Foundations of sand - by Richard... Friday, October 14, 2011

Foundations of sand - by Richard... Friday, October 14, 2011

Mercifully limited in media coverage, finding its way into a Press Association report and theDaily Express - and very little else – is a report on healthcare by the Taxpayers' Alliance (TPA).

Its self-important press release captures the flavour of the report, telling us that the TPA "can today reveal that nearly 12,000 fewer people would die each year if the NHS matched standards in Europe".

Even this is weasel-worded, though. The comparison is not with "Europe", as might be inferred from the claim, but with somecountries in Europe, specifically the Netherlands, France and Spain – chosen because the figures have been collected on a comparable basis - not that that means they are comparable.

And in that last comment lies the fatal flaw. The comparator chosen by the TPA is the "Mortality amenable to healthcare" index, using "aggregate mortality" amenable to healthcare to compare performance between the different system. This does not support the conclusions offered.

To establish this, one need only find that the TPA cite for its methodology Nolte & McKee and a paper in the BMJ in 2003. And here in that same paper, the authors state:

So how can amenable mortality be used to understand the performance of a health system? We argue that it does have some value, but not in terms of the aggregate values (although arguably the rankings produced by amenable mortality have greater face validity than those using disability adjusted life expectancy). Instead, it enables comparison of the elements that make up the overall figure, permitting investigators to dig down to look at specific policies and learn from different experiences.

In other words, while the TPA claims that the measure "is a comparative method that is robust and well respected", that is very far from the case. And just to reinforce that, in a paper later than that cited by the TPA, Nolte & McKee revisit the concept of "avoidable mortality" which underpins the idea of "mortality amenable to healthcare".

Here, they re-affirm that, when the concept of "avoidable mortality" was first developed, it was seen as a way of identifying topics for further study rather than being an end in itself. "This", they add, "is even more true now that it was then". The information can be used to track changes within a national system, but it is less valid as an international comparator.

For this reason, another system is proposed, measuring the difference between amenable and non-amenable causes, which better reflect economic, cultural, lifestyle and ethnic effects, which may be obscured by a single index.

With that, we find that the OECD - an organisation dedicated to making international performance comparisons – warns that "avoidable deaths should not be interpreted as absolute measures of outcome. They "do not provide definitive evidence that a particular service is wrong".

Yet, that is precisely what the TPA does, going on to build a series of recommendations of a highly political nature, on what amounts to a foundation of sand. One can, of course, concede that there are many things wrong with the NHS and in a highly politicised debate, there are plenty of views.

No one is helped, though, by low-grade research of little more value than a polemic, in an area where good quality work is urgently needed. We do not have enough resources that we can waste effort like this.

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Postpone the revolution? - by Richard...

A smashing piece from Witterings from Witney, but he's getting to sound like EU Ref in his calls for a revolution. Actually, we have but a few chances to avoid one, and it is now becoming a desperate race against time to bring our political class under control. Being the incurable optimist, I think we can do it … and I've already suggested that they key is to attack the money tree.

But maybe just basic survival will become our priority – even the MSM is waking up to the potential of Katla, although they are trailing behind as usual and there is nothing recent which would seem to warrant the current alarm. However, a major eruption on the near horizon is certainly a possibility and that could change everything.

Perhaps we should postpone the revolution until we know what we're up against ... or should we get in first?

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A sanctimonious turd - by Richard... Thursday, October 13, 2011

Any which way you look at it, Booker's column last Sunday ran a scoop about council finance, heavily researched, dealing with issues of considerable importance, and well ahead of the game. However, as his "three", he writes a lightweight filler, to make a point about the inefficiency of wind power. And which does George Monbiot choose to focus on in his boring little blog?

That, of course, is why George Monbiot is a sanctimonious turd.

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They did not win - by Richard...

A report from The Daily Mail appears to portray the victory of plucky fighters against the system in what could be presented as the classic "David and Goliath" story. In fact, it is no such thing.

The essence of the report is that a small number of motorists, wrongly issued with penalty notices for parking infringements that they did not commit, have reclaimed the fees or had their fines set aside. And this is hailed as a victory.

The system, though, goes on unchanged, not in any way harmed or damaged, continuing in exactly the same way, issuing millions of penalties, a huge number of which are actually fraudulent, and deliberately so.

It is part of the system though that where a few vociferous complainants are persistent enough to surmount the bureaucratic obstacles placed in their way, they are given their money back. But no action is taken against the people who issued the penalties, or those who sought to enforce them – not even when they use vehicles which themselves are in actual breach of parking regulations (below).

Criminal fraudsters would love this sort of system. They could go door-to-door, taking money with gay abandon. Only when caught out would they required to give back the money to the individual complainants, with no further action then taken. You might call this a fraudsters' charter.

And that is what we are dealing with here – criminal fraud. Parking enforcement in many areas has long ceased to be a matter of traffic control and is now primarily a revenue generating exercise – for which there is no legal sanction. Council officials try it on, because they can get away with it, and the system has degenerated into a structured fraud.

Thus, there will be no victory until these criminals are brought to book and some are actually jailed. On the face of it, these council officials are breaching S.2 of the Fraud Act 2006. People wrongly issued with a penalty should be reporting their councils to the police.

And yes, we know exactly what the initial reaction of the police would be – but we have persevered with two cases against bailiffs, where the reaction of the police was dismissive, and will shortly have encouraging news to report.

The long stop is, of course, a private prosecution. Fraud is triable either way, so it is possible to take out a summons and commence criminal proceedings. When a few local authority finance officers start being put in the dock and made answerable for their crimes, we might start seeing some changes.