Hello. Just a very quick one today, as time is very tight. The FT reports that shadow chancellor George Osborne accepts that there will be greater variation in public services under a Conservative government.

That’s nice. Tomorrow he may admit to the existence of gravity. On Sunday, we may hear that the Earth is round.

Worrying about public sector variation is all too often a proxy for actually thinking about what the goal is. This is not to suggest that variation does not matter: it does, hugely, as Professor Alan Maynard of this parish has spent most of his career pointing out to anyone who will listen. Which remains, sadly, a smaller cohort than it should be.

The question is more usefully framed about what constitutes acceptable variation. It relates to the crucial concept of efficiency – buying as much output of the kind people want and need for the tax pound. But it also relates to equity, and more precisely, the right kind of equity.

There is a concept of mathematical equity, where the goal is for everybody to get the same. In practice, this will lead to levelling down; poor financial control (as overspenders get bailed out by the prudent); and a reversion to the mean – statistically and metaphorically.

Unacceptable variation relates to ineffective or deliberately inadequate measurement of activity and outcomes. The NHS has gradually been moving in the right direction, towards greater use of measurement

Yet the recent methodology wars between the DH and Dr Foster Intelligence show that even a really basic, fundamental metric such as mortality rates is contested. When in doubt, dispute the data.

Social care debate bangs on
You will already have seen the Kings Fund’s recommendations on social care funding, which proposes “a ‘partnership model’ … the state guaranteeing to pay 50 per cent of everyone’s care costs and matching every £2 contributed by individuals with a further £1”.

Now The Times has an authoritative-looking leak about Labour’s proposals.

Watson and Rose suggest that “the idea of having compulsory payments to fund it — caricatured as a £20,000 “death tax” by the Conservatives — will be introduced only gradually and could be held back for at least five years”. They also write that the Conservatives will “boycott any such discussions while a compulsory option is still on the table”.

So this won’t be solved any time soon.

And finally …
Have a look at this excellent article from Paul Hodgkin of the very fine Patient Opinion on how the ‘new economics of voice’ will change the NHS.

Have a good weekend.