Will small hospitals kill you?

Disquisition on medical statistics in The Guardian

A recent front-page article in The Guardian claimed to show that small NHS hospitals are killing people. “Huge disparity in NHS death rates revealed” was one headline. “Patients less likely to die in bigger hospitals“. “Safety in numbers for hospital patients” is another headline. The article makes no secret of its political agenda: “The results strongly suggest that smaller units should close. This presents a major challenge to the health secretary, Andrew Lansley, who has stopped all hospital reorganisation.” Online, Polly Toynbee decries “Hospital populism”, saying “Local hospitals may be loved, but they can kill.” Wow. That’s pretty bad. Here’s the schematic of the story: Smart and selfless experts want to save lives. Dumb public clings to habit (in the form of community hospitals). Evil politicians pander to dumb public, clings to campaign promises. “The health secretary, Andrew Lansley, has now put the project on hold, in line with his election promise to halt hospital closures, to the dismay of experts who believe that lives will continue to be lost.”
Continue reading “Will small hospitals kill you?”

Xenophobia: An international perspective

I find the difference in perspective on immigration between North America and Europe all the more striking, because on the standard left-right axis the European consensus — typically to the left of the U.S. on issues like healthcare, private enterprise, and invading other countries and torturing captives — is so far to the right on the U.S. and Canadian political spectra that it’s hardly to found at all. This was made clear in the recent controversy over the Arizona law that would have police checking papers when they have “reasonable suspicion” that someone is illegally in the country. This was treated as such an obvious affront to decency that even most of the right wing didn’t want anything to do with it. In most European countries, there would be nothing controversial about permitting police to stop anyone to ask for identification. (The U.K. is a slight exception here, as the irrational hatred of foreigners has to contend with an irrational hatred of identity cards. Utility bills are considered a superior form of identification.) In Germany (which, despite the popular association in the anglophone media with police-state tactics, is fairly casual about immigrants) I needed to show proof of immigration status in order to get a library card. And whereas even the farthest right in the U.S. distanced themselves from Republican representative Duncan Hunter’s proposal that the children of illegal immigrants be deported (presumably after having their citizenship revoked), I don’t know of any country other than the U.S. and Canada that automatically grants citizenship even to the children of legal immigrants. For instance, my daughter born here is not a U.K. citizen, even though her mother, as an E.U. citizen, has the right to live and work here. (The usually even-tempered journalist Joan Walsh has called Hunter’s proposal “crazy“, and says “I’m not sure Hunter has a soul.” I don’t think it’s a good idea, but it’s obviously not an absurdity, even if it does involve the procedural hurdle in the U.S. of requiring a constitutional amendment. There’s clearly a problem of having minor U.S. children whose parents can be (and are) deported.)

In the U.K. context, it’s barely controversial to bash legal immigrants, much less illegal immigrants. In the most recent prime ministerial debate, the one thing David Cameron and Gordon Brown agreed on was that the Liberal Democrats’ proposal of an amnesty for long-term illegal residents was simply insane and indefensible. They didn’t even have to respond to his counter-arguments, pretend that they had an alternative solution for the problem. It’s the putatively left-wing party in power for the past 13 years in the U.K. that can’t think of enough new ways to attack foreigners, that they have to invent bizarrely creative ways to attack foreigners, like the law banning foreigners from marrying without Home Office approval, or instituting new proposals that immigrants need to perform “volunteer” work to earn citizenship.

What I find amazing is how clear the consensus in the U. S. and Canada in favour of (legal) immigration is, and that the very idea of basing citizenship primarily on parentage rather than on birth in the country is treated as an absurdity by right-thinking people.

Where the money is…

Mathematical finance as an accessory to crime

Not long after I finished my PhD in probability theory, a significant fraction of the field was devoured by the financial mathematics moloch. Particularly in Europe, probability theory positions disappeared, to be replaced by openings in financial mathematics, which either went unfilled or cycled among a very few senior researchers and a few quick-change opportunists (and, gradually, their fledgeling academic progeny).

