Tag Archives: Policy

Who thinks these things up?

Right now, there is the proposed NHS Reinstatement Bill, a lobby document which lays out a way to reverse many NHS reforms.

This lobby document, which is what is it, is familiar reading, and brings back various structures that in the past have failed. You can find information on it at this link.

What is interesting about this approach is the aura of respectability that it wraps itself in, by proposing the changes as a legislative draft, almost as though it were ready to go to committee.  This is, obviously, an influencing tactic designed to force debate onto the topics covered in the proposed bill, and disarm critics who don’t agree that the points in the lobby document are the right starting points. In that respect, the lobby document polarises positions, particularly against current policy direction.

The whole lobby document’s comments and notes identifies proposed changes to a variety of existing legilsation. What we don’t find, though is any evidence that the authors were in any way persuasive  or influential during public consultations at the time. We call that ‘sour grapes’.

Approaches such as this suffer from the following:

  1.  a belief that the fundamental values underpinning the health service can only be protected in a particular way and these are the ways things used to be.
  2. a belief that the changes that have been made have violated these values; moreover, that the solutions have made things ‘worse’ as they see it.
  3. selective use of academic research to support the positions that one wishes to avoid changing.

New PublicManagement as reform of government itself must sit uncomfortably with this regressive thinking.

For the authors, they would no doubt point to market failure logic to prove that the NHS should not be ‘marketised’ as they put it, forgetting that a greater fear is ‘government failure’, for which there is ample evidence, not just with the NHS but a whole host of other public initiatives and legislation that has wasted public money.

Healthcare systems are complex and by trying to overlay what they see as simple solutions to the problems they claim arise from the reform agenda of past years, they misrepresent what the actual problems are. As messy, or complex/wicked, challenges, the authors believe that by taking away that messiness, they’ll also take away the problems. But they know just as well as anyone, that their solutions will only create, perhaps even recreate, the very problems that led to reform in the first place, except now they will be today’s problems, not yesterday’s.

One might argue that the authors are committing a type 3 error, of unintentionally solving the wrong problem well, but that would assume that they have are not clear in their minds what they are proposing. Therefore, it appears they are do know better and are committing a type 4 error, of intentially solving the wrong problem well because that fits with their policy preferences, or prejudices.

That’s why this is a lobby document, designed to intensionally convince, (is mislead too strong?) others of their definition of what the NHS problem is.

What Cognology says

The lobby document and the authors are caught by a fundamental policy trap: of solving the wrong problem.

Want to know more?

Government failure in the UK is examined in Anthony King and Ivor Crewe, The Blunders of Our Governments, 2013 (@Amazon) and in Richard Bacon and Christopher Hope, Conundrum: Why every government gets things wrong and what we can do about it, 2013. (@Amazon)

New Public Management was originally conceptualised by Christopher Hood, in 1991, A Public Management for All Seasons. Public Administration, 69 (Spring), 3-19. Some (Dunlevey et al) argue that New Public Management is dead and that governance in the digital era requires greater, not less, government. That may be the case for some, but if you actually look at the tools that are available to government in a digital world, you’d find that there is little reason for government to own or run very much. See Christopher Hood and Helen Margetts, The Tools of Government in the Digital Age, 2007. (@Amazon)

I have found Leslie David Simon’s book, NetPolicy.com (Woodrow Willson Centre, 2000) an early, and compelling way of laying out the digital agenda in a policy context really well. (@Amazon)

I would also recommend Vito Tanzi, Government versus Markets: the changing economic role of the state, 2011. (@Amazon)

 

Where’s a good paradigm when you need one?

Measuring Up: the health of NHS Cancer Services is a report from Cancer Research UK.

I have no difficulty accepting much of what they have discovered and the report’s key points are sensible. But, two main conclusions are unsurprising and disappointing: more money and better leadership.

There will never be enough money, so we need to think differently about how we organise care itself. More leadership is a typical lament which says that the people responsible for the service haven’t done what they need to do. When I read reports such as this that call for more leadership I can only shake my head that they were not able to think further about the underlying causal landscape.

