It is popular amongst many politicians and the public to say we need to spend more on more nurses and doctors, and less on managers and administrators. We need to spend more on medicines and treatments, and less on expensive computer systems.

            This may be true, but it should not go unchallenged. A hospital or doctors’ surgery does need managing. Someone has to make sure there are the right staff doing the right things, that the medical supplies turn up on time, the meals are served and the floors scrubbed. In the 1980s when the NHS was reviewed, the Report concluded that the NHS was then undermanaged.

           Maybe now we have too many managers and too many layers of management. Part of the aim of the current government’s reforms is to simplify and reduce the management overhead, which is a worthy aim.

            A successful hospital also needs good administration with excellent computer records. A nurse or doctor reviewing a patient’s progress, administering continuing treatment or preparing a patient for an operation needs quick and easy access to the patient record. It is important they have the full background so they know what to administer, which treatment to pursue, and what to watch out for.  One of the surprising things in some hospitals is how much is still done manually or with written records after years of high budget spending on computerisation.

          Some hospitals still have handwritten notes at the patient’s bed end. They dispense drugs based on the patient written notes. A proper computerised system would be better at ensuring the right drugs were administered at the right time, as the computer would remember it had already dispensed a given drug, and could check that it was the right drug against a bar code prior to the drug being offered to the patient. Some hospitals I am told now have these properly computerised systems, with the necessary checks against wrongful dispensing or overdosing, and with proper audit trails created by each action in the system.

           Sorting out the balance of work between medical professionals and adminsitrators is part of good management. Nurses and doctors do have to be involved in note making and recording, as it is their judgements which need to inform the system based on the evidence assembled from tests, talks with the patient and visual inspection of the problem.

         The government aims to legislate and change the administrative arrangements governing the rights of visitors, recently arrived people and illegal migrants to health care on the NHS.  They are currently consulting on what changes they should make, so your views are particularly relevant on this issue whilst the government is making up its mind on the detail.

          The government believes that there should still be an entitlement to free emergency care if a visitor, recent migrant or an illegal migrant is caught in a bad accident or develops a serious condition that needs rapid treatment. The issues to be settled are what entitlement if any do these categories of people have to the rest of  NHS care.

           If someone comes to work or stay here for a longer time period on a legal visa they currently can register with a GP for free primary care. If a visitor needs GP care during a shorter visit they too can currently onbtain free care from a GP. A visitor is not meant to receive free hospital treatment for anything other than an emergency whilst staying here. They can obtain health insurance or pay cash for any treatment they do want in a UK hospital, or wait until they return home.

          People exercising their right to work here under EU movement of labour rules qualify for free treatment like all UK citizens. The NHS is meant to cross charge the country they have come from for the treatment offered.  

          The government has suggested charging other new arrivals £200 as an initial payment or contribution to NHS costs, to be followed by a continuation of current practice of free treatment thereafter.

          Is this a sufficient levy and a fair approach, covering people like students and short term workers coming to the UK with a visa? Should temporary residents qualify for free GP care? Should hospitals have to take more care over charging people from 0verseas receiving treatment? How far should we go to ensure that we are running a National Health Service, rather than a World Health Service?

           I see this morning’s papers are full of news of high death rates and poor performance by a number of NHS hospitals. What should the government do about that?

            My question for Mr Hague, is will he act in support of the last Conservative Manifesto on the crucial question of the EU’s power?

              The Manifesto we both fought on was crystal clear on the matter of the EU. It said in the opening paragraph that “We will work to bring back key powers over legal rights, criminal justice and social and employment legislation to the UK”. I saw no need to say something different in my personal manifesto on these items, other than to pledge to vote for a referendum.

             The Manifesto went on to say:

“In future, the British people must have their say on any transfer of powers to the EU….We will introduce a UK Sovereignty bill to make it clear ultimate authority stays in this country, in our Parliament. The steady and unaccountable intrusion of the EU into almost every aspect of our lives has gone too far…”

          Nest week I will willingly vote for a simple motion  opting us out of all 133 Criminal Justice measures we can opt out from. I cannot vote for a motion to opt back into any them, especially something as fundamental as the European Arrest Warrant. We should opt out, and then negotiate arrangements for extradition between ourselves and the rest of the EU on a bilateral basis, as we do with other non EU countries. I do not wish this matter to be put under the control of the European Court, and to be put beyond our amendment or improvement in  later years by incorporation as a sole EU competence or power.

