Wednesday, January 24, 2007

From the commonplace book of David Aaronovitch

yes yes yes, I know you're all gagging to know what happened at the Nick Cohen "live chat", but we have an Aaro to watch. (Matthew has a couple of Nick nuggets for those that can't wait).

This week's Tuesday column has the "sofa rule" conversational headline ("Not likely!"). It actually has one good point in it. But it reads weirdly - different paragraphs appear to be contradicting or talking past one another. The Jyoti Basu anecdote is funny enough, but it doesn't really have anything to do with the rest of the article and the attempts to refer to it in the ending paragraphs look really forced - and Aaro has shot his bolt with respect to ministerial hypocrisy last week with "dyslexogate" anyway.

The good point is that, in general, the local campaigners are full of it on this one. The IPPR study captures the central point perfectly - that there are economies of scale in emergency care, and that a combination of large hospitals and fast ambulances is better in terms of clinical outcomes for serious cases. But I don't think Aaro really tackles the reasons why the protestors are protesting. I see three.

First, is simple Nimbyism. It's true that the fast ride to the big hospital can be better on average. But if you accept that we need fewer, larger hospitals, it is still better for me if the one that's near me is one of the big ones and the one near some other bugger is one of the ones that closes down.

Second, although this may be true for serious emergency cases, these don't actually make up the majority of A&E experiences. Most times you go into an emergency room, it's not a life or death situation; it's just a matter of something that effing hurts, and you want it sorted out sooner rather than later. Small local hospitals are going to have shorter wait times for cases lower down the triage list, which, barring unfortunate coincidence, is closer to the median voter.

But third, and in my view most important, there's something "more than rational" about the politics of closing down hospital A&E departments. The issue here is the slight wrench that you feel in the stomach when you pass a hospital and see the sign saying that it has no A&E. It's a real instinctive reaction, because you can't help picturing yourself walking up to that hospital, bleeding or in pain, and being told to go somewhere else. The fear of being turned away from a door is pretty close to a Jungian archetype - being turned away from a door certainly gets a starring role in the Bible, for example (and I note that you tend to get a lot of local protests aimed at saving maternity units, too). Call me Frank Luntz here, but it's not something that can be argued against with the results of a linear programming model.

But anyway, paragraphs that don't speak to one another. In the para. beginning "By 2008", Aaro notes that the big increase in NHS spending has had big effects in terms of clinical outcomes. Two paragraphs later, we're "spend lots more money and don't get much more work". Well no, Dave. That wasn't the problem with GP contracts at all. If we hadn't got much more work, then the piece-work contracts that GPs were put on would have worked out more or less according to plan. In fact, we got shed-loads more work, meaning that the piece-work contracts suddenly turned ruinously expensive. Note, though, that this is a) a financial problem, not a medical one and b) not exactly a completely unheard of phenomenon in the history of piece-work contracts. The way you deal with it is by extending the minimum targets for next year, same as you do with salesmen on commission.

And then it's just a blah about Cameron. Ooh, hey he doesn't have many policies, does he? Aaro wants to say that Cameron is in favour of increased marketisation (not clear whether he thinks this is a good or bad thing), but the evidence isn't there, so he dances around the topic. Then he says that you can only be radical "if your radicalism goes with the grain of your assault on power". Whatever the hell that means. Have a look back at Labour in the 1990s - stakeholding, the Third Way, etc - and tell me that the current, very radical, policy agenda has anything to do with it. I suspect that the sudden lunge at the end in the direction of an endorsement of Brown looks like either triangulation, or a warning shot from the Murdoch organisation across the bows of the (other) Boy Dave.

The status quo is no longer an option. Again.


Blogger Benjamin said...

Nick was pretty useless in the live chat. Daniel Davies asked some pretty pertinent questions and Nick was very weak. Kept saying google Labour Friends of Iraq and stated, rather bizarrely, that Harry's Place is an "excellent website".

The guy has lost his bearings somewhat. His book will sell moderately and will be quietly forgotten like the Euston Group rotting on a siding.

1/25/2007 09:18:00 AM  
Blogger ejh said...

"Excellent" is such a cliché now, anyway. If you want to praise a website, call it "excellent". We had the same thing with football fanzines years ago, when the mainstream press started mentioning them. Always "excellent". Not "thought-provoking" or "well-written" or "stupid", just "excellent". Fair got on my nerves.

1/25/2007 09:35:00 AM  
Anonymous Anonymous said...

Skimming through the chat, I note that (i) Nick really didn't answer many questions, and the questions he did answer often weren't answered properly; and (ii) he doesn't actually know much about Iraq, beyond what's required to bluff the occasional column on the topic. (Actually, the absence of a detailed analysis of the situation in Iraq, as opposed to bland proclamations about what "the left" ought to be thinking about it, is a general deficiency among the Decentist tendency)

1/25/2007 12:10:00 PM  
Anonymous Anonymous said...

Re. Nick - does he subscribe to some variant of the 'one drop of blood' argument (i.e. if 999,999 people + George Galloway go on an anti-war demo that makes all of them 'Trots'/appeasers/whatever)?

1/25/2007 01:47:00 PM  

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