Their use of tipping point language is useful, though, as it does suggest catastrophic, rather than incremental, changes are likely. A tipping point means a move from one state to another (like tipping over the milk pitcher), where other factors come into play (otherwise it wouldn’t be tipping!). That suggests that there will be a change of state in which the old rules are unlikely to apply or be useful. After Kuhn, we call this a paradigm shift. Edward de Bono characterises two situations: one he called a problem, where you use existing rules; the other is a crisis for which you need new rules. My take is that the NHS is moving into territory where the need for different thinking is more important than problem-solving. That healthcare is a complex (wicked) and adaptive system should alert us and not surprise us that solutions create new problems and indeed crises.

Based on the report, though, we’re more likely to see hyperactive civil servants and NHS “leaders” rushing about with Powerpoint presentations full of exhortations and flow charts, accountability matrices and maps. We’ve tried that so often, one wonders if there are any other tools in the box. However, that the current state of affairs may have been caused by past reform and changes is an important insight, but to argue for essentially what is more of the same is plain silly. If past actions have destabilised cancer services and tipping is likely, then new thinking and new rules are needed. Did I miss something in the report?

If we take the simple flow of patients through the system, we are told the rate of entry is rising as GPs shift to ‘urgent’ referral, presumably the only way they know to get an oncologist’s attention, but the velocity through the system hasn’t changed. Why should that be surprising when resources are rigid and constrained by NHS structures (such as lack of effective transfer of patient information), and what appears to be performance measurement of the wrong things, creating perverse incentives.

The diagnostic phase is what appears to be rate-limiting across the patient and treatment pathway and hence is the primary blockage. While increased investment in diagnostics would be timely, how to do that is where a paradigm shift is needed. The delay in procuring proton beam equipment (so much in the news) illustrates the procurement logic that undermines service delivery. Entrepreneurial creation of free-standing diagnostic centres, providing on-demand services to oncologists and patients would be one way to deal with this. Does the NHS need to own the equipment, labs etc. or does it just need access to the service? By-passing the GP would also be another option, as the gatekeeping function appears to be another form of avoidable delay (ask women how long it took for ovarian cancer, for instance). Would it not be better for patients to access directly oncology diagnostic centres, which might also speed GP referral in turn?

The policy-down focus on leadership has clearly produced organisations of dubious purpose, but with evocative titles: Clinical Senate. Wow! But systems are judged by their performance, not what they’re called. A focus on leadership shifts cognitive priorities from a service orientation to one of lining up organisational structures, job descriptions, role definitions and mandates, meetings, minutes, but distractions if the challenge is where the rubber meets the road. The intersection of patient with system defines the leadership challenge, not the other way round.

In the end, the report is a narrative exhortation to get people to meet and plan to do what they are currently not able to do, or otherwise they would have done what needed to be done. Why not?

What Cognology says

I don’t buy the authors’ argument that change-weary people don’t need more change. They may embrace the logic of wholesale paradigm change if it got rid of the nonsense that stops them from doing what needs to be done. My take is that there is a strong case to be made for unbundling cancer services (this logic can apply in other clinical service areas, too) defined by the demands of the patient pathway. I would also look for ways to encourage entrepreneurial solutions, particularly in the form of investment in diagnostic technologies, and in enabling oncologists to work autonomously with each other and with patients. This would call time on the hospitals’ monopoly control of oncologists, cancer diagnosis, testing, and services, which is organisationally rate-limiting, and many of the identified problems are consequences of a system subjected to serious rate-limiting blockers, but lacking the ability to alter its structure to bypass, elminate, or reform those blockers.

 

 

Broken logic: NICE and the Cancer Drug Fund

Sir Andrew Dillon, the erstwhile leader of NICE as said that it is irrational for the Cancer Drug Fund to pay for drugs that NICE has turned down.

He’s right of course, it is irrational. But only if NICE’s logic is compelling.

The problem for Sir Andrew, and like-minded people, is that there is another logic that trumps NICE’s rational world. Don’t get me wrong. NICE performs a useful, but technocratic, function with analytical assessments that any rational person would indeed want to know. Where we part company is believing that NICE’s logic is the final word on the matter. Which it isn’t.

Tasked, perhaps unenviably, with parsing the performance of medicines and clinical practice, cannot also mean that they are above challenge. Many of NICE’s rulings fly in the face, not of logic, but of our beliefs as humans. It is why we do things when the odds are against us, because not to do so would be wrong. If we think of the challenges NICE faces as wicked problems, that is complex problems with a multiplicity of solutions, it becomes self-evident that their logic is just one way of deciding and choosing. We could use other rules, other criteria. The Cancer Drug Fund is just such an approach. It is another matter whether we should have in place alternative funding approaches that individuals can avail themselves of (such as co-payments or co-insurance); for extraordinarily costly therapies, co-funding would not apply, so we’ll back to the problem anyway.

