Tag Archives: Economics

Mixed economy of healthcare is more intelligent than a supertanker

From the UK Guardian: private healthcare providers.

The research on comparative performance of for profit and not for profit healthcare providers is well developed, so it is surprising to see such a weak quality assessment about private providers in the NHS.

The NHS is a very difficult customer for a number of reasons, primarily the glass box of public scrutiny and politics. But many countries successfully navigate public scrutiny of providers in general. So what is the story behind this newspaper article?

  1. It is true that many private providers have handed back their contracts to the NHS usually because either they didn’t do their sums properly, or found the environment more challenging than they expected. But a significant number of NHS providers are in substantial financial trouble, too, and they can’t hand back their contracts, but instead get a state bail-out. This is hardly a level playing field of course, but indicates that the financial regimes for public and private providers is different and that the commissioners may be unable to purchase care services from a mixed economy of providers.
  2. Private providers are often accused of not providing the highest standards of care. This is an interesting problem as virtually all the doctors on private contracts work the bulk of their time in the NHS and all belong to their Royal Colleges and the GMC regulates doctors, not just NHS doctors. It is worth being reminded that the NHS employs 57% or so of all registered nurses, while 37% work in private settings and an additional 7% in nursing homes. As well, the public sector is not the major employer of pharmacists and nutritionists, and the list goes on. Are these health professionals agreeing to work in less well-run and managed private facilities or do they believe they are providing a higher personal standard of care.
  3. Yes, the private hospitals are free-riders on the training system for health professionals as they don’t participate in that system, but there is no reason they couldn’t. They also don’t have emergency facilities, which is pointed to as evidence of poorer standards of care as a patient in trouble would need to be transferred to an NHS provider. But in the NHS, A&Es are being rationalised, converted into trauma centres, and patients transferred to superior treatment facilities when a particular hospital cannot cope. Patients and ambulances are apparently queuing outside the A&Es. There could be a case to be made for private urgi-care centres (18 hours a day, out-patients only), but the private sector would need to made a strategic decision that they wanted to elevate their service mix above elective, private insured care. Until they do something to fix that fault line, they’ll likely be continuing target.
  4. As for the money, in the total scheme of things, private contracting is still less than 10% of total expenditure on the NHS. The article typically falls into the trap of making numbers look big, when as a proportion they are quite small.
  5. NHS managerial expertise is generally what is used to run private hospitals. Many former NHS managers work in hospital contract management, where a hospital is run by a management team on contract.
  6. Circle had trouble not because the Hinchingbrooke is particularly challenging but because the managerial and financial environment was unsustainable partly because of underfunding of the contract by the NHS among other reasons.
  7. It is worth keeping in mind that while the US is seen as a bastion of private healthcare, the majority of providers are not-for-profits (including the hospitals associated with universities where the care is of world class excellence) and that the US care system is over 50% funded from the public purse. Private care providers exist globally and we might usefully look to countries in Asia, such as South Korea, to see what at future healthcare system might look like. Think Samsung.

What Cognology would say:

The government does not consider healthcare as a whole system but fragments regulation by ownership type; this is the root cause rather than something intrinsically problematic with private care, especially given the substantial evidence of problems with NHS care. This means they have failed to create a single regulatory environment to cover both public and private providers which would benefit all citizens in the country regardless of their personal choices. Taking this one step further, embedding intelligence in organisations, hive mind type logic which drives complex adaptive systems, would alter the objectives of regulators and embolden the component parts toward greater autonomy.

 

 

No skin in the game

NHS England and other English health organisations have produced a five year ‘forward view’ [here]. The refreshingly short and precise document establishes a new approach to the

English: British National Insurance stamp.

“Skin in the Game” British National Insurance stamp. (Photo credit: Wikipedia)

English health service, something political reform has failed to achieve since perhaps the beginning in 1948, namely the realisation that top-down reform really doesn’t work. This is a bit surprising given how oftenNHS folk have travelled, particularly to the US, and other places, where the notion of a top-down approach is anathema. All these visits, reports and breathless commentary on lessons learned has really, it now seems, to have been for nought.

