John Redwood's Diary
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Independent bodies and democracy

There is a disjointed contradiction at the heart of UK politics. The major parties claim to believe in the supremacy of Parliament. In Commons exchanges Opposition parties hold the government to blame for everything that happens in the public sector, and for much in the private on grounds they could have regulated it. Ministers rarely deny collective responsibility. 

 

Yet the major parties this century have also created and empowered more and more so called independent bodies, arguing that panels and boards of independent  experts should be much better at deciding things and at spending tax money than politicians without specialist knowledge and with public opinion to please or appease. The independent bodies who often get things wrong, make mistakes and annoy people usually escape blame and shelter behind the Minister who was not allowed to interfere with the mistakes when  they were making them. 

 

One of the most prominent examples of this confusion is the Bank of England. Most MPs believe Gordon Brown made it independent. Most believe the Bank has one overriding aim, to keep inflation  down. This is embodied in one simple and memorable target to keep inflation at 2%. Recently inflation hit 11%, more than five times target and more than five times the Bank’s forecast a year or so earlier. Opposition politicians blame the government for the inflation. The government blames the Russian invasion of Ukraine, glossing over inflation already at 5.5% before the tanks rolled. No one seems to blame the Bank that owns the target, sets interest rates, and printed £895 bn of extra money which must have had some impact. 

 

Take the Environment Agency. It is charged with many tasks which include both keeping us free from flooding and ensuring we have enough water. Some years ago it allowed systems to keep the Somerset levels dry to silt up with fewer working pumps. The inevitable flooding took place. Ministers  had to intervene to get some order restored. The Agency was expressing a political preference for salt marsh over farms which did not reflect tradition or local residents needs.

 

The reassuring truth is we are still sufficiently a democracy so when an independent  body annoys enough people or makes a big enough mistake politicians do usually intervene. They impose new measures or new men and women on the agency or change the way the whole thing is done. The frustration is the need to often go through a long period when a quango is visibly failing pretending not to notice, or blaming someone else with Opposition and Ministers united in the view politicians  should not interfere. 

 

The reason our traditional constitutional theory gave power to Ministers was twofold. Often it needs a common sense decision taker to sift the professional advice, challenge the experts and decide what to follow. It also does need a specialist at what the public will accept and at what the public wants, which is what good politicians know. 

 

Today the NHS is at the centre of political rows. It is ironic it is so, as both main parties believe in the NHS, both support its values, both give more money to it, both want the waiting lists down. The rows are mainly about results. Sometime ago Parliament set up NHS England with its own CEO , Board and well paid senior executives. All agreed the politicians should stay out of running the  NHS. So who is to blame for the current high waiting lists for non urgent assessment and operations, poor labour relations, the shortage of beds  and long waits for urgent treatment? The Opposition will blame Ministers and Ministers blame the epidemic, the unusually high seasonal pressures and global trends. Few ask whether the executives could have spent money better, raised staff morale, used considerable powers over grading, promotions and increments to look after staff better. The quangos seem untouchable. 

 

 

If the UK wants to persist with its model of independent bodies it needs to make their CEOs, Chairmen and Governors more directly accountable. Their tenure and remuneration should vary depending on performance. Their responsibilities need to be more tightly defined. If Ministers have to run these things  that is probably best done by taking them back into direct departmental control.

 

Jerome Powell the Head of the Fed, America’s Central Bank, recently argued strongly for narrow limits being placed on how much independent power a body like the Fed should have. He sees the political imperative to keep main policies under democratic control through the Congress. He said the Fed should not be set aims to  promote the net zero journey or other social objectives, as these are contentious matters that need political judgement and leadership. The Fed should stick to its economic objectives which are cross party and relate to the direct tools and expertise the body has. He is very conscious that the Fed has to earn the right to have such powers by doing a good job and avoiding straying into more disputed policy areas.

