Status-Q

Looking back

Ah, nostalgia! I've been looking back at the first messages I sent right back in 2004 using the latest hot new web phenomenon: a beta version of the recently-announced GMail. (I had a friend who had a friend in Google, so got an invitation fairly early.)

They are mostly examples of literary brilliance such as:

Subject: Quick Test of Gmail

Let's see how it works.

But later that day I had settled down a bit. Here's an extract from a message I sent to John:

It's a very nice webmail system, with an unusual amount of storage available per person (1G).
My concerns with the current beta are:

(a) I have 0.7G of email already on other systems, so it wouldn't be a complete solution for long, and

(b) it really is, at present, just a webmail system. It's the nicest one I've used, but it has no IMAP or other access, and hence no way to export your email. Meaning that messages in Gmail can never be moved to another system. (Though there are some scripts out there which connect, parse the web pages etc)

I imagine they'll have to add this in some form before too long, but I'm also sure they don't want to make it too easy. In particular, they probably want to keep the browser as the main interface so they can control advertising around the email.

Back then, a free email account was pretty rare, and a free e-mail account that gave you a whole gigabyte of storage was amazing!

In the intervening 18 years, I've never used my Gmail address as my main account, but it has been handy as a backup. I forwarded copies of incoming messages there from my main account, for example, until I realised it was probably foolish: I was giving Google access to all of my life history without even making use of the free email service in return! But I am a big fan of some of the other Google services, and a heavy user of YouTube, Google Maps, and to a lesser extent Google Docs, so having a Google account has always been important. I even earn a little bit of pocket money from some of my YouTube videos.

I did like the early versions of Google Docs which actually let you edit the CSS used in rendering your document, so you could make it look just as you wanted! Sadly, that feature went away in 2010. And I'm conscious that Google products and features do have a tendency to vanish rather unexpectedly.

I expect the ones I've mentioned above are pretty safe, but this page is a nice reminder that the free product you depend on today may not be here tomorrow. 2022 is the tenth anniversary of the demise of Google Video, for example, and this blog used to have quite a few links to content there. That was probably pretty safe, wasn't it? It had been around for seven years, after all! My golden rule about making sure you can get your data out of any system in a useful form, before putting too much of it in, is particularly applicable to Google products.

There's no such thing as a free inbox

Anyway, the good news is that my Gmail messages are still around, and Google now give you 15x as much storage for free as they used to, but that's not enough for the amount of old email I've been storing there. I've been paying a modest amount for Google One storage for the last couple of years, and that's no bad thing: for a service to be sustainable, its true costs do need to be met somehow. Buy my subscription has just come up for renewal, and since I already pay for cloud storage in a couple of other places that don't also use my data for other purposes, I've decided to thin down the amount of stuff I've been keeping on Gmail. My account isn't going away, but it'll just be a temporary space; all the important stuff will be sent elsewhere.

The good news is that Gmail did introduce support for IMAP a few years after my early messages, so moving my 17GB of Gmail messages over to join the 24GB in my main account is much more straightforward than it would otherwise have been! (There will be a lot of duplicates, and if you're doing anything similar and are happy on the command line, you might find my IMAPdedup script useful to get rid of them.)

Lastly, even though I recognise and appreciate the innovation and usefulness of some of them, I'm very glad that I didn't invest any serious time in any Gmail-specific features!
You may have seen my article a few months ago about why I, and a significant number of my colleagues, will no longer keep important data in our Cambridge University email accounts, for similar reasons.

Anyway, I'm trying to develop Quentin's Golden Rules of Data Storage. Here's an early draft of the first two:

• The more important your data, the more open its storage format should be.

• The amount of data you put into any proprietary system should be proportional to the ease of extracting it in a usable non-proprietary form.

P.S. You can use these nuggets of wisdom for free at the moment, but I don't have a sustainable business model for them yet, so I may need to charge you gradually-increasing amounts for them in the future.

My parents live about 13 minutes' drive from the nearest hospital. There's also a more substantial one 20 mins away. Over the last few years, they have on several occasions needed to call an ambulance after falls and other serious issues, and the waiting time is always measured in hours; on a couple of occasions, more than eight hours.

