Thursday, 27 November 2014

Why are people so cross these days?

















I thought of calling this blog ‘The ceaseless quest to find out why people hate politicans’. I haven’t done so, mainly because the answer isn’t terribly hard to find.

Even so, it is strange that a string of former Labour cabinet ministers still write articles suggesting compulsory voting or voting by phone, as if voting was the problem. I’ve just read another one by Charles Clarke.

I’ve suggested some reasons before. This is another one, and it occurred to me this morning, early in the damp mist in Sussex as I texted the bus company to find out the arrival time of my next bus.

You can do this in London too, and it costs about 25p and tells you what buses are arriving at your stop and when. In Sussex, you get what purports to be that, but – on closer examination – just turns out to be the bus timetable.

It wouldn’t have been my choice to spent 25p to look at the timetable, since it is also glued to the bus stop. Do I get cross? A little.

It made me realise how important this gap has become between the fundamental purpose of a public service and its actual purpose in practice.

And how enraging it can be.

The text service for the Sussex bus company is a small example. It purports to have a purpose of giving transparent information to customers. Its actual purpose is to show that they are using technology – and maybe to raise money to pay for it. The audience purports to be the customers when it his actually the county council paymasters.

This example doesn’t matter much, but take Atos, the company charged (until the end of its contract) with assessing fitness for work. Its public purpose was to police the boundary between fit and unfit claimants. Its actual purpose – built into the system provided for them by DWP – was to shave money off the welfare bill.

I am not saying that saving money on welfare is an ignoble cause. The issue here is that the gap between appearance and reality is first disturbing, and then – when you meet it in every public service – it is absolutely infuriating. It is alienating.

I interviewed a GP today for a BBC programme and was fascinated, again, by the number of prominent warnings – together with pictures of the police and blue lights – warning patients not to abuse staff.

Of course, they must not abuse staff. But the fact that these notices are as ubiquitous as they are is a symptom of that gap between the public purpose of a health centre (to cure you) and its real purpose (to control you and your behaviour).

Ask yourself what the real purpose is of your bank when it deals with you (sell you financial products) and the real purpose of many, if not most, government call centres (to get you off the phone in two minutes).

Add that up to a gap in every institution we used, public and private – and voluntary sector too, whose real purpose is often to collect target figures for the Big Lottery, then it amounts to a reason to be cross. Very cross.

My take on this, which is partly the way of the modern world and partly the by-product of the Blair-Brown control system, is that it has hollowed out our institutions.

Never mind the loss of authority and trust, which the BBC is always banging on about. People have never trusted their MPs very far, unless they happen to know them – and sometimes that doesn’t help – but when they see this unarticulated gap, day after day, between the public and real purpose of ever official they deal with, it is a reason for deep distrust.

The effect was clear in Rochester and Strood.  Perhaps I should have called this post: 'The corrosive gap between public and real purpose'.  I will next time...

Wednesday, 26 November 2014

The constipation of the NHS

There is an awful lot of old nonsense written about the Health and Social Care Act.

It is said that it was a mistake to put decision-making in the hands of GPs. Well, it did at least provide the foundations for shifting power away from the hospitals – though, of course, GPs are not really in control (they are providers and the CCGs are purchasers, so they can’t co-ordinate properly, as they need to).

It is said that it has opened up the NHS to privatisation. On the contrary, most of the marketisation measures were removed by the Lib Dems, and most of what we have now are the basic outsourcing structures set out by the Blair-Brown governments (yes, there is an issue around the scale of what is happening now).

But what on earth possessed the Department of Health to split regulation between three competing bodies – NHS England, the CQC and Monitor – and to leave the boundaries between the three of them obscure enough to get in the way of innovation?

I encountered all three of them in a brief official capacity, and found them all obsessed with each other’s remits, nervous about each other and very, very careful.

It does explain something of the bitterness behind the NHS blogger Roy Lilley’s attack yesterday morning on the way the NHS is led – a dearth of leadership on the ground, and a pointless stream of negativity from the regulators to anyone who thinks differently or experiments or takes risks with the targets.

It is as if the coalition took the disastrously concrete and wasteful design of public services from the Brown years, and then set up three super-quangos to entrench those mistakes further.

When I met CQC in 2012, they were still using fax machines – enough to make any of us nervous.

Now, you can criticise Roy for trying to let NHS providers off the hook. The CQC, which is – as he says – far too big for its own effectiveness, is the illegitimate child of the Mid-Staffs scandal. But this paragraph is absolutely right about NHS leadership:

“As the boss, you have no control over the business model, compulsory frameworks that might be completely inappropriate for where you work, fixed prices, targets and tariffs that create perversity, arbitrary regulatory rules, and required to do plenty more with plenty less.”

