matt_black
Recent activity
Comments (3)
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Comment on: HSJ live: rolling news 16.1.2013
Both the government and some civil servants have never quite got a grip on what is required to drive or sustain A&E performance. It was obvious to A&E experts, for example, that lowering the target from 98% to 95% would make performance worse because it sent a strong signal to trusts that this was no longer a big focus. Also the focus on quarterly performance encourages gaming and lack of focus on consistently speedy treatment for patients. Somebody needs to be paying attention to the underlying and unpublished metrics about A&E behaviour as well as the headline numbers. For example, the distribution of waiting times for patients (how many wait 3hrs, how many wait 3hrs 15 mins, how many wait 3hrs 30 mins etc) is a good indicator of the effectiveness of A&E processes (and it clearly shows the difference between last minute rushing and routinely speedy processes). And the civil service needs to learn that the indicators that get published are not always the best ones to use for directing management attention. The previous government at least understood that how long patients wait for treatment is very important for patients and they spent a lot of time setting (unpopular) targets to drive the performance of the system.
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Comment on: Commissioning board's funding formula move was not 'political', says Dalton
The real problem here is a failure on the part of many commentators (and possibly now by the commissioning board) to distinguish the distribution of need and the distribution of effective ways to spend money. Few seriously doubt that deprivation relates to worse health, but whether spending more NHS money reduces that health inequality is entirely unclear. It may be that spending on say, social housing, would make a far bigger difference to health inequality than more NHS spending. Spending more NHS money in deprived areas certainly looks good to naive politicians, but if it doesn't actually achieve better health and lower inequality, it is a bad way to allocate the funding. It looks like the NCB have caved in to the naive belief rather than making the judgement they should be making which is to focus the money where it will do the most good.
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Comment on: Health Bill could bring in US-style system, report warns
So an author who believes that anything done in the private sector (not just in health) publishes an analysis based on the assumption that any health reform is evil and comes to the conclusion that the bill is all about driving us to the american system. Which part of this is news? The conclusion of the paper only makes sense if we impute machiavelian motivation to the entire government and assume that nothing good can come from the changes. I'd prefer to assume that many aspects of reform are good ideas but the bill has been a catastrophe in detail and implementation.
