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The NHS and a Web of Deceit.

Summary: the NHS and our social care services are under extraordinary pressure. The government continues to claim that the NHS is “safe in their hands”. It is not at all. They claim the NHS is the best in the world yet a report suggests that amongst the top 12 economies, the NHS is the second poorest in terms of preventing, detecting and treating illness. So many wrong decisions have been made about so many aspects of doing the right thing for the NHS it is difficult to know where Labour might start if they get into power. So many of government claims are simply being “economical with the truth”. They must be resisted at every turn.

The NHS is the best health service in the world. True. Or at least it was when Labour handed responsibility for it first to the coalition and then to the Tories. We were all greatly reassured by David Cameron many years ago claiming “the NHS is safe in our hands”. He repeated that in his first major speech after 2015 election and said “a 7-day NHS, safe in our hands, for every generation to come”. Theresa May has continued to parrot that phrase, oblivious to the reality faced by anyone who goes near an NHS hospital in 2018.

So how come we see television pieces and read in the news media daily about one disaster after another? Ambulances queueing to pass individuals in need of urgent treatment.  Stressed nurses working in overloaded A&E departments around the country. Patients waiting on chairs or trolleys in corridors, unable to be admitted because of other patients stuck in A&E. Patients stuck in A&E because other patients capable of being discharged from wards have nowhere to go since the social care system has been damaged even more than the NHS by real cuts.

We have an ageing population, a growing population and a rapidly growing increase in demand. A system that is as grossly overloaded as it is simply cannot cope with any additional pressure from winter flu or any kind of disaster. It takes so long now to get treatment in A&E that many patients are left much worse because they have not been treated in time.

Staff are under an intolerable pressure. Shortage of nurses (currently around 40,000) and doctors (about 9000) add to the strain. Application for a nursing position in the NHS requires passing a complex English language test intended for academics that includes a significant essay question. This causes many who speak perfectly adequate functional English to fail. Applications from nurses from the EU have dropped enormously, by a factor of more than 20, because of the risks around the insanity of Brexit that the nurses may simply be arbitrarily repatriated. Doctors appointed to NHS hospitals from overseas currently cannot get visas because the quota has been exceeded.

Nurse training now requires fees and accommodation to be paid for by the trainee nurse and not by the NHS who used to provide bursaries and subsidised accommodation. The idea that any young person might wish to become a nurse given the current TV coverage of the awful stress they will experience seems quite unlikely. 4/5 NHS nursing directors say their hospitals rely on the goodwill of staff to keep things running. There is more here: http://outsidethebubble.net/2017/02/02/government-driving-up-non-eu-immigration-intentionally/ .

What is causing this chaos? Surprise, surprise it’s all about money and the Tory obsession with austerity! It all started when Thatcher introduced the internal market, splitting the purchaser (health authorities) and the provider (hospitals) that were contracted to provide services. Labour opposed this strongly until they got into power then embraced it with enthusiasm. Tony Blair went much further, making the structure much more complex as well as getting into Private Finance Initiatives which to this day continue to drain money from the NHS. At least during the Labour years money continued to grow for the NHS. Not now, under the Tories.

When the Tories got their hands on the whole business the decided to trim every aspect of the health and social services in the UK (efficiency savings, of course), and further cuts are planned (yes, seriously). The Bank of England managed to print nearly £500 billion of new money in recent years to keep the banks afloat. When it came to health and social services, cuts were the order of the day. Income tax on the wealthy, increased to 50% in 2010, was reduced to 45% a couple of years later.

Over the last 10 years funding for the NHS and in particular the social services has lagged well behind inflation. The increase in demand and the size and age of the population continue to be simply ignored. The Tories insisted that the extra demand was simply because of large scale immigration from the EU. The right-wing media seized on that and the effect on demand of the (almost non-existent, in reality) scroungers.

Public funding for healthcare is forecast to fall from 7.6% of the GDP in 2009/10 to 6.8% by 2019/20. The rates in France are just under 9%, and Germany just over 9% of GDP.  Increases in the NHS will average only 1.1% per annum through that period, very far from keeping up with the increasing demand or the increase in the cost from improved treatment procedures.

