Matthew's Journal

One of the things that has concerned me for a while with the thrust of government policy is its faith in the private sector (or, perhaps, its lack of faith in civil servants), and in the power of markets to make everything better. There's an assumption that government departments are large inefficient bureaucracies staffed by indolent jobsworth civil servants who are impossible to fire, whereas the power of the market means that companies can do the same jobs better and for less money. This lead to the privatization and marketization of utilities and the railways, and I think is underlying what looks rather like attempts to move towards markets and privatization in the NHS and university sectors.

One of the problems with markets is that they tend to value easy to measure things over things that are harder to quantify[0]. In healthcare, this seems likely to result in quality of care being sacrificed on the altar of driving down costs. The NHS Confederation agrees: "Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the USA confirms this, with falling prices and reduced quality, particularly in harder to observe measures". And, for all that some people in the US make a great deal of money out of healthcare, it's hard to see it as anything other than deeply dysfunctional on the whole. Even many UK doctors are against the proposed reforms, substantially because of their market-based nature[1].

In a similar vein, the government is trying to introduce a market element into higher education via variable tuition fees; there is also talk of encouraging more private input into the university sector, maybe even allowing companies to fund places at university for their chosen students. It seems likely that this is partly motivated by the successes of the big American private universities; but as this LRB article notes, even if you don't care a fig about public good, the US system doesn't deliver cost-effective excellence in Universities.

I appreciate that the boat has rather sailed, but I think it's time we realised that private enterprise may not be the best way to run services in the public interest, and that sometimes things that are hard to measure are more important than cold, hard cash.

[0] There is an ethical question here, too, of whether profit is the best motivation for, well, anything, but I think that's an aside for now
[1] http://www.bmj.com/content/342/bmj.d7.full [probably behind a pay-wall]

The Beeb has recently started a "Scrubbing Up" column for professionals to opine about healthcare in the UK. This week's is by the President of the Royal College of Surgeons, and rants about (amongst other things) the "choose and book" system. When I interacted with the booking system, I was unimpressed, and I also agree with Mr Black's other comments about interactions with consultants - my GP said "there's no reason not to go to University Hospital", and it was the closest, so I ended up going there, but I had no good basis on which to make that decision (separate from my GP's advice). I saw a different doctor (or set of doctors) every time I went to the hospital, too. I agree that it's not great from the patient perspective - the whole process was a lot of sitting around and waiting, a fair bit of discomfort, and rather impersonal.

I try and avoid grumbling about the NHS - I'm generally of the view that it makes a BALGE effort at a difficult job. It has annoyed me today, though.

I need a referral to a hospital for some diagnostic work. My GP tells me some paperwork will come through the post, and that I might as well go to the local University hospital. Today, said paperwork arrives. It has an appointment number and a "password", as well as my 3 "choices" of clinic, and a website where I can get "information to help you make your choice of alternative".

The website doesn't work - it refuses point blank to talk to my web-browser. Surely we learned in about 1997 that you offer people something, if necessary with a caveat "this might not look so pretty". So,I try the NHS website proper. That will at least show me the location of my three choices (the paperwork conveniently fails to tell me where the George Eliot Hospital is); much of the other useful data is "not available yet". No-where can I find out anything I might want to know like: who the specialist is, what their post-op complication rates are, what the waiting time's like, what's the food like, etc., etc.

So, I make my Hobson's choice, and call the University Hospital. I wait for 3 or 4 minutes while the person apologises for "the new systems a bit slow", having taking all my details again (surely the referral must have told them where I live???). The first they can do me is 5th September - a fair way off, but *shrug*, it's nothing urgent. The first couple of weeks in September, though, atreic and I are planning on being away, so I ask if I could have something a little later. "Well, I can only offer you dates up to the 7th of September. If you want something later than that, you'll have to make an appointment now, and re-book it later".

WTF? In what way is this a sensible system? I'd rather they'd spent less money on the illusion of choice and instead had an appointment-booking system that's fit for purpose. As it is, I'm going to get through a load of mostly-useless paperwork, have to make another appointment later, and then presumably get the same paperwork a second time.