Farage's Folly?

I'm not sure Nigel Farage was wise to announce that he's considering running in the Eastleigh by-election.

On the one hand, if he decides not to, he'll look like he's running scared of a fight in a seat currently held by the Euro-fanatical Lib-Dems. He'd have to come up with a pretty convincing reason not to run now.

On the other, if he does stand he'll almost certainly lose and, in the process, block the candidate of the only other party committed to delivering a referendum on EU membership and letting in Labour or the Lib Dems. This will illustrate perfectly the Tory message that a vote for UKIP is a vote for the EU fan boys in Labour and the Lib Dems.

There is a third option around a electoral pact. Toby Young proposes one scenario whereby the Tories don't stand in Eastleigh if UKIP agree not to oppose Tories in any of their current seats.

I can't see this being acceptable to the local party, given that they have a chance of winning. However, given the Lib Dems duplicitous reneging on their coalition agreement commitment to even-up the sizes of parliamentary constituencies, the Tories do need to look at more tactical options, as the system is rigged against them.

Health Inequality And NHS Funding

Labour claims that a small change in the way Primary Care Trusts are allocated funds is designed to transfer money from "Labour" to "Conservative" areas of the country.

Labour point to a report by Public Health Manchester. Unsurprisingly, Manchester comes out as a victim of this evil Tory conspiracy. Of course, their conclusions are totally unbiased and deserving of the weight Labour have given them. But even if you believe that, and the figures are true, is this method of allocating cash to areas of the country really that sensible?

The change being suggested is to reduce the amount of additional money allocated to areas of considered to suffer from "health depravation". On first look that sounds sensible. They'll have more issues so need more money. This money is intended to be spent in more preventative activities such as encouraging healthier lifestyles and sexual health etc. Again, that sounds like a sensible thing to spend money on in places with such issues. But there is something fundamentally wrong with that approach.

One sign that something is wrong is that the money is always targeted at the same areas. Year in year out. In other words, the money is not buying preventative services that are making any significant difference. No doubt there are the odd examples of success here and there, but no overall relative upward trend in general health in these communities is discernible.

There is no doubt that there is a serious problem with health inequality in Britain. It ends up costing the tax payer more and more as the issues go unaddressed. So there certainly is a case for spending money on it. But what is the best way of allocating funds?

We can easily turn Labour's claims round and point out that they originally ran a system that benefitted Labour areas at the expense of Tory ones. But this shouldn't be a party political issue. Instead we should think about the best way to fund activity that will improve health across the nation.

I would argue that funding for preventative health initiatives should be linked to outcomes. Where one initiative produces success it should be given funds to expand its activities to other areas etc. And it shouldn't matter if the initiative is state run, charity of private. The most successful provider should attract the most investment. But the current system just rewards failure. As long as an area keeps its "deprived" status its PCT can rely on some more money. The money fails to improve anything so they need more next year and such is the story of NHS spending over the decades.

The original idea behind setting up the NHS was a (typically deluded central planner's) view that it would cost less and less as the health of the nation improved. Instead we've spent more and more of our national income on it and have barely kept up with our international competitors in terms of overall national health. In some cases outcomes are woefully behind.

The NHS reforms go some way to at least lay the foundations for more effective funding of health care in Britain. But they have been watered down too much and much more is needed to transform the attitudes of NHS staff and users so that they are less resistant to change.

But a good first step would be to show real progress in addressing health inequalities by rewarding success in this area rather than failure and ignoring politicians who want "their" people funded more than the "other's".

NHS Reforms. What's Changed?

Good summary of the NHS reform changes, from The Times...

Muscular Liberalism or Lack of Leadership?

I always vowed never to subscribe to The Times when it disappeared behind a pay wall. But then I began to miss some of my favourite columnists such as Giles Coren, Hugo Rifkind, Daniel Finkelstein, David , Rod Liddle and Matthew Parris.

But Saturday's column by Matthew Parris hits the nail on the head on the subject of NHS reform.

He imagines a Britain where our agricultural system is run like a Soviet collective. Everything is controlled by the state, everyone involved is employed by the state, all supplies are directed centrally. He then develops this crazy fantasy. The government decides on reform to allow farmers to choose between suppliers. He describes the response to this suggestion as follows...

