Author: johnredwood

The government has embarked on administrative reform again for the NHS. This time it stems from the senior management of the NHS rather than from any political agenda. As the new budgets transfer and shake down it is time for Ministers to engage more fully with NHS management over how the extra cash is going to be spent. They need also to chase up how the special budgets of the covid period will be closed down as we move on from needing huge sums to be spent on vaccine development and roll out, on test and trace, and on supplementing NHS capacity with rights to use much of the capacity of the private sector or with the construction of new temporary facilities.

It seems that Ministers find it difficult to get all the information and reassurance they need from senior management of NHS England. The structure is said to be devolved, with considerable independence granted to the senior management. That is all very well but Ministers are thought to be responsible and have to answer for the service in the Commons and to  the public and media. There is rarely any sign of senior management taking public responsibility for mistakes and removing senior managers that have failed, so Ministers do need to insist on seeing, influencing and signing off the main plans and headings of spending. Ministers after all have to make the overall judgement about how much money the NHS needs to perform its tasks, and to weigh priorities where choices have to be made.

The Secretary of State needs to press the management to come up with a proper staffing plan. More medically trained people are needed to perform procedures, to diagnose problems and supervise treatments. The UK needs to train more of our own people to provide the numbers we need. The NHS could look into what is relevant and necessary training for each of the medical tasks that need to be performed. As we saw with vaccine roll out the registered doctors and nurses could be supplemented by others to get the job done.

The government needs to decide how much use it wishes to make of the private hospitals and clinics to provide additional care free to NHS patients . During the early days of the pandemic it was paying for a lot of private capacity it was not fully using. Speciality centres that are good at cataracts or hip replacements or knee surgery could offer high quality treatments at fair prices for the NHS to take some of the burden off the District General hospitals.

The government and NHS need to decide how far the digital revolution in health care should go. Many people may well be happy to see their GP via a video link as it avoids the travel and delay for a visit. Others who wish to see them in person should have that option unless there is a good reason not to. Hospital records, vaccination records and drug treatment patterns in hospital or at home could all benefit from digital recording with easy access for patient and medics alike.

The US President is putting out a lot of information about Russian troops, weapons and naval deployments. He is telling us that an invasion of Ukraine may well be imminent. Russia denies an invasion but cannot credibly deny the deployment of a lot of military might. Mr Putin tells us these are Russian and Belarus forces jointly exercising on their own lands. The USA has a different view.

The USA speaking for NATO makes clear that NATO  forces would not respond to invasion by entering the fight in Ukraine, but NATO would clearly be on the side of the Ukrainian government and the large  majority of the people who would fight against a military takeover of their country. Some NATO members have supplied weapons to Ukraine and offered training to Ukrainian personnel. Presumably in the event of an invasion more such support would be supplied.

NATO’s main threat to Russia is its members  will impose wide ranging sanctions with a view to damaging the Russian economy. The idea is these would be tougher than the ones introduced after the annexation of Crimea . It is not clear they would extend to preventing Russia using western banking systems, nor has Germany made clear whether any of this extends to gas.

France and Germany hope for a  negotiated settlement of the issues surrounding the Russian presence in Luhansk and Donetsk. They wish to revive the Minsk 2 Agreement they helped broker in 2015 which aimed to secure Russian withdrawal from east Ukraine in return for substantial devolved power to  new elected governments in the two anti Kiev  provinces. The original Agreement failed because the local forces and Russia  wanted more devolution than Ukraine wished to provide, and Ukraine wanted a faster and more comprehensive Russian withdrawal than was on offer. Events in Crimea followed the expulsion of an elected Ukrainian President who wanted to follow a more pro Russian and less pro EU foreign policy.

The fate of East Ukraine is not however the only thing Russia is raising. Russia also wants assurances Ukraine will not pursue her wish to join NATO, and wants NATO to cut its forces deployed in its eastern member countries for self defence. The USA needs to handle the NATO discussions following consultation with allies, and France and Germany should continue the Minsk discussions following talks with the Ukraine government and the Eastern opponents of the Kiev line. President Biden has to erase again  his suggestion that a limited Russian incursion would not  be so bad, and stress the corrections his team have put out.