Everyone felt they had to get in on the action, and of course there was a certain amount of positive feedback. When many jobs chase few graduates, it generates huge demand among students for training in such a demonstrably burgeoning field. Obviously, the academic feedback was limited by the fact that most of the eager young ‘uns were seeking employment in banks, not in academia — but the banks were hiring as well. Anyway, just about 10 years ago, a Dutch colleague asked me if I might be interested in joining his own institute’s planned financial mathematics group, for which they were proposing to create TEN new positions. My reply was that finance did not interest me as a topic of research, but I added that there was something unseemly — bordering on unethical — in mathematicians’ headlong chase after banking lucre. The current generation of mathematicians is the trustee of a vast and powerful system of analysis, whose creators were supported, honoured, and financed by public institutions. What is it but a crime, when we abscond with the fruits of this scholarship, and sell it off (cheaply) to banks, who will use it to extract billions of dollars from financial markets? Continue reading “Where the money is…”

In praise of the National Health Scapegoat

All over the world babies are babies, and birth is birth, but having a baby in Oxford is certainly quite a different experience than having a baby in California. The comparison is mostly favourable to Oxford, in our experience. The prime directive of the NHS (which recently celebrated its 60th anniversary) is borrowed from Douglas Adams: Don’t Panic.

The NHS is a great success by any definition. When you factor in the constitutional niggardliness of the British taxpayers and Her Majesty’s government — leading the UK to spend per capita on healthcare substantially less than half what the US spends, and much less than any major industrialised country except Japan — it seems a veritable miracle of efficient socialism. Whereas health research in the US is dominated by the profit motive, producing marginally improved drugs at breathtakingly higher prices*, the NHS has a brilliant record of pioneering cost-effective healthcare solutions, which may be individually trivial, even slightly absurd, but which together add up to systematic and measurable improvements in public health. (For example, this scheme to prevent complications due to chronic lung disease by providing patients with automated telephone warnings of impending cold snaps. Or something as simple as reducing infections by requiring doctors and nurses to wear short sleeves.) Continue reading “In praise of the National Health Scapegoat”

Missing Canada

I was recently in Montreal for a conference, and briefly in Kingston and Toronto. Registering at the conference (actually, filling out a receipt when buying a Canadian Mathematical Society t-shirt) a secretary wanted basic address information. She looked at my conference name-badge, and asked, “Oxford… Is that in Ontario?” (To be fair, it was the France-Canada Mathematical Congress, so it was not unreasonable for her to assume that anyone apparently not French was probably Canadian, and the best guess for an English-sounding place-name is Ontario. In fact, there is an Oxford, Ontario, though it is actually a county — or, more precisely, a regional municipality — and does not, to my knowledge, have a university.) What followed, though, was typically Canadian. “No, UK.” “Oh, you came all the way from the UK? Welcome to Canada!” The greeting seemed touchingly enthusiastic and heartfelt. It was like someone saying, “So glad you could drop by. Sorry, the place is a mess, but make yourself at home.” It’s a sense I’ve often had in Canada, of an unpretentious pride in their humble home; it’s really not much, but we hope you’ll enjoy it. I really enjoyed the three Canada Day celebrations (July 1, naturally — British imperial order ensured that any important events would happen January 1 or July 1, and you’d be crazy trying to make anything happen in Canada in January) that I attended — in Vancouver, Kingston, and Ottawa. The tone was remarkably inclusive and I felt none of the crazy world-dominating fervor of US patriotism, or the weirdly forced exceptionalism of British national pride, expressing itself in such atavistic ideas as the recent government report on citizenship, which proposed encouraging school children to swear a formal loyalty oath to the Queen. (What is this monarchy thing about, anyway? I’ve never seen people more touchy than the British about someone putting on airs, or acting like he’s better than someone else; and yet, they’re content to let their country be formally ruled by someone whose qualification for the post is that her great-great-great-great-great-great-great grandfather was Elector of Hanover (or something like that). Of course, the Canadians also have Queen Elizabeth on their money and stamps, but they keep her at arm’s length through the Governor General.) It is perfectly possible to be proud of being Canadian, without hating other people for being something else. The US finds its existence threatened by the mere existence of people in the world who neither are nor aspire to be American, and in this struggle the UK sees its proper role to be the valet de bourreau.