There is the NHS in a nutshell. What can you do about it? Well, I think you have to accept that the NHS can’t be run as a vast great centralised edifice any more.

The danger is that anyone who says this tends to get accused of wanting to sell it off – but it badly needs to be decentralised to local units, and to accept that these might look very different.

You also urgently need to decentralise inspection. There is no way that mega-CQC can do more than a paint by numbers approach, and they need to be stripped down to concentrate on training local authorities to inspect instead.

I’m not sure that Monitor has a role at all, though clearly somebody has to watch over the business practices of the foundation trusts and to speak for patients and their right to be treated flexibly.

Somehow this devolution has to be done without a major new re-organisation, which is politically unacceptable. Nor can you use rhetoric like ‘setting the NHS free’, because again it sounds like weasel words for privatisation.

But you do have to rescue the NHS from its undergrowth of constipation. In short, we need a major dose of laxative.

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Tuesday, 25 November 2014

Politics and the art of the impossible

I felt rather sorry for Emily Thornberry, whose innocuous tweet caused such a stir.  I wasn't sure if it was actually the sensitivities of the Labour Party she really upset.  Their conscience has been plaguing them for the complete abandonment of the working classes in recent decades.

No wonder Ed Miliband was so cross.

On the other hand, it is clearly right - given the Ukip surge - that the political elite should be examining their consciences.

I have a feeling the sense of alienation from conventional politics, which - as a Liberal, I rather share - lies in the strange loss of ambition that seems to have gone hand in hand with globalisation.

Instead of setting out a vision which can be achieved, frontline politicians have to spend their time defending a series of compromises which the establishment has made on our behalf, often for very good reasons but not conclusively so.  And maybe because they have to: globalisation has been a paradoxically constraining force.

They have to defend the status quo in energy for fear that investment in the infrastructure the nation needs won't be forthcoming.

They have to defend rising property prices for fear that buy-to-let landlords will withdraw from the market and they will have to deal with the resulting homelessness.

They have to defend the bureaucracy around global trade because it underpins the single market, and all the other trade agreements which have constrained our political freedom of movement.

And so on and so on.  It is the politics of binding compromise, with a whiff of the politics of fear.  It is the result of the political class losing control of the levers.

They may be the right compromises, and the establishment knows they are inevitable - so they never get discussed.  It is hardly surprising that a political movement emerges, simplistic enough to fail to understand them - and to contemplate tearing them all up and starting again.

There is a reasonable longing for politicians to be politicians again, to dream dreams and say 'why not?'  To act on the national stage, to make things happen.  The art of the possible has become the art of the impossible.

But when that happens, there are circumstances when the least attractive alternatives suddenly appear to some people compelling.  After all, if the opposite of populism is just to close ranks and defend the usual compromises which have dominated our lives since the 1970s, then populism has its attractions, even for me.

Especially when those compromises involve defending institutions because of what they were designed to do, when every one knows - perhaps everyone but those in Westminster - that they don't actually work as intended.

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Monday, 24 November 2014

A recipe for old-fashioned economics

The trouble with standing for election is that it gives you the potentially disturbing opportunity to see yourself as others see you.  You fail to get elected, and suddenly you are puzzling out obsessively what it is about you that sort of failed to enthuse people.

All of which is a way of saying that I'm out of sorts at the moment, having failed to get elected to the Lib Dem federal policy committee for the second time in two years.  But, hey, my electorate have spoken...

Dammit.

Of course there are compensations.  I won't have to crawl up to London and back again at dead of night.  I won't have to sit through interminable debates about the Health and Social Care Act, or constitutional reform as understood around 1956.  But I'm sorry, nonetheless.

I imagine that not nearly enough people want a member of the policy committee who is really pretty loyal to the current leadership.  I'm not on anyone's lists - both the Orange Book people and the Social Liberal Forum furrow their brows when I speak.  Perhaps I should be pleased to have won as many votes as I did (thank you, everyone!).

But one thing does worry me.  I stood on a promise to take the party's economic policy by the scruff of its neck and to make it work for people.  I might not have succeeded in this, but I was determined to try - because it worries me that even self-described radical Liberals seem to have almost no interest in economics at all.

The result is that Lib Dems tend to get rolled over when it comes to economics.  This is not a critique of austerity, but it is a criticism of our failure to think creatively about what else might be possible.

And when you don't think radically about economics - when you can't see the point, I'll tell you what happens.  You become deeply conservative on the subject.

