Tag Archives: politics

Martin’s law of meetings, and the ‘national conversation’

I’m slightly amused by all the news reports this week that the government wants a ‘national conversation’ on the future of the NHS. While this is a laudable idea which will appeal to the punters, I doubt it’s actually very practical.  

My late friend Martin King used to say that the ease of making any decision is inversely proportional to the number of people involved in making it.  So trying to have a committee of 70 million people might be counterproductive?  Anyway, Martin’s theory was that you shouldn’t, in general, try to make any decisions in meetings; you should only use them to ratify decisions you have already made!

A wise man, in many ways.

My own view of how to fix the NHS, for what it’s worth (and I admit it’s not worth very much, probably!) is as follows:

Firstly, it needs to be more tightly integrated with social care (so people can get out of hospitals quickly), secondly, it needs much better ways of rewarding efficient and effective workers and getting rid of others (because of the often amazing administrative inefficiency and incompetence of many otherwise lovely and well-meaning people), and thirdly, of course, it always needs more funding.  (Oh, and fourthly, we should re-join the EU, but I’m not holding out much hope there…)

So let’s talk about funding. We should be completely open with the public about how much more funding is needed. My guess, based on the cost of private healthcare plans, is about £1-2k more per person per year.  We currently spend just under £4k/person/year on healthcare.

I wrote more about this topic a couple of years ago.  Note that, despite much common rhetoric, the NHS has never actually had any cuts in funding, except once, when the increased spending during Covid returned to its normal levels after the pandemic.  But the rate of growth in spending has varied under different governments. This interesting page from the BMA suggests that, under the Conservative government, there has been an cumulative ‘underspend’ of £446bn, which they base on the fact that the longer-term historical rate of growth (a pretty substantial 3.8% in real terms) hasn’t been maintained at the same rate in the last decade and a half.  If it had, they would have had that much more.  

It sounds like a terrifying figure, but it’s only £6K per person, or £400 for each of those years, to recover all of it.  Another interesting observation is that we spend the same proportion of GDP on healthcare as most other comparable countries.  It’s just that our GDP hasn’t been doing very well lately!  (So I guess the counter-argument would be that we get the NHS we can reasonably afford, and we need to fix the economy to get a better one.) But let’s assume, for the purposes of argument, that we want to fix the NHS and we can’t immediately fix the economy.  

We should then simply propose adding whatever amount is really needed to income tax or NI.   There are far too many people who complain that the NHS is underfunded but assume that the funding is going to come from somebody other than themselves!  

For people to accept this, these funds should be ring-fenced, so they really can’t be spent on anything else.   Then we should just make people vote on whether they really want it, based on the extra x% of tax it’s going to cost them, either through a referendum or as a manifesto at the next general election.  (Count me in, for all reasonable values of x!)

Actually, a referendum would allow the extraction of real numbers for x.  Imagine going to your polling station and being presented with just one multiple choice question; something like this:

How much should the government raise the current standard rates of income tax for the exclusive purpose of further funding the NHS and Social Care systems? (choose one answer)

  • Not at all
  • 1%
  • 2%
  • 3%
  • 4%
  • 5%

Then you do the maths and give people the NHS they’re willing to pay for. The ballot box, I would suggest, may be the only way to make a decision when the participants in your ‘conversation’ are truly ‘national’ in their numbers!  

Otherwise, Martin’s law applies.

P.S. I do know that some of the above is over-simplistic. Historically, raising overall tax rates hasn’t usually actually raised overall revenues for any length of time, for example, but I think raising them for this explicit purpose, and then cutting them elsewhere if you want to, would prove popular.  However, I’m not an economist, and you should feel free not to vote for any government proposing to appoint me as Chancellor or Health Secretary,

 

 

 

 

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A Decisive Moment?

I generally try to avoid anything too political here, but I loved this photo of Helen Morgan, the new Liberal Democrat MP who won the North Shropshire by-election a couple of days ago, and so took a seat that has been Conservative for 200 years.

Regardless of your political opinions, as well as the pleasing facial expressions, I think the suspense encapsulated in this is just brilliant. Many photos make you laugh because you can see the inevitable, but often you’re glimpsing just a split second into the future. Here, you feel they could hold this pose for quite some time yet, but with all the certainty of Greek tragedy, you know what’s eventually coming!

Photo credit: PA, originally spotted in this FT article.

