What should it cost to get one out of bed?
COVID-19 has the occasional silver lining. One is that the Department of Health and Social Care is finally addressing bed-blocking. On 19th March, the DHSC announced new measures which will release “at least 15,000 beds by 27th March” and thereafter from the NHS stock of around 140,000. Coincidentally, this roughly restores the total hospital bed count to 2010 levels. Unsurprisingly, occupancy has increased from around 85% to about 90% and the peaks in that figure are responsible for long wait times in winter at A&E.
The first problem with the “at least 15,000” claim is that bed-blocking, or, technically, “Delayed Transfer of Care (DTOC)”, only accounts for 4,500 beds. Where are the other 10,500 coming from?
Under the new measures, “Every patient on every general ward should be reviewed on a twice daily board round to determine the following. If the answer to each [of several] question[s] is ‘no’, active consideration for discharge to a less acute setting must be made.” There is a slight fudge between the main text and this quote from Annex B: the latter merely requires consideration to be given to a less acute setting (possibly a community hospital) whereas the main text reads “Transfer from the ward should happen within one hour of that decision being made to a designated discharge area. Discharge from hospital should happen as soon after that as possible, normally within 2 hours.”
About two thirds of DTOC is due to NHS hospitals’ bureaucratic processes. I have two personal experiences of the difficulty of escaping from a hospital bed once cured. Papers must be signed and the necessary signatories fail to show up. Both times, in desperation, I discharged myself but even that is not supposed to take place before signing to say the patient takes full responsibility and preparing such a document is itself a slow process.
Section 3.1 of the new measures requires, inter alia, “At least twice daily review of all patients in acute beds to agree who is not required to be in hospital, and will therefore be discharged. Ensure professional and clinical leadership between nursing, medicine and allied health professions for managing decisions.” And “Social care colleagues should be involved in daily ward reviews.” Since the patients themselves need to agree with the decisions, there will be quite a cohort moving from bed to bed. There is no mention of what records will need to be kept by whom. Stand by for a wave of lawsuits in a year or two!
Another silver lining in all this is eliminating the current protracted argument between local authorities and the NHS over who pays for “Continuing Health Care”. If the post-hospital care is primarily medical, the NHS is supposed to pay, otherwise it falls to the local authority. Committees meet endlessly to debate where the line should be drawn. The new measures give local authorities the benefit of any doubt.
Chucking patients out of wards within an hour of being cured, rather than several days, should save the NHS money rather than costing them more but for reasons unexplained they are being given an extra £1.3bn to do so. If the DTOC figures are correct, that is about £430,000 per bed. I think I would get out of bed for that. We cannot match the Chinese who seem able to build a thousand-bed hospital in a week.
Clearing the beds for which the NHS is itself responsible for the delays is the easy part. The 1,500 DTOCs for which local authorities have responsibility are the difficulty and they have been allocated £1.6bn to deal with their side of the problem. The main 2018/19 reasons are:
Awaiting care package in own home (20.8%)
Awaiting further non-acute NHS care (17.2%) – surely an NHS responsibility?
Awaiting nursing home placement or availability (13.9%)
Patient or family choice (12.4%)
Awaiting residential home placement or availability (12.3%)
Awaiting completion of assessment (11.3%)
The new measures adopt a robust approach to the first item, namely send them home first and worry about the care package second. In the context of the current crisis it is hard to argue with that and maybe, force majeure, we should adopt the Spanish practice of requisitioning empty hotels, re-employing and re-training the hotel staff to take care of the ex-patients. Doing so by 27th March, though, is a bit fanciful.
I have previously accused Matt Hancock of trying to run his department by press releases. Yes, unblocking 15,000 beds by the end of this week may look good in the media but it seems a trifle short on substance.
Altrincham isn't the best place to live
The Sunday Times tells us that Altrincham is the best place to live on our sceptered isle. This is clearly, obviously, not true. One of us dealt with this last year when Orkney was claimed as the spot.
