A row has broken out over a debt-ridden NHS hospital being handed over to a private company that will keep a large chunk of the millions of pounds in savings it will seek to make.

Bosses at Circle, which is running the Hinchingbrooke Health Care Trust in Cambridgeshire, have insisted they will improve standards despite claims that they will need to make what have been described as “eye-watering” cuts.

The Health Service Journal (HSJ) has published a report saying the hospital will need to make surpluses of at least £70m over the next decade if it is to clear its debts and meet Circle’s contracted share.

A letter deposited in the House of Commons library by Earl Howe, a junior health minister, and uncovered by the HSJ, details for the first time the terms of the deal to hand running of the hospital to Circle.

A statement from the HSJ said: “The first £2m of any year’s surplus goes to Circle; the company then takes a quarter of surpluses between £2m and £6m and a third of surpluses between £6m and £10m.

Cue wailing about cuts.

However, that’s not actually what is going to happen. The services they must provide are detailed elsewhere. They can’t, for example, collect a cheque for doing hip replacements and then not do any hip replacements.

What they have to do is increase the efficiency with which the money they get is spent. That is, provide the services they are contracted to provide at a lower cost, thus creating that surplus through greater efficiency. Only if they manage to do that do they then get a slice of those efficiency savings.

Which brings us to the meaning of “cuts” in this instance. There will be no fewer services: only less money spent on providing those services. So what we’ve actually got is people whining about inputs again instead of what we all want to be concerned about, the efficiency with which inputs get turned into outputs.

Very, very, British lefty. Insisting that it is the amount of money spent which is important instead of the outcome of having spent it.

Diabetes threatens to ‘bankrupt’ NHS within a generation

Treatment will use £16.9bn of budget as the number of diabetics rises from 3.8m patients to 6.25m by 2035

I don’t really see what the problem is. We pay for the NHS to treat any diseases or illnesses that we might develop. More of us get diabetes? Well, that’s what the NHS is for.

However, the important part of this is here:

Their research, funded by the drugs company Sanofi, also examined the costs of diabetes to the UK as a whole.

What does Sanofi make? Diabetes drugs.

Diabetes UK have just sold themselves out lock stock and barrel.

Christina McAnea, the head of health at Unison, the largest health union, which will present its evidence on regional pay on Monday at its health conference, said: “The Department of Health’s evidence on regional pay is built on sand. For a government that says it wants to cut paperwork, introducing regional pay would be a massively expensive, bureaucratic nightmare, designed to cause huge disruption and conflict.

“Regional pay would cause skills shortages in so-called low-cost areas, with nurses, midwives and specialised staff being hard to recruit and retain, hitting the care of patients.

The actual evidence is that national pay rates make recruitment in high cost areas more difficult and that this then leads to people dying.

You twat.

This is of course pure rent seeking. If there are not national negotiations on what the national pay should be then what point national unions who aren’t negotiating national pay?

In a letter to Berkshire Hathaway shareholders, the 81-year-old billionaire revealed that he has stage one prostate cancer but his condition “is not remotely life-threatening or even debilitating in any meaningful way”.

I’m not quite sure whether it is many, most or nearly all 81 year old men who have prostate cancer.

For most, many, nearly all, it’s an irrelevance as it grows so slowly that something else kills them first. There are fast growing types too, but they’re rare.

That sounds bad but:

Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten was considered major, and, in 2% of the patients, the iatrogenic disorder ended in death.

The short definition of iatrogenesis is “doctors fucking up”.

Yes, agreed, this is not a rigorous statistical comparison. However, it is the correct one.

It isn’t “are women and google misdiagnosing?” but “how much worse than doctors are women and google diagnosing?”, a question to which I don’t see a clear answer as yet.

If indeed they are worse…..

When I was born, almost 50 years ago, in the bitter winter of 1963, the National Health Service was just 15 years old. It must still have been hard for people to believe that – for the first time in the history of these islands – they could fall ill without risking financial ruin, that nobody need die for want of funds.

That’s also the first year that the NHS actually built a hospital. Before that it was simply using what others had built from private funds.

And as to not dying for lack of funds: what the hell does anyone think NICE does? Decides who will die for lack of funds of course.

It’s a different method of taking the decision, sure, but it’s the same decision being taken.

A new treatment for prostate cancer can rid the disease from nine in ten men without debilitating side effects, a study has found, leading to new hope for tens of thousands of men.

Glad they start to get it sorted out as I enter the age group where I might be interested in their having sorted it out……

According to the latest research, 48% of men and 43% of women in the UK will be obese by 2030, a trend that will significantly increase the prevalence of strokes, heart disease and cancer, and lead to higher costs for the NHS.

Bzzzt! No! Wrong!

In order to find out whether something costs the NHS money or not you have to add up what it does cost the NHS and then compare it with what the absence of that something or other would cost the NHS.

And for both obesity and smoking we get our answer here.

Fat boozing smokers die younger, before they spend a decade in that clammy embrace with Alzheimer’s.

Now, what you can say is that obesity (smoking, boozing, shagging around, whatever) costs those who do it some part of their lives. On average it certainly does.

But then they are their lives to waste as they wish, aren’t they?

Thus the way in which the lies are endlessly told, that it costs the rest of us money and thus the rest of us (or our puritans self-appointed on our behalf) have a right, nay a duty, to prevent this choice being made.

