Polly Toynbee explains why the NHS should be privatised

Not, admittedly, what we would expect to hear from Polly but the case she makes for the privatisation of the NHS is logically perfect:

Ration life! Limit the value of a good year of human life to £13,000 to spend on any one drug, says a report from Prof Karl Claxton of York University. Spend more, and other patients die for lack of funds.

That’s the crunch point in NHS funding, according to health economists at York University, inventors of the original notion of measuring health spending by Qaly – a quality adjusted life year. If all health spending was put through this rigorous analysis of ensuring every pound bought the best value, there would be a remarkable shift in NHS priorities. Mental health would score highest, not lowest, in spending, as each pound can buy the most effective diminution of intense suffering. Suicides are rising, most among young men in deprived areas – deaths that could be preventable at reasonably low cost. Instead, a minor operation may take priority, as headline waiting time targets matter more politically.

During a period of the steepest cuts per capita the NHS has ever known, the government has weakened attempts to ration rationally.

Politics, being politics, means that the NHS is being run irrationally. The solution is therefore to remove the NHS from being run by politics. That part of national life which is not run by politics is known as “the private sector”.

Thus the NHS should be privatised. QED.

And do remember, it’s not us telling you this, that’s Polly Toynbee saying it.

We do sometimes wonder about the boffins

One of the endearing things about the very British idea of a boffin is that they are assumed to be entirely indifferent to the real world. What matters is the theoretical world going on inside their heads, not the more mundane one in which we all pass our lives.

This does, of course, lead to some hilarity when that theory is applied to said real world. Perhaps our favourite example of this was when the new economics foundation decided to take their principles of what constituted the good life and rank countries so as to decide upon where was the very bestest place to live. Their answer was Vanuatu (subsequent versions of the report changed the ranking method so as to produce a less embarrassing result). The best society on the planet was one of Stone Age tribesmen, wearing penis sheaths, who worship the Duke of Edinburgh as a Living God. This rather startling result does of course tell us a great deal about the theories the nef uses to evaluate the world.

We’ve a close contender for this in The Lancet Global Health:

Belgians are known for their chocolate and waffles, while Hungarians are famous for their rich goulash.

But now, a global study has revealed they are among the nations with the worst diets in the world.

Meanwhile, Chad and Sierra Leone, in Africa, have the best diets, consuming the most fruit, vegetables, nuts and wholegrains.

It will be interesting to see what “best diet” here means.

As part of the study, a team of international researchers analysed data on the consumption of 17 key food items and nutrients related to obesity and major diseases like heart disease, stroke, type 2 diabetes, and diet-related cancers.

They looked at the changes in diets between 1990 and 2010 in countries around the world.

They looked at three different diet patterns and gave each a score.

The first was based on 10 healthy food items: fruit, vegetables, beans and legumes, nuts and seeds, whole grains, milk, total polyunsaturated fatty acids, fish, omega-3s, and dietary fibre.

The second was an unfavourable diet based on seven unhealthy items: unprocessed meats, processed meats, sugar-sweetened drinks, saturated fat, trans fat, dietary cholesterol, and salt.

The third was an overall diet pattern based on all 17 food groups.

Hmm. So, by this ranking system the top five countries, the countries with the “best” diets are Chad, Sierra Leone, Mali, Gambia and Uganda. And the five with the “worst” diets are Armenia, Hungary, Belgium, Czech Republic and Kazakhstan.

Average lifespans in our best diet countries are, respectively, 51, 46, 51, 59, 56. For the worst diets, 74, 75, 81, 78, 68.

Meaning that whatever criteria our boffins are using for best and worst diet it seems to be an entirely theoretical one, existing in their heads not this reality we inhabit. For at the very least there’s not even a correlation between their idea of better diet and longer lifespan. Which, we would all rather assume, would be a useful definition of “better” in relation to diet, no?

We are reminded of the New Yorker cartoon with one caveman saying to another: “If all our food is free range and organic then why are we all dead by 30?”

Keep Politicians out of the NHS

In the run-up to the election, politicians are trying to out-bribe us with our own money to pay for escalating NHS expectations. Democracy has a dark side. Doctors are telling politicians to: “stop messing with NHS to win votes.” (The Times, 17th February, p.15).

Demand will always outstrip capacity for a free good such as health. The questions are simply two: how much money should be allocated to the NHS and how should those resources be best managed to maximise welfare?  The former question is essentially political but the latter should not be. The budget should be set annually and not agonised over every day.

