I don’t usually do requests, but I received a message from dreamingspire asking me to clarify Andy Mayer’s report of my comment that people may not want choice, but choice is the means to give them what they do want, which is good local services.
My comments came in response to a doctor and Lib Dem councillor who commented firstly that the next nearest schools to her were 11 and 12 miles away respectively, so that her choice was in fact limited; and that most people did not want choice, they just wanted “A good, local school.”
In this latter point she was, at least in part, correct – choice is not an end in itself, but a means. The point of choice (and competition, and markets, and all those other scary things that cause Social Democratic stomachs to knot in fear) is that it is the most effective driver in improving standards.
The reason for this is simple, and one that liberals should consider to be a matter of fact: monopolies do not serve their customer’s interests. By comparison, nothing encourages providers to satisfy their customers more than competition, or “freedom of exit” as one might also put it. It is the fact that I can take my money and spend it elsewhere that makes those firms that I patronise continue to struggle to provide the best goods and services available; while others struggle equally hard to woo me with better offers. So for example, my employer has recently expressed its dissatisfaction with the supplier of sandwiches for lunch meetings by switching to another supplier, which is far easier and more efficacious than trying to make the previous supplier change their methods.
And here is where my frustration with the Defenders of the State(/us quo) begins. For the opposition to choice in public services is in the end a belief that citizens should be obliged to utilise public services that are delivered by pubic servants and managed by the government even if that provision is inferior to alternatives that are on offer. Lest my publically-employed readers and colleagues move to quickly to jump to the defence of the public sector, I should add that nothing in that statements implies that public services do or must deliver poorer outcomes for citizens. What I am saying is that if a patient or parent believes that they can access better healthcare or schooling elsewhere, it is the height of arrogance to deny them their freedom to do so.
This was clearly why Nick Clegg told the Manifesto Conference on Saturday that “every patient should have a guarantee of treatment within a specified waiting time - and to drive the NHS to deliver that, everyone should have the right to receive private treatment, paid for by the NHS, if the waiting time’s not met.” This need not divert a single penny of taxpayers’ money from the NHS, if only it is able to deliver prompt treatment, but if the NHS is unable to deliver on that simple requirement then patients should be free to get their treatment elsewhere, rather than being compelled to wait for months or years (often in acute pain or with consequent deleterious effects to their health and wellbeing) for the NHS to be able to deal with them.
Of course, choice will not be exercised by every citizen, and one of the greatest concerns of those opposed to choice is that it will benefit the articulate and the pushy at the expense of the marginalized. But this is not in fact the case at all, for the choice of some is beneficial to all. If I continually go to the same electricity provider or supermarket without ever exercising choice, I still benefit from the freedom of others to choose, which drives all providers to aim to deliver the best. This is so common in private markets as to go largely unremarked. Yet evidence from districts where parents have been given school choice suggests that the same applies to public services, too: the standards of public schools did not fall when the ambitious parents exercises choice and moved their children to private schools; rather, the public schools responded by “upping their game”, improving their own teaching in an attempt to limit the exit of their citizen/customers.
Hence my interjection at the Manifesto Conference: choice raises standards across the board, not just for those exercising their freedom.
But what of our doctor and councilor who lives so far from other schools that she fears that choice in her village is meaningless? Real choice in fact still exists, because she can exit. The example of the Elmgreen School is instructive: dissatisfied parents, rather than tolerating inferior education for their children, exercised their freedom to exit the public system by taking their public money and financing an entirely new school. In their case, it was a novel idea that required the local authority’s permission, but in theory any group of parents could do just that, using their public money to home-educate, or pooling their resources to set up a local school or merely hire teachers to visit them at key times to teach their children.
Choice is too often seen as a Trojan Horse for privatization, but that is a lie spread by those for whom individual as opposed to collective solutions are anathema. Real choice may very well be private, but it just as equally may be public, voluntary, charity, religious, co-operative, self-help or any of a host of other possibilities. As Clegg went on to say, “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”
And as for the much-stated assertation that voters do not actually want or care about choice, I will conclude as I did at the conference by reminding readers of what David Bell, the Permanent Secretary at the Department for Children, Schools and Families, once commented: people may say that they do not care about more choice, but just try taking away the choice that they have already been given!
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Monday, 14 January 2008
Thursday, 15 February 2007
Unicef report may be flawed, but there is still much to worry about
The Unicef report on child well-being in rich countries caused an instinctively sceptical reaction in me, partly because of the known left-wing bias within the UN agencies and partly because of its reliance on relative income measures. As I commented to Cicero earlier today (I have since rectified the typos!):
Having reviewed these, I remain very sceptical of the relative poverty issue. Furthermore, many measures are based on subjective reporting (“aspiring to low skilled work”; “finding their peers kind”; “agreeing with the statement that…”) and others are probably based on surveys that may not be entirely accurate (reports on how many books are in a house or how many educational tools – did the children consider the family computer an educational tool? Or a toy?).
