Tag Archives: health

A greener buzz?

When I was young, electric toothbrushes were something we laughed at.  Imagine being too lazy even to wiggle a toothbrush up and down without powered assistance! But as an adult, I discovered that most dentists now thought they were rather good, and recommended them.  

Electric toothbrushes did a better job of cleaning in general, they said, and the smaller head would get into places that manual toothbrushes wouldn’t reach.  Perhaps, I thought, gadget enthusiasts like me shouldn’t feel embarrassed about actually trying one.  I wouldn’t have to admit it to anyone..

“There’s a huge range”, I remember my dentist telling me. “Don’t go for the ones with silly prices and dozens of bells and whistles.  40 quid or so is probably about right.”

So, for a while, that’s the kind of thing I used.  They’re probably about 50 or 60 quid now.  They have a rechargeable battery, sit on a base that charges it inductively, and have a simple timer to help you spend the right amount of time brushing.  You know the kind of thing.

But one thing about them always bugged me: the batteries were rubbish.

Long before the motor or the casing gave up the ghost, the built-in, non-replaceable battery would die, or stop holding enough charge even for one brush, and the whole thing would have to go in the bin.  Then I’d buy a new one, which came with its own charging base, so the previous base, and cable, and plug – they all went in the bin too.

This was not very good for my wallet, and a great deal worse for the environment.

So I expect you will laugh, gentle reader, when I tell you that what changed my purchasing habits was brushing my dog’s teeth.  Yes, our spaniel gets her teeth brushed every night, and she enjoys her chicken-flavoured toothpaste, but won’t tolerate brushing for very long, so we got her an electric brush, too, to make maximum use of the time available!

We weren’t going to buy her any big 60-quid devices, though, so we looked online for ones designed for children, and Tilly now has a children’s Oral-B toothbrush.  It’s pink and blue and I think it has fairies or princesses or unicorns on it, but she doesn’t seem to mind.  

And as we used this, a few things struck me:

  • The motor mechanism looked as if it was just the same as my own expensive one.
  • It took the same brush heads.
  • It used replaceable AA batteries.  I had plenty of rechargeable Eneloop AAs.  (Take a look at my post from about 10 years ago to see why I like those. I’m still using much the same system now, and most of the batteries I had back then are still in use.)
  • This also meant I didn’t need to have charging bases and cables in the bathroom.
  • It didn’t have a timer.  But I could count elephants.
  • It cost about one quarter of the price.

And so I now have, and can recommend, a very basic Oral-B battery-powered toothbrush. Currently £14.99 on Amazon.  It has lasted longer than my previous expensive ones, and the two AA batteries hold their charge way longer than the built-in ones ever did.  Occasionally, I take them out to charge and swap in some fully-charged ones from my drawer — that’s why I love Eneloops and similar rechargables: they stay fully-charged in the drawer — and freshly-charged batteries seem to last for weeks.

Since I got this, some years back, nothing has gone in the bin except the occasional elderly brush head, and when it does eventually die, it’ll be far less wasteful than something that takes its batteries and charging base to the grave with it.

Oh, and best of all? Mine doesn’t have any princesses or unicorns on it.  Tilly is still bitter about that.

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Drug-inspired Lyrics

I know that many popular lyrics have been inspired by the use of drugs, so I thought I’d try my hand at it.  This was written recently while packing for a journey.  Or, perhaps, a trip.  My brother, a highly-qualified medic, was on hand to help. With the lyrics, at least.

John and Yoko are busy composing the melody, but in the meantime you can sing it to the tune of It’s a long way to Tipperary.

I need one more Atorvastatin
  I’ve got one more to go.
I need one more Atorvastatin
  It’s the neatest pill I know.
Goodbye to cholesterol
  Farewell, LDL!
I need just one more Atorvastatin
  And all will be well!

I expect it to become a hit amongst other middle-aged music afficionados.

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Fixing the NHS problem

My parents live about 13 minutes’ drive from the nearest hospital. There’s also a more substantial one 20 mins away. Over the last few years, they have on several occasions needed to call an ambulance after falls and other serious issues, and the waiting time is always measured in hours; on a couple of occasions, more than eight hours.