We know of those who would reject that near Manchester contention out of hand for it’s north of Watford Gap. Even one, to our knowledge, who would do so because it’s north of the Marylebone Road. Which is ridiculous, of course, but also the point.
There are many of this “this is the best place to live” sortings. Just as there are many “this is the best way to live” rankings out there. Those various alternatives to GDP that are constantly touted for example. The problem with them all being that they are subjective.
They are, that is, how those compiling the list, or determining that good life, define what is that good place or good life. And a very basic piece of economic reasoning is that utility is personal. We all enjoy different things and it is the duty of the liberal - like us - to keep insisting that the good life is the one that meets those personal definitions of what one is. The liberal polity being the one that enforces the ability to chacun a son gout.
That we don’t all flock to Altrincham - or last year to Orkney - to live shows that it isn’t that place for us. That we don’t all value equality of income, or a pristine environment, or one that’s tobacco free - just to mention three of the measures that are in various GDP alternatives - is exactly why they’re not good measures of the quality of existence.
GDP itself has problems, certainly, but it is at least objective - the value being added in the economy. Given that it’s at market prices it’s also the value added according to those entirely personal measures of utility. That is, it’s a better measure of how we’re doing at creating the liberal world order than any of the purported replacements.
We don't have to abandon logic here
There are silly things to say about the coronavirus and this is one of them:
And now Covid-19. Imagine if blunt economic interest was, in fact, dictating our response. Would we be shutting the economy down? What we know about the virus tells us that it most often kills what are by the numbers the “least productive” members of society. The majority of the working population experience symptoms barely more significant than a regular flu. Unlike regular flus it does not threaten children, the future workers. The virus may be bad, but simplistic economic logic would dictate that until we have a vaccine it would be best to keep life going, because, you know, “it’s the economy stupid”.
Economics - and thus the economy - is not about money, or production, or consumption, incomes nor any of the specifics that are actually studied. We study those specifics in order to work out how to maximise utility. That is, as much as is possible of what people want.
Matters like GDP - and production, recorded consumption and so on - are only proxies for this underlying thing we’re trying to maximise. To talk of “the economy” is to reify that proxy, an error that often enough doesn’t matter - that’s the way with proxies, they’re often good enough - but we must not forget that it is just a proxy. And increased GDP means that we can produce more, therefore we can consume more. It’s an increase in our ability to maximise utility, that’s the very point.
Not killing grandpa by not going to the pub - or work - is an increase in utility, we have no conflict here. Except among those with the silly belief in that reification of “the economy”.
There are also stupid things that can be said:
It is the commercial logic of drug development that defines the range of vaccines we have ready and waiting; obscure coronaviruses don’t get the same attention as erectile dysfunction.
There is no possible system of organisation that would have a vaccine ready today. No one actually knew that there was anything to have a vaccine about until December at the earliest. Going back through blood samples gives us November 17 as the first (at this point at least) recorded evidence of the existence of the virus. To wibble that it’s commercialisation that created the current absence is to claim that the HIV drugs should have been created in 1959.
Yes, we have a problem here. But logic is an aid to solving problems, problems are not an excuse to abandon logic.
If it's so terrible why do you want more of it?
The Guardian tells us that the Home Office is terrible, awful, simply not fit for purpose:
The review exposes the department as unfit for the society it is supposed to serve, after a series of colossal failures, rooted in a toxic internal culture and an ingrained misunderstanding of Britain’s colonial history.
....
There is not one easy fix to the culture of the Home Office, or the inhumane policies driving the unnecessary suffering it creates.
For once we actually agree with that newspaper. However, we would go on and insist that there’s nothing particular nor specific about the Home Office. This is just what bureaucracies become, it’s an inevitable outcome of the points made by C. Northcote Parkinson. Once established the purpose of any bureaucracy is the perpetuation of that bureaucracy. Whatever it is that it was originally supposed to do becomes entirely an irrelevance to its own working procedures.
