A Django site.
November 20, 2015

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» A personal reflection on the structural changes in health and social care in Wales

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy This week’s blog is by another long-term friend of WIHSC, Tony Garthwaite, Senior Fellow at the Institute. Many readers will remember Tony as a leading figure … Continue reading

December 10, 2010

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» Challenging ineffective practice in the Welsh NHS

As we know all too well, times are hard in our public services, and almost the last thing they should be doing is spending money on things that don’t work.  The VERY last thing they should be doing is spending money on things that not only don’t work, but might actually be harmful.  Surely none are?  Well…

As the evidence base evolves it becomes clear that some interventions are effective. However that is not true of all interventions in healthcare. Indeed some treatments are shown to offer no benefits but risk of additional harm.

Health Boards in Wales are committed to reducing harm and waste. So they are drawing up lists of procedures which are believed to be either harmful or of low enough effectiveness to be a waste of resources compared with other options. They have been assisted in this by Public Health Wales who have reviewed evidence not already covered by NICE guidance. Now Public Health Wales is producing a report highlighting variation in provision of surgical procedures of questionable effectiveness.

Variation is not of itself a problem.  It may be a sign of provision of specialist care targeted to selected individuals who might gain particular benefit from a treatment not generally advised. The report by Public Health Wales is not able to demonstrate whether the variation is justified in this way. The use of procedures of questionable effectiveness should be justified, however, and the report on variation in provision is the starting point for further investigation by the Health Boards.

This is not the stuff of accountancy penny-pinching.  In a finite budget, spending money on things that DON’T work means denying money to things that DO.  That’s unethical.

Written by Marcus Longley, Professor of Applied Health Policy and Director of WIHSC

July 7, 2010

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» Tortured By The Comfy Chair?

The older readership of the WIHSC Blog may recall the Monty Python comedy sketch about the Spanish Inquisition, in which their ruthless leader Cardinal Fang would inflict his most vicious torture on his victims – The Comfy Chair!

I have spent more than 40 years of my life working in the NHS and throughout that period experienced two prevailing feelings. Firstly, a tremendous sense of satisfaction with the contribution I was making, and secondly a vague sense of unease about being undervalued. The coffee morning talk would often turn to how much fatter our pay packets would be if we were working in the Private Sector.

Reading the newspapers over recent weeks has led me to question whether my unease was rooted in reality, at least for the last few years of my working life. It appears that statistically a typical Public Sector worker in the UK now earns 30% more per hour than their Private Sector counterpart. Looking locally, this translates to Public Sector workers earning 20% more per week than Private Sector colleagues in Wales. Immediately I damned these statistics with the explanation that there are a higher proportion of skilled workers in the Public Sector, so these differentials would be expected. Sadly my dismissal of these numbers was apparently inappropriate as a piece of work from the Institute of Fiscal Studies has shown that even taking into account skill mix, the Public/Private differential still exists at 2% for men and 4% for women in favour of Public Sector workers. This study incidentally was undertaken in 2006, before the wage cuts, job losses and reduced working weeks that Private Sector workers have suffered as a result of the recession. I am sure that readers will recognise the now much used phrase ‘gold plated’ Public Sector pensions, and perhaps even the general public’s perception that job security is a feature, more of Public Sector than Private Sector employment. Incidentally this latter perception is rather borne out by the statistics – the chance of somebody employed as a Civil Servant being made compulsorily redundant have, up to this year, been 0.00007%.

I know all this is about to change, but after looking at these comparators I was left mightily impressed by the ability of Public Sector Trade Unions to persuade Government of the value of their Public Sector workers. Much rhetoric is now being generated about Public Sector industrial action, and I am left wondering whether Unions can be equally persuasive with the general public if industrial action rather than budget reductions are seen by the public to limit their access to Public Services.

I know the argument is that Public Sector employees should not be affected by the actions of Bankers, but I am sure that the car workers, employees of bankrupt retailers and other Private Sector staff felt exactly the same way. A calculation by the International Monetary Fund shows that bank bail outs, the credit crunch and the recession account for 14% of the expected increase of Britain’s debt burden, the remaining 86% is from growth in public spending on health, benefits, pensions and long term care.

It seems I need to re evaluate my sense of being an undervalued Public Sector employee. Perhaps after all, I was being tortured in the Comfy Chair.

There are hugely difficult times coming for individuals in the next few years. The detached discussions about what percentage budget cuts need to be imposed to rebalance our Nation’s finances are going to hide thousands of individual tales of sadness, but this is not designed to be anything more than a reflection on my past good fortune, and a sense of great relief that I am now ‘out of it all’.

I would like to leave the last word on perceptions of the Public Sector workforce to the epitome of British satire, Private Eye. Sometime ago, I saw a cartoon of a balding, scruffy and overweight middle aged man sat at a bar, sat next to him, is a young and curvaceous blonde. He turns to her and says ‘actually, I work in the Public Sector.’ On hearing this she leans forward, smiles and throatily whispers ‘Oh my! How interesting.’

Written by Glyn Griffiths, WIHSC Associate

» Tortured By The Comfy Chair?