 

This is all good advice. It is time for the UK to review how much power these bodies wield, and to assess how well they have performed. Ministers who fail to do this stand in danger of taking the blame for the errors they have not themselves committed. 

 

 

 

 

My Telegraph article on Central Banks

Jerome Powell, the leader of the world’s most important and powerful Central Bank has made a strong case for limited independence within a democratic framework. Warning against a Central bank  widening its remit and scope too far, he spoke out  against Central Banks taking on roles to  put us on the road to net zero and other social objectives. He argued  that “addressing climate change seems likely to require policies that would have significant distributional and other effects on companies, industries, regions, and nations. Decisions about policies to directly address climate change should be made by the elected branches of government and thus reflect the public’s will as expressed through elections” . If you give an independent body one or two targets and aims it is possible to monitor success and demand improvements or changes where needed. If you introduce a range of targets the Bank is distracted, making compromises where the aims are in conflict. It also  opens itself up to more political criticism. There is no serious  body of opinion in the US or UK wanting banking instability or high inflation so setting  targets for these  does not politicise the Bank. The ways to net zero, the speed of transition and the desirability of its various policies remain much disputed, and are far outside the powers of a Central Bank to deliver.The Bank of England and the European Central Bank should consider this advice carefully. 

 Jerome Powell wisely recognised a Central bank needs to justify its independent power to raise or lower interest rates. He  said “ the Fed must continuously earn that independence by… achieving our assigned goals of maximum employment and price stability, and by providing transparency to facilitate ….. effective oversight by the public and …..Congress.”  He did not consider how it came to pass that with this independence the Fed kept rates very low, created trillions of dollars  and ended up with inflation five times its 2% target. The Fed was free to buy bonds on a huge scale and did so.  The Bank of England adopting a similar policy was not independent over money creation and bond buying. Under the agreement first entered into by the Labour government at the time of the great banking crash, all the money created and bonds bought in the UK  required the written consent of the Chancellor who answered directly to  Parliament.  Labour, the Coalition and the Conservative governments all provided a complete taxpayer indemnity for the Bank against losses on the bonds. The Fed is just going to take the losses and record the fact on its balance sheet without taxpayer payments. I agree that keeping  rate setting out of the hands of politicians  makes sense, but also think the elected bodies that appoint the Governors and  question them need to do a better job at finding out why inflation got away. The leading Central Banks should take more interest in monitoring and responding to excessive money and credit creation. There needs to  be a proper debate about how they can avoid another  big inflaitonary upsurge – or banking crash – in future.

 

The Fed Chairman went on to say  we should “stick to our knitting and not wander off to pursue perceived social benefits that are not tightly linked to our statutory goals and authorities. In a well-functioning democracy, important public policy decisions should be made, in almost all cases, by the elected branches of government. Grants of independence to agencies should be exceedingly rare, explicit, tightly circumscribed, and limited to those issues that clearly warrant protection from short-term political considerations.”

This is very good advice. As the Fed, ECB and Bank of England have just shown it is easy for Central Banks to make major errors in their prime task of counter inflation policy, just as they all have questions to answer about  their role in the banking crash  in the previous decade. Taking on additional roles impedes focus on the central tasks of low inflation and banking stability which must be their rationale.

 

It is no surprise that Mr Powell should chose to make this intervention into the political debate as he faces a recently elected Republican led House of Representatives who have very different views on fossil fuels and net zero transition to their Democrat opponents who lost the majority. It shows his customary political sensitivity that he at this moment rules out some of the favourite Democrat themes from the core message of the Fed. The Bank of England also needs to concentrate on the knitting after a bad period over inflation. The Bank  needs to balance pressure down on inflation without creating a needless deep and long downturn. That is the part of the Fed remit that makes great sense, to worry about employment as well as inflation within the context of an overriding  target to keep inflation down to 2%..It is the job of elected governments to decide energy policy, food policy, transport policy and housing policies that are all involved in current ambitious plans to decarbonise.

