The Rise of Incompetence

Somehow, actual competence does not seem to be a requirement for appointment to senior office, at least in the UK.

And I think it seems quite obvious if you look around, or examine most organisations in which you might work or study. Yes, there is the UK Prime Minister as the quintessential incompetent example, but I actually don’t think of any of the front benches as having people I can identify as having shown any competence.

And it isn’t just politicians. A sadly long litany of bankers has shown themselves to be unequal to the demands of their tasks. And I think that University leaders show the same lack of ability to do the work for which they are employed. Is industry well-managed? Well clearly major infrastructure projects aren’t.

Of course, there will be some exceptions, and we don’t see them because they don’t do things wrong, but I don’t think it is rose-tinted looking at the past to suggest that the past was a better place for competent management.

Prime Ministers: Johnson, May, Cameron, Brown, Blair, Major, Thatcher, Callaghan, Wilson. I think Blair (with Brown, perhaps) was possibly the transition, but going backwards from Major is just a different class of competence to our last three. And if I look back at VCs, it seems about the same to me. And all the people that supported them, in the cabinet or Deans etc.

Why? Whose “fault” is it?

Is it the Peter Principle at work? Perhaps a bit, but only partially (and if so. why not before?)

We have allowed ourselves to be seduced by a desire for a bunch of characteristics that mean that people are unlikely to also be competent.

We want leaders who will promise better things, of course, but how? The idea is always radical change. It is never that we could perhaps manage what we do more competently – if you suggest that, you lack “vision”. And that is the word that Really Pisses Me Off – “vision”. If anyone aspires to lead, and doesn’t have “vision”, they are completely discounted. And of course they need a 10-point plan too, which promises to change everything.

Did you notice there was no discussion about being competent to actually achieve the vision of the plan? Who cares? They have Vision.

Quite a lot of this comes out of the MBA world, I think. You can manage an organisation without knowing or understanding anything of its business. It isn’t just that, but it contributes.

The Civil Service used to be able to plug the gap in the leaders’ competence, but because recently the leaders have been so incompetent that they almost destroyed it, the Civil Service doesn’t have anything like the capability to work competently as it used to.

Oh, I should have mentioned targets. No discussion of whether the targets are sensible. How many Covid-19 tests did we need to perform by 1st April? Who cares? We had a target of 10,000, and so the question (to our leaders) is simply whether “they” achieved that. How many tests do we actually need by the end of the month? Who cares? We have a target of 100,000, so that’s all we need to know.

Quite often this is all referred to as “populism”. I don’t think that is right, and dangerously misunderstands, because it is a very deep change; and the intelligentsia (or Notting Hill Set or whatever) are probably more to blame than the rest of the population. They are the ones who promote this idea of vision and plan and organisational revolution and targets. As if that was all that is needed to run an organisation.

Perhaps ironically, it seems that the political system in China is delivering competent leaders in all walks of life, where the UK system has signally failed.

Gove put his thumb on it when he said UK people have had enough of experts; but that should have been taken to mean people feeling that we don’t actually need people who have expertise in running things effectively and competently.

But I think we are seeing that in fact we do, and now when we really need them, and we look around for them, we can’t find any.

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University Teaching

I retired from the University about 10 years ago; last night someone asked me why? I realised that many people have an idealised view of the freedom and even pleasure of lecturing.

Here’s some reality, of how it felt like 10 years ago (it may well be worse now – I’m sure it ain’t better).

Let’s say, a bit ago, you decided, perceptively, that Blockchain technologies were an important topic in Computer Science. So you decided to spend considerable effort informing yourself all about them, and are now a leading researcher in the field. You think the time has come to share this expertise and knowledge with the students at your institution.

So you write a module proposal for the course committee, proposing a module – this will be a fair size document, involving you in considerable work. The course committee looks at it, and decides it is not core Computer Science (there is a lot of competition for core modules), nor does the course need any further, optional, advanced modules.

Oh well. You need to teach something. The second year Databases core module is short of a lecturer: you really don’t know much about Databases, but no one else does either – there are no database researchers in the department. So it may well be that you will be asked or expected to learn another subject such as that, to a deep level, simply and solely to teach it.

However, in your studies of Blockchain, you found yourself needing to learn a lot about cryptography. There is a suggestion that an optional advanced course on Cryptography would be very useful. Not exactly your field, but at least you are up to date in certain aspects of it, and have some interest in it.


