Tuesday, 19 April 2011

Lies, half-truths and dodgy statistics: NHS

Part of a series on the many lies and exaggerations used by politicians and the media which are backed up by very questionable statistics.

"There are three kinds of lies: lies, damned lies, and statistics." So goes the quote popularised by Mark Twain, his phrase describing just how easy it is to twist any statistic you can find to suit your given belief. I would add another and qualify two of them, there are actually four types of lies: lies, repeated lies, exaggerated half-truths, and misused statistics.

I bring up this now in light of abuses of supposed 'facts' by Number 10, which have very real consequences for us if they are allowed to go unchallenged.

The misuse of statistics in relation to the NHS is the most dangerous of all, these are the 'facts' which are being used to persuade the public at large of the need for reform. Many of them appear in a new leaflet issued by Number 10 and are reproduced by the Department of Health, entitled 'Working together for a stronger NHS'. The facts it uses are not difficult to debunk, but the issue is that many people will read the leaflet and never be exposed to the arguments as to why it is factually incorrect.

The leaflet starts with a series of statements about the rising age of the population, the rising cost of medicines and so forth which are in fact true, though they do not directly support these particular reforms, merely reform in general. It takes a massive logical leap to go from 1) We need reform, + 2) These are reforms, = 3)We need these reforms. It is a fallacy of necessity.

But on with the leaflet. We soon get away from these truths and into very questionable areas indeed, with a whole page devoted to this devastating fact:

"If the NHS was performing at truly world-class levels we would save an extra 5,000 lives from cancer every year."

If that doesn't convince you we need change, what will? Well, it might be a devastating argument if it had any real basis in fact. The source they use to make this claim comes from the British Journal of Cancer, and was published in December 2009. So it comes from a reputable source and is recent, what could possibly be wrong then? The issue here is that the government has used research which was never intended to predict current rates and possible future improvements, the data covers the period from 1985 to 1999. The very latest data included was from 12 years ago!

Since that time the NHS has improved massively, with the NHS Cancer Plan in 2000 having massive impacts. It may be frustrating for politicians trying to make a point, but health data simply does not fit into their ideal of being immediately available for analysis and scrutiny. There are complex epidemiological factors at play, to the point that even studies which they use from late 2009 have to analyse data that is massively out of date. This is why changes in the health service, even if they were desirable, should never be implemented at this speed, it allows no time for scrutiny of impact and could well be harmful.

Other such lies have been dealt with by Ben Goldacre in this article and I shan't waste any more space here going over them again.

Needless to say, it seems very dishonest of the government to deceive people in this way, but what can be done to stop it? John Majors abuse of statistics led to the formation of the Office for National Statistics, perhaps it is time the NHS had its own independent statistics, to stop it being used as a political football.

Sunday, 17 April 2011

Clegg's fake 'red lines' for the NHS.

What follows is a master class for all hopeful future politicians. A handy trait to master is the art of talking tough, to ease voters worries, whilst simultaneously bending over backwards to please your superiors and assorted vested interests. To demonstrate this beautifully, step forward the nation's darling, Nick Clegg.

He today wrote to all 56 Liberal Democrat MPs, in what the Independent called "the clearest sign yet of a major coalition schism over the reforms", setting out his five 'red lines' that were non-negotiable in relation to the NHS reform. He said that these amounted to 'substantial changes' to the bill and would save the NHS from privatisation. The rhetoric is strong, but the measures set out as his 'red lines' are pitifully weak. Here's a look at his five 'red lines', and what they actually mean:

1. Competition should be driven by quality, not price. -

This has already been amended in response to BMA lobbing in March. Whilst competition is now not to be explicitly based on price, the competition itself is still being implemented, leaving the NHS open to EU competition law and turning health care into a market. The role of Monitor will remain as a competition enforcer as opposed to regulating Foundation Trusts as it does presently. This first 'red line' therefore has not only already happened, but fails to meet any of the demands of the BMA or RCN who have been so damning in their verdicts on the Health and Social Care Bill.

Verdict - Already happened.