This shocks me, but it shocks my American wife even more. When they had to call an ambulance for her mother in Michigan -- a fairly regular occurrence in her later life -- they would worry that something was wrong if it hadn't arrived in twenty minutes, because normally it was there in about ten. For all the outrageous costs and several other failings of the American health system, there are some things it does do rather well.

The simplistic public response to the NHS problem is to blame under-funding. "It's because of Tory cuts!" Here's a graph that was popular on Twitter last year, for example, and looks pretty damning:

But let's be clear about what this graph shows: this is expenditure growth, above the rate of inflation. In other words, since its foundation, every government has given the NHS significantly more money in real terms every year. Some have increased it faster than others, but there have never been any 'cuts', from Tories or anybody else. So, while more money is desirable, that's not the primary problem.

(As an aside, we all love the story of Captain Tom Moore who so caught the public imagination by his sponsored walks around his garden between his 99th and 100th birthday that he raised a whopping £33M for the NHS, earning him a knighthood, an honorary doctorate and an RAF flypast on his 100th birthday. It was a great feel-good story during the pandemic, and I don't want to take anything away from his achievement by pointing out that he, and all his millions of sponsors, funded the NHS for a total of about an hour and a half. The world would be a much better place with more Captain Toms in it, but a whole battalion of Toms are unlikely to make a significant difference to the NHS.)

Now, I've written before about some NHS experiences that have convinced me that serious administrative incompetence is the source of many of its issues. And, to the extent that proper funding is also needed, I pointed out, it simply requires us all to vote in a government that is going to charge us about £1000 more per family member per year, and earmark that exclusively for the NHS. The UK public has only very occasionally been given the option to do something like that, even on a more modest scale, and they have never voted for it.

So I was intrigued by John Burn Murdoch's analysis in yesterday's FT. (The page itself is probably behind a subscriber paywall.) He provides the usual worrying statistics about A&E and ambulance waiting times, but points out:

While the pandemic has undoubtedly created a shock in the UK's publicly funded health system, the NHS's underlying issues are chronic. Waiting lists for elective treatment have been lengthening for 10 years, and the target of keeping 95 per cent of A&E waits under 4 hours missed for just as long.

...

It would be easy to blame underfunding, but in 2019 the UK spent just over 10 per cent of GDP on healthcare, placing it among other wealthy western European countries. The trend over the past two decades has also aligned with comparable nations, according to the OECD.

The key problems, he suggests, are also not simply with staff shortages:

While the number of fully qualified permanent GPs in England has fallen by 8 per cent since 2009, that of hospital doctors has grown by a third, outpacing the growth of the elderly population that accounts for an outsized portion of hospital demand. Nurse numbers continue to grow despite more departures this year.

In other words,

... ever growing resources are being used to treat ever more sick people, but ever fewer are being used to prevent them from getting sick in the first place.

The UK ranks among the highest for admissions to hospital for some conditions which would, in other countries, be largely treated within primary healthcare. (I am reminded of my wife's surprise that GP practices in the UK don't generally have X-Ray machines: you have to go to hospital for a check on a minor fracture!)

Anyway, the first part of his proposed solution is that we need to rethink the balance between primary care and hospital care; this is more of an issue than overall funding levels.

And the second is that it's easy to blame staff shortages, but studies have shown that A&E delays, for example, are primarily about physical capacity -- especially bed capacity -- in the rest of the hospital, and are not significantly affected by staffing levels.

In summary, he says,

Much like any chronic illness, the NHS's afflictions will not be cured with a sticking plaster. The road to recovery is paved with long-term investment to upgrade the physical capacity of the system, and to gradually shift the balance from treatment in hospitals to primary and preventive medicine.

A nicely-written article, and one of the many reasons I would pay for an FT subscription if the university wasn't kind enough to do so for me.

Update, about six months later: There's a very interesting page at the BMA providing an overview of current health spending in the UK and how it compares to other countries, and to the past history of the NHS.