Posts Tagged ‘health’

The Clegg era starts here

Saturday, January 12th, 2008

Notwithstanding my gripe on Thursday, Nick Clegg has had a very good week. He started by putting the finishing touches to his front bench, made a series of appointments regarding reforming party structures (about which I must get around to blogging about it detail at some point), made a well-judged debut at PMQs and has now made a major speech on public services reform.

This is the speech I didn’t get during the leadership election but nonetheless voted for, so I’m delighted my gamble seems to have paid off. Linda Jack’s point that he spelled out his approach in an SMF seminar in December misses the point: he spent the election campaign downplaying all this stuff when so many of us were urging him to be bold. Making a token speech to the SMF, towards the end of the campaign and with no fanfare is the oratorical equivalent of putting planning proposals, to quote Douglas Adams, “on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of The Leopard‘.”

So much for the past and back to today’s speech. I’m happy with it because it moves us forward, not in some symbolic “break with the past” way that some of the headbangers in the party might like but through clear-headed liberal analysis about what is wrong with public services in the UK and how they work elsewhere. There is a clear continuity with the approach the party has always had and the direction it has been traveling in.

It is a very politically calculated speech, and I mean this in a good way. He’s correct to say that the Orange Book was correct to call for the marrying of social and economic liberalism. What no doubt would have been more boring to say was that notwithstanding the question of how you get the balance right there is virtually no-one in the party who would disagree with that sentiment (a point about which most political commentators seem unaware): he could equally have said the same about the “social liberals’” answer to the Orange Book, Reinventing the State.

Some sections in it, such as his call to scrap F and G GCSE grades, probably won’t transform society, but they represent a move away from an “everyone shall have prizes” approach to education and towards clearer delineation between pass and fail. This is symbolism, but in a meaningful way.

Possibly the most important passage of the speech can be summed up in a few lines:

I stand for these simple principles:

The state must intervene to allocate money on a fair basis.

The state must intervene to guarantee equality of access in our schools and hospitals.

And the state must oversee core standards and entitlements.

But once those building blocks are in place, the state must back off and allow the genius of grassroots innovation, diversity and experimentation to take off in providing an array of top-class schools and hospitals.

At first it sounds very motherhood and apple pie, but in practice this is a real challenge for political parties of whatever hue to live up to. Clegg singles out Brown’s approach for failing to live up to these core principles, but the same could be said of Cameron, such as his proposal for a “Tsar of all the MRSAs.”

It will be a key test of the Lib Dems in the future to see if they can live up to these principles or are tempted to jump on this interference bandwagon. The biggest challenge is what exactly is meant by “core standards and entitlements”. You could argue that the National Curriculum does that; Labour certainly do. The National Curriculum is a “minimum standard” that has grown and grown over the past two decades, driven by political expediency. One person’s minimum standard is another person’s nanny-state interference. Literacy? Some educationalists argue you shouldn’t even start to formally teach reading until the age of seven. Sex education?

How do you stop minimum safety nets from transforming into straitjackets over time? And who sets those minimum standards: national or local government? My suspicion is that we need to better spell out what checks and balances need to be put in place for such a system to work in practice, but that is for another time.

His model for Free Schools will also need careful crafting. Over the New Year period, Clegg caused some controversy by endorsing the role faith schools have to play as “engines of integration” in The Jewish News. I commented a few months ago about the hypocrisy of Jonathan Sacks making the same point while opposing any measures which would stop faith schools from being able to choose their own pupils. If Clegg wants to ban selection completely, which also means taking on the handful of local authorities which still have grammar schools, he will have to also take on the faith lobby which he has been courting.

Orthodox Judaism isn’t the real issue here anyway. I’m sure the Vardy Foundation will have very little problem with banning selection if what they’re getting in exchange is even greater freedom to teach creationism. I’m sure the Scientologists Applied Scholastics are similarly licking their lips. And these problems are relatively simple in urban areas where there is a great enough population density to mean that parents have a wide choice of schools to choose from; in rural areas the economics works very differently.

It isn’t all one way of course; under this proposal there is nothing in principle to prevent a group of parents setting up their own school and effectively starving the local brainwashing academy of minds (so long as they can find enough support). If it is an open enough system for L. Ron Hubbard’s supporters, it is certainly an open enough system for fans of Richard Dawkins. The challenge for this proposal (which emphatically is not a fatal one) is how we combat liberalism’s greatest enemy: monopolistic power.

