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In a week dominated by the NHS crisis, the health secretary, Steve Barclay, allocated just 45 minutes to talks aimed at preventing the next two-day nurses’ strike – the second only in history. But aside from vague promises of backdated pay from a future settlement, he was most interested in discussing “productivity”.

“Work harder” was the message – to nurses already putting in 18-hour shifts to maintain continuity of care in a system at breaking point.

Who let this man loose with a typewriter? Productivity is not work harder, it’s work cleverer. Anyone who doesn’t know that is too stupid to be allowed in print.

As economics commissioner on the (now dismantled) Sustainable Development Commission, I heard this narrative trotted out like a mantra in every region we visited across the country in the years leading up to the financial crisis. Inward investment in hi-tech industry would bring high-wage jobs that would spread wealth to the community. It’s not that different from the defunct trickle-down theory that laid Liz Truss and Kwasi Kwarteng low. It failed spectacularly at the time. Its chances of working now are even slimmer.

But there’s a more telling point to make. The debate on both sides is predicated on a profound misconception that wealth comes first and health comes second. That we can only afford care if the economy is booming. It couldn’t be more wrong. Without health there is no wealth. Without care there is no health. Care is investment. It’s not a luxury consumer item. It’s the most fundamental investment of all. And scaring nurses into impossible ward rounds is the very opposite of productivity.

And that tells us why the SDC was shot. No, health care, social care, that’s consumption, not investment.

Our willingness to invest public money in financial assets, military hardware or physical infrastructure and not in people makes no sense.

Paying nurses is wages, consumption, not investment.

Tim Jackson is professor of sustainable development at the University of Surrey and director of the Centre for the Understanding of Sustainable Prosperity

There’s a corner of academia that could be disposed of, no?

21 thoughts on “Idiot”

  1. allthegoodnamesaretaken

    ‘trickle down’: you instantly know he’s talking bollocks.

    “…in order that these benefits will eventually “trickle down” to the masses of ordinary people. But no recognized economist of any school of thought has ever had any such theory or made any such proposal. It is a straw man. It cannot be found in even the most voluminous and learned histories of economic theories.” Thomas Sowell

  2. I googled this chap and his first degree was maths from Cambridge in the 70s. So he is clearly anything but thick.

    As BiS noted on another post, we have to conclude that these people are simply lying, in this case deliberately confusing investment with consumption and falsely claiming that improving productivity means forcing people to work harder.

    the defunct trickle-down theory Also previously mentioned here (by Tim?), “trickle down economics” is a lefty straw man and I bet Professor Timmy knows this too.

    The Centre for the Understanding of Sustainable Prosperity is mainly funded by the Economic and Social Research Council ie fucking muggins the taxpayer. Quelle surprise. Another oxygen thief on the public teat bleating for MOAR!

  3. So…. I don’t have a mobile phone for twenty quid, I don’t have a 40 quid pocket computer more powerful than anything that existed outside the military or universities before 2010, I don’t have access to 500 TV channels for 15 quid a month, I don’t have a 50mpg car that cost me 500 quid, I don’t have huge chunks of human knowledge at my fingertips for 20 quid a month without leaving my home. Yeah, trickle-down does not exist.

  4. “Without health there is no wealth. Without care there is no health. Care is investment. It’s not a luxury consumer item. It’s the most fundamental investment of all. And scaring nurses into impossible ward rounds is the very opposite of productivity.”

    Something like 40% of NHS spending is on over 65s now. That’s not an investment. It’s spending. We’d like it spent, but it’s not boosting the government’s coffers like fixing up a 21 year old.

  5. A nurse former school friend informed me a 12 person ward needs two nurses. So the ratio of patients to nurses should approach 1:1. It actually approaches 1:3.

  6. Playing devil’s advocate, Baumol’s Cost Disease means that there’s less room for productivity improvements in healthcare (especially at the dirty end, changing bedsheets and wiping bums) than in tech (£40 smartphones). Prescription medicine costs are already tightly controlled. Dentistry prices are capped so low that dentists are turning away work.

    More use of telemedicine could relieve GP workloads; and cheaply too, if the tele-doctor is in India or is an AI. But how much scope is there for productivity gains in hospitals?

  7. We do definitely need a clear definition of investment. Id go for “where the principal is recoverable”. Anything else is either spending or speculation.

  8. @jgh
    If there was such a thing as “trickle down” it’d be the spending of the richer ends up in the pockets of the poorer. Entirely valid in many cases. What you’re talking about is the benefits of increasing productivity. What would have been out of your reach becomes affordable. That doesn’t necessarily require a transfer of wealth from the rich to the poor.

  9. Tim Jackson is professor of predictable propaganda, a prick who pillages the pockets of people poorer than himself. Lionesses! (I don’t suppose he’s manly enough to justify lions.)

  10. Andrew M
    from Dominic Lawson in todays Mail
    “As Mark Britnell, professor at University College London’s Global Business School for Health, told the Sunday Times: ‘While industries from banking to car production have slashed costs and driven up quality and productivity, the NHS has barely started. Junior doctors can spend as much as 45 per cent of their time fulfilling simple administrative tasks which could be largely automated.’”

