Most toxic is the role of commercial competition, with Monitor acting as enforcer. By opening every NHS corner to “any qualified provider”, the whole service can be taken over by private companies, with a few token charities and mutuals. NHS hospitals, cherry-picked of lucrative work, risk bankruptcy when left with only complex cases. Stroke care surged ahead by creating pathways so ambulances take patients to designated units, open on rota, working together. Cancer and heart results improved dramatically, due to collaboration. Commercial competition prevents that – and drains away cash.

Dr Clare Gerada, of the Royal College of GPs, points to Nottingham, where 30 physiotherapy practices are now licensed to trade, breaking the close working with surgeons after operations. “How are patients to choose? By colour of the wallpaper?” she asks. “And how can the Care Quality Commission possibly check the competence of every provider?” The CQC, with a 30% cut, has just 900 inspectors to check 8,000 GP practices, 400 NHS trusts, 9,000 dental practices and 18,000 care homes. NHS instructions say: “Commissioners cannot refuse to accept providers once they have qualified.” So the bill opens the NHS to EU competition law. The GP Sarah Wollaston – a Tory MP – rightly calls the bill “a hand grenade thrown into the NHS”.

It’s not “the right” being conservative here, is it?

Perhaps Mr Lansley knows something the rest of us do not, but on past form I doubt it. Twenty years ago, when senior surgeon at the Royal Hampshire Hospital Paddy Ross inquired of Ken Clarke, then a Tory health secretary, how he anticipated the Health Service would function as an internal market, he replied candidly enough: “I don’t know – we will just have to see how the dust settles.” Not an encouraging precedent.

This is why we use markets. Because in large parts of life things are simply too complicated not to use markets.

That we don’t know how to plan things, for there are too many interacting parts, too many possibly conflicting incentives, is exactly the reason why we don’t try to plan things . Rather, we set up a simple set of rules…law of contract and so on….then throw it all up in the air and see what happens.

If we actually knew how to plan it…..say, like the making of a curry with all ingredients to hand…..then we could indeed use a planning system….with the curry a recipe. When it’s all too complex to plan…..for example, the system of producing all of the ingredients and making sure that they are easy to get to hand…..then we not by choice but by necessity use markets.

Some 5% of the UK workforce, some 10 % of UK GDP, the NHS, this is too complex to plan. Thus, by necessity, we should use markets.

Perfect knowledge means we don’t need markets: uncertainty means we have to use them.

Medical regulators are drawing up new advice for more than 30,000 Britons who have received “metal-on-metal” devices because of fears that they are even more dangerous than previously thought, a Sunday Telegraph investigation has found.

Problems occur with such devices when friction between the metal ball and cup causes minuscule metal filings to break off, which can seep into the blood and cause inflammation, destroying muscle and bone.

There are also concerns that the fragments could put the nervous system, heart and lungs at risk of being slowly poisoned.
…..
tests to establish the levels of cobalt and chromium in their blood,

Err, why are levels of cobalt and chromium to be tested? The usual metal for such implants is titanium.

Co and Cr would be strange metals to use in the first place: given that they can indeed be toxic inside the blood system. I’ve had a look around and I cannot find anything about what metals these implants are in fact made from: Ti, Ta or Nb sound to me like the most likely ones for they are, as far as the human body is concerned, inert.

The presence of Co and or Cr indicates that they were, or at least are being assumed to be, made from a high grade stainless steel (Co perhaps substituting for Ni). Which sounds like a slightly odd thing to make implants from.

Anyone got more info?

Update, note first comment. CoCrMo alloys are used for implants. Seems a bloody strange alloy to use but then what the hell do I know?

How can £20bn cash cuts and increased marketisation lead to a better NHS?

1) Markets (note, not capitalism, markets) promote innovation better than centrally planned or run systems.

2) Innovation leads to increases in total factor productivity.

3) Increases in tfp are synonymous with (as in, this is the definition of tfp) being able to do more with the same resources, being able to do the same with fewer resources.

A market driven health care service (note please, not a capitalist one) will be more efficient over time than a not-market driven health care service.

That’s how.