The health proposals are less problematic for me. The idea of allowing patients to go private after a waiting time period has expired is a sensible middle way between the Tory’s old policy of voucher system which would simply have undermined the NHS by allowing the wealthiest to take the money and run, and Labour’s target culture.

Overall then, this is an excellent start for the Clegg era. It is the most thoughtful speech given by a party leader since Ashdown departed these shores for Valinor. I think he needs to slightly change his mode of attack on Cameron, with whom he is so frequently compared. He needs to emphasise that while Cameron adopts similar rhetoric, even if he is being sincere he can never deliver while he is at the mercy of a mulish party which only allows him to lead when it feels like it.

The key fight to pick with Cameron, which to Clegg’s credit he seems to have identified as well, is over school selection. The more Clegg challenges Cameron to support a system which emphasises parental choice over school selection, the more the swivel eyed loons in the Tories will go nuts and start banging on about grammar schools. The fact that Cameron has already buckled under the pressure once suggests this will be a fun fight to watch.

The important point is, Clegg’s speech today is one that Cameron could never afford to make. That is what annoyed me so much about the “senior official’s” interview in the Guardian on Thursday. Our strength, ultimately, is our unity. The Tories’ fatal, potentially election losing flaw is their internal division. It makes no sense to talk up disunity within the party when it prevents us from exposing our opponents’.

Finally, this has been a good speech about challenging what he calls “inherited disadvantage”. That’s fine but ultimately if you want to truly tackle social mobility you need to tackle inherited advantage as well. As Clegg has set up a social mobility commission, he can’t afford to leave it too long before starting to address that.

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BBC undersells major medical breakthrough

Wednesday, November 14th, 2007

According to the BBC today:

Smoking while pregnant reduces the fertility of boys by affecting a key testis gene, researchers say.

Hold the phone - did I miss a memo? How long has male pregnancy been available on the NHS?

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The true enemies of reason

Sunday, September 9th, 2007

I saw Richard Dawkin’s two-part documentary The Enemies of Reason a couple of weeks ago and I’ve been meaning to add a note of criticism here.

It’s not that I disagree with his assessment that people such as spirit mediums and alternative health gurus are not antithetical to enlightenment values; far from it. My problem is that the programme lacked analysis about why such movements have grown in popularity over the past forty years.

Take homeopathy for instance, and the fact that the NHS now ploughs millions of taxpayers pounds into clinics such as the Royal London Homoeopathic Hospital. How has such a thing come to pass? Have health managers lost their minds? While no doubt there are true believers working inside the NHS who are pushing for homeopathy, I suspect the underlying reason is more prosaic. Indeed, Dawkins himself alluded to this, as Susan Blackmore points out, by alluding to the Placebo effect and comparing the amount of time a homeopath spends with their patient - 1 hours - to the amount of time a GP spends with their patients - 8 minutes.

We could, arguably, achieve the same effects as homeopathy by allowing GPs to prescribe a wider range of treatments. A week in a health spa, for instance. Healthcare professionals know however that such leftfield treatments would be politically untenable. Mental health treatment is very much a Cinderella service, despite the fact that it is now well recognised that depression and a whole range of long term health problems are inextricably linked. So is it any wonder therefore that they turn to an approach with is supported by people such as the Prince of Wales and has at least a quasi-scientific basis to it? Who can blame them for indulging in a noble lie, if the result is more people treated successfully?

Who, then is responsible for creating this climate whereby mental health treatment is marginalised while homeopathy is lauded? We can’t really blame the Prince of Wales. The real problem is that the latter is championed by a whole section of the media. The same media champions horoscopes, the Bible Code and all sorts of anti-intellectual faffery. By coincidence, it also advances an agenda that women are better off staying at home being dutiful housewives, that Princess Diana was murdered, that the poor get what they deserve, that padeophiles are lurking on every street corner, that asylum seekers live like sultans at taxpayer expense while local people struggle to find housing and that the house price boom is an unequivocal good.