 

A recent cruel Matt cartoon showed someone being told on their mobile phone that they are  now Number One in the queue to pay extra tax to fund the NHS, but several million down the list to get the health treatment they have been waiting for. The Plan to cut waiting lists finally produced on February 8th came a long time after the legislation to put in place a tax rise to pay for it. That made me suspicious as I always think you need to know what you are buying and what it costs before deciding how much to budget.  The delay apparently arose because the Treasury and PM wanted reassurances that the money would be well spent so the waiting lists could come down. The NHS was unwilling to offer any such promise. Their voice, the Secretary of State, has told us all that despite the extra cash waiting list  numbers are likely to go up, not down.

So what did the Treasury wrestle from the NHS for yet more extra cash? The promise is no-one will have to wait for elective surgery (non  urgent treatment) for longer than two years by July of this year, and  no longer than eighteen months from April next year. These are modest promises. Aware of the possible criticism that with its large reorganisation underway and with so many Health bodies with Chief Executives overseeing the hospitals and surgeries that the NHS spends too much on overhead, we are told that by international standards it has a low cost. It is according to the NHS 2% of total spend. I suspect that is based on careful definitions. It quite clearly is not comparable with many overseas health systems  where admin costs include the costs of payments and insurance. The UK admin costs should include all the administrative costs of the Income Tax section of the Revenue as we would not need Income Tax without the NHS, or the admin  costs of several other entire taxes if you hypothecated them instead.

I find it strange that the NHS cannot or will not tell me how many Chief Executives they have on their payrolls amidst all the quangos that work with and for them. I am disappointed that we still do not seem to have the staff plan which must be central to delivery of shorter waiting lists and fundamental to costing the programme. We are told “further work is needed to train, recruit and retain staff”. We can have precise time based targets for the results of the planned work  but no precise targets for how many trained medical people they will recruit and pay to get the work done. Whenever I have supervised budgets for an organisation forecasting the staff costs is usually the easy bit as  you know how many people you employ and how many extra you plan to add.

I and others will keep pressing the Secretary of State to tell the nation how they will expand treatments  sufficiently to remove the long waits, which mainly requires more staff or more full time staff. The Chief Executive of NHS England needs to tell Ministers and the public more about how she intends to turn round the very high waiting lists, given the willingness of the government visible over the last two years to supply very large additional sums of cash to the service.

My critics on here include those who complain I have gone soft on public spending and am too casual about the extent of borrowing. How wrong they are.

I have constantly called for a Growth strategy which is the best way to get the deficit down more quickly. I have pointed out that this year so far the deficit has undershot gloomy Treasury forecasts by £60bn because the economy grew more quickly and so revenues shot up without any change of tax rates. I have also continuously pointed out that whenever a government has had the courage of cut rates of tax on incomes, gains and transactions it has always collected more revenue as more people work, invest more  and switch assets more often.

I promote policies which will boost revenues substantially. Granting licences to produce more of our own oil and gas will mean a large increase in UK domestic tax revenues, and an end to UK consumers paying too much tax to foreign governments of the producing countries providing us with imports. Policies which promote growth also promote higher total income and employment levels at home which in turn delivers more tax revenue.

Nor have I been silent on reducing needless or wasteful spending. I am with many in urging the government to pursue more of the fraudulent payments made during the pandemic rapid response, where they should get more back than their critics imagine. I am pressing for the early end to widespread free covid tests, to make large reductions in the cost of the  very expensive test and trace programme. I regularly pursue the issue of closing down illegal migration, to cut the large costs of housing people once they have landed here from their smuggler run  small boat crossings. I voted against HS2 but accept a shorter version is now going ahead. I have turned my attention to the need for better timetables to maximise use and passenger fare revenue from  a railway network which is receiving far too much subsidy for running too many largely empty trains. I supported the reductions in overseas aid spending, wishing to end all assistance to countries with nuclear weapons, space programmes and the rest. I look  forward to huge savings on the cost of vaccinations, now that  most people have had three doses against covid.