This shocks me, but it shocks my American wife even more. When they had to call an ambulance for her mother in Michigan — a fairly regular occurrence in her later life — they would worry that something was wrong if it hadn’t arrived in twenty minutes, because normally it was there in about ten. For all the outrageous costs and several other failings of the American health system, there are some things it does do rather well.

The simplistic public response to the NHS problem is to blame under-funding. “It’s because of Tory cuts!” Here’s a graph that was popular on Twitter last year, for example, and looks pretty damning:

But let’s be clear about what this graph shows: this is expenditure growth, above the rate of inflation. In other words, since its foundation, every government has given the NHS significantly more money in real terms every year. Some have increased it faster than others, but there have never been any ‘cuts’, from Tories or anybody else. So, while more money is desirable, that’s not the primary problem.

(As an aside, we all love the story of Captain Tom Moore who so caught the public imagination by his sponsored walks around his garden between his 99th and 100th birthday that he raised a whopping £33M for the NHS, earning him a knighthood, an honorary doctorate and an RAF flypast on his 100th birthday. It was a great feel-good story during the pandemic, and I don’t want to take anything away from his achievement by pointing out that he, and all his millions of sponsors, funded the NHS for a total of about an hour and a half. The world would be a much better place with more Captain Toms in it, but a whole battalion of Toms are unlikely to make a significant difference to the NHS.)

Now, I’ve written before about some NHS experiences that have convinced me that serious administrative incompetence is the source of many of its issues. And, to the extent that proper funding is also needed, I pointed out, it simply requires us all to vote in a government that is going to charge us about £1000 more per family member per year, and earmark that exclusively for the NHS. The UK public has only very occasionally been given the option to do something like that, even on a more modest scale, and they have never voted for it.

So I was intrigued by John Burn Murdoch’s analysis in yesterday’s FT. (The page itself is probably behind a subscriber paywall.) He provides the usual worrying statistics about A&E and ambulance waiting times, but points out:

While the pandemic has undoubtedly created a shock in the UK’s publicly funded health system, the NHS’s underlying issues are chronic. Waiting lists for elective treatment have been lengthening for 10 years, and the target of keeping 95 per cent of A&E waits under 4 hours missed for just as long.

…

It would be easy to blame underfunding, but in 2019 the UK spent just over 10 per cent of GDP on healthcare, placing it among other wealthy western European countries. The trend over the past two decades has also aligned with comparable nations, according to the OECD.

The key problems, he suggests, are also not simply with staff shortages:

While the number of fully qualified permanent GPs in England has fallen by 8 per cent since 2009, that of hospital doctors has grown by a third, outpacing the growth of the elderly population that accounts for an outsized portion of hospital demand. Nurse numbers continue to grow despite more departures this year.

In other words,

… ever growing resources are being used to treat ever more sick people, but ever fewer are being used to prevent them from getting sick in the first place.

The UK ranks among the highest for admissions to hospital for some conditions which would, in other countries, be largely treated within primary healthcare. (I am reminded of my wife’s surprise that GP practices in the UK don’t generally have X-Ray machines: you have to go to hospital for a check on a minor fracture!)

Anyway, the first part of his proposed solution is that we need to rethink the balance between primary care and hospital care; this is more of an issue than overall funding levels.

And the second is that it’s easy to blame staff shortages, but studies have shown that A&E delays, for example, are primarily about physical capacity — especially bed capacity — in the rest of the hospital, and are not significantly affected by staffing levels.

In summary, he says,

Much like any chronic illness, the NHS’s afflictions will not be cured with a sticking plaster. The road to recovery is paved with long-term investment to upgrade the physical capacity of the system, and to gradually shift the balance from treatment in hospitals to primary and preventive medicine.

A nicely-written article, and one of the many reasons I would pay for an FT subscription if the university wasn’t kind enough to do so for me.

Update, about six months later: There’s a very interesting page at the BMA providing an overview of current health spending in the UK and how it compares to other countries, and to the past history of the NHS.

