supply Service would end up undermining the supply of food.

The government has responded by saying it is all part of a managed transition to devolve decision-marking closer to the eater so services are designed in a better way.

The timing of the reforms has also been questioned. While the Food Supply Service will be getting small funding rises in the next four years, it is still being asked to making savings – £20bn by 2014.

Peter Carter, of the Royal College of Washers Up, said: “This reform programme could come off the rails, as people concentrate on saving money rather than delivering quality food.”

Meanwhile, back in the real world, Tesco, Sainsbury’s, Asda, Morrison’s, the Co-Op, Waitrose and a host of others are competing ferociously to supply food, there are no shortages, food quality is excellent and improving and prices are under control.

But there is no central planning, so obviously we are all heading for a disastrous future of starvation.

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Lecturing by Stealth

Mark Easton in his BBC Blog had a thoughtful piece on the nature of Right wing politics yesterday, in which he was kind enough to mention my post on Andrew Lansley.

Mr Easton was pointing out the fault line that has existed in Conservative politics since time immemorial – between the idea of individual liberty and social responsibility – both ideas dear to the Right. The Government’s whole “nudge” philosophy attempts to bridge the gap between these two. As he said:

The health secretary draws a distinction between the “nanny state” and the “nudging state”. Last summer he told doctors he is opposed to “lecturing people and telling them what to do” preferring to “harness behavioural science…nudging individuals in the right direction”.

Which really begs the question. Who decides what is the “right” direction? The answer, of course, is Mr Lansley and his mates in the Government. Or rather, in practice, it is the civil servants and officials who really run the country most of the time.

There is a moral point here that people like Mr Easton can understand – the question about whether those people actually have the right to decide for everybody else what is “right”.

But there’s a deeper point even than that, which the Chattering Classes who run the BBC absolutely do not understand. And that is that dispersion of decision making leads to more effective decisions.

A market works more effectively than a centrally-planned economy. In part that is because of incentives due to competition. However, it is also because many small decisions are made rather than a smaller number of big decisions.  In both cases, some of the decisions will be wrong. But overall, the many small decisions lead to better outcomes.

This principle applies to social matters as well. A smaller number of centrally-made decisions will lead to worse outcomes than a mass of small decisions made by individuals for themselves. Politicians like Andrew Lansley, and indeed David Cameron, completely fail to understand that, simply because they don’t even notice that those central decisions can be wrong.

I’ve mentioned before the baby deaths that were caused by poor advice from health professionals to lie babies on their fronts to sleep. That was a “nudge” from the State if you like – and it led to hundreds of preventable deaths. The advice was simply wrong. If that decision had been left to individual mothers, most would have put their babies on their backs. Sure, some would have got it wrong and put their babies at risk. But overall fewer would have died.

All of which means that the “nudge” ideas that Mr Cameron seems to favour so much are not just immoral, but likely to be harmful as well and lead to worse outcomes than if they minded their own business.

Mark Easton finishes his post thus:

Here are a few of the estimated annual health costs which, it is argued, a public health strategy might help reduce:

• smoking-related illness – £2.7 billion
• alcohol-related illness – £2.7 billion
• drug-fuelled crime – £13.9 billion
• noise – £5-8 billion
• poor air quality – £9-19 billion
• working days lost to sickness absence – £13 billion (2007)
• hip fractures – £1.4 billion
• poor mental health – £77.4 billion (2003).

Nudge or nanny? Faced with the bills for all of this, one can imagine why Mr Lansley is reluctant to let go of the apron strings completely.

Even this is wrong. A moment’s thought will tell you very clearly that these figures are completely made up nonsense. Let’s test them:

Smoking- and alcohol-related illnesses – well, it’s been pointed out before: if people don’t smoke or drink themselves to death, they still die of something eventually. So if you don’t treat them for lung cancer or cirrhosis of the liver, you end up treating them for something else. What’s more, if you stop them smoking or drinking, they live longer – which actually costs the NHS more. And that’s before you even start on the taxes they pay on their cigarettes and booze. Epic fail – reducing drinking and smoking might be “desirable” but it will cost money not save it.

Drug-fuelled crime – hey ho, that’s a good one! The fastest way to stop that is to legalise the drugs. (Which I don’t support, by the way, because like all good Conservatives I hold those two contradictory principles, of individual liberty and social responsibility, at the same time!) In fact, though, economically speaking, the figures are rubbish anyway. Most of that money that is supposedly “cost” by drugs, is made by criminals – who then spend the money on things that have nothing to do with drugs. When a car company sells a nice shiny new car to a drugs baron, the money goes back into the legitimate economy.