The  numbers involved in these savings are large. Test and Trace cost £37bn over two years and could drop to very little from April with the changes suggested. Vaccinations must have cost another £20 bn or so where top ups will be much cheaper where needed going forward next year. Health procurement in total surged by £44bn in 2020-21, with very high costs for finding enough PPE during the height of the pandemic when world markets were short of PPE and prices very elevated. This budget should be much lower next year.

SAGE thinks it should continue with forecasts of covid and with plenty of advice to carry on testing and tracing and enforcing various limitations on freedom to try to reduce the spread of this particular disease. They think people trust them more than the government.

I seem to remember in the run up to last Christmas SAGE offered strong advice to keep us in lockdown for longer, planning to damage economic recovery and undermine Christmas . When I and others argued that Omicron appeared much milder from the South African figures and experience SAGE responded that was not established and the UK  might be different anyway. It turned out an important  difference with South Africa was we had more people vaccinated which increased protection for many. SAGE have subsequently come round to the view that Omicron  is a lot milder than previous variants, and established that the vaccines offer good protection against it.

It is time to return to normal and to repeal the emergency legislation which Parliament allowed when we were faced with a new dangerous disease without vaccines or medicines to combat it. It is great that skilled scientific researchers and doctors have pioneered vaccinations and treatments quickly which greatly reduce the incidence of fatal disease. It is time to reap the benefits of these advances.

It is of course true as SAGE advises that some people with other medical conditions, and the elderly and infirm are more at risk than others from the latest variant of this disease. It is also true they are more at risk from other diseases like flu and other lung infections where we did not remove the liberties of others in the past to try to contain transmission. It is also true many are more at risk of early death from the backlog of treatments for other conditions which need to be addressed. Of course our public health and care  settings need to work away at infection control and protection of the vulnerable. Those who feel at risk should be helped by employers to work at home where possible, be helped by friends and family to limit risky social contact and provide alternatives, and to use on line shops and entertainment where possible to cut risks from social contacts.

The polling  tells government a large majority believe the planet is warming thanks to man made CO 2. Polling would also tell government that a majority do not think that means they  should buy an electric car, install a heat pumps or stop eating meat.

More curiously around half do not even want to accept a free smart meter urged on them  by greens. People have been suspicious about these products fearing they might be used to change tariffs or even cut power off at busy times. This has always been denied by the suppliers and the smart meters fitted have not been used in these ways.

Now we learn that the energy companies do want to use them to get people to use power overnight and not use it during the morning or evening peak. They plan to offer new tariff schedules with cheap overnight power and dear peak hour power. They say these will be discretionary, not mandatory.

I guess it would be possible to set washing machines, driers and dishwashers to run overnight. You could not cook the meal,turn the lights on  or have the Tv running outside peak hours. The tariffs would have to be steeply tiered to change conduct but will put people off if the  rates are too high for all the normal uses people will have at peak times.

All this is only needed because we keep putting more wind generation on the  system leaving us short of power at peak times on low or very high wind days.

I do not think Russia will launch a full scale invasion of Ukraine. Russia will recognise that the main population of Ukraine outside the eastern cities is very hostile to Russia, would offer strong resistance to invasion and refuse to accept attempted rule. Crimea has accepted Russian rule as there was  a much larger pro Russia population in that part of the country when Russia marched in without resistance.

Russia pretends to believe that NATO is a threat to it, yet there is no evidence that NATO has ever wanted to expand its territory by military means. All NATO troops and weapons deployed in the eastern member states are there for defence only. NATO makes no territorial claims. It is true after the split up of the USSR some states asked to join NATO. They were not made to by an alliance often reluctant to accept new members given  the  burden they bring to the collective defence.