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Strength Gel

Samson had his long hair, Asterix and Obelix their magic potion, but for today’s man-about-town wishing to increase his muscular prowess, I discover that this small and convenient tube of ‘Strength Gel’ is readily available from most pharmacies!

It’s surprising, because Anbesol is a name I knew from my youth. A treatment for mouth ulcers and similar dental complaints, it was packaged as a very small vial of liquid. Well, the strength gel, it turns out, can also be used for this antiseptic and anaesthetic purpose, and, indeed, has such a powerful calming and numbing effect that I’m surprised Simon and Garfunkel didn’t write a song about it.

As to why it might be Adult strength gel, though, I can only leave to your imagination. The packaging is very uninformative about any use in more intimate situations, but I would suggest any experimental applications be done very, very cautiously.

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Well, that’s reassuring!

I discover that what has been happening to my waistline recently is perfectly normal and natural, and lots of other people are being tested for it too.

It’s called ‘lateral flow’.

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Covid: Destiny and Density?

It always seemed probable to me that Covid infection rates would be closely related to population density. When you walk down the street, how many people do you pass? Are you in a house surrounded by fields or in a tall vertical apartment block where you share an entrance and staircase with many other households? How big are the schools? And so on.

At a country level, though, this is difficult to test. I plotted the very latest total number of Covid-related deaths per million population against the population density per sq. km. for some countries similar to my own (UK), and it didn’t show a clear correlation.

Sources: Statista and Wikipedia.

(As usual, whatever they’re doing in the Netherlands is good. Why do the Netherlands keep doing that with everything? Please stop. It’s very annoying to the rest of us.)

Depending on your political persuasions, or whether you’re a glass-half-full or a glass-half-empty kind of person, you could interpret this in various ways!

My own view (at present), for what it’s worth, is that our government and senior civil servants didn’t put enough emphasis on lockdowns in the early months, and that cost us a lot. But they did put much more energy and resources than most other countries into securing vaccines on a huge scale, very early, and we’re now reaping the benefits. So depending on the time period you examine over the last year, the picture relative to other countries can look very different. (The sadly-missed Hans Rosling would have had some nice animations, no doubt!)

At present, if you take the long view of total Covid deaths per capita, we’re a bit higher than the average for similar countries, but our rate of new deaths is lower than almost anyone’s, so we will probably look better over time. So it could have been much better, and it also could have been much worse.

Anyway, back to population density. The problem is that density is far from evenly distributed. If I plot England on the map, as distinct from the UK as a whole, it appears in a very different place: the top-right:

England is up there with the most-afflicted other countries from my list — Italy and Belgium — but it does have a notably higher population density than any of them.

Anyway, the results of my quick graphs are that I was probably wrong: it’s not clear that population density is a useful metric, at least when done at this scale.

What we really need, if we want to compare the situation in different countries, I think, is statistics about both Covid cases and population density across Europe on a 20km grid. Then we could compare them more usefully, and one day, perhaps, we’ll know whether I’m wrong in the details too, or only on the larger scale!

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Keeping things in proportion

Yesterday, in response to another thread about the AstraZeneca vaccine concerns, I tweeted,

“I hear there’s also a risk of having a car accident while driving to or from your AZ vaccination! Why is this not being revealed to the public?”

Which got some cheery replies, like,

“You could be run over walking from your car too, these car parks are dangerous places!”

And Clive Brown responded with a quick back-of-the-envelope calculation which showed that, yes, indeed, if you drove 6 miles for your vaccine, an accident was more likely than a blood clot.

Getting mine tomorrow, if I survive the journey…

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Mid-life Covid crisis?

I’m a middle-aged computer geek, but my iPhone is too old to run the NHS Track & Trace app. I think this is a limitation of the Bluetooth hardware, but my phone also can’t run a recent-enough version of the operating system.

