Portaloise – the HIQA report

Mother and Child - Photo by Aaron Kraus CC BY-NC-SA 2.0

Mother and Child – Photo by Aaron Kraus (CC BY-NC-SA 2.0)

The widely leaked HIQA report into Portaloise Hospital is out now. The various pieces can be downloaded from www.hiqa.ie

The context is well known, serious failing in maternity care in Portlaoise, identified by a great team of reporters from the RTE programme PrimeTime investigates, and detailed in a very clear, and very explicit,  report from Tony Holohan, the CMO.

Continue reading

DOCTRID conference – selected notes

I’m just back from the fourth DOCTRID conference  in Belfast. DOCTRID is the research arm of the Daughters of Charity. It funds and oversees research in the field of ID and autism by bringing experts from medicine, social science, education, computer science and engineering together. DOCTRID was established in 2010 as an international, interdisciplinary coalition of universities, service providers dedicated to improving the quality of life for people with Intellectual Disabilities (ID) and autism through research and technology.

Continue reading

Primary care and the new GP contract

The new GP contract  was the subject of much debate and discussion at the IMO AGM over the weekend, and the members have supported it. There are more details of the draft contract on the IMO website, but all seem to be in the members-only section. (As I’m a member I can read them, but I don’t think it appropriate to share more widely). The council of the other main GP representative body, the  NAGP, met on Sunday, and are reported as having rejected it unanimously. What is going on?

Continue reading

Adoption and same-sex couples – some evidence

In the light of recent discussion on the Child and Family Relationships Bill, and some issues raised by the referendum on marriage equality, I have looked at recent evidence on the outcomes for children adopted by same-sex parents. The short version is that there is no evidence for worse outcomes in children adopted by same-sex couples. My judgement is that there is enough evidence to support equality in adoption for same-sex, and heterosexual couples. I believe that the onus is on those who argue against allowing adoption by same-sex couples, to to produce the evidence to support their case. In a future post I will look at the wider evidence on children raised by same-sex couples.

Continue reading

‘On Wednesday We Wear Pirate Hats’ The BT Young Scientist &Technology Exhibition and the state of younger people in Ireland

I was lucky enough to be one of the judges at the BT Young Scientist’s exhibition in Dublin in the first week of January. This gave me two rather different opportunities to see Irish school children. First, I got to meet the people who put in projects. These included the eventual winners, Ian O’Sullivan and Eimear Murphy from Cork, and about forty other people, all aged between 12 and 18, whose group projects, all entered into the Social and Behavioural Sciences section of the exhibition, I got to judge. (Every single project gets judged three times, independently, and those in the running for prizes are reviewed by further judges.)

Continue reading

HSE Service Plan 2015

The HSE Service plan is out today, and you can read it here. I’ve just finished reviewing it for the Pat Kenny show on Newstalk.

Some key points

  • Some money to reduce waiting lists in acute hospitals
  • Some money to support moving patients out of hospitals in to home care or long term care
  • Hospital groups to happen
  • Palliative care service in the Midlands for the first time
  • Better access to diagnostics for GPs – ultrasound now, more services in 2016
  • Some increase in spending on disability services and mental health
  • 0.7% increase in spending from 2014 outcome
  • New use of balanced scorecard methods to hold managers to account
  • More investment in ICT

Continue reading

Have your Say in Ireland – Seanad Éireann

The next Seanad will be elected, most likely in June 2016, in the same unsatisfactory way as the current Seanad. Most of the senators will be elected by the votes of local authority members, and members of the Dail. The Taoiseach will appoint eleven senators. Six members will be elected, most likely as at present, three by graduates of TCD, and three by graduates of the NUI. There is a slim chance, if the bill on electoral reform is passed very quickly, that six candidates will be elected by graduates of all higher education institutions (HEIs) in the state. Unfortunately, given that the next election has to happen by the end of March 2016, at the latest, it looks as if even this modest reform may not happen in time.

What can we do to make the best of this bad lot? The only part of the Seanad that has any shred of democratic legitimacy are the two third level panels. This is far from perfect, with a very restricted franchise, but it is the best we are likely to have in time for the next election. It is also the only place where Irish citizens living outside Ireland can influence Irish elections, and it might form the seed for more effective Seanad reform after the next Oireachtas elections.

If this is to happen, I think we need to get as many people as possible voting, and that means encouraging people to register for their votes, and use them. The Seanad electoral register closes on February 26th, and will be used from June 2015. The only requirements are that you must be an Irish citizen, and you must have graduated from the NUI or TCD.

From today, November 2nd, there are 116 days to go. Please help me to get the word out. I’ve set up a Facebook page for this at http://www.facebook.com/HaveYourSayInIreland.

Trinity graduates

Full information about the Trinity Seanad election and the electoral register is here. Short version, you have to fill in this form, sign it, and post it to Student & Graduate Records, Academic Registry, University of Dublin, Trinity College, Dublin 2. It must be received by Thursday February 26th, 2015. You may not email it.

TCD degrees

Most eligible graduates attended Trinity, but there are also many DIT graduates who have TCD degrees. I’m not aware of any other such institutional links. Please let me know if I am missing any. Please note, you have to be an Irish citizen to vote, but you do not need to be Irish resident.

NUI graduates

Full information about the NUI Seanad election, and the electoral register is here. Short version, you have to fill in this form, sign it, and post it to National University of Ireland, Records Office, 49 Merrion Square, Dublin 2. It must be received by Thursday February 26th, 2015. You may not email it.

