Cutting the deficit by penalising people for doing their jobs

The Coalition government is planning to not provide money to hospitals for treating a patient if they are readmitted with a problem related to the one they had on first admittance. They are claiming this is to stop hospitals discharging people too early.

Here’s figures from the BBC story linked below. 

  • Emergency readmissions 1998-99 – 359,719
  • Emergency readmissions 2007-08 – 546,354.
  • Readmissions as a percentage of all patient discharges 1998-99 – 8%
  • Readmissions as a percentage of all patient discharges 2007-08 – 10.5%
  • From these we can roughly work out total number of procedures done, 1998-99 -4,500,000
  • Total number of procedures done, 2007-08 – 5,200,000
  • Number of extra people readmitted, 2007-08 – 186, 635
  • Number of extra procedures done, 2007-08 – roughly 700,000

And from that we can see that even if we grant the premise, there were 500,000 or so people who benefited without needing to check back in. That’s not nothing. (We also need context on why people are readmitted – how related does it need to be? Are the figures mainly due to individual things like MRSA? Is it all just demographics, e.g. if more procedures are being done on elderly patients you might expect more of them to need to come back. Better understanding of the importance of home care? But let’s move on.)

For super-duper double irony, Lansley also called for patients to be given more control over their healthcare. But, in order to avoid financial penalties, hospitals will strongly be against releasing patients when they want to go home (although I suppose there could be a disclaimer; but surely not even the Tories would refuse to pay for patients who release themselves) and/or readmitting patients until they have passed that 30-day waiting period.

There’s nothing wrong with wanting hospitals to not kick sick people out the door before they are ready. But the use of financial disincentives is not going to help. Getting people out of hospital and into home care in order to make space for new patients is also a good thing, and the measures proposed show no sign of taking that into account. This looks very much like being a way of cutting budgets – through financial penalties and just plain doing less – while claiming to have maintained the ringfencing. Especially since even before the Big Bad Labour got their way, 8% of procedures required readmissions and there was never a Golden Age of zero readmissions.

Look forward to schools being penalised for each pupil who doesn’t leave with 5 A*-Cs and each pupil who has taken advantage of Evil Labour Grade Inflation by leaving with 10 A*s.

(As an experiment, and following something I read on Rough Type, Nick Carr’s blog, on removing links from text, all links presented below)

BBC story on this lunacy

Nick Carr’s bit on moving links to the bottom

 A picture of Sir Partrick Stewart being knighted 


The wisdom of a crowd of hacks

There are two ways that the publication of the government’s COINS database could be intended to go (well, three if you include ‘Oh boy, we’re doing just what they do in America wheee’).

1. Crowdsourcing opposition to excessive government spending.

With this, well, I think we’ll have to wait and see.  Some of the Guardian’s work on getting useful commercial data – postcode databases, Ordnance Survey maps and the like – into widespread use has been laudable, but I think it’s led them to believe that if it works for some data it must work for all data. There is a Guardian-imagined utopia of billions being made by startups using public data to make Google Maps apps that allow ordinary people* to see exactly how much money has been spent on filling potholes outside their house compared with the house three doors down. And then to whinge and complain take appropriate democratic action to ensure proper allocation of funds. In principle there’s nothing wrong even if it takes a while for people to be responsible, i.e. not using it for attention-grabbing sales-chasing headlines. In practice, as long as the information available to the public is incomplete and not put in a context in which it is comparable with the private sector it could lead to…

2. Crowdsourcing opposition to government spending.

The Guardian led off with two headlines which, while they aren’t in the Telegraph expenses scandals league** could seem to the casual observer to be scandalous. Government spent £1.8bn on consultants and Government lost £600m in bad debts. The latter story also advances claims of pre-election splurging which we’ll return to.

But first, two obvious contextual problems with the headlines – comparison with the private sector, and definitions.

Nowhere in the Guardian article do we learn what exactly is meant by consultants (in fact they note – far away from the headline – ‘Many of the labels on spending in the database are vague, raising more questions than they answer’). Is it anyone with a suit? Anyone overpaid and useless? Anyone with the word consultant in their job title (which would cover the guy I got to stop my basement flooding)? Anyone on a very short-term contract? Tom Steinberg? Shut up and look at the big number.

And nowhere do we learn if, as a percentage of revenue, that is to be considered comparatively good or bad. I’ll go out on a limb and say that these are large sums of money. In fact I’ll go further and say that even an increase of a mere £0.3 billion is still a large sum of money. But I have no idea from this story how it compares with how much any other company – Guardian Media Group perhaps –  spends on consultants or writing off bad loans.

