To a point Senior Lecturer

Normally I have a lot of time for the Public Accounts Committee. Over the last decade few committees have done better work. But this is far from its finest hour. There are three reasons why the NHS is in trouble. They are:

The internal market, which creates massive costs and enormous inefficiencies
A lack of funding
Brexit, which has harmed recruitment

Just to address 1).

NHS England has more internal market than NHS Wales and NHS Scotland. NHS England has been getting more productive faster than NHS Wales and NHS Scotland. A reasonable conclusion thus is that internal markets improve productivity.

That is, the costs and inefficiencies of internal markets are less than the benefits they bring.

Someone who knew economics would know that…..

39 comments on “To a point Senior Lecturer

  1. “Brexit, which has harmed recruitment”

    I’ve never understood why the left are so relaxed about the UK stealing nurses from other countries. Do people not get ill overseas so they don’t need nurses.

    Nicking resources from other countries seems so ‘Imperial Empire’.

  2. I believe that the language proficiency tests, brought in late 2018, was far more of a kybosh on recruiting nurses than Brexit. And having a reasonable proficiency in English for health workers strikes me as a good idea. Sadly there is a lack of ability in both foreign and local workers.

  3. You would think the fifth/sixth largest country in the world could staff its own health services.

  4. Fifth largest country by what criterion?

    Area? So that would be Brazil then.

    Population? Ah! Brazil again.

    Feck me, what’s Brazil got to do with this topic?

  5. Rob said:
    “You would think the fifth/sixth largest country in the world could staff its own health services.”

    We’re the 5th / 6th largest economy; we’re only, what, 20th largest country (by population).

    And that difference may be part of the problem – we’re richer per person than most of the world (three times average?), so it will be more difficult for us to find people to do unpleasant, low-paid work, because there are other opportunities, so it’s easier to import staff from poorer countries.

  6. I read somewhere that NHS recruitment from the EU has actually increased since the referendum vote.

    There’s still a million unemployed people in Britain; it cannot be beyond the capabilities of the ‘envy of the world’ to train them to mop floors and provide basic care.

    I understand that much of the NHS funding has been squandered on IT systems, PFI and giving GPs the life of fucking Riley.

  7. @ MC
    A lot of the unemployed are on ESA, so no – it CAN be beyond the *competence* of the NHS to provide them with useful employment. The private sector could find them useful employment in jobs designed to fit around them if the incentives were aimed to help the genuinely handicapped instead of whingers. when I was young every large/medium firm had to employ a %age of physically handicapped or show good reason why not and they mostly did.
    Bring back Remploy, run properly as it was for a generation after WWII before some managerialists wrecked it.

  8. People who attend hospital as outpatients are often, by reason of age or illness, unable to walk far unaided. It is therefore a Jolly Good Thing for there to be an adequate number of Disabled Parking spots, adequately policed, near the hospital entrances.

    This really easy challenge has proved too much for our local World Famous Teaching Hospital to cope with.

  9. RichardT

    so it will be more difficult for us to find people to do unpleasant, low-paid work, because there are other opportunities, so it’s easier to import staff from poorer countries.

    Rather this

    so it will be more difficult for us to find people to do unpleasant, low-paid work, because we are happy to pay them benefits to sit on their fat arses without working, so it’s easier to import staff from poorer countries.

    How is it that Choudhury for example was able to claim JSA benefits before his conviction. I presume now he’s out he’s back on the brew

    John77

    As to Remploy, the less productive used to be paid less. That’s strictly illegal now unless you attempt a scheme to distinguish the jobs, which is itself capable of being challenged.

  10. On Murphy, I see the Uni at which he is a Prof has changed. I assume it was Murphy himself who wrote the para about himself.

    Should Uni of London be told, in case they don’t want to be associated wrongly with an irascible dickhead?

    https://www.commonspace.scot/articles/14349/summer-cs-forums-social-security-and-automation-richard-murphy-green-new-deal

    Richard Murphy, professor of Political Practice in International Political Economy at the University of London, is one of the leading advocates of the Green New Deal in the UK, having been a founding member of the Green New Deal Group in 2007 and authored numerous works on a Green New Deal. Murphy has also written on the economics of Scottish independence, arguing an independent Scotland could break from the neoliberal UK system if it took a radically different approach to tax and public investment.

  11. The idea that internal markets lead to inefficiency is a mantra of his mate Ann Pettifor. This comes out in just about every article she writes. She might even believe it

  12. @BraveFart

    The giveaways that Murphy penned his own bio are;

    “one of the leading advocates”

    “a founding member of the Green New Deal Group”

    “authored numerous works”

    “neoliberal UK system”

  13. The thing about nursenaries is they go home when the exchange rate dictates, not at the convenience of the employer. You can find warnings in Machiavelli.