We also now have some explanation why the attempts to adapt lessons and approaches from other countries has failed — the heavy overarching deadweight of central control has stifled innovation. Given the additional volumes of studies of the NHS, think tank policy papers, round-table discussions and consultation, researchers, in the UK at least, seem to have been trapped within their own paradigm and failed to see the internal fault lines that pointed to this blind-spot.

Anyway, that said, we now see that Simon Stevens, head of NHS England, has not wasted his time in the US, as not only does the report quote Lincoln’s Gettysburg Address, but tacitly acknowledges that the US (and other countries, but not in the UK) favour decentralised experimentalisation with payer and service delivery flexibility.

Lawton Burns in his important book on healthcare innovation [The Business of Healthcare Innovation, 2005, @Amazon] notes that one reason the US dominates the health technology innovation space is precisely because of the flexibility to experiment, try new things in healthcare service development.

This report, together with the other surprising ‘discovery’ that the funding of healthcare and social care are also part of the problem, after decades of dysfunction, shows that there is now a window within which major changes can be achieved to remove perverse policy incentives, drop barriers to change and get rid of the zombie administriative rules that kill off good ideas.

So where might this all go? Yes there are some very good examples already in place and one hopes more to come. But putting the cat amongst the pigeons may have other rather interesting consequences.

If we see increased power shifting to cities, will we see Swedish-style county-council run healthcare? Such an approach has the merits of democratic accountability, and challengingly, puts funding options within local taxation strategies. Given years ago I advocated with the other big city in the UK a local-council run NHS which caused no end of criticism, I would be surprised if this doesn’t come back on the agenda.

The rising priority of prevention also highlights one weakness of the NHS.  Dating back to 1819, employers had legal duties imposed on them for the health and safety of their workers, a responsibility which the creation of the NHS in effect removed at least in respect of health.  The report notes that employers pay National Insurance as though that were sufficient motivation. What the report fails to add is that NI employer contributions are not experience-rated in terms of the health of the workers themselves. The NHS has flirted with workplace healthcare in the past, but the concept of “primary care in the workplace” has failed. Stevens will know (and others should) how many countries separate workplace health from general health. Some places call it “workers compensation” and it involves risk-based employer premiums, adjusted for actual workplace health, injuries and accidents. Countries with such systems include the USA, Canada, Australia, Japan, and others.  What taxation does is risk-pool, but that means it is hard to link individual behaviour to risk.

American Accountable Care Organisations and other similar approaches in other countries of long-standing, only work when organisations are free to associate in ways that make financial and healthcare sense. US ACOs are forming partly in response to the financial signals in healthcare legislation there, but these signals, coupled with systems of rigourous inspection (and a failure regime), focuses minds. Vertical or horizontal integration in the NHS is needed, and would serve to remove at a stroke the barriers that bedevil patients. I’ve seen how building primary care onto the ‘front’ of the hospital enabled speedy patient access to specialists (they simply came down from the wards) and avoided inappropriate admissions. Buying a nursing home added a step-down into the coummenity releasing pressure on in-patient beds. GP integration toward secondary care pulls diagnostic imaging and laboratory technologies toward the patient, and removes hospital monopoly control of what is the major cause of delayed diagnosis.

What Cognology says

The end result is in the UK, consumers, patients, employers, have no real skin in the game, which in these days of behavioural economics means that it is additionally challenging in the NHS to activate the essential incentives to align patients around their care, or employers around healthy workplaces other than through moral suasion.

We may need to revisit how to use the NI contributions as co-payments to create the necessary financial incentives that serve to quantify risk to both patients and employers.

Of course, one should be grateful for small miracles, which is why this report is welcomed.

P.S. I suspect this can be done without new money.

 

 

 

 

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.

Artistic Plagiarism: a commentary

Learning to steal?

Learning to steal?

I wrote an opinion piece in the Art of England (issue 77,  January 2011) on the issue of artistic plagiarism called “On Learning to Steal”. I start by musing on the usefulness of students learning art by copying works in art galleries. You know the story, littered around the floor are art students busily copying, sketching some work or other. As I note in the article, they seem more like a piece of performance art to a failing art education system, than serious learning. I make the point that this only encourages further theft: “bad artists copy, good artists steal”. They are learning how to steal.