Now the real pain starts.

A full module proposal goes in. This will have prerequisites, co-requisites, aims, objectives, details of assessment, and details of what will be taught in each topic of the module. Essentially the whole syllabus. This is for a module in an advanced, fast-moving field that is unlikely to begin in less than 18 months. The proposal goes to the Department course committee for approval (few of whom will know much about Cryptography); then to the Faculty Committee (most of whom know little of Computer Science or Cryptography); then to the University Committee (even fewer of whom know anything of Computer Science or Cryptography). If you are lucky this will all go smoothly, and you may even get some useful suggestions on rare occasions, but if not, there is a whole bunch of work and then you restart the process.

Wahay! You have an agreed task in your work. You can now embark on it.

So what will be the next thing you need to do?

Write the exam paper. Yup. That is what will be demanded from you, long before the module starts. You know that interesting conference you were going to next month where you will be finding out there is an exciting new topic in cryptography? Sorry mate, you won’t have the pleasure of fitting much of that into the module – it isn’t on the exam paper and certainly isn’t in the syllabus. Maybe you can submit a revised syllabus for the following year, but the deadline will probably pass before you can, and it will be two years.

Oh, and any assessments too will be required too.

The exam paper and any assessments will of course have to conform very closely to what the appropriate committee has decided these things should be, probably along with “model answers”, for what should be open-ended questions in an advanced topic. They then go off to an external examiner for comment, who may or may not know anything about Cryptography. And you are well-advised to take action on any comments from them.

I should have mentioned that, before you can do the exam paper, you actually need to study the subject more! You aren’t an expert in cryptography. Although you know about certain aspects of it in great depth, for the subject as a whole, as required for teaching, you need to have a far greater breadth of knowledge than you had. So the request for the exam paper is likely to precipitate a frantic period of study and late nights, while you dig in to all those nooks and crannies that were not relevant to your Blockchain needs.

Finally, the need to actually have the module content ready to deliver becomes pressing, although you may by now have lost all enthusiasm for it, and in fact your research focus may well have moved on in the years since you first started the process. There is an expectation that you will provide notes on all your lectures for the students. You can probably get away with finalising these as you go along, but you will need to do them. Were you thinking you could just go into the lecture theatre and talk to the students excitedly about the material, while those who wished to could take notes? Think again. If you don’t provide detailed lecture notes for them, the students will moan – probably not too badly. But also, you will get pilloried by the multiple Quality Assurance (QA) processes that are coming at you like a speeding train down the line.

Finally(!), you get into the lecture hall, with a bunch of students. You aren’t really teaching what you wanted, nor is it the subject in which you feel the most expertise; but you are going to have the enjoyable contact with a bunch of smart people, who are keen to learn from you.

Of course, it doesn’t always work like that, but if you work at it there is a good chance that you can enjoy the interaction with the perhaps 200 people, many of whom are most concerned to ensure they know exactly what the syllabus is, so they can work out what is in the exam, so that they can get the marks. And you can forget any ideas you were taught in the training about discussing the choice of material with the students – that’s all fixed. But that’s OK. This is what it is all about – you got there.

However, now the rest of the pain starts.

A brief mention: assessment. You will possibly have some coursework to mark. You will certainly have exams to mark. Let’s look at the time on exams. Each student should answer three questions – most do, but maybe not all. So 200 students provide about 500 answers to mark, and remember these are in an advanced topic, which should need some thought, if the questions are any good, and you want to be conscientious. Were you to spend two minutes marking each (including all the mark processing, second marking, moderation, exam boards etc.), that’s 1000 minutes. Compare that with how much time you spent in the classroom! 20 lectures of 50 minutes each. Ah, that’s 1000 too. So just marking the exams can take you as much time as the entire time you spent in classroom contact. Really?

Oh, and timescales. 1000 minutes is over two days marking. The time between a final year exam and the marks being required from you can be a small number of days. However, this will not be the only module you are teaching! And there will be individual and group projects to mark in addition, with viva voces. And you are still doing the rest of your job, managing research projects, supervising postgraduate students, sitting on committees, giving lectures on other courses. And acting as an external examiner at another institution. Double shifts and missing weekends are all in order.

I mentioned QA. Sometimes it feels like university life is nothing but QA.