This isn’t a criticism of the app; you need the right hardware to do something like this. But it makes me wonder about the proportion of the population that will actually be able to run it. Perhaps middle-aged computer geeks like me are actually the most likely to have elderly phones? I wonder whether anyone has done a graphic, plotting the age of users against the age of their smartphones? Probably a kind of 3D histogram?

On the one hand, younger users are probably more likely to be swayed by a desire for the latest gadget and by competition with their peers. But older users are, I guess, more likely to have the disposable income to upgrade. Mmm.

And now, of course, we have some interesting extra dimensions. The effectiveness of the app is highly dependent on its market penetration, and that penetration in different age-groups is going to be constrained by this distribution.

Is it particularly important that older people, who are more vulnerable to Covid, have this app? Well, probably not directly, because the app doesn’t protect you; it protects those who may come into contact with you in the future. On the other hand, perhaps older people are more likely to be in contact with other older people in the future, so it is important that they know when they shouldn’t be socialising.

There are lots of lovely opportunities for research, here, and for inventive data visualisation. Anyone got any funding available?

One thing is clear, though. The more of a social animal you are, of whatever age group, the more important it is that you run this. (That’s a serious point, so no snarky comments, please, about whether middle-aged computer geeks often fall into that category.)

Now, here’s a last thought. I have been considering that it may finally be approaching the time when I do upgrade my phone. But I’m likely to wait until Apple announces their next models, presumably sometime between now and Christmas. (This isn’t because I want the latest one, necessarily, but because the current top model will probably be demoted to a cheaper price bracket when its position is usurped.) I imagine many others may be in the same position, and large numbers of us will become track-and-traceable only after that point.

So…

Given that this same technology is being used around the world, how many lives might be dependent on the timing of the next Apple and Samsung product announcements?

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Passing the buck the right distance

Here’s something I don’t quite understand. It’s the responsibility of the National Health Service to provide a health service to the nation. Presumably, things like the sourcing of PPE, the purchasing of ventilators, the arranging of tests, and even, to some degree, the deployment of diagnostic phone apps, is their area of expertise. It’s what they do.

Now, these are not normal times, of course, and there’s always the complaint about insufficient funding, past and present. But I doubt that’s valid now since, presumably, the government would now happily write bigger cheques for the provision of these things. So I’m slightly intrigued that the NHS is complaining that the government isn’t providing them, rather than the other way around! Intrigued, though not surprised.

Now, clearly I’m missing something, because everybody else seems to think the government is responsible for medical supplies too. It could be that PPE supplies are primarily delayed because of something like customs and excise rules, in which case, yes, clearly the government is culpable.

Or it could be that the NHS is saying, in effect, “you underfunded us for years, so now that we have a big problem, it’s actually your problem! So there!” Government departments are presumed to be more competent at logistics than the NHS, when both are given sufficient funding, so we’d better hand it over to you, even though we’re the ones with the contacts and the contracts.

But I think it’s probably that the boundary between the government and public services is a sufficiently blurred one that, if you are senior enough in the NHS, your job title begins with ‘Minister’ or ‘Secretary of State’. This is very convenient, because it means that anyone who wants to complain about how things are going — to increase the ad sales in their newspaper, for example — can make it a political complaint, which is acceptable and even popular, rather than be seen in any way to be criticising the NHS, which would be suicidal.

So that raises the interesting question of where the boundary of blame can sensibly be drawn, while maintaining political correctness. Everyone is allowed to blame the Prime Minister and nobody is allowed to blame a nurse; so where does, and where should, the buck stop between the two?

To the extent that some people believe the UK Covid response has been badly handled, how do we hold the correct public institutions, or individuals, accountable when it comes to be reviewed? When the next health crisis comes along, should we expect the health service to handle the provision of health-related services, or the political party currently in power at that time?

I don’t know anything about the management hierarchy involved, but I’m guessing that, as you ascend it, you reach a point where the payslips no longer have an NHS logo on them; where NHS administrators become civil servants. A bit higher, civil servants become short-term political appointees. Are either of these the correct point for rational people to start assigning blame in the case of unforeseen medical emergencies? Should it be higher or lower?