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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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The Liar Tweets Tonight

This is just brilliant…

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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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The question UK voters should be asking this morning

Well, we live in interesting times! The key emotion most of us felt, I imagine, on hearing the election results, was one of amazement, closely followed by joy, anger, disappointment etc depending on your political persuasion. Almost nobody expected this result, and though the polls had been predicting a probable Conservative win, it was expected to be a modest one, and their lead had been diminishing in recent weeks. So this was fairly astonishing.

If you are as surprised as I am this morning, and as I imagine most of my acquaintances will be, whatever their political persuasion, then I think there’s a key question to ask yourself:

What is it about my social circle (both online and offline), my sources of news, my breadth of reading, my understanding of politics, my grasp of statistics, or my knowledge of history, that caused me to be so mistaken about the country’s mood? And how should I rectify that?

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Capitalism and Machine Learning

You may have wondered why AI companies, like DeepMind, who specialise in machine learning systems, seem to devote so much time to creating systems that can play chess, or Go, or Space Invaders. Why don’t they do something more useful?

Well, part of the answer is that a machine, like a child, can only learn the right things if you give it very clear feedback about how it’s doing. And the key thing about games is that they have scores, which quickly give you this simple, unambiguous, reinforcement. And they do so without much delay, and in particular without much interpretation or interference by fallible humans.

Compare that with, say, recognising that a dot on an X-ray taken in one hospital eventually became a tumour which was diagnosed two years later by a physician in another clinic inspecting an MRI image taken from another angle. The key problem, in the majority of machine learning systems, is not the one of noticing the dot or even distinguishing it from other dots. It’s the one of assigning it a score, when there are so many complicated factors in the way.

I was thinking of this when reading David Brooks’s opinion piece in the NYT: “I Was Once a Socialist. Then I Saw How It Worked.” (This is behind a partial paywall, but you can probably read it with some carefully-placed clicks or a free subscription.)

Extract:

Socialist planned economies — the common ownership of the means of production — interfere with price and other market signals in a million ways. They suppress or eliminate profit motives that drive people to learn and improve.

It doesn’t matter how big your computers are, the socialist can never gather all relevant data, can never construct the right feedback loops. The state cannot even see the local, irregular, context-driven factors that can have exponential effects. The state cannot predict people’s desires, which sometimes change on a whim. Capitalism creates a relentless learning system. Socialism doesn’t.

Lots of good stuff in here, and most of it, no doubt, is not new, but I don’t normally spend more time than I have to thinking about politics!

All of these leaders understood that the answer to the problems of capitalism is wider and fairer capitalism.

…

But capitalism, like all human systems, is always unbalanced one way or another. Over the last generation, capitalism has produced the greatest reduction in global income inequality in history. The downside is that low-skill workers in the U.S. are now competing with workers in Vietnam, India and Malaysia. The reduction of inequality among nations has led to the increase of inequality within rich nations, like the United States.

…

These problems are not signs that capitalism is broken. They are signs that we need more and better capitalism.

…

A big mistake those of us on the conservative side made was to think that anything that made the government bigger also made the market less dynamic. We failed to distinguish between the supportive state and the regulatory state.

The supportive state makes better and more secure capitalists. The Scandinavian nations have very supportive welfare states. They also have very free markets. The only reason they can afford to have generous welfare states is they also have very free markets.

(Emphasis mine)

Good reading, given the current rhetoric of the UK political parties as we approach our election on Thursday.

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Hillary Blofeld?

Wow! I thought Hillary Clinton was just an American politician. But according to Donald Trump last night, she’s some kind of global potentate: a villain that would be rejected by Bond film producers as far too implausible:

After four years of Hillary Clinton, what do we have?

ISIS has spread across the region, and the world.

Libya is in ruins, and our Ambassador and his staff were left helpless to die at the hands of savage killers.

Iraq is in chaos.

Iran is on the path to nuclear weapons.

Syria is engulfed in a civil war and a refugee crisis that now threatens the West.

After fifteen years of wars in the Middle East, after trillions of dollars spent and thousands of lives lost, the situation is worse than it has ever been before.

This is the legacy of Hillary Clinton: death, destruction, terrorism and weakness.

What’s really shocking is that, on top of doing all that, she also used the wrong SMTP server!

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The Canine Party

Just thinking about one of my favourite Dilbert cartoons.

dilbertvote

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