The English and Welsh NHS comparisons

In today’s debate on the NHS in Parliament I asked Labour why they only wish to talk about England’s NHS when we are in the run up to a UK election, and why they do not explain the poorer performance of the Welsh NHS over waiting times and A and E. The following figures illustrate the differences:

Waiting times
To start treatment Wales 13.7 per cent of patients waiting more than 26 weeks.[1]
England 12.5 per cent of patients waiting more than 18 weeks.[2]
A&E Wales 19.0 per cent of patients waiting more than 4 hours in December 2014[3] England 10.2 per cent of patients waiting more than 4 hours.[4]
Diagnostic and therapy services
Wales 31.0 per cent of diagnostic patients were waiting more than 8 weeks.[8] England 1.2 per cent of diagnostic patients were waiting 6 weeks or longer at the end of November.[9]

Ambulance Responses (category A calls)
Wales 56.9 per cent of ambulances arrived at the scene within 8 minutes.[10] England 71.8 per cent of Red 1 & 68.4 per cent of Red 2 ambulances arrived on the scene within 8 minutes.[11]

Will Germany pay the Euro’s bills after all?

There is a big battle going on over the future of the Euro. If the easy money people win, the issue is will Germany stand behind all those bonds the ECB buys up? Will German taxpayers after all be expected to stand behind Greek and Spanish banks if they get into trouble? Will the Euro architects find a way of allowing newly created Euros to find their way, if indirectly – into financing the deficits of less fiscally prudent countries within the zone?

Indeed, the question is how can Germany avoid being dragged in to Quantitative easing if the zone as a whole decides on that route? By virtue of being the largest shareholder in the ECB, Germany will become the proud part owner of a wide range of government bonds from other countries in the zone as the ECB seeks to do what the Fed, Bank of Japan and the Bank of England have already done. If those bonds subsequently lose money, Germany surely loses as well.

Some say they have found a way round this dilemma. Why not, they say, empower the individual national central banks of the zone to simply buy up their own government debt, and to take the losses if losses there subsequently are. However, the individual central banks do not have the power to create euros. So presumably they will have to borrow the euros from the ECB to buy these bonds. What if they get into trouble? How do they repay the ECB? Surely there has to be recourse by the national central banks to the ECB, so in the end Germany will be pushed into supporting the whole edifice.

There is also the little problem of the Swiss franc. When the Swiss authorities wisely decided to quit their link to the Euro, their currency shot up. Markets revealed just how depressed the Swiss unit was by its forced association with the Euro. Imagine what the value of the DM would now be against the Euro if Germany had done what Switzerland did, and declined to actually join the Euro.

The Swiss event and the agony of QE reveal the continuing strains of the Euro project. If it is to work in the longer term Germany has to put her tax revenue and banking system behind it. She is still reluctant to do so. It is a bit like London refusing to stand behind the rest of the UK – an absurd idea which would damage the pound greatly if anyone tried it.

Gas in Burghfield

I have received this email from Scotia Gas Networks (SGN):

“Following my call to your office earlier today, here’s some more information on the gas supply incident we are managing in the Burghfield Common area.

We were called to James Lane, Burghfield (RG30) yesterday evening after our gas main was damaged by a third-party contractor.

Our engineers have been working throughout the night to establish the extent of the damage and make the situation safe. Work continues to repair the damage and ensure gas supplies remain on for the local residents.

We are bringing in specialist equipment to carry out this particularly complex repair today. It is difficult to estimate exactly how long it will take to complete the repair at this point.

To assist us with our on-going work we have sent a letter to local residents to ask that they reduce gas usage wherever possible from 4pm this afternoon through to 10pm. We appreciate the difficulties this may present at this time of year.

Portable electric appliances for heating and cooking are available for customers who are elderly, disabled, chronically sick or other special needs. These can be obtained from our Emergency Centre or by calling 0800 912 1717 or contacting our staff on site.

Our Emergency Centre at Burghfield Community Sports Association, James Lane will be open until 10pm tonight and our staff will be happy to assist with any questions.

We will keep you informed of progress and updates will be available on our website www.sgn.co.uk.

If anyone is experiencing low gas pressure, a loss of gas or have any concerns about gas safety, please ask them to call the National Gas Emergency Number on 0800 111 999.”

