When, on 12 June, Elon Musk made Likes on X private (so that only a post author can see who likes their post) this seemed like a small change. But small changes in complex systems like X can have big, unpredictable effects. 1/7 What the change means is that if you like a post, no one can see that you've liked it (apart from the poster). This increase the likes posts get. 2/7

The argument that’s often made for why we need an alternative model to the NHS or radical reform is that the NHS is unsustainable. The latest to make the argument is Sajid Javid. But *is* the NHS unsustainable? A Friday🧵 The NHS is said to be unsustainable because (1) spending on it, as a share of our national income, is rising each year and (2) (obviously) that can’t continue forever.

BBC reports that excess deaths in 2022 were among the worst in 50 years. This is based on a crude comparison with deaths in 2019 (9% more) – not adjusting for changes in population size and age.

But there are other (in my view better) ways of looking at excess deaths/mortality. The respected Institute and Faculty of Actuaries' Continuous Mortality Investigation tracks excess mortality based on past mortality rates by age and sex. It has just published its latest update covering the whole of 2022. @COVID19actuary @ActuaryByDay

Yesterday the govt announced £200m to get 2,500 people who are medically fit for discharge out of hospitals into care homes. The policy has been criticised by social care experts. I’ve been trying to make sense of the numbers. 13k people on average are in hospital fit to be discharged. Policy aim is to provide alternative (care home) for 2.5k of these people between now & Mar. That’s 2.5k x 80 days = 200k days of care. £200m is therefore around £1000 per day of care. That’s a lot – even for a care home

Overdue 🧵on social care charging reform. It's been more than 2 weeks since the govt announced delay, but I wanted to let my anger and frustration settle. I’ve spent much time & energy working on this issue so here are my thoughts. 1/22 The autumn statement delayed social care charging reform (the cap on costs & more generous means test) again. The Treasury, with cover from local govt, has again triumphed at the expense of vulnerable people.2/22

Long ambulance response times and their devastating impacts on patients and families are frequently in the news. We wanted to get behind the stats and take a whole system view. A🧵based on our new analysis, which featured in a powerful ITV report last night . 1/13 First, a reminder of those response times stats. Category 1 incidents (life threatening): 7 mins pre-pandemic now 8.5 mins. But cat. 1 rightly prioritised so much bigger increases for other incidents. Cat. 2 emergency (e.g. stroke) up from 22 mins to 41 mins (target=18 mins) 2/13

The NHS/govt sees the independent (private) sector as a way of expanding capacity for the 6.5m (and growing) NHS patients waiting for hospital treatment. A🧵on what’s been happening and implications. 1/10 Let's focus on treatments requiring hospital admission (rather than outpatient treatments). First thing to note is that overall number of treatments is still 14% down on pre pandemic numbers (the govt aim is to be 30% higher). 2/10

Deprived areas have experienced many more deaths from Covid than richer areas. As vaccines are being targeted to reduce mortality you’d think that this would mean that more people would be being vaccinated in deprived areas. (1/5) But as a consequence of the approach being taken, the most deprived areas may currently be vaccinating *fewer* people than richer areas. This is because they have fewer over 80s – the group who are being vaccinated first. (2/5)