For teaching: there is QA from the University; QA from the professional bodies; QA from the Government.

In my case we had:

  • University QA – the University would periodically send a team in;
  • BCS (British Computer Society) accreditation – because the courses were accredited by this professional body, a panel would come and crawl all over everything;
  • IET (Institution of Engineering and Technology) – another professional body that does the same;
  • TQA (Teaching Quality Assessment), now the TEF (Teaching Excellence Framework) – the government activity to do something similar to OFSTED, for universities.

Since these visits are on a 3-5 year cycle, barely a year goes by without one of these visits, potentially stressful for all concerned. I recall having three in one year.

Each involves something similar to an OFSTED inspection, I understand. Every module is examined, all the department processes on teaching are reviewed, staff are observed, and students are interviewed. Most of it is about processes, as I recall:- less than 10% of the QA assessment is concerned with actually what happens when lecturers are talking with students.

I think I may have given some sense of why I was happy to retire; while regretting deeply that I get no more contact with smart young people who were often eager to learn from me.

Remember: The whole of this edifice is just for a single module, which constitutes around 20 lectures of 50 mins each. It is likely that each minute of contact time involves more than that in preparation time – remember that this is an advanced module, which is not being taught in this form anywhere else in the world, and you are teaching it for the first time, essentially creating a book of lectures notes to go with it. As discussed, you will have to spend more than twice the lecturing time on non-content, non-contact activities. And that is not to count the time that you spend on those activities in support of others’ modules.

And also note: The teaching activity only represents perhaps a third of your employment duties. Despite all these requirements, and the constant and detailed QA, you will never find yourself deeply valued in the system for excellence in teaching.

The only thing you will be judged on, and will cause career progression, is your research. And that has its own administration, a different, separate QA, etc. etc..

And there is the other third of your duties – administration (and scholarship?), which also has its own, different, separate QA etc..

You may have formed an opinion about whether this system is sensible. Is it delivering the best experience for students? Is their learning time being exploited efficiently? Do they get good value? Is it the best way to spend some public funding? Are universities being nurtured and growing as centres of scholarship for the next millennium? I have only commented on how I see it from a staff point or view.

And I’m well out of it.

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The Latest Alcohol Study and a Report on it.

Sigh – I’m sort of even pissed off that I feel the need to comment 🙂

BBC: No alcohol safe to drink, global study confirms

based on:

The Lancet: Alcohol use and burden for 195 countries…

So what’s wrong with this?
Some things in pretty random order:

This study doesn’t even seek to answer the question of whether alcohol is good or bad for you!!!, as implied by the BBC report

Yeah, that’s right. Despite what the article might be suggesting.

It’s about population health, which is quite different. It is about what “burden” alcohol might put on the health of a country/society.

So, for example, if alcohol use increases the risk I might cause someone else to be hurt in a car accident, that counts towards the statistics.

And all the statistics are worked out against this objective.

There’s a lot of violence

As with almost all the similar studies I have seen, a serious part of the negative statistics comes from an increased correlation with the results of violence:- car accidents, interpersonal violence, self-harm and increase in communicable disease.

OK. Fair enough. But this is not what people understand about “health problems” I would suggest.

What is missing?

A hard thing to do with this sort of research is to work out how the whole thing might be flawed, as opposed to examining the details of the research. In this case, the big question to ask is what is missing; and it turns out there might be quite a lot.

If the authors can take such care on the input side to include tourism and even home brewing in the consumption of alcohol figures, surely they can take care to include all the stuff on the output side?

How about other illnesses that might be affected by alcohol? Maybe ME/CFS/PVF? Does peoples’ experience of MS change? And are there other physical illnesses that should be included? But the big one…

What about mental health?

At first sight the authors look like they have tried to characterise all possible adverse or positive health-related issues that might be affected by alcohol.

It has to be that mental health has the possibility of being an important factor in the increase or reduction in the “burden” of alcohol? Mental health problems can be utterly debilitating and disabling, and surely should contribute to the “disability-adjusted life- years (DALYs)”.

For example I find no mention of “depression” or “anxiety” in the entire paper. These illnesses have enormous cost to society, and any increase or reduction in them might even swamp all the other considerations. I would love to know similar research to this around these illnesses.