Last fall I received a letter from our Toronto lawyer, informing me that our permanent residency application in Canada had been approved. It was not only the accompanying bill for $4000 that left me feeling slightly sad, but also the sense of a missed opportunity. Of course (!) I miss the Kingston winter, the bracing -20°C mornings, tramping through the snow, and skating with Chaya in the park, or the Market Square. (I noticed here a day care mentioning in its brochure that the children would go outside every day, unless the temperature were below 0°C. You’d never leave the building for months with that policy in Kingston!) I loved Chaya’s Waldorf school in Kingston, and am struggling to come to terms with the state church here. But there was something more fundamentally attractive about Canada and the idea of Canadianness. I have always cherished my status as an outsider to any group I may be suspected of belonging to, but I think I could have enjoyed getting to be a Canadian. What’s more, it seemed even vaguely possible, whereas regardless of good intentions, oaths sweared and formal conferral of citizenship it seems absurd to imagine becoming British. I don’t think there is any country more welcoming of foreigners than Canada. (Well-off and well-educated foreigners, to be sure, but then that is my experience.) Just compare the immigration authority home pages: Immigration and Citizenship Canada is full of smiling faces and links to promotional information like “Coming to Canada as an immigrant is an exciting opportunity” and “Canadians are proud to hold one of the most prized citizenships in the world. Every year about 150,000 people become new citizens of Canada.”  The grim UK Border Agency page, on the other hand, leads with the declaration “The UK Border Agency is responsible for securing the United Kingdom borders and controlling migration in the United Kingdom.” On this particular day (15 July) it prominently features the news flash that “Foreign nationals wishing to become British citizens will have to earn the right to stay, the Government announced today. The tough new approach will require all migrants to speak English and obey the law if they want to gain citizenship and stay permanently in Britain.” The presumption being, of course, that migrants are unlikely either to learn English or to obey the law. (This is followed by somewhat defensive sounding citations of public opinion polls which supposedly show the populace supporting this “tough” approach — or some tough approach, anyway.) The underlying legal regimes may be quite similar, but there’s no mistaking the difference in attitude, between the Canadian “Please consider joining us. I hope we can use your skills” and the British “We may desperately need your skills, so please come, but fuck you anyway.” (For specifics, see my comments on Polish nurses and maternity ward overcrowding here.)

canada-map UK map

National identity theft

“Now a new king arose over Egypt… He said to his people, “Look, the Israelite people are more numerous and more powerful than we. Come, let us deal shrewdly with them, or they will increase… Therefore they set taskmasters over them to oppress them with forced labour. They built cities… for Pharaoh. But the more they were oppressed, the more they multiplied and spread, so that the Egyptians came to dread the Israelites.” (Exodus 1:8-12)

These words, central to our recent Passover celebration, came to mind while I was thinking about the British immigration policies. I can’t figure out whether the UK is the most xenophobic country I’ve ever lived in, or whether it just acts like it. On the one hand, the UK has a well-deserved reputation as a sanctuary for the persecuted and would-be persecutors temporarily out of office. On the other hand, UK politicians, who (one presumes) know better, seem to cheer themselves up when they’re feeling blue by attacking immigrants, either directly or (more commonly) by insinuation. The same is true for pillars of society like the BBC. Immigrants are corroding the fabric of society, hence the need for ever-mounting restrictions. They are unleashing a crime wave on peace-loving Britons (at about the same rate per capita as the native hoodlums, but at least you understand what a British thug is screaming while he kicks your head in, or at least, you could if he weren’t so drunk). (Who trusts pointy-headed statistics anyway?) And, worst of all, after they’ve sneaked in here with their legal chicanery, following their perverse urges to clean our toilets and mop up bodily fluids in NHS hospitals, they’re breeding. That’s right, the same Polish nurses who are keeping the NHS maternity wards from dissolving into a mass of MAR, are now bringing those wards to the point of collapse by having babies themselves.* And there’s nothing we can do about it! Or so one would have thought…
Continue reading “National identity theft”

