"We need safe spaces..." - how the NHS ducks the big questions

I can't remember the precise moment or why the subject came up but some point in 2016, in a meeting with NHS folk, something along these lines was said: "we need safe spaces to discuss the real challenges facing the health and care system". What they really meant was that some subjects are just to difficult to discuss other than in a carefully protected space - protected, that is, from the public. This answer is a reminder that our populist, planned health system is facing something of a crisis.

Before we go on to talk about the challenges we can't discuss in public we have first to talk about money. I had a Twitter exchange with someone recently where I asked what she meant by 'adequately resourced' in the context of the NHS. The answer, as these things often are, was something of a cop out but was at least better than the more usual response to such questions - a response typified by this piece of populist cant from Tim Farron:

Farron said voters had reached the stage of not believing the NHS’s problems could be solved through efficiency savings and might be willing to pay more if they were convinced it would go to the health service.

He said he did not want to pre-empt the conclusions of an independent panel formed by the Lib Dems, which will look at possible taxes to help the NHS.

In varying forms this is the default response to concerns about our health system - more taxes, more resources. The problem is that, for all that sticking a ring-fenced penny on income tax sounds good, it goes nowhere to making the NHS more sustainable. Bear in mind that, despite the claims of its founders, the NHS has required above inflation increases in funding throughout its existence meaning that it now spends approaching £120 billion out of those taxes.

In one respect our health system needs that extra cash - as Jonathan Portes pointed out recently the proportion of GDP spent on health has fallen and we do spend less per capita than other places (significantly so than the USA). But when you open the NHS up, every single element within the system will tell you that with a little extra cash they can solve this or that problem. Indeed most of those individual bits of healthcare systems - the non-clinical as well as clinical - will tell you that right now they are starved of cash meaning that people might die.

So maybe we do need more cash. But first we need to huddle in that safe space and discuss some more fundamental things about the NHS. By way of example, West Yorkshire has eight or nine general hospitals (I forget the precise number but it doesn't matter for this discussion). All of them are seen by their local community as "their" hospital and the popular expectation is that the general means they do everything that community needs. The question we need to ask in that safe space isn't how do we get more cash for those hospitals or what services do we cut to stop them overspending. No the questions are more fundamental - does West Yorkshire need all those hospitals, are they in the right places, do the facilities meet modern needs or public expectations?

We might ask, for example, why Leeds has two huge general hospitals with real access issues right bang in the city centre? Should we be finding a greenfield site somewhere more convenient and building a new large hospital? And do all those hospitals need to have high support accident units, heart care centres and cancer wards or would it be a better service to have specialised units?

I don't know the answer to these questions - or indeed to thousands of other questions about health and care provision - but I do know (because I've been given a privileged peep inside the system) that the NHS simply isn't discussing these issues at all. Mostly for fear of adverse public reaction but also because the planners within the health system are driven by issues of sustaining what's already there rather than by more fundamental questions about structure and organisation.

There's a further problem, one stemming from the very top of the NHS (indeed from the World Health Organisation), which is the belief that the drivers of rising costs are lifestyle factors especially smoking and obesity. Even when the health systems own statisticians point out that longevity is the problem, we still get strategies founded on the idea that being fat and liking a fag is the problem. This is where the proposals for limiting access to surgery come from (like this one from York) - they don't really address the problem, they're usually overturned and they make it look like the Clinical Commissioning Group (CCG) is doing something.

It seems to me that the NHS, for all the "Our NHS" and "Save the NHS" rhetoric, isn't really all that good. OK, I'll grant that it's better than a system such as that in the USA which manages to be both very expensive and to leave out great chunks of the population from effective care, but there are other approaches - Sweden, France, Holland, Singapore - that might offer some ideas about how we might improve our health outcomes. The UK has a very centralised system that is painted to look like a dispersed and localised system. As the recent round of reorganisation - called Sustainability and Transformation Plans in that jargonistic NHS way - has shown, the idea of local control or direction is anathema to the system's bureaucracy.

The Tim Farron solution - whack up a few taxes - sticks a slightly bigger plaster over the wound but doesn't address the fundamental problems (just as allowing councils to stick up council tax a bit more does solve the care crisis) in the health system. We have a health estate that was mostly designed by Victorians (to which we've added a lot of prefabs) and a structure that would do the Soviet Union proud - right down to the endlessly revisited five-year plans. Until we actually use that safe space we mentioned to discuss the real problems of the health system the NHS will carry on lurching from self-generated crisis to self-generated crisis. And worse, populist politicians like Tim Farron will go on waving the NHS's problems about as a cheap source of votes.

