Talk me off the edge: UK democracy

Great Debates
101

…**more **is a relative term. The dictionary tends to define it as “a larger or extra number or amount”.

So if we were to take 100 rocks. And if you promised me that next week I would have 100 more rocks, how many rocks would someone expect to have next week?

I would expect to have 200 rocks.

But its a week later and I don’t have 200 rocks.

I’ve got 100 rocks.

I ask you: you promised me 100 new rocks!!! Where are the rocks?

And you reply “I didn’t promise 100 **new **rocks. I promised 100 **more **rocks. The statistics show that you lose 20 rocks every week. So we’ve replaced them.”

“But I didn’t lose any rocks last week!” I insist. “You haven’t done anything! You haven’t given me 100 more rocks. You didn’t even give me 20 new rocks. This is misleading!”

“I’m not sure how “more” is particulary misleading” you reply.

If you can’t see how a promise of “50,000 more nurses” when a substantial part of that promise is bog-standard staff retention measures used in every industry (that won’t literally result in more nurses, just the same amount of nurses) then I don’t know what else we can do to help you out. But the definition of “more” that you and the Tories have chosen to use doesn’t fit the why that anyone uses the word. The use of the word has been designed to mislead…and you have been misled.

102

Yes, and that is exactly the point that the minister made.

I have 280,000 rocks now, and at a set point in the future I have 330,000 rocks. I would say that I have more rocks. I would say that I have 50,000 more rocks.

If I told you that you would have £10,000 more in your bank account next year and £3000 of that was due to me stopping people stealing cash out of your wallet and £7000 was a wage increase…what would you say?

I’m really not seeing the problem you are having with this. Is the number 330,000 more than 280,000? If so, how many more? take your time.

If you can’t honestly answer that question then there is no point in further conversation because I simply can’t trust your honesty or your abilty to perform simple calculations.

103

If the global economy naturally grows by 20,000 rocks in that timeframe, be it because of immigration rocks or birth rocks, you don’t get to claim those 20,000 rocks as a revolutionary result of your policies when it’s really about rocks fucking.

104

…that wasn’t the point the minister was making.

Except that isn’t what the pledge says and this isn’t what the minister is saying.

There won’t be 50,000 more rocks.

There will be 31,500 more rocks.

It won’t be 330,000.

I would end up with 311,500 rocks.

This isn’t a suitable analogy. Employee retention isn’t a static process. You are always gaining and losing employees. Its always in flux. It is entirely a normal part of the process. Every business and every industry has to deal with staff retention.

Staff retention rates are typically measured by percentage. What percentage left last year? How many new staff did we bring on to replace those that left? The difference is the retention rate.

This isn’t how the government is measuring retention. Your cite says:

How are the government determining who is a “potential leaver?”

The reality is there is no way of determining this. What the government can do though is to improve the retention rate.

If the government were to have a retention rate of 100% then the UK will not have **more **nurses. They will simply have the same amount of nurses.

The number 311,500 is less than the number 330,000. You can’t get to 330,000 using the numbers provided by the government.

LOL. I answered your simple question. My ability to perform simple calculations isn’t at question here.

105

Not what I asked, is the number 330,000 more than 280,000? If more, how much more?

106

…where is the number 330,000 coming from and how is it related to this discussion?

107

Suggest we wait until the Queens speech for the next installment of this utterley fascinating discussion.

I expect that clarity, if any, is more likely to come from PMQs when Boris is called upon to explain exactly what those figures mean

108

The 330,000 is the number of nurses that the minister specifically stated will exist, you know, in the interview, the one I first talked about? a number that is 50,000 *more *than the 280,000 we have currently.

Look at it this way.

Imagine you run a company that has 100 employees.
Every year you lose 10 of them for various reasons.
Because you know this you already budget for training up 10 people to replace them, that’s just the standard way you run your business because the jobs they do need a long period of training and qualification so you always have a cohort in training (and it is indeed the way that the NHS runs)

Current state - The number of employees stays at 100, there are no more employees than there were before

Now imagine you want to increase your capacity. You continue to budget for the training of 10 replacements as before, nothing changes there, but you *also *put in place a program of incentives to reduce the number you lose by half. That’s sensible, it is far cheaper to keep the ones you’ve already got, that is the right place to start.

**Current state now **- The number of employees now rises to 105, there are 5 *more *employees than there were before.

Now imagine that on top of that you *also *increase the number in training by 5 and you *also *specifically bring in an additional 5 people from another company.

Current state now - The number of employees is now 115, you have 15 *more *employees but only 10 of those can be honestly described as wholly “new” positions and indeed 5 of the 15 are people that were already in the company.

To claim you now have 15 more employees is perfectly legitimate, to claim that only 10 of them are truly “new” seems also to be perfectly legitimate.

