The NHS doesn’t want to change. Simple administrative improvements could save a fortune. I asked my consultant why it takes weeks for a letter to arrive after I have spoken with her. “I dictate it, my secretary types it up, I review it and then post it”. No use of any modern tech that would allow the dictation to go straight to screen, allow an overnight pause to review (good practice in any role) and then email it.
It is in no senior managers interest to reform public services as it reduces their empires (as a councillor, that attitude is rife in local govt). Organisational change would free up millions in each organisation.
Well choose. Are you what lots of ex-Tory voters thought you were, a right-wing party, or not? Are you broadly against what Labour want to do, or not? And once you've chosen, try and convince us. Yet more money for the NHS? Yet more public sector employees? Yet more resources allocated by the state? Where's deregulation, low taxes for businesses trying to innovate, freedom of speech guarantees, an aim to reduce tax, an ambition to unilaterally declare free trade? Still hankering after Blairism, decades after it became clear it was a disaster.
Good article but your graphic proves that any voters lost to the LibDems and the Greens are a drop in the ocean compared with the numbers lost to Reform and staying at home. Also can't you deal with any losses to the Greens by telling voters what the Greens are REALLY like? They're to the left of Labour for a start.
I think the graphic is misleading. A similar number of voters chose Labour in 2019 and now but that doesn't mean they were same voters. Instead, a chunk of voters switched to them from 2019 Conservatives, while a chunk at the other end of their coalition filtered off to Greens of left-wing independents, or simply not voting at all.
Personally I’d recommend two changes in Government strategy. Change the economic focus to growth in GDP per capita(ideally at the median wage) and for net Zero, switch to carbon consumed instead of carbon produced (Ideally this should be changed to an aspiration, in line with other countries, but that may not be achievable)
Unfortunately I think this is all pretty much academic. I suspect your One Nation group will drag the Conservatives to be a pale, second hand clone of Labour, in which case why vote for the imitation when you can have the real thing?
“why the NHS will be better under us”... yeah, great if you can answer it, but can you or indeed anybody? Shifting resources to prevention and detection is good, and will help, but the fundamental problem is that demand will always rise to consume any and all resources that can be put into it, so we will always have more critically sick people in need than the system, or any system, can handle. This is the basic problem with anything that's free, even moreso free at the point of delivery. I desperately don't want the NHS to change that, and neither do the vast bulk of the British public, but we may have to admit it is simply unsustainable as a proposition
It has always been true. A quote from Economics of Need, published in 1974:
"In a zero-price market no level of provision exists to eliminate excess demand and remove the necessity for rationing. This rationing function has never been explicitly recognized, but has fallen by default upon the medical profession as the main decisionmakers of the Service. Doctors, however, have claimed the complete clinical freedom to act solely in the interests of each individual patient while being accountable only to their own personal consciences. As a consequence, rationing has taken place only implicity, resulting in inconsistencies of medical practice and in inequalities of provision. Further, need being limitless, the Service has found it easier to claim shortages of resources than to examine critically their current deployment."
50 years ago and still we refuse to deal with the root cause of ghe problem.
I'm sure you do, as do I, however the definition of 'ill' evolves over time, as does the range and sophistication of treatment to address it. The line between what I might term 'classic' illness and the consequences of lifestyle choices is blurry and porous. Obesity for example, or gender reassignment, or ADHD, or even depression... frankly the list is endless, and not clearly defined.
Excellent blog. No mention of culture war issues here though? Surely the toughest issue (alongside net zero) on which to most efficiently triangulate between Green/Lib/Lab vs reform votes. Unless you consider it a fringe issue vs immigration/the NHS, in which case one has to wonder why it was such a feature of the last 2 years of Conservative rhetoric.
I would add to your sensible views on immigration that it would be good to also focus on how to mitigate the resultant labour shortages. Things like more places at university for medical students, maybe full grants for nursing or other shortage occupations etc. Perhaps this would be a good use of the aid budget - grants and bursaries to train our own people up to fill the shortage occupations. Also tax incentives for firms to automate like the 100% write-down you had going for capital investments.
You’re right about the need for opening up training places for Doctors and Nurses. That is constrained by a combination of the Treasury and the BMA. However, in many cases the immediate impact of reducing the over supply of Labour will be rising wages with the commensurate rise in prices. Some companies will close under the pressure, some will be forced to innovate. There is no magic wand. Successive governments have corrupted the labour market for too for the correction to be painless. One of the most frustrating things I find is the phrase that is used by business, politicians and media, “UK people will not take these jobs” without finishing the sentence, “at these wages”.
Spot on! The Tories or Reform have 5 years to do some serious thinking and explaining about how this will be done and what the trade-offs are. Pros: more affordable housing, less pressure on infrastructure and public services, council houses and other benefits reserved for British citizens, preservation of British culture and identity, rising wages in some jobs. Cons: inflation in some areas, higher costs for public sector, some firms will go under, probably some low-end services (hand car washes, Deliveroo, some coffee shops and marginal restaurants etc) will disappear, more imports (as some food and goods will not be cost effective to produce here), quite a few less well known "universities" will shut, harder to get elderly care and nursery places.