As every government IT project demonstrates, government does not do management well. One can blame either politicians or civil servants but it is the combination that is fatal. Apparently the present Secretary of State for Health assembles his entire team every Monday morning to micro-manage NHS issues in Darlington, Taunton or wherever. Or rather to attempt to micro-manage. This may improve media coverage but it builds confusion and disheartenment throughout the NHS.

All the best-run large businesses know that those at the top should lead, not manage. The first level of management should be empowered to deal with the micro-stuff and thereafter the next level of management should deal with matters the lower level cannot sensibly address. Because the NHS is so very large, that lesson is the more important.

How can politicians be removed from NHS management? Simple. We have a relatively new, well experienced, NHS England Chief Executive. He seems excellent and a great improvement on his predecessor. NHS England and the other national NHSs should be converted into public corporations, like the BBC, i.e. a stand alone operations funded and responsible to government but managed, day to day, independently. Whether to close, say, a cottage hospital would be a matter for NHS England. Politicians will still, rightly, lobby but they should not be making the decision.

Our political leaders should lead, not second guess local NHS doctors and managers. In addition to setting the budget, politicians should agree the budget and the strategy, i.e. what, overall, we should expect for our money. Then they should get out of the operating theatre.

A neat solution to the vaccine problem

A bit of free riding is inevitable in a free society. But sometimes you get so much that it ruins things for everyone. To stop the spread of infectious diseases, you need a certain number of the ‘herd’ to be immune to protect unvaccinated people from the disease’s spread.

In some parts of the US, after years of (baseless) scaremongering about the MMR vaccine against measles, mumps and rubella, so many parents have now chosen not to vaccinate their children that this herd immunity no longer exists. Until recently they were able to free ride on vaccinated children and avoid the disease, but now measles is staging a comeback.

If it were only the children of these parents who were at risk, we might judge that risking their lives was a price worth paying for parental autonomy, depending on how lethal the disease was. But some children (and adults) cannot be vaccinated for medical reasons or because they are too young, so there is a clear external cost to others.

Because of that, depending on the lethalness of the disease, there is a case for government intervention, but it would still be nice to minimise coercion if possible. KCL academic Nick Cowen suggested one elegant way of doing that:

Modest proposal: pay parents of new borns about £2,000 ($3,000) on completion of all vaccines on a standard schedule, or on submission of a medical exemption certificate (just to be fair to children with genuine vulnerabilities to vaccines).

That should get everyone enrolled apart from the truly rich and stupid, and bring herd immunity (the public good we are looking for) up to scratch. If that doesn’t do it, double it. It functions as a good excuse to channel more money to families with young children – think of it as an upfront capital grant. The distribution is so broad that it will have few dead weight losses.

I imagine this would probably work, and it avoids having to put anyone in jail or take anyone’s children away from them.

The ethics and practice of blood donation

We’ve one of those lovely Guardian discussions over the morality of commercial practices. You can guess the tone just from the headline:

Blood money: is it wrong to pay donors?

And we of course observe the comments section filling up with outraged screams that of course it’s morally wrong.

Which isn’t actually the point that should be under discussion. What we’d really like to know is whether paid blood donation is efficient. And the answer there is that no, it’s not really. When offered a choice those who purchase blood place a higher price on blood that has been donated rather than that which has come from paid donors. Such pricing is because donations do tend to be og higher quality. So, if we could fulfill our requirements for blood and blood products purely from donations we would, by preference, do so.

But we can’t so fill our preferences. So, for blood products specifically in the UK, we purchase from paid donors in other countries. Shrug. It’s either that or simply don’t offer the treatment and it’s hardly moral to deny treatment because of some squeamishness that cash was involved in the process.

The important of this observation isn’t confined just to blood of course. We tend to think that kidney transplants are better than he slow death which is dialysis. But many do die simply because there aren’t enough kidneys available for transplant. And this would be true even if ever potentially usable organ was stripped from corpses, the wishes of their now deceased former owner be damned. To fill this gap we must therefore ask for live donations (much the same being true of liver and lung transplants, heart such cannot of course be carried out from a live donor). But there’s a rather limited supply of people willing to live donate a kidney.

When, as we do from time to time, we suggest that the obvious answer is simply to pay donors, as they do in Iran, we’re told that paying for kidneys would simply be immoral. As with those shouting about blood. Shrug: this means that people will die because of some squeamishness over cash having been involved.

Oh yes, most moral that outcome is.