That’s lack of context. Add to that incompleteness of figures, for which we go to the FT, which points out a few problems with the Guardian’s splurge claim by looking at the public finance figures which, by the bye, are public already (the clue is in the name), if not as sexy and open. Surprise, although there may be some spending that was rushed in (unsurprisingly, since the chance to spend it was about to disappear) there is also a seasonal spike around that time. So, no smoking gun. Next time, Gadget!

And, at the risk of sounding a bit postmodern, there’s no way to see the money that isn’t spent. The trouble with relying on data like this too much is it can lead to the assumption that if the data doesn’t exist, there’s no problem. If there’s no open database showing where repairs haven’t been made, libraries haven’t been able to update stock, if there’s no API to grab hold of the people who didn’t even apply for further education, if we don’t know how many people are failed just a little bit more by their country every year we can’t be proud of reducing that consultants bill.

Still, so what. Birds got ta fly, fish got ta swim, newspapers got ta sell news. Drink deep, or taste not the Pierian spring I say, but it’s not as if anyone in government is likely to resort to incomplete and out-of-context figures to sell policy, right?

…We are now shining a spotlight on that waste and it is a scandalous sight to see.

A Department for Work and Pensions that increased benefit spending by over £20 billion and gave some families as much as £93,000 in Housing Benefit every year…

So… incompleteness? Yep. Why did that spending increase? Was it  unjustifiable spending increases, or more unemployed and people reaching retirement age. And lack of context? Ayuh. What families got that much housing benefit? Were immigrants involved? Was it one in a million? One in a thousand? The three families that consist of 24 disabled people and a carer? Was it intentional or a mistake? How much money in total went to families that received c. £93,000 in housing benefit every year?

Shut up and look at the big number.

And this is where my cynicism really kicks in, especially when it comes to the timing of the data release. Obviously someone like Cameron is going to make a case for cuts with sleight-of-mouth. But he’s selling something that is a choice – his choice – as making it out to be fate (which, as an aside, doesn’t make him look like much of a leader). However much good could come from making figures from all bodies more open, if they are reported in the wrong way by hacks looking for scandal all this transparency will just become another tool for spinning one particular economic plan.

On the spinning of cuts see also: It all rests on an If…., This country doesn’t have an overdraft you twat, Why Cameron is wrong about the 8m “economically inactive”

*For a restricted value of ordinary, of course.

**Although while we’re on that subject, this post is an interesting counterpoint, especially Point 5 which is obviously a huge influence on what I’m writing here.

5. Crowdsourcing accountability multiplies the degree to which people who are obliged to publish information are made accountable. Most of the organisations and individuals that rival MPs in dictating public policy are not subject to the same rules on transparency.


Academic freedom in action

This story in the Guardian doesn’t really seem to deserve the headline Rightwing historian Niall Ferguson given school curriculum role. Reading between the lines, it sounds more like Michael Gove just got a little overexcited about talking to a real, live celebrity! off the telly! But even without taking seriously the replacement of sofa government by questions at a literary festival government, there’s a couple of problems with the idea.

Firstly, and most obviously, that there’s no general belief among school history teachers that  a single grand narrative that knits together what pupils learn over a year, or over a school career, is what is needed. Is that’s what’s going to rescue history from being regarded as ‘boring’? Has he any real evidence beyond what’s popular on the TV (and no, trending on Twitter doesn’t count). How well do grand narratives work in other countries? Is a curriculum based on political interference – and that’s what it is when it’s designed by people handpicked by the politicians – ever going to work?

Secondly, I hardly think it’s unfair or tending towards the militant to state that Ferguson isn’t regarded by his peers as uncomplicated or uncontraversial. Even if you don’t think the rightwing-historian, apologist-for-empire narrative is crap, the idea that he would have such control over schools is a problem. He’s also not necessarily going to be an expert on history as taught in schools just because he has a Harvard gig and a camera crew.

Thirdly, that in terms of content we would just be swapping one set of facts for another, and never getting round to the bit where history helps develop actual skills. Ferguson’s annoyed that his kids know who Martin Luther King is, but not Martin Luther? Fine, but no course is going to teach everything. Include Martin Luther and you will leave out important people, and important ideas. Yes, even if you are following a curriculum designed by Ferguson. Better to get to the point where the children can and want to find out about whatever you are leaving out by themselves.

And finally, that these TV presenters who work to save our schools – however noble their intentions are – serve two masters. I don’t want the ratings of a Channel Four show to determine anything, let alone what and how my child is taught. (It might also concern people worried about cronyism and corruption and the like that Ferguson’s plans to produce materials for use in schools might be made a bit more lucrative if he’s invited to help write the curriculum. But Gove’s not worried about the profit motive so I guess we should stay calm as well.)