Nonetheless, perhaps a third of the measures were clear, objective measures based on official statistics in which we ought to have at least some faith. The following stand out as cause for real concern:
· Above average infant mortality
· Above average number of births with low birth weight (they say “birth rate below 2500g” but I am inferring what they meant!)
· Below average immunisation against DPT3 and Polio, and significantly below average immunisation against Measles
· Above average number of overweight 13 and 15 year olds (according to BMI).
· Significantly below average participation in education among 15-19 year olds
· Below average number of 15-19 year olds in either education or employment
· Significantly above average number of children living in single-parent and step families
· Significantly above average adolescent (15-19 year old) fertility rate
(For statisticians among you, ‘Significantly’ refers to more than one standard deviation difference, which puts the UK into the bottom quintile).
No matter how you cut it, that means that the UK’s children are less healthy and dying more often than peers in less wealthy societies including the Mediterranean countries, the Czech Republic, Slovenia and Malta. They are not undertaking as much further study and are more likely to expect to work in unskilled employment – not a good place to be with a billion Chinese yet to join the global labour market. Traditional family structures are more fragile (though I hesitate to draw any conclusions from this).
I do not believe it follows that the solutions must be more Government intervention in family lives or massive statist structures institutionalising childhood. But there is clearly room for improvement in our public health and education, currently subject to two of the largest Government departments. A more thorough immunisation programme, better sex education and improved technical educational opportunities for non-academic school leavers would be a good start.
One thing is for certain: despite the instinctive scepticism and lingering doubt of myself and many liberal-minded colleagues, this report leaves no room for complacency.
I fail to understand how a poor child in Britain is worse off than an even-poorer child in Slovakia, simply because the British child is able to see a Porsche from her window rather than a clapped out Lada.Having said that, I’ve decided it’s best to read the report before spilling too much virtual ink. Sadly (sic.), I’m about to disappear off to Cape Town (where the temperature is in the 20s and the sun sets late over the sea) and so won’t have time to read it and write about it until it is quite stale, so I’m going to make a few observations based on the very informative annex, which has the 40 separate indicators which led the report writers to their conclusions.
Having reviewed these, I remain very sceptical of the relative poverty issue. Furthermore, many measures are based on subjective reporting (“aspiring to low skilled work”; “finding their peers kind”; “agreeing with the statement that…”) and others are probably based on surveys that may not be entirely accurate (reports on how many books are in a house or how many educational tools – did the children consider the family computer an educational tool? Or a toy?).
Nonetheless, perhaps a third of the measures were clear, objective measures based on official statistics in which we ought to have at least some faith. The following stand out as cause for real concern:
· Above average infant mortality
· Above average number of births with low birth weight (they say “birth rate below 2500g” but I am inferring what they meant!)
· Below average immunisation against DPT3 and Polio, and significantly below average immunisation against Measles
· Above average number of overweight 13 and 15 year olds (according to BMI).
· Significantly below average participation in education among 15-19 year olds
· Below average number of 15-19 year olds in either education or employment
· Significantly above average number of children living in single-parent and step families
· Significantly above average adolescent (15-19 year old) fertility rate
(For statisticians among you, ‘Significantly’ refers to more than one standard deviation difference, which puts the UK into the bottom quintile).
No matter how you cut it, that means that the UK’s children are less healthy and dying more often than peers in less wealthy societies including the Mediterranean countries, the Czech Republic, Slovenia and Malta. They are not undertaking as much further study and are more likely to expect to work in unskilled employment – not a good place to be with a billion Chinese yet to join the global labour market. Traditional family structures are more fragile (though I hesitate to draw any conclusions from this).
I do not believe it follows that the solutions must be more Government intervention in family lives or massive statist structures institutionalising childhood. But there is clearly room for improvement in our public health and education, currently subject to two of the largest Government departments. A more thorough immunisation programme, better sex education and improved technical educational opportunities for non-academic school leavers would be a good start.
One thing is for certain: despite the instinctive scepticism and lingering doubt of myself and many liberal-minded colleagues, this report leaves no room for complacency.
Tuesday, 6 February 2007
Our parents have mortgaged our future
It’s a good job my father doesn’t read my blog, because I’m about to point the finger of blame firmly at his and his parent’s generation.
Over Christmas I read Living with Leviathan: Public Spending, Taxes and Economic Performance, by David B. Smith, Visiting Professor in Business and Economic Forecasting at the University of Derby and a visiting lecturer at the Cardiff University Business School.
