The NHS is hiring assistants, not nurses - why might this be?

Quite who is complaining about this is one thing, what they’re complaining about another:

NHS hospitals are "plugging the care gap" with healthcare assistants amid a growing shortage of nurses, a new report suggests.

The study found the number of healthcare assistants is rising at four times that of nurses, amid a shortage of around 35,000 nurses.

For every nurse taken on between December 2015 and December 2017, four of the cheaper workers were hired.

In some areas, hospitals lost almost exactly as many nurses as they hired healthcare assistants, raising fears that the cheaper workers were being used as substitutes, endangering patient safety.

The study found almost one in three care roles in NHS trusts is now filled by a healthcare assistant.

We don’t know whether this is a good idea or a bad one, we’ll not claim expertise in clinical assessments. We do think it’s an entirely unsurprising outcome though.

The direction of movement in recent decades has been to make nursing a profession. Graduate entry only - or at least a degree is required as part of the training. It was quite blatantly pointed out that this was the aim, too. Make nursing that profession, a higher valued occupation, in order that nurses will be higher valued.

Well, people employ or buy less of higher valued things. Thus the creation of that graduate profession is going to lead to substitution with non-graduate staff. What else did anyone think would happen?

It’s also true that we still require the same amount of pillows plumped, bedpans emptied, bodies turned. The things that nurses might not be doing now that they’re prescribing and generally being more professional. So, again, substitution away from those with the higher qualifications to those with the minimum required to do that work that still needs doing.

We can imagine complaints about this view. That we’re not taking something seriously. But the logic is impeccable. For think about what the argument about the other end of nursing is. That nurses should be picking up goodly parts of doctoring. On the grounds that we don’t need people with 7 years of university, perhaps another decade of training, to do all that such have historically done. We can instead substitute to more specifically - and thus for a shorter period - trained nurse practitioners. Thereby using more narrowly but just as well trained staff to do what must be done.

Which does indeed make the logic impeccable. If nursing should move upmarket by biting off some of doctoring then that same new profession will find the lower levels of itself being chewed off by the nurse assistants.

What did anyone think was going to happen when nursing moves to an all graduate profession?

Mariana Mazzucato does have problems understanding her economics, doesn't she?

We’ve noted before that we’re unimpressed with Ms. Mazzucato’s understandings of the economic basics. But this particular complaint of hers strikes us as being laughable.

The NHS is facing ever growing challenges, not only because of recent cuts but also due to steadily rising expenditure on drugs. Our health innovation system is not serving the people that fund it; instead it provides monopoly profits for large pharmaceutical companies.

Well, yes, monopolies are bad things. Except when we deliberately create them to solve some other problem. Here it’s the public goods problem of knowledge creation. Once we know that aspirin cures headaches then everyone can go off and make aspirin. But the people who proved this - and in the modern world, more importantly, the people who spent $1 billion to prove this to the licencing authorities - can’t recoup their billion. Thus the billion never gets spent, we never do know and the authorities never issue the licence. We institute the time limited monopoly to get over this problem.

Certainly, there are other possible models out there. Reducing that regulatory cost is the one that strikes us as being most useful. Perhaps the model we use isn’t the right one from that palette of options. But whatever ones’ views there this is still a laughable complaint:

The global health innovation system lacks direction to tackle the areas of greatest need. Research shows that diseases that are not potential growth markets are largely ignored. Between 2000 and 2011 only 4 per cent of newly approved drugs were for neglected diseases that affect lower and middle-income countries, while 78 per cent of new medicine patents corresponded to drugs already on the market.

We’re against monopolies but we’re also against that market competition - other drugs to treat the same conditions - which reduces monopoly?

Is it too much to ask that a critique of this modern world at least be internally consistent?

Arbitrage and the gains from trade - cannabis edition

We know how to make the world that little bit richer. It’s only governments stopping this boost to global wealth happening. But then isn’t that so often the way with government decisions about and restrictions upon trade? That all they do is keep us poorer than we need be?

