Carlo Morelli

No evidence that patient choice in the NHS saves lives

The Health and Social Care Bill 2011 has been framed to abolish direct parliamentary control and public accountability for the National Health Service (NHS) in England. In the face of enormous public opposition to the Bill, the UK Government stood down the legislative process between April and June, 2011. Prime Minister David Cameron used the temporary pause to advance the case for the Bill and argued “Put simply: competition is one way we can make things work better for patients. This isn’t ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates.” The study to which Cameron referred was a working paper by Zack Cooper and colleagues. However, contrary to Cooper and colleagues’ claims, their study did not show a causal inverse relation between patient choice and death rates. A statistical association is not the same as causation. As set out by Bradford Hill in his seminal paper, certain factors must be considered when determining whether a statistical association is likely to be causal: ”experiment” or study design, plausibility of intervention and outcomes, strength, consistency, specifi city, coherence, temporality, and quality of data. Cooper and colleagues’ study does not meet scientifi c standards. In the absence of evidence proving that competition improves health, Cooper and colleagues’ work should not be cited as scientifi c evidence in support of choice, competition, or the current market-oriented Health and Social Care Bill 2011. A revised version of the study, published in The Economic Journal, clarifi ed points of detail, but Cooper large comparative studies, one reporting data from two academic institutions and one from a multicentre community-based cohort, both noted—after many adjustments for case-mix and disease risk—substantially improved outcomes after surgery compared with radiation. The community-based analysis also recorded, as did Warde and colleagues, better out comes after either surgery or radiation than after androgen deprivation monotherapy. In both studies, diff erences between treatments were small for men with low-risk disease, and increased progressively as risk rose. Warde and colleagues have provided the strongest evidence to date that androgen deprivation therapy alone for men with high-risk prostate cancer is not adequate. These patients require an aggressive, multimodal approach incorporating prostate-directed local therapy. However, the crucial question—whether the optimum initial strategy should include radiation combined with androgen deprivation therapy, or surgery followed by selective radiation on the basis of pathological fi ndings and early biochemical outcomes— is still open. The defi nitive answer will only come through trials of men with high-risk disease randomly assigned to receive surgery or radiation as an initial treatment.

Constructing a Balance between Price and Non-Price Competition in British Multiple Food Retailing 1954–64

The objective of this article is to examine the transition from atomistic to oligopolistic competition within the British grocery food retailing market. The focus of the article is the period from the end of post-war rationing in 1954 to the passing of the Trading Stamps Act in 1964. It was during this decade that multiple retailers fundamentally altered the nature of competition within the industry. This article maintains that it was this decade that also defined the future pattern of development of firms within the grocery retailing market. However, as the article makes clear, multiple retailers were neither united in their approach, nor entirely voluntary participants in this transformation.

Information Costs and Information Asymmetry in British Food Retailing

This article examines debates over the emergence of multiple retailers’ market power through the historical growth of relational contracting within British food retailing. The article documents the changing pattern of relational contracting. Contracting is suggested to adapt to changes in the importance of branded goods, own-label goods and asset specific investment in retailing outlets and logistics. In conclusion the article challenges the neo-classical view that markets are characterised by discrete classical contracting in favour of a view which emphasises firms’ risk minimising strategy based upon relational contracting and market power.

The managing of competition: Government and industry relationships in the jute industry 1957–63

This paper examines the development of the 1963 court case brought by the Board of Trades Restrictive Trading Agreements Office against jute manufacturers, in order to examine the impact of the newly introduced competition policy for government–business relationships. Governments active enforcement of competition marked an important change in the direction of industrial policy in the UK and the jute industry was one of the cases to be examined.

Universal versus Targeted Benefits: The Distributional Effects of Free School Meals

UK government policy over the past thirty years has seen a movement away from universal provision of welfare towards the targeting of welfare. The advent of devolution in Scotland, and to a lesser degree Wales, has, however, created new policy forums in which the shift towards targeted benefits has been reversed in a number of important fields. Welfare provision in relation to children is a further key area in which this policy debate has emerged. Little evidence has been provided for the effectiveness of this shift in policy until now. We examine the effect of this divergence in welfare policy. We look at the issue of universality and targeting by examining the impact of the proposal for the introduction of universal free school meals to all children in full-time state education. The current system of free school meals is found to be the least effective method of welfare provision. Other methods of targeting are found to be more effective than the current system, but universal provision is found to be the only mechanism for consistently providing welfare to all low-income households.