There we all were naively thinking the Olympics would bring pride, excitement and tourism revenue to London this summer. But what none of us has properly accounted for, according to six new papers published in Lancet Infectious Diseases, are the health risks to visitors of stampedes, heatstroke and mass infections.

Events ranging from Barack Obama’s inauguration and Glastonbury through to the Hajj pilgrimage and football World Cups have all provided evidence that is now being used to minimise the health risks that will accompany the London games. A system called Bio Diaspora will be used, which tracks air traffic to help anticipate the global spread of diseases. The internet will also be closely monitored to spot early geographical evidence of “disease activity”.

As we all remember the plot of Rainbow Six is the deliberate introduction of a virus (some form of ebola?) into the crwods at the Sydney Olympics.

Good to see that the doctors are keeping up with fine literature.

However, it could never happen, and not because I’m so enlightened, sensitive or any of the other euphemisms for “whining hippie” usually dumped on vegetarians. My conversion to flesh-eating couldn’t happen because, frankly, I’m not stupid enough. As in, I can read.

Analysis of more than 6,000 pancreatic cancer cases published in the British Journal of Cancer says that eating just 50g of processed meat a day (one sausage or a couple of slices of bacon) raises the likelihood of pancreatic cancer by a fifth. 100g a day (the equivalent of a medium burger) raises it by 38%, 150g by 57%.

Hmm. Age adjusted incidence of pancreatic cancer is 12 per 100,000.

So the eating of processed meats raises it to 18 per 100,000 or so does it? (Not really, as the 12 rate already includes those who eat processed meats but still….)

Ho hum, that’s about the risk of dying in a car crash isn’t it? Just one of those minor risks that confront us all, that have to be navigated on that route from cradle to the inevitable grave.

80mph speed limit ‘risks rise in road deaths and obesity’

Obesity?

and a potential rise in obesity due to more people taking advantage of shorter car journeys.

Eh? They’re raising the speed limit on motorways for cock’s sake.

A motorway journey is not a subsititute for a waddle around to the corner shop for lardy buns.

Data released in Parliament show that in the most deprived areas of the country, the mortality rate is as high as 1,500 deaths per 100,000 people in a single year.

By contrast the death rate is 1,427 in Rwanda and 1,452 in Botswana, according to the World Health Organization.

They point out a number of caveats. The areas being discussed are tiny, so simple statistical variation will have a large impact (the national average death rate is some 462 per 100,000).

The presence of a hospital or hospice will alter the figures dramatically (which means, I think, that the figures are drawn from place of death, not place of residence at time of death?).

But do not doubt that this will be taken as proof perfect of the shameful iniquities of the rampant inequality in the country.

And as ever, the elephant will be missed.

Yes, we know there is health inequality. We also know that there is socio-economic inequality. We even know that there is a correlation between the two.

However, in the usual public health discussions it is assumed that the causation runs from socio-economic inequality to health inequality. And I would certainly be open to the argument that some of the correlation does run that way.

However, I would also insist that some of the correlation runs the other way. That health inequality leads to socio-economic inequality. Become ill with some chronic disease and your employment and income prospects simply are going to decline.

And sadly, at least as far as I can see, that’s not a causation that is allowed to enter into the discussions of inequality and public health. Certainly I looked through the Marmot thing and could not see any evidence at all of it being discussed, even to reject it.

If it is and I missed it please do correct me. But if it isn’t then we’ve another one of those lying with numbers things, don’t we?

We do have, the way that they are counting, an increase in admissions related to alcohol. This is partly because of the following effect: there has been a rise in admissions. Actually, there’s been a 40% or so rise in admissions over the decade. And, if you are, as they are, stating that 0.3 of this type of admission is booze related and then 0.2 of that type, then a rise in overall admissions will lead to a rise in booze related admissions.

BTW, a rise in admissions when spending on the health care system roughly doubles is not a great surprise, whatever the underlying health of the nation.

Over here we get more of the necessary information.

This is speculative, but my guess is that the alleged rise in alcohol-related hospital admissions is in fact a rise in obesity-related hospital admissions, which are linked to some of the same diagnoses at similar ages.  Perhaps the statisticians behind this weekend’s newspaper stories could find time to look into this hypothesis.