  14. @ Bravefart
    That sort of thing gets me hot under the collar and wanting to bring back the stocks for the culprits. Of course the more productive should be paid more and to condemn a willing worker to sit at home watching daytime TV and/or drinking himself to death because Remploy is not allowed to pay him a wage matching his reduced ability to produce stuff is sinful.

  15. MC,
    It may be true that GP’s couldn’t believe their luck when they found they could give up weekend work, but much of the GP crisis has been caused by a) more female GPs going part time, and b) GP leaving early, as they are caught by higher tax and restrictions on their pensions, which means they can be subject to marginal rates of tax of around 100%.

  16. Government run healthcare. When it goes bad, the answer is that it just needs some tweaks around the edges. But it’s still a good idea.

    A few rule changes, and MORE MONEY, and it will be fine.

    Uh-huh.

  17. @ Nautical Nick
    Just a)
    The fuss about pensions is male Consultants (not GPs) being caught by tax on pensions if they work extra shifts (usually to cover for their female colleagues).

  18. Five years ago I was on a contract rolling out Win7 systems to GP practices all across the county. Next week I start a contract rolling out Win10 systems to the exact same GP practices all across the county. IT does seem to be a bit of a money pit for the NHS.

  19. I vaugely remember from school history lessons fights against piecework, where workers were explicitly paid according to their productivity – if you made 20 widgets you were paid for 20 widgets, if you made 10 widgets you were paid for 10 widgets – and “reforms” to being paid regardless of productivity.

  20. I see the potato has bigged himself up describing himself as a professor of Political Practice in International Political Economy as if the course was Political Practice in International Political Economy rather than professor of practice in International Political Economy.

  21. GPs often buy into the company as a partner or shareholder. Or set up a new company.
    They can usually employ someone to work weekends.
    Around here there was a separate company that won contracts for out of hours services. The GP practices operated during the week and provided visiting GPs as needed, out of hours the other company provided GP visits.

    dearieme – I have used multiple local hospitals over the years plus the hospital near my parents house. 6 hospitals, none of which have anything like enough disabled parking.

    And not really enough non disabled parking either. Driving round the hospital car park trying to find any space at all never mind a disabled one for a 4pm appointment is hard. And cannot leave the car park without paying, the token machines requiring the car to be parked up to use.

  22. The fuss about doctors’ pensions: we know two GPs who retired early because of it. One likes her job so much that her retirement lasted only 24 hours though.

  23. “One likes her job so much”: a flash of the bleedin’ obvious occurs to me. She’s one of nature’s Mums, just made for it – her GPing is an extension of that.

  24. @Andrew C June 12, 2019 at 1:07 pm

    +1

    The solution to our dentist/doctor/nurse shortage is remove Gov’t and GDC & GMC & RCN cap on student numbers

    With all being female dominated we need more.

    @Fatmatt June 12, 2019 at 1:19 pm

    +1

    Interesting thing is a lot of antipodean nurses were failing the test. iirc RCS were using wrong test.

  25. @john 77 June 12, 2019 at 2:42 pm

    employ a %age of handicapped

    Minimum wage resulted in most being sacked

    @john 77 June 12, 2019 at 4:31 pm

    Nope, GPs too

    (at end of article)…The truth is doctors don’t want to be GP partners any more. The administrative tasks, regular inspections and annual appraisals can be seriously off-putting. Doctors can instead earn excellent money as locums, with none of the responsibilities of looking after the buildings, staff, number-crunching and box-ticking that being a GP partner entails.

    Then you have the fact that 70 per cent of those coming out of GP training are now women, and they are more likely to work part-time as they juggle their job alongside raising a family.

    Senior GPs are increasingly taking early retirement as new tax regulations mean they’re penalised if they carry on earning and adding to pension pots….

  26. @Anon June 12, 2019 at 4:53 pm

    Is the Win7 system broken? If not why upgrade?

    .
    @BraveFart June 12, 2019 at 5:03 pm

    FFS? Yes

    Tell the snowflakes to FO

  27. “I understand that much of the NHS funding has been squandered on IT systems, ”

    That would be the £12BN spunked on the centralised records system. One of Blairs big governemnt wank fantasies. At trust level most of the IT is run on a shoestring.

    Hell they still run XP. That’s why that recent worm outbreak hammered the NHS so badly.

  28. @jgh
    June 12, 2019 at 5:01 pm
    I vaugely remember from school history lessons fights against piecework, where workers were explicitly paid according to their productivity – if you made 20 widgets you were paid for 20 widgets, if you made 10 widgets you were paid for 10 widgets – and “reforms” to being paid regardless of productivity.

    I recall when I first started work after leaving school, being told explicitly by the Union Rep I should under no circumstances exceed the mandated piece work target to boost my own pay. If I did, the targets would be raised for all.

