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March 16, 2010



Interesting point, Chris. There are also geographical anomalies to consider. There was a report recently on the chances of cancer survival in different boroughs and counties in England. Kensington & Chelsea came out top, whereas Herefordshire, my girlfriend's home county, came bottom. While headline comparisons were not pretty, but the data couldn't take account of the geographic differences beteen the two places. Routine trips to a GP are harder in a sparsely populated rural county, when compared with a wealthy, densely populated Royal Borough that has plenty of private health insurance and a world class hospital. Geographic trends also seems to influence the provision of services in other ways. Westminster council is by no means a paragon of virtue, but going on personal experience, they are certainly one of the most efficient jurisdictions I've ever lived in. Partly, this is its enormous tax base, but equally the number of senior experienced professionals who serve as councillors - former directors of IBM, NHS managers etc - must influence how competently it manages its services.


Very interesting take on capabilities in public service provision. As you point out though, pecuniary status is not the only determining factor wrt capabilities.

Encouraging those who experience poor public services to agitate for better is only likely to be effective if said agitation leads to improvements - i.e. if the public services are locally accountable. Example - commuters reliant on a train service can campaign till their blue in the face for punctuality/reliability/fair fares etc, but unless there's an obligation on the service provider to listen then all the raised expectations in the world won't alter the service (replace trains for schools/hospitals/roads/police as appropriate).

Any thoughts on the appropriation of the capabilities approach (or an approximation thereof) by the likes of James Purnell, who I'm sure I don't have to remind you designed our current 'workfare' system of benefits...?


"They (the poor) are less able or willing to make demands upon educational authorities or doctors, and more easily fobbed off if they do"

That must be why almost a third of Glasgow's population are 'on the sick'.



I can't help thinking about the letter to The Times today from GPs complaining about the whinging slightly unwell. The GPs may have a few valid points but they sound as if they are only interested in patients with something interesting wrong with them. So if you are eloquent you'll see the doctor, if not you'll see the nurse.

john malpas

charlieman - how does 'interesting' become 'eloquent'. A vague sniffle is a vague sniffle even if owned by shakespeare.
A lot of people who go to emergency units have colds and sore throats. ? eloquent.
Often it is the ambience sought .


John Malpas: GPs employ gate keepers (euphemistically called receptionists) who determine who sees the doctor and when. The eloquent will express their symptoms in such a way that the gate keeper will provide access for them. Others are compelled to wait until their symptoms have been assessed by a nurse before they are permitted an expert hearing.

I agree that a lot of people clutter up A&E with trivial complaints. Many may be fools but rational others may be driven to illogical behaviour because the GP surgery fails them.

"Often it is the ambience sought .": Which is why so many alternative therapies are successful. The conundrum is how to deliver talking therapy that helps a patient without consuming GP time, that at the same time can discover serious ailments.


Comment from a psychologist friend...

"Yeah, I think that there might be some truth in this. But also, well in the case of psychology services anyways, there are some areas which have historically received poor service to the extent where 'no-one watches what you do', and this has actually meant that psychologists are more able to use other, less evidence based (but anecdotally) more useful models of therapy - for example, Newham, which has been neglected for years, has a very sucessful family therapy service as opposed to the bog standard CBT approach."

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