Jeremy Hunt’s rubbish response to my letter about the NHS contract

In April, I wrote to my MP, Cabinet Minister Justine Greening, about the fact that there’s no evidence that the new contract being imposed on the NHS  will improve anything and some evidence that it’s discriminatory. My letter’s here.

Greening forwarded me the Health Secretary’s response – which doesn’t address any of hunt-response-1 my points about the NHS. Greening’s covering letter is here, and Hunt’s letter is here and here (sorry for it being two files…)

I have today written to Greening again, and will post here if I get a response.


Dear Justine,
Thanks for forwarding Jeremy Hunt’s response to my letter to you (published here) concerning what he’s doing with the NHS. And by the way, congrats on your appointment to education.
Sadly, neither your letter nor Hunt’s addresses any of my points about the NHS. Those were mainly actually points for you, rather than him, as they relate to the response of the rest of Cabinet to all this. I remain interested in your/ his response to those points. To repeat, they are:
  • Hunt claims that the new contract will improve patient outcomes (or maybe cost-effectiveness) – as does your letter to me (1 June). But we don’t know that that’s true because the contract has not been tested. Why is he allowed to dismiss the idea of testing it in a small area before imposing it across the whole system? (He might be wrong: it might make things worse!)
  • Why is he allowed to introduce a new contract which even his own department admits is discriminatory against women? (discussed in the Telegraph here). The measures he cites in his letter may be true, but they’re obviously insufficient to prevent even his own department saying that the contract is discriminatory.
  • Why is he allowed to keep mis-citing the BMJ study, claiming that it shows that the higher rate of deaths at weekends results from there being few doctors around then, when it doesn’t, and the Editor of the BMJ has publicly written to him to say that?
Your letter (1 June) talks about constituents being worried about the effect of the strike. To be clear, that is not my concern at all: I, and many other Putney residents with whom I’ve discussed this, am concerned about the effect of what they are striking about, i.e., the contract which Hunt seems bent on imposing on them despite having no evidence that it’ll improve anything.
Please send your response by email, not post: the last one got lost in the post for two months.
With thanks
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Letter to my (Tory) MP on Jeremy Hunt and the NHS

Tomorrow sees the first walk-out by junior doctors in the NHS’ history. My MP is a member of the Cabinet (Sec of State for DFID). I sent this to her today. I urge you to write something similar to your MP. My letter references a conversation she & I had about evidence in public policy, about which you can read more here. I will publish her response to this letter when it comes.

“Dear Justine [Greening]

I hope that you are doing very well.

I write to ask why the Conservative Cabinet is allowing Jeremy Hunt to destroy the NHS.

Tomorrow’s planned strike is unprecedented. It is in opposition to a contract which he yesterday refused to pilot in a few regions and have rigorously evaluated. I’m glad that of all MPs, you are mine, because you might be able to understand the craziness of that better than most MPs: DFID seems to understand better than most departments that the answers to tricky problems are not obvious and that experiments & rigorous evaluations can help us find – indeed, are often the sole way to find – the right answers. You and I talked about how DFID funds loads of rigorous evaluations of pro-poor programmes, and syntheses of them for that reason.

Indeed the Conservative-led coalition set up various What Works Centres precisely to gather and collate experimental evidence on social policies because ‘the right answer’ is rarely obvious. Why then is a member of a Conservative Cabinet allowed to rubbish the notion of finding out empirically whether his proposed contract will improve patient outcomes?

It’s particularly ironic that he’s doing this in *health*, because health, of all fields, has seen the greatest gains in outcomes precisely because of experimentation. And Britain was the crucible of that.

Furthermore, why is he allowed to introduce a new contract which even the DoH admits is discriminatory against women? (as discussed in the Telegraph, here).

Hunt’s plan for the NHS seems to be to deal with the ‘fact’ that deaths increase at weekends. Umpteen people have pointed out that that’s nothing to do with the staffing that he seems to be trying to solve, but instead largely due to the fact that the people admitted at weekends are more ill than those admitted in the week: a ‘selection effect’ rather than a ‘treatment effect’. Radio 4’s More or Less noted this, and no less a figure than the Editor of the British Medical Journal wrote to him publicly to ask/tell him to stop misquoting their study.

It’s all the more bizarre because the basic problem in healthcare isn’t weekend deaths or doctors’ contracts, but the fact that an aging population will vastly increase health- and social-care costs, for which Hunt seems to have no plan at all.

While we’re here, why is the Education Secretary allowed to impose a governance form on all schools when that hasn’t been rigorously evaluated either?

I’m genuinely confused because I thought that Conservatism was about freedom and choice, and intelligently using evidence, and rationalism and encouraging diversity/inclusivity in the workplace – and generally avoiding intuited centrist diktats.

I’d be grateful for your view / rapid intervention. And it’s fine to reply by email: MPs weirdly normally reply by letter – an unnecessarily expensive process now almost unique to them.

Caroline Fiennes”

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Euphemisms for fundraising

For some reason, people in nonprofits often dislike to say that their job is raising money. So they use loads of euphemisms for it, many of which seem to me really weird. I’m collecting examples. Please send others!