The agony and the equity

There was a time when the British, like their American and Canadian counterparts, believed in promoting equality. Now, all anyone cares about is equity. Housing equity. The UK, like the US, is entirely in the grip of the house-price inflationists. One of the most extreme examples is a recent BBC report, which reads like an investigation of satanic cults and their strange and twisted morality, but is actually about young workers who have not been able to afford to buy their own homes, and who, deep in their poverty-depraved hearts, wish secretly for… a decline in housing prices. Horreur! One “frustrated young professional” is quoted saying “I can’t wait for the crash. Bring it on… People talk about the crisis in the property market. But the real crisis is that so many people can’t afford a home of their own.” Terribly immature, the article suggests, as it goes on to quote a more mature voice, a 29-year-old teacher who “is old enough to remember the repossessions and negative equity that followed the crash in the early 1990s.” Even this otherwise reasonable person is being driven to vile wishes for a housing Armegeddon. “‘Morally, I feel bad about wanting it because I know people will end up on the street,’ she says. But unable to find anywhere affordable on her £30,000-a-year wage packet, she admits that doom-and-gloom headlines are giving her hope.”

Continue reading “The agony and the equity”

The established church

One of the most seemingly archaic features of modern Britain — and the one that outsiders may be least prepared for — is the “established church”.  Formal secularism takes many forms, in the US, Canada, France, Turkey; but one does get used to thinking of religion as no proper business of the state. Not in the UK, where the Queen is Defender of the Faith, and the Prime Minister had to wait until he had left office before he could comfortably change his religious affiliation. The highest position in society that anyone can aspire to who does not happen to be the first-born of the House of Saxe-Coburg and Gotha — I mean, the House of Windsor — is to marry the first-born of this famous princely family, and a Catholic maiden, however virginal, may not aspire to this august status. (My impression is that current law currently restricts the spousal position to members of one sex as well, and the constitutional status of a same-sex civil partner of the heir to the throne is, so far as I can tell, still unresolved.) Apparently Jews, Muslims, and Wiccans are not formally excluded, though the tabloid press might raise a fuss if the next queen hosted witches’ sabbaths on a regular basis at Buckingham Palace. Balmoral might be another matter…

Punch cartoon: Shows the struggle between Anglicans and Dissenters for control over education, while the needs of the children are ignored.

The most practical consequence of this establishment is that a large fraction of the state-funded schools (called “maintained schools”) are actually subsidiaries of the Church of England. The state provides most of the money, and the church gets impressionable children to proselytise at will. In some parts of the country these schools are selective and people get themselves and/or their children baptised to get them in; in Oxford, the C of E snapped up most of the good school sites long ago, and we’d have to travel far from home to find a non-church primary school. Not that that would do any good, given that daily Christian worship is required by law in all state schools. (To be precise, the communal worship must be “mainly of a broadly Christian character”, “which accord a special status to Jesus Christ”) There are literally no secular state-funded schools in the UK. You can worship whatever you want, as long as you do it in school, rather than in, say, a church or other such inappropriate institution.

Data and security

Security in the UK

Crime statistics in the UK are a mixed lot. On the one hand, the overall levels of crime victimisation are fairly similar to those in the US, Canada, and Western Europe, a bit on the high end overall. Homicide rates, on the other hand, despite recent well-publicised drops in the US, are still drastically lower (by a factor of about 3) in the UK and most of Western Europe (and Canada). Presumably this is attributable, at least in part, to the smaller number of guns. Gun murders in the UK are the lowest in the world, as a proportion of population, about a factor of 20 lower than in the US. (This does not directly contradict the “only outlaws will have guns” NRA rhetoric, if we generalise from a recent report in the NY Times, explaining that the classic random-mugging-murder is now extremely rare in New York, leaving mainly revenge killings and turf wars between drug gangs, and kinds of intimate crimes that are the meat of crime fiction. Gun bans, presumbly, have relatively little impact on the former — and the RMMs — but quite a lot on the jealous spouse and Double Indemnity types of crimes.)