Written Answers from the Department for Health and Social Care

The Department of Health and Social Care has provided the following answer to your written parliamentary question (117392):

Question:
To ask the Secretary of State for Health and Social Care, whether he is taking steps to encourage NHS managers to use (a) promotions (b) increments and (c) flexibilities in pay scales to retain and motivate staff. (117392)

Tabled on: 06 January 2023

Answer:
Will Quince:

Retention within the National Health Service is a complex issue and decisions to leave are taken due to a multitude of factors, of which pay is only one. The NHS Retention Programme seeks to understand why staff leave, resulting in targeted interventions to support staff to stay whilst keeping them well. Locally, employers in the NHS have the option to use measures like pay increments and promotions to attract and retain staff.

The answer was submitted on 12 Jan 2023 at 11:11.

Written Answers from the Department of Health and Social Care Regarding Hospital Beds

The Department of Health and Social Care has provided the following answer to your written parliamentary question (117396):

Question:
To ask the Secretary of State for Health and Social Care, whether he is taking steps to increase the number of beds in NHS hospitals. (117396)

Tabled on: 06 January 2023

This question was grouped with the following question(s) for answer:

  1. To ask the Secretary of State for Health and Social Care, what steps he is taking to increase the availability of NHS hospital beds. (117756)
    Tabled on: 06 January 2023

Answer:
Will Quince:

As part of the NHS England’s operational resilience and capacity plan for winter, the National Health Service is increasing bed capacity by the equivalent of 7,000 general and acute hospital beds. This includes a mix of new physical beds and innovative virtual wards.

On 9 January the Government announced £200 million of funding to allow local areas to buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up hospital beds for those who need them. This is an addition of the £500 million Adult Social Care Discharge Fund announced in December which is also supporting hospital bed capacity.

The answer was submitted on 11 Jan 2023 at 14:09.

Written Answers from the Department of Health and Social Care

The Department of Health and Social Care has provided the following answer to your written parliamentary question (117394):

Question:
To ask the Secretary of State for Health and Social Care, what steps he is taking to help recruit more permanent staff to the NHS and reduce dependence on Agency staff. (117394)

Tabled on: 06 January 2023

Answer:
Will Quince:

This Government is growing the National Health Service workforce. There are now over 42,000 full-time equivalent (FTE) more staff working in NHS provider trusts and commissioning bodies than October 2021, including almost 4,700 more doctors and over 10,500 more nurses. We are working hard to deliver 50,000 nurses by the end of March 2024 and we are well on the way towards achieving this aim with over 36,000 more nurses working in the NHS now compared with September 2019.

The Government has funded 1,500 more medical school places each year for domestic students in England, a 25% increase over three years. This expansion was completed in September 2020 and has delivered five new medical schools in England. There are currently record numbers of medical students in training.

The Department of Health and Social Care has also commissioned NHS England to develop a long-term workforce plan. The plan will look at the mix and number of staff required across all parts of the country and will set out the actions and reforms that will be needed to reduce supply gaps and improve retention. A temporary workforce market allows the NHS to meet demand fluctuations without the need to increase capacity above that which would be required on a sustained basis. Staff can be drawn from internal staff banks or external agencies.

Measures were introduced in 2015 to control agency spending and include price caps, limiting the amount a trust can pay to an agency for temporary staff, the mandatory use of approved frameworks for procurement, and the requirement for all trusts to stay within the specified Annual Expenditure Ceilings for agency staff. The agency rules outlined were effective in reducing spending on agency staffing by a third between 2015/16 and 2020/21.

The answer was submitted on 12 Jan 2023 at 11:10.