NICE has a troublesome relationship with the notion of ‘rule of rescue’ and so has decided to ignore it. There replacement, the “end-of-life premium” is really just a reweighting of the logic they use.

You see, the rule of rescue is what we might call a meta-rule — it is a rule that tells us if other rules are working properly, and importantly, as a moral imperative which tells us what to do. The rule is often invoked in a particular form: that people facing death should be treated regardless of cost. The rule as originally formulated is really about assisting identifiable individuals facing avoidable death (Jonson, 1986); the bioethicists and economists have shifted this to a cost-effectiveness approach, making it one about trade-offs instead.

The problem for healthcare systems is that all patients are becoming identifiable as medicines become personalised (medicines may become orphan drugs). The problem for the NHS is that it does not allow such people to rescue themselves because it prohibits any sort of co-funding or other arrangements. The only option is an opt-out (and private medical insurance has rules about pre-existing conditions). Given the funding priorities of the NHS, we should be reflecting not so much on how to make the pot bigger, but on using the money that is available better (there will never be enough money), and ways to introduce practical co-funding.

Since individuals have no other options in the NHS, the rule of rescue as a moral imperative will be violated and we will act, not out of analytical error (i.e. make a technical mistake), but unethically. You see, the NHS must be the healthcare system of last resort and therefore of rescue, otherwise, identified individuals are destined to a death sanctioned by public policy and is that a policy or healthcare system worth having?

We have seen a similar challenge to NHS/NICE logic recently with the King family and proton beam therapy, and the NHS will also use NICE logic to determine access. Whether beams or drugs, it is the same argument.

But why cancer? The main public policy question is why should cancer patients be given preferential treatment as against any other deserving group? This may in part be driven by the often astronomical costs of new cancer therapies themselves, which demarcate cancer patients decisively from equally deserving patients with less cost-contentious therapies. I have just finished some work on motor neuron disease, for which there is one specific medicine and life expectancy from diagnosis is 3 to 5 years, with median survival rates that are measured in months. NICE reportedly is developing guidelines for this disease. Costs are considerable, and at least in the UK, highlight the bureaucratic illogic of separate healthcare and social care, but that is another story.

What Cognology says

The moral dilemma that the economists at NICE are trying to reduce to an equation is whether a new therapy is extending life, or delaying death. The Oregon approach collapsed when the hard choices emerged and people were unable to resolve this dilemma, which is not a quantitative issue, but one of how we value our humanity. Kierkegaard’s Concluding Unscientific Postscript speaks of the leap to faith as involving self-reflection and the emergence of scepticism. It is worrisome that NICE is so confident.

Further reading

Cookson R, McCabe C, Tsuchiya A. Public healthcare resource allocation and the Rule of Rescue. J Med Ethics. 2008 Jan 7 [cited 2014 Sep 4];34(7):540–4.

Jonsen, AR 1986, Bentham in a box: technology assessment and health care allocation, Law, Medicine and Health Care, Vol 14, pp172–4.
Richardson J, McKie J. The rule of rescue, working paper 112, Centre for Health Program Evaluation, Monash University

Think again: Public versus private hospitals

This report on the regulation of private hospitals in England from the Centre for Health and the Public Interest is important, but 15 years too late.

The UK has had and continues to have a love/hate relationship with the private (or independent as it is termed) healthcare sector. This has created a significant fault line across all reform and policy making on the NHS for at least 15 years. Reluctance to create a level regulatory playing field has been evident for years, despite the obvious need for one. I think part of the reason is that creating a level regulatory playing field so that the NHS and private hospitals had to meet common standards would legitimate the private sector itself.

However, when I first worked with a colleague to suggest, around the early 1990s, that the NHS hospitals should undergo some sort of accreditation, resistance was clear. At the time, I noted to others that there were more deaths in NHS hospitals arising from substandard care than from road traffic accidents.

