Both SB's and SD's schools are closed today. Didn't find out about SB's until just before I was going to take him. So we are at home. Yes, we have built a snowman because you have to really.

Snow in the dish means no Sky and the really irritating feature of Sky+ is that it wont play back recorded programmes when there is no signal. Bastards. I do not feel inclined to climb up and clear the dish though. It should melt during the day.

Trying to wangle today as working from home rather than holiday. I have done as much work already as I would've done all day at the office (i.e. sent a couple of e-mails). Not sure if that counts though.

Update: Sky's working now. That's handy as it means I don't have to actually interact with SB - the TV can do the parenting. It's traditional.

Reading various medical blogs, you will always get some comment saying, basically "Scrap the NHS, got to a US-style system, let people take care of themselves". It's one view, certainly. Then you read that, per head, the US spends twice as much on healthcare as the UK does. Then you find out that 30% of that cost is administration, billing etc. I know a bit about insurance and I can see that there's some more work in an insurance-based system than in one where you just pay for stuff. Not that much more though. What I reckon (although I have no proof) is that a substantial amount of the administrative effort in healh insurance goes on not paying for treatment.

I think it's down to motivation. The motivation for a private health insurer is not treating people, it's making a profit. 30% of your turnover might sound a lot, but if it saves paying out 50% of claims, then it's worth it. People who sell mortgage protection, mobile phone cover or any other sort of insurance know this.

The targets and psuedo "market pressures" put on the NHS seem to have a similar distorting effect. For example, the A&E waiting times. The motivation is no longer treating the cases by priority, but making sure that someone is "dealt with" within the 4 hours, regardless of whether they've got a sprained ankle or a serious head injury. Financial pressures also distort: it's cheaper for a hospital to pay a manager to work out ways not to treat people than it is to pay a doctor to treat them.

I'm sure those of us who work in IT have seen the badly designed target before. For instance, at Crap Corp they were aiming for, on the helpdesk, a 50% fix-on-the-phone rate. The easiest way o hit this is to, whenever someone phones with "Windows has frozen on me" to advise them to reboot, then close the call. If it happens to them 10 times a day, then your stats look even better.

From what I see, things like the subbing out of routine operations to private treatment centres are also fucked. There is incentive to do, say, a hip replacemen cheaply but if it goes wrong, there's no comeback. The NHS has to pay again to get it fixed. Crappy contract. (Even worse are the ones where they pay a private centre to do n operations, but because nobody wants to go there they only do a fraction of the number but still get paid.)

Assuming that there have to be some measurements of NHS performance, it's hard to come up with ones that wont distort what's done. If, instead of chopping up the NHS into PCTs, hospital trusts or whatever, there was just a "regional health body", you could possibly try something like: premature deaths/days incapacity. The idea being that the only target is to reduce illness. I fear though that this would then distort what counts as "illness".

Anyway, I'm sure I had some sort of a point, but I can't remember what it was.