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Thursday, 13 October 2011

TPA – Health Service Hatchet Job

[Update at end of post]

Today brings a supposedly authoritative “report” from the so-called Taxpayers’ Alliance (TPA), this time laying into the NHS. Under the title “Wasting Lives”, it purports to be “A statistical analysis of NHS performance since 1981, which TPA observers will be unsurprised to learn it is not. It is, however, a classic of TPA output in that it selectively presents information to suit its conclusion.

The wasted lives of the report title are those hypothecated as being “amenable to healthcare”, assuming that the “amenable mortality rate” for the UK can be measured against that for “selected European countries” (which, to no surprise, have lower amenable mortality rates), with the difference multiplied out to give a suitably large number, just over 11,500 for 2008.

This figure is then put forward, together with increased spending on the NHS between 2001 and 2011, and is held to prove that the NHS is not such A Good Thing and should therefore be reformed, although what a reformed system would look like is not told, possibly because the models followed in those “selected European countries” (the Netherlands, France and Spain) are all different.

There are a number of problems with this approach. Firstly, as the TPA at least concedes, is the lifestyle factor, which is known to influence significantly life expectancy levels across the UK. Second, the TPA seems unable to limit its comparison to the Netherlands, France and Spain, bringing in comparisons with Australia, Sweden, Norway, Canada and even Cuba.

And thirdly and potentially most important, the only country that has its healthcare spending examined in depth, together with productivity, pay and increases in frontline staff versus managers – always a fertile patch for the TPA, for whom the thought that large private sector organisations have lots of managers does not enter – is the UK.

The nearest the TPA gets to making a cost comparison is when they describe the system in Switzerland (yes, yet another comparator thrown in to the mix) as “expensive”. So the NHS is getting rubbished by comparing it to systems across Europe and elsewhere, but there is no comparison of costs, just the inference that the NHS model is wrong and everyone else’s is better.

So what the TPA have presented is a partially researched hatchet job on the NHS, with sufficient information provided to fit the headline already written – rather like the Daily Mail, the kind of paper that eagerly churns over their press releases. The sad reality is that informed debate on the NHS cannot be other than A Good Thing, but this is not it. It’s a waste of time and money, and that’s not good enough.

[UPDATE: As Clifford Singer at The Other Taxpayers' Alliance has pointed out, the TPA "report" does contain comparative cost data, in a graph on Page 16. This shows that NHS spending between 1981 and 2008 was, on average, less than 90% of the level of what it calls "EU-peer spending" (whether that is the same three countries - the Netherlands, France and Spain - mentioned previously, or all EU member states, or some other grouping, is not told). The supporting narrative, though, does not mention this, and instead talks of spending increases while ignoring the inconvenient fact that spending on the NHS has not got even close to that "EU-peer" level for a period of almost thirty years.

The TPA's head non-job holder Matthew Sinclair has also not mentioned this in a post on the "report" on ConservativeHome (not, of course, that the TPA are Conservatives, oh no) until a commenter pulled him up on it. The vain and immodest Sinclair's measured reply to the heinous act of criticism was to whine "You have just set up a complete straw man", which is more or less word for word what he said last time he spat out his dummy at me for calling out the TPA on their creative use of statistics.

So yes, there is some comparative data there, but while visible, its presentation is veritably discreet. More slanted TPA copy - no change there, then]

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