Russia will doubtless wish to foment tensions in Donbas further where there are more pro Russian citizens unhappy with Kiev rule. France and Germany tried to negotiate a peace in eastern Ukraine with Russia and the Kiev government. The  Minsk  Agreements sought a solution of devolved government for Donbas but the elections did not take place and we still await a constitutional settlement. It is best for that group to try again to adjust the  Minsk Agreements to current conditions and get on with the  implementation.

I am not surprised the Foreign Secretary got nowhere with the Russian Foreign Minister. I hope she now returns to end the talks with the EU and get on with putting in a solution  to the Irish Protocol issue.

Yesterday the government announced that it will be licencing more oil and gas fields for production in the North Sea soon. This follows an intervention by the Chancellor with the Business Secretary, whose department and regulators were delaying or refusing permissions for development of  some discoveries. This announcement comes on the back of the recent licencing of the small Abigail field.

I have been making the case that it means less carbon dioxide is produced if we burn our own North Sea gas delivered by pipeline rather than import LNG from  Qatar by ship. I have argued that we will collect much more tax revenue if we burn our own gas rather than importing as the UK imposes substantial taxes on the production of oil and gas . It also means we create and keep more well paid jobs by sustaining our domestic industry instead of relying on imports.

I look forward to further successes for commonsense and for import substitution.

Rt Hon Sir John Redwood MP (Wokingham) (Con): Does the Minister agree that there is no reason why we should not produce 100% of the temperate food that we need? We lost a huge amount of market share when the common agricultural policy was introduced, and some of us want to get that back now that we are out of the CAP. Is it not better to cut the food miles and rely on local jobs and local production?

Victoria Prentis (The Minister of State, Department for Environment, Food and Rural Affairs): It is also a pleasure to talk to my right hon. Friend about these matters. I have also spoken to him many times, in this instance about his plan to boost horticulture, particularly fruit and vegetable production, in his constituency and, indeed, across the nation. Fruit production has fallen to 16% of what we consume nationally, and fruit is one of the very few foodstuffs whose price has risen in comparative terms over the last 10 years when the price of most other foodstuffs has fallen.

I do not think the present government is getting the best out of the Civil Service. The Prime Minister has a new opportunity to construct a Downing Street structure and appoint staff he trusts to help him deliver his vision.

The Levelling Up Secretary has just unveiled a wide ranging set of proposals to spread prosperity, better jobs and ownership more widely around the UK. He will need the help of the Prime Minister to mobilise the various Whitehall departments that have crucial roles to play. He needs many actions from Education and Transport, from Treasury and Health, from Trade and from Business and from several others.

Inspired by the good response to my article on how Downing Street worked under Margaret Thatcher, I think it might be helpful to set out how the Thatcher team worked with Whitehall to put through bold new policies that were designed to improve the prosperity and freedoms of citizens. We were able to make substantial and timely changes without major constitutional upheavals or Civil Service reform.

I was struck by a recent article by Daniel Hannan which was critical of the Civil Service. He pointed out that officials make many errors and design bad policies which Ministers get blamed for. He felt Ministers now cower before Civil Service political correctness, and are told much of what they want to do is impossible owing to the views of independent quangos, the body of law and the results of arranged polls and one-sided consultations. He argued that the Civil Service has specialised in improving its diversity of recruits, whilst ensuring there is no diversity of outlook or view.

He contrasted the successful pursuit of working vaccines by an individual brought in from outside to lead a specialist small unit to solve the problem, and the difficulties with the rest of the pandemic response that mainly relied on more traditional Civil Service people and procedures. He sees the Civil Service as internationalist, pining for Remain and in favour of a larger but not necessarily a more effective state. Ministers he concluded are there to take the blame and to be in the wrong, but often have insufficient engagement or leverage over the large staffs that work in their departments and quangos.