List of NUI colleges

The list of NUI colleges is longer than you might think. Besides the obvious, UCD/UCC/NUIG/NUIM, it includes RCSI, NCAD, the IPA, Milltown, and the Shannon College of Hotel Management. Some graduates of other institutions are also eligible, depending on exactly when you graduated – these include Mary I, St. Pat’s Drumcondra, NIHE Limerick (but not NIHE Dublin), Thomond College, and St. Angela’s. A full list is here. Please note, you have to be an Irish citizen to vote, but you do not need to be an Irish resident.

Funding universities – newish ideas from the IEA

There is an admirably bonkers new paper from Peter Ainsworth of the IEA with the title “Universities challenged: funding higher education through a free-market ‘graduate tax’”. I’m obsessed, amongst other things, with ways of funding higher education, so I read it cover to cover.

Some background first, as many people will not be familiar with the IEA. They describe themselves as a think-tank whose members, “all those associated with the Institute support free markets – though with different “schools” of free market economics being represented”. Their official history begins with a quote from John Blundell, their former director-general thus “Hayek advises Fisher; Fisher recruits Harris; Harris meets Seldon. In nine words, that is the start of the IEA.” This gives a pretty good idea of their perspective on the world. It isn’t mine.

The report itself, a concise 52 pages, has a good deal of useful material. There is a very good summary of how the UK got to their current situation, where a student loan scheme, intended to reduce Government payments to Higher Education, is now likely to cost more than the direct grant system it replaced. There is a very lucid analysis of the different economic perspectives of students, higher education providers, and the state. There is also a good description of the various perverse incentives in the current system in the UK. There is nothing on the perverse incentives on other countries, for example the US. There is less on the perspective of the families of students, but this is, I think, a relatively minor omission. There is a good review of the graduate premium to earnings, with useful data showing how it has varied over time, and between disciplines. There is particular emphasis on the variation between individuals in this premium, and the consequent uncertainty about investing in Higher Education.

Ainsworth’s key idea is this ” Universities should individually or collectively offer contracts to their students, who would agree to pay to the university they attended a given percentage of their [future] earnings. That percentage could vary by course and institution, though some agreement between universities could be helpful to achieve standardisation. Essentially, the university would be taking an equity interest in the graduate premium earned by the student, although any student who chose to do so could, alternatively, pay the full fees up-front prior to beginning their studies.”

He suggests that, based on a few models around the world, this might be between 4% and 10% of their income over a certain level, for a number of years, and that these payments should receive tax relief. This would be a private contract, and, as such, universities could securitize the earnings.

What’s right with this idea?

  • It could do a good job of aligning the economic interests of students and universities. Presumably institutions whose graduates were of very poor quality, as perceived by employers, would do badly. There would certainly be a strong incentive for universities to give students access to skills and competences, rather than information. Some of these would be specifically vocational, and others more generic.
  • Higher education would be free at the point of use, at least in the sense that there would be no upfront fees. These are, to say the least, a disincentive to poorer students. Ainsworth suggests that the state might choose to provide maintenance grants to support some students at university.
  • It would do a very good job of sharing the risk in choosing to do higher education between the students and the university, with the university taking all the downside risk – i.e. the student never gets a high enough salary to start paying.

What’s wrong with it? Ainsworth does try to address several challenges, for example, there would be an obvious incentive for universities to concentrate on subjects with a high graduate premium – putting less vocational course at risk. Such courses could instead be state supported, as a matter of public policy.

I see some further serious objections, which are not fully considered.

  • Incentives to select students – there would be a huge incentive to the university to cherry pick students, and I foresee a large premium on very low risk people, for example white male students from UK ‘public’ schools (i.e. private schools in other countries). Students with disabilities would be a significant risk to the university.
  • Incentives to select the courses provided – many universities, including all those I’ve worked in, provide courses which are actually uneconomic, or at best very very marginal. We also do a lot of experimentation, running course for a few years to see if they meet a need. These courses, and the associated innovation, provide a wider range of choices for our students, and support a wider range of voices and perspectives within higher education. I doubt that targeted government subsidies would, or could continue to support these.
  • Cost – the cost of collecting these funds is not discussed, apart from a suggestion that universities might get together to do it, or set up a common organization to collect the money. This is not unreasonable, but I suspect the costs would eventually eat up a sizable fraction of the money collected, perhaps 20% or more. The cost of collection is a critical part of any higher education funding system.
  • Risk – bringing in such a scheme is fraught with risk. There would be very large uncertainties, which would put at very serious risk any but the most well endowed (i.e. highly capitalized) of higher education providers. The education system requires fairly stable funding, if it is desired to provide a stable education. A reasonable estimate is that is takes 5 to 6 years from the start of development, to the first graduation of student from a new 4 year degree program. It might be another decade before the graduate premium from such a program could even be estimated. It would be very hard to make a business case for such an investment. The transition costs of any major shift in education funding are large, and are not considered by Ainsworth.
  • Feasibility – Ainsworth argues, on the basis of a number of examples, that such a scheme is feasible. The examples he gives are for small scale, highly targeted schemes. I’ve reviewed each of them, as best I can, and I remain very dubious of the ability to scale such ventures. One important example, CareerConcept AG seems to have had no media activity since 2011, which is surprising. Lumni looks much more promising, but has still only covered 5,000 students in four countries since 2002.

In short, I think the IEA report well worth reading, but I do not think that the proposals in it are feasible, desirable, or affordable. The UK desperately needs a better system of funding Higher Education. This isn’t it.