Thousands of elderly people are dying unnecessarily early because ‘despicable’ age discrimination in the NHS is denying them treatment for cancer, a charity has warned.

Yes, obviously. For the system is set up to do this.

Indeed, I’ve seen Polly commending the NHS for taking such a robust attitude to expense control. Why spend fortunes on the last few months of the elderly when we could be eradicating child inequality?

According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if if mortality rates from cancer matched those in America.

It’s generally accepted that that’s one of the reasons that makes the US system so expensive and the NHS so cheap. Because the NHS does a fairly brutal triage on who it will bother to treat aggressively and who it will offer simple palliative care to based upon the crude measure of age.

Now, whether it should be this way or not is one matter (one I’m really not sure about myself). But the amusement might come from reactions to this report. I can see the usual suspects clamouring that this just proves how the Tories are bastards while ignoring their own previous stance that this shows how wonderful the NHS is because it doesn’t waste resources.

Small quantities of processed meat such as bacon, sausages or salami can increase the likelihood of dying by a fifth,

The likelihood of dying is one in one. Unity, 100%.

OK, I’ll give you the Virgin Mary, the Prophet Elijah and even Lazarus Long if you wish. Still indistinguishable from one, the chance of dying.

A controversial system of mobile euthanasia units that will travel around the country to respond to the wishes of sick people who wish to end their lives has been launched in the Netherlands.

The scheme, which started on Thursday , will send teams of specially trained doctors and nurses to the homes of people whose own doctors have refused to carry out patients’ requests to end their lives.

The NHS was always rationed. What matters is whether it is done rationally or haphazardly, nationally or by postcode, in public or secretly. Entering its greatest ever cash crisis, it matters more than ever how its shrinking funds are spent.

Indeed, something free at the point of use and also highly desirable will need some form of rationing. Which is why we want to have markets in the health care industry.

For there’s something we learned in the short 20 th century, that period betweem 1917 and 1991.

Market based systems improve total factor productivity better than centrally planned systems.

Agreed, the socialist insistence at the start of that period was that planning would do better than that wasteful nonsense of competition, repetition, reinventing the wheel and profits. It didn’t quite turn out that way and the socialists are reduced to arguing that economic growth, “hunh!, who wants it anyway?” as an argument for the very same socialist planning. Indeed, there are those who insist that as we cannot afford to have growth then we must have socialism.

Leave aside all of the technical arguments for a moment: that change in the justification for the very same policies is all we need to see that the 20th century did indeed teach us something about productivity growth.

And rationing is a product of the constraints imposed by that productivity we’re discussing. If we can improve tfp by, just as an example, 2%, then that means that we can have 2% more health treatment for the same resources we expend on providing health treatment. If 10% then 10% and so on.

Which is why we want markets in that health care stuff. Because it means that, over time, we can improve tfp and thus we need to less rationing. Because we’re able, through that increased tfp that markets work towards, to provide more health care for the same ingoing resources.

QED.

That’s a lot, certainly.

The study was carried out in the US, where up to 10% of the adult population took sleeping pills in 2010. The authors estimate that sleeping pills may have been associated with 320,000 to 507,000 extra deaths in the US that year.

And that’s two a lots. Lots of people and lots of deaths. However, there’s a little problem as far as I can see.

Deaths and Mortality

(Data are for the U.S. and are final 2009 data; For the most recent preliminary data see Deaths: Preliminary Data for 2010 Adobe PDF file [PDF - 724 KB])

* Number of deaths: 2,437,163

Perhaps there’s something I’m missing here but I just can’t see how something that 10% of the population does accounts for 20% of all deaths.

It’s certainly possible if it’s something new: 10% of the population could get some lurgy that kills them outright immediately and that could be 20% of deaths in that year. But I’m not sure that I can see that something ongoing, something that’s been happening for decades, can, if only 10% of the population do it lead to 20% of the deaths.

Help me out here. What is it that I’m missing?

Targets always tempt statistical massaging, but the extremity of this cheating means no waiting-list figures can be trusted.

Indeed they do. Central setting of targets is always subject to gaming by those at the front end. This is exactly what people are complaining about about the banks. That hitting a short term target boosts the bonus of the banker at risk to the larger company, the bank, and possibly the financial system as a whole.

And this is wat Polly is complaining about in the NHS: that these centrally set targets are subject to such gaming.

What amuses is that Polly then makes the leap to an insistence that central management by targets must be continued.

And as for this:

Just to survive, the NHS always needs 2.5% above inflation,

Yes, we know, Baumol’s Cost Disease and all that. But that’s why we’re trying to change the system from a centrally planned monolith to a market based (even if tax funded and free at the point of use) system., Precisely becuse total factor productivity increases faster in market based rather than planned systems. We’ve the evidence of the entire 20th century for this.

And yes, higher tfp growth is the solution for a higher inflation rate. They’re actually the sides of the same coin. A higher inflation rate is evidence that tfp is growing more slowly than elsewhere in the economy. To which, of course, the answer is to try and encourage tfp growth in this sector of the economy as well.

It may well be that Baumol means we’ll never get tfp in medicine up to hte rate of, say, manufacturing. But this doesn’t mean that we shouldn’t at least do the best we can.

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.