"Now picture a special conference called by the farmers’ trade union to debate the proposals. Here is an extract from a union leader’s speech to the conference. He is railing against a duty, in the proposed legislation, to promote localised competition . . .

'I want proper controls nationally considered, not locals trying to sort things out . . . I want politicians of every stripe to understand that we do not need competition to run Britain’s food production. It creates duplication that is wasteful — and why give state agriculture’s money to private shareholders? What Britain’s food production needs to improve quality and efficiency is collaboration and co-operation across [all] sectors, [not] different materials being delivered by different providers in order to try to get a cheaper deal — fertilisers in one place, feedstock in another, veterinary services in another and follow-up somewhere else.

'Which brings me to one particularly unacceptable idea in the Bill: performance-related bonuses ... otherwise known as the ‘quality premium’. The idea is that farmers’ groups that ‘purchase well’ — ie, save money — will be given some money to hand out to their members . . . this idea stinks.'"

Only Parris doesn't have to imagine this response. These quotes are taken from a keynote speech by a Doctors leader at a British Medical Association conference in London last week. All Parris did was change references from healthcare to food production.



It highlights the perverse sentimentality we have in this country about maintaining a Marxist style healthcare system despite all the evidence that things could be so much better if a degree of competition, even if it is only in the supply of certain services or supplies, were introduced.

But the main point he makes is how today's Conservative party is failing to champion capitalism. Nothing illustrates this more than the backtracking on the NHS reforms we're seeing now. Many will put this down to the influence of the Lib Dems but the truth is that it is also a symptom of the Tories desire not to re-contaminate their brand. The simplistic messages put about by socialists is far easier to get across in soundbites on the telly and in newspaper headlines than some theory associated with free markets. Free markets that many people associate with selfish pursuit of profit by "fat cats".

A leader must make and keep his party electable. Cameron has gone some way to detoxifying the Tory brand (although not far enough to win a majority, it has to be said). However, sometimes public opinion needs to be led, not followed. Tragically, the case for reform has not been made effectively enough, so a dilution in the proposals was inevitable. But that doesn't mean the case for change shouldn't continue to be made and made strongly, one might say muscularly. A case that, given enough effort, would convince a sceptical public that a free at the point of use health service doesn't have to be totally provided by the state working to some monolithic central plan. That real responsiveness and quality improvements can be achieved through providers competing to be chosen by GPs and patients rather than there being only one option.

It's here David Cameron still has to prove himself. Will he lead a muscular liberal coalition that brings true liberalisation to Britain's public services and with it much improved service and efficiency? Or will he allow the left's preferred definition of the word liberal to prevail, an option that pollsters would tell him would be the best option. In which case we'll miss the greatest opportunity for decades to setup the high quality and high value health service that we need.

UPDATE
This article on the ConservativeHome website by Paul Goodman (@PaulGoodmanCH) covers the liberal/pragmatist debate really well. Definitely worth a read.

NHS Reform and The Evil Market Boogyman

There is no doubt that the government's proposed NHS reforms have proven to be controversial. Originally backed by Lib Dems, Andrew Lansley has now lost their backing as the party descends into panic mode after the poor local election results. Without the support of the Lib Dems the reforms stand little chance of getting on the statute book.

It seems the main sticking point for the Lib Dems is the extent to which the market will play a role in the provisioning of a free-at-the-point-of-use service.

But, what is this evil market that is threatening our fantastically efficient and effective NHS, in the minds of the left anyway? If you read the Guardian or watch the BBC you'll be under the impression it is some kind of malign mechanism that is designed to sap whatever is good out of anything that comes into contact with it. A diabolical agent of the right wing, whose only purpose is to destroy the NHS and replace it with a US style health care system, where only the rich can afford decent treatment and the poor will be left to die in agony on the streets (because they'd have sold their homes to pay for what inadequate treatment that could pay for).

It suites those on the left, the statist planners and advocates of entrenched public sector interest, to characterise the market as a thing, a device, usually portrayed as an ideological paragon at the heart of the plans of frothing mouth right wingers hell bent on suppressing the poor and enriching their banker mates in the city. But, if you haven't already dismissed this as ridiculous (genuinely) idealogical nonsense, think on a bit more.

What is "the market"? It is nothing more than the choices made by you, me, our neighbours, their friends and family, in fact everyone. It's not an extraneous body with an agenda of it's own. Why shouldn't our needs as patients be put at the heart of our health service?