But the view at the time was to ring-fence the NHS from that sort of performance and quality scrutiny at an institutional level. Based on some of the work I was doing at the time, and my own experience with accreditation systems, I felt that the negative reaction reflected a fear that NHS hospitals would fail; using pretty standard accreditation standards from the US, Canada and Australia at the time, I perceived that many NHS trusts would indeed fail. Mainly on safety and quality control grounds (I was teaching NHS managers about quality and quantitative methods in healthcare at the time). Many hospitals lacked any quantitative analytical or operations management capabilities within their organisation and had rather weak data for quality control and performance management purposes. The Department of Health, it must be said, had such expertise on contract but that was to inform their own policy making, not to improve operational performance. I would suggest that such quantitative expertise for quality is still missing at the hospital level.

The consequence has been years of fiddling with quality assurance and inspection regimes. Government has been advised, I think badly, by people who also shared the operative underlying assumption that a single regulatory and inspection system for both the NHS and private hospitals would be politically a step too far. Consequently, the private sector and the NHS have moved in different directions. The private sector has been both an opt-out for patients through private insurance arrangements, and an overflow supplier to the NHS when it ran into capacity constraints. Only more recently, has it been a direct and core supplier of services.

The UK situation constrasts wildly with practices in other countries where ownership of the hospital does not exempt the organisation from regulatory oversight. Indeed, many European hospitals seek out US-based Joint Commission International accreditation, a very high standard. Interestingly, there are no private providers in the UK that have achieved this standard, while (with any type of accreditation) there are 26 in Ireland, 3 in Belgium, 2 in Netherlands, 4 in Germany, 26 in Italy, 15 in Portugal, 23 in Spain, 13 in Malaysia and so on. Perhaps they know something?

I agree with the report’s sentiments, though perhaps not so much how it characterises the private sector as exceptionally risky. Indeed, the past years have demonstrated that NHS hospitals can be exceedingly risky. For instance, the report notes the 6000 admissions per year to the NHS from independent hospitals, while also noting that such hospitals do not have emergency facilities. One might ask whether a common regulatory environment would have led some independent hospitals to invest in such facilities? But such a figure should not be a surprise any more than transfer between NHS secondary hospitals of patients who need more complex tertiary and quaternary care; not every organisation can do everything. In respect of equipment, NHS equipment, too, has failed, gone missing or not worked properly (I have had personal experience of a nurse using equipment that lacked recent calibation); so before we cast the net, let’s make sure we know what we’re fishing for.

The report notes that the private hospitals do not directly employ their doctors, as though this were a problem. Many countries do not directly employ doctors, using fee-for-service type arrangements for compensation. What the report failed to note is that the private hospitals in the UK employ a system called “privileges”, which requires doctors to prove competency in areas for which the hospital in turn grants them privileges to offer that service in the hospital; NHS hospitals do not use a comparable system. I have argued that the NHS should introduce a privileges system, which would bring a more rigourous standard of clinical performance management than the NHS consultant employment contract does and would have the additional benefit of increasing flexibility in the supply of doctors, and perhaps importantly, keep doctors within their scope of primary competency.

A few other points that struck me:

1. Clinical risk does not transfer to the private provider when treating an NHS-funded patient. I’m not sure how this is a useful restriction, especially if the patient chose the private hospital. It seems to me that part of a level playing field would ensure that clinical risk transferred, too. The report addresses this obliquely in terms of whether the NHS is the provider of last resort.

2. The observation that clinical workflow is different is interesting, but it does appear somewhat anecdotal. The private sector is excluded from the requirement to take trainees, and that may contribute to the lack of depth, but I doubt the public would feel reassured that the clinical depth the authors referred to was reliance on trainees! We know what that looked like with registrars. The solution is to ensure the private hospitals are included in the system for training the health professions as a consequence of a common regulatory regime. By the way, I’ve looked at the supervision and training of junior doctors and other health professions and one should not be complacent that it is done well. However, I share the authors’ concerns over the organisation of clinical work, but would not single out the private sector on this point.

3. The volume of work in specific areas is a point well taken. However, I would again suggest that is an artefact of the regulatory system, and lack of effective use of the clinical resources themselves. Proper contracts for suitable volume, rather than handling overflow, would shift workload closer to levels where higher quality standards apply. It might also enable the consultant, for instance, to integrate their clinical workloads, rather than adding the private patients on at the end of an already busy day. Again, organisation of work arises from the current rules and may perhaps be causative of may of the identified problems.

4. I note that only one of the two authors is a specialist in healthcare or health policy, particularly patient safety with grounded expertise.