It is enormously sad for me that such a paper can be peer-reviewed and published without reference to mental health; are we still in a world where the only “real” illnesses are physical? Yes, the paper mentions “self-harm”, but that just makes it worse: the pain of mental illness is seen through the lens of people hurting themselves physically, rather than the pain they are feeling.

It’s not a big number

I can’t see it in the Lancet paper, but the BBC article says:

“They found that out of 100,000 non-drinkers, 914 would develop an alcohol-related health problem such as cancer or suffer an injury.

But an extra four people would be affected if they drank one alcoholic drink a day.”

(Edit: David Spiegelhalter’s excellent Medium article tells me that it is The Lancet press office that published these figures.)

Let’s just ponder that for a moment.

Almost 1% of non-drinkers will have a problem. That’s perhaps quite a lot. Or maybe it isn’t – I don’t know; people do get cancer, beaten up or fall.

Now, if all those 100,000 people decided to drink one unit a day, an extra 0.004% of them will have a problem. That is definitely not quite a lot.

And note that it includes violence (see above).

Another way of looking at it is relative risk, which the paper is hot on.
My (ignorant!) calculations suggest for these figures it is a Relative Risk of 1.0044, which actually corresponds pretty much to what I can see in the graphs.

This might be a significant figure when aggregated for a nation (although actually I think not, especially given the error bars (see below)), but is definitely not the sort of level at which I suggest people should be making life choices!

Correlation is not causation

Maybe I have missed something in the paper and appendices, but I can’t find out where they tackle this for some things.

They seem to say they account for possible confounding stuff in the area of the abstainer because they are ill. But do they for everything?

A statistical correlation between alcohol use and self-harm, for example, seems particularly difficult. Does self-harm cause increased alcohol use? Probably not, but then that is as likely as increased alcohol use causing self-harm, in the absence of other information. I don’t see any evidence that the authors tried to filter for confounding variables around these.

And remember that violence is a serious part of many of the statistics, so this is potentially significant.

It’s not really a “new global study” – it’s a meta-study of existing research, and doesn’t contain a single new measured value

I can’t even find out whether they have discarded any of the studies as being unreliable. If not, this is the worst sort of meta-study. A proper Cochrane Collaboration review would have discarded the majority of the studies they found as not meeting the criteria for inclusion.

As I said, I can find no evidence that they discarded a single study as being unsatisfactory.

This may well be “big data” at its worst.

It’s a “Global” study – but the data is very location-dependent

Tuberculosis is a significant number in many of the graphs, and so presumably is a significant influence on the headline numbers. I have to question whether this means that any inference can made at more local level, given the variation.

India (and many African countries in particular) has a TB level orders of magnitude greater than the countries that might be trying to use these statistics to direct health care.

UK: 0.01%, US: 0.003%, India: 0.211%, China: 0.064% (UK gov figures)

They even extrapolate from the USA to the rest of the world

RTAs (Road Traffic Accidents): They say they can only get statistics for the effect of alcohol use on RTAs for the USA, and so “Because of data availability, we assumed that locations outside the USA would follow a similar pattern to what we estimated with FARS” (US Fatality Analysis Reporting System)”

Really? You might have tried to be honest, but can we assume that Saudi Arabia, Japan or Turkey have anything like the same patterns, no matter how hard you try? And the USA has an RTA death rate more than three times the UK’s – can the patterns really be assumed to be similar?

“car crash involving alcohol” becomes “drunk driver”

Deciding on whether alcohol (or speed) is a genuinely contributing factor in an RTA is notoriously difficult. The FARS data is simply reporting whether alcohol was “involved”, not whether it was a contributing factor in the death. Although the authors may have allowed for this, it is hard to tell – are there confounding variables they are ignoring?

And as far as I can see (Appendix 1, Section VIII), they simply use “Driver BAC >= 0.01” as the criteria. And the fact their terminology moves smoothly from “alcohol involvement” (which of course it might not actually be) to “drunk driver” in the figures’ captions deeply undermines their claim to objectivity, in my eyes.

There are huge error bars in almost all the figures

I think the only reason that the authors can even begin to say anything with any confidence is that they have so many studies. In effect, however, they can only do this if they consider each of the studies as separate “experiments”. But can you? Many of these papers will be using similar, possibly flawed experimental methods, and who knows?, some of them may even be re-using the same data!

This is particularly true at the low end of alcohol consumption, which is where all the attention is likely to be focussed.