Explaining the Growth of British Multiple Retailing during the Golden Age: 1976–94

The author examines the growth of multiple retailing during the ‘golden age’ in Britain. The growth of real turnover is used as the dependent variable in a quantitative analysis of the growth in large-scale multiple retailing from 1976 until 1994. The author examines for the first time the determinants of this growth against a variety of supply and demand variables. It is found that the importance given to capital investment in previous studies of the golden age is not justified by the data.

Devolution as a Policy Crucible: The Case of Universal Free School Meals

The election of the Scottish government, in May 2007, raised expectations that devolution may at last give rise to a sea change in the development of welfare policy. Certainly, in the areas of education and health the newly elected Scottish National Party (SNP) Scottish government, despite its minority control of the parliament, lost no time in announcing significant changes to previous policies in the areas of hospital closures and primary school class sizes. The proposals to introduce universal free school meals in all primary schools for school children in years one to three from 2010, following a pilot in selected local authorities, was one of these changes. This policy shift is of significance for three reasons. First, the previous executive had explicitly rejected proposals for universal free school meals on two previous occasions. Second, it represented a movement towards universality and away from the strategy of targeting and means-testing welfare adhered to by both the Westminster UK government and the previous Scottish Executive. As such, therefore, the introduction of universal free school meals marks a significant victory for the campaigning groups behind the move. Finally, and perhaps of still greater significance, the introduction of a pilot scheme for universal provision in England, announced by the Westminster government in September 2008, further highlights one other goal of devolution: that of a potential for policy experimentation and divergence. Universal free school provision may be the first example of devolution providing a crucible for welfare policy for the wider United Kingdom. This paper assesses the extent to which an extension of the entitlement to free school meals is likely to improve the access of free school meals to children from the poorest of households and the extent to which changes in free school meal provision leads to a regionally specific impact on child poverty due to variations of household composition within the English regions and Scotland, Wales and Northern Ireland. In doing so we suggest that evidence for the advantages of universal provision provides a positive example of devolutions potential for acting as a welfare policy crucible.

Devolution & Entrenched Household Poverty: Is Scotland less mobile?

The Scottish National Party led Scottish Government has identified household poverty as a key focus for its anti-poverty strategy. The government’s ‘Solidarity Target’ seeks to both increase wealth and increase the share of total income gained by these three deciles. The ability to demonstrate the advantages of policy divergence within Scotland, relative to the other parts of the United Kingdom, is central to the Government’s aim of gaining support for increased powers for the devolved government. This paper seeks to provide evidence on one aspect of the government’s anti- poverty strategy; the degree to which Scotland differs from the rest of the UK over levels of entrenched poverty. The paper demonstrates that not only does Scotland have greater entrenched poverty but that the changes in mobility since the 1990s have impacted on Scotland to a lesser degree than the rest of the UK.

The Living Wage: An Economic Geography Based Explanation for a Policy for Equality

This article examines the theoretical underpinning of living wage campaigns. The article uses evidence, derived from the UK Quarterly Labour Force Survey from 2005 to 2008, to examine the extent to which a living wage will address low pay within the labour force. We highlight the greater incidence of low pay within the private sector and then focus upon the public sector where the living wage demand has had most impact. The article builds upon the results from the Quarterly Labour Force Survey with analysis of the British Household Panel Survey in 2007 in order to examine the impact that the introduction of a living wage, within the public sector, would have in reducing household inequality.

Introduction: The Financial Crash and Post-Crash Economics

This book undertakes an examination of the problems facing economics as a discipline taught in universities. It does so against a background when economics is more influential within public discourse than has been the case in decades while at the same time when the ideas typically identified as the totality of the economics are being fundamentally critiqued and challenged from both within and out with the discipline. The book, written from the perspectives of those engaged with the discipline from across a range of universities, seeks to provide some indication of where the discipline should look for more appropriate theories for the world we live in.