It was good to hear the Secretary of  State for Health on Friday say a bit more about treatments, and express some optimism that this year should see approval for treatments for CV 19 which make it much less likely someone will die or have a bad version of the disease. The UK is currently conducting 96 trials of drugs and 9 trials of other vaccines. Worldwide there are reported trials of 700 drugs that may help with treating CV 19, with a total of 2607 clinical trials running for the drugs and vaccines. The USA alone is currently organising 555 clinical trials for CV 19 treatments and vaccines.

I have been long advocating the UK puts resource into these important efforts.  Without medical training, I do not know which if any of these possible treatments can do good. It must be  worth trialling them to find out.

So far the UK has approved dexamethasone, remdesivir and tocilizumab as options for doctors to prescribe where they think they are appropriate. There are a number of other treatments used elsewhere, and we await progress with further trials here for those. There have been strong arguments over Vitamin D, hydroxychloroquine and ivermectin in particular, with disagreements about the conditions for some past trials and strong views of whether these might be effective or  not. All  possible medical options should be fairly and promptly assessed. I hope the government’s new enthusiasm to share some more information and to express some optimism is a good sign that the medics do now feel treatments from adapted existing drugs and from new drugs can make an important contribution to lessening the suffering from this disease. I will follow up with some more questions to the government.

The poor UK GDP figures for 2020 are  not comparable with many other countries. As I explained on 12 August on this site, the UK statisticians reported a large fall in health output with the big drop off in non CV 19 work, and a big fall in education output with the closure of schools from the second quarter of the year. Other countries with large state sectors in education and health report the cost rather than the output, so they do not show any decline in these large areas of activity.

I agree with the UK statisticians that GDP should be based on output. It is a pity other countries do not use the same basis. If we included all the UK spending instead of output in the state sector then the UK had a relatively good GDP performance last year compared to other European countries.

This week the government published “Working together to improve health and social care”, a White Paper sketching proposals for reorganisation of the NHS and the wider care sector.

It set out three aims.

1, Better health and wellbeing for all

2. Better quality health service for all individuals

3. A sustainable use of NHS resources.

I have  no problems with these very general aims. 2 and 3 should be the main drivers of NHS care, whilst 1 of course will entail individuals and the private sector to continue to apply  our energies to the task which is so wide ranging.

The main reorganisation entails creating two new bodies in each local government area. The first will be an Integrated Care System  ( ICS )  NHS body to control, procure  and direct local NHS services and to supervise capital budgets of the local NHS Trusts. The second will be an Integrated Care System Partnership to work with local government and presumably with private sector care providers to ensure good services and relevant procurement.

The White Paper envisages removing some of the competition provisions in current health regulations, to take away powers to control trust mergers, and to limit competitive tendering. They wish to go over to a more collaborative model. NHS England will be merged with Monitor and the NHS Trust Development Authority. The Clinical Commissioning groups are absorbed by the new ICS bodies.

I need to know more about how joint working will take place between Councils and the NHS under these arrangements. I also want more detail over what additional powers the NHS will have over private sector care providers, and how if at all the relationship between  care homes and the NHS will alter.

As I consider my response more fully I would  be interested in any comments.

The world figures show accumulated cases of 107m  or 1.3% of the world population with deaths at 2.365 million or 0.03%.  These figures are by nature of variable quality, depending on how much testing was done throughout in each country, and subject to variations in definitions. There is the perennial issue of death with covid or death definitely from covid, In some places people will have died at home and not been tested. In other  cases there will be tests with false positives.  They are nonetheless important figures and invite come comparisons, subject to analysis of how they were collected in each country, how much reliable testing took place and how deaths were certified.

The figures show that the Europeans  and Americans have suffered more than the rest of the world. The USA has had a very high caseload, at 8.4% of the population compared to the UK at 5.8%, Portugal at 7.6% and Germany at 2.75%. Belgium has had the  worst death rate apart from a few small countries at 0.186%, with the UK and Italy also quite high by world standards. The USA at 0.1456% shows that it has a better recovery rate from its  high infection  levels. India has only had a case rate of 0.78% and a death rate of 0.01%.

Case numbers have been higher in the advanced world and have been higher in winter than in summer. Clearly high levels of international travel can introduce a community to more variants and cases of the virus, and large cities like London, New York and  Paris see spread  from more social contacts using mass transit systems and enjoyment of the social facilities of hospitality, leisure and entertainment which attract more people there. Asian countries in general have fared better that Europe or the Americas. Could there be something in the diet, or in past exposure to Asian flu types which has given Asian populations  better resilience to the disease? Did they handle test and trace better than the Europeans?