We know, absolutely, that there has been a change in the pattern of disease (or ill health perhaps) over the decade. Yet the proportions of ill health which are defined as being alcohol related have been held static over that decade.

To be absurd for a moment, if plague was definied as being 0.3 of an alcohol admission then the Black Death would have showed a rise in alcohol related admissions.

To be not absurd for a moment, many of the diseases and illnesses associated with obesity are defined as being some portion of an alcohol related admission. Meaning that as muffin tops spread then so do booze related admissions.

These statistics simply are not fit for use.

Yet, as we can see, they are being used to pressure for minimum prices, higher booze taxes and in general, the imposition of Methodist values on a non-Methodist population. Next up the cooking of the numbers about dancing so that the Baptists can have a go, eh?

Hospital admissions linked to alcohol problems have reached a record high, prompting fresh concern about the harm being caused by binge drinking.

Hospitals in England admitted 1,173,386 patients for treatment for alcohol-related problems in 2010-11, NHS statistics show, up 9% on the 1,056,962 in 2009-10, the first time the figure topped 1 million. In 2002-03, there were 510,780 such admissions.

These are the drinking figures which don’t in fact show that the specific problem is to do with drinking, aren’t they?

I can never remember whether they’re measuring all admissions where someone has had a pint or they simply say that x % of all y type injuries must be drink related. And I’m almost certain that there’s been a change in what it is that they’re measuring in that decade.

In other words these statistics are toss.

Therefore all health care should be run by federal government.

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NHS cancer patients to be offered experimental drugs
Cancer patients will get much quicker access to experimental drugs and other treatments still in development, David Cameron will announce today.

The biggest cost in pharmaceutical development is the trials. Phase III trials particularly. phase II trials clearly come before them.

If you wanted to aid the pharma industry then you’d try and find a way in which organising such trails is easier, cheaper and above all, faster. For the patent clock starts running before these trials are even attempted.

No, really, you get 17 years on the patent and the first 6 to 7 of those years are spent in trying to show everyone that the drug actually does something useful and doesn’t kill people in the meantime.

So, allowing earlier access to experimental drugs means that those tests can be done earlier/faster and then the few drugs that make it through the process have more patent time, are more profitable and hey, we’ve just given pharma a boost.

And it’s by definition a boost that will happen in the UK, for it’s the NHS that will be offering these new drugs.

There’s also the interesting side effect that those who get these new drugs that do work will live longer, some of them will even be cured of their ailments.

All very sensible: so the one thing we know about it is that a politician didn’t think it up. But at least they’ve picked up the idea, eh?

Loved ones not always told their relative is on controversial ‘death pathway’
NHS doctors are failing to inform up to half of families that their loved ones have been put on a scheme to help end their lives, the Royal College of Physicians has found.

Rise in ‘bed blocking’ is costing the NHS £500,000 every day

What’s happened to England’s rugby team this autumn is obviously not just about money. But it’s an excellent example of something free marketeers often ignore, but that research proves: that adopting a market system does encourage people to think about cash and their individual wellbeing.

Indeed this is very true. Market incentives do change behaviour.

Now imagine a healthcare system in which the sick are treated by staff increasingly encouraged by successive governments to see themselves as providers in a market. Care doesn’t necessarily get worse, but it does change – and in ways that patients might not like.

Yes, indeed, let us think of this.

So, let us ponder the English rugby team of 2011. Let us compare it to the England rugby team of 1991, when it was indeed still an amatuer (hmm, OK, shamatuer) game.

Let us place the England team of 2011 on the field against the England team of 1991. We’ll use a time machine to bring the old team here at their playing ages, not their current ones. But everything else stays the same: fitness levels, tactics, training periods, etc.

Who will win? I think we know the answer to that, don’t we? The 2011 team will walk all over the 1991 team. Heck, I’d back the 2011 Italian team to walk all over the 1971 Lions, let alone the Welsh 2011 to beat the glory days of 70s Welsh rugby.

So, the quality of output has increased in this move to market incentives: and we expect what to happen as we introduce market incentives into health care?