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More good analysis tools from the FT

I’ve talked before about some of the nice statistics the Financial Times is gathering about the epidemic, and the clear dispassionate way it’s presenting them.

Their latest tool gets more interactive, and lets you compare, in various ways, how your country is doing against others. I like three things about this in particular.

  • Firstly, you can choose a linear scale. Log scales are handy for scientific visualisation but are harder to grasp intuitively.

  • Secondly, you can get the numbers per capita, which I think is much more useful than absolute figures, though it doesn’t of course take into account population density, which is also important.

  • Thirdly, when you get the analysis in a form you like, you can capture that in the URL and send it to others: the inability to do that is a common problem in today’s over-Javascripty pages!

So you can do your own investigation and see that by some measures, your country is doing fairly well (cumulative cases compared to Spain):

And by other measures not so well (daily new cases compared to France):

You don’t have to switch countries to get different viewpoints, though. Suppose you wanted to make the case that the UK and France were pretty much neck-and-neck, you’d plot the absolute cumulative deaths on a log scale:

(Neither of these capture the fact that France has less than half the population density of the UK, but they’re still useful illustrations.)

Here’s another example:

Let’s display the same data about the UK and Italy in two different ways.

Do you want to make the UK (or its government, healthcare system, population, whatever) look reasonably good? Plot the cumulative cases.

Does your editorial policy or personal preference dictate that you want to make the UK government, healthcare system or population look bad? Then plot the same data as a daily rate (roughly the gradient of the above graph).

That’s the same data over the same period on the same kind of axes.

All of which illustrates why it’s good to have a tool where you can explore the data yourself. As long as you really do explore it and don’t just stop when you get the conclusion you want!

In the above examples, the images are links to larger versions: the links in the text take to the FT site where you can experiment to your heart’s content.

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Spare a thought for the politicians

I am constantly bemused by the number of naïve people who want to blame politicians for all the evils of the world, and especially those medical evils that are besetting us at the moment. As I pointed out in an earlier post, this is happening in many, if not most, countries — which should immediately give any critical thinkers pause for thought — but let’s focus for the moment on the UK.

The NHS is, as the Guardian so nicely put it recently, “the UK’s unofficial religion”, so to question any aspect of its operation is blasphemy. If the health service were given free rein, clearly everything would be fine and sunny, so, as Epicurus would have wondered, “whence cometh evil?” Other religions usually deal with this problem by inventing the idea of devils, who exist to take the blame for the difficult problems raised by the belief system. Also to blame are heretics, who consort with them, don’t pay sufficient tithes to the gods, and should therefore be burned at the stake. In the modern world, we group these problematic actors together and call them politicians. (Oh, not the ones you voted for, of course. They are the priests.)

Anyway, since we don’t just have a two-party system, and not everybody votes, the majority of the population will probably disapprove of whichever party is currently in power. That party is therefore always an easy scapegoat for significant frustration. And the minister in charge of the particular challenge du jour is probably Beelzebub himself in human form. Certainly, any media outlet suggesting that is going to get higher advertising revenues than one that suggests the opposite, so it’s a meme that propagates by simple Darwinian processes.

But is that really fair?

Now, just to set the scene, let me emphasise that I’m no particular fan of our current government, and I didn’t vote for them. And yes, with hindsight, there are some things that they could have been done better. It’s easy to say that now. We must never forget that they are fallible humans, after all, with fallible advisors, and voted for by fallible people.

But if, like me, you didn’t vote for them, then try assuming, as a thought experiment, that the people you did vote for came to power in the election just a few weeks ago, and had this dumped on them. They would, I hope, if they were smart, have taken broadly the same decisions. Yes, they would. They would have had the same health service, the same civil servants, the same scientific advice from the same scientific advisors and, hopefully, would have followed it roughly as the current government have done. So they would have had the same outcomes.

There might have been variations — the advice they’re given by the experts isn’t unanimous, after all — which might have moved the infection curve forward or back by a week or two. But it probably wouldn’t have been a significant change (unless your politicians chose to ignore the scientific advice completely like a certain transatlantic President I could mention!)