The book is a long and detailed investigation of the pernicious effects of high levels of taxation and public spending on the economy. There are many findings and quite a few prescriptions, some of which even the author recognises are not politically viable.
However, the one bit that sticks out is the results of a piece of econometric modelling in which he estimates that “If government spending, as a proportion of national income, had been held at the level experienced in 1960, econometric evidence suggests that output in the UK would, today, be nearly twice as high as current levels. Total public expenditure would then be higher, albeit as a lower proportion of a much bigger national output.”
This is a startling finding for two reasons. Firstly, the suggestion that the policies of successive UK governments have cost us £1 trillion of GDP per annum defies adjectives. Indeed, I struggle to imagine what this would mean for UK standards of living today. Suffice to say that we would be half as rich again as citizens of the United States, and somewhat higher than Dubai. David B. Smith notes that we could spend far more on public services and still have lower taxes as a result. I might go further and suggest that most, if not almost all, of us would be able to afford to buy private healthcare and education of higher quality than our present, tax-funded system can afford, and still have more left over for fun and frolics.
The second startling fact here is that this lafferesque story of counter-factual economic history does not require us to have foregone our welfare state. By 1960 the welfare state was over a decade old, public expenditure was a third of GDP and our hospitals and schools were in rude health. So the argument often deployed by people who oppose supply-side measures that those proposing them would condemn the poor to ignorance and disease simply does not hold up.
Over Christmas I read Living with Leviathan: Public Spending, Taxes and Economic Performance, by David B. Smith, Visiting Professor in Business and Economic Forecasting at the University of Derby and a visiting lecturer at the Cardiff University Business School.
The book is a long and detailed investigation of the pernicious effects of high levels of taxation and public spending on the economy. There are many findings and quite a few prescriptions, some of which even the author recognises are not politically viable.
However, the one bit that sticks out is the results of a piece of econometric modelling in which he estimates that “If government spending, as a proportion of national income, had been held at the level experienced in 1960, econometric evidence suggests that output in the UK would, today, be nearly twice as high as current levels. Total public expenditure would then be higher, albeit as a lower proportion of a much bigger national output.”
This is a startling finding for two reasons. Firstly, the suggestion that the policies of successive UK governments have cost us £1 trillion of GDP per annum defies adjectives. Indeed, I struggle to imagine what this would mean for UK standards of living today. Suffice to say that we would be half as rich again as citizens of the United States, and somewhat higher than Dubai. David B. Smith notes that we could spend far more on public services and still have lower taxes as a result. I might go further and suggest that most, if not almost all, of us would be able to afford to buy private healthcare and education of higher quality than our present, tax-funded system can afford, and still have more left over for fun and frolics.
The second startling fact here is that this lafferesque story of counter-factual economic history does not require us to have foregone our welfare state. By 1960 the welfare state was over a decade old, public expenditure was a third of GDP and our hospitals and schools were in rude health. So the argument often deployed by people who oppose supply-side measures that those proposing them would condemn the poor to ignorance and disease simply does not hold up.
"What's the bleeding time?"
"Ten past ten, sir!"
Sadly, as is so often the way with bureaucracies, costs began to escalate. In the 1960s and 1970s welfare expenditure ballooned until by 1980 it reached nearly half of national output, and despite the “small state” rhetoric of the Thatcher/Major years, it stuck well over 40 per cent. Under Gordon Brown it has risen again to over 45 per cent and shows every sign of rising further.
This massively bloated welfare system has not created schools or hospitals significantly better than were enjoyed in the 1950s. Healthcare is of course better – it is not so clear that the same can be said of schools – but this is as a result of technological advancement and the increased wealth our nation has enjoyed. Indeed, this latter factor would have been far higher had our parents and grandparents show a little more restraint.
Voters since the 1960s have cost those leaving home today half the potential wealth they might have enjoyed, with the higher living standards that would have resulted. We would all be better off had they shown more prudence. It is not too late to learn that lesson and to adopt a growth plan for future generations.
This massively bloated welfare system has not created schools or hospitals significantly better than were enjoyed in the 1950s. Healthcare is of course better – it is not so clear that the same can be said of schools – but this is as a result of technological advancement and the increased wealth our nation has enjoyed. Indeed, this latter factor would have been far higher had our parents and grandparents show a little more restraint.
Voters since the 1960s have cost those leaving home today half the potential wealth they might have enjoyed, with the higher living standards that would have resulted. We would all be better off had they shown more prudence. It is not too late to learn that lesson and to adopt a growth plan for future generations.