Noise – eh?! Not sure what he’s on about there. How on earth can noise cost £5-8 billion?

Poor air quality – the vagueness of those figures (£9-19 billion)  tells you all you need to know about how much you can rely on them.

Working days lost to sickness absence – that’s a good one. First, some of those were actually shirking and not real sickness. Second, some of the work not done was caught up when the person returned to work. Those figures are nonsense as well.

Hip fractures – assuming that is the cost of treating them on the NHS, how much would the government need to interfere in people’s lives to reduce that? And when do we, the people, get to choose whether to do whatever it is we’re doing that leads to the fractures, and pay the extra taxes to fix them, or whether not? Never of course. Mr Lansley will decide for us.

And poor mental health. £77 billion!! Good grief, that’s somewhere near the entire cost of the NHS. That figure too is complete rubbish.

Overall, then, Mr Easton’s figures of potential savings from “nudging” are not worth the paper they’re printed on (or the computer screen they’re displayed on). They are typical public sector “facts” – nonsense dressed up as fact by being uttered by supposed experts who often actually have no clue about anything much. Those people always – always – have their own agenda in producing the figures, just as people in the private sector do. And those are the people, remember, that Mr Lansley wants to make those decisions about what is good for us.

“Harness[ing] behavioural science…nudging individuals in the right direction” is actually the same as “lecturing people and telling them what to do” – except that it’s done secretly and not openly.

Basically, nudging is stealth lecturing. That is why it is both immoral and likely to damage our society.

Andrew Lansley’s Socialist Nudges

The Coalition has come up with its latest Nanny State proposal.

They will give schoolchildren shopping vouchers if they walk to school, rather than taking other less environmentally-friendly transport.

The proposals will apparently be part of a Health White Paper, to be announced tomorrow.

Every school in the country will be offered access to technology which would allow children to use swipe cards to track their journeys, so that points can be swapped for consumer rewards.

This is all part of the government’s famous “nudge theory” approach. Apparently it is completely different from Labour’s Nanny State approach. Labour would lecture people to change their behaviour. The Conservatives will bribe people to change their behaviour – sorry

harness the latest insights into behavioural science … nudging individuals in the right direction and encouraging positive choices

as Andrew Lansley, the Health Secretary, put it.

Whichever way you put it, it’s more Socialist than the USSR ever was.

A recent immigrant from the old USSR shocked me a little last year by saying in passing “of course, the government here is much more powerful than it is in my country”. That was in a completely different context – but it applies here too. The government of the USSR would never have dreamed of interfering in people’s lives to the extent of telling them what transport method they “ought” to take to get to school.

Ordinary people are sick of the government telling them what they should or shouldn’t do – even in matters that are none of the government’s business. And if they want the support of Conservative Party members like me, to tramp the streets during election campaigns, they need to change their approach. I for one have no intention of lending my efforts (not to mention the money from my Conservative Party membership) to keep a government in power that increasingly looks like New Blue Labour.

There’s a simple response that we all ought to give Mr Lansley for this nonsense: MIND YOUR OWN F***ING BUSINESS.

Demanding Money with Menaces Ought to be a Last Resort

Dick Turpin – Who Seems to Have His Admirers Today

There was an earnest discussion on Radio 4 this morning about the “drink problem”. The problem is that large numbers of people are drinking too much in towns across the country, and causing trouble while they are drunk.

The discussion on Radio 4 concerned a proposal from America. The idea is that when somebody is convicted of a drink-related crime, then they could have an order placed on them, requiring them to be breathalysed twice a day for a period.

As the discussion went on, the area for debate widened into a general one about how to stop people drinking so much.

The whole debate centred around which approaches would be effective.

The guy from Alcohol Concern said that he applauded the idea of tackling “problem drinking” but he wanted to know whether people would remain sober after their “breathalyser order” had expired.

He was also concerned about whether government funding for this would continue. In fact, he mentioned that just a few seconds after somebody else had mentioned that the people concerned would be paying for their own breathalyser tests. Perhaps he was becoming confused between government funding for this suggested scheme, and government funding for Alcohol Concern.

For the record, in 2008/9 that included £542,000 in government grants, and a further £321,000 from “Consultancy and Training”. They have one member of staff, presumably their Chief Executive, earning over £60,000 per year. Their staff numbers fell from 12 to 10 in 2008/9, but their salary costs went up by 11 percent.

Their annual report states:

The growth in income is largely due to Primary Care Trusts and Local Authorities taking on the Public Service Agreement national indicator at a local level which has required both assessments of their ability to deliver against the target (consultancy) and then train staff to understand and deliver alcohol interventions
(training).

