Policy matters

I admit it. My eyes glaze over on a lot of important public policy issues. It’s especially foggy when you’ve got one group of advocates loudly advocating one position, and another group advocating something different. And then when it’s something remote from my direct experience, like UK public health policy, it’s even harder to focus.

So, for instance, I tried to puzzle out the Health and Social Care Act of 2012, and even the Wikipedia page was too much for me. I got bogged down in the details, and when the occasional name I knew, like “David Cameron”, came swimming out of the murk, they just discouraged me even more from trying to follow along.

But here’s something I can understand. It’s a graph of the financial health of the UK National Health Service.


Whoa, that’s dramatic — the whole enterprise went into freefall right after the implementation of that miserably opaque Health and Social Care Act. Shouldn’t that be sending British bureaucrats scrambling to figure out what went wrong and fix it?

And shouldn’t it be a general principle that government ought to care about what actually works and pay attention to empirical data? Sometimes it seems like it doesn’t.


  1. urbanwitch says

    It’s deliberate policy to run down the NHS by underfunding it and selling off the profitable bits to private companies. Then the Tories can claim it isn’t viable, and use that as an excuse to privatise the whole thing. It’s not just incompetence by ministers; it’s partly spite, and partly because so many f them have interests in Health Companies.

  2. Athywren - not the moon you're looking for says

    the whole enterprise went into freefall right after the implementation of that miserably opaque Health and Social Care Act. Shouldn’t that be sending British bureaucrats scrambling to figure out what went wrong and fix it?

    And shouldn’t it be a general principle that government ought to care about what actually works and pay attention to empirical data? Sometimes it seems like it doesn’t.

    I guess the question is, ‘do the Tories want to fix the NHS?’
    I should probably admit that this is one of many things that is making me increasingly angry, and I occasionally have to walk myself back from some fairly conspiratorial thinking, but I’m really not convinced that they do. It could be that the Tories in general and Jeremy Hunt in particular are just incompetent wastes of skin… it could, and I certainly believe that accounts for some of it, but given their previous habit of selling national services off for a fraction of their value, and their general hostility toward the British people, I find it entirely believable that they’re deliberately piloting the NHS into the ground so they have plausible deniability when they break their promise to never privatise it.

    …Again, of course, I am not being objective about this and I suspect some of my reasoning. But I’m not sure if I suspect it because I just don’t like the idea of being right, or if I have good reason to be. I honestly hope I’m just letting my increasing hatred of Cameron’s smug band of privateers get the better of my reason.

  3. says

    Wait, that’s a conspiracy theory now? Didn’t it used to be the main joist in the Tory party platform, wherever they may be found? Starve government of funding so it can’t function, then claim it as evidence that big government is inherently bad. Why else stick to austerity after the IMF has shown pretty solidly that it’s holding back growth? Because of the ideological conviction that less government is better governance.

  4. laurentweppe says

    I guess the question is, ‘do the Tories want to fix the NHS?’

    And allow the rabble to be as healthy and long lived than their betters? Come on!

  5. Athywren - not the moon you're looking for says

    Maybe my increasing cynicism hasn’t yet burnt through my wide-eyed optimism. It’s just that it feels like the sort of thing that only monsters who would torment the homeless by burning money in front of them woul-

  6. Dunc says

    Yeah, I really don’t think it’s a co-incidence that (a) I’m seeing a lot more ads for private healthcare on the TV, and (b) a lot of Tory ministers have significant interests in the private healthcare sector.

    It doesn’t necessarily mean that they have a proper, clearly thought-out, moustache-twirlingly evil plan for all this – it’s just that that’s the sort of bastards they are. They desperately want to privatise the NHS, both for simple idealogical reasons and because there’s something of a dearth of good investment opportunities these days. They’re suspicious of the concept of public provision in general. They’re naturally penny-pinching misers who really do believe that the poor are just feckless. Put all of their natural tendencies and cognitive biases together, and they’re gonna go that way even if they’re not making bank on it. Add in some pecuniary motivation and it becomes inevitable.

  7. numerobis says

    Incompetence means failure to get your job done — if your job is to break the system, then the minister here is supremely competent.

  8. sqlrob says

    And shouldn’t it be a general principle that government ought to care about what actually works and pay attention to empirical data? Sometimes it seems like it doesn’t.

    Sometimes? Feels more like the vast majority of the time.

