Radical
Statistics
Lessons and laughs from the past: how the Health Group developed
Alison Macfarlane
I was among the people who responded to the letter in RSS News and Notes, as it then was, and turned up at LSE for the inaugural meeting of Radical Statistics in January 1974. This came at a time when many other professions had spawned radical groups, and I agreed that we needed one for statistics. It was decided to work in subject-based subgroups and I joined the Health Group. Over the next year or so, we had a few meetings at which we wondered what to do and shared the problems we encountered in working for doctors.
We were finally spurred into action early in 1976 by Barbara Castle's document Priorities for health and personal social services in England. This was the first attempt to set out a programme budget for the services concerned and aimed to give higher priority to elderly, mentally ill, and 'mentally handicapped' people and to prevention. These services were projected to grow faster than acute services, which were to have lower priority than in the past.
Unlike the British Medical Journal which attacked the document as 'A policy of despair', we supported the priorities. On the other hand, closer scrutiny of the data in the document showed it was unlikely that the policies would ever be achieved. We also looked at an accompanying document 'Prevention and health: everybody's business', which contained misleading graphs and arguments. The group began to grow and we were joined by radical doctors, including Tom Heller, who had already written his own critique of the document. At the time he worked at the William Temple Foundation, directed by David Jenkins, who subsequently achieved notoriety as Bishop of Durham and used our material when speaking on health in the House of Lords.
By the autumn, we had drafted a critique and wondered how to get it published quickly, as the consultation on the document was about to close. One of the group, Trisha White, lived in a squat in West Hampstead where her housemates were anarchist print workers, who were also interested in demystifying their techniques. They typeset our manuscript and initiated us into the craft of 'paste up', to create camera ready copy. In the days before the invention of word processors, this now forgotten art involved using a scalpel to cut pieces of typeset text into the right shape and pasting them onto a layout card with 'Cow gum'. They also put us in touch with a group being set up to distribute publications like ours to left and alternative bookshops.
Thanks to their help, we were able to get the pamphlet, Whose priorities?(1) out in ten days. We wrote to the British Medical Journal to publicise it. Some of the authors, who included Iain Chalmers, Andy Haines and Martin Bland have now achieved great heights, but as we wrote from our 'work' addresses, I got into trouble at the time. Not long afterwards, I received a letter from my funding body, the Department of Health and Social Security to say that my contract definitely would not be renewed when it expired. This underlined the need for those of us who were contract researchers to maintain a distinction between what we do for Radical Statistics and what we do at work. Those who were civil servants remained anonymous, of course. Where Health Group publications of this era contained authors' names, the list was inevitably prefaced by 'Contributors include'.
We next turned our attention to a further document with commendable aims but dubious statistics, 'Sharing resources for health in England'. This presented the first of many formulae for allocating resources to the NHS in England. The Resource Allocation Working Party (RAWP) aimed to overcome historic inequities by ensuring that areas which had been 'overfunded' in the past should 'grow more slowly' than those which had been less privileged. Our critique RAW(P) deals(2) pointed out that if the services did not grow as fast as hoped, this would lead to cuts in the 'overfunded' areas and questioned whether the formula would ensure that the most deprived populations in the less privileged areas would see any benefit. It took the form of a typescript, published in conjunction with the National Union of Public Employees, which duplicated it for us. Demand exceeded supply, and we kept having to make further copies.
After this, we decided that the time had come to initiate debate, rather than just respond to policy documents which had already been published. In 1978, the Labour government set up a Royal Commission into the NHS. We were concerned that this would be used as an opportunity to make the case for changing to an insurance-based system. This led us to write a pamphlet In defence of the NHS (3) attacking the inefficiencies of 'item of service' fees and insurance-based systems, along with private practice. It commended health maintenance organisations as an alternative to this, in the United States context at least. This pamphlet had a professionally designed cover and we paid someone to do the 'paste up'. A few things went awry and we decided that professionally designed covers were a definite asset, but we would do our own 'paste up' in future.
The pamphlet was submitted as evidence to the Royal Commission and was widely circulated and discussed. As with Whose priorities?, we were also invited by Vicente Navarro to turn it into an article for the International Journal of Health Services.
After this, we decided to write a wide-ranging critique of health care policy. Unfortunately this was too ambitious for us and we narrowed our objectives to a guide and critique of the data available. We published the first edition of The unofficial guide to official health statistics(4) in 1980. 'Paste up' was led by Dave Leon, who joined us after long experience on student and left publications. The first 2,000 copies sold very quickly, as did a further 2,000 reprinted the next year.
The early 1980s were a relatively quiet period for the Health Group, although we continued to hold meetings. Other activities called, notably those of the anti-nuclear movement. Unlike many other groups, we did not seek funding from the Greater London Council or the other metropolitan council, which were supporting radical activities. This enabled them to expand their activities at the time, but many collapsed when the authorities were abolished in 1986.
We were finally propelled back into print in 1985 when Norman Fowler, Secretary of State for Social Services, circulated 450,000 copies of a leaflet containing statistics to support claims that the NHS was prospering under the Conservatives. As we could not afford a similar number of leaflets for a rapid response, we chose the 'fanzine' approach to circulate our response, an 11 page typescript with hand drawn graphs, entitled Unsafe in their hands.(5) Following an approach used by the supporters of the Greenham Common women and some less commercial bands, among others, we sent copies to NHS organisations and trades unions and invited them to make as many copies as they liked and circulate them as widely as possible. We also press released Unsafe in their hands and it was quite widely reported, as well as being quoted verbatim in speeches by Michael Meacher and David Owen, the Labour and SDP health spokespeople at the time. It also led to invitations to write articles and give talks.