But more worrying, of course, is artistic plagiarism, and I draw attention to a recent high-profile example in Australia. I come down hard and negatively toward artists who maintain an atelier where their job is signing finished works of art (I call them signaturists). I observe that these artists themselves sense this is a con, otherwise, why would one well-known artist preface recent work by saying the work was done personally.

Plagiarism in all its forms is not to be trifled with. In the visual arts, copying is rife, not helped by the ease of cut-and-paste off the internet.

Nevertheless, we must be vigilant of artists who fail, as one artist put it, to adequately reference their sources.

Should art have footnotes?

Want to know more?

An overview of artistic plagiarism by Denis Dutton

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The digital future of 21st century arts organisations

A debate started on the Arts Journal on Leadership/Followership raises a number of challenges for arts groups.

In my view, the simple lead/follow dichotomy is not helpful as arts organisations are both repositories of a society’s culture (on behalf of people) and a way to placing before the public new ideas in way that engages and informs (on behalf of new ideas).

Bruno Frey has commented that people may not need to see the original piece of art itself but perhaps a print would do.

You are there!

Taking that notion further, why are exhibitions not online?  An opening could be a simple ‘app’ instead, and the show curated with additional content and searchable features, individual pieces could be zoomed and viewed in the round.

It would not cease to exist when the exhibition closed — a problem for exhibitions in the real world, and poorly captured in the exhibition catalogue. Few people can actually make it to many openings, and moving art around can damage the art itself. The modern world is increasingly location-independent with the use of smartphones and tablet computers making where we are less important when accessing information, people or events; this is likely to evolve further. Thinking past the current fad for social networking (and something will follow Facebook!) leads to a world where intelligent software ‘agents’ can help individuals find and view the art they are interested in, alert them to new shows.

Perhaps some people may be in a position to attend in person, but generally this is not true.

Digital technology allows time-shifting, so I can view the exhibition when I want and probably reduces my carbon footprint at the same time. The openings can be teleconferenced, so people can attend in real-time or listen to later. If I instead choose to attend, then the app becomes my personal guide, which I can annotate and keep.

Ah, but imagine a gallery of giant video screens, the real art protected. It does challenge us to reflect, as Frey does, on what it really is we want to see when we view art: is the experience of the art object itself (if so, why bother buy the catalogue or art books), an experience few really can have, or is it the art (in which case the sale of posters is explained).

It seems to me that arts organisation leadership might benefit from a dose of ‘disruptive’ thinking to embrace modern possibilities. We now have, for instance, galleries with searchable online catalogues, and we find some degree of interactive art itself, but this is a feature of the art not of the art experience. I wonder if today, the “2 second advantage” (to take from a book of that name) for arts organisations offers a clue on how to move beyond the collection idea to something rather different.

The notion of capturing artistic interests in ‘real time’ would enable a ‘video-enabled’ gallery to be able to anticipate art interests (though mindful that much needs to be made of the random ‘shock of the new’ that accompanies the joy of discovering a new artist), and assemble art for the individual in a way that helps them experience the art more personally. I miss not being able to visit some galleries which house art I like because I simply can’t afford the airfare to visit them — the ability to be telepresent in these galleries would be wonderful and at $£€4.99 worth a lot more than the book.

As I’ve said elsewhere, there’s an app for that.

Just a thought…….

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On Learning to Steal

“On Learning to Steal”

Originally published in Art of England, Issue 77, 2011. Reproduced with permission.

I was watching some students in a gallery the other day, planted in front of a variety of different paintings, with sketch books. They appeared to be copying the paintings.

What exactly is the point of this, I wondered?

I went back to my cork-lined room, and sat in front of my plagiartron, typed in some search terms and found a couple of articles on plagiarism, did a cut and paste and produced, yes, this article. Not really.

But in the real world, some students and some well-known authors do a kind of cut-and-paste on their writing all the time. But what about artists? Is arts a plagiarism-free zone? Can artists just copy willy-nilly? Is anything original any more?

