Medical history is full of bizarre and gruesome procedures. People have received milk transfusions (milk being the perfect substitute for blood); skulls have been drilled (to relieve pressure and cure headaches); and toddlers have had their teeth cut (to prevent infant death, which often came at the same time as teeth). The list is as long as it is horrifying.

A workshop with Prof Angie Hobbs exploring the ethics of decision making for clinical leaders.

What should decision makers do with analysis that challenges deeply held assumptions? In this blog, Fraser Battye reflects on a surprising recent finding about community services.

The first effect of policy is on expectations. In every case I can think of, the effect is inflationary. And policies created on the promise that payments can be linked to outcomes are a stand-out example. In this case, the hype – delivery gap is more like a tectonic chasm. 

It’s difficult to be precise, but the decade after the election of the Coalition Government in 2010 probably saw the peak of enthusiasm for policies based on this approach. 

“Dad, why are all your ‘peptalks’ about death?”

Children can be a source of fundamental insight. They seem to specialise in feedback of the unvarnished, unmediated and fully caffeinated variety. The kind of feedback that cuts straight to it.

My youngest daughter, mid-way through our sunny walk down the hill to school, pressed on:

“And you wear black all the time. You look like a crow…”

Fundamental insight, and now fashion advice. This was quite the school run.

In our recent paper we explore why levels of care continuity have been declining and what might be done to turn things around.