Author: johnredwood

The Commons is half way through its closing debates on the Health and Care Bill.

I have concerns about both main elements of the legislation.  The first concern the extensive reorganisation of NHS England. This gives legislative force to the  creation of Integrated Care Boards and Integrated Care Partnerships. These bodies are  being set up to change the landscape of purchasing services from the NHS trusts, GP partnerships  and other providers. They bring together various  budgets, decide on what they need to provide for their area and divide up the budget to seek to procure what is needed.

I am not clear as to how they will  be better than the Clinical Commissioning Groups they replace  nor see why their boundaries have been configured as they are. There are big variations in geographical area and populations covered by these bodies. They need to hit the ground running now, as they have a big job to supervise the expenditures of large and increasing sums of money with a view to providing high quality care throughout England, and to bring waiting lists and times down to more acceptable levels. My concern is too much time and resource might go into reorganisation when we need it to be pushed to the front line to provide the extra treatments and care needed by the large influx of patients.

The second concern is about the social care reform. I have written and spoken before about the need to put raising the quality of care and supplying enough of it to the fore of the consideration, rather than the vexed issue of how much people need to pay for themselves where they have assets. For many years there has been cross party support for the proposition that all frail elderly people should get their health care free as part of the NHS pledge, but should pay for their own board and lodging where they can afford to do so. It has meant that where someone moves into a Care home leaving their old home empty it is usual for it to be sold and for them to pay for their hotel costs at the Care Home from their own resources.

There have been some who suggest that placing a cap on care costs will free many people from having to sell their homes to pay the bills, but this does not cover the costs of board and lodging which can be considerable. There is a danger that some will think this new system and legislation will free their families from the need to sell a home and spend the proceeds, when in many cases there will still  be substantial bills that people need to self fund. There is also the danger that the introduction of a Care Tax , starting at around 1.25% on National Insurance, will make people think social care is cheap. In practice this tax will pay for around one fifth of the total state costs of social care.

There needs to be more discussion and more consideration of what social care will look like in five years time, and how we will all help pay for it.

As one who wanted Freeports I am deeply disappointed that they were not set up and open for business on 2nd January. I am fed up with the delays and with the lack of incentives to make them fly.

I read that the Treasury first delayed them, then watered them down. Apparently officials ignored the enthusiasm of the PM and the one time enthusiasm of the Chancellor. They limited any tax relief on the grounds that it might just redirect business from another part of the U.K. to a free port, cutting tax revenues. No thoughts then of growing a bigger economy by offering some tax cuts so you collect more revenue. It’s a pity the Chancellor did not stand up to this unhelpful redrafting.

There is a strong case for more generous tax cuts and incentives to attract new investment that would not otherwise happen. The Freeports could also have simplified planning requirements and assistance with land assembly.

Even better would be to extend the tax cuts to the whole country.Set a Corporation tax rate of 15%, the same as the new rate for Ireland, and watch the business pour in. Where is the imagination  and enterprise vision? Why does the Chancellor go along with dismal Treasury views that will slow our recovery and keep the deficit high?

The Health Secretary struggles to tell us how many CEOs there are in NHS  England and seeks more money to get the waiting lists down without saying how the money will be spent or by how much waiting lists will fall.

The Transport Secretary presides over a railway sending largely empty trains around  the country making huge losses, told by the railway management they need to carry on with the same timetables and same cost base as pre pandemic.

The Home Secretary tells the Home Office to stop the people smuggling and trafficking, approves more resources and a new Channel Command,  but the numbers keep coming.

Government has been made much less responsive by the theory of independent bodies run by civil servants or CEOs who seek to keep Ministers at arms length. NHS England, Network Rail and Border Force have their own powers and independence when it suits. When something goes wrong they expect Ministers to vote more money and take the blame.

Given the growing gap between what the public wants and what some of these independent bodies deliver, Ministers need to take more control. Change, better service and more value for  money is needed. The NHS needs to get the waiting lists down, the railways need to tailor services to changed demand and border force needs to stop the illegals.

I will be writing several blogs about the productivity problem in the public sector, the myth of independent bodies and the need to reset management and aims of important services.

Yesterday I discussed the state of the GP service with some local doctors. They told me they are seeing substantially more patients now than just before the pandemic struck, as there has been a surge in demand. They see the majority of patients face to face. Some patients agree a remote consultation makes sense and may be more convenient for them. I have not been receiving complaints about this surgery and am grateful to them for the work they are doing.

They also drew my attention to the need to receive prompt confirmation of sufficient budgets for their patient list size and workload. There is a danger the new commissioners, the Integrated Care Board, will delay or misjudge the competing claims of GPs and hospitals. There is also a need for NHS England to limit  the number of additional demands or changed commands they issue in year. There needs to be a clear understanding of the split of the workloads between hospitals and GPs where primary care effectively undertakes some of the work for the Hospital Consultant.

Good GPs are concerned about some of the commentary suggesting surgeries are not doing enough or are refusing to arrange easy face to face appointments. Those who allege this or circulate rumours need to be more precise over who they are criticising and what the evidence is. All GPs under contract to the  NHS do have to run proper complaints procedures so people with a concern should use these.

It is important that the large sums approved for health in the last two years are directed to those in primary care and hospitals who can do most to provide great care and help clear the backlog.