It is unclear from the report how they delivered this increase in their work with a drop in staff numbers, or why that was accompanied by a 20 percent increase in average salary per head in the
organisation.

In the Radio 4 programme, the Health Secretary, Andrew Lansley, was quoted as believing that “nudging” people to behave properly – by measures like minimum drink prices – was more effective than compulsion. There it is again – discussion of the means to control people, but never any discussion of whether controlling people is actually a morally right thing to do.

All of this, whether it is compulsion or nudges, is funded by taxes. And taxes, remember, are extortion of money with menaces. Yes, they really are. A libertarian would perhaps conclude that taxes are immoral, which is a logical position to hold.

Personally, I don’t take that view. I actually do believe that the government is right to extort money with menaces (i.e. levy taxes) for certain purposes that we all need.

I do actually believe that extorting money to pay for Defence, or the Police, or even the National Health Service, is justifiable. That is because it allows the provision of universal services without the problem of “free riders” that would occur if the services were funded voluntarily. (The free riders are the ones who use the services but don’t ever contribute).

The idea of placing “breathalyser orders” on people convicted of drink-related crimes sounds fair enough – because those crimes affect other people, and people who have been convicted of crimes surely forfeit some of the rights that everyone else has. We accept that when we accept that criminals should sometimes go to prison.

However, it is morally wrong to extort money from people (levy taxes) and then use the money to try and drive their behaviour.

Extorting money with menaces to pay for “five a day co-ordinators”, or even Alcohol Concern, is quite simply immoral. It is – well – extorting money with menaces.

And that’s why the whole discussion on Radio 4 this morning was so completely objectionable. Basically, it represented a self-appointed elite discussing openly what was the best way to use our money to control us.

Mr Lansley please note, whether you call it “nudging” or whether you call it “socialism”, extorting taxes and using them to control people’s behaviour is wrong.

Nag, Nudge, Manipulate or Control – Is There a Difference?

Andrew Lansley – Fighting the Manipulators in our NHS

Andrew Lansley, the Health Secretary, has been telling the British Medical Association that the NHS needs to stop nagging people.

Here’s what he said:

Jamie Oliver, quite rightly, was talking about trying to improve the diet of children in schools and improving school meals, but the net effect was the number of children eating school meals in many of these places didn’t go up, it went down.

So then the schools said ‘It’s OK to bring packed lunches but we’ve got to determine what’s in the packed lunches, we’ve got to decide what’s in the packed lunches.

To which the parents’ response was that they gave children money and children are actually spending more money outside school, buying snacks in local shops, instead of on school lunches.

He then said that the response was to suggest that shops near schools should be banned.

Actually, where do we end up with this?

All of which tends to prove that Mr Lansley has some good sense in his head.

The BBC got the wrong end of the stick, deliberately or otherwise, and headlined the article Lansley Rejects Jamie’s Dinners.

“Jamie Oliver, quite rightly, was talking about trying to improve the diet of children in schools and improving school meals” doesn’t sound like rejection to me.

The “public health experts” weren’t happy either though. The BBC quote Professor Alan Maryon-Davies of “the UK Faculty of Public Health” as saying:

I find it deeply distressing. I think what Jamie Oliver did was excellent. The whole thing managed to improve school meals and pushed the government into investing more money into them.

Of course, we could probably do a little less nagging, but you still need to nudge people. It is about creating the right environment so healthy choices are easier to take as well as encouraging them to change their behaviour.

Wrong. It is none of the NHS’s business to “nudge” people or nag them or to try to make them behave in any particular way. Have we really reached the stage in this country where someone in the public sector can blithely suggest that their job is social engineering and not be challenged? The job of the NHS is to provide services to the people, not mould their behaviour.

Note the use of the word “invest” as well. This is, of course, typical of the public sector. No matter whether that extra spending on school dinners was a good thing or not, it was not “investment” but consumption. Or spending, if you like. Next time I go shopping in Sainsbury’s I must remember to “invest” more in our Sunday dinner.

The Faculty of Public Health, by the way, is, according to their website:

the standard setting body for specialists in public health in the UK. We are a joint Faculty of the three Royal Colleges of Physicians of the United Kingdom (London, Edinburgh and Glasgow).

They are a registered charity, but their accounts reveal that around a quarter of their income comes from “grants for public projects” and most of the rest from members fees and subscriptions – and most of their members work in the public sector. In other words, they represent the professional “nudgers” from our National Health Service.

The Tories in Opposition talked a lot about using this “nudge” philosophy to achieve changes in public behaviour. Mr Lansley’s comments are a welcome indication that in office, they may be more robust in their attitudes.