In Britain we have come to expect a free-at-the-point-of-use healthcare system. There are some powerful moral arguments for it and it appeals to our sense of fairness, that everyone, regardless of ability to pay, should receive the best healthcare available. We call the system the National Health Service and we are all very attached to the concept. And quite right too.

Free at the point of use it maybe, but cost free it certainly isn't. The cost to all us tax payers runs to over £100 billion a year. It has the income of a small nation but with the burden of expectations of a very large, complex and demanding one. As multiple reports over the years prove (including this one), the NHS is neither efficient or effective in delivering the standard of care we expect. As someone who has had a love one almost die of malnutrition on an NHS ward, I know for a fact that reform is needed.


The model we use currently is predominantly based on services being delivered by state owned entities and staff. New Labour's early reforming zeal attempted to introduce a more modern and competitive environment but met the same seemingly immovable forces of self interest in the form of public sector unions and others, such as the doctors' union, the BMA, who mobilised to scare the general public and the Prime Minister of the day into believing change was too risky. Old Labour fifth columnists like Gordon Brown and Ed Miliband made sure these voices were heard and moved to scupper all subsequent attempts at reform that threatened their friends and party funders and (as they saw it) loyal Labour voters in the public sector. Sadly, history may be repeating, with Cameron replacing Blair and Clegg replacing Brown. Cameron may not be worried about upsetting Labour voters in the public sector but he is worried about re-contaminating the Tory brand with the poisonous idea, no matter how untrue, that he wants to privatise the NHS.

So, we're spending enormous sums on an organisation built on the 1940's concept that centralised state planning and provision is the only way to provide a national health service free at the point of use. This approach has failed to deliver consistently excellent service as expected. There's been much tinkering at the edges to attempt to improve things but nothing that has been in any way adequate. And now the money's running out. David Cameron is committed to maintaining real terms funding and is avoiding real NHS budget cuts. However, after a decade of fiscal incontinence that has seen the NHS's budget more than double, the organisation has lumbered from poor productivity to worse. Some, politically motivated performance targets have been met (especially around elective appointments) at the expense of professional medical judgement in many cases and overall quality of care has dropped.

What's needed is choice. For example, GPs should be able to assess the performance of local care providers and send patients to the most appropriate one dependent on their needs. If that happens to be a private outfit rather than a public one, so be it. As far as the patient is concerned, it is free. The only difference would be quality. Where appropriate the patient should be provided with adequate information to be able to make informed decisions of their own about where and how they are treated.

I think the proposals have been rushed out and not communicated to key stakeholders in healthcare or to he general public very well. Taking time to pause and refocus is sensible. But, if the reforms are watered down or delayed until the next parliament we will merely end up with an organisation that has grown to rely on massive year on year budget increases to achieve bare minimum standards, if even that at times, facing the prospect of budget increases at barely inflation levels only. It won't know how to adapt. Services will be cut instead of unnecessary bureaucracy, productivity will carry on falling, outcomes will continue to lag behind international standards, cost efficient prevention will still play second fiddle to expensive cure etc etc.

Those that oppose the market playing a larger roll in the provision of healthcare are opposing the NHS becoming more responsive to our actual needs. They prefer to promote their ideological belief that only the state can provide adequate healthcare, despite all the evidence to the contrary.

All that patients care about is that their treatment is of the highest possible quality and free. Who provides it is irrelevant.

The Spending Cuts In Context And The North/South Divide

A report by the Centre for Economics and Business Research (CEBR) tomorrow will expose the true extent of the Coalition's cuts.

It will point out that analysis of figures from the OECD reveal that the UK is cutting public spending LESS than the European average over the next 2 years. And this despite the fact that public spending increased far more sharply in this country than other major economies during the recession years.


This report is just further evidence of the myth being propagated that this country is being put through some kind of especially draconian state spending squeeze. Fraser Nelson's Coffee House blog analysis further proves the point. Fraser demonstrates with the graph below how Osborne isn't even cutting as hard or as quickly as Labour did the time they bankrupted the economy before last.


Indeed, projected spending in most departments is expected to increase by 2014/15 compared with 2009/10.