Democracy day

750 years ago today England made an important democratic advance. The so called De Montfort Parliament met at Westminster. It was not the first Parliament, and it was the idea of a rebel government that had outmanoeuvred the King. They invited two knights from each shire and two burgesses from each important town, as well as nobles.

This was far from the first time powerful people in the land had instituted formal discussions with the King, the executive government. After all, on June 15th we will celebrate 800 years since Magna Carta. That too was a negotiation between Crown and powerful forces in the country. That established the idea of more meetings between Crown and barons to keep the King honest and to ensure follow up to promises. Subsequently Parliaments of varying composition had been called.

The central underpinning of this proto democracy was a simple one. Those who paid tax and offered allegiance to the King, should be able to seek redress of their grievances before granting more money. They should look to the Crown to offer impartial and fair justice for all, so disputes could be sorted out and criminal conduct dealt with in an independent and acceptable way.

Parliament grew from these origins. There was a strand of work gradually widening the franchise, until all adults came to enjoy the vote. There was another strand of political action, tightening the grip of Parliament over taxation, so monarchs first had to deal with Parliament to get supply, and then became figureheads as Parliament took over the administration of the executive and its budgets.

This impressive story of the growth of democracy was interrupted by our membership of the European Economic Community. It is still causing troubles, as there is no proper redress of our grievances with the EU before they take our tax revenue. There is no easy way of removing the EU government if it no longer pleases us the voters. That is why we need to have a constitutional debate about our relationship with the EU, and need to sort it out. This year of anniversaries reminds us of how precious our early development of freedom under the law, habeas corpus and Parliamentary representation was. It also reminds us how it has been damaged by EU administration and jurisprudence.

Start up loans for new businesses

The government’s Start up loans scheme has helped 25,000 new small business so far. They now wish to treble that number to 75,000 up to 2020. In the South East there have been over 2000 loans made worth more than £11 million. 14 of these have been in the Wokingham constituency.

If you are a UK citizen planning a new business or with a new business less than two years old and are over 18 you may be eligible for a loan. They can be up to £25,000, and up to 5 years before repayment, at an annual interest rate of 6%. You also qualify for advice and mentoring from someone with plenty of past business experience as part of the package.

Just google startuploans if you are interested.

Improving Accident and Emergency

A few hospitals this winter have had to put a temporary stop to some non urgent work in order to cope with the large numbers of people arriving at A and E. Fortunately this has not happened to our local hospitals.
There are, however, pressures on the A and E departments of most hospitals. Demand is surging for a variety of reasons. Some find it difficult to get an appointment with their GP, so they think it is easier to admit themselves to A and E who have to look at them when they turn up, and treat them if necessary. Some are not well informed about their GP and his or her arrangements, but know the local hospital. Some want to go out of hours or at the week-end, when A and E might be the most obvious available option. Some visitors or illegal migrants to the UK may go to A and E because they are not normally asked about their entitlement, but might well be if they tried to get on a doctor’s list.
Each of these cases requires a different solution to reduce numbers sensibly. In an ideal world only people with a clear need for emergency treatment would turn up at A and E. If you have been in an accident then of course A and E is the place for you if you have anything other than a minor injury. If you are suddenly stricken by an unknown condition that seem serious, which may include a stroke , or heart attack, then again A and E is for you as quickly as possible.
The government is examining what it can do to relieve pressures. Can some GPs be attached to the local hospital to handle some of the cases? Can GP surgeries be strengthened to offer more hours of service? Can more use be made of the walk in centres?

Labour’s health troubles

Labour’s attempt to make a crisis out of the modest slippage in the English NHS seeks to ignore the far worse performance on waiting times in the Welsh NHS which they run.

Labour of course do not describe the fact that nearly one in five people in Wales have to wait for more than the target four hours for attention in A and E as a crisis. However they do think that if one in ten have to wait more than four hours in England that constitutes a crisis. This language is designed to politicise the NHS, and makes running the English NHS a bit more difficult.

Politically it is a weird strategy. Labour wish to go through a whole UK General Election talking about the English NHS. That means they have no message for Scottish or Welsh voters at all, as they hope to avoid talking about NHS Wales which they run, and of course the SNP and the Edinburgh Parliament run NHS Scotland. They wish to highlight anything that is going wrong, inviting comparison with Wales, and with their record of running NHS England in the previous decade. It reminds us of the disasters at some hospitals, with major lapses in care standards.