  11. @AndrewM

    Junior doctors can spend as much as 45 per cent of their time fulfilling simple administrative tasks

    Rather than automating an admin task it might be better to eliminate them. Does anyone do anything with the admin work they produce other than to summarize it into other reports that no one ever reads let alone needs?

    Unfortunately some things resist automation as the NHS employs lots of people whose sole output is to create non productive work for the staff who could otherwise be doing something that would improve patient outcomes. Just think how much harm an industrious diversity trainer can wreak by tying up entire classrooms full of medics.

  12. I sometimes worked 18 hours and was not paid extra. You can be damned sure any non doctor health worker is on time and a half for their extra hours.

    The nurses down my way work in 36 hour blocks, usually 3×12 and then have two days off. Weekend ward duties are usually handed over to agency nurses.

    Inefficiency : last week I had to go to local hosp to see a sawbones. I turned up an hour early because I expected to have a Xray. Told that this was not required and take a seat. Consultant had goofed off earlier and so his clinic was now running 40 mins late. 90 mins after my arrival, nurse told me to go and have a Xray and that I had been “missed” earlier. Radiology these days is very efficient and I was in and out in minutes. Reported back to clinic. Half hour or so later saw consultant and we had long chat about my Xray which he found interesting, he had forgotten what he had prescribed me and was shocked
    a) that I had been on the meds for so long
    b) the country has run out of them
    Two and a half hours buggering about with the halt and lame. He didn’t need to see me, the Xray was sufficient and he could have got a report from my local clinic where I go once a fortnight and only see me if I seemed to be a dodgy case.

    Oh and I had been double booked with another consultant at a different hospital for the same problem. I have cancelled that appointment now especially as it was six weeks too late to do anything.

  13. “A nurse former school friend informed me a 12 person ward needs two nurses. So the ratio of patients to nurses should approach 1:1. It actually approaches 1:3.”

    Not sure if this was accounted for but if a ward needs 24 hour staffing (I think it would) then in order to put one nurse on at all times you need to hire between four and five people to account for shifts, vacation, sick, etc.

  14. Hard as it may be to get into a NHS hospital it’s harder to get out of one.
    Some estimate that one in ten beds are occupied by patients medically fit for discharge.
    The form filling required is a 50 item checklist, on several different forms to be completed by several different medical professionals.
    The two commonest reasons for bed blocking are 1. the weekend, when the consultant isn’t at work and 2. the pharmacy closed at four o’clock.

    (Incidentally, in France to be licensed to open a pharmacy you have to join a group and stay open on x/y nights and weekends. So there is always a way to get your meds at any time.)

    The NHS estimates the cost of a hospital stay at around 400 quid a day. That’s 5 million quid, or 2 billion a year.

    Envy of the world it is. Not.

  15. Otto – read a post, somewhere, fairly recently, by a recently retired GP. Two things stood out, first being the explosion in paperwork, around the time of Shipman.

    Second was that he used to be able form a decent working relationships with the consultants he would be referring to. Then that suddenly vanished, so there was no real information flow to and from the GP. He didn’t know how that had happened.

  16. My GPs took no interest in my problem, once I had managed to get the meds out of them their response was “Good luck !” ( Literally). They palmed me off as soon as they could.

    The other important thing to remember is that nothing happens in hospitals before 8am and precious little after 4 pm.
    I once had what I thought was a serious issue after an operation and went to A&E at 10pm. Was seen at midnight, had a Xray ( amazingly ) and was discharged at 4am. Total doctor face time 10 mins. Doc on duty said “Why didn’t you just go to your GP ?”
    “Because it looked really serious and they would have just sent me here anyway !”
    “Oh well, I suppose you got an Xray out of it.”

    Turns out to have been a blood vessel bursting as a reaction to the operation, but it was causing me to ooze blood through my skin.

  17. @philip

    Over a decade ago, I was diagnosed in A&E with a kidney stone blocking my ureter. The NHS specialist said that if if didn’t emerge naturally within four days he’d go in and get it out.

    I said “well I’ll come back in a few days then”.

    “No” I was told “if you don’t stay in hospital until then, you’ll go to the back of the list and we don’t know when we can operate on you”.

    I was in no pain or discomfort at all (the body had stopped trying to expel it, which causes the pain), but I had to stay in hospital for four days until the op.

    I did piss them off by leaving in the morning for work and not returning till evening, but I essentially spent four days blocking a bed.

  18. “I choose a lazy person to do a hard job. Because a lazy person will find an easy way to do it.”

    —Bill Gates

  19. Napoleon iirc had the same view on smart lazy officers who’d find the easy way. Stupid industrious types are to be avoided.

  20. “Productivity is not work harder”

    It is if you’re paying the person to do the work – if you can get them to work harder for the same pay, that’s a productivity increase. The unfortunate worker obviously doesn’t see it that way! Shows you the attitude of the politicians that they have this point of view.

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