What Cognology says

Many of the report’s comments, with which I broadly agree can seem quite disturbing, really arise from the regulatory box that the private sector has been put in. Given that private hospitals use the same doctors in the main as practise in the NHS, do these doctors lose their minds when they practice privately, or something else is certainly wrong at a system level. My guess is that the box is the problem, and the private hospitals are quite capable of meeting care standards, given a level playing field.

My remarks are meant to focus attention on the important distinction between the NHS as an organising principle for ensuring (and assuring) healthcare to people and the mechanisms used to identify and engage providers who meet the requisite standards. Focusing on the latter, would necessite doing what the report recommends, but ’tis a shame it has taken this long, to say once again, what has been said for years.

Further reading

Vito Tanzi’s excellent book, Government versus Markets The Changing Economic Role of the State. Then think again about this.

report.

Disclosure:

1. I don’t have private health insurance.

2. I have received NHS-funded care in a private hospital.

3. My NHS trust has recently been reviewed as overall inadequate by CQC.

4. I know something about the issues I am writing about.

The Vampire Art Schools: a commentary

Main entrance of Ringling School of Art

An art school: I wonder what goes on in there?

I wrote an opinion piece on failing art schools in the UK in Issue 75, November 2010, of Art of England magazine.

Are students in art schools actually getting an education worth paying for. Considering the stresses in higher education funding, and the appalling career opportunities for many art school graduates (upwards of 90% never work at their core art competencies after graduation), that some art schools appear to be failing, not just their students, but also in the quality of the work they do, is a clear waste of money.

One of my suggestions is that some university art schools be downgraded to non-degree colleges, with a sharper vocational focus. The other is to widen their appeal to support the learning needs of older folk, to attract later-blooming artists, of which there are many. The problem for the universities is that at some level art-making is essentially vocational; university art studies really are less on the practice of art-making as on the scholastic study of art (an often confused and obscure activity with its own obfuscating terminology, but that is another matter). If artists are to enjoy the benefits of academic positions, they should be contributing to the advancement of knowledge at some level.

No doubt these failing institutions will argue that they offer value, by way of research, but research-led institutions are fine but not if the students are trying to build practical careers in which case you have a serious mis-match. Research in art in my view is important, but is not advanced by students spending the bulk of their time in studios. We need people who understand and can research art as it contributes to civilisation, and how art is made as a function of brains at play. As I wrote in this opinion piece, if students want to paint, they can keep a studio at home. This would eliminate, perhaps to much acclaim, the graduate art shows of frequently pointless academic art.

While not a heathen with respect to universities, I have a doctorate and have been a senior lecturer, there are some things better done for the learner in more accessible and less puffed-up learning centres. The current educational system doesn’t incentivise them.

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Censorship and Arts: a commentary

"Study drawing shows the allegorical figu...

Do we applaud the reading or censor the nudity? A censor’s job is never done!

In Art of England magazine (Issue 78, February 2011), I wrote an opinion piece exploring arts censorship in the context of WikiLeaks.

The WikiLeaks saga is important for a number of reasons I have explored on my policy blog (The Cognologist) in particular what I call ‘digital exceptionalism’. This simply means that for arts, an art show in a bricks and mortar gallery is not the same thing as the same exhibit on the Internet — images in a gallery can be pulled from the wall, while once on the Internet, they are there ‘forever’. Authorities and lawmakers are grappling with this distinction, which in my view is fundamentally specious, but which is driving a considerable amount of excessively intrusive conduct by governments and enforcement authorities. Of course, there are sensible reasons for this: mainly the ease of access to the material, frequently by vulnerable and impressionable or young people. But such illiberal conduct in the past has been justified on similar grounds.

The real reason for concern lies in an observation by Nicholas Negroponte in his book Being Digital: the Internet facilitates the one to many relationship between an individual and the rest of the world. Individuals have much greater social reach and with appropriate search engines, just about anything can be found within a reasonable period of time. Contrast this with the pre-Internet world, of bookstores which stocked only so many books and you had to specially order some, or libraries with paper-based card catalogues — if you didn’t understand the Library of Congress or Dewey Decimal filing system, you might not find what you were looking for.

So in this brave new world (Huxley said it first) the censors have found new energy. The real problem is that in the Internet WikiLeaks type world, it is becoming harder and harder both to hide and to keep secrets. It is almost like living in the film The Invention of Lying, or Liar Liar. It used to be much easier to be duplicitous — the chances of being found out have escalated considerably.