Wednesday, 10 January 2007
Labour’s new gimmick: an education lottery that has nothing to do with one’s postcode
This lunchtime BBC London reported the latest idiotic wheeze planned for education. Apparently, the government is to do away with the “postcode lottery” (a misnomer for what is in fact a postcode auction) by replacing it with a real lottery!
Schools will be encouraged to offer places not based on local catchment areas but on a simply lottery basis: parents put down the name of their children and names are randomly selected.
There is no doubt that the current system is unfair. A friend of mine in Muswell Hill once pointed to a street where the houses on one side of the road were worth £100,000 more than those on the other side, because one side of the road was in the catchment area for a highly rated state school. This new system would, by comparison, be more equitable because access to good state schools would not be decided by wealth, with only the richest parents able to move into the catchment areas of the best schools. Instead, every child would have an equal chance of “winning” a place in the school of their choice.
This raises its own problems, of course. Children would not now be guaranteed a place in their local school but may have to travel for long periods each way for an education. This would be costly – a cost that would probably fall on the local authority and undoubtedly in the end on the taxpayer – and would expose children to stress and risk.
More to the point, however, it represents a complete U-turn by the government that only two years ago promised parental choice. While parents may now have the choice whether to participate in a particular school’s lottery or not, clearly the ultimate decision is now to be taken not by parents, teachers or administrators, but by chance. There seems something strangely fatalistic in a government admitting that a random process is better than a rational decision taken in the interests of a specific child (though I am confident that a random process could be no worse than a decision made about an unknown child by a faceless bureaucracy).
The real problem, though, is that it fails to get to the heart of the education problem – a problem that leaves a quarter of school leavers functionally illiterate, innumerate and without any decent qualifications. The reforms needed to improve educational standards and so enhance both children’s opportunities and our economy’s future are those that would raise standards across the board and tailor education to the pupil. In practice the only way to improve standards is by rewarding success and eliminating failure in education, which can only be achieved by injecting competition into the system. If schooling is to meet the specific needs of individual children it must enable parents to exercise real choice about both the school to which their child goes and the content and balance of the curriculum. In addition, both goals would be served if schools were free to innovate and so explore new methods of teaching.
This will never come about as long as education is provided by a state monopoly and children are allocated schools irrespective of their or their parents’ needs or desires. The solution is to establish a voucher system whereby parents can exercise choice about (for example) whether their child should attend the local school or a particularly good school far away, and whether they should attend one that specialises in science, the arts or language. As the cash would follow the pupil, good schools would expand and bad ones wither; eventually successful providers would take over failing establishments to improve and rejuvenate them – just as the failing Skoda car company was bought out and saved by Volkswagen and is now a successful provider of cars far superior to anything that Czechoslovakia’s state monopoly provider could produce.
A voucher scheme would represent a real revolution in provision that would enable all parents to access good schools and provide the best for their children. By comparison, this new government gimmick is a disgraceful effort to replace an unfair system with a system where nobody bears responsibility. It is the sign of a government devoid of ideas.
Schools will be encouraged to offer places not based on local catchment areas but on a simply lottery basis: parents put down the name of their children and names are randomly selected.
There is no doubt that the current system is unfair. A friend of mine in Muswell Hill once pointed to a street where the houses on one side of the road were worth £100,000 more than those on the other side, because one side of the road was in the catchment area for a highly rated state school. This new system would, by comparison, be more equitable because access to good state schools would not be decided by wealth, with only the richest parents able to move into the catchment areas of the best schools. Instead, every child would have an equal chance of “winning” a place in the school of their choice.
This raises its own problems, of course. Children would not now be guaranteed a place in their local school but may have to travel for long periods each way for an education. This would be costly – a cost that would probably fall on the local authority and undoubtedly in the end on the taxpayer – and would expose children to stress and risk.
More to the point, however, it represents a complete U-turn by the government that only two years ago promised parental choice. While parents may now have the choice whether to participate in a particular school’s lottery or not, clearly the ultimate decision is now to be taken not by parents, teachers or administrators, but by chance. There seems something strangely fatalistic in a government admitting that a random process is better than a rational decision taken in the interests of a specific child (though I am confident that a random process could be no worse than a decision made about an unknown child by a faceless bureaucracy).
The real problem, though, is that it fails to get to the heart of the education problem – a problem that leaves a quarter of school leavers functionally illiterate, innumerate and without any decent qualifications. The reforms needed to improve educational standards and so enhance both children’s opportunities and our economy’s future are those that would raise standards across the board and tailor education to the pupil. In practice the only way to improve standards is by rewarding success and eliminating failure in education, which can only be achieved by injecting competition into the system. If schooling is to meet the specific needs of individual children it must enable parents to exercise real choice about both the school to which their child goes and the content and balance of the curriculum. In addition, both goals would be served if schools were free to innovate and so explore new methods of teaching.