  • Development“. This is perhaps the most frequent term. It’s bonkers because fundraisers aren’t in charge of developing the organisation: that responsibility is with the management team or board. Sometimes organisations let the direction of their development be by donors’ wishes – universities building new buildings or departments because a donor wants them are a common example – but surely that’s pretty bonkers too: how an organisation develops should be a function of what its beneficiaries/market needs and what gaps are left unserved by other providers. ‘Development’ is also really confusing in international development NGOs – everybody in those organisations works in ‘development’, meaning two completely different things.
  • Head of Philanthropy“. You may think that ‘philanthropy’ means giving money out, but nonprofits sometimes use it to mean getting money in! I really dislike fundraisers having this title as it implies that they think they’re in charge of your philanthropy. I once got approached by a fundraising foundation about it’s ‘head of philanthropy’ role, which I assumed meant ‘head of giving money out’ but in fact meant ‘head of getting money in’. The job of ‘giving money out’ was called ‘investments’: how they referred to actually investing capital before it was given out, I never discovered.
  • Institutional advancement“. This seems to be an American term, and just make me think of Napoleonic armies.


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A reminder about how Twitter works

If you write a tweet which starts with @, it won’t be seen by many people.

For instance, if your tweet starts with @carolinefiennes, it will only be seen by people who follow both me and you. That may not be many people. If you want people to know that “@carolinefiennes has written a marvellous article”, you would do better to write a tweet which doesn’t start with @. For example “.@carolinefiennes has written a marvellous article” or, better, “Read this marvellous article by @carolinefiennes

Tweets which start with @ are public – they can be seen on your ‘tweets and replies’ page – but don’t get seen by many people who don’t go looking for them.

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Somebody else is engaged to Matt Ridley!

Polyvore is reporting the engagement of ‘Hon. Caroline Fiennes and Hon. Matthew White Ridley’. Congratulations to them!

However, please know that that is not me. In fact, we’ve no idea who it is: I know of three Caroline Fiennes’es, none of whom is engaged to Matt Ridley and nobody in our family knows of a titled Caroline Fiennes. Furthermore, father, son and grandfather in the Ridley family are/were all called  Matthew: the use of the ‘Hon.’ for the Matthew here implies that it refers to the son of Lord (Matt) Ridley, the science writer and former chairman of Northern Rock.

The joys of big families. On which note, here is a random photo of Ralph and me:

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The variable value of £50

I have been looking through the catalogue for spending airmile-type points from the airline Etihad. Alongside the various objects and experiences are vouchers at various retailers. Strikingly, the price (in points) of a £50 voucher varies between retailers – pretty substantially. Money at Harrods costs over an eighth more than it does at Goldsmith, a high street jeweller. I thought that kind of funny because ostensibly £50 is worth the same anywhere.

I’ve long hated vouchers. They’re a way of giving people money but destroying much of the value – choice – therein. At best they’re an interest-free loan to the retailer; at worst you lose them and it’s a donation to the retailer.

Here’s the range of ‘prices’ for £50 vouchers on Etihad’s airmiles programme (i.e. a £50 Harrods voucher costs 11,815 points):

11,815 Harrods, £50
11,802 Selfridges, £50
11,720 Marks & Spencer, £50
11,531 Boots, £50
10,739 Interflora, £50
10,490 Goldsmith, £50
3,222 iTunes, £15
10,740 iTunes, £50 (equivalent)
Variance in cost of £50 vouchers

Even money is more expensive at Harrods. Funny old game. Gotta love classical economics…




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Family news

A member of our family, James Fiennes, was recently fatally stabbed in London. Obviously this is truly dreadful news. James’ wife is called Caroline – that is, Caroline Fiennes. However she is not me: she does not work with charities or philanthropy – as misreported in The Telegraph and Daily Mail. (Neither is she the other Caroline Fiennes, Ralph & Joseph’s step-mother).

Obviously our thoughts and prayers are with Caroline and her family.

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The trouble with Nobel Prizes

… is that they don’t go where you’d think they should go.

Nobel 2Badly-organised prizes are characterised by rewarding people who nobody thinks should be rewarded. A good example is elections which are obviously rigged: nobody believes that the ‘winner’ should have won.

Well-organised prizes recognise precisely the people they should recognise. The Venn diagram is like this. The Wimbledon Championships this year is a good example: everybody thinks Nobel 1 that Marion Bartoli and Andy Murray should have received the singles prizes this year, because they got to the finals and won. No negotiation, no subjective judgement, no disagreement. Though you might think it was kind of weird that so many top women flunked out making Bartoli’s path strangely easy (she didn’t play any top 10 player all tournament), nobody disputes her prize. Royalty is another example: there’s no debate about who gets the crown, irrespective of any discontent about the rules of succession or indeed the whole monarchy system itself.