The recent announcement of a very small increase in the NHS budget in the 2017 budget is tiny and will have very little effect on the current multiplicity of crises. Estimates from The King’s Fund suggest that funding is currently running at least £4 billion lower in real terms than required.

Less than a year ago Theresa May again claimed the NHS was the best in the world, and absolutely safe in Tory hands. In fact the NHS was rated the second poorest out of 11 rich countries in healthcare outcomes assessed on the prevention, detection and treatment of illnesses. The pay cap on many including nurses in the NHS has been lifted yet no new money provided to fund increases.

Yet there is worse still. Social care funding has dropped over the last eight years in real terms of over 8%. As a consequence the availability of places for convalescence, essential to help unblock the bed occupancy in hospitals is even poorer than it ever was. Only by providing such space is it possible to unblock the appalling logjam that is a typical NHS hospital today.

Only today the Children’s Commissioner for England, Anne Longfield, reports that the provision for children’s health in England is much poorer than in Scotland, Northern Ireland or Wales. In Scotland they have just passed an ambitious act to reduce child poverty and develop a new mental health strategy. The Tory government seems to see children as a burden on society. Austerity means we now have 72,000 children in care. The Tories made this worse by introducing a two child limit for family credit. This shows just how much they value children and how happy they must be to make the lives of poor families even more difficult.

Child obesity now runs at about 20% in year 6 (ages 10-11), and up to 26% in children from disadvantaged backgrounds. An obese child has an 80% chance of becoming an obese adult, with a life expectancy shortened by between 10 and 20 years. The Tories claim to have a world-leading plan to deal with child obesity. It is probably as complete as their Brexit Impact assessments (i.e. doesn’t exist).  Legal action is again being taken against the government for their failure to deal with the High Court judgement against their inadequate plans to improve the quality of the very toxic air in our cities.

Where will the money come from? Assuming that the government are not prepared to get the Bank of England to print perhaps 1% of the money they printed for the banks over recent years, the idea of increasing tax on the very wealthy is totally dismissed by the Tories. Today we also have the news from the Tax Justice network that the Treasury have instructed HMRC not to worry about Amazon’s non-payment of tax. Another source of money that would make such a difference to the NHS but instead going to multi-billionaires overseas.

It is clear that the NHS really is NOT safe in their hands. Those hands are pretty lethal in reality. Labour will have to work so hard to unscramble this mess that is so bad that even 70% of Tory supporters are very concerned about the NHS, and fewer than 40% think Jeremy, the Health Secretary, should keep his job.

Don’t Conflate Brexit with Party Politics.

Summary: Brexit is not a party political issue. The increasing pressures on Labour to come out against Brexit must be resisted. Labour must get into power. A second referendum, becoming increasingly likely with Nigel Farage supporting it, is the only way it could be reversed if our democracy is going to retain any element of respect. All Labour need to do is to say they will bide by the outcome of whatever referendum result stands. They need to concentrate on gaining power not by risking their fragile majority. They have the policies and an energetic and enthusiastic party base. Even if Brexit does come to pass, one managed by Labour would be so much better for the country as a whole.

Brexit is not a party political issue. That may seem a strange thing to say. Yes, referendum was a consequence of political machinations at that time and, yes, the Brexit negotiations are being handled, albeit badly, by politicians. The conventional political party lines were crossed by very many voters because the political parties provided little helpful guidance. The vote to Leave was not driven by one party or another.

The campaign before the referendum was deeply flawed but the result was one arrived at democratically. Let there be no doubt that the only way respect for democracy can be maintained is if a second referendum is held, hopefully with much more detail of what the Deal might be. No political party could possibly reverse Brexit if they came to power without the support of a second referendum. It would be seen as a further example of the power of the establishment to try to reverse Brexit without it.

Labour are being advised by many to come out against Brexit. For many months, Labour has consistently avoided stating what their view of Brexit actually is. However the most important thing that Labour has to achieve is to become the next government with a reasonable majority. Nothing, including Brexit, should be allowed to distract from that goal. So far Labour have managed sitting on the fence. As soon as they declare one way or the other significant numbers of voters would leave the Party and no doubt others would join.