My Speech on the NHS Long-term Strategy – Opposition Debate

Rt Hon Sir John Redwood MP (Wokingham) (Con): No one can deny that the health service is under extreme pressure. No one can look at it and not realise that there has been a big surge in extra demand, that there are problems from the hangover of covid when a large waiting list for less urgent treatments built up, and that we are short of doctors and nurses, not because Ministers will not authorise their appointment but because there are vacancies to be filled. As one of those who has been urging for some time to see a published workforce plan, I welcome the decision of Ministers to insist on that, and the sooner we get it the better. However, I am quite sure that there are a whole series of workforce plans already in the many dozens and hundreds of working trusts and quangos that constitute the NHS. It is about aggregating and making sense of those plans.

Yes, indeed. From my hon. Friend’s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.

 

Dr Caroline Johnson (Con): We often talk about the shortage of doctors. We know we cannot create a doctor overnight. It takes a substantial amount of time to train them. The Chancellor, a former Health Secretary, invested in five new medical schools to increase the number of doctors in training. Does my right hon. Friend agree that the Chancellor, with the Health Secretary, needs to invest more money in more medical schools and medical school places, but also look at how we increase the Toggle showing location of Column 647number of doctors by reducing the amount of bureaucracy and paperwork they have to fill in, so that they can spend more time doctoring and less time filling in forms?

 

Rt Hon Sir John Redwood MP (Wokingham) (Con): My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over £100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.

Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the public’s priority—and indeed the Opposition’s priority—is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra available—every time we meet another additional sum is announced—but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.

I had better not, because we are very short of time for colleagues.

The money has to be well spent and I hope that senior managers, as they give us a published workforce plan, will share more of their thinking. It is not good at the moment that there is such a breakdown in relations with talented and important staff in the health service. There is a complex system of pay reviews, increments, promotions and gradings of activities. All those things have flexibility within them. I look to the senior managers

We need more supply because there is excess demand, for understandable reasons. Huge sums of money were tipped into the system to deal with covid. Not all of it was well spent, but that was understandable given the unknown nature of the beast at the beginning, and the obvious pressures in this place and elsewhere to get instant results with personal protective equipment, testing and so forth. That is now behind us, but unfortunately it disrupted normal hospital work and normal GP work and created backlogs.

I urge the Government to understand that part of the answer is having more bed spaces in hospitals, with the staff to back them up. I do not know why so many senior health executives never want to admit that. They always say that there are lots of bottlenecks and other issues. Yes, of course we need to move people on from hospital as soon as it is safe to do so, and of course we need more capacity in social care, but I say to Ministers that it would be great to have a bit more capacity in the main hospitals to give us extra flexibility and take some of the pressure off. Could not some of the extra £20 billion, £30 billion, £40 billion or £50 billion that has been found in recent years be spent on the combination of physical capacity and the staff to support it that we so need?

Vaccines

I do not have expertise in the chemistry or the medical effects of vaccines. If you wish to discuss this topic then go to sites that are capable of handling these issues and have articles from people who do know about them. Nor do I wish to host a debate about Mr Bridgen’s  words. As you can see I have not written about this medical issue.