The claimed increase is not the story, the ability of the government to do it, is. The piss-poor interview I saw focused on the former and not the latter.

109

Seems to me like you lost 5 old employees, gained 20 new employees and increased your total number of employees by 15. I’m not sure where the 10 comes from.

110

exactly, not hard is it? The overall increase of 15 is the important bit is it not?

Bingo! therein lies the problem with using the word “new” and why I suspect the word “more” was very carefully chosen.

The 10 “new” ( and I put it in scare quotes) employees are people over and above business as usual. The 10 replacements that the business *always *has in training is nothing “new” or “extra”. The additional 5 training places and 5 recruits from other companies are the only ones I’d allow as truly “new”.

Here’s where your terminology, thought technically correct, is actually more confusing. I’m not sure exactly how many nurses graduate each year, but for the sake of argument let’s say it is 30,000

Consider this. Using your own definitions a health minister could honestly claim that next year there will be 30,000 new nurses in the NHS even while the overall figure of 280,000 stays exactly the same, they could even say that there will be 150,000 *new *nurses in 5 years time and yet the overall figure stays at 280,000. I say that is far more misleading.

111

In abstract terms, you’re correct, but these are people, not abstract constructs. It’s not as if some of them are “regular hires” and others are “supplemental hires” - as far as they’re concerned, they’re all new hires, right? You’re treating *potential *numbers (who many usually leave, how many are usually hired) and treating as if they’re *absolute *numbers, which is what’s confusing things.

That’s why I think we should be talking about *positions *rather than about individuals. In your example, we could say that the company added 15 new positions. Right?

112

…if that is what the minister specifically stated will exist, then the minister is wrong. This isn’t the number that will exist. The correct number (assuming all the projections are correct) would be 311,500.

And its here that your argument falls apart. If you have 100% staff retention then you don’t spend that money you’ve budgeted for training replacements. The number doesn’t rise by 5. You don’t end up with 105 staff. You end up with 100 staff with a surplus in your training budget. You don’t hire 5 new staff because you haven’t been allocated the budget to cover their wages.

This is why the ministers argument is bullshit. You can’t have a staff retention rate of 105%. That isn’t how it works. When staff leave you replace them. If more staff leave you need to replace them with more staff. If less staff leave then you’ve got to find less people to replace them. But if nobody leaves then you don’t hire anybody.

But if you want to increase capacity then you have to budget accordingly then hire more people. A retention plan doesn’t and can’t increase capacity: a retention policy is all about maintaining the current capacity.

You don’t get 15 more employees unless you budget for it: the plan only budgets for an additional 10.

A reminder of the position taken by the Tories:

How will the government identify who is and isn’t a “potential leaver?” How will they determine that “they have been persuaded to stay”?

Retention doesn’t increase capacity. Retention only can get you to 280,000 nurses. To get to 330,000 you need to actually budget for and hire an additional 50,000 nurses.

The claimed increase is absolutely part of this story, and the ability of the government to do it is part of the story as well. The interview wasn’t piss-poor: it simply showed how incomitant the minister actually is.

113

This is like watching people try to apply the old missing dollar riddle to government policy.

114

I don’t understand the distinction you are making here or why it really matters. A baseline training cohort that represents “business as usual” is a different beast to actively recruiting additional fully trained employees or increasing the size of the training cohort to a new level or actively retaining existing employees. They certainly are different types of “hire” but the upshot of all those courses of action is to have more employees, to leave the company at the increased level of staffing that it needs. That is the key point.

It’d be perfectly fine by me. (though it seems now you are describing people in the abstract).
The company is now employing 15 more people, 15 more positions if you like. If you chose to call those 15 “new” then by all means give that a go. A reasonable person will know what you mean but the interviewer I saw will simply challenge you again on the use of the word “new” They will ask why these are 15 *new *positions when 5 of them already work for you and you will have to show your (perfectly reasonable) working out, and probably still be met with slack-jawed incomprehension.

As I say, sticking to “more” seems the sensible option.

115

There is clearly a subtlety you are missing here.

The NHS has a regular churn of staff who leave and newly trained ones that enter. In a situation where we are happy with the number of nurses those two figures are balanced to keep numbers more or less stable.

If the number who leave is reduced (by whatever means) and the number in training just remains the same…what happens to the number of nurses overall?

116

I think the bit that people are assuming is that the number of nurses under training is planned to shrink to take account for the additional numbers being retained. Unless I’ve missed a key part of the policy that is absolutely *not *the case. Not only do training numbers *not *decrease (whilst more nurses are retained), the numbers training actually increase.

117

But there *are *15 new workers! I could give you a list of their names, if this wasn’t a hypothetical exercise!

