Last week-end I tried a day return to London from Twyford  by train. Whilst this line is outside my constituency it is close to the northern boundary. I went outbound by TFL and returned by Great Western.

A large sum has been spent on changed logos,signs and facilities on the stations to introduce the TFL brand. The trains both ways were little used. They were running too many carriages. The TFL trains have nine carriages when two or three would have done. The seats were hard and uncomfortable especially on the Great Western.

The TFL railway was designed for five day a week mass commuting. The trains lack toilets and envisage a lot of people standing, using hanging straps in the large open central  areas in the  carriages. The seats are down the sides. The idea seems to have been  to sell commuters an uncomfortable strap hanging experience  at a high price. The poor service of Network Rail is one of the main reasons people do not want to return to five day working in an office. The pandemic allowed a major revolt against the nationalised train service with timetables and standards laid down by government.

The train I went on was an expensive way of carrying out a leisure journey for taxpayers. Clearly TFL need to look at how to make it more attractive for the  leisure travellers who will play an increasing role in providing passengers to offset the  decline in people travelling to work. The nationalised railway shows no wish yet to publish a plan to innovate or to change the source of  its revenues to justify its huge state backed costs. Getting to the  station by car, parking, paying  and then crossing the track to access the station was not easy. Railway planners need to grasp that most of us need to drive to get to a station and see that as part of the journey. The state railways needs to work with Council roads and highways to make it easier.

Most people think boosting productivity is a good thing. If you increase the amount of goods or service each individual worker can produce you have a more efficient economy and pay can rise to reflect the boost to output.

Now that the NHS is taking such a large amount of the national budget and a substantial share of total public spending, the issue of working smarter and better in the NHS has returned to prominence. According to the ONS NHS health productivity fell by 0.8%, the last year (2019) before the pandemic disrupted it. In the period 1996 to 2019  NHS productivity advanced by 0.7% per annum, or a bit faster if you make a quality adjustment to the figures. This is a disappointing result given the ability to use digital technology to boost output through more remote consultations and the growing efficacy of some less invasive treatments.

Quality and efficiency are two sides of the same coin. Get things right first time and there will  be no remedial pains and costs. Eliminate hospital carried infections and cut the workload. Recruit and train more nurses and doctors who share the aims of each  Trust and wish to be regular employees, cutting back on the need for agency staff. Encourage specialisms so skilled teams become excellent at elective treatments  through regular experience from specialisation. Fashion  protocols for additional  less invasive treatments. Adopt more medicines with good test results for treating conditions. Cut waste levels in the use of drugs, surgical and nursing products and medical equipment.

We are still waiting for the plans to spend the extra money for the waiting list reduction and the manpower plans. Why don’t we get extra hospital beds capacity for all the extra money? The Health Secretary needs to challenge the NHS CEO more.

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 .