The solution therefore is to have as few bureaucracies as possible doing as little as possible. The Indian civil service in the days of the Raj was never more than 1200 people administering several hundred million. That might not be quite the exact and precise proportion we should have today but it’s a useful target to aim for.
The bit we truly don’t understand though. We get endless complaints from those to our left that government isn’t doing this right, or it’s appalling, or that the system has entirely lost its way. At which point we agree, of course. It’s just that having done this complaining, often providing convincing proof of the assertion, why do they then call for more of what so clearly doesn’t work?
The full dope on the costs of regulation
A standard point made about markets is that there must be regulation. Bureaucratic such, standards and methods and rules must be the same across all participants in order for the market to work at all. We see this in European insistences about access to the Single Market. We see it often enough in more domestic settings too. Only strong central control can create the level playing field necessary.
We, contrary as we are, insist the opposite. Rather the point of markets is that the playing field isn’t level - what is comparative advantage if it isn’t an insistence that we’re not all starting from the same point? Leaving such theoretical issues aside, we can also observe the effects of regulation out there in the wild.
Well, sometimes we can. It’s not all that often that we can see a large and functioning unregulated market operating alongside one regulated for the same goods. One of those sometimes is cannabis in the newly legalised areas:
The consensus on Vancouver’s cannabis-focused Reddit feeds is that the legal market is struggling to attract buyers because its product is more expensive but lower in quality than the black market alternative.
This is not a good advertisement for the merits of regulation.
“The government’s pot is too expensive. The government doesn’t show you a picture of what you’re buying before you buy it, so you cannot be informed as a consumer. The government weed has been full of bugs, mouldy or too dry in some cases, and often takes too long to get there,” one user said.
“The legal stuff is garbage,” said another Reddit user. A third said: “Friends don’t let friends smoke government weed.”
That’s not a good one for the merits of the government provision of an item either.
Government regulation, making things worse and more expensive. That being an impressive double achievement as there are few things that manage both at the same time.
COVID19: How To Deal With Business Collapse and Keep the Economy on Track
The Government is going about supporting the economy in the wrong way. A hodgepodge of support on business rates for some businesses, and supporting some staff on mortgages and maybe rent if they get laid off is confusing and not thought through. The administration of this is also a nightmare.
The key problem for the economy is that businesses have been interrupted and will remain so for a period of months, indeterminable at this stage. There is no way most businesses in the hospitality or leisure sector can take advantage of the loan offered by Rishi Sunak as they are not in a position to make a profit for a number of months at least to be able to pay back the loan at a later date. It makes more sense for them to liquidate the business, sack all their staff and not pay their suppliers, or indeed the taxman who is often the largest creditor. Such a response will set off a domino chain which could be devastating for the economy. We know from our own experience that this is what is starting to happen now. Helping the staff of those businesses with mortgages does not help the business survive and thus the future of the jobs.
In normal circumstances when a business has an interruption it claims on its insurance and that way the business has the confidence to be able to continue. It is a disgrace that the insurance industry is washing its hands of this interruption now and the Government needs to put pressure on the industry to step up. But in the meantime the government must itself become an ‘insurer of last resort’. It did something similar with terrorism cover in 1993 after the bombing of the Baltic Exchange in London when it set up “Pool Re” and more recently with Flood Re in 2016 as the insurance industry were failing to cover for losses then. It worked with the insurers to ensure businesses were fully supported.
What the Government needs to do now urgently is set up a “COVID Business Interruption Fund” which would allow businesses to claim on a monthly basis for losses incurred and pay out with a very short turnaround i.e. days, not weeks, without the convoluted investigations typically made by insurers. Companies could submit their last set of audited accounts to show what their gross margins are and the losses and the Government should reimburse right away. The process should be simple. Once the coronavirus subsides businesses can later be audited to ensure the claims were fair and reasonable. Perhaps the insurance industry could supply the personnel to do these checks after the event.