The consumption scale is too coarse

Looking at the graphs, it seems that many of them only do curve fitting at integral number of units per day, and others only half. This really doesn’t give me confidence that the graph fitting they have done at the lower end is valid. There could easily be more J-curves hiding in there, or certainly other interesting things.

Figure 3 from the main paper is really strange on this. “Ischaemic heart disease” (both) are very angular, and clearly only fitting curve points at integral values. Whereas “Diabetes” (male) has a point at 0.5 which gives a very strange angle.

It doesn’t actually address costs

If this is for forming public policy (which apparently it is), then it should actually be about costs, rather than “alcohol-attributable deaths and disability-adjusted life- years (DALYs)”

Perhaps the cost of different problems is different? I know that treatment for diabetes and its related problems, such as the need for limb amputation, can be very complex and expensive to both health and social care. Given that alcohol use seem to be beneficial in reducing diabetes (good news, especially for women – possibly up to five units per day is still better than none!), maybe the reduced cost is sufficient to outweigh all the other problems. Who knows? The study makes no attempt to address this issue.

Good news?

I am guessing/hoping the authors have tried very hard to be honest, and would be able to satisfy all my concerns if they were asked. And indeed they discuss these and other limitations. But at the moment I am left with considerable unease as to the real value of these statistics, and concern they will be used to drive public policy decisions based on unreliable data.

And I have to repeat that the lack of a mental health angle is deeply worrying, We have all heard people justifying drinking on mental health grounds! Surely we need the science on this, so that assertions on the benefits of alcohol to mental health can be challenged or supported? I am left worrying that the reasons that this is missing, and that I can’t easily separate out the violence from other issues is because the authors sense or even know that the results would be other than they would like.

Mind you, I think it is quite a good paper – well-written, and it enabled me to see a lot of what they were doing!


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My Experience of the Privatised NHS is crap

So it seems it is often accepted as given that the patient’s experience is improved when NHS services are delivered by external contractors.
And there are all sorts of issues to do with money and stuff, which I will ignore for now.

But, having just waited more than 20 minutes on the phone to get an answer from such a contracted company, I thought I would rant about how the whole experience was worse than I get from the “normal” NHS.

My GP referred me for ENT investigation.
I ended up being invited for a consultation with someone from something labelled as “Community Outpatients”. It is not immediately obvious that this is a private company, especially given the name, but it is.
I had the consultation; some treatment was prescribed, along with a CT scan.
The CT scan was at RHCH (Winchester NHS Hospital). That was amazing:- the whole visit and scan was executed so quickly that I didn’t pay any parking charges because I was in and out in less than 30 mins., including the scan itself and walking the length of the site twice.
I then had another consultation with Community Outpatients (by telephone, in fact, but that isn’t unusual nowadays, my GP does that), and was told they were recommending I look at having surgical treatment.
So I have now been referred (you guessed it) back into the maintstream NHS to see a consultant at the RHCH.

So what has happened?
Privatised service: I will have had three consultations with three different consultants, and then an operation scheduled. And they can’t even answer the phone in a timely manner, or provide the records I need, by the way.
Non-privatised: (Typically) I would have two consultations with the same consultant and then an operation scheduled. And I can get through on the phone.

OK – not *such* a big difference, but the point is that it is different, and *worse*, not *better*.

And what really pisses me off, of course, is that my worse experience has cost the NHS *more* money. At the minimum, they have had to fund an extra consultation.
In fact, they will have also put some profit into someone’s pocket. I accept that Community Outpatients has managed some stuff, and therefore can be paid for management as well as the clinical stuff, but they are actually a big business making a chunk of profit from my taxes that are funding the NHS.

If you want to know, they are one of a number of subsidiaries of Concordia Health Holdings LLP, which is owned by two Mr Hurds from Nottingham, and which had a turnover of over £18M in 2016, with a gross profit of over £6M.

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“It’ll be alright”

And yes, I mean Brexit.

I heard this yet again the other night from a street interview on TV: we might have a bit of short term economic disruption, but it’ll be alright after that.

I mean, where does the come from? Since when did the the future of me, my children and grandchild(ren) depend on some vague conviction that “it’ll be alright”, without any decent study of the processes, and attempt to understand?