What I’m getting at, of course, is that the missing third part of Dawkins’ the Enemies of Reason is an expose of Paul Dacre, his poisonous empire and his competitors at the Express. It seems odd to expose well meaning dowsers as frauds while failing to lambast the people at the top of the chain. Of course, were Dawkins to indulge in such a project he would find himself having a torrent of shit poured onto him by the very people he chose to attack. That may be what is holding him back. But if he doesn’t, who will? It would at the very least be entertaining to watch the likes of Melanie Phillips and Peter Hitchens go bright purple.

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Doughty news values (UPDATED)

Wednesday, May 30th, 2007

Originally posted May 29, 2007 @ 18:16

Despite coming from a different political galaxy, I wish 18 Doughty Street every success if nothing else than for the fact that if it works, it opens up the possibility of other, more politically sympathetic, rivals. It really needs to work out what its agenda is however. One minute they are producing rightwing attack ads, the next they are bending over backwards to improve the political balance of their programmes.

A related problem is highlighted by Iain Dale’s recent outburst about Greenpeace refusing to share studio space with Dominic Lawson. Now, personally I’m a bit of a Greenpeace-sceptic and I’m sure I’m not the only one who is wryly amused to hear them pontificate about refusing to debate with people who do not accept the “scientific reality” (Greenpeace, and FoE’s agenda is only tangentially related to scientific fact and always has been). But the tactic is sound: in debates where there is no common ground there is little point in taking part and legitimising your opponent’s views. If Greenpeace don’t want to waste their time, why should they? There are certainly times in my own life where, retrospectively, I’d wished I’d done the same. When I went on the Daily Politics with Laurence Boyce last week, I made this very calculation (and concluded that the cat was already out of the bag).

I fear that Iain gives the game away by criticising this decision by labeling Greenpeace as “Enviro-fascists”. Leaping from wanting a ‘balanced debate’ to slamming one side as being ‘fascist’ rather suggests that Greenpeace were being set up. Their biggest crime was to call Iain’s bluff.

The big irony is that the BBC, that most hated of media empires, do this sort of thing all the time. It is epitomised by programmes like You and Yours which regularly features articles in which an issue that is plainly barking mad is given large amounts of airtime, justified purely on the basis that they have a token rational human being on as well to declare it to be nonsense. More recently of course there was that Panorama about Wi Fi which was ‘balanced’ only in as much as the fact that it had people arguing both sides of the argument. This sort of lopsided ‘balance’ - where you claim that the views of an individual are of equal weight to the established scientific consensus - only ever has one purpose: to undermine confidence in that consensus. Sometimes it is due to simply sloppy thinking; sometimes there is an agenda behind it. Either way, the effect is the same. At its worse, we have examples such as the MMR scare, which has brought back near-extinct childhood diseases with a vengeance (I write as someone who caught the mumps - the fucking mumps! - aged 30. Thanks a bunch, Andrew).

What I don’t understand is why 18 Doughty Street are pursuing this BBC definition of ‘balance’. Polemic I can understand, genuine balance which looks at the weight of evidence and recognises the scientific consensus would be even better. But surely this mealy-mouthed, insincere “one the one hand… on the other…” drivel is precisely what 18 Doughty Street was set up to fight?

My suspicion is that a lot of people who rail against the BBC’s news bias have a very selective analysis. Where the BBC’s news values correspond with the Daily Mail’s (and they do, increasingly so), they are all for it.

UPDATED: Iain has now moderated his tone following a chat with Greenpeace’s Ben Stewart. Not by much though. I confess this para may have been in the original, but it did stand out to me this morning:

Anyone who seeks to constrain debate on this hugely important issue is adopting the tactics of crypto-fascists. They act as if scientists are in one hundred per cent agreement. They are not. The hubris and condescension in this email is almost beyond parody.

No they don’t. They do act as if the scientific community is in 90% agreement, which it is, a fact which people like Lawson and Iain Dale consistently downplay. Ben Stewart stated in his original email that he would be happy to debate the issue with Bjorn Lomborg and Dominic Lawson isn’t a scientist. Finally, it is the standard tactic of anti-fascists. Why hasn’t 18 Doughty Street had Nick Griffin on yet if they are so concerned about no platform policies?

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A single cluster (or even seven) does not prove a link to phone masts and cancer

Monday, April 23rd, 2007

The Times has an article today about how a cancer clusters have been identified around mobile phone masts. Quick! Panic!