The demographics of Remain or Leave voters are complicated and transcend conventional party political lines. It is difficult to see what benefit there might be for Labour in declaring one way or the other for Brexit. A second referendum is becoming increasingly likely particularly as Nigel Farage has come out today in support of such a referendum. He is convinced that the majority for Leave would increase. In a sense any second referendum, no matter what the result, would be progress as it might give a bigger majority for one side or the other. That would perhaps clear up the ambiguities for a considerable period.

The Brexit battles will continue but there is no particular need for these arguments to affect Labour’s policies. Indeed there are relatively few of their policies that would be dramatically affected by Leaving or Remaining, apart from the economic impacts of leaving which would be pretty serious. Those in favour of Remaining should organise themselves as best they can independent of party loyalties and let the parties get on with politics and running the country.

At present, the Tories are so preoccupied with every aspect of Brexit that they have little energy left over to run the country. The current shambles with the NHS, social care, education, defence, you name it, is all because the Tories have run out of new ideas and, because of Brexit, do not want to upset anyone. This is exactly the environment that Labour should be capitalising on now. Labour have strong policies which are in many cases well worked out. These really should appeal to those living in areas that voted strongly for Leave. Nothing should be done to risk losing these potential voters. Labour have to manage an important communications program to reach the communities most affected by austerity. But don’t talk about Brexit!

All that Labour need to do as far as Brexit is concerned is to make it clear that they wish to support the democratic will of the people. If their democratic will is found to have changed after a second referendum, well that’s fine. And if it hasn’t changed we just have to live with it sadly. Those like me who want to Remain must make the case clearly and in a way that reaches those who had voted to Leave but we must not conflate Brexit arguments with Labour party policy, nor should we pretend that Labour strongly support one side or the other. If we do then Labour will simply lose votes. Opinion polls do not suggest a very strong lead for Labour. We must not become complacent and take risks. Only one thing matters. Getting Labour into power. Brexit can sort itself out.

Owen Jones in his recent piece for the Guardian (see: https://www.theguardian.com/commentisfree/2018/jan/03/stop-brexit-campaign-vote-leave-populist) has made the matter unnecessarily complicated by failing to separate Brexit from day-to-day party politics. That is why the strongly anti-Brexit Lib Dems have garnered almost no additional support by their policy. He is right, however, that a Labour-managed Brexit would be preferable to one being run by the hard right of the Tory party. That can only be done if Labour win power. Nothing else will do.

Labour Must Rethink Its Brexit Strategy.

Summary: Labour’s policy on Brexit is far too poorly defined. We don’t need to come out for or against Brexit nor for or against a second referendum. The shambles of the Tory Brexit negotiations will continue and probably get worse. Decisions by Labour about its approach can be left until later in the year. Tony Blair has produced an interesting commentary suggesting that Labour should be much more proactive in its relationship with Brexit. Just because he is so unpopular with the left we must not ignore everything he says. What he says makes a lot of sense. Shoot the messenger if you must but read the message first.

In the 1930s and 40s there was a lot of excellent scientific evidence that smoking was a major cause of lung cancer. It was ignored and dismissed by tobacco companies and politicians because that research had been done in Nazi Germany. The research was repeated and came to the same conclusions. The 10 year delay in taking action caused millions of deaths worldwide. My own mother, advised to smoke for her nerves when pregnant with me, died early with lung disease. Nobody liked the messenger then so the message was ignored. We mustn’t make the same mistake again.

Tony Blair has produced a lengthy piece about Labour’s strategy surrounding Brexit (see: https://institute.global/news/brexit-what-we-now-know , and summarised on LabourList at: https://labourlist.org/2018/01/tony-blair-this-is-our-last-chance-brexit-and-the-fate-of-britain-will-be-decided-in-2018/ ). Like many on the left I’m pretty allergic to him and his ghastly legacy. Another case of a disliked messenger yet that is no reason not to listen carefully to what he says. In fact many of his views make a lot of sense, and it should be considered seriously and without prejudice. There is no doubt that Labour policy on Brexit is at best ambiguous. The Tory government is making a complete hash of the Brexit negotiations. Labour really do not need to mouth the foolish “cake and eat it” phraseology beloved of the Tories. We can’t be outside the single market while being in “a single market” as John McDonnell seems to believe. We need to restructure Labour’s approach to maximise its effect on the electorate. If Labour hope to become a government it must learn to develop strategies and articulate them.