Who said “Good artists copy, great artists steal”? Did I? Does it matter that I might say I did, even if I didn’t? If I said I had am I lying or just being economical with the truth. If you don’t catch me out, shame on you.

Of course the point is many artists don’t get caught.

Now back to the students beavering away in the gallery. What are they doing and how is it contributing to their artistic development? When we learn creative writing for instance, we aren’t given passages of Hemingway to copy, or handed a Shakespearean manuscript to copy out the text to mimic the handwriting, as though that had something to do with the words used. Art teachers say copying has something to do with learning about design, the way the paint is applied, mark-making, colour choices, etc. But if this is true, why are the students sketching with a pencil, and with the absence of any passion — a type of forensic duplication, devoid of any creative insight. So, again, what are the students learning to do?

I suggest they are learning to steal.

Some will never progress beyond mere derivative work, while others will become truly proficient. The painters whose work I want to see are the ones who are not in the gallery with their sketch books, but elsewhere using their brains. Copying is essentially a pointless activity (like rote repetition of multiplication tables) and I wonder why the students put up with it — perhaps they don’t think either.

In our cynical sort-of-post-modern world, it does draw attention to what the students are doing, with other gallery goers looking over their shoulder; they become almost as interesting as the paintings, a type of performance art, perhaps an unintended commentary on the failings of art education.

But copying has been handed down over the centuries from atelier to salon to studio to today.

Some well-known artists have been accused of appropriating the inspiration of others to produce works they have claimed as their own. Critics have said this type of artist looks outward rather than inward, forgetting to acknowledge their sources. Artists accused of plagiarism may describe copying as an act of tribute, rather than overt theft, but that seems self-serving.

I think we look to artists to be the authors of their own work, to actually make the pieces they sign. The notion of atelier with employed painters completing pieces to be signed by the ‘master’, turns artists into the worst type of signaturist. I think real artists know this is a con. Why would an atelier artist recently show new work proclaiming that he had done them with his own hand?

In the end, it is the authenticity of the work through the intimate link between idea and result that defines genuine authorship and creativity, not merely the act of fabrication.

We certainly expect people to acknowledge their sources, and where there is suspicion of plagiarism, to have an explanation. Consider the similarities between Henri Matisse’s “L’Escargot” (1953) and Alma Thomas’ “Watusi (Hard Edge)” (1963) of Obama White House fame, where there is an explanation.

Contrast this with the allegations of plagiarism involving Sam Leach’s “Proposal for Landscaped Cosmos” which won the Australian Wynne Prize and which is seen as having what are referred to as “heavy references” to Adam Pynacker’s “Boatman Moored on the Shore of an Italian Lake”, produced some 350 years ago. The artist admits having failed to “reference” the Dutch work when he submitted to the competition. Academics said that had Leach submitted his work for academic assessment, he would have been accused of plagiarism. (source: Michaela Boland, “Spot the Difference: artists Sam Leach denies plagiarising Dutch master”, The Australian, 14 April 2010. http://www.news.com.au/national/spot-the-difference-artist-sam-leach-denies-plagiarising-dutch-master/story-e6frfkvr-1225853423386; accessed 5 October 2010)

Perhaps works of art should have footnotes.

As for the students, I still don’t know why they are being taught to steal.

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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The Artist as Entrepreneur

Spot the entrepreneur

Spot the entrepreneur

Art of England (issue 68, 2010) has published a short piece of mine. It is about the ‘grants welfare state’ and proposes that artists should be funded more as investments, over a few years, leading to artistic and financial success, rather than supported through project grants.

I see this as a recurring theme of relevance to artists as the future for many will require them to become far more entrepreneurial and commercial. Financial difficulties within public sector funders will only be heightened with rising public debt. There is, too, the continuing debate whether art has intrinsic value and should be funded for its own worth — but of course the problem as always is deciding the features of intrinsic worth.

It also points to the need for more commercial content in the post-secondary arts curriculum. Should art schools and business schools develop some common courses for students to hone their abilities?

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