This graph from the FT is a good way to see that most comparable countries to the UK are following a pretty similar trajectory; the UK peak is higher than most, but our numbers are dominated by London’s population size & density, and its transport infrastructure; neither of which are replicated in many otherwise comparable places. If you restrict your view to urban centres, Paris followed a pretty similar curve to London. France, however, has half the population density of the UK overall, and that’s probably a significant factor in limiting the spread on a national scale. And so on.

Anyway, let’s assume that your favourite party is in power and hasn’t done a significantly worse or better job, because they don’t have that many parameters to tweak. Where they might have made different decisions, these would have had other costs of their own: damage to the economy, significantly higher future taxes, closure of businesses leading to higher unemployment, etc. The best choice wasn’t necessarily obvious back then; managing this is almost always about having to choose the lesser of two evils. And now they’re being blamed by the media and everyone on Twitter for the shortage of PPE, tests, and ventilators.

I assume that those who are complaining have never actually set up a vast manufacturing and supply chain combined with an instant nationwide distribution network. You have? OK, well done. But let’s imagine, instead, that you’re a young guy — we’ll call you Matt — and you have no particular expertise in this area but have been put in charge of everything and suddenly had the world’s most difficult supply-chain problem for some time dropped in your lap. You have to try and sort out in days and weeks what would normally take those who do have lots of experience weeks and months.

Assuming you’re up to this superhuman task, let’s compound it with a few problems:

  • You work for a large, bureaucratic, inefficient and slow-moving organisation. You’re trying to organise this on behalf of and with the help of another large, bureaucratic, inefficient and slow-moving organisation.

  • Many of your key decision-makers are not in the office. Some of them are sick. Some are in intensive care. Including your boss.

  • Many of your lower-level staff are also off sick or have child-care issues to deal with because all the schools are closed. It’s a bit like trying to organise this during a Bank Holiday.

  • This is true of every single organisation you’re dealing with. And there are hundreds.

  • There’s a global shortage of materials needed to make your products. Many of those suppliers are just not operating at the moment. Sometimes their governments wouldn’t even let them sell it to you if they could.

  • There’s a global demand for the product itself. Everybody else is trying to buy it, as well as you. Not just everybody nearby. Everybody in the world.

  • You don’t actually work for or have any real authority in most of the companies concerned.

  • All of this is costing you way, way more than it normally would.

  • If you do manage to manufacture this product, then all the delivery drivers who might eventually distribute it for you are busy delivering other things.

  • Sorry, did I say this product? You’re actually trying to do this many times over, for a whole range of different products.

  • And every day, journalists are badgering you with questions about why you haven’t finished it yet – don’t you know people are dying out there?

Now, given all that, I don’t know about you, but I’m not 100% certain that, even if I were Secretary of State for Health, I’d actually be able to sort this out in the next couple of weeks so we can all go back to work.

Would you? OK, make sure you stand for parliament next time around, so we can elect you before the next crisis hits, and it can then be your name in the papers. Personally, I fancy that role even less than I fancy being a health worker with insufficient PPE!

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Clapping to a different beat?

There have been a couple of evenings recently when UK residents have been encouraged to go outside and clap and cheer for all our wonderful health workers who are doing such a great job. This is, in many ways, a good idea, and I would have joined in, had I known about them in advance! (We’re a little bit isolated out here and so didn’t hear about them until the following morning.) It’s all rather cringe-worthy, but a significant proportion of my family work for the NHS, and a large number of friends, and they’re working very hard in difficult circumstances. Some of them have come down with coronavirus themselves. So, yes, I probably would have overcome my natural reserve and clapped, at least if anybody other than passing rabbits would have heard me!

I was interested, though, today, to come across this thread on Twitter where a large number of people, mostly who work for the NHS or in healthcare, were expressing their discomfort with the idea, for a variety of reasons.

They had various motives, but the key one seems to be that politicians who have voted against increasing NHS funding have no right to praise those who are now having to be heroes as a result, and certainly not to lead the public in praising them in this low-cost way.