Worryingly, the CEBR report highlights that the economy in regions like the northwest, northeast, Wales and Northern Ireland will still be dominated by the public sector where it will still account for over 50% in 2015, after the spending cuts have been implemented. So we will still have large parts of our country where the sector of the economy that contributes tax income is smaller than the part that consumes it.


Of course, Ed Balls, seeing a report that undermines his economic "master plan", has already begun to spin it in his favour. It is obvious that public spending cuts will affect areas with the highest public spending the most. But rather than address the questions this report raises about his economic strategy, he prefers to point to the obvious fact that proportionately, northern areas dominated by the public sector will see bigger affects of the cuts. He ignores the government's plans to assist private enterprise in these areas so they can take up the slack and instead claims the government is attempting to exacerbate the north/south divide.

Expect a lot more of this kind of spin from Labour and the left generally. Attempts to revitalise regions of the UK to make them less dependent on the dead hand of the state will be portrayed as typical Tory attacks on traditional Labour voting areas. Labour's fear being that once freed from the employ of and dependancy on the state people there will take a more independent view when they vote. God forbid.

Ed Miliband's Credibility Deficit

"Watch my nose grow out to here when I talk about the deficit"

Ed Miliband writes in Thursday's Times newspaper that the deficit that the Government (or Conservative-led government as he insists on spinning it, in a pathetic and transparent attempt to alienate Lib Dems) is grappling with, is not the fault of the last Labour mis-led government.

In continuing his attempts to convince voters, who he clearly thinks are as gullible as 4 year olds, that this is the case, he is demonstrating what a poor leader he is and how he hasn't a clue about creating a credible narrative for his party that could return the credibility required to make them electable again.

In attempting to sell the lie that the deficit was caused by a "global economic crisis" he merely invites Coalition supporters to remind everyone, as if they needed reminding (sorry), that it is the structural deficit that is being addressed. In other words, the difference between what is spent from and earned in taxes after the economic cycle is taken into account.

The deficit wasn't created by the evil bankers, as some would have us believe. The bail outs of the banks, something Labour and Gordon Brown are quick to claim were part of their "save the world" strategy, certainly have added to the overall debt levels but not to the yearly structural overspend (a better word for deficit in my opinion). Eventually, those banks will be sold off (presumably just before the next election) and the taxpayers money spent on buying them out will be returned with interest. So, even the bank bail outs are only temporarily inflating the debt level that is being added to by the tune of £150bn a year, currently.

It is the £150bn overspend that needs eliminating if we are to start to tackle to frightening level of debt already racked up. The overspend has been caused by reckless and politically motivated structural spending increases that were unaffordable and now have to be brought back under control.

If you cast your minds back just a few years, you will remember a time when the word "cuts" was political poison. Labour's electoral strategy (something Ed Miliband was heavily involved in) was to keep spending more and more and then dare their opponents to suggest spending was too high. If they did, as the Tories had done in previous elections, the cry of "cuts in hospitals, nurses, doctors, police, schools, teachers, etc etc" would go out and voters were duly repelled. It was a successful strategy until the growing recession hit the banks and sparked the banking crisis. After that, people looked to government to spend more on supporting the economy and on social welfare for those cast into economic difficulty. But they saw a Government that had spent all the money during the good times and now had to rack up enormous debts to act to support an economy during, what was an inevitable downturn. We, the electorate, have to take some of the blame for being taken in by Labour's strategy and
the Tories learnt they had to avoid talking about cuts if they were to "detoxify" their brand.

So, the one thing Little Miliband gets right in his Times article was this lack of political clarity from Labour's opponents back then. That is regrettable but not an excuse to ignore the crisis now, as he proposes. His approach would leave us continuing to add to the £4.8 trillion debt mountain that is already a millstone around our childrens' necks.

2011 will be a testing year for the Coalition. It's on the right economic path but it starts getting rocky and is uphill for most of the rest of the Parliament. Let's hope it can keep itself together during the coming dark days of unpopularity and political tests, like the forthcoming AV referendum. The only way a clown like Ed Miliband will get elected is if the Coalition drops the ball in the middle of the game. The inbuilt electoral bias will return a Labour government with them just a few points ahead (or even possibly one or two points behind) the Tories. So, it's time for Tory and Lib Dem politicians and supporters to gird their loins and battle through the next couple of years while doing everything they can to counter the deceits put out by Labour such as "the deficit wasn't our fault"