    So glad now as an employer in a small business, I can set my own pay rates based on skills and application. I really fear a Corbyn Gov. The potential of forced unionisation would kill us without the flexibility we need as a business with a turn over < £1M and 8 employees.

  29. Microsoft has announced they are going to drop support for Windows 7.

    This time, they really mean it.

  30. Musings from an IT security consultant (retired, I think 🙂 )

    Hell they still run XP. That’s why that recent worm outbreak hammered the NHS so badly.

    I wouldn’t be surprised to learn that there are still NHS admin systems running XP, But the problem (shared by manufacturing industry) is that you spend millions on a big piece of kit (e.g. for the NHS, a CAT scanner) that is operated from a PC running XP. Unless the manufacturer is prepared to update their software to run on a newer OS, you’re then stuck with it (which need not be a catastrophe – see below).

    Microsoft has announced they are going to drop support for Windows 7.

    Which will mean no security patches. But this need not be a major problem for specialist systems (like the examples above) that can be carefully shielded from the Internet (or, better, not networked at all). I know of banks running ATM systems on OS/2 in this way.

    But if the real issue is that no-one has a budget to update the thousands of PCs running Office, then remaining with Win 7 is likely to cause problems, sooner rather than later.

  31. @Gamecock June 13, 2019 at 1:43 am

    Microsoft has announced they are going to drop FREE support for Windows 7.

    Doesn’t matter, if it works keep using it.

    It’s like ISPs saying the don’t support XP, Linux, etc – doesn’t mean they don’t work; means their free help-desk won’t help you.

    .
    @Chris Miller June 13, 2019 at 2:09 pm

    +1

    Dos and Win 3.x systems still working fine too

    iirc the NHS XP infection was caused by a user doing something they’d been told not to do.

    “If it ain’t broke, don’t fix it”

  32. “caused by a user doing something they’d been told not to do”

    Yeah but this is something that employees do, and as you increase the number of them that probability approaches one. Orgs that do internal security assessments by seeing how many staff will click on links in the security department’s fake phishing emails seem to get pretty high rates despite shelling out time effort and money on security education.

    Saying it was the fault of one of the incompetent employees not following basic security as they were told isn’t really a good answer to a client whose data has been breached or whose service has been interrupted.

  33. “Orgs that do internal security assessments by seeing how many staff will click on links in the security department’s fake phishing emails seem to get pretty high rates despite shelling out time effort and money on security education”

    Chap I know is involved in IT security at a high ranked university, he says its absolutely impossible to stop the staff from clicking on email links, downloading attachments, setting obvious passwords etc, regardless of how many times they are told not to do those things.

    I think cyber security is one of those things you have to assume that the system users will do the things you tell them not to, and you need to make sure the system can cope with that, not just rely on them complying with the rules, because that will end in disaster.

  34. @ Jim
    Yes, but part of that is down to the utter dickheads running the systems.
    This evening my wife had a problem logging into hotmail (long story, basically the strap on my computer-carry-bag broke while she was taking her PC to the repair shop in the High Street) and Microsoft asked her to remember all the data she had submitted last century – no ‘phone to call to talk through it – what was her grandfather’s job? – er, which grandfather? – what were her previous passwords and *all* the answers had to be correct. She had written the answers down then, which may have been before we moved house so the piece of paper ain’t here – she could guess a few of the answers but had no idea of some of the past passwords because Microsoft has repeatedly asked her to change passwords for no good reason and she has run out of memorable passwords (I rarely use hotmail and I’m on my last memorable one). Eventually she remembered her latest and, to my mind, utterly unmememorable, password so got back in.
    She is a Cambridge graduate – how do you expect an average person to cope with this sh1t?

  35. @john 77 June 14, 2019 at 9:54 pm

    Security gone mad

    1. Bank – Memorable data: town of birth; mother’s maiden name… Must be eight or more characters

    2. Costa loyalty points:

    Your password needs:
    8 characters or more
    1 lowercase letter
    1 uppercase letter
    1 number
    1 special character, like !”#$%&'()*+,-./:;?@[\]^_{}|~

    :banging head on wall

  36. @ Pcar
    Most of the so-called security data that I have to supply would be known to any crook who had done “hacking 101”, so I always try to answer the questions with an add-on to imply that I’m not a hacker. You just need a copy of my birth certificate to find my mother’s maiden or my town of birth or my father’s occupation. All box-ticking with no value.

  37. @john 77

    You missed point:

    Bank requesting memorable data, then stipulating one must lie (and write down or forget):
    Town of Birth: Ayr, Bath, Belfast, Frome, Glasgow, London, Stoke, Wigan – Computer Says No

    Costa: no financial info recorded, it’s “Coffee Club” points; complex pwd is stupid and OTT

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