Not sure the bit about the Doctors is a valid point, actually. You do most of your learning while you're asleep, and your brain re-codes the day's experiences. If you don't get enough sleep, you don't learn as much. I think 48 hours may be too few, but 80 hours is way to much. Doctors are smart, but they're still human.

It could go either way though, I suppose. The nice thing is, we'll find out, won't we?

And that says nothing abour error rates. Mistakes skyrocket into the 12th hour of a shift. Why the US Gov't will let Doctors work that long but not truck drivers or heavy machine operators seems a bit schizophrenic.

Posted by: Brock at December 8, 2005 01:40 AM

James, I went along to hear the show and I thought you came over very well indeed, although with the length of the interruptions, you had very little time to lay out your case.

Even with what was covered, it staggered me how complacent the panel of interrupters were.

They were reluctant to acknowledge the extent of health, education, and poor provision before the welfare state, or its mechanisms; silent when it came to the idea that the pre-welfare state model might have improved further over the last 60 to 100 years; and despite one of them claiming to be an economist, did not seem to take the point at all that the welfare state had hugely increased dependency on welfare or that this might in any way be undesirable.

Nor did it occur to them to question that the state should itself be the deliverer of health or education. While they may reluctantly have accepted the welfare state was not perfect, they seemed content to think it was as good as any alternative - and only needed still more money thrown at it to improve.

Presumably they think it only a matter of administration. They need not look far to see better delivery models: my cat and car get far more reliably attentive and effective care and service from our local vet and garage than I or my family have had from the NHS, where delay and neglect are endemic, but then pets and cars are not bother and expense for vets and garages.

Thanks for an interesting evening.

Posted by: Tim at December 8, 2005 09:21 AM

It didn't take a Nostradamus...

A stacked panel of hecklers...

An institutional bias to the Left prevents the BBC having a fair debate on this issue.

The very people chosen to 'debate' the issue are themselves products of the welfare system!

As well have a 'debate' about the morality of cannibalism with a panel of cannibals.

Posted by: niconoclast at December 8, 2005 10:13 AM

James, I look forward to hearing the talk. I admire you for speaking out on this topic, as I have found myself that people simply don't like any challenge to the role that the state plays in our lives. They assume that anyone who mounts such a challenge is either an amoral "rich bastard"; or is simply unrealistic.

They cannot face up to the frightening truth that the state in its current form makes people miserable. If you get out there and meet one of the 2.7 million people on incapacity benefit, you will find a dejected, unhappy individual who cannot afford to go to work because of the perverse incentives that welfare creates. The employees of the massively expanded state apparatus know that their salary is paid despite they achieve little or nothing. Our health service; surely a sector that we should passionately care about; employs more and more administrators while operations are cancelled due to funding shortages. Bright children prevented from achieving by a schooling system that encourages mediocrity above all else. Little things - like the 45 minutes I spent in the post office queue the other day - that add up to a massive waster that would never be tolerated (or possible) in the private sector.

While they may reluctantly have accepted the welfare state was not perfect, they seemed content to think it was as good as any alternative - and only needed still more money thrown at it to improve.

Why not consider a society that doesn’t rely on such an archaic way of spending vast sums of money? Computers allow us to create and improve markets, for example by quickly matching job seekers to jobs, or allowing people to understand, create and administer their own pension fund. Why do we need the government to do so much with our own resources? The Left repeatedly spout ‘human rights’ and the importance of an individual free from coercion, yet at the same time support a system which takes £40 from every £100 on the basis that we can’t be trusted to spend it for ourselves. The government, which knows nothing of our lives, preferences or situations, knows better than we do what that £1 should be spent on.

I find it sad that it is those who claim to campaign on behalf of the poor, and the supporters of 'social cohesion' etc that have done massive damage to those causes, creating millions of wretched, miserable people.

Posted by: Alec Hodgson at December 8, 2005 10:38 AM

Like Alec says, am looking forward to hearing the broadcast. Perhaps you could ask the BBC for an unedited copy of the talk to post on this site - or ask them to post the full version on their website?