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Dear Liberal Democrats, please rebrand as the European Party. Please.

It's a long while since the Liberal Democrats were in any recognisable way either liberal or democratic. This makes the idea - mooted by Richard Dawkins - that they become the European Party a sensible one:

Writing to the Guardian, the 74-year-old, said: “Following its victory in the Richmond by election, I write to suggest that the Liberal Democratic party should change its name to The European Party.

“We of the forgotten 48% are surely more numerous today, now that Brexit’s rudderless fiasco is becoming as obvious as the shameless lies earlier told by its advocates.”

The reason why this is a great idea isn't that the 48% will flock to its banner but rather that this leaves the way clear for a genuinely liberal and democratic party in Britain. Right now Farron's Euro-fanatics, by hogging these words, are preventing a genuinely liberal, free market and internationalist message from being heard.

Indeed the Liberal Democrat Party's obsession with Europe has, even in those moments when there were glimpses of actual liberalism, meant that the cause of big government has sat at the heart of its policies and programmes. It's clear that today's Liberal Democrats are more comfortable with the eco-fascist Green Party, complete with crashing the economy and living in mud huts while scraping a living from a vegetable patch.

Here in Bradford, our liberal democrats prefer to patronise regular folk in the cause of public health - vaping one month, fizzy drinks the next - rather than admit to the idea of choice, responsibility and agency.

So get on with it Mr Farron (who's pretty much a communist) and rebrand your Party so we can set up one that argues for free markets, free speech, free trade and free enterprise.

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Tim Farron and the illusory wool boom...

Like Tim Farron, I represent a lot of sheep (although these are now going for economic reasons to be replaced with beef cattle and horses) so I'm always struck by his strange and limited connection to economic reality:

Tim Farron, South Lakes MP and chair of the all-party parliamentary hill farming group, said: "We need to do all we can to support our farming industry, particularly in the uplands where life can be a real struggle. This support and funding could make a massive difference to upland farmers throughout Cumbria and help show the next generation that there is a real future in a career in farming."

OK there's some votes in this for Tim but is he really saying that there is a 'career' in upland farming when - a breath earlier - we read this:

An upland farmer earns, on average, only £6,000 a year, which has led to a number of people leaving the industry.

Six grand-a-year! That's half the minimum wage and Tim Farron thinks that this is some sort of sustainable industry? There's more - despite a (rather illusory) 'boom', here's the economics of upland sheep farming explained:

Will Rawling, chairman of Herdwick Sheep Breeders' Association, said he was getting about 50p a fleece. It costs him 70p to have each animal sheared; bundling and transport fees take the total cost per sheep up to about £1.50, three times what he gets back. 

To be fair the article also says most farmers are "breaking even" but it does seem that, not only isn't there a boom, but farming sheep on the fells isn't a viable business. If Tim Farron had said this and continued with 'but we need to find ways to continue the job, done by hill farmers at the moment, of caring for the fells', I would be with him. But he didn't, he simply called, like the good liberal, for price fixing.

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Tim Farron wants expensive fuel to go with the expensive food....

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You have to admire the populism of Tim Farron, president of the Liberal Democrats:

Mr Farron told The Sunday Telegraph: “I am afraid the Government has seen flashing pound signs, and has not considered the long-term threats fracking poses to the countryside. “I think this is a very short-sighted policy, and we will all be left to live with the consequences.”

Now this is a man who campaigned for expensive food. I know it didn't look that way but rather as an admirable campaign to protect the livelihoods of farmers (many of whom Tim represents). Nevertheless, the impact of his campaign - and his continued support for agricultural protectionism - will lead to higher food prices.

So now, in the interests of a headline, Tim is supporting expensive energy. I know it doesn't look that way. Rather it's portrayed as caring for the environment. But the effect of Tim's campaign - if it succeeds - against fracking will be higher energy prices. Meaning that less well off people (perhaps there aren't so many of these in South Lakeland) will struggle to heat their homes especially since Tim's campaigns already mean such folk pay more for their food.

Even worse Tim's campaign already misleads:

“With a wind farm you can actually choose where you put it; that is not the case (with) fracking,” 

Actually you can't 'choose' where to put a wind farm - to have a chance of viability turbines have to be in places where there's lots of wind, which isn't just anywhere.

And then, having misled, Tim scaremongers:

 This technology can lead to earth tremors and I’m particularly worried that buried nuclear waste in my part of the country could be affected.

