Wednesday, January 4

Maths and the NHS

 I don't know who is now advising Rishi Sunak. James Forsyth has recently transferred from The Spectator to his political team and I had previously been impressed with his writing and argument when discussing the government's actions so I would be surprised that the latest releases are his responsibility. Whoever suggested, however, that it would be a good idea to say that students should continue to study maths until they're 18 needs their own head examined.

Firstly, I should make it clear that I am something of a mathematician. I love numbers and have Pure Maths and Applied Maths A Levels and really do enjoy solving quadratic equations and wondering aloud about topology, doing sudoku and various other games involving numbers. But I am slightly bonkers. It would not expect the population at large to be like that. I would expect them to be able to do some simple sums without needing a calculator and to be able to recognise that some numbers are simply either too big or too small to be sensible answers to a question that might arise in daily life. That's all. And these are numeracy skills which are around Level 1 or 2 at most and are currently pretty much unavoidable at schools and colleges as things stand.

I was under the impression that almost every student does pass some basic numeracy test before leaving and those that don't get another go at College if necessary. Numeracy NVQs at Level 1 as I recall had virtually 100% pass rates even at Dunstable College where neither the standard of teaching nor the standard of student behaviour or English comprehension was particularly great at the best of times. You had to be pretty thick not to pass or to suffer from some other problem which meant you probably shouldn't have been put in for it in the first place without some extra guidance and support.

The sort of maths that comes later is the more awkward stuff, maybe involving triangles or the terrifying matrices. I can't imagine integration being on the agenda for all 17 year-olds. "Differentiation is a science; integration is an art," my St. Albans School Maths master used to say. There's no way any student should be made to study either unwillingly.

So I am very much concerned at what Rishi Sunak is getting at, or what he hopes to achieve with this announcement. Yes, by all means, let's have a more numerate group of students entering the workplace but there is already sufficient testing. Perhaps the teaching and type of testing could be improved but that's about it and I certainly don't think we should spend too much political capital losing votes by forcing everyone to 'do maths' every week. It would be better that 'Social Studies' or 'Black history lessons' or 'White privilege / diversity training', however, now I think of it. Bit I can just see Labour lining up a series of advertisments featuring attractive modern schoolgirls looking bored at their desks in a 70s-style classroom with a boring-looking teacher covering a blackboard with white chalk equations and symbols in 2024.

Think again, Rishi. And sack James if this is his first idea in post!

What has got everyone's attention recently is the NHS. Or, rather, the lack of S in the NH. Labour, of course, see this as a free ticket to government and there will be cries of how badly the Tories have done with all the crises being reported within and all around the National Health Service. Christ, even the nurses are on strike and junior doctors are regularly searching for posts in Australia. It is so easy to stick this one of the Tories, as Labour will continue to do, probably dragging the Brexit £350 million for the NHS bus poster out again too.

Secretly, however, I suspect that Labour are thanking their lucky stars that they're not in government at the moment as they wouldn't be able to do much about it either. 

The problem is not of the government's making. It is simply the case that the National Health service is incredibly badly run now. It's vast, it's hugely complex and collapsing under its own weight. As we all get older and live longer we demand more treatment for ailments and cost a lot more money as both the time spent under care and on drugs to help us soar ever upwards. Unless the funding for the NHS is similarly linked and increases vastly ever year in line with the need then something is going to break. I don't hear anyone willing to give that commitment as the implications for us tax-wise, would be too high.

It is necessary to separate the service from the administration and management as far as possible. The former does need the continued expansion in one form or another but the latter should not. That may then lead to a more acceptable element of funding year to year. Non-service costs really could be frozen in total, if not reduced. I suspect that there is a huge amount of waste from a lack of joined-up thinking, centralised purchasing can be a double-edged sword too, without sufficient thought given in negotiations on prices payable and quality receivable. Management and middle management salaries seem very high in comparison to equivalent job roles in other employment. Many staff are being paid  substantially more than MPs or company general managers with considerably more responsibility. My guess is that a massive amount could be saved by cutting swathes of NHS Management posts without anyone actually noticing.

This still is unlikely to be enough in the long term, though. I just can't see how we can continue to provide a free service to everyone. Times have changed. We could offer a free service for day-to-day care and advice and for hospital treatment to treat serious illness and injury to everyone as before but with some differences. Non-essential treatments should be chargeable in most circumstances. So someone who wants bigger boobs shouldn't be able to get them installed on the NHS unless there was some genuine psychological support for the spend. Basically, much more limited cosmetic work for free. 

Develop lots of local centres where people can get some treatment and care and advice without having to go to a big town hospital. I am sure many of the simpler, less invasive and more general treatments can be delivered this way without the need for main ward services.

Help people that have to go to hospital get out quicker by using more recovery areas, like what used too be called convalescence. This needn't be on the East Coast as many seemed to be in the old days but might even be incorporated in the local centres too.

Incorporate care in the home and Care Homes in the service so that there is some continuity in everything.

Now for the big change: provide all this free but require anyone in employment or self-employment to have private health insurance in addition to their normal NI payments. All treatment and care is costed and debited to our NI accounts. That's for everyone and a charge is made for those with insurance. Private medical care also remains available so if the person has used alternative facilities there would be no NHS charge in such a case, or maybe just a partial charge for initial investigation or consultation perhaps.

Everyone continues to get treated and no-one is turned away through lack of funds or given less good service. It is simply that there will be a bill for everyone in future and those who can afford to pay more will do so. Their insurance premiums will rise as they age and earn more. It is almost an extension of National Insurance but does not just gather more money to go into a bottomless pit. the funds are directed to pay the bills arising.

The administration and management side of the NHS should be mostly a fixed cost and calculable so that the required amount can be drawn from the normal payments made by everyone through National Insurance. These might be included in the 'bills' to be provided for each interaction with the NHS too but I need to think about that a bit more as there is an element of the cost that needs to be billed to everyone and I can't figure out yet whether that can be covered by the basic NI contributions alone. If it can be then I'd say that it needn't be featured in the 'bills' for interaction, that would be only for the occasions when the person used the service. 

No-one would actually pay these bills but they would be valuable reminders and aid accounting for the NHS generally, making it much more like a business that can compare income with expense. Insurance funds would meet many of the bills, of course. I cam also imagine a scheme whereby someone who goes through life with very little use of the NHS will benefit, possibly by a credit in older age or an entitlement to free or subsidised home or Care Home care.

Perhaps there might be  a scheme whereby some of the unpaid 'bills' accumulated by someone are deducted from one's estate on death, subject to all sorts of caveats to ensure fairness, continuity of spouse entitlements etc. I don't know about that but, again, there is a sense of payment for health care by those who can afford it which, whilst frowned upon and shouted at by left-wing politicians, may not actually be so bad an idea after all.

One thing is certain. The government should resist any more payment increases for any NHS staff at this time. It is now time for the NHS management to try and do the job they are very nicely paid to do - run the service. They need to decide what their priorities are. At the moment I fear that they are more about causing trouble for the Tories than helping people who fall ill.

Nurses need to think more about this aspect and stop believing all that they read and are told by their trades union representatives. If their lives are hard and the work is tough then is it really the government that is to blame? Who is really determining what they do and when each shift? Who is being paid a whole lot more than them for taking no personal risk or doing no long hours or night shifts at all? Who could set about recruiting more staff?

NHS managers.

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