This will never come about as long as education is provided by a state monopoly and children are allocated schools irrespective of their or their parents’ needs or desires. The solution is to establish a voucher system whereby parents can exercise choice about (for example) whether their child should attend the local school or a particularly good school far away, and whether they should attend one that specialises in science, the arts or language. As the cash would follow the pupil, good schools would expand and bad ones wither; eventually successful providers would take over failing establishments to improve and rejuvenate them – just as the failing Skoda car company was bought out and saved by Volkswagen and is now a successful provider of cars far superior to anything that Czechoslovakia’s state monopoly provider could produce.
A voucher scheme would represent a real revolution in provision that would enable all parents to access good schools and provide the best for their children. By comparison, this new government gimmick is a disgraceful effort to replace an unfair system with a system where nobody bears responsibility. It is the sign of a government devoid of ideas.
Sunday, 7 January 2007
Ministers may fear science but the people still believe in progress
On Friday I reported that a general distrust of scientific progress caused by misunderstandings encouraged by anti-scientific groups was putting important scientific research at risk.
In this specific case, work aimed at finding cures for major diseases such as Motor Neurone disease, Parkinson’s and Alzheimer’s was being undermined because ministers (specifically health ministers Patricia Hewitt and Caroline Flint) had become spooked after a majority of the 535 respondents to an unrelated consultation on human fertility treatment reacted negatively.
At the time I implied that the majority of the 535 respondents to that consultation probably did not indicate a majority in the country. I would have guessed that most people in the country support this important and valuable research.
I am therefore glad to note that the BBC is running a poll on this question and so far there is clear support for the research. But there's everything left to play for, so please do go and cast your vote (whatever you believe).
In this specific case, work aimed at finding cures for major diseases such as Motor Neurone disease, Parkinson’s and Alzheimer’s was being undermined because ministers (specifically health ministers Patricia Hewitt and Caroline Flint) had become spooked after a majority of the 535 respondents to an unrelated consultation on human fertility treatment reacted negatively.
At the time I implied that the majority of the 535 respondents to that consultation probably did not indicate a majority in the country. I would have guessed that most people in the country support this important and valuable research.
I am therefore glad to note that the BBC is running a poll on this question and so far there is clear support for the research. But there's everything left to play for, so please do go and cast your vote (whatever you believe).
Friday, 5 January 2007
Fear of Frankenbunny
Fear of science is back in the papers. Once again irrationality is in danger of trumping reason.
Caroline Flint, our public health minister, and Health Secretary Patricia Hewitt, have become spooked by adverse reaction to a consultation and are rumoured to be about to block pioneering stem-cell research that may help develop cures for terrible illnesses such as Motor Neurone disease, Parkinson’s and Alzheimer’s.
Now I am a firm believe in giving credit where credit is due. The Government has generally provided an excellent environment for medical research – so much so that Stephen Minger, one of the leading research scientists involved in this latest controversy, left the US to work at King's College, London. Without declaring a research free-for-all, the Government has created a licensing system that has enabled researchers in Britain to push the bounds of human knowledge and bring us closer to developing cures.
However, a recent consultation into the regulation of fertility treatments generated some negative results from religious organisations and anti-embryo research groups. This has caused Ministers to fear that public opinion is opposed to medical research.
Into this have stepped two research teams (one led by Dr. Minger), who are applying for licences to create embryos from neutralised cow and rabbit eggs implanted with human cells. Their aim is to create human stem-cells which they would use to examine the progress of diseases: if the neutralised eggs were implanted with the cells of a Motor Neurone suffer, for example, the stem cell would have Motor Neurone disease and so the scientists could study to progress of the disease. It may also be possible in future to clone cells and use them for transplants.
None of this requires the use of animal eggs, of course. However, human eggs are in short supply and those who are most concerned by this kind of research tend to be the same as those who object to using human eggs in research and to destroying fertilised eggs at all. In fact their concerns about breading a race of Frankenbunnies and Mootants is ill-founded; it is the implanted cell that will give the egg its DNA, while the tiny trace of animal protein and mitochondria from the egg would be replaced by human substitutes. Furthermore, there is no plan to actually implant these eggs and bring them to term.
What is more, the consultation that has caused all this concern was about an entirely unrelated issue (human fertility treatment) and the Ministers’ fears are based on a majority of opinions from among just 535 responses. Considering that 855 people have petitioned the Prime Minister to change the national anthem to Gold by Spandau Ballet, this seems to be rather a timorous overreaction.
In fact, it highlights the dangers of public consultations and “participatory democracy”, which are invariably captured by the most vocal and most well organised (often the best funded) groups, and where perversely it is easier for minority groups to organise than majorities.