In Nobel Prizes, the overlap between the circles seems uncomfortably small. The group of people who ought to get it and who do get it – the intersection – includes the International Red Cross (Peace), Crick & Watson for discovering DNA (Medicine) and so on.  But there seem to be many recipients who don’t obviously merit it, such as President Obama in his first year in office, and the European Union. Since literary genius and contribution is often contested, I imagine that many literature prizes are controversial. Nobel 3On the other side of the Venn diagram, there are many people and organisations who one thinks should get it but don’t. The physicist Jocelyn Bell is perhaps the best example: her discovery of pulsars landed Nobel Prizes for her two (male) supervisors but not for her. (She’s still alive, so it’s not too late for the Nobel Committee to correct.) Einstein never got one for relativity – arguably the greatest achievement of the human mind – despite empirical evidence (a prerequisite for the Prize) during his lifetime. Another example might be physicist Peter Higgs for his accurate prediction of the particle which bears his name. It’s possible that that Higgs is ineligible because his predication resulted from a collaboration between many people and the Prize can be shared by no more than three people, though it could be awarded to CERN, for finding the particle, because organisations can receive it.

A further problem is the list of subjects. It excludes maths or anything related to technology, yet includes peace and literature which are unavoidably subjective and hence controversial. To see the limitations, try to figure out in which category could recognise Tim Berners-Lee’s invention of the internet, or contributions to international poverty alleviation.

Such developments are perhaps the real dynamite of our time.

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MPs should donate their payrise if they really don’t want it

UK MPs are to have a payrise of £8000 which many say they don’t want. They may be unable to avoid it because their salaries are set by an independent body. So they should give it away. Giving Evidence’s Caroline Fiennes has this letter in the Financial Times today:

Dear Sir,
If MPs truly don’t want to receive their proposed payrise as some are claiming, they could donate it to charity or other social-purpose organisations. Such donations can be made well or badly, and such organisations vary between fantastically effective and useless. Giving Evidence, which supports donors to give well, is happy to advise any MP on expertly offloading their windfall.
Yours, Caroline Fiennes

If you are an MP – or anyone else – wanting to donate money or other resources, do get in touch, at enquiries [at] giving-evidence [dot] com 

Some quick pointers:

– ‘they could donate to charity or other social purpose organisations’: Much charitable work and ‘good work’ is done by entities which aren’t registered charities. For instance, social enterprises, co-operatives and mutuals, some arts organisations, and some universities aren’t charities, for good reasons.  The ‘charitable work’ in which you’re interested may be best done by local authorities, individuals (e.g., artists, carers), or even for-profit companies, e.g., developing pharmaceutical drugs.  There’s a whole chapter on this in It Ain’t What You Give.

– ‘such donations can be made well or badly’. One bad way of giving is to divide the funds between loads of recipients,  as we discussed in Freakonomics. The bad ways become more pronounced, and worse, when giving at scale, as illustrated by NatWest’s Community Force programme.

– ‘such organisations vary between fantastically effective and useless’: this article and this one document sizeable variation in the effectiveness of charitable programmes. Here are examples of charitable programmes which don’t work, and here is perhaps one of the worst charities in the world.

– If you just want some good organisations to fund, look at those we’ve recommended, are recommended by Giving What We Can or GiveWell. If you’re giving a lot, are a company, want to be engaged with orgs which you’re funding, and/or can’t the lists mentioned don’t have a good fit for you, do get in touch.

And never, ever judge a charity by its admin costs. Here’s why–>

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Why Nobody Gains from Valentine’s Day

All people in the universe are either in a relationship or not, and all people in the universe are either happy about that or not. Whichever category you’re in, Valentine’s Day is useless – with one microscopic and surprising exception.


Happy Singles

It’s totally irrelevant! And at the margin, a bit annoying because you can’t get a restaurant table, lots of your friends can’t come out to play because they’re out on contrived dates (see below), and should you happen to want to buy flowers for your mum, they’re suddenly absurdly expensive.

Happy Couples

They don’t need it: they’ll be capable of being romantic without instruction from Clinton Cards or whomever. Since spontaneity, originality and celebrating our uniqueness are central to love and romance, Valentine’s Day is a hindrance because it suggests actions (dinner, flowers etc.) which aren’t our own. Flowers on Valentine’s Day are less expressive, romantic or thoughtful than flowers on any other day of the year.

Unhappy Singles

Oh dear. Valentine’s Day highlights their misery. And not just for the one day, because the cards and flowers in shops remind them of their misery for weeks beforehand. Plus it pretty much prohibits dating for a while, for fear of an unnaturally fake ‘romantic’ dinner on the big day.

These may be the biggest losers, because the spotlight on their unhappy single-dom may prompt them into bad relationships.

Unhappy Couples

What are they supposed to do? Pretend, for one day, that everything’s OK, and go for an excruciating date together? Try to ignore it? Split up to avoid it?

In fact, this group may contain the only winners from the day – ironically – since it may prompt bad relationships to conclude rather than drag on.

So there we have it. Valentine’s Day is helpful for precisely nobody. Except…

The business of business…

Of course, the winners of Valentine’s Day are card companies, florists, chocolatiers, restaurant-owners, jewellers and other purveyors of other predictable ostensible vestiges of romance. Vestiges best ignored by real lovers who delight in celebrating each others’ individuality in more personal ways.

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