It would be good to have more commentary from experts on how and why, for example,  Taiwan had practically no deaths from  the virus and was able to get her economy back and running fully, so GDP is now higher than a year ago. Why has Germany done so much better than Italy or Spain? How does the USA manage cases of the virus to achieve a lower death rate as a proportion of cases? Is it partly that the USA tests more and so identifies more mild or otherwise invisible cases of the virus? Is it a greater range of approved medicines and treatments?

This week I was pleased to be sent an update  by Ministers on all the tests underway in the UK of existing drugs and treatments. It will be good to see more results soon, as a wider range of treatment options would probably help doctors and their patients.

 

Yesterday in a debate on the local government finance settlement for next year I raised some general issues about Councils and our Town Centres as well as local matters over the adequacy of grants and other  central government assistance.

When we come out of this extended lockdown we will be able to judge the permanent damage done more easily. Some shops and service providers will decide they cannot continue in business, given the long period of closure and partial working and the impact that has had on cash flows and borrowings. Some successful businesses will decide that they can carry on in future with more of their offer coming from digital commerce and less needing physical premises in each town and Village Street. There will be pressure to lower shop rents, and to move more rents onto a turnover related basis. Government will remain under pressure to keep business rates low where they have been reduced, and to cut them where they have not.

Councils are part of this debate because many have come to be important players in their local shopping areas. All principal Councils are important regulators and planners of shopping areas, deciding on what landowners can and cannot do with their properties, defining the streetscape and controlling the transport policies. Many are also now landlords of shop properties themselves, needing to consider the impact of recent changes on their rental and tenancy prospects. Many employ Town managers, help control shopping centres, run public sector facilities and determine the car parking and access strategies. They therefore need to both  decide how much of these various involvements they want, and what they are trying to do with their interests in these matters.

I urged them to wish for one thing – a strong commercially led recovery, helping shops and businesses rebuild their trade and earn the means to pay the rents again as soon as possible. The High Street has a high job content in what it does, adds to the variety of life by creating a social focus, and a backdrop for cultural, sporting  and civic events. It represents much of what we have missed during lockdown. Forlorn High Streets stand largely empty, each closed shop a reminder of the economic damage to tenant and landlord alike of forced closures.

A good Council will make access and parking easier to rebuild trade. It will be flexible over planning permissions for changes of use and adaptation of buildings. Where it is an owner it will be realistic over future rents and uses itself. It seems likely there will need to be closures of a good many shops, as we have too many for likely future levels of physical shopping. That means we need imagination by developers and good will from Councils to convert or rebuild retail estate as homes, places for entertainment  or other workplaces as soon as possible.

I was surprised to read of possible plans to undertake another reorganisation of the NHS. Apparently the government is thinking of reversing some of the changes introduced by the Lib/Con coalition government when Messrs Cameron and Clegg launched a joint document proposing giving GPs the power to procure services from hospitals and others through Clinical Commissioning Groups. There was some resistance to these changes which prompted a  review led by Oliver Letwin which concluded by  continuing the policy with some alterations to the detail. This system has been in place for a short decade now, and has just been tested by the pandemic. Reponses to the virus have greatly strengthened central decision making and resource allocation.

Ministers have become more involved in issues like protective clothing, capacity and medical priorities, listening to the advice of their national Scientific and Medical advisers on these matters and then making decisions based on that advice. As Health is a devolved matter the Chief advisers to Scotland, Wales and Northern Ireland have also had bigger roles, and there has been some effort to get agreement between the four parts of the UK. Usually there has been high level agreement about the overall priority of fighting the virus, sharing of approaches and data, but detailed differences in timing and magnitude of lock down responses. There have also been some differences in success with obtaining a range of supplies and in the pace of vaccinating. The roles of the NHS country Chief Executives and of national quangos and advisory committees have also been tested in public debate about their quality and wisdom.

The pandemic does provide an opportunity to review the system, though it would be wise for the crisis to be past before rushing to conclusions about what worked and what needs improving. During the phase of seeking to scale up the provision and future supply of protective equipment there was a danger of competing initiatives bidding against each other, and making it complex for local care homes and hospitals to know how best to secure the needs they had. There needs to be some review of how big are the benefits from central purchasing, how central purchases are  best distributed, and what are the continuing  benefits of local determination of need and procurement of supplies.