A more honest approach would be to confess they have problems and a worse A and E performance in Wales, and set out how they will remedy this. It might also be wise to talk about some of the topics in the General Election which apply to all of the UK, and not just England. It is an irony that Labour do not understand their own devolution settlement and what it means for General Elections.

Oil’s long reach

The more I think about the halving of the oil price, the more significant it seems. The scale of the change makes it difficult for commentators and forecasters to think it all through and understand the magnitude of what has happened so far. There is reluctance to simply assume that in future oil revenues will be under half the levels of last year. Prices might go up again. Some of the oil is under long term contract or special arrangements which may limit the price damage a bit. Some of the industry’s commitments to put in new investments and sustain programmes of maintenance and development cannot be easily cancelled in the short term.

However, until the price rises again the safe assumption to make is that oil revenues will be well down. This means the cancellation of a large number of new projects to find and exploit oil in places where it is dear to find it and get it out. It makes the development of shale gas provinces in Europe a less immediate prospect. It means delays and cancellations to new projects in the USA. It means bankruptcies or refinancings of projects recently completed in high cost areas. It means a gradual reduction in future output to bring the market back into balance, barring some crisis to the output of one or more of the major oil producing countries or areas. Banks may need some of their new reserves to deal with extraordinary losses on oil financings.

It also means sharp contraction in state oil revenues. This will be most marked in Venezuela, already struggling with debt problems, and in Russia where oil dependence by the state is high. It also changes the once easy budget positions of various Middle Eastern countries, who have started to spend up to the revenues that oil at over $100 a barrel gave them. It will cut the oil based revenues in the UK more rapidly than the decline in output was already doing. Do not expect any PRT revenue now, and expect a big fall in oil based corporation tax receipts in a year or so. Scotland’s contribtion to UK revenues has just taken a large knock, just a few weeks after the SNP assured the people of Scotland that Scottish oil could buy them a better future.

The bad news for the few is offset for the world by the good news for the many. This level of price fall is a big boost to the large consumers like China, Japan, India and the Euro area. It takes the inflation pressure off as well, allowing easier money for longer. In the UK it is good news for the government. Although the government cannot claim it brought about the price fall by its actions, government gets blamed for anything that goes wrong on its watch and gets some benefit from what goes right, even where it is not the cause. Labour’s cost of living campaign does not look on the money now real wages are rising. Petrol at a little over £1 a litre- maybe soon at below £1 a litre – is a great refutation of Labour’s crisis talk. The banks may lose more on energy accounts, but some of their other loans may now be easier to service and refinance as many companies benefit from lower energy prices.

Overall this is good news for the world economy and good news for the real incomes of many.However, if these prices persist we should not underestimate the possible damage to the energy sector. They face, at least temporarily, the prospect of income cuts, job losses, and refinancings as they struggle to rebalance their busiensses at very different price levels.It will also change the balance between nations, putting Russia under more severe financial pressure and reducing the incomes of the Middle East.

I wonder if Mr Obama and Mr Cameron talked about the value of human lives and military interventions?

I am proud of western values. These for me include the idea that every person matters, and we should all enjoy the right to certain freedoms. We do not think some people are of greater worth than others by dint of birth or acquired status – all must be equal under the law. We think that all who face allegations of criminal conduct deserve to be told of the accusations and have a fair trial to assess the validity of those claims. The basic freedoms in Magna Carta, topical this year, should unite the transatlantic brothers, as they are part of our shared heritage. If people are thought to be immediately dangerous our system allows for their detention pending trial with charges known.

It would be good to think that the two leading ancient western democracies, the UK and the USA, can now do some soul searching on how we preserve and enhance our system and our beliefs in an age of terrorism, asymmetric warfare and fundamentalist revolts. Mr Cameron did have to raise again the issue of Guantanamo Bay. It was no great advert for western freedoms and liberties. The argument that if people are bad enough they deserve to be locked up without trial does not fit neatly into our belief that the accused should stand trial to establish his guilt, and only if established then face an appropriate punishment. To those who say it is naïve to give to violent thugs the same rights as to other citizens, I say no-one said it was easy defending freedom, but who is to say who should be locked up without trial? And what if they locked up the wrong people?