Or don’t. I’m frankly amazed that, even taking into account the general appalling reporting of science in the UK press, that a journalist would fall for that one. The story is about seven , isolated clusters, all of which have been ‘discovered’ by anti-phone mast activists around phone masts. They don’t appear to have found a link to a specific cluster, but rather a vague linkage to “cancers, brain hemorrhages and high blood pressure”. Anyone who knows anything about statistics (and I would never claim to be an expert) knows that clustering is a fact of life.

I play a lot of board games, and thus I’m accustomed to the fact that people can roll 12s on two dice with alarming frequency. It doesn’t happen neatly once in every 36 throws. On the road my parents live on, which has around 20 houses, there were 6 instances of breast cancer in a two year period. They have no mobile phone mast nearby - a fact which causes me great inconvenience when I come to stay.

The point is, not only do statistically insignificant ‘clusters’ happen all the time, but our very existence depends on it. If the universe was uniformly spread and had no ‘clumps’ in it, there’d have been no big bang, no universes, no stars, no us. While cancer clusters can indeed suggest there is something in the environment causing it, most don’t: they are simply brutal reminders of reality.

Who is this ’scientist’ who has co-ordinated this study? Well, Dr John Walker, it emerges, “spent 40 years in statistical research for Dunlop.” I’m afraid that isn’t reassuring. You don’t send a glorified tire number-cruncher in to do an epidemiologist’s job. The biggest nonsense is when he is quoted as saying:

“Masts should be moved away from conurbations and schools and the power turned down.”

The man is clearly as much an expert in radio communications as he is in disease control. You can’t have both. Either you move them away and ramp up the power (in which case, individual phones will have to use more power to work - right next to your ear where they would be doing more damage), or you turn the power down and have them nearer conurbations and schools. I actually quite like the latter idea, but I suspect it has a snowball in hell’s chance of finding favour with Dr Wilson and his anti-mast pals.

UPDATE: Bad Science this week is relevant here.

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Labour’s hospital grab is somewhat overstated

Thursday, April 12th, 2007

There appears to be a small nugget of truth to this story, but it has been exaggerated.

One does not build a hospital overnight (at least I hope one doesn’t), so the 2005 General Election figures are irrelevant to the number of hospitals built over the last decade. Compared to the 1997 results, the picture is somewhat different:

Labour: 418 MPs (63%) and 33 hospitals (70%)
Conservatives: 165 MPs (25%) and 10 hospitals (21%)
Lib Dems: 46 MPs (7%) and 2 hospitals (4%)

In other words, Labour is indeed over represented, and the trend increases if you take into account the 2001 election results, but not by terribly much. Once you factor out the fact that Labour has the lion’s share of seats, it doesn’t add up to much. If the whole system of where to build hospitals were conducted entirely at random, you might very well end up with a similar result.

The article also does not make it clear what areas those 5 remaining ‘cross-party’ hospitals cover. If they are predominantly Lib Dem/Tory areas (Cornwall for example), then the trend is even less significant. While Labour would remain slightly over-represented, the Lib Dem and Tory areas might not be under-represented at all.

Nice try Andrew Lansley, but I’m not convinced.

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God’s lottery

Friday, March 2nd, 2007

Grant Shapps is frequently cited as one of the Tories’ brightest of bright young hopes, but if this is anything to go by, I wouldn’t get too breathless just yet.

Access to IVF on the NHS is a lottery, with different areas adopting different rules, an MP says.

Mr Shapps, whose own three children were conceived through IVF, said that PCTs were, to some extent, “playing God” - deciding who had the right to a child and who did not, based largely on the state of the PCTs’ annual budgets and deficits.

He explained: “Couples are effectively being told that they cannot have a baby while their friends on the other side of the street, who might have a similar set of circumstances, are able to obtain three cycles of IVF provided for them by the NHS.”

All of this may well be so, but how exactly does this square with Gideon Osborne’s plea yesterday about being “disciplined and responsible with public money.” It might not be a nice thing for people wanting IVF to hear, but the cost of offering fertility treatment universally on demand would be exhorbitant. In a debate about spending priorities, it is always going to lose out.