I know what he means, but I think many of the answers lie in the hands of good Ministers. Ministers with a large majority have the crucial power to change the law if the old laws get in their way. They can command huge resources of people, money and message. They can abolish quangos, appoint new Heads, issue clear new public instructions to them which Parliament may debate. They can ask their departments to do more of this and less of that. They have the power of the purse and of the pulpit.

When I helped Thatcher there was of course a Civil Service culture and a controlling set of ideas within the Civil Service machine that was not the same as the collective views of the government. The official Civil Service government was not proposing Union reform or privatisation or lower taxes. It would have preferred to live with a larger public sector and older comfortable ways. It seemed to find the wind of change we wanted as abrasive. Some probably wanted it to fail to be able to say quietly it had warned us of its imperfections. Aware of this I decided on a careful course of action to implement the big idea of wider ownership, of everyone an owner. It was a popular idea that embraced many of the actions and policies that the Civil Service and Unions found challenging.

I did not suggest to the PM that she held a Cabinet, flagged up the big policy aim and challenged the Civil Service to create and use the conventional architecture to deliver it. The last thing I wanted was an overarching Cabinet Committee for wider ownership. That would doubtless have slowed and diluted what we wanted to do. It would have given critics of the whole idea a forum to debate the philosophy and sow doubts. Cabinet Ministers would have been less willing to accept individual responsibility. Instead the PM and Cabinet colleagues introduced the main ideas split by department, with the PM discussing with each of the relevant colleagues how they could pursue the key parts as stand alone ideas within their areas.

The Treasury was to lead on privatisation with John Moore, a Minister, to work bilaterally with the other sponsor departments on the relevant industries. The Treasury would mastermind the timetable and offer central resource on the preparation and sale process. The Social Security department was to lead on pensions reform, introducing personal portable pensions for the first time so people could control their own retirement savings more directly. They did so via a general welfare review to gauge demand, to seek outside views, and to reform other features of what they were doing. Norman Fowler did a great job, with no leaks as he prepared the ground for radical changes.

The Business department led on making it easier for people to set up and grow their own businesses and worked with the Treasury on tax incentives. The energy department worked on radical proposals to get more cheaper energy to fuel our businesses, introducing pro competitive policies, as well as preparing gas and electricity for privatisation. The Housing department was to hone and improve the Right to buy policies to give more people a chance to own, and to develop homesteading, shared ownership and sales of redundant public sector land to boost wider home ownership at affordable prices. The Transport department offered National Freight for sale to its employees in an exciting experiment with employee ownership as well as selling BA and bringing in more private capital to buses.

It was only when I was confident that each Cabinet member had found policies they liked and were willing to see through, and was sure the Departments would assist them, that I proposed to the PM she set out the overarching vision and tied it all together. As there was already buy in by the main departments the vision then helped. The Civil Service ensured each major privatisation we did needed individual legislation, resisting enabling powers. I decided not to fight this as we needed a measured pace of privatisations and Parliamentary process allowed a public debate and consideration of all the detail in each major case.

Today there needs to be similar commitment to levelling up department by department. Education will doubtless take responsibility for challenging targets for literacy, numeracy and qualifications. Health will need to think through how it achieves the bold aims on eradicating health inequalities by region. Transport has a major task to clear the jams and improve the trains in many places. Business and the Treasury need to give more thought to improving the UK’s competitiveness so more businesses start up and more investment is attracted.

The Government’s enthusiasm for more devolved power to Mayors and Councils will cut across some of the national targets and programmes and will provide a complication more than an impetus, save in the minority of places that find and back a Mayor or Council that does know how to do it and how to work with central government.

The new structures at 10 Downing Street risk being top heavy.  They will need the Chief of Staff to work well with the Cabinet Secretary, the Permanent Secretary of the Cabinet Office and the Permanent Secretary of Downing Street. This weeks failure of the government machine to deliver an NHS plan in time for the PM and Secretary of State to announce it on Monday is a sign of how things need to be improved sharply.