2. Family doctors should not commission services alone. -

Whilst the last 'red line' has already been changed, there was no need to amend the bill to comply with this red line. It was never, ever going to happen. Indeed, one of the issues with the reforms would be that not only would doctors be commissioning services, but that they would likely turn to private providers to help with commissioning. Doctors tend to study medicine in order to help people. If they wanted to commission services they would have taken an accountancy course.

Verdict - Was never going to happen.

3. GP consortia must not go ahead in 2013 if they are not ready. -

Again, this has already been agreed, as seen in the Health Service Journal interview with David Nicholson back in February. It also does nothing to address the issues raised by the prospect of certain areas being run by consortia outside of their local area, thus destroying the primary goal of these reforms.

Verdict - Already happened.

4. The principles of the NHS constitution must be protected. -

This is a very woolly 'red line' at the best of times, without specific examples you can essentially interpret the constitution to fit any set of reforms that might be put forward. Even so, this again is a case of Clegg demanding something that has already happened. It is explicitly mentioned on pages 330, 332, 333, 340, 365, 375, 395 and 402 of the revised bill.

Verdict - Already happened.

5. GPs must work ‘hand in glove’ with councils. -

This is already included in the bill through the inclusion of Health and Wellbeing Boards, which states the many ways in which the consortia will be working closely with the local authority, 'like hand in glove' as Mr Clegg may prefer.

Verdict - Already happened.

So, having actually looked at his 'red lines', which will apparently ensure 'substantial reforms' to the Health and Social Care Bill, we see that he has actually included four things that have already been included and one measure that was never included in the first place. Quite an achievement.

That only serves to show just how impressive it is that Clegg has managed to turn this letter, which adds nothing new, into a statement which newspapers are proclaiming as the Liberal Democrat fightback. He has managed to create a fake difference of opinions, which will no doubt help him in local elections, whilst causing Andrew Lansley no problems whatsoever.

There are many people within the Liberal Democrat party who are anxious to see real changes to the NHS reforms, including those with real influence such as Norman Lamb and Evan Harris, but Nick Clegg is once again folding as easily as a house of cards caught in a tornado.

He has shown himself to be a vacuous salesman, a pawn of the Tory hierarchy, and in doing so has provided an excellent example of how to dupe the British public into believing you are listening to their demands. Here's to hoping he doesn't succeed.

Hat-tip to Health Policy Insight for some links and highlighting the vacuity of his letter.

Wednesday, 13 April 2011

AV vote becoming increasingly partisan

I fear that this Alternative Vote referendum is becoming more and more about party political preference rather than what it should be, a question of how best to represent the wishes of voters. This isn't a sleight aimed at any party, or indeed any individuals, and both sides of the referendum are engaging in it, it's merely an observation which is really quite disappointing.

This vote shouldn't be about what system will help which party, but yet many, many people who's views I respect and agree with on so many other things are basing their support or opposition to the Alternative Vote based on how it will affect their political party. They argue that what is in the interests of their chosen party is in the interests of the country, and so any change to the system which is bad for their party is bad for the country, and vice versa.

Whilst the belief that the interests of your party are in the interests of the nation seems a rather natural belief, it should have no bearing on this referendum. You cannot drag the electorate along with you based on a malfunctioning voting system, you have to earn and keep their trust. When judging electoral systems you should look at it from a completely impartial point of view, and base your decision on whether or not said system reflects the wishes of the nation. If that harms your party, then tough, you should focus more energy into making sure you do represent them.

Too many people in this country don't have a vote that matters. AV is not a cure-all, but it will end the very worst of FPTP in that it takes away the need for tactical voting. I find it outrageous that in a modern democracy people cannot vote for the candidate they prefer simply for the fear of letting in someone worse. If all that happens is AV is the end of this kind of campaigning then I think it will have been worth doing.

I may dislike Tory policy, but is it right that people are denied the chance to vote for them?

I have already made many cases for AV, but this was simply me expressing my exasperation that party politics kept getting dragged into the debate. This is about making sure that MPs truly represent their constituents, not just the ones that are members of their party.