While getting tough on lawbreakers, the hapless government of Gordon Brown is now having to answer for its own role in aiding and abetting identity theft. Supposedly a “junior official” of Customs and Revenue copied the entire database of families receiving the state Child Benefit (7.5 million families, comprising about 25 million individuals), including names, addresses onto compact disks, and sent them by unrecorded internal post to the National Audit Office. They did not turn up at the other end. As they say, it’s an ill will indeed that blows no good. Until this blunder sprawled over all the newspaper headlines, I had no idea that there was a Child Benefit, a monthly payment to parents (or anyone else raising a child) worth about £80 a month for families with one child. (It’s funny that we got caught out on this, because we were irked to discover, shortly before we left Canada, that we’d missed out on applying for a similar benefit there. For some reason governments don’t go out of their way to inform new immigrants of these things.) Anyone moving to the UK should be aware of this: official information is available here. My understanding, though, is that it’s generally only available for Europeans (which I’m not, but the rest of the family are).

If you wanted to contrive a damaging political scandal, without anyone really getting hurt, it would be hard to better this one. All the ingredients are there: Incompetence, money, long-term uncertainty, vast number of potential victims, new technology (making everyone particularly uneasy), and, most important, children. Furthermore, there are reports that

  1. The Audit Office requested an anonymised version of the database, but C&R refused, claiming it would be too costly. (Oops.)
  2. C&R suggested the auditors come visit them to peek at the database. Too much trouble, they said. (Oops again.)

Why are they e-mailing CDs anyway? Anyone with even a tiny bit of technological literacy could have used SSH to transfer the files over the Internet, and saved them the price of a stamp.

The Chancellor of the Exchequer, Alastair Darling (I can’t escape the feeling that there are names you meet at the top levels in politics here that would simply provoke too many giggles in the US or Canada) whose head might be expected to roll, explained that it really wasn’t his fault. In an inversion of the Eichmann defense, he explained that he just makes the rules. “There are rules that mean you can’t download this info and stick it in the post… In asking ourselves what has gone wrong here the rules appear to have been breached with catastrophic results.” Sounds reasonable. It’s not his fault if someone doesn’t follow the rules. This reminds me a bit of the reaction of the day-care teacher in Berkeley who instructed me, after my then two-year-old daughter ran out of the school unnoticed (fortunately I was still right outside the building when she came out), “You need to tell her that she’s not allowed to do that.” She did not return to that daycare centre. Yes, the “junior official” ought not to have flouted the rules; but it should not be a matter of rules. The junior official should not have access to an extremely sensitive database, that he can download onto two CDs and send throught the mail. Once he can do that, he might just as well copy the database onto two other CDs and sell them to criminals. Who is to say that another junior official did not do that?

Of course, Mr Darling could reasonably protest that he only just took over the ministry a few months ago. The blame must really fall to his predecessor in the office, who put the database system into place over the past year. It’s a hard argument to make, though, since his predecessor is now the prime minister.

Weather and Politics

From the old “Moving to Canada” blog, originally posted on 22 Jan, 2006:

Two things I did not anticipate for January in Kingston: A federal election, and having to remove my coat to cool off while bicycling.

Weather (or où sont les neiges d’antan?)

I didn’t expect to be able to bicycle at all in the winter, since I expected the roads to be icy and dangerously narrowed by snowbanks.  Instead, the two feet or so of December snow have vanished, except for a few tough icy rinds, and we’re back to shuttling Chaya to daycare in her bike trailer.  Some nights it has not even been dipping below freezing.  It’s like an unending late fall, with the days getting longer. Meanwhile, Europe has been having a Canadian winter.  The natives here complain about the weather.  It’s too slushy. They want the streets properly frozen.

Skating is a big deal in Canada.  Skating rinks are an essential public service, and municipal governments are judged in their effectiveness on their ability to keep them well maintained, and in their social conscience on making them available to the poor.  In this, they are like the swimming pools in German cities, or railway bicycle storage in the Netherlands.  Or prisons in the US…  The Market Square in Kingston (soon to be renamed the Springer Market Square, according to a backroom city council sponsorship deal which is now the topic of legal action) has had a cooled outdoor ice rink installed, open 12 hours a day every day, and several parks have had wooden ovals installed, which they hose down at regular intervals and let freeze, if the weather is cold enough.  Whereas middle class men in the US are always off to their basketball leagues, here they go play hockey at midnight, because that’s when they were able to get the ice free. Continue reading “Weather and Politics”