It just seems so simple to me. In a regular year, they lose 10 and gain 10 (or maybe lose 15 and gain 15 - there’s no reason the number has to stay the same each year). This year, they lost 5 and gained 20. The 20 people they gained are *real *people, as are the 5 people they lost. The 5 people they didn’t loss, and the 10 people they gained that they wouldn’t have gained in a regular year, are *theoretical *people. They don’t actually exist, in that you can’t give me a list of their names. Do you see what I’m getting at?

Anyway, what’s important is that the company changed from a company with a complement of 100 workers to a company with a complement of 115 workers. That means that in total, there are at least 15 people employed by the company who hadn’t been employed by the company before. Hence, 15 new positions.

118

Apologies if I missed it, but what is the source for this number? If that is the true number planned under government policy, then I would agree with you that the minister was mistaken. But at the moment, I am not seeing anything to suggest that.

Agreed.

This is where you are going wrong - you are neglecting the thousands of nursing diploma/degree graduates who join the profession each year, regardless. As Novelty Bobble has repeatedly explained, assuming this continues, if the NHS were to magically achieve 100% retention of existing staff at the same time, the number of nurses would go up.

You are right that this would require the NHS to create more nursing positions to accommodate this. My understanding is that that is the policy intention. If the plan is for the number of nursing positions to increase from 280k to 330k, then the claim “50,000 more nurses” is correct. I don’t know where your figure of 311,500 comes from.

119

…There is clearly a subtlety you are missing here.

A “nurse in training” is not a nurse. Hancock stated there are currently just over 280,000 nurses in the NHS and committed to take that to just over 330,000 nurses in the NHS. The 18,500 nurses that will be retained are already in the 280,000 nurses that are currently employed. The number in training isn’t relevant here.

Conservative sources say that there will be 31,500 newly recruited nurses, made up of 5,000 apprenticeships, 14,000 training bursaries and 12,500 overseas recruits. The only way to get to 50,000 is to hire an additional 50,000 nurses. Retention can’t get you there.

The number in training doesn’t matter. What matters is how many the NHS employ. If the goal is to increase the numbers of nurses to 330,000 the only way you can do that is to hire 50,000 more nurses than you’ve got in the system at the moment. Even if you managed to maintain 100% retention of all of the nurses in the system there is no path to 330,000 without employing 50,000 more nurses. The Tory plan, as laid out by conservative sources, simply can’t get you there.

120

We also need to be careful about what is meant by a nurse in post - seems pretty obvious but it isn’t.

Having been in public service for a long time I have seen this over and over, numbers rarely mean what they purport to say, and this is because of the management measurement system that is used to cover up reality whilst appearing to achieve the desired outcomes.

Anyone in public services will be familiar with the process of inspection and targets - these are rarely intended to assist the organisation in identifying areas for improvement. These usually come in the form of Key Performance Targets(KPT) or Key Performance Indicators(KPI)

Ostensibly an the organisation will be issued with a list of measurement standards - usually a set of statements at varying levels or standards and the organization is then expected to operate in a way to achieve the highest standards given the resources they have. The inspectors will then visit and require evidence to be provided that shows what has been achieved in relation to those statements.

So if the NHS has been given an intended measurement of numbers of nurses, the devil is in the details - what is actually meant by a nurse? Is that a student in last year of training? Is that a person who is actually a ward manager and rarely interacts with patients, does that mean nurses who are NHS registered but work in private care homes? Does that mean a nurse in post who works 37 hours or just any registered nurse who works part time.

The hospital managers and directors have careers that are dependent upon achieving the inspection results - this does not necessarily means provide a good service - the two are not the same thing at all.

The result is the there is huge incentive for the whole ministry and management chain to change indicators to fit a definition - so suddenly a nurse becomes who they say it is, I’ve seen so many dodgy ways of meeting targets - such as defining a multi-disciplinary case as several cases at once, when in truth it refers to one person with multiple issues - which means that fewer bodies are being counted more than once.

In the case of a nurse, well for maybe 20 hours they could be working say, on infection control and perhaps another 5 hours doing paperwork and managing staff working hours and maybe work one shift a week with patients - would you call that a full time nurse?

This is the sort of abuse of targets and inspection processes that happen throughout the whole of the public sector - inspections cost an absolute fortune but in the end they largely reinforce the culture of deception because it is on no-ones interest to blame poor performance on lack of resources - that would be very bad for a career.

All this in turn enables a minister to get up on its hind legs in parliament or on tv interview and bray on about how certain performance numbers are showing an improvement, when it is all lies.

Both Labour and Conservatives have relied upon these lies for the last 20 years, neither has a real interest in exposing the truth on their watch since it makes them look bad.