My Conservative Home article – The aims of the government

          Rishi Sunak  in his New Year speech set out three economic targets and two promises on NHS waiting lists and illegal migrants. There is  nothing wrong with putting three economic matters top of his five point plan. It is” the economy stupid” as Clinton reminded us  that will determine the election result. It is the economy that is on most minds, as people navigate high inflation and worry about a recession. I am glad he regards economic improvement as central to his task over the  next two years. Most of the rest would flow from economic success.
         The problem is that economic language and overlapping economic targets do not set the pulses racing or reveal much about the vision. All main parties want inflation down, debt under control and some growth. The issue on the economy is who has the best policies to achieve those aims? Who is most likely to see it through?  What do those generalised abstractions mean for individuals trying to pay the gas bill, seeking a better job or running their own small business? If you are in government and have been in office for some time you need to show you have produced good results and have done all you can to maximise people’s life chances and minimise financial pain.
         The first aim to halve inflation should happen this year. The Bank of England has shifted from too lax a policy promoting inflation in 2021, to too tough a policy now, leading us into recession. This will bring prices down the hard way. Halving price rises still leaves inflation well above the 2% target.
          The second is to “grow the economy”. That is an excellent aim, but not one we will see for much of 2023 on current policies. The government needs urgently to present to Parliament a growth package. Several of the pro jobs and business tax proposals in the Truss/Kwarteng budget would help, along with the more vigorous Free Ports, Enterprise zones, public/private partnerships and realistic energy policies that they proposed. These need to shaped into an affordable package, balanced by some spending reductions as the government wrestles with public sector budgets that are costing too much and delivering too little. Encouraging and helping more people into work would be  an obvious win win that would help by cutting benefit payments and raising tax revenues. Stopping the Bank of England taking so many losses on its badly bought bond portfolio would also assist. Producing more something for something pay deals in the public sector to lift productivity from its current deep low could be transformational. Pushing through more UK oil and gas production would not only cut imports but boost tax revenue.
         The third of the economic aims is to “get our national debt down, so that we can secure the future of public services”. It turns out this relates to the old Maastricht target of debt falling as a proportion of GDP, a target even the EU has suspended. It  relates to five years hence, well into the next Parliament so it is no early constraint on action. The best way of achieving such a goal if you must is to promote faster growth – or reverse a recession – as debts and deficits fall when growth generates more revenue and cuts the  cost of unemployment as more get jobs. Putting up taxes this year does not lower the deficit in five years time, as the recession and energy support payments are going to mean a lot more borrowing this year than was planned in the March budget Rishi put through himself.
         The fourth aim is to cut NHS waiting lists so people can get  care more quickly. That should receive almost universal agreement. The issue is not the aim but the means. It also leaves open why hasn’t this happened before.
         The fifth aim is Rishi’s first stated priority when he became Prime Minister. He will legislate to ensure if you come illegally you will “be detained and swiftly removed”. That would be popular with many Conservatives. It assumes Ministers now know which powers they need to take to make sure the courts and lawyers do not thwart their wishes again, as this has long been the stated aim. We are awaiting early legislation in Parliament.
            The speech went on to stress the need for innovation in business to power higher productivity and higher wages, stronger communities, world class education, better healthcare for patients and placing the family at the heart of social life. Most of this was general in nature but drew on his own family background well to illustrate the themes. The one specific, more maths education for all six formers, is an idea in search of a policy. It does not mean all have to take maths A level. It  will require consideration by teachers over what can be taught to those not offering specialist maths/ There is the problem who can teach it and what assessment or qualification if any would follow.
              Many ask me if this is a winning vision. I think the Prime Minister is right that his strength must be  competence so what he needs to do is to demonstrate he can deliver on these five promises he has made. He chose the ending of illegal migration as his first priority, seeing the political significance of not being able to control our own borders. He understood the resentment felt by many to see young men pay substantial sums for a dangerous boat trip to enter illegally and to be put up in hotels with free medical care paid for by UK taxpayers. Stopping this would be an important achievement, saving lives and giving proper priority to the asylum seekers from Afghanistan or Ukraine where we have legal routes of entry for them. There will be a success to report when we see many hotels return to their proper use.
               Getting  NHS waiting lists down will be difficult. The fast growing population from migration and the backlog of health cases brought on by covid disruption of other NHS services means the NHS is under pressure. There are too  many unfilled vacancies and the employees are unhappy.  The PM will need to persuade the senior management of the NHS to expand capacity quickly, which will need more beds and medical staff. The government does  not have the time nor mandate to embark on major reform of the NHS before the election. It can encourage managers to improve staffing arrangements, reduce pressures where waiting lists and times are unacceptable and expand capacity as much as possible. It is odd how resistant NHS managers are to putting in more beds with the medical staff to support them. The latest package offers us virtual beds, not the real things in hospitals. Some of the many extra billions provided to the NHS needs to find its way into extra capacity rather than more quangos, Diversity Officers and management consultants.
                 It will be the economy that determines how most voters feel about the government come election day. You cannot hope to create a better economy just in time for the election and expect people to forget what has gone before. By 1997 the then Conservative government had recovered the economy well, but the public was not willing to forgive them for the deep  recession brought on by their policy of joining and then getting ejected from the European Exchange Rate Mechanism. It is most important this government is seen to be battling against recession as  the Bank of England and the other major Central Banks deliberately slow things down to curb inflation. Allowing the Bank to overdo  it and give us a long and deep recession would be bad economics and worse politics.
                    That is why the government urgently needs a growth package. If we can boost investment in energy, in food, in transport and all the other areas where there are shortages which create inflationary pressures we will be tackling growth and inflation at the same time. Urgent and successful interventions to limit the downturn, to increase  investment  in the future mainly through private sector action, to get more people into work and to promote better pay for more output in the public services would be a winning combination. It does now require visible improvement, not just words, from a Prime Minister who rightly stresses the  need to deliver.