         I understand the government’s Lib Dem problem. They apparently will only vote for the opt out from the 133 if there is to be some opt back in, whilst many Conservatives have no wish to opt back in. It poses a difficult question for Ministers. I assume Labour will back the Lib Dems as they usually do. Both these parties it seems take delight in giving as much power away to Brussels as possible.

 George Osborne made a most important statement at the Treasury Committee on Thursday. He said a Conservative government if elected  would  not need more tax rises in the next Parliament. Further moves to get the deficit under control would be achieved by a slower pace of spending gr0wth, and by the natural buoyancy of existing taxes, not by more rises.  I agree. The UK’s problem is not that tax rates are too low, or too few things are taxed.

Presumably Labour and Lib Dems will disagree with this approach. They seem to be busy trying to find more ways to tax us.

           Public officials do know how to stoke the age old UK debate about “inadequate funding”. This week the media is alive with claims that the NHS will run out of money if it is not given large real increases to cater for rising demand and increasingly costly treatments.

            Private sector industries never debate like this. You do not hear leaders of the mobile phone and smart phone industry on tv  demanding higher allocations of future individual budgets to comunications, or threatening a shortage of capacity if prices do not rise. We used to have capacity and service quality problems with phones when we had a nationalised monopoly service, but have solved most of these by competition, choice and private capital. The changes to the range and types of service delivered, and the cost reductions owing to better technology and productivity have been stunning.

            It is true that the UK is wedded to the admirable principle that health care should be provided according to need, with much of it provided free at the point of  provision. We pay for our health care over our lives, paying more in when we are healthy and successful, and less in when we are not. No main political party wishes to change this approach.

            What we need from the officials who help Ministers lead and grow this crucial national service is constructive advice and help on how to adapt and develop the service, not screaming headlines of future crises imagined if more taxpayer money is not forthcoming. As we develop our NHS model, we need to ensure that it can embrace the innovation and productivity improvements that we rely on to keep the bills down in successful private services,without having to confont Granny with a bill when she visits the GP or hospital. I intend to look at ways to boost income , improve quality and performance and increase productivity over the next few days, without resiling from the popular underlying principle of “free” healthcare for all.

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           The decision of the ECHR to prevent the UK keeping really violent and unpleasant criminals in prison for a long time will not go down well amongst Conservative MPs, nor in much of the rest of the country. The Lib Dems refuse to allow Conservative Ministers to tackle this unwarranted interference this Parliament. We will need robust proposals for tackling the wayward Court in our next Manifesto. I hear that will happen.

          At the same time Mr Clegg and the Lib Dems have apparently refused to allow the Coalition government to get back the 133 powers granted under Labour’s Criminal Justice co-operation with the rest of the EU unless the government opts back into crucial federalist measures like the European Arrest Warrant. This too is being taken very badly by many Conservative MPs. We so rarely get a chance to get powers back from the EU, so we do not wish to miss the full  opportunity.

            The press drew attention to the happy spirit of unity the Conservative party achieved when as a  united party we voted for a referendum last week. We had to cut loose from the shackles of coalition to do so, as the Lib Dems no longer supoprt an EU referendum. Next week it looks as if the Coalition is back in business, to the annoyance of Conservative MPs who want more power from Brussels and do not wish to lose any part of this opportunity to reassert control over our own criminal justice system.

           It is easy to unite the Conservative party on the EU – it will always be united when we are working  to make a reality of a “new relationship with the EU” that means we are able to govern ourselves again. The party was united in voting against Nice, Amsterdam and Lisbon, and was united in voting for a referendum on whether to stay in. Anytime the Coalition grants powers to the EU or fails to take powers back, it will be opposed by many Conservative MPs.

 If you buy something from the private sector, you benefit from the mantra that the customer is always right. If you are forced to buy something from the public sector, you are usually under the mantra that the supplier is always right.

         If you buy a planning permission you are put under threat to get everything right and follow the rules. If you park in a Council car park you have to study the rules and end up with a fine or a wheel clamp if you make a mistake.When you have to pay your taxes you are expected to be master of the infinite complexity of modern tax laws, or else face a penalty payment.

        Wouldn’t it be better if the public sector used encouragement more and enforcement less? Wouldn’t it be a good idea to offer people money back if they do not need to use certain public services? If , for example, you went the last year without borrowing a library book, shouldn’t you get a rebate on your Council tax for libraries? If you do not use the local Council’s leisure facilities, isn’t that worth a thank you in the form of a discount on your next tax bill? If you are a regular user of a Council car park which is not normally full shouldn’t you get a bulk discount on the daily tariff?