So, an obscure debate took place in the Commons last Thursday, about the way money is created.  It was the first time Parliament has debated this very important issue for well over a century, and there was a great deal to be said about the underlying causes of the 2008 crash.

You don't have to agree the entirely line by Positive Money, the campaign group around these issues, or to have agreed with everyone who spoke - and many of them disagreed with each other - to find these issues pretty important for the future design of our money system.  Both Adair Turner and Martin Wolf have been talking about this issue in the last few months.

I'm not even sure what I think myself - but it is a healthy departure to have MPs discussing the possibility of varying how much publicly-created, interest-free money there is in circulation (a good deal less now than when I was born).

But here's the point.  The debate was sponsored by MPs from four parties but no Lib Dems.  As many as 30 MPs took part, including a very distinguished former cabinet minister, and - you guessed it - no Lib Dems.

I think we urgently need to take what Keynes said to heart (as a good Liberal):

“Practical men who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist."

That's what happens when you stop thinking about it.  The defunct economist in all of us, the default common sense of a few generations back, comes to the fore.

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Thursday, 20 November 2014

Why privatisation is over (nearly)

I have a BFI copy of the classic Post Office film Night Mail, with the Britten-Auden collaboration that emerged as night mails crossing the border-bringing-the-cheque-and-the-postal-order. It now looks like a hymn to public service commitment.

One of the other features in the DVD was a sequel, in colour, dated from 1963, called Thirty Million Letters. It is a touching, emotional and absolutely brilliant evocation of what a postal universal service obligation used to mean. There are postmen walking through blizzards, delivering post from a pony and trap, by plane and in constant supportive contact with the public.

The universal service obligation, which the newly privatised Royal Mail is so keen to dispose of, was portrayed there as a thing of beauty – a commitment of pride, a national treasure, a precious stone set in a silver sea...

I can see that the chief executive of the Royal Mail is in a difficult position. Now the Royal Mail is a private company, its continued universal obligation holds it back.

The pressure is on from innovative new competition, from click and collect to Amazon drones. It is difficult out there. It is also difficult for Business Secretary Vince Cable – criticised that he undervalued the shares, and now criticised just weeks later that he overvalued them.

But the abolition of the universal service obligation, a feature of the Royal Mail since Victorian times – which now seems inevitable – is such a scandalous volte face by the Royal Mail that I have been wondering if it marks the end of privatisation as an instrument of policy.

The appalling things is that, as predicted, a universal service obligation shifts from something which we took for granted with quiet pride in the 1960s into something which is too expensive.

Privatisation was born in 1984 as a means of improving service, encouraging innovation and providing a form of popular capitalism – and also of course of raising national revenue (selling the family silver, as Harold Macmillan put it).

After three decades, it has become something else. Here are three reasons why it is reaching the end:

1. Instead of setting free public services by giving them entrepreneurial energy, the process seems to have had the reverse effect – it transforms them into the worst kind of intractable bureaucratic megaliths, apparently without care or thought.  As bad as before, but more expensive.

2, Customer facing UK business is itself going through a period of serious dysfunctionality, based on dysfunctional CRM business practices, set in concrete by dysfunctional IT systems. The prospects of handing over any more services to that kind of customer services does not bode well.

3. Nobody any more believe that privatisation will lead to a better service. Quite the reverse.  That was not the case in the 1980, and the great privatisations back then – British Gas, BT – have retained their functionality, but it certainly is now. State owned East Coast railway lines provide by far the best service.

4. The need to save money means that there is simply no opportunity for profits that privatisation might once have offered, especially in health – which is why so many contracted out NHS services are being abandoned.

None if this suggests that privatisation will stop dead. There are also good reasons for contracting out some services inside the state system – and always will be - but, despite the scare stories, privatisations seem to me to have reached the end of the line.  The revelation of just how much universal services and competition are incompatible will only hasten their demise.

The remaining two justiications are that privatisation helps raise money – which is not enough of a reason for doing so in itself if the management is going to be worse or more expensive – and that they can then raise investment money off the government's balance sheet. This is still an important driver. But there is a political limit: if privatised services are acknowledged to be worse,  less reliable, less effective and less universal, then the tide will turn,

I think it just turned.

Tuesday, 18 November 2014

Iinnovation versus manipulation in the NHS

Targets came from Jeremy Bentham, in a labyrinthine journey via Robert Macnamara and Key Performance Indicators. They purport to provide transparency and accountability, and – in some ways, in the absence of anything else – they do.

