Tag Archives: privatisation

Evidence-based policymaking

The shouty left are far more likeable than the New Labour ‘left’ or the Tory right in general, and their opinions on the things that really matter – murdering foreign civilians, locking people up without charge, banning freedom of speech, and such like – are generally spot on.

However, one way in which they drive me mad is their refusal to accept actual evidence as a factor in decisionmaking and policymaking, in areas where the goal isn’t contentious but the ways to achieve it are.

This is best exemplified by anyone who calls for water utilities to be taken back into public ownership, as the public sector authorities in Scotland and Northern Ireland provide a poorer service than the private sector English water companies at about the same cost.

But another good example, spotted by Rick at FCFT, relates to the different policies adopted toward the NHS by the English, Welsh and Scottish governments (FT article, registration may be required).

The introduction of targets for NHS waits in England, followed by more choice, competition and greater use of the private sector, has been highly controversial. While the impact of choice and competition in England is not yet clear, “the terror of targets” worked, according to Carol Propper, a professor of health economics at Imperial College London.

After rises in NHS funding, “waits are down in all three countries”, she said. “But they have come down much faster in England.”

The English NHS is hitting a maximum 18-week wait for treatment that Scotland will not achieve until 2011.

Waits are worse in Wales, and a few years ago a Welsh Audit Office report noted that the poorer overall health of the Welsh population did not explain the performance. Northern parts of England, it noted, had similar health status “but have consistently delivered more healthcare at lower cost”.

In other words, the much-reviled NHS internal market and targets, as one might expect given that markets and targets do have an impact in pretty much every other area of life, has worked better at delivering improved outcomes in England than the traditional centralised NHS model has at delivering improved outcomes in Wales and Scotland.

Like the water example, this is unlikely to change the Shouty Left’s minds. Shame there isn’t some kind of Evidence-Based Party to support – just right-wing ideologues who happen to be right in the cases listed above, and left-wing ideologues who happen to be right on other things.