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.

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.

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.

An NHS in peril.

Readers will doubtless have heard many of these arguments on this blog in the past, but as this post was written for OpTank, I have tried to write the most complete summary of the reforms that I have done to date.

From 'Moral Leadership' to privatisation

In 1944, with the country emerging from a devastating war and crippling debts, Aneurin Bevan was tasked with introducing a health care system fit for a new era of Britain's history, which would treat patients based on need rather than wealth. In July 1948 he unveiled the National Health Service at Park Hospital in Manchester. The institution, he said, gave us 'the moral leadership of the world.'

Aneurin Bevan: Architect of the NHS

62 years later and the National Health Service faces the greatest threat to its existence in its history. Andrew Lansley's reforms may not remove the NHS from our lexicon, but it threatens to take its very soul, leading us on an increasingly rapid path towards a time when the NHS will be nothing but a brand name.

This all seems very melodramatic, but looking closely at the reforms shows that they are not merely a reshuffle of management, nor about cutting bureaucracy, but about a fundamental shift in what the NHS stands for and how it works to achieve those ends.

Forcing Competition into the NHS

For reform which is intended to give much more power to doctors in guiding patient care it is notable that nearly the entirety of the medical profession is united in its opposition to much of this bill. The reason being that whilst GP-led commissioning is welcomed, there is a widely held belief that this portion of the bill is merely a fig leaf to mask its more sinister elements, the elements relating to competition.

Monitor, which currently has the role of regulating foundation trusts, will now regulate competition in the NHS, ensuring that any willing provider is able to tender a bid for NHS services. No longer will Monitor focus on patient care, but will instead focus on enforcing competition, fragmenting well established partnerships at a local level when they are deemed 'anti-competitive', and leaving the patients with a poorer service as a result. NHS services will be at substantial risk of closure as the most profitable parts are cherry picked by private providers.

For those reasons, a recently convened Special Representative Meeting of the British Medical Association passed the following motion:

"That this Meeting believes price competition is a hugely retrograde step and:- i) that price competition in healthcare is damaging; ii) that with scarce resources the prime focus will be on cost and not quality;"

Indeed, that very same meeting passed a range of motions providing a devastating critique of the health reforms. People who watched the meeting will know that the Health Secretary was only spared a vote of no confidence because of the plea of the chairman not to hinder negotiations and lobbying. The motion may not have passed, but be under no illusions, few at that meeting had any confidence in Andrew Lansley whatsoever.

Furthermore, even if the detail of the reforms wasn't hugely dangerous, the pace and scale are mystifying. To enforce a £3 billion top-down reorganisation on the NHS at a time when the organisation is being asked to find further savings of £20 billion to protect services for the future is outrageous and wholly unnecessary.

Lies, damn lies, and Cameron's statistics

The government is of course keen to stress that reform is necessary, that the NHS simply doesn't perform well enough as it stands. Facts, however, would seem to dispute those claims.

Firstly, despite the attempts by the secretary of state to hide the research, it is now known that patient satisfaction with the NHS is at an all-time high. Hardly a sign of an organisation in peril.

Secondly, it seems a new favourite claim of David Cameron that we are performing very badly in preventing and treating both heart disease and cancer. He may be better served by first seeking to understand the meanings and trends behind research before diving into the argument with his own ill-judged opinions.

Whilst we may have higher mortality rates from heart attacks than nations such as France (which is the lowest in Europe) we have seen the greatest reduction in those rates during the past 30 years, and on current trends will have lower rates than France as soon as 2012. All this despite seeing a lower increase in health spending.

Again, with the claims on cancer, the independent King's Fund showed that our survival rates were improving. And comparisons to nations such as Bulgaria neglect to mention the fact that the two nations have very different levels of cancer registry coverage, making comparisons naive at best, and deceitful at worst. Perhaps it is for these reasons that the BMA also passed the motion:

"That this Meeting deplores the government’s use of misleading and inaccurate information to denigrate the NHS, and to justify the Health and Social Care Bill reforms, and believes that:- i) the Health Bill is likely to worsen health outcomes as a result of fragmentation and competition;"

In summary

There are positive elements to this bill, but they are few and far between. GP-led commissioning could be implemented without the need for legislation. It is only now being used as the government hopes to pass through damaging reforms in the name of greater power for patients and doctors. And when those reforms are widely rejected by the BMA, the Royal College of GPs, the Royal College of Nursing, the Kings Fund, UNISON, and even ex-GP, now Conservative MP Sarah Wollaston, it is time for a rethink.

In 1951 Aneurin Bevan resigned from the cabinet over the introduction of a 1 shilling prescription charge introduced to boost the Treasury coffers. Lord knows how he would react were he alive to witness the destruction being rained down on the nation's crown jewel by the lunacy of Andrew Lansley.

In his now oft-used quote, Bevan said that the NHS 'will last as long as there are folk left with the faith to fight for it.' With petitions gathering pace, and demonstrations planned, it is time for the public of England to stand up and show that they still have the faith, and that they will fight for their NHS.

The smearing of UKUncut

It's taken a little time for all the details of events at Fortnum & Mason to be clear, and in that time it seems UKUncut has been getting a very bad press indeed. For an organisation that enjoyed a range of support from the Guardian to the Daily Mail, this is a very new experience.

People from all shades of the political spectrum have been, including the left who claim they ruined the message of such a well organised and executed march. Several MPs who supported their cause in the past have withdrawn that support, and those that insist on continuing to support them like John McDonnell are labelled radicals.

I'm not going to write another long post about why I think they're such a breath of fresh air in protest, or why their message needs to be heard. Instead, I thought I'd leave a selection of the most important links to help people understand what went on. Hopefully, they will provide the proof that far from changing tack and becoming more radical, UKUncut are just as peaceful as they ever were, and that they were badly let down by both police, and by other more violent protesters.

- Video proof that shows police first promising that UKUncut would be free to go before then breaking said promise and arresting them individually once outside, as well as police officers inside the building appreciating the peaceful nature of the protest. Video found here.

- Personal story from one of the protesters detailing conditions which the protesters were kept in, and the bemusement of the police who 'regretted having to charge the protesters on orders from Scotland Yard.' Story here.

- A few photos from the occupation at Fortnum & Mason's showing the 'damage' and peaceful nature of the protesters. Photo album here. (Hat-tip to @MissEllieMae)

- A slideshow on the frontpage of UKUncut's home page showing the range of people attending their entirely peaceful protests, from very young children to the elderly. Page here.

- Finally, a video from inside Fortnum & Mason's during the occupation. Bagpipes? Yes. Vandalism? No. Video and article here.