I think Tony Blair is wrong that Labour should become anti-Brexit wholeheartedly, nor should they declare themselves for or against another referendum. By maintaining that aspect of their ambiguity they are protected from attack from both Leavers and Remainers. The Tories can be left to continue tearing themselves to pieces. But Labour must not continue doing and saying nothing about it. It dominates a great deal of what is going on in the UK today. We mustn’t take the “don’t talk about the war” approach indefinitely with Brexit.

What Labour must do is to focus on what is happening in the Brexit negotiations and making it clear just how badly these are being managed and just how unrealistic Brexiteer ambitions actually are. There is a lot of evidence that those who voted to Leave were socially conservative and that conservatism was more important than their concerns about the economy. The emphasis of the Labour criticism of the Tories must be to point out just how badly wrong the Brexit process is going. The deals being discussed will not be in any way socially conservative. They will be revolutionary in a way that will also be deeply damaging, in the worst possible way. Labour has to explain just what the Tory approach will do to the country and to those already damaged so much by Tory policies.

Tony Blair is right that Labour must make certain that Brexit is understood to be a pure Tory Brexit. Tory interests will be looked after (big business, finance, the City and the wealthy). The left behind will continue to be left behind only now more so. The economic uncertainties will force bigger and more widespread cuts than we have seen so far. Every aspect of our social fabric will be further damaged. At a time of crisis in the NHS, the social services and many other aspects of what matters to so many of us has to be deeply damaging. The Tories must be blamed for that unambiguously.

We cannot be sure of a chance for a general election during 2018. Again Tony Blair is right about that. The most likely scenario is that the Brexit Deal produced by the Tory government will be patchy, contain many uncertainties and attempts to postpone detailed negotiation until the transition period. After the exit date in March 2019 we will indeed be out of the EU and many of the options we might otherwise have may be closed off. Labour must ensure that a vote on the Deal takes place during 2018. Only then should Labour make it clear that if public opinion has turned against Brexit then another referendum should be held and the Brexit process paused if not terminated.

A Tsunami is Coming This Way!

Summary: With unemployment in the UK so low it is easy to ignore some radical changes that are likely to make the employment of humans much less attractive in the not-too-distant future. British productivity will grow mainly by investment in advanced machines. Important developments in robotics and artificial intelligence will drive this forward at increasing speed. Some countries are already planning to normalise much shorter working weeks. A broad interest in Universal Basic Income will make part-time working more attractive. That would help to create a fairer society to improve the work-life balance for those today shackled to a system requiring long working hours, low pay and with little prospect of advancement. These changes are already happening. We cannot ignore them or imagine for a moment we will be insulated from them in the UK.

It may seem strange when UK unemployment is at a 42 year low to be concerned about the near future prospects for jobs. Our low unemployment rate disguises the fact that there is a lot of slack in the labour market with people employed part-time or on jobs that are highly repetitive and boring. The economy is growing very slowly indeed. The rise in Bank of England interest rates might make you think the corner has been turned but it’s still not looking good at all

Once the present Brexit/Tory shambles is sorted out we can expect significant increases in investment in the economy partly by government but particularly by business. Labour are keen to invest in infrastructure development. The worryingly low level of productivity in the UK will be boosted by investment in new machines and assembly and manufacturing techniques. In other countries this has gone ahead quite strongly while the UK lags. By starting late we will be investing in more advanced machines than other countries. Yet investment doesn’t imply massive increases in employment. Nissan are investing £100 million in their facility in Sunderland but will only increase jobs by just over 100. That’s all the jobs you get these days for £100 million investment

Car production lines are highly automated largely staffed by robots who work tirelessly, uncomplainingly, 24/7, don’t need bathroom or lunch breaks or an HR Department to keep them happy. Outside vast production lines robots are becoming increasingly entrenched. Their capabilities are improving daily. Have a look at this movie from Boston Dynamics (see here: https://www.youtube.com/watch?v=-7xvqQeoA8c ). Robots are under development in the UK that will repair potholes in roads (big market there clearly). Autonomous aircraft and ships and vehicles are under active development worldwide for military use (see: http://outsidethebubble.net/2017/04/10/defence-in-the-21st-century/ ). The rate of improvement in robot capability is dramatic. Tasks which were thought impossible a few years ago are now managed routinely.