It would also be good to think that instead of considering how best to pursue further military conflict in Iraq and maybe other places, the two great democracies also paused to consider what good has been achieved by recent past Middle Eastern military interventions. What can be learned from the collapse of law and order in Libya and the absence of effective government, once a nasty autocrat was successfully removed by force? What has been learned from the long and difficult campaigns in Afghanistan? And what effects have drone attacks across the borders into Pakistan had on those the allies wish to defeat? Can Iraq survive and prosper as a united nation, now Sunni,Shia and Kurds wish to fight each other for control of parts of their country?

The west was rightly horrified by the deaths in Paris at the hands of terrorists’ guns, and went on a peace march to show solidarity against the evil ones. The west continues to be appalled by the barbaric actions of ISIL in Iraq and Syria, and offers limited military help to local forces fighting ISIL on the ground, seeking targets to bomb from the air. The west condemns the even greater brutality of Boko Haram in Nigeria( as measured by numbers of reported deaths in recent attacks) but does not intervene militarily there, giving limited advice and training to Nigerian forces when requested. Which of these responses is the best? Why are they so different?

If a young thug travels from the UK to Iraq to join ISIL our treatment of him changes. All the time he is plotting murder and mayhem in the UK we proceed by collecting evidence with a view to arrest and trial. If he reaches Iraq and plans murder there, he may be blown up by a smart bomb sent to his address or attacking a vehicle he might be using. Again we need to think through our varied responses in these difficult times.

The destructive power of the Euro grows

This week has seen two important developments in the evolution of the Euro. Senior European lawyers have given guidance which many see as indicating the ECB does have the power to create new money to buy up government bonds in the zone, despite heavy German opposition. The Swiss franc, which was linked to the Euro in a desperate effort to stop people fleeing the Euro to buy the Swiss franc has given up the struggle and is now being revalued against the weakening European currency. It rose by 13% on its first day of freedom, despite imposing a negative interest rate of 0.75% on deposits, such is the enthusiasm for people to switch out of the Euro.

The lawyers were not as clear as some in the press would have you believe. Whilst deciding that the ECB did need considerable autonomy in the field of monetary policy, and implying this could stretch to bond buying programmes on a scale to the Bank’s choice, they struggled more with the clear Treaty requirement that the Bank should not simply print money for European governments to spend.

Their convoluted argument accepted that the Treaty does ban lending money directly to governments in the zone. They then said two conditions had to be met to allow something like it. The first is the ECB cannot be involved in conditions and negotiations over new borrowings. The second is that the Bank cannot buy new bonds issued by a government to cover new spending, but can buy bonds already issued from someone else. This is a nice distinction which can easily break down in practice. If Government A is selling new bonds of ten years duration, and the Bank is buying old bonds also of ten years duration at the same time, there could easily be a simply swap by an intermediary from the older bond to the new one, so the Bank is very close to simply creating money to finance Government A’s expenditure. The lawyers said there had to be some timing differences and there had to be clear price formation on the new bonds before the Bank bought them up, but this still leaves some doubt on the wider issue.

However qualified the judgement may be, the spin is clear. The mood is shifting away from Germany towards allowing quantitative easing, which is an indirect way of printing money to pay for excess public spending over tax revenue by making it much cheaper and easier for government to borrow to spend more.

The loss of Switzerland from the wider area is no surprise. It is good that Switzerland still has the freedom to run its own currency, though unfortunate that it is so attractive to investors that it suffers from runs into it from the Euro with the danger that it drives up the value of the Swiss unit too much. The Swiss can’t win, either by staying within the wider Euro ambit or by leaving, but just as with the ERM the pressures within a managed European system become too great to handle.
A much bigger game is afoot. Germany may be being drawn into a lower value Euro kept going by money printing. Whilst single country currency areas have managed this process, within the Euro area it implies dragging Germany more into the role of paymaster, standing behind more of the debts of the zone. It is not what Germany had in mind. Meanwhile the delay in loosening money and the refusal to break up the zone and have economic policies which work better is dragging Euroland back into low growth and recession, and is generating mass unemployment.