  9. blf says

    An article in, I think it was today’s International New York Times (formerly IHT), discussed the failure of PPP’s in the UK: PPP is officially “Public-Private Partnership”, meaning outsourcing to private companies work that used to be done by local councils (in the main), but I tend to refer to it as “Prey on Public Pounds”. It was claimed to be cheaper, offer better service, yada yada yada. In reality, to little surprise, it’s more expensive and — the main point of the article — when something happens which is not covered by the contract, such as a flood, to get any work done (which is often needed on an emergency basis), the council / whoever has to first negotiate an “extended services special deal” (or something like that) at, very often, a significant cost. That not only delays any response and makes things more expensive, the service itself is generally only what is explicitly (specially-)contracted-for and not necessarily precisely what is needed “on the ground”, where you often happen to be quite flexible and respond to unanticipated difficulties. As a result, at least some councils are taking back in-house outsourced services, sometimes even canceling the contracts(at a cost) before they expire.

    PPP is largely a nasty party policy — albeit aided and abetted by the other main parties — and it is telling some of the councils not-extending or canceling PPP contracts are nasty party dominated.

  10. Dunc says

    PPP only failed if you believe that it was intended as a cost-effective means of delivering public services. As a means of transferring vast amounts of public money into private hands whilst cloaking the whole thing under a shroud of commercial confidentiality, it’s been a smashing success.

  11. auraboy says

    It’s not remotely conspiracy, my partner works in the NHS and is in the middle of a huge whistleblowing case at the moment. Several execs and directors have been working hand in hand with Tory council members and a local MP to bankcrupt several services in order to enforce a move to private tender services. It just so happens that one of the execs used to work for the MP, who is also a director in a multinational private health services provider. I am being deliberately vague as obviously the whistleblowing is a rather politicized hot potato now. But never think it’s a crazy conspiracy – the Tory party is working at every level, from Westminster to parish councils to dismantle the NHS until it is sold off piecemeal.

  12. cartomancer says

    It’s not just about the privatisation-by-the-back-door that the act of 2012 tried to bring in. Another major strain placed on NHS budgets at that time comes from the fallout of Tory cuts to social services spending, particularly on the elderly and disabled. Many of the poorest disabled people in our society have been forced to suddenly rely on emergency medical treatment in hospitals rather than having their conditions managed properly in the long term. It’s utterly unforgivable.

  13. =8)-DX says

    I’ve seen successful as well as unsuccessful privatisation ventures. For instance the privatization of Czech Telecom company ended its years of unfair pricing and monopolization of phone wires. Sadly it took a further decade, plus aggressive EU as well national regulation to get to our current non-restricted contracts and market-level pricing as well as cheap and high-bandwidth internet.

    So yeah: if you privatise you have to heavily regulate or you just end up with crappy overexpensive monopolized services.

    (Conservatives selling off of parts of the government at a loss, filling the politicians’ pockets through direct or indirect corruption is an everyday nondisputed fact of our political history, so no I wouldn’t be at all surprised if that’s what Cameron and the Tories are doing to the NHS in the UK. In fact I prefer to consider any such policy corrupt by default, unless there is transparency at a level not seen in most places in the West.)

  14. blf says

    Another thing going on at the moment (which I admit I have not been following too closely (so please correct / clarify / expand)) is the imposed change to the contracts for what is called “Junior Doctors”. I suspect that term, “Junior Doctor”, is the too-common British trick of giving a lessor-sounding job title to avoid paying more (the British Army does this with the rank “Brigadier”, which in other armies is “Brigadier General”: that lack of “General” in the rank means the pay, etc., is lessor; but — backfiring — also means British “Brigadiers” are known to sometimes be not-invited to high-level conferences / situation plannings, etc., they should / could attend, since they aren’t “Generals”).

    The standard contract for Junior Doctors has been changed to impose mandatory(?) out-of-normal-hours shifts at no(?) extra pay. (I vaguely recall it also increases the maximum number of hours per week, from an already high figure to something using astronomical units.) There is a small(?) increase in the base(?) pay, which, as I understand it, the nasty party claims will, for most Junior Doctors, increase their pay compared to the present contract. Since this is the nasty party saying that, people are very skeptical — the Junior Doctors have staged strikes with apparent considerably public support, and more have been announced.