As a result the group began to grow again and develop the ideas into a new publication, which became the book, Facing the figures: what really is happening to the National Health Service.(6). As well as scrutinising claims about growth in the health service and developments in community care, this looked at specific issues, such as private health care, competitive tendering, increasing charges to service users, prescribing and health education. It specifically concluded that health maintenance organisations were an appropriate response to the excesses of the US health insurance system, but had little to offer the NHS. Word processing had arrived and we sent our discs off to be typeset directly. Graphs were produced separately on Apple Macs. The length of the book, 192 pages, meant that we could not possibly paste it up ourselves, especially as we wanted to get it out before the 1987 general election.
This objective was achieved, just, but the book made little immediate impact during the last days of the campaign, as the press did not have time to digest. By this stage in the campaign, the 'debate' about the NHS was dominated by stories about individuals who had been denied NHS care. The book was widely used afterwards, however, both in policy debates and in teaching.
had a considerable impact on the development of government statistics when it was used as source material for a programme Cooking the Books, in the Channel four Dispatches series. This presented ten examples of misleading use of statistics by government. About half of these were based on Facing the figures and many of the rest came from other Radical Statistics sources. The programme created a considerable stir and prominent feature articles in broadsheet newspapers reinforced its message. These called into question the credibility of government statistics and set in train processes which eventually led to changes in the Government Statistical Service. Not long afterwards, the Royal Statistical Society held a packed meeting on the state of government statistics and set up a working party to look into the problems raised.
In the early 1990s, we moved into a different mode, as we turned our attention to health care rationing, health promotion and the impact of the internal market. We held conferences jointly with the Public Health Alliance on 'The health of the nation' and on rationing. We wrote a number of articles on these subjects in journals, notably the British Medical Journal(7,10,11) and Health Service Journal,(8) as well as contributing more frequent shorter articles to Health matters. More recently, we have looked at the privatisation of the NHS and this has led on into Allyson Pollock's own research on the private finance initiative.(12)
We were also working on a new edition of The unofficial guide to official health statistics. Progress was slow, as contributors were finding that we had less and less 'spare time' as the amount of work required by our employers expanded. In the hope of speeding up the process, a charitable trust funded Sue Kerrison to work on it. Despite all her excellent work, progress has still been slow. We decided to look for a commercial publisher and received a stream of letters telling us that although the book looked useful, it didn't fit in with that company's list. Finally, Arnold agreed to publish it and it is all but finished. Official health statistics: an unofficial guide(13) should be out later this year.
What next? As usual, we are looking for new members with fresh ideas for future activities.
REFERENCES
- Radical Statistics Health Group (1976), Whose priorities? A critique of priorities for health and personal social services statistics in England, London: Radical Statistics, Pamphlet. Reprinted as a journal article in: Radical Statistics Health Group, (1978), 'A critique of Priorities for health and personal social services statistics in England', International Journal of Health Services, 8, pp. 367-400
- Radical Statistics Health Group (1978), RAW(P) deals. A critique of sharing resources for health in England. London: Radical Statistics
- Radical Statistics Health Group (1977). In defence of the National Health Service, London: Radical Statistics, Pamphlet, submitted as evidence to the Royal Commission on the NHS and then reprinted as a journal article: Radical Statistics Health Group (1980), 'In defence of the National Health Service', International Journal of Health Services, 10: pp. 611-645
- Radical Statistics Health Group (1980), The unofficial guide to official health statistics, First edition, London: Radical Statistics
- Radical Statistics Health Group (1985), Unsafe in their hands: health service statistics for England, London: Radical statistics, Pamphlet. Reprinted in Radical Statistics 33 and in Medicine in Society Vol. II No. 2 and then as a journal article: Radical Statistics Health Group, (1986), 'Unsafe in their hands: health service statistics for England', International Journal of Health Services, 16, pp. 298-308
- Radical Statistics Health Group, (1987), Facing the figures: what really is happening to the National Health Service? London: Radical Statistics, Book, 191 pages
- Radical Statistics Health Group (1991), 'Missing: a strategy for the health of the nation', British Medical Journal, 303, pp. 299-302
- Radical Statistics Health Group, (1991) 'Let them eat soap', Health Service Journal, 14, pp. 25-7.
- Public Health Alliance and Radical Statistics Health Group (1992), The health of the nation: challenges for a new government, Birmingham: Public Health Alliance
- Radical Statistics Health Group (1992), NHS reforms: the first six months - proof of progress or statistical smokescreen', British Medical Journal, 304, pp. 705-9
- Radical Statistics Health Group (1995), 'NHS "indicators of success": what do they tell us?', British Medical Journal, 305, pp. 1045-50
- Pollock, A.M., Dunnigan, M., Gaffney, D., Macfarlane, A.J., Majeed, A.M. (1997), 'What happens when the private sector plans hospital services for the NHS: three case studies under the private finance initiative', British Medical Journal, 314, pp. 1266-71
- Radical Statistics Health Group (to be published in 1999), Official health statistics: an unofficial guide, Edited by Sue Kerrison and Alison Macfarlane, London: Arnold
Alison Macfarlane
40 Warwick Road
St Alban's
Herts. AL1 4DL
Tel/Fax: 01727 852111
E-mail: alison.macfarlane@perinat.ox.ac.uk