The background here is that Canada is just legalising the consumption of cannabis for pleasure reasons. That is, it has decided that adults may be adults once again without Nanny telling them they must, well, pretty much, eat their vegetables before they can have any ice cream. Canadians will be able to do what adults should be able to do, ingest that which pleases them.

There is a little wrinkle in this:

The latest data from StatsCan pegs the average combined cost of nonmedical and medical cannabis at 6.74 Canadian dollars ($5.19) per gram in the second quarter.


Canada’s supply of legal cannabis at current production levels is estimated to meet just 30 to 60 per cent of total demand, according to a report from think-tank C.D. Howe Institute released this week. The estimated demand across the country is roughly 610.6 tonnes but the forecasted available marijuana supply in the fourth quarter of this year is just 146.13 tonnes, the authors said.

As David Ricardo was known to have pointed out, Adam Smith too, trade is a pretty neat thing. And it’s the obvious solution to both any shortage of domestic production and what we might think of as the high price of it.

The UN telling us that cannabis in Malawi costs some $3 a kilo. Yes, that is $3 a kilo, as opposed to the Canadian price of $6-ish a gramme dependent upon which dollar you want to use.

Yes, we do know, really do know, that Malawi Gold is a perfectly respectable dope. Actually, considered one of the finer variants.

So, obviously, buy by the Great Lakes of Africa to sell around the Great Lakes of North America. With a 2,000 times price uplift there’s a margin in there. And in the absence of any laws stopping this it would obviously happen too. Actually, likely it has been happening even if in the small quantities the illegality would suggest.

Sadly, the new Canadian law - yes, we checked - only allows import for medical use, not recreational. Which is where the market is going to be, obviously enough.

So, in the absence of legal restrictions Canadian pot consumers would get likely better and certainly cheaper blunts. Some of the poorest people in the world, Malawian farmers, would see their incomes increase. Through that generally enriching form of trade, us all buying things made by poor people in poor countries. And it’s only government standing in our way.

How lucky we all are that government protects us from such mutual enrichment, eh?

Oh, and if you could tie crypto into this somehow you’d probably be able to float on a stock market by Monday morning.

To correct an historical misapprehension about the Indian economy

This is a common enough complaint. It’s also an odd one:

Politicians are a sorry excuse for historians

So Ben McIntyre, the historian, is going to put the politicians straight:

Take India. The British left much of value, including railways, laws and democracy, as well as a legacy of goodwill that a post-Brexit Britain would do well to cultivate. But the Raj also oversaw the destruction of Indian cultures, some appalling massacres and economic exploitation: in the 18th century India’s share of the world’s economy was equal to Europe’s; after two centuries of British rule it had plunged sixfold.

That claim about the Indian economy being a feature of a recent book by Shashi Tharoor MP. And one that does need correction by an historian, something we don’t get in The Times.

For of course the Indian economy did grow, substantially, over the period of Empire.

From Angus Maddison’s figures, the usual source, GDP per capita went from around $1,100 when Clive turned up to $1500 in 1945. And to about $1500 by 1994 too. Not a great increase in the average living standard of the average wallah to be sure.

The population of India moving from Clive’s 200 million or so to Nehru’s 400 million or so at Partition. And vastly higher in 1994 for we should add the population of Bangladesh, Pakistan, to India’s near billion.

400 million living at the same standard as 200 million is an economy which has doubled in size. an a billion doing so is a further increase of 2.5 x isn’t it.

That is, the Indian economy grew under Empire. Just as it did aterwards. The difficulty being that it was entirely Malthusian growth, more people at the same standard of living, not increasing standards of living.

You know, like everywhere grew, like everywhere does, without an industrial revolution and the accompanying (causative?) capitalism and free-ish markets.

The real point here being that what happened in India - economically, not politically - between Clive and 1947, between 1947 and 1994, is by historical and global standards just normal. The abnormality wasn’t there at all, it was that Britain, then other North Atlantic economies and now, finally, near everyone else, broke free from that normality.

The nutshell here being not what did happen to India but what didn’t?

Venezuela Campaign: reading into the schools crisis

Most Venezuelan schools are now empty of children and teachers, in a major crisis for the poverty-stricken country.