It should be remembered that it was a Conservative government that introduced a National Curriculum that had the effect in part on restricting what teachers could teach. It was also the Conservative intention at the time to do so to get more ‘proper’ history, more Shakespeare etc. They were stymied in part because they invited experts who didn’t go along with that intention. Because they were experts. Obliquely inviting someone like Ferguson to do the job might indicate that Gove is determined not to repeat history.


Insert Laws-Related Pun Headline Here

(The only way headline writers will be happy losing a Laws from government is if they get a Balls for Labour leader.)

Two things unconnected with the emerging personal tragedy narrative.

  1. The speed of events was impressive, but also somewhat counterproductive. The first headline I read on the BBC news site was about Laws making his initial defence and the somewhat lukewarm government reaction to it. There will be people taking a long weekend who won’t know what is (was?) going on till Tuesday. Obviously it seems the final decision was made by Laws himself, so the timing wasn’t entirely in the hands of the government’s spinners. But there’s also a sense that the government’s response was to get this over with as soon as possible, that they had wanted to avoid looking like New Labour which did sometimes try to defend people past the point of no return. However, the blogosphere – the first responder of damage control –  was only just getting into its stride, offering a range of defences some of which were not entirely shaky. The MSM would have run with the best of those soon enough. Instead they got cut off at the knees. And now we’re seeing such fulsome praise for Laws that one could expect him to be back in office this time next week. Aside from whether it’s bad PR, it’s a bit worrying when people appear to prefer being quick over being right.
  2. Things worked out for the Coalition this time. But what is going to happen the next time if there is disagreement between the two party leaders over the course of action?* If Cameron wants to defend a Tory where Clegg, or members of his party, believe it’s an open-and-shut resignation case? Or, what happens if Clegg and Cameron are in agreement that someone should be cast loose where that someone is popular within the parliamentary party? Are Lib Dems really going to be happy seeing a Tory defending the government’s decision to sack one of their own? People might be fine when it’s party decision but less accepting when they think there’s some blame to be placed on people who are, at best, temporary allies.

Edit: This article in the Independent does seem to show, as well as how difficult it was to persuade Laws to stay, that there was a certain amount of haste involved in their decisions.

*I am assuming that Nick Clegg will occasionally have different thoughts to David Cameron. Otherwise, what is the point of him.


I want doesn’t get

Refusing to appear on Question Time unless Alistair Campbell wasn’t present was only seventh on the list of Coalition demands.

6. No red M&Ms in the hospitality suite.

5. Only Labour MPs serving in the shadow cabinet who also served in the last government for at least two years and in an important job allowed to appear on television, and then only if they wear ill-fitting suits and too much eyeshadow.

4. Every television and radio programme to end with the words ‘It’s all Labour’s fault.’ Even the shipping forecast.

3. Production of at least three episodes of Doctor Who in which the Daleks are defeated through lowering taxes.

2. All telephone interviews for Today to begin with a discussion with Charlotte Green about what she is wearing.

1. Vince Cable to replace Danielle Hope as new West End Dorothy.


Laws, Child Trust Funds and (I think) an actual technical begging the question

 The BBC has this justification of the scrapping of the Child Trust Fund from David Laws:

Mr Laws said it was “deceiving” people if they were handed funds that were from borrowed money.

“I know that this will be a disappointment to some parents, but we need to be honest about what we are doing,” he said.

“At present, the child trust fund is based on the claim that young people will build up an asset which they can use later in life.

“But since government payments into the scheme are essentially being funded by public borrowing, the government is also storing up debts which will have to be repaid by the same young people.”

So. There’s income the government receives, tax revenues etc., and there is what the government spends. Anything spent over the income has to be borrowed. But not all government spending is borrowed money, thankfully.

Laws argues that putting borrowed money into savings is deception. Well and good (except for the bits that redistribute wealth and encourage more saving than otherwise would take place and maybe leave paying back the borrowing to a more suitable time). So therefore he is deciding to cut it.

But! There’s no reason why all the money for Child Trust Funds is to be automatically considered part of the excess spending that causes the government to borrow. So the reason he considers it ‘borrowed’ money is because he has decided it should be cut.

Child Trust Funds should be cut because they should be cut. I think that’s a solid beg.


The Nuclear Club

PW Botha asked for the warheads and Shimon Peres, then Israel’s defence minister and now its president, responded by offering them “in three sizes”.

Botha: Uh, could I have a Medium nuclear bomb?
Peres: Do you want the Medium size or the middle size?
Botha: What’s the difference?
Peres: Well, we have three sizes. Medium, Large, and Jumbo.
Botha: What happened to the Small?
Peres: There is no Small. Small is Medium.
Botha: What’s… Medium?
Peres: Medium is Large, and Large is Jumbo.
Botha: Oh-kay. Gimme the Large.
Peres: That’s Medium.
Botha: Right. Yeah. And two hardboiled eggs.

March 2017
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