Others say that anyone who voted for those politicians should also not be outside clapping.

My view is that anyone who is not willing to pay a substantially increased personal tax burden should also have pause for thought. I’m guessing that, to have the service we’d all like, we should be thinking of paying about £1000 per year more per family member. (And yes, people who choose to have children would, and of course should, pay more.) However, the country as a whole has been given the opportunity to make rather more modest contributions than that on more than one occasion, explicitly earmarked for such things as health and education, and has turned it down.

I base that £1000 figure, by the way, on the fact that Rose and I have to pay rather more than that for a basic level of private health insurance, on top of what we currently pay for the NHS. We are fortunate to be able to do that, but it’s not because we’re particularly wealthy. We’re clearly a very long way from being poor, but we work for a university and are still, most years, basic-rate taxpayers, not high-rate. So this is a significant chunk of our income, and it’s a luxury but also a kind of voluntary taxation: yes, we get much better service, but in exchange we don’t have some other luxuries, and it doesn’t free us from paying for the NHS: we do that too. But we’ve placed much less burden on it, over the years, than we would have done otherwise.

If, by paying that amount to the NHS, I could be confident of all of us getting the improved level of service, I’d be happy to do so! Instead, at present, we pay so that thing are a lot nicer for us, and a little bit nicer for others.

The problem is that under-resourcing, though clearly a significant challenge, is certainly not the whole story.

On all three of the last three times I’ve had to go to NHS hospitals because friends or family have been there, I have been struck by the many wonderful, cheery, helpful workers… but also by the quite extraordinary levels of administrative incompetence. I encounter employees who would never be able to keep a job if this were a commercial enterprise. I experience procedures which, if they were followed so poorly in a business, would quickly result in that business no longer existing. (Though to be fair, that’s often true of many public bodies.)

And this, I’m sad to say, has been my almost constant experience. On both of the last two occasions I’ve had friends or family staying overnight in hospitals, they have occupied a bed for a whole day longer than necessary. Why? Not because they were still sick, but because the doctor literally forgot to come and discharge them before going home at the end of his shift. Two different hospitals. Two different doctors. Two different patients. Same problem. Actually three doctors, because one friend was forgotten twice in a row, though I think one of them might have been the nurse’s fault. They are not just short of hospital beds for lack of funds!

And this malaise is not just in the area of patient care. I remember when, as a struggling startup company, we were trying to sell a product to our local NHS hospital. They liked it, they wanted to buy it almost immediately, the cost was trivial, but it still took them more than a year to go through their procurement procedures and write us a modest cheque. Even then — and this was explicitly explained to me — they only managed to get it to us because somebody persuaded the person responsible for the relevant account to stay for a meeting which finished after 5pm. He was annoyed, and made it clear, because he normally went home soon after tea-time, at around 4.30pm. For those of us working long hours and weekends to produce the product, we just had to laugh. I know from talking to other technology providers that our experience was certainly not unique. But that was then – what about now? Well, now, remember this story when you hear that they can’t get the supplies they need.

These are just anecdotes, of course – I have no knowledge of the bigger picture on any statistically-valid level. I speak only of what I’ve experienced. But I have certainly not exhausted my stories: those are just a couple of the more worrying examples.

So yes, I love the NHS. I’m enormously grateful for what they’re doing now. And yes, I wish it were better resourced.

But anyone who thinks that somebody else will pay for a better service for them is living in cloud-cuckoo land; we all need to be willing to stump up significant amounts of cash. How many of those people out there clapping think that the problems now being experienced are all somebody else’s fault?

Anyone who thinks that money is the only problem, or that the politicians are the only problem, is similarly deluded. In this country it is very unpopular to talk about any degree of commercialisation of the NHS, and clearly that’s not a silver bullet: one only has to look at the costs of drugs in the USA for an example of how commercialisation can get out of hand.

But so far, nobody seems to have come up with a good way of instilling the disciplines and efficiency and levels of accountability that govern the commercial world into the public sector. And until they do that, it seems to me, we will continue to have some situations where we just have to rely on some people being heroes.

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