Former President Hugo Chavez used to boast that he was improving the education system, but his policies have had the opposite effect. The almost total collapse of the Venezuelan economy, caused by nationalisations, expropriations, price and currency controls, hyperinflation, mismanagement of the oil industry and abandonment of the rule of law, has ravaged the education sector.

The schools have been getting worse year by year. By 2016 about a quarter of Venezuelan school-age children were not enrolled. A study by Venezuelan universities at the beginning of 2018 revealed that out of Venezuela’s 8 million schoolchildren, some 3 million were absent. Fe y Alegría, a movement that provides free education in over 170 schools across Venezuela, reported a drop in student numbers of over 50% compared to 2017. As the economic crisis deepens, education is being affected more and more.

When the school term started this September, very few children came to school. In the poor community of Caucagua some 75 kilometres from Caracas, only three students arrived at the Miguel Acevedo public primary school out of 65 students registered. In the first week of classes, the turnout rate across the country was only 15-20%, the lowest in the previous century.

There are a number of inter-related factors in the collapse of the school system. One is the absence of many teachers, who are not being paid, or receiving enough to live on. “With my last pay check, I was able to buy a kilo of meat and a kilo of sugar,” said Roxi Gallardo, a 35-year-old teacher in the city of San Cristobal who, like many other teachers, is looking to leave Venezuela. The Venezuelan Association of Catholic Education reports that 3,500 of its teachers have quit their jobs, either to leave the country or to engage in informal work.

Another factor is that due to hyperinflation, basic items such as books, pencils and school uniforms are completely unaffordable. More importantly, many children came to school to receive free school meals. However, these are now rarely provided, and even then they are too small and lacking in protein to bother with. As the public transport system has collapsed, getting to school is much more difficult for children and teachers alike. Walking a considerable distance to school is difficult for children who are already under-nourished.

Children have been reported to become dizzy or faint because of lack of food. How can they learn when they cannot eat? “We were singing the national anthem and I felt nauseous. I’d only eaten an arepa (a local cornbread) that day, and I fainted,” reported Juliani Caceres, an 11-year-old student in Tachira state.

“Hungry people aren’t able to teach or learn,” said trade union leader Victor Venegas, president of the Barinas chapter of the national Federation of Education Workers. “We’re going to end up with a nation of illiterates.”

That Chavez made any improvements to education is largely a myth. The adult literacy rate was already 93% when he came to power, after decades of work by previous governments. Chavez sought to politicise the school system by turning it into a vehicle for his propaganda. Even Maths textbooks were turned into propaganda tools. Today’s absent schoolchildren will be spared the indoctrination, but the downside is that they are not being educated at all. Despite having the largest oil reserves in the world and having once been South America’s richest country, literacy rates risk a return to levels last seen in the 1920s.

More information on the Venezuela Campaign can be found on their website

To correct a commonplace error about Facebook

Not to pick upon one specific writer nor outlet here, but this is simply untrue:

Portal, which will go on sale next month in the US, is supposedly designed to make video chatting hands-free and immersive. A smart camera follows you around and ensures you stay in view while the system minimises background noise and enhances the voice of whoever is talking. “It’s like having your own cinematographer and sound crew direct your personal video calls,” Facebook says. It doesn’t mention the fact that said cinematographer has a history of flogging your personal information to all and sundry.

The selling data part that is. That’s not what Facebook - nor Google and so on - do at all. Certainly, they gain revenue from our attention. But that is a rather different matter:

Though Facebook doesn’t directly sell your information, it does “let businesses and organizations connect with the people who are most likely to be interested in their products and services,” as its ad education portal explained.

What they sell is advertising. That personal information not being sold to even sundry, let alone all. It being used instead to allow people to decide who to advertise to. Approaching any other media outlet - any one at all - will gain you a set of demographics of their customer base. So that you can decide whether you’d like to advertise to these people.

This is why Parturition Monthly will have piccies of babies and ads for nappies, why Mid Life Crisis Weekly articles about sports cars and ads for virility enhancers - where the two differ that is. Facebook et al are simply able to distinguish rather better among their users instead of delivering a total and undifferentiated bundle.