Strikes

The government’s statement on proposed new strikes legislation was short and simple. It praised the nurses for agreeing minimum service levels before going on strike, recognising their greater duty to the public to avoid action which could lead to the death of a patient. The government said it needed to put in place similar minimum service agreements for the NHS , the fire service, education, railways, nuclear decommissioning and borders. They argued they had no wish to take away the right to strike, and were copying practices in some other European countries. The Opposition saw it as an attack on workers rights and said they would oppose.

It will be interesting to see how the government proposes to enforce any such law, as by definition if people have gone on strike it is difficult to get them to come back to work against their will. The Bill implies action for damages against Unions not ensuring the minimum standard, but it will need clarification. Certain workers will  be identified as essential to maintain the minimum service and they will be expected to turn up.  It will also be difficult to decide what is a safe necessary minimum standard of rail services, given the way motor transport, planes and boats can be substituted for trains. The government intends to consult on minimum standards which will doubtless produce a  variety of views. I would be interested in comments on these matters as I do not have settled views myself on how this will work.

A Health package

At last Ministers had something to say about getting waiting lists for treatment down and waiting times at A and E reduced. The fundamental principle of the NHS is free access to health care based on need. Rationing by delay is not part of the deal to taxpayers who are now paying  very large sums for the service.

The NHS needs more medical capacity. It needs more GP surgery slots, more hospital beds and more operations performed. The backlogs are unacceptable. This is why I and others have been calling for a Manpower Plan. This needs to set out expectations of manageable workloads per employee and realistic targets for staff  numbers needed to cope with likely demand. They also need extra to get rid of the oversized waiting lists.

This raises various questions over training, recruitment and retention. Could we introduce high standards of training in specific areas that take less time than a full doctor’s qualification to staff specialist centres for cataracts, knee surgery and the other high volume standard procedures for elective surgery? Can nurses and pharmacists have more authority  over prescribing and providing medicines? Can medical tests be streamlined and  be more efficient?

When it comes to retaining doctors that does highlight the general tax issue where people get taxed at 60% in the £100,000 to £125,000 range, and where the allowed level of savings for pension has bee cut  back substantially. It would be good to ease these tax issues for all as doctors tell us they lead more to retire early when we still need their skills.

The Secretary of State yesterday announced more money to buy bedspaces in care homes to allow earlier discharge from hospital for some elderly patients. He also announced the equivalent of 7000 extra beds in the form of virtual wards where people are clinically supervised remotely by professionals whilst be in bed at home. he also announced some increase in capacity through adding modular units to allow more day care in A and E. He also proposed more work for pharmacies to cut the demands on GPs.

There is still no full workforce plan,  nor stated plans to add beds with relevant staff to hospitals. As the population keeps on growing, and as an ageing population needs more hospital care the NHS does need to expand its core bed capacity.