By stepping up in this way, there is absolutely no reason why any business should go bust or lay off staff as their gross margins would be protected. The Government would not need to pay people’s mortgages or give rates relief (although the latter is needed anyway aside from COVID19). A chain of bankruptcies could be halted and we could remove the business panic which is gripping the economy. Businesses would be able to continue and whilst not actually trading perhaps get on with some of the tasks set aside for quiet periods, like repairs and maintenance.
Furthermore by acting as I have suggested, the Government will only have to deal with thousands of business affected rather than potentially millions of smaller claims, so the management of the process will be much simpler.
Lance Forman is a former MEP for The Brexit Party and the Conservative Party, the owner of H. Forman & Son, Britain’s leading salmon smokers, and author of Forman’s Games.
Don't just do something, stand there!
The usual suspects are lining up to tell us how government should make plans for the coronavirus. For example, the man unable to tame a bacon sandwich tells us we must tear up the economic rulebook. This is not, you should not be surprised to find out, the correct response.
We face not risk but uncertainty. The medical outcome is anywhere between the usual ‘flu season and the majority of the population being afflicted. Sans plans and government action the economic effect is anywhere between shaving a percentage point off GDP for a quarter to 5%-10% for a quarter. We do not have any knowledge here - that difference between uncertainty and risk being that we just don’t know, rather than can assign probabilities - and thus plans are rather difficult things to make.
It’s also true that trying to get the behemoth that is government to do anything at all in short periods of time is like trying to train an elephant to pole vault. Amusing perhaps but not likely to be greatly effective and probably rather messy if you actually succeed.
The actual solution is to muddle through. Things will happen, we know not what, and we should deal with them as they do. Further, what should be done, what can be done, will be different in each of the 65 million cases among the population. The decisions simply have to be, for we have no other method available to us, devolved down to those 65 million people.
Some would call this using the market. Others muddling through. We don’t mind what it is called even as we insist it’s the only method we’ve got that will actually be useful. There are too many variables for any central plan to possibly cover them all.
There is also the obvious truth that this is what an economy is anyway, the British one being those 65 million people muddling through. Reacting to the incentives and situations faced as they arise - why change what works? We do have good evidence - 1989 and looking east from the Brandenburg Gate only being one revelation of this truth - that this produces the best outcome possible after all.
There is also a rather more parochial point. It’s oft been pointed out that Britain didn’t really have any plan in the late 1930s, that we muddled through the whole war thing. Which, to a great extent, we did too. We also won. Why mess with what we’re obviously good at?
To give just one example from the press. One of the more stupidly statist commentators has insisted that we must have rationing and price controls to beat a possible black market - absurd in itself - using supermarket loyalty cards. The limits on what may be purchased to be set centrally by the state, of course. As it happens each individual supermarket has set limits upon what any individual customer may buy. The state, with its plans, force and centralisation, not being required, obviously enough. Muddling through works.
The absurd way we're ruled now
This caught our eye:
British households will need water butts in order to cut use by 20 per cent, says Environment Agency
The idea that we’re going to run out of water in a country as damp as Britain does raise an eyebrow. It’s to make the same claim that Italy is going to run out of excitability, or Finland stoicism.
The new National Framework for Water Resources, launched on Monday, warns that the average person needs to reduce their water use from 143 to 110 litres per day.
An Environment Agency spokesperson told The Telegraph this will include encouraging households to invest in water butts, dual-flush toilets and eco-friendly showers in order to cut waste.
The department has been working with NGO Waterwise to find ways the average person can reduce their water use.
Ah, Waterwise, that’s these people. Who state that their target is 100 litres per person per day. For no clear reason other than just, well, everyone should be smellier apparently.
As to facts:
The UK receives a large amount of rainfall, however there are limited natural or man made methods for water storage. This means that there is a relatively small volume of water available per person in the UK.
The solution is thus to build more reservoirs.
Apparently that’s not allowed these days. Despite the obvious point that we’ve already got a very useful, rather large and entirely efficient water recycling system in the country. It’s called “clouds”.