There have been around 100,000 fracking wells drilled and the biggest tremor recorded from this is 3.6 on the Richter Scale, which is a bit like having a heavy lorry drive past the front of your house. Typical tremors are 1.3 to 2.6:

If there is an earthquake of 1.5, they have to stop. The British Geological Society says a tremor like that is not usually felt by anyone. It describes an earthquake of 2.3 as being like someone dropping a bucket of water. To put it in context, there have been three of those in Britain in the last month. 

So - getting a cheap headline, presenting misleading facts and scaremongering. A good day's work from the Liberal Democrat's president!

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A "Grocery Code Adjudicator" won't save a single hill farm but will increase food prices for the poor

First my usual disclaimer when writing about food – I’m no particular friend or fan of supermarkets, I like high quality, artisan-produced food and am an enthusiast for the new retail systems of farm shop, farmers market and veg box. But I don’t believe that these systems should succeed because government has fixed things in their favour, I think it wrong to deny others choice because foodies like me can influence the agenda.

And, while I’m about all this, food production is not undertaken for the benefit of the producer but for the benefit of the consumer. I know it seems daft that we need reminding of this but we surely do – here’s Liberal Democrat MP, Michael Moore:

“Over the years, supermarkets have held our local farmers over a barrel and it’s time for this injustice to be tackled and for the farmers, who produce the food we all enjoy, to be paid a fair price for their produce.

“I am extremely pleased that as a result of Liberal Democrats working in Government, legislation will now be introduced this parliament to bring in a Groceries Code Adjudicator.

I note your quizzical look – how does this represent acting on behalf of the producer? Surely Mr Moore is targeting the rapacious supermarket, this won’t affect us as food consumers, will it? I guess that the answer is ‘yes’ – by raising prices (which is what Mr Moore means by a “fair price”) you raise costs to the supermarket, costs that will be passed straight onto the consumer. Unless of course, the supermarket can go and buy it somewhere else in the world where there isn’t a “Groceries Code Adjudicator” to beat them up over some random judgement of a “fair price”.

If the supplier cannot produce the desired product for the price that suits the customer – and remember that those supermarkets pressing down on suppliers to lower prices are doing so, at least in part, for our benefit – then one of two things will happen:

1.       The price will rise to allow the producer to cover his costs (this will happen where no-one or very few can meet the price demanded), or:

2.       The price will be met by someone in the market and the customer will be supplied

What the campaigners for a “Groceries Code Adjudicator” want to do is raise farm gate prices – to force supermarkets and food manufacturers to pay more:

Referencing the recent announcement of a cut of 2 pence per litre (ppl) in the price paid to dairy farmers for milk by four of the major processors: Dairy Crest, Robert Wiseman, Arla and Muller, which will exploit these farmers to the tune of up to £20,000 per year, Tim (Farron) praised plans for a referee, who will have the power to protect farmers.

Look at it this way instead, rather than this “exploiting” the farmer, it could just as accurately be described as “benefitting” the consumer. After all, that price cut passes through the production chain until it lands in lower food bills for ordinary people. Yet, as the advocates of the “Grocery Code Adjudicator” say, this proposal is:

...backed by all the major parties, and a draft Bill has been examined by two select committees. This means it should pass through Parliament quickly and without controversy.

I find it odd that, at a time when the economy is in a deep hole, when ordinary people are struggling to pay their way, where we even have reports of families being unable to put food on the table – at a time of hardship we are proposing to introduce rules that will result in higher food prices. And not just higher prices – after all us foodies already pay more for the posh stuff – but increased costs targeted specifically at the poorest in society.

And the saddest thing in all this is that the Grocery Code Adjudicator – whoever he or she may be – won’t stop the continuing decline in farm businesses and especially the sort of farm business championed by Tim Farron and Michael Moore. These proposals will be followed by further calls for more protection, more support and greater subsidy – and yet the industry will continue to decline, the farms will continue to consolidate and the nature of the business will continue to change.

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Tim Farron - Communist

Supermarkets are evil, they are driving down the prices for suppliers forcing poor farmers to go out of business. This must be stopped!

But just a minute – how do we do this? After all those farmers already receive a subsidy from the Common Agricultural Programme to produce their sheep, beef or milk so the taxpayer is already (in theory) subsiding the price of these goods.

Apparently we need a regulator! Who – according to Tim Farron, President of the Liberal Democrats -  would:

Totally agree! A strong regulator would make sure consumers don't pay more & that farmers get a better price

So we create a system where the price to the supplier is fixed (or subject to controls to guarantee a minimum price which amounts to the same hill of beans) but the supermarket can’t pass that on to the consumer.

We would have a subsidised, loss-making farming business with state determined minimum prices and a grocery sector with state determined maximum prices. If that’s not a recipe for disaster, I don’t know what is!

Rather reminds me of the Soviet Union!

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