While at Oxford it has proved virtually impossible to engage in an intellectual and coherent discussion with the Left as a result of their intolerance for anything not involving more Government money; higher taxes on the rich; or not conforming with their misguided idea of human rights.

They are particularly fond of labelling anyone at all on the right as "fascist racists". Recently, while discussing the Make Poverty History campaign and the broader question of how to help Africa solve the challenges it faces, the discussion came to a grinding halt because those on the Left opted to become hysterical, hoping to invoke some form of emotional argument-winning trump card.

Posted by: Rory at December 8, 2005 12:23 PM

I'm not sure about your point om restricted hours for medics.

The reason that traditionally, they've worked such long hours is because the NHS and BMA and royal colleges colluded to restrict supply. It has been a cartel to drive up wages.

Left to the free market, there would be many more doctors, they'd be paid less and hospitals would restrict staff hours as part of their quality control procedures. Remember, medical mistakes are one of the leading causes of death in this country (and the US, where a cartel of a different type exists).

Posted by: HJHJ at December 8, 2005 08:17 PM

I attended this lecture yesterday and enjoyed it immensely.

I was utterly astounded by the lack of intellectual curiosity displayed by the Lib Dem MP. He was totally unable to conceive that the question in the lecture's title should even have been asked.

The format of the event was somewhat odd - and I could sense your frustration at not being able to make your case more comprehensively.

I look forward to finding out what the edited version sounds like...

Posted by: Richard G Brown at December 8, 2005 08:21 PM

"They cannot face up to the frightening truth that the state in its current form makes people miserable"

Oh, I think they know that, but they think that if they just make this little change here, this new policy there and a little bit of means testing there, then it will all magically work and we'll all be living in happy-happy land.

The endless repeated failure of the other tweaks and policies is ignored or wished away or statistically fiddled away. But Plan 413 will *really* work this time.

Which is why there are zillions of nonentities employed in the public sector. Organising their endless changes without any knowledge of the subject in question, usually. Every new one brings more nonentities in, and the old ones never go away.

The administrators in the NHS. Well, if you just bring in more and better administrators (as has happened today in many of my local hospitals) then it will all be great. (What they do is fiddle the resources, sack doctors and nurses and shift the budget about of course).

I look forward to listening to the radio show. I can have a wild guess as to the responses of the debaters. I would hazard a guess that they refuse to actually engage on any of the points raised by JB at all. It's easier to smear him as a "right wing loony" who "doesn't care about people".

Posted by: Paul at December 9, 2005 09:29 AM

The 48 hour week is a real problem.

At the risk of sounding more and more like my father (!!) when I was a hospital doctor, we worked either 1 in 2's or if you were lucky, 1 in 3's.

i.e. You do the full working week then ON TOP you do every other night and every other weekend (or every third night and third weekend). These hours were ridiculous and the pay was derisory..... but you learnt. In six months as a busy house man in a leading London teaching hospital I saw, examined, wrote up (or clerked) as it used to be called, between 60 and 100 patients a week. That is over 4000 patients in the year, and I did 3 years of jobs like that.

I do not claim this was the ideal system. But what is indisputable is that the learning curve was rapid, the experience founded medical abilities for life.

It has all gone.

There are consultant surgeons being appointed now who can tell you how many appendixes they have removed. They should have lost count years ago.

Inexperienced junior staff are now being carried by experienced consultants who trained the old way. Soon they will be gone. The inexperienced juniors will become inexperienced seniors and the standard of medical care will be dire beyond beleif.

Trouble is, there will be no one around who will know. It will all be a memory.

It is sad that a British doctor feels he has to go abroad for medical care, but it is true.

And an interesting though anecdotal trend I have noticed. I practice in a relatively affluent home county. I have a lot of patients who have houses in Spain. They all used to keep their BUPA up and return to Englnad for treatment. More and more now, they return to Spain for treatment. And as far as I can judge, the treatment is excellent. I have had 3 patients who have had hip replacements done in Spain, and done just as well and far quicker than they would have been done here. And the patients were full of praise for the hospitals , particularly remarking on their cleanliness.

It is very depressing.

Posted by: Dr Crippen at December 27, 2005 12:58 AM