The difficulty is that they never quite measure what they claim. They are indicators of the thing – success – and not the thing itself. And in that gap, so many difficulties follow.

I write all this because of a blistering attack by the influential NHS blogger Roy Lilley this morning about the effects of too close attention to targets is having on an NHS which feels itself embattled – and the tricks the managers are laying to avoid confrontation with the regulators, like delaying all operations to insert patients from the waiting list, or declaring a local emergency so that the targets don’t apply.

Many of us involved in Lib Dem policy in 2010 believed that the coalition would dump the Blair-Brown idea of targets altogether, and they did to some extent. But enough of the old edifice remains to twist the purpose of services and create waste.

Why didn’t they go further? I think because nobody had thought through enough – as they still have not in enough detail – how to provide accountability without some kind of target-driven inspection system.

But we have come some way. What we have left is the bones of the old Blairite, utilitarian design that dreamed that public services were giant humming machines, run outside politics by men in white coats, huddled over the dials.

That system remains because Whitehall has not yet realised how far the target numbers are from reality – cf. Goodhart’s Law – and how delusory their progress figures are. Or what to do about it. That is all now deferred for the next Parliament.

I thought before, and still think, that it was a wasted opportunity, but you can’t move until there is some consensus about what you do instead – and that remains elusive, though John Seddon’s work points in a pretty clear direction.

In the meantime, the NHS is still overseen in this bizarre system of management-by-numbers, which stands in relation to leadership as painting-by-numbers stands to art (see my book The Tyranny of Numbers).

You can see how targets might keep hospitals to the task in hand when budgets are increasing. But when they are shrinking, and demand is rising – partly because of the way contracts have tended to narrow services and spread costs – then targets just become ridiculous.

And in the midst of a crisis, like wartime for example, checking on the success of hospitals by peering at the target figures just becomes like satire.

The real question is this: who in the top eschelons of the NHS is watching over trusts and hospitals and supporting their leadership when they are providing innovative solutions despite targets? And who is holding them to account when they are meeting targets by putting all their energy and ingenuity into tricking the system?







Monday, 17 November 2014

Why free traders might oppose TTIP

David Cameron chose to emphasis TTIP in his speech in Australia, explaining that the Transatlantic Trade and Investment Partnership – its proper title – will give a ‘rocket boost’ to the global economy.

I find this argument strange. There is very little evidence for it. The study it was based on has been discredited (at least according to WDM), and – in any case – you have to be suspicious of this kind of cost benefit analysis, which only adds the benefits and does no subtraction for the disbenefits.

Similar one-way analyses have been used to justify an end to supermarket restrictions on Sundays and the expansion of Heathrow. It is a kind of fantasyland.

There are three accusations that are being thrown at TTIP at the moment. The first is that it endangers the NHS. I believe this isn’t the case since the European Union has legislation that puts public services beyond the reach of TTIP.

But actually nobody seems to know and I find it extraordinary that, because these issues are not on the mainstream agenda for Labour or Conservative – the BBC fails to pin down the chapter and verse, or even to cover the issues much. Nor do any of the parties volunteer it.

The second accusation is that the special measures will allow corporations to sue sovereign nations for undermining their investments.

This seems to be quite true and bizarrely, presumably because it involves American corporations rather than, say, Romanian ones, UKIP stays silent on the issue.

The third accusation is not really articulated properly and is about the limits of the free market. This is the critique of the research which Cameron uses for his claims about the benefits of TTIP. Again, completely unexamined by the BBC.

There are difficulties here. It is true that open markets will tend to raise all boats, but there are already wide-ranging trade agreements between the EU and the USA and it is not clear how much this one will add.

It is also true that the meaning of free trade has become blunted and coarsened since its great days as the centrepiece of Liberal economics.

What began as a critique of monopoly, and an underpinning of the right of the small to challenge the weak, has become the opposite. Free trade, as understood by mainstream policy-makers, seems to me to have become the absolute reverse: a justification for monopoly and a buttress for the strong and rich to control the weak. This is not its original meaning or its correct one.

It seems to me highly likely, given this, that TTIP is a buttressing of the big over the small – I can’t see how my local healthcare co-op is going to be taking over any American hospitals. It is a means by which the big can ride roughshod over the small – it is a recipe therefore for poorer service and the suppressing of innovation.

Since small businesses create jobs in a way that big businesses are constrained from doing, this would make TTIP a net job destroyer and therefore corrosive of prosperity.

This column is my assertion of the right as a free trader to oppose TTIP. In the absence of clear evidence, it is a technocrat’s charter and, as such, brings the backlash against technocracy – really our biggest threat at the moment – that much closer.