The solution is not offering universal health care, but accountability over local health budgets: replacing a postcode lottery with postcode choice. I thought the Tories were headed in that direction, but Shapps has clearly undermined this if it is the case. These sorts of headlines put pressure on governments to tighten the reins, not loosen them.

And as for going on about ‘playing God’ - IVF - healthcare for that matter - IS playing God! IVF has created a world whereby infertility is literally a death sentence in poor countries (no children means no-one to look after you in old age), and largely avoidable in the West. Invoking theology is lazy, kneejerk populism that dismisses the no doubt very real ethical dilemmas that healthcare managers have to face on a daily basis.

In short, Shapps has added nothing to the public forum apart from his own name. It looks like crusading politics, but I doubt he would ever want a government to rise to his challenge.

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Pant Watch: the Grand Coalition

Friday, November 11th, 2005

Pants
Welcome to Pant Watch. Pant Watch exists to chronicle the dying days of the Blair administration. Technically, we are now at P-8, P-1 being the day that Steve Bell published this cartoon showing Blair wearing John Major’s pants of power. To be sure, Bell has portrayed Blair as a pant-wearer before, most memorably here, but it would appear that Blair has now acquired something unmistakeably Major-like in his impotence in administration now, as if we have reached, if not the end of the Blair administration, then at least the beginning of the end.

(for more on this by Steve himself, see here)

It would appear however that both the Tory contenders look at Blair’s pants with envious eyes. I mention the Tories here, not simply to make a gratuitous link to that ridiculous story, but because I think a lot of the commentariat has missed a point here.

The story goes that Blair has lost all authority and that his attempts to push through his reforms on health, education and welfare will all be for nothing, that he won’t be able to squeeze a single thing through. Those commentators appear to be missing one very important ingredient; pretty much everything Blair wants to do to health, education and welfare is broadly along the same lines that the Tories want to do as well. Indeed, Cameron has repeatedly emphasised that on a number of issues in the past, the Tories were wrong to oppose Blair.

Cameron is onto a real thing here and even if he doesn’t win the leadership ballot, it may well be that elements of his nascent strategy emerged under Davis anyway. Tactically, the best thing the Tories can do right now is work with Blair on these reforms, partly because it means they get broadly what they want despite not having the prerequisite bums on seats, and partly because it is likely to provoke an unholy civil war within the Labour Party.

How long will it be before Blair wins a vote on a ‘legacy’ issue, with the Tories bolstering him in the face of a major Labour rebellion? It didn’t happen in the case of the terrorism vote, and civil liberties in general, mainly because it wouldn’t wash with the idea of modern conservativism, whichever flavour you choose. Public services are a different matter.

What we could be looking at here is the beginning of an informal Grand Coalition, which has the potential to develop into a more formal arrangement after the next General Election. It would inevitably be more problematic for Labour than the Tories, but it would also be in Labour’s interests, or at least the Blairite-reformist wing that forms the majority of MPs. It is surely only a matter of time before they realise that a marriage with a rebranded, modern Conservative Party is preferable to one with Old Labour. Meanwhile, any Tory who can count - and I understand there are a few - is all too aware that however well they do over the next few years, they can’t form a majority in the Commons (pdf). Their future will either be spent in the wilderness or in coalition, and it is unlikely that the ‘natural party of government’ will choose the wilderness.

Many Labour supporters will snort in derision at this, but this is the precisely the corner that Tony Blair has got them in. This is the danger of triangulation, especially when the people at the top end up believing it. Abandon ‘modernisation’ and you open up ground for the Tories to capture. Stick with it and you will have to rely on the Tories to get everything through.

So even if the current wearer of the pants shuffles off, it may be that his successor finds them freshly pressed on his bed when he enters Number 10 for the first time.

Meanwhile, whoever the Tories choose for leader may find he has the real power in the country. Even David Davis.

Think about that one.

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More ironies

Thursday, November 10th, 2005

With apologies to any American readers out there, a couple more notes on my bemusement of the sheer zaniness of British politics:

  • The Government pontificating on the need to listen to professionals when it comes to the police, while doing the exact opposite in the far more complicated field of medicine.
  • Labour legislating to prevent “losers” in first-past-the-post elections to the Welsh Assembly from also standing in the top up list elections, and calling for similar reforms to be made in Scotland, while simultaneously rewarding one of their most famous losers in this year’s General Election with a life peerage.
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