In the article I note that the arts have always attracted the attention of officials particularly during times of crisis (now, perhaps?). Artists in the UK during the 1914-18 war were viewed with considerable suspicion — marine painters were virtually banned as the paintings of ships might aid the enemy, as might a landscape painting reveal the relationship between buildings and the lay of the land. We are perhaps a bit beyond this today, but the censorship of artists remains a real concern in some countries where freedom of expression is curtailed.

While I have always held the view that some artists seem at a loss for something to say, and produce appropriately poor work, other artists express deep political and social commentary, threatening to regimes depending on terror and repression. And some art is just socially challenging and fall foul to political correctness, a socially enforced form of self-censorship.

We are not yet free — even Mark Twain’s book Huckleberry Finn, the most banned book in the US, has had a rewrite to remove his use of certain terminology which today is seen as unacceptable. The Soviet Union used to rewrite history like this and were justly criticised. While the faces have changed, the objectives remain the same.

Frankenfolks can be artists too!

“Frankenfolks” can be artists too!”

Originally published in Art of England, Issue 86, 2011. Reproduced with permission.

Are older people curiosities, especially the long-lived? Do we see them as ‘marvellous’ simply for their fact of survival. Perhaps instead, we trap others in the medico-social web of nursing homes, expensive end-of-life care, and dependency on others. Perhaps old people become ‘Frankenfolks’, as Margaret Morganroth Gullette wrote recently in her book on ageism.

Working as I do in the health arena, but a painter as such, her comments drew my attention. Figuring out what her comments mean entails coming to grips with something else she wrote: “Sometimes pop culture looks like nothing more than a giant machine for excreting ageism.”

Certainly less than a century ago, the average life expectancy was 40 years, death of children was expected; today neither is true, with life expectancy of a healthy person being at least to the mid 90s. Furthermore, most of us will not pass our final days in nursing or care homes. And despite doom-laden predictions of rising cancers and metabolic disorders, most people should expect healthy ageing and natural death. So much for the good news.

The departure of Cy Twombly is a timely opportunity to reflect on all his work, and how it evolved, and challenged us as he himself moved through the phases of his life. All long-lived artists evolve, some like Picasso were condemned in old age for what was seen as inferior work by people with short memories.

We all have life trajectories, and some are acutely aware of the process of personal evolution and seek to reinvent themselves over and over again. Others, whose lives may be more tied to the corporate business cycle may just stop when they hit a ‘retirement age’. Regardless of personal life experiences, ignoring the evolving talent potential of ‘older folk’ echoes ageism.

I’ve noted in other writing the dismal performance of the UK’s art schools. It is also worth noting that while an arts education is a wonderful thing in and of itself, few arts graduates actually make a career out of their studies. And this at the expense of art schools themselves becoming engines of creative expression for the whole of society regardless of age. Like pop culture, art schools also seem to be engines of ageism.

There may be a reason for this. For some, art history is broadly linear; this is a typical western approach, that present perceptions replace past perceptions, a sort of movement from/to. Other cultures see all history as living in the present, so art movements of the past also speak to the present: Sumi-e for example. Can abstract expressionism, described as dated by some, be relevant – no sooner had abstract expressionism burst upon the scene, pop artists were claiming it was obsolete. Really?

The point here is a simple one and betrays the superficial approach to creativity that abounds in the art world and that fosters ageism, namely, that new art replaces old art, and when an art ‘style’ has been replaced, it has no more to say to us. In that respect, we are always looking for the ‘shock of the new’, like Matisse’s gouaches découpés, themselves his response to ageing.

Is everything before transformed, as newness forces us to reassess everything that went before, and must we then consign it to the bins of the history of art?

What can Malevich, or the Futurists, say of relevance to ourselves in our 21st century angst when no sooner are we tweeted than we’ve moved on to the ‘next big thing’. And the next big thing is showing his or her work at some dodgy art school of middling quality at taxpayer’s expense, hoping to shock you with some edgy work of marginal interest (this sentence could go on and on….)

And so we never notice that we are drawn to the specious moment, in our search for that euphoria of artistic discovery, a type of addictive behaviour overwhelms, which always needs a fix. In this way the conditions for ageism in art are created. QED.

The Vampire Art Schools

“The Vampire Art Schools”

Originally published in Art of England, Issue 75, 2010. Reproduced with permission.