        The public sector is not good at managing demand. That’s why it resorts to queues, inconvenience for users, high charges and poor estimates of what is and what is not needed by communities. Do you have good local examples of services that are not needed, or services which are wrongly priced?

            Uk politics is dominated by the debate about how much money each public service needs and deserves.  Labour specialise in defending each and every public service, regarding any attempt to do more for less or to reduce certain types of public service as damaging and against the public interest. The public sector itself spends a lot of time and some of the taxpayers money on presenting its case for more cash.

           Of course those managing public services should be expected  to stand up for their own service. They need to tell the politicians making the financial decisions what the consequences are likely to be for any given level of financial support. The issues arise as to how much they should spend on promoting their views on financial resources, whether they should do all this in public as well as in private, and how can those making financial judgements be sure they are getting a fair and balanced understanding of what the money will buy?

         In recent years some public sector managers and public sector suppliers have worked with lobbyists, PR and advertising people to get across their need for cash. They often hire a dining room in the Commons to present their general case to groups of MPs over meals or at receptions. Various interests provide financial support and other back up to All party Parliamentary groups. In the health field most different types of illness have groups and campaigns to explain the importance of their treatment group, the need to use certain drugs and protocols and the like. How much of this is sensible? Should there be any limits on what the public sector pays to lobby the public sector? Is it better if the lobbying is done by a private sector supplier who hopes to get the contract or the extra business  if the case is accepted? 

           Should some or all of this argument be made in private to Ministers responsible and to MPs taking an interest, or should it be part of a public campaign? If it is public, does it make the relationship between public officials responsible for proposing budgets, and politicians having to settle the budgets, more difficult?

           The politicians have to be the taxpayers’ representatives as well as the service providers’ leader. They are the substitute for the many choices of individuals in the market weighing price, value, need  and performance. They require good impartial information from their managers about the options for service delivery. They need to find a way of driving quality improvement and cost reduction. They need to choose between the nice to have and the essential to buy, to end up with a balanced and affordable package for taxpayers and service users.

 When Tony Blair allowed Gordon Brown to step up the rate of increase in public spending after 2001, he did have a mantra which said extra money had to go hand in hand with reform. He attempted to introduce more types of school, developing the Academy model. He came to the conclusion that he had been wrong in his first period in office to remove the outgoing Conservative government’s reforms in the NHS to try to give patients more choice and more control over how the money is spent. All this proved very contentious with his own side, and especially with the public sector trade unions.

          One of the main problems with monopoly public services is there is no way of ensuring change, innovation and progress. Whenever the service disappoints or lets people down, the cry goes up from the providers that more money is the only thing that is required to put it right.  There is no easy way of closing down, replacing  or stopping a public service which is no longer needed, or which is failing.

           The customers of public service, the taxpayers, have little choice or authority over the providers in most cases. I do not get to use many public services. I do have to use the Council rubbish collection service, and pay for it through my Council Tax.  If it were a bad service, I would have to try to complain  through a Councillor. I cannot simply switch to a cheaper or better supplier. There is no competitive edge in the service market, and the end user is not necessarily   the customer. The customer of the refuse service is in many areas in effect  the Council not the homeowners. This means the service provider is more interested in wooing the Council officials than the users, unless the Council is well run and focused on end customer satisfaction.

           Various reformers have sought to find ways to strengthen the customer voice, to empower the end users who pay through their taxes. With the current monopoly model for most services there are rows over rationing -some  users cannot get the school place they want for their child, or cannot get the treatment they need when they need it from their local hospital. There is also a reluctance to close down failing services, as any closure always produces a small group campaigning to keep the service open, or petitions and protests from the providers.

            There is also a heavy reliance in public service on enforcement and penalties for improper use of services as defined by the public provider, and practically no reliance on incentives or rewards. My local refuse service limits people to a certain number of refuse sacks a year to limit the cost of landfill disposal for the Council. If you need to dump more you have pay extra. I am happy with that idea. I would also like an incentive proposal. As I do not use all the sacks they supply me with, why do I not get a rebate on my refuse charge? One of the ways to test out how popular some suitable free public services really are might be to allow incentive payments for non use, as with my refuse sack idea.