I have written before about the danger posed to our society when we allow important and valuable research to be prevented by the illegal activities of minorities. In this case, however, it is not law-breakers who are threatening progress but law-makers. While I disagree with the irrational fear that fires the anti-research lobbyists, they are acting perfectly legally and have made their concerns known in the correct way. It is the reaction of Government ministers that is the problem here.
Stem cell research – including the use of hybrid embryos – has huge potential benefits for mankind. It will help us cure terrible diseases and alleviate great suffering. It is opposed by only a small fraction of the population, though a vocal and well-organised one. Ministers should have the courage to stand up for progress and for reason.
The decision has not been taken yet. Now is the chance for Hewitt, Flint and their Labour colleagues to show us they have some backbone and deserve their oft-claimed title of ‘Progressives’.
Caroline Flint, our public health minister, and Health Secretary Patricia Hewitt, have become spooked by adverse reaction to a consultation and are rumoured to be about to block pioneering stem-cell research that may help develop cures for terrible illnesses such as Motor Neurone disease, Parkinson’s and Alzheimer’s.
Now I am a firm believe in giving credit where credit is due. The Government has generally provided an excellent environment for medical research – so much so that Stephen Minger, one of the leading research scientists involved in this latest controversy, left the US to work at King's College, London. Without declaring a research free-for-all, the Government has created a licensing system that has enabled researchers in Britain to push the bounds of human knowledge and bring us closer to developing cures.
However, a recent consultation into the regulation of fertility treatments generated some negative results from religious organisations and anti-embryo research groups. This has caused Ministers to fear that public opinion is opposed to medical research.
Into this have stepped two research teams (one led by Dr. Minger), who are applying for licences to create embryos from neutralised cow and rabbit eggs implanted with human cells. Their aim is to create human stem-cells which they would use to examine the progress of diseases: if the neutralised eggs were implanted with the cells of a Motor Neurone suffer, for example, the stem cell would have Motor Neurone disease and so the scientists could study to progress of the disease. It may also be possible in future to clone cells and use them for transplants.
None of this requires the use of animal eggs, of course. However, human eggs are in short supply and those who are most concerned by this kind of research tend to be the same as those who object to using human eggs in research and to destroying fertilised eggs at all. In fact their concerns about breading a race of Frankenbunnies and Mootants is ill-founded; it is the implanted cell that will give the egg its DNA, while the tiny trace of animal protein and mitochondria from the egg would be replaced by human substitutes. Furthermore, there is no plan to actually implant these eggs and bring them to term.
What is more, the consultation that has caused all this concern was about an entirely unrelated issue (human fertility treatment) and the Ministers’ fears are based on a majority of opinions from among just 535 responses. Considering that 855 people have petitioned the Prime Minister to change the national anthem to Gold by Spandau Ballet, this seems to be rather a timorous overreaction.
In fact, it highlights the dangers of public consultations and “participatory democracy”, which are invariably captured by the most vocal and most well organised (often the best funded) groups, and where perversely it is easier for minority groups to organise than majorities.
I have written before about the danger posed to our society when we allow important and valuable research to be prevented by the illegal activities of minorities. In this case, however, it is not law-breakers who are threatening progress but law-makers. While I disagree with the irrational fear that fires the anti-research lobbyists, they are acting perfectly legally and have made their concerns known in the correct way. It is the reaction of Government ministers that is the problem here.
Stem cell research – including the use of hybrid embryos – has huge potential benefits for mankind. It will help us cure terrible diseases and alleviate great suffering. It is opposed by only a small fraction of the population, though a vocal and well-organised one. Ministers should have the courage to stand up for progress and for reason.
The decision has not been taken yet. Now is the chance for Hewitt, Flint and their Labour colleagues to show us they have some backbone and deserve their oft-claimed title of ‘Progressives’.
Friday, 15 December 2006
The lifestyle police are on the prowl again
Between the overweight, smokers and those who are fond of the sauce the social moralists are busy these days. Indeed, they’ve still managed to find time to berate parents, the indolent and various other groups too. It seems there is no rest for the self-righteous.
Today it is fat people whose lifestyles are under scrutiny. A team of public health professionals including Sir George Alberti, the Government’s national director for emergency care, and Laurence Gruer, director of public health science at NHS Health Scotland, have written in the British Medical Journal that large-sized clothes should have a fat-help line phone number printed on the label, sweets should not be available at checkout counters, fatty food should be taxed, urban roads should only be allowed if cycle lanes are built in, and a centralised agency should be set up to coordinate all aspects of obesity.
This is a shame. The issue that the report addresses is a serious one: while obesity is a sign of the success of our society – far fewer people die of diabetes than of malnutrition in the world – it is now one of the major health risks in Britain. Some of the proposals make a degree of sense but need thinking through better. Others, however, are misjudged, paternalist and judgemental.