Leave all of that aside and assume that there really is the requirement to use less water. We have two methods in front of us. We can use the labour of an NGO, the government, society at large if you will, to hector the population into reverting to medieval practices instead of using modern technology to supply the desired resource. Rather than the efficient method of changing the price.
We desire to ration something, price is the efficient method of rationing. One of us lives where there is just such a system. A flat monthly fee - a low one - is paid for the usual reasonable supply for a household. As consumption rises above this the price per unit rises. A missinstalled stopcock led to a leak and a £600 monthly bill. People don’t - OK, people learn not to - waste water. And gardens simply are not irrigated with potable water, not at those prices they’re not.
That is, everything that is being said and done about water supply is, in this British scheme, wrong. There is plenty of water, we’re just not collecting it. Instead of collecting it the solution is to limit household consumption. But instead of doing that they efficient way - charging for it - we must be bureaucratically managed into the correct obsequies to the current religion.
This is absurd. And we should therefore stop doing it. Price water by level of consumption and leave the efficient method we’ve got, the market, to deal with the problem.
In praise of Budgens
Sadly, we think this is probably a mistake, just one of those things, rather than a planned response to panic buying. It’s still the right thing to be doing of course:
Outraged customers have threatened to boycott a UK supermarket after accusing it of hiking up its prices amid coronavirus panic buying.
British grocery store Budgens is charging £4 for a four roll pack of Andrex Supreme Quilts toilet roll, despite a £2.50 RRP sign on the packaging.
Sharing a snap of the loo roll from their local shop, one shocked customer tweeted: 'Disgusting behaviour at your Crystal Palace branch, raising the price of toilet roll. Anything to make a profit huh? #boycott #disgraceful.'
As the number of confirmed coronavirus cases in the UK has risen above 1,000, panicked Brits have stripped shelves across Britain bare of essentials, including toilet paper.
So, people panic. There is no shortage of toilet paper in any useful sense. However, people feel somewhat helpless, something must be done. Humans don’t always have to make sense and buying 6 month’s worth of loo roll today is something. So, that’s what is done - it’s something that actually is under the control of those who feel helpless in the face of the vicissitudes of the universe. Shrug.
But what is it that we want to happen with those smallest room supplies? We want what there is to be purchased and used by those who actually need it - preferably, need it for something other than the satisfaction of having done something in the face of the pandemic. Raising the price does that.
We can prove that raising the price does too - Budgens still have toilet paper on the shelves, the entire complaint here being that people won’t buy it at this price. Excellent, job done then.
That is, price gouging is the cure for panic buying. All hail greed and the price system.
We will admit that we’re not quite sure why this insistence on doing something, whatever, has fallen upon these particular supplies. That there’s going to be something, sure, we get that. But this thing?
Why? The Guardian’s still printing isn’t it?
We’d just add a comment seen elsewhere:
Customer: How come you’re asking £4 for loo roll, it’s only £2.50 at Tesco.
Shopkeeper: So go and get some from Tesco.
Customer: But Tesco haven’t got any.
Shopkeeper: Well when we haven’t got any it’s £2.50 as well.
Disturbing opinion poll findings about coronavirus
The Sunday Times uncovers something most disturbing:
By a margin of 52% to 26%, people say the government should declare a state of emergency; 63% support the introduction of food rationing, according to the YouGov survey for The Sunday Times.
It’s the 63% supporting food rationing that worries. Clearly, large numbers of people are less than fully informed.
Of course, if people mean that they want the Commissars to start insisting that each prole may only have one can of beans at a time then that’s alarming nonsense. That only 37% are against such is worrying.
But much worse is to take a step back from that and ponder the idea that 63% of the population don’t seem to understand that we’ve already got a method of food rationing. It’s called the price system. The important part here being that this idea that people front up their own resources in exchange for those of others is the only one that has proven to work. We’ve many thousands of years of experience of this too, everything from Diocletian’s price controls causing local famines through to observing Venezuelan weight loss plans under Maduro.
We have rationing, it works, why would we want to change that?