Unboiling a Frog

They're not really going to boil us, it's just a thought experiment, I think

Apparently, although I’ve never tried to verify this, if you put a frog in boiling water it’ll jump out but if you put it in water at room temperature and heat it up it’ll happily sit there until it boils to death.

One thing about this that doesn’t need an experiment to demonstrate it is that if you then cool the water down it won’t unkill the frog. Once boiled, it stays boiled. There is a parallel that can be drawn between these phenomena and the process of political change. Some changes are like going straight from room temperature to having a pan of boiling water to put a frog into – they fail because the frog will refuse. The Poll Tax is a famous example of this – too many people rebelled when it was introduced so that it became untenable as a policy. The frogs jumped out leaving a pan of boiling water.

The Health and Social Care Bill is not the new Poll Tax for this reason. If passed, it will not result in massive civil disobedience. That’s why even doctors whose professional bodies and unions oppose the Bill are in parallel working on how they will implement it. It won’t be open to them within the NHS to decide to carry on as they did beforehand and use the abolished PCTs to commission services. They won’t be able to compel the Secretary of State to take a holistic view of national requirements. It will be more like the scenario of having a pan full of water at room temperature sitting on the hob with the gas on.

What they will be able to do is decide upon whether they will turn the gas up high, leave it at its lowest setting to heat the water more gently, heat it up more quickly and then simmer or something else. If the water at the moment is too cold and it is better for the frogs to warm it up (perhaps they are Amazonian tree frogs which find our pond water a bit chilly), being in the pan isn’t a bad thing. There seems to be general agreement that there is need for reform of the NHS albeit a long way short of going to a fast boil.

The question is, does the Bill make it inevitable that we will proceed to turn the heat up in our hypothetical pan of frogs so that they boil to death? Or will it allow for the water to be heated to the best temperature for the frogs to thrive? The government believes the latter. The panoply of critics believes the former.

However, if the critics are right and the Bill goes through, what then? Andy Burnham, the shadow Health Secretary has stated that if he were to become Health Secretary after the next General Election in 2015, he would repeal the Bill. That means, in my laboured metaphor, he would immediately put as much ice into the pan as needed to bring it back down to room temperature.

If the Bill has had the catastrophic effect that he and the other critics have claimed, that would be akin to attempting to unboil the frog. At best it might make it easier for us to put our hands in to get the frog’s corpse out but it wouldn’t revive the beast. On the other hand, if the practical implementation of the Bill had just had the effect intended of making the conditions under which the NHS operated more benign and sustainable, why would you want to undo that? You might want to find a different mechanism for maintaining the temperature of the pan, or to equip the frogs with heat suits to protect them from temperature changes, but turning off the heat and going back to room temperature (particularly if the room has got chillier) is pointless.

It may make sense to say that the NHS ought not to be reformed in the way proposed by the Bill. But, if it is reformed in that way, it makes no sense beyond a soundbite to say that the Bill will be repealed. The last time Labour was in opposition it made similar claims in respect of the privatisation of the railways and committed to renationalisation. In power it realised that that particular frog had been boiled. The practical issue between now and 2015 for those opposed to the Bill, if they are not successful in stopping it being passed, is to ensure that the frog of the NHS is not boiled. That’s where the GPs and other health professionals who are being entrusted with making decisions about the NHS have a responsibility to maintain the temperature of the pan at the best level. Does Mr Burnham really think that they would be more inclined to do this badly than Mr Lansley left with the ultimate responsibility over the gas tap…?

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Any Colour You Like As Long As It’s Black

Choice is usually a good thing. It means that you can get what you want rather than what someone else thinks you ought to have or what they feel like providing you. The title of this post comes from Henry Ford’s famous description of what colours customers could buy a Ford Model T in. What is less well known is that until Ford moved to using a production line, customers had a choice of colours, but black was best for the production line as it was quickest drying. So that was what customers had to have. There was a benefit to customers in that the production line also brought prices down through efficiency, but the choice of colours was removed first and purely for the benefit of the producer.

However, some people think that choice is bad and that we’d all be better off without it. One of these people is Dr Eoin Clarke who has recently republished a blog of his from last September about how because he finds ordering coffee at Starbucks too complicated there definitely should not be any choice in the NHS. Now, I know that I said that I wouldn’t use this blog to have a go at other bloggers, but this is stupendous even for the egregious Dr Clarke.

Oh no, I’m getting the fear

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1946 And All That

The Health and Social Care Bill has been, to put it mildly, rather contentious. This morning, the influential editor of the ConservativeHome blog published a piece urging the government to drop the Bill to avoid the risk of it fatally wounding the Conservative’s chances of winning the next General Election. Everyone seems to be united in opposition to it.

From the furious debate it would be easy to think that the Bill involved dismantling the NHS so that it no longer offered universal healthcare to all people in England, free at the point of need. It does not do this. It certainly does not usher in the derided American model of private healthcare or even the French model of socialised medicine which seems to work very well for French people. Continue reading