Being an old fart, I see this as part of the decline of society, and it isn’t just Brexit, of course. I have a sense that Trumpism is the same. People can’t be bothered (or don’t want to) think about and try to work out what will happen. They want something to change, and vote for something to change, and just do, confident in the ‘knowledge’ that “it’ll be alright”.

I suspect that the same is true of many of the credit bills being run up – I don’t have the money now, and I don’t know where it will come from in the future, but “it’ll be alright”. Although I have no evidence for that.

So what is going on?

Is it anti-intellectualism – we can’t trust those experts? I’m not so sure.

I have a feeling it is just that the world feels so complicated, that any attempt to actually analyse and predict just feels so hard, that it feels like it isn’t worth trying. It is much easier to believe that “it’ll be alright”, and just go with the flow.

Only, of course, the future won’t be like you want it to be just because that’s what you want.

I am reminded of when I used to play chess as a 12 year old, and why I stopped playing. It would get to the complex middle game, an hour or two in, and I would make a big mistake. I worked out that what happened was that I had been sitting looking at some difficult combination for a while, and it just got so hard, that I would just say to myself “Yeah, I think this move is OK – what could go wrong? Anyway, it’s only a game.” A few moves later I would have discovered what could go wrong, when I lost a piece, or whatever. This meant that I had to grind on for another two or three hours trying to rescue a draw, when what should have happened is that I won.

This is, I think, what is happening with Brexit and many other decisions being made – and, unfortunately it isn’t just a game.

And here’s some more from later:

In technology, the government is pathetic with this.
1. Let’s ban end-to-end encryption. But e-Commerce will die. Oh, it’ll be alright, someone will solve the problem.
2. Let’s have a backdoor in mobile devices. But it will put everyone’s data at risk. Oh, it’ll be alright, someone will solve the problem.
3. Let’s require ISPs etc. to log everything. But that puts peoples privacy and human rights at risk. Oh, it’ll be alright, someone will solve the problem.
4. Let’s require all porn sites to verify the age of uses. But all sorts of things might go wrong and are unpredictable. Oh, it’ll be alright.

And, as Steve Harris said, what about climate change, population growth, the end of high levels of employment.

I think what really pisses me off about it is the utter and outrageous irresponsibility of it all. The population elects people to spend their time understanding the consequences of actions. That is what they have to do. And so many just completely renege on the deal.

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Headline Statistics

Baby teeth removals ‘up 24% in a decade’
These bloody statistic things really piss me off.
They quote a big headline figures, and then make it difficult to work out something sensible.
For your information: allowing for the 16% increase in the UK (0-4) population over the last 10 years, I calculate an increase of 6.6% (of the order of 550 extra for the whole UK, by the way – that’s a couple of extra kids in the whole of Southampton, I think.)
And since they mention it, they clearly thought it might be relevant, but don’t bother to work it out.
Of course any figures are not nice, but 7% is a loooong way from 24%.

And it is the Royal College of Surgeons‘s fault – their press release is the offending document.
As so often happens, they create the biggest nonsense figure they can think of and then put it in the headline.
It would even have been natural to put the sensible (population-normalised) figure in the table in their Note 3, but they chose to leave it out.

Actually, there is possibly a really interesting story here.
It turns out that much of the increase is in the last 5 years or so. Could it be that in the post-2008 financial climate, people in general are not going to the dentist? Ah, you might say, but children are free. Yes, but recent reports suggest that children aren’t going to the dentist because their parents aren’t.

By the way, the same organisation’s Report on the State of Children’s Oral Health is much more sensible than the press release. It says:

However, it is not immediately clear why the number of hospital admissions for children with dental caries is increasing. One possible explanation is the similar percentage increase in the birth rates of these children, but there has not been a significant change in the level of treatment for children with dental caries in primary care. Other explanations could be that children are not being treated appropriately in primary care, or they are seeking dental treatment when the caries is already at an advanced stage so must be referred to specialist services. Alternatively, it could be that preventive measures such as moderating the consumption of sugar and/or brushing teeth are decreasing.

One final comment – in 2000, Department of Health changed its recommendation about general anaesthetic, saying that it should only be done in hospital, due to safety concerns. It is always interesting to think about what other policy changes might have contributed to statistical changes. For example, it may have taken a while for the advice to be implemented, or maybe that has contributed to a change in dentists’ behaviour, in that they are more likely to recommend extraction in a hospital than extensive other work in the surgery.
7% (of the order

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