I see there is also discussion of rolling into the agenda possible changes to the financing and access to care homes. This is a perennial topic which we can debate again another day in the context of intergenerational fairness and fairness between elderly people with different ailments and needs. Any change to the approach which states that if an elderly person needs care home accommodation and hotel service they should pay for it out of capital until they hit a minimum when they can qualify for state payment of the fees could be an expensive new commitment for taxpayers, though popular with those who might then inherit the housing wealth of the elderly person. I think the urgent priority is to see government thoughts on how the central and the local management of the NHS has worked during the pandemic, and what can be done to improve it for the future.

Yesterday there was an Urgent Question on the EU ban on exports of bi valve molluscs from the UK to the EU.  The Defra Secretary told us he had prior assurance  from the EU confirming the legality of this trade post Brexit, but the EU have now changed their mind. The UK has been supplying continental restaurants and food shops with some shellfish. The English fishermen supply them straight from the sea, with continental processors  cleansing  them for sale with their own depuration facilities. He promised to seek urgent reversal of the decision, understanding  the damage it is doing to small fishing businesses. It affects oysters, muscles and clams, not  the larger  trade in lobsters and crabs. Demand on the continent is down anyway given the widespread closure of restaurants.

I urged him to make help available to the UK industry so we can process the shellfish here. Then they could be exported as food products. It would also mean we could sell them through our own fishmongers and food stores. The EU is being unreasonable over various food trade issues. It is high time the UK government took tougher action to enforce our UK internal market and ensure the smooth passage of food into and out of Northern Ireland, and time to be firm over fish. I did get a more encouraging reply to a recent written question on growing more of our own food.

 

The Department for Environment, Food and Rural Affairs has provided the following answer to your written parliamentary question (144914):

Question:
To ask the Secretary of State for Environment, Food and Rural Affairs, what steps he is taking to promote and support more protected growing of vegetables and salad crops to extend the UK growing season. (144914)

Tabled on: 28 January 2021

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

1. To ask the Secretary of State for Environment, Food and Rural Affairs, what assessment he has made of the potential to extend the UK fruit growing season; and what support his Department provides to growers to extend their season. (144915)
   Tabled on: 28 January 2021

Answer:
Victoria Prentis:

We have the ideal climate and landscape to enable us to produce a wide range of fruit, vegetables and salad crops throughout the year. Innovation such as the development of new plant varieties and growing systems has already allowed growers to extend the domestic growing season for products such as strawberries.

We will continue to encourage and support our growers to produce more high-quality home-grown fruits and vegetables, ensuring a reliable and sustainable supply of top quality and healthy home-grown fresh fruit and vegetables throughout the year, all produced to high environmental standards.

Growers of protected and salad crops are currently able to apply for financial support to help them improve their productivity via the Fruit and Vegetable Aid Scheme, and looking ahead the Agriculture Act will provide powers to offer financial support to anyone starting, or improving the productivity, of an agricultural or horticultural activity.

Later this year, growers will have the opportunity to apply for support to invest in equipment, technology and infrastructure via the new Farming Investment Fund. This will help them to boost their productivity whilst also reducing impact on the environment.

The answer was submitted on 08 Feb 2021 at 14:57.

There was some strange briefing in  the Sunday papers, purporting to come from unnamed people in the Treasury. The argument went that the budget deficit has ballooned to £400 bn so the budget would need tax rises to cut it. Various ideas of new taxes and tax rate increases were discussed, usually to raise relatively small amounts compared to £400bn. The individual proposals typically would cut the deficit  by 1-5% only on the figures given.

The truth is the huge deficit is not sustainable, and needs to be brought down by getting the economy back to work. it will be recovery that makes huge cuts to the deficit, not tax rate rises. The deficit will tumble as soon as the controls are removed from social distancing so  hospitality, travel, leisure and entertainment can flourish again. Let us hope vaccination and the decline of the virus allows the government to let this   happen soon.  There is a double benefit for the deficit. Spending will fall sharply as furlough ends, special help to small businesses and the self employed ends and the extra money for health reduces with the job of vaccination done. At the same time tax revenues rises rapidly from low levels, as people spend money again, as businesses pay their rents again, as incomes of individuals and companies pick up from recovery.

It is most important that tax and benefit policy does everything possible to restore the lost 10%of national output and income the anti pandemic policies have taken away. Tax rises will deter investment, deter spending, reduce taxable profits  and generally get in the way of recovery. They sap confidence and can even result in lower revenues if they hit transactions and activity. The country can afford the one off hit of a bad year with a massive deficit which everyone understands was a one off related to health policy. It is now important  for confidence that there is a good prospect of early and sustained recovery to bring the deficit down  by the reverse of how it rose. It went up because activity suffered such a bad hit,  not because the tax rates were too low.