The importance of this is that it makes one set of demands out there ludicrous. That it’s our data, that the data is valuable and we should be paid for it.

At one level it’s already silly of course. Facebook makes perhaps - in revenue, not profit - $100 a year from a rich world user. 30 US cents a day. So, any system of paying us for that, well, how much is the accounting and distribution system for that sort of sum going to cost? As if any of us really care about that sort of sum anyway.

It’s also true that the data itself is valueless on its own. It’s the agglomeration of it, the slicing and dicing of it, which adds the value. That being exactly what Facebook is doing and it seems reasonable enough that the people adding the value get to keep it.

But now look again at the demand being made about that they pay us. What is sold is the ability to advertise to us. So, the demand is that we should be paid for being shown advertisements. And however tempting that is when shown yet another smiling, dry, baby or virility enhancer zooming along a mountain road we do all recognise that’s not quite how economic reality works out, don’t we?

In simpler terms the internet isn’t selling our data therefore there’s no money we can insist on having back from the sale of our data, is there?

Yes, yes, but how much?

We really do need to remind ourselves of Paracelsus - the poison is the dose:

'Huge concentrations' of toxins found in Grenfell soil, study finds

Exclusive: Public Health England has not acted on early findings of report warning of potential carcinogens

The question is the meaning of that word “huge” isn’t it?

Early results of the study by Prof Anna Stec prompted her to privately urge Public Health England (PHE), the Department of Health, the police and Kensington and Chelsea council to organise a range of tests to ensure any potential health risks can be properly assessed.

In briefings to senior health agency staff, Stec said she had found “huge concentrations” of potential carcinogens in the dust and soil around the tower in west London, and in burned debris that had fallen from the tower.

High levels of hydrogen cyanide were also present in the soil she analysed.

Well, what’s “high”?

HCN, prussic acid, hydrogen cyanide, being something that is produced in fires. It’s in cigarette smoke, car exhaust and absolutely every house or structural fire residue. Also almonds.

As a gas floating around it’s pretty dangerous. But the reason it wasn’t used for long as a WWI gas is because it’s rather light. It dissipates up into the atmosphere and with a boiling point just above room temperature it doesn’t lie resting around in the soil all that much either.

Sure, we’d like to know that it’s there. But the important thing we want to know is “how much?” For we know, absolutely, that there’s going to be some there just because humans have been burning things in London for some time now. We’re also interested in whatever additional amount Grenfell might have led to. But we are only interested as an intellectual exercise.

Without that dose information we’ve nothing but scaremongering on the back of that tragedy, do we?

Surely these people have actually been to Europe?

A line that rather surprised us:

Some people will victim-blame here, and say that these people should get off their lazy arses and cycle to the shops. But there are deep, systemic reasons for these problems. Travel to parts of Europe and you see the reliance of other cultures on the square – a place to meet, converse and for children to play, but also often containing a greengrocer and a bakery and a butcher. This side of Britain feels lost to the big supermarkets, our high streets rendered redundant by out-of-town shopping centres and internet giants. There could be radical architectural solutions, but with government investment in housing dispiriting at best, these are unlikely to take place any time soon.

That idea that people sell cauliflowers on the town square. Perhaps in a small village, where the square is the town. But not in anything of any size - the property is far too valuable to be trying to sell something as low margin as vegetables. Town squares are for the jeweller, the fancy fashion shop, the restaurants and cafes.

It’s as if these people haven’t actually been there to Europe despite that budget airlines revolution.

Such trivia aside there’s a deeper logical error:

Those of us who have ever had a “cornershop dinner” will know the sort of options available in food deserts: the only shops for miles around sell very little fresh food, so you’re left with a choice between meals such as dried instant noodles or pasta, tinned Scotch broth, and if you’re lucky enough to have a freezer cabinet, pizza. These small shops are also often very expensive, too, but in the trade-off between spending money on transport to the nearest big Tesco for broccoli or a filling, carb-heavy meal, it’s no wonder people opt for the latter.