Someone said once (probably Adam Smith) that teachers should be paid after the lecture. Based on the recent National Student Survey, “academic artists” employed at some arts schools would be hard pressed to pay their rent.

Of the 154 institutions in Britain ranked on student assessment of lecturer performance (the quality of their teaching), the bottom three are arts schools:

  • 152: Glasgow School of Art

  • 153: University for the Creative Arts

  • 154: University of the Arts London.

These universities are like publicly funded vampires, sucking the taxpayers’ blood, at great expense yet failing to deliver in ways that students value.

The Glasgow School of Arts styles itself as “internationally recognised as one of Europe’s foremost university-level institutions for creative education and research” and a “creative hothouse” on its website. GSA received taxpayers funding of £7.5 million for teaching and £1.5 million for “research excellence”. Their website says: “the GSA was ranked as the second largest art and design research community in the UK, with 25% of our research considered to be world leading and a further 25% internationally recognised”. 1900 students are enrolled, and there are 400 staff.

The University for the Creative Arts is spread across the South East. This institution’s 2010/11 “recurrent grant” (a.k.a. taxpayers’ money) of about £24 million, with £1.5 million for “teaching enhancement and student success”. This institution is the merger of smaller institutions and enrols 6500 students. Their website cites teaching performance studies from 2005 as evidence of the quality of their education and lists alumni such as Emin.

The University for the Arts London’s website says: “The combination of a varied student group, cutting-edge research and highly-experienced staff creates a unique, multifaceted learning experience for students at the University.” This institution’s funding is almost £52 million, with £6.5 million for research. It got £3.5 million for “teaching enhancement”. The university enrols 20,000 students, and has 1228 teaching staff.

Blissfully, these three institutions didn’t get all that much research funding, sparing us more tiresome academic art. To be fair, though, useful art research does exist, but generally it is middling on the research rankings. And yes some of the academic staff may be very good at what they do in terms of being creative, having insight into art history, and generally conducting studies that inform our appreciation of visual culture.

An informal internet survey produced observations such as whether some of the academic staff would be likely to earn a living selling their art if they didn’t have these publicly funded jobs or that students and lecturers can have strong differences of opinion over the quality of their own art-making and may downgrade academics on that basis. This is a no-win situation with only victims on both sides.

Since the 1980s, Higher Education has reduced the choices on offer for learners, creating a large and dysfunctional university system, mixing excellent universities and some little better than a 2-year college. Learners get drawn into this big lie, thinking being a university is an imprimatur of excellence, but some of the best US institutions don’t even have university in their name: MIT and Rensselaer Polytechnic. The arts world has fallen for this lie. What these three art schools exemplify is how weak institutions free-ride on the university ethos; the effect is to attract second-tier academic talent and third-tier students. The problem is we don’t really know which is which although this survey is a clue.

We need to distinguish between art scholarship such as art history, from simply art-making and you don’t need to go to university to learn to do the latter; the whole arts curriculum is confused.

I would relegate the majority of art schools to college status, and strip them of degree granting power. Their mission would be to offer to the many learners (including the late blooming artists of which there are many) opportunities that the universities have abysmally failed to create. Students wanting art scholarship programmes would focus on that, and if they want studios, well, find space at home. As for graduate ‘art shows’, well, don’t get me started.

As Groucho Marx might have said, I wouldn’t want to attend an art school that would admit me. Perhaps we should think again how we want to nurture and develop creativity in our society. As far as I can see, the current system is broken.

How to swing the arts funding axe

Arts groups prepare for funding cuts

Arts groups prepare for funding cuts

No doubt many in the arts community are concerned at rising levels of public sector austerity. For many their very existence depends on public funding of one sort or another.

Few, though, will of necessity understand the underlying logic why there are public funding programmes for the arts in the first place, apart from vague notions that the arts are valuable.  But funding the arts gets mixed up in funding culture and that involves public values and what is, and what isn’t, of culture importance.

I have a short piece in the UK magazine, Art of England (Issue 72 August 2010), “How to swing the arts funding axe: a user guide”, which draws on my own experience in policy to present what are essentially four options facing the arts/culture community. Choosing amongst the options would lead to an approach to the use of public funding and have an impact of one sort or another on the shape of culture institutions and the behaviour of artists themselves.

If you are concerned about the ways the arts are funded, but don’t want to read a thick book, this short article may illuminate the issues. Email me with your preferred choice.

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