Well, I for one would expect the quality of output to rise to similar to those other health care systems that have a modicum of market incentives in them. You know, the French, German etc etc, health care systems?

Do note, perfectly willing to agree that one can go too far: relying entirely upon private health insurance as in the US system seems not to work so well. Relying upon private health savings accounts plus government run catastrophic health insurance (roughly the Singapore model) seems to work extremely well.

All markets all the time markets is not the solution to every problem we as humans encounter. But a fit of the vapours over some markets some of the time markets, where such has been proven to work elsewhere, is not the solution to any of the problems we as humans encounter.

Patients admitted to NHS hospitals for emergency treatment at weekends are almost 10 per cent more likely to die than during the rest of the week, according to a comprehensive new report.

Hmm.

I think we would start by looking at staffing levels, wouldn’t we? They are the thing which is most likely to vary over such periods.

Many hospitals have far fewer senior consultants on site outside of normal office hours, the data show, and rely on junior doctors and nurses to treat critically ill patients.

And, if rumour is to be believed, many fewer junior doctors too.

It has prompted a strong response from the Department of Health, which wants trusts to find out why patients are not receiving the same standard of care around the clock.

Well, actually, I think I would start with the rules that limit the hours that doctors can work. You know, the EU ones which came in just a couple of years ago?

The way I would check and see if they’ve had an effect is to run the same counting exercise over the death statistics from a decade or more ago. If we saw the same peaks in the death rate over the weekends then perhaps it isn’t responsible: if we don’t see the same peaks then perhaps it is.

As I say, I don’t know whether this is the problem or not. But that is the place to start looking.

Hands up everyone who thinks they will actually look there though?

The real reason we want competition in the NHS.

There is now strong evidence that smoking in vehicles exposes non-smokers to high levels of second hand smoke which is known to be damaging to heath, the BMA said.

We’ve really got to start hanging these lying bastards right now.

Barack Obama faced a new and unpredictable hurdle to White House re-election next year when the US supreme court announced it is to rule on whether his healthcare bill, the major legislative achievement of his presidency, is constitutional.

The court is to hear the arguments in March next year and is to expected to publish its decision in June, just five months before the White House election.

I’m scheduling in massive supplies of popcorn for June then.

Labour MP Valerie Vaz, who sits on the health select committee, said the revelation should prompt second thoughts by ministers: “It is difficult to comprehend how Circle can maintain a proper standard of healthcare while maximising profit; as a company they would have to make a profit, but that can only come if costs are cut – such as a shorter stay in bed to recover, one less nurse. That must compromise patient care,” she said.

It is actually possible to make things “more efficient” in their use of inputs.

It’s one of the ways that the economy grows you know, we find out new and interesting ways to do things that require fewer resources than the previous methods.

An example for you in health care….and I’ll make it a simple one for you are a Labour MP and thus require simple examples….curing headaches.

There was a time, a century or so ago, when the only cure for a headache was a comely maiden bathing your forehead with a damp cloth. Didn’t work very well, took a lot of inputs (not least the labour of said maiden) but that was the best we had.

Now we’ve got aspirin at 50p a hundredweight. Suck one of these and the headache goes away. We now have a better treatment for headaches which uses fewer resources. It really isn’t the distressing shortage of maidens, comely or not, that has led to our changing the method of treating headaches.

In the jargon this is known as an improvement in total factor productivity. Human progress depends upon it.

Now what we want to know is what sort of system increases tfp the best? Excellent, that’s a question we can answer: the 20th century provided us with a natural experiment. The Soviet system, one which had no markets, did not, according to several well known and proficient economists, manage to increase tfp at all. Some 80% of the growth in the market economies was however as a result of increases in tfp (the other economic growth, both the remaining 20% and all of the Soviet Union’s, was from increases in resources used).

Excellent, so, to increase tfp we want to change the last remnant of Stalinist central planning, the NHS, from the USSR style no markets and no tfp improvements into the markets and tfp improvements stylee thing.

Which is how a company can make profits: by increasing tfp, by just doing things better than they were done before.

If France has socialized medicine then Britain has communist medicine.