The older readership of the WIHSC Blog may recall the Monty Python comedy sketch about the Spanish Inquisition, in which their ruthless leader Cardinal Fang would inflict his most vicious torture on his victims – The Comfy Chair!

I have spent more than 40 years of my life working in the NHS and throughout that period experienced two prevailing feelings. Firstly, a tremendous sense of satisfaction with the contribution I was making, and secondly a vague sense of unease about being undervalued. The coffee morning talk would often turn to how much fatter our pay packets would be if we were working in the Private Sector.

Reading the newspapers over recent weeks has led me to question whether my unease was rooted in reality, at least for the last few years of my working life. It appears that statistically a typical Public Sector worker in the UK now earns 30% more per hour than their Private Sector counterpart. Looking locally, this translates to Public Sector workers earning 20% more per week than Private Sector colleagues in Wales. Immediately I damned these statistics with the explanation that there are a higher proportion of skilled workers in the Public Sector, so these differentials would be expected. Sadly my dismissal of these numbers was apparently inappropriate as a piece of work from the Institute of Fiscal Studies has shown that even taking into account skill mix, the Public/Private differential still exists at 2% for men and 4% for women in favour of Public Sector workers. This study incidentally was undertaken in 2006, before the wage cuts, job losses and reduced working weeks that Private Sector workers have suffered as a result of the recession. I am sure that readers will recognise the now much used phrase ‘gold plated’ Public Sector pensions, and perhaps even the general public’s perception that job security is a feature, more of Public Sector than Private Sector employment. Incidentally this latter perception is rather borne out by the statistics – the chance of somebody employed as a Civil Servant being made compulsorily redundant have, up to this year, been 0.00007%.

I know all this is about to change, but after looking at these comparators I was left mightily impressed by the ability of Public Sector Trade Unions to persuade Government of the value of their Public Sector workers. Much rhetoric is now being generated about Public Sector industrial action, and I am left wondering whether Unions can be equally persuasive with the general public if industrial action rather than budget reductions are seen by the public to limit their access to Public Services.

I know the argument is that Public Sector employees should not be affected by the actions of Bankers, but I am sure that the car workers, employees of bankrupt retailers and other Private Sector staff felt exactly the same way. A calculation by the International Monetary Fund shows that bank bail outs, the credit crunch and the recession account for 14% of the expected increase of Britain’s debt burden, the remaining 86% is from growth in public spending on health, benefits, pensions and long term care.

It seems I need to re evaluate my sense of being an undervalued Public Sector employee. Perhaps after all, I was being tortured in the Comfy Chair.

There are hugely difficult times coming for individuals in the next few years. The detached discussions about what percentage budget cuts need to be imposed to rebalance our Nation’s finances are going to hide thousands of individual tales of sadness, but this is not designed to be anything more than a reflection on my past good fortune, and a sense of great relief that I am now ‘out of it all’.

I would like to leave the last word on perceptions of the Public Sector workforce to the epitome of British satire, Private Eye. Sometime ago, I saw a cartoon of a balding, scruffy and overweight middle aged man sat at a bar, sat next to him, is a young and curvaceous blonde. He turns to her and says ‘actually, I work in the Public Sector.’ On hearing this she leans forward, smiles and throatily whispers ‘Oh my! How interesting.’

Written by Glyn Griffiths, WIHSC Associate

February 11, 2010

Welsh Institue of Health and Social Care Blog
wihsc
is about »
» Public services really are better!

As the Assembly seeks new legislative powers and as the general election approaches, is there still time to build the new Jerusalem somewhere along the M4?

Wales has eschewed much of the New Labour agenda as its fledgling Assembly increased in strength and bathed in clear red water. Within the NHS the use of market forces as a deliberate tool of policy to spur efficiency has been read the last rites as the new Health Boards come into being. NHS Wales is not in hock to expensive PFI schemes. Even England is now thinking of scrapping hospital car parking charges.

Obama struggles against the power of vested insurance and other interests in the USA as enough of that country continues to believe that Government is “bad” and individual freedom is “good”. Financial institutions have been seen to have no clothes as the complicated financial instruments which they invented and sold have managed to transfer wealth from the poor to the rich whilst simultaneously mortgaging the future earning power of most economies for the next decade. All this from a creed bowing before the wisdom of the market. “Wise” bankers who created the mess command millions “because they’re worth it” while the genial Terry Wogan’s daily army of 7 million TOGS seemingly cannot justify his more modest BBC fee just because it is paid by a public body acting for us all.

Is it too much to ask that the NHS – the antithesis of marked-based approaches to creating and distributing one form of wealth (personal and collective health) – should continue to show that an alternative creed can, and does make sense? Is it hoping for too much to expect the new Welsh Health Boards to cherish the Welsh tradition of solidarity that spawned the NHS and re-invent it for the 21st century? And is it still a good thing to have public services staffed by people whose worth and “output” is judged by the good they do, rather than by the price some arcane system of mathematics places on the few bits of healthcare it thinks it can value?

Tony Beddow, Visiting Professor, WIHSC