Regular health checks for primary and secondary school leavers make some sense, but it would be better to ensure that children saw their GP regularly (and more than twice) than to send health inspectors to schools. Prohibiting all road building that does not factor in cycle lanes looks good on paper, but cycle lanes of the sort most common in Britain – a painted strip 18 inches from the curb – are unsatisfactory. Real cycle lanes need to be as distinct as the road is from the pavement, but this would incur huge costs. It is unlikely that the presence of a British-style cycle lane is going to tempt many out of the car and onto the bike; carbon taxes are more likely to achieve that!
While both these suggestions are worthy, however, others are less so. Creating a centralised agency is the knee-jerk reaction of the prominent bureaucrat, the professional expert and the righteously indignant. Far from centralising policy and decision making, what is needed is more focus on the individual and more tailored local provision. Taxing fatty foods is an example of nannying: the State’s role is to protect people from one another, not from themselves, and the taxes will be either ineffective or punitive, serving nobody but the Chancellor and probably hurting poor people who are best placed to decide how to allocate their own meagre resources.
As for sowing health advise into clothes above a certain size, one might as well print the word “Fatso” on the label, and ask the buyer to apologise for using up so much space as they hand over payment. The labels, far from providing useful information to those who do now know where to look for help (WeightWatchers and the family GP are both pretty well known), will act merely as a badge of shame, undermining people who are happy with their shape and further depressing those for whom it is a cause of upset.
The authors of this report are correct to say that “pull yourself together” is not an adequate response to obesity. Neither is finger-pointing. The responses that this problem requires are far more complex and far more subtle than can be achieved by a creating a new quango and handing down policies from the centre.
Today it is fat people whose lifestyles are under scrutiny. A team of public health professionals including Sir George Alberti, the Government’s national director for emergency care, and Laurence Gruer, director of public health science at NHS Health Scotland, have written in the British Medical Journal that large-sized clothes should have a fat-help line phone number printed on the label, sweets should not be available at checkout counters, fatty food should be taxed, urban roads should only be allowed if cycle lanes are built in, and a centralised agency should be set up to coordinate all aspects of obesity.
This is a shame. The issue that the report addresses is a serious one: while obesity is a sign of the success of our society – far fewer people die of diabetes than of malnutrition in the world – it is now one of the major health risks in Britain. Some of the proposals make a degree of sense but need thinking through better. Others, however, are misjudged, paternalist and judgemental.
Regular health checks for primary and secondary school leavers make some sense, but it would be better to ensure that children saw their GP regularly (and more than twice) than to send health inspectors to schools. Prohibiting all road building that does not factor in cycle lanes looks good on paper, but cycle lanes of the sort most common in Britain – a painted strip 18 inches from the curb – are unsatisfactory. Real cycle lanes need to be as distinct as the road is from the pavement, but this would incur huge costs. It is unlikely that the presence of a British-style cycle lane is going to tempt many out of the car and onto the bike; carbon taxes are more likely to achieve that!
While both these suggestions are worthy, however, others are less so. Creating a centralised agency is the knee-jerk reaction of the prominent bureaucrat, the professional expert and the righteously indignant. Far from centralising policy and decision making, what is needed is more focus on the individual and more tailored local provision. Taxing fatty foods is an example of nannying: the State’s role is to protect people from one another, not from themselves, and the taxes will be either ineffective or punitive, serving nobody but the Chancellor and probably hurting poor people who are best placed to decide how to allocate their own meagre resources.
As for sowing health advise into clothes above a certain size, one might as well print the word “Fatso” on the label, and ask the buyer to apologise for using up so much space as they hand over payment. The labels, far from providing useful information to those who do now know where to look for help (WeightWatchers and the family GP are both pretty well known), will act merely as a badge of shame, undermining people who are happy with their shape and further depressing those for whom it is a cause of upset.
The authors of this report are correct to say that “pull yourself together” is not an adequate response to obesity. Neither is finger-pointing. The responses that this problem requires are far more complex and far more subtle than can be achieved by a creating a new quango and handing down policies from the centre.
Tuesday, 28 November 2006
The myth of the postcode lottery belies the awful truth
Last night on Channel 4, John Snow presented a Dispatches on Britain’s Healthcare Lottery. According to Snow, healthcare is applied differently in different regions and as such a “postcode lottery” applies across the UK. He cited a gentleman in Wales who was not able to get treatment that was available to English patients across the border, and an arthritis sufferer who was denied treatment that was available to a women with a similar condition only a few miles away.