What they’re calling food deserts now the rest of us would call the 1970s. Britain not exactly being well known as a mecca of fine foodstuffs easily available back then. It also wasn’t a nest of obesity back then either so there’s something else going on, isn’t there?

It might well be true that the future arrives unevenly over geographic areas. But that the vast majority of the country has had it, some small part remaining mired in the past, isn’t the cause of obesity.

A supposition most unlikely to be true about food prices

The Social Market Foundation tells us that poor people in Britain are obese because food for them in “food deserts” is so expensive.

More than a million people in the UK live in “food deserts” – neighbourhoods where poverty, poor public transport and a dearth of big supermarkets severely limit access to affordable fresh fruit and vegetables, a study has claimed.

Nearly one in 10 of the country’s most economically deprived areas are food deserts, it says – typically large out-of-town housing estates and deprived inner-city wards served by a handful of small, relatively expensive corner shops.

Public health experts are concerned that these neighbourhoods – which are often also “food swamps” with high densities of fast-food outlets – are helping to fuel a rise in diet-related conditions such as obesity and diabetes, as well as driving food insecurity.

As the report itself says:

Food is a key component of household budgets in the UK. Across the country, food accounts for about one in every ten pounds spent by households. For households in the bottom income decile (the poorest 10%), food accounts for about 15% of all expenditure and takes up about a fifth of household disposable income.

Just under a fifth (17%) of households surveyed as part of this research said groceries put a strain on their finances. For individuals with a household income of £10,000 or less, about two fifths (39%) said groceries were a strain on finances, as did about a quarter (23%) of those with a household income of between £10,000 and £20,000.

A strain on finances? Yes, obviously so, this is the definition of being poor, where everything is a strain upon finances.

But this idea that the expense of food - healthy food if you desire - is causing the obesity epidemic strikes us as most unlikely. For the remarkable thing about food in Britain today is how amazingly cheap it is by any historical or global standard:

Britons spend an average of 8% of their total household expenditure on food to eat at home. This is less than any other country apart from the US and Singapore, according to data from market research firm Euromonitor.

Food spending varies considerably around the world. Greeks spend 16%, while Peruvians spend 26%. Nigerians spend the most on food in relative terms - 59% of their household budget.

The full spreadsheet can be found here. That 15% of income for those poorer households puts them among Italy, Slovenia and Brazil as a portion spent upon food. Those three nations all suffering an outbreak of obesity? And, of course, that 15% is vastly lower than anyone in this country was spending a century ago when we were all worried about the malnutrition based stunting of the working classes.

We’re simply not willing to believe in this supposition that obesity is caused by the great expense of food in this country.

Madness behind the method in racial pay gap stats

Madness behind the method in racial pay gap stats

Yesterday the front pages were filled with the news that the Prime Minister was going force all companies with more than 250 employees to disclose how many of each census ethnicity they have, and what different ethnicities get paid at the median.

This builds on the gender pay gap stats that Kate Andrews at the Institute of Economic Affairs has so roundly rebutted before, but companies nonetheless have to report. A totally useless set of statistics used to bash businesses and one which does not solve the issues it purports to.

Leaving aside the fact that there is nothing to force employees to disclose their race to their employer, or that there is something weirdly sinister the government demand companies do so, I’m convinced this crude measure will add yet another unnecessary burden to business and do nothing but sow division without reason.

As Tim Worstall, a Senior Fellow here at the Adam Smith Institute, said in a letter to the Times today: these figures are “misleading because the age structure of the population differs by formally defined race. From the 2011 census, the whole population median age was 39, that of the white population 41, Asian, black and other, 30, 30 and 29 respectively, and mixed 18. Pay rises with age, as promotions to better-paid positions are earned through experience.”

To put it bluntly, in the United Kingdom we’ve seen a large change demographic change in the past 50 to 60 years. In the UK, you’re like to earn the most between the ages of 40 to 54. If the white population’s median age is at that point and at peak earning potential at present, while other groups are younger and so behind in peak income, then any figure that does not control for this but is used to highlight a supposed ‘gap’ will be misleading at best, or otherwise downright dishonest.