The one area where humans have a distinct advantage is where skills are important and have to be learned with training taking months or years to complete. Think here of drivers, pilots and even surgeons. Humans need to be trained to carry out skilled tasks. The training principally involves the learner being helped to absorb the experience of others who are already skilled. Artificial intelligence (AI) is able to use the human experience to process datasets of all sorts that are too extensive for the intellect of individual humans. However recent progress in self training systems has been most impressive.

Google achieved a major milestone in October 2017 at their facility in central London. For some years they had been training computer systems to play the ancient Chinese game of Go, widely believed to be more difficult to master than chess. These trained systems had achieved very high levels of performance. However, the extraordinary new achievement, explained in a Nature paper (https://www.nature.com/articles/nature24270.pdf ) was to use a specialist computer system to teach itself Go without any external training. It was simply given the rules of the game and told to get on with it.

It started by simply playing Go against itself. It played a very large number of games, around 30 million, but by the end of that time had reached a level of expertise at Go that no human has ever achieved. Playing against the previous version of the machine which had already beaten all human players, it won 100-0.

Human players don’t ever play 30 million games but they do learn from many others who have honed their skills by building on the experience of yet more individuals. That is how we humans can learn very quickly. Yet the idea for the first time that a machine can be told what is needed and can train itself to achieve that goal so quickly has enormous implications for most other kinds of mechanical and intellectual challenges. The consequence must be that the number of jobs available for humans will decline and probably decline rather rapidly.

Another interesting announcement this week was that there are moves within Germany to make the standard working week only 28 hours long. At present, Germans work much shorter weeks than we do in the UK (it averaged 32.3 hours in the UK while in Germany they averaged 26.4 hours in 2014). At the same time, German workers have some of the highest levels of GDP per person in the world. 28.8 hour weeks were actually agreed within Volkswagen as far back as 1993 in negotiation with unions concerned that the reduction in demand for cars would lead to a massive redundancy in the main VW facility of over 30,000 jobs.

What is happening now is that German workers want a fair share of the benefits of Germany’s growing economy. They want to improve their work-life balance as well as achieving better hourly pay. They anticipate that the national demand for hours worked will continue declining and want the hours available to be shared as equitably as possible. They do not suggest stopping people working longer weeks but they want to ensure that someone working 28 hours per week will have a good standard of living.

The reducing demand for worked hours will mean that more and more people will be working at best part-time. The economics of this for employers becomes complicated and many countries are considering introducing a Universal Basic Income (UBI). Trials have already been carried out in Finland with great success and are about to start in part of Canada.

In Finland one region with 2000 unemployed individuals were given £500 per month with no strings attached. They didn’t have to pass any test or give any undertaking on how it might be spent. The results, however, were remarkable. Individuals receiving the UBI payments felt that the implicit security of this basic income gave them more confidence to take on additional, part-time jobs that might of themselves not give a big enough income. They also felt emboldened to try setting up their own small businesses that would never be profitable enough in the short-term to live on but with their lives being underpinned by UBI they felt it was something worth trying.

A scheme such as UBI at the right level could eliminate unemployment benefit, basic state pension, child benefit and many other payments already made to individuals. In fact, in a way, such payments are made to all of us already.

We have a tax-free allowance on our income, a way of supporting people on low income. A full UBI implementation would provide the same level of payment to everyone irrespective of their income. It would be added to that income and taxed accordingly but for the poor no tax would be payable until they had a decent income from other sources.

It is inconceivable that a Tory government would ever willingly give money to the poor with no strings attached. However Labour have been much more receptive to the idea and shadow chancellor, John McDonnell, has called UBI “an idea whose time may well have come” (see here: https://www.newstatesman.com/politics/economy/2017/07/could-labour-implement-universal-basic-income ).

The conclusion that we must face up to is that we shouldn’t expect the British full employment averaging 32 hours per week will continue for long. Robots and Systems which can teach themselves the skills that most of us have will increasingly make the employment of humans relatively unattractive. We must position ourselves to implement a revolution in employment before the tsunami overtakes us. We will all be surprised and shocked just how quickly it is upon us.

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