It sounds as if the government is now going to take more action to clamp down on the people trafficking and smuggling that is a daily event across the Channel. Many people are writing to MPs to complain that Poland and the EU is seeking to resist large illegal movements across their border whilst the UK authorities  are daily assisting people smugglers and traffickers to make money out of endangering the lives of a mixture of refugees and illegal economic migrants from France, a safe country.

The government is taking new legislation through Parliament to strengthen the law. All too many failed asylum seekers who have lost their case and more than one appeal stay on, with a legal industry seeking to frustrate the decision of the Home Office that they so not  qualify as asylum seekers. The Home Secretary needs to check her draft Bill to make sure it will be a sufficient instruction to the courts. Those who claim to be asylum seekers should be given a fair hearing and opportunity to make their case. They should have the right to a single appeal to an independent court. There should not be a way of using delayed processes to allow them to carry on living in  the UK long after it has been determined they are not asylum seekers .

Conservatives and greenery go together. We wish to conserve what is best in nature and our environment. Conservatives have often pioneered legislation to improve water quality, clean up our air, protect our countryside and conserve what is best in our landscape and heritage. Around the country Conservative Councils are often struggling with the dilemma of people needing affordable homes whilst many others regret the passing of woods and pastures to grow crops of new houses. Many of us share the passion for clean air and water and for the gentle contours of English rural landscapes.

The levelling up agenda provides a heaven sent opportunity to do something better. There is no reason why planning policies should continue to direct ever more executive homes to the hard pressed south east, when other parts of the country could benefit from the jobs and investment major new housebuilding creates. Now that in the post pandemic world more homeworking and remote working is becoming part of our lives many more people will be freed from the need to live close to London on a commuter pathway. More small businesses and start up enterprises could be encouraged to establish away from the lure of the capital city. That requires more attractive housing for the investors, managers and entrepreneurs who will help populate the growth and success of areas that are grasping the opportunity to level up.

Levelling up will be a vast series of personal journeys. For everyone in an area that is improving who does set up a business or brings in a new investment there will be many others who will seize the opportunity to get a better job, to use and develop their talents to advance the new enterprise. Every major company siting a business premise in a new area represents an opportunity for smaller companies to spring up to supply everything from the lunchtime sandwiches and coffees through to the technology support, the cleaning and components they will need. Every new housing estate creates first round jobs for the building trades to be followed by all the jobs to support new residents in their new homes.

Government’s role is not only to provide better planning policies, but also to help with high quality education and training. Working with business there can be a new can do approach in places which have been sidelined by investors in recent years. The main thing enterprises need is talented people to work for them and deliver great customer service and product excellence.

Over the last fortnight the UK government has valiantly tried to craft worldwide agreement over the issue of climate change. It was always a difficult task. India, China, and Russia, three of the largest producers of carbon dioxide on the planet were never going to agree to curb their appetites for burning coal, oil and gas. China accounts for some 30% of the total world creation of additional carbon dioxide, and has decided to mine more coal and build more coal power stations. The conference was divided on the very issue of whether coal burning should be completely phased out worldwide or not. In the end the assembled countries could only agree to a diluted sentiment that coal would be phased down, without timetables or pledges from the main users of the fuel. Germany kept a low profile, though she as an advanced country is holding out to burn coal in power stations through to 2038. The Greens are wanting to form part of the new governing coalition after the recent German election, and are pressing to bring this down to 2030 to bring Germany a bit closer to other advanced countries and the UN approved policy of phasing out coal quickly. It still shows how difficult it is to agree the end of coal when a major advanced industrial country clings to it as a prime source of energy.

The problems besetting COP 26 were not just the divided world over how feasible it is to decarbonise, nor even just the disagreement over how much money rich countries should send to poorer countries to help them change. Central to the whole debate is the question of people’s buy in to what the transition means for their own lifestyle. It is only when there are sufficient affordable and good products available to heat your home, to travel to work and to fill your plate with carbon free food will the green programme take off. So far the elites who come to summits have lectured the many that we need to change our lifestyles whilst they themselves fly in jet planes to air conditioned hotels to eat meat diets as if none of their advice applied to themselves. When challenged they might claim that they have spent money on carbon offsets, whilst seeing no choice for their own purposes but to carry on using jet fuel, gas heating, traditional food products and the rest. The digital revolution sweeps all before it without government requests or demands, without subsidies and taxes to drive it. People want mobile and smartphones, computer pads, entertainment downloads and the other services that the digital giants can offer. For COP 26 to succeed it needs to spawn a new generation of products and services that meet the carbon requirements whilst also being affordable and better solutions to the problems of everyday life.

Levelling up can of course help produce the range of new jobs and skills which a popular green revolution could generate. The main thrust is to electrify much more of life and then to generate more power from renewable or carbon neutral sources of energy. As governments bring this about they need to reassure people that there are ways of keeping the lights on when the wind does not blow and the sun does not shine. COP 26 set up various working groups of countries to explore new technologies to provide better travel, heating and industrial process. The sooner they produce results the better. If there are more breakthroughs with cheaper and better ways of doing these things that cut the carbon, then India, China and Russia will also want to adopt them. If there are not even the advanced countries will find it difficult to sell the practice of decarbonisation to their own electors.