    The BMA (British Medical Association) is opposed to the new contract, and a number of “trusts”, the local-ish organisations which run hospitals (at least), are not very happy with the contract — and especially its mandatory imposition by the government / minister. (I may have my ministersclowns confused here, but the clown now making a bigger mess out of a messy situation is the same eejit who made a complete mess of education.)

    There was an attempt to negotiate the new contract, but each side accused the other of essentially going La La La, I cannae hear you!, leading to the clown saying, in effect, This is teh new contract. It is better. You have no choice. Feck off. (Yes, that is the level at which the nasty party operates.)

  15. unclefrogy says

    as with the discussion of racism in an other thread I have a hard time thinking of conservative policies as expressed and implemented these days as being very coherent or thought out in all of there long term implications.
    I confess that I do hold some beliefs about what government is and how it works so I might have a bias here.
    I think that government exists with the consent of the governed, That any country is made up of all of the population of that country.
    I wonder just why the vast majority of the populations who receives little to no support or benefit for living in that country should continue supporting that government or feeling like they owed it some kind of allegiance or support or more importantly how long they will continue to do so.
    uncle frogy

  16. brett says

    It’s a huge bummer that the Tories are trying to privatize the provision side of health care piece-by-piece. Single payer definitely works, but it won’t save nearly as much money as running the whole thing NHS style does.

  17. opposablethumbs says

    It’s so fucking depressing. Possibly the UK’s greatest achievement ever, in terms of the well-being of the many, being deliberately eroded for the profit of a few – little by little, so we don’t quite protest and rebel enough at any one time, like the proverbial frog in the cooking-pot.
    We really need a Corbynista Overton-window-shift, more urgently than ever it seems. If we lurch even further to the right in the next couple of years instead of coming back a bit towards the centre … the prospect frightens me.

  18. John Phillips, FCD says

    Well, some of the ‘advisers’ who were helping the GOP fight Obama care and help the insurance companies tweak it to their liking have also been advising the Tories even before they won in 2010. So, perhaps it is no big surprise that the Tories are using all kinds of underhanded tricks to privatise the NHS, or more accurately, find ways to hand out public money to their supporters. They have been very good at that ever since Maggie came to power, not that Blair was much of an improvement.

  19. jrkrideau says

    P. J.,

    You may have failed to realise that this was done under a Conservative Government. Think of them as Republicans but not quite so foaming at the mouth rabid but generally just as nasty and committed to dismantling any government structure that does not enrich them or their friends other than the military, of course.

    I don’t know much about British politics but if they follow the general right-wing agenda they are probably trying to destroy the NHS. Certainly, this is the pattern we have seen in Canada until we got rid of that vicious and incompetent Harper and, it certainly seems what is happening at the moment in Australia under the Liberal—read Conservative—government. I belief it is currently dismantling or trying to dismantle the CSIRO, just as here in Canada, the Cons gutted the National Research Council, and just about anything else it could get at.

    Combined with this, conservative, that is right-wing, governments in the English-speaking world have become progressively more incompetent over the last 30–40 years. I am not sure why but I suspect the insane level of belief in a totally unfettered free market economy plus the influx of religious fundamentalists into the Conservative ranks has provided an ideology that does not allow rational decision making. When you have basically nothing but Saint Milton and the Bible (KJ Version) on which to base policy formation you may have a problem.

    So, given incompetence plus malevolence it is no wonder the NHS is in deficit.

    @ 7 numerobis

    Incompetence means failure to get your job done — if your job is to break the system, then the minister here is supremely competent.

    Good point, however it is a bit easier to burn down the building than construct it but I’d expect some one like Peter MacKay to have even bungled that.

  20. John Phillips, FCD says

    jrkrideau yes, the present damage is being done under the Tories/conservatives, which is a continuation of that started initially under Maggie Thatcher. However, Blair’s labor, (or more accurately Tory lite) government also continued the damage with the things like PPPs, which they were very fond of. Which then made it that much easier for the Tories when they got back into power in 2010 and, often now through back door means as people cottoned on to the more obvious attempts, have been trying to kill off the public nature of the NHS and hand control and public moneys over to their financiers. Sadly it is an ongoing fight with the recent junior doctor ruckus simply a continuation in an attempt by the government to turn the public against the junior doctors and, by extension, the NHS as a publicly owned and run organisation. I.e. sell off the profitable bits to their cronies and financiers and underfund the rest so that it fails or appears to fail in the hope that the public will settle for any solution that appears to ‘rescue’ it.