This concept of the postcode lottery is a fallacy. While there is no doubt that different Strategic Health Authorities and even NHS Trusts have different priorities, this is not a lottery. A lottery, were it to apply, would at least be fair, for the totally arbitrariness and randomness of such a system would mean that every patient had an equal chance of “winning” treatment, irrespective of other factors.
What we have instead is a postcode auction, with houses near good public services worth significantly more than houses where provision is poorer. I well remember an evening walk in Muswell Hill, when a friend pointed out that the houses on one side of the road were worth £100,000 more than those on the other side, because one side of the house was in the catchment area for a highly rated state school whereas the neighbouring school was far less well regarded.
This is a disgrace that points to the heart of the current Government’s public services failure. What both John Snow and the Labour Government seem not to understand is that differences in provision are unavoidable: schools and hospitals will always vary in quality – uniformity is a pipe-dream – and there will always have to be differing priorities in different areas. As long as citizens are parcelled up by district and told which health provider or which schools they may access, house prices will reflect the quality of public services and the rich will be able to access better services than the poor.
Where schools are concerned, this is probably one of the main reasons why social mobility has fallen in recent years; where once bright children from poor backgrounds could access good schools, they are now stuck with whatever school their parents can afford to live near. Thus poor people are obliged to send bright children to underperforming schools.
It is time decisions about services were taken away from bureaucrats and handed to citizens. Rather than public services being allocated by postcode, they should be selected by the user. The Government’s “choice” agenda is a nod to this, but it does not go nearly far enough. The Government should get out of direct provision of services. Education should be provided by a voucher scheme that allows poor parents to buy their way into good schools: as the money follows the pupils and the pupils follow success, failing institutions will be replaced by successful rivals and the overall quality of education will improve. This already happens in havens of Social Democracy such as Sweden.
As regards healthcare, Government should use the tax system to fund individual health insurance for every citizen, rather than try to provide health through a state monopoly. Thus patients would be able to access, through their insurance providers, whatever treatment they required, rather than being at the mercy of state planners who have decided that in a certain region a certain treatment does not meet the bureaucratic requirements.
The tired old phrase about “a postcode lottery” is a myth that belies the truth: a postcode auction that enables rich people to buy access – through higher house prices – to the best public services. This travesty is the inevitable outcome of state planning. It is time to move to a system for providing essential services that is truly fair. Power over their own health and over their children’s education must be returned to the people.
This concept of the postcode lottery is a fallacy. While there is no doubt that different Strategic Health Authorities and even NHS Trusts have different priorities, this is not a lottery. A lottery, were it to apply, would at least be fair, for the totally arbitrariness and randomness of such a system would mean that every patient had an equal chance of “winning” treatment, irrespective of other factors.
What we have instead is a postcode auction, with houses near good public services worth significantly more than houses where provision is poorer. I well remember an evening walk in Muswell Hill, when a friend pointed out that the houses on one side of the road were worth £100,000 more than those on the other side, because one side of the house was in the catchment area for a highly rated state school whereas the neighbouring school was far less well regarded.
This is a disgrace that points to the heart of the current Government’s public services failure. What both John Snow and the Labour Government seem not to understand is that differences in provision are unavoidable: schools and hospitals will always vary in quality – uniformity is a pipe-dream – and there will always have to be differing priorities in different areas. As long as citizens are parcelled up by district and told which health provider or which schools they may access, house prices will reflect the quality of public services and the rich will be able to access better services than the poor.
Where schools are concerned, this is probably one of the main reasons why social mobility has fallen in recent years; where once bright children from poor backgrounds could access good schools, they are now stuck with whatever school their parents can afford to live near. Thus poor people are obliged to send bright children to underperforming schools.
It is time decisions about services were taken away from bureaucrats and handed to citizens. Rather than public services being allocated by postcode, they should be selected by the user. The Government’s “choice” agenda is a nod to this, but it does not go nearly far enough. The Government should get out of direct provision of services. Education should be provided by a voucher scheme that allows poor parents to buy their way into good schools: as the money follows the pupils and the pupils follow success, failing institutions will be replaced by successful rivals and the overall quality of education will improve. This already happens in havens of Social Democracy such as Sweden.
As regards healthcare, Government should use the tax system to fund individual health insurance for every citizen, rather than try to provide health through a state monopoly. Thus patients would be able to access, through their insurance providers, whatever treatment they required, rather than being at the mercy of state planners who have decided that in a certain region a certain treatment does not meet the bureaucratic requirements.
The tired old phrase about “a postcode lottery” is a myth that belies the truth: a postcode auction that enables rich people to buy access – through higher house prices – to the best public services. This travesty is the inevitable outcome of state planning. It is time to move to a system for providing essential services that is truly fair. Power over their own health and over their children’s education must be returned to the people.
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