The absolute last thing the health service needs is more university places for medical students; there is a huge oversupply of qualified doctors who can’t find employment because the actual bottleneck is at the post junior doctor/pre consultant stage, because the supply of postings is arbitrarily restricted by the government and the BMA. This has then lead to a shortage of senior consultants to train said qualified doctors, making it tricky to remove the bottleneck in the short term even if you wanted to!
Thanks Ned, this is the sort of knowledge I am talking about. I would like to see the Tories come out with a proper plan that says: "in order to cut foreign doctors by 50% we would first need to do x, y and z. In order to reduce the demand for foreign nurses by ...." and so on.
Precisely - I think these sorts of multi-level problems (where you first need to solve x, to solve y, to solve z several years down the line) are a real political comms challenge. There’s simply no patience among the general public and commentariat to tolerate anything other than direct solutions to direct problems
Don't by any means agree with everything you write here (particularly on Higher Education!), but was very pleased to see this morning that you had managed to hang on.
Don't by any means agree with everything you write (particularly about Higher Education!), but was very pleased to see this morning that you had managed to hang on.
Thanks for the blog Neil - I think there may be more (economic/social/electoral) value in putting the next £1 of spending into local government rather than the NHS, but this seems a relatively uncommon view. Am I crazy on this?
The NHS doesn’t want to change. Simple administrative improvements could save a fortune. I asked my consultant why it takes weeks for a letter to arrive after I have spoken with her. “I dictate it, my secretary types it up, I review it and then post it”. No use of any modern tech that would allow the dictation to go straight to screen, allow an overnight pause to review (good practice in any role) and then email it.
It is in no senior managers interest to reform public services as it reduces their empires (as a councillor, that attitude is rife in local govt). Organisational change would free up millions in each organisation.
Net zero will bring down the Labour Government. The cost entailed by their plans are staggering, and brown outs are likely.
Well choose. Are you what lots of ex-Tory voters thought you were, a right-wing party, or not? Are you broadly against what Labour want to do, or not? And once you've chosen, try and convince us. Yet more money for the NHS? Yet more public sector employees? Yet more resources allocated by the state? Where's deregulation, low taxes for businesses trying to innovate, freedom of speech guarantees, an aim to reduce tax, an ambition to unilaterally declare free trade? Still hankering after Blairism, decades after it became clear it was a disaster.
Good article but your graphic proves that any voters lost to the LibDems and the Greens are a drop in the ocean compared with the numbers lost to Reform and staying at home. Also can't you deal with any losses to the Greens by telling voters what the Greens are REALLY like? They're to the left of Labour for a start.
I think the graphic is misleading. A similar number of voters chose Labour in 2019 and now but that doesn't mean they were same voters. Instead, a chunk of voters switched to them from 2019 Conservatives, while a chunk at the other end of their coalition filtered off to Greens of left-wing independents, or simply not voting at all.
Personally I’d recommend two changes in Government strategy. Change the economic focus to growth in GDP per capita(ideally at the median wage) and for net Zero, switch to carbon consumed instead of carbon produced (Ideally this should be changed to an aspiration, in line with other countries, but that may not be achievable)
Unfortunately I think this is all pretty much academic. I suspect your One Nation group will drag the Conservatives to be a pale, second hand clone of Labour, in which case why vote for the imitation when you can have the real thing?
“why the NHS will be better under us”... yeah, great if you can answer it, but can you or indeed anybody? Shifting resources to prevention and detection is good, and will help, but the fundamental problem is that demand will always rise to consume any and all resources that can be put into it, so we will always have more critically sick people in need than the system, or any system, can handle. This is the basic problem with anything that's free, even moreso free at the point of delivery. I desperately don't want the NHS to change that, and neither do the vast bulk of the British public, but we may have to admit it is simply unsustainable as a proposition
It has always been true. A quote from Economics of Need, published in 1974:
"In a zero-price market no level of provision exists to eliminate excess demand and remove the necessity for rationing. This rationing function has never been explicitly recognized, but has fallen by default upon the medical profession as the main decisionmakers of the Service. Doctors, however, have claimed the complete clinical freedom to act solely in the interests of each individual patient while being accountable only to their own personal consciences. As a consequence, rationing has taken place only implicity, resulting in inconsistencies of medical practice and in inequalities of provision. Further, need being limitless, the Service has found it easier to claim shortages of resources than to examine critically their current deployment."
50 years ago and still we refuse to deal with the root cause of ghe problem.
Why is demand limitless? I go to the doctor when I'm ill, not because it's free. People don't go to A&E for the fun of it.
I'm sure you do, as do I, however the definition of 'ill' evolves over time, as does the range and sophistication of treatment to address it. The line between what I might term 'classic' illness and the consequences of lifestyle choices is blurry and porous. Obesity for example, or gender reassignment, or ADHD, or even depression... frankly the list is endless, and not clearly defined.
Excellent blog. No mention of culture war issues here though? Surely the toughest issue (alongside net zero) on which to most efficiently triangulate between Green/Lib/Lab vs reform votes. Unless you consider it a fringe issue vs immigration/the NHS, in which case one has to wonder why it was such a feature of the last 2 years of Conservative rhetoric.
Congratulations Neil on re-election.
I would add to your sensible views on immigration that it would be good to also focus on how to mitigate the resultant labour shortages. Things like more places at university for medical students, maybe full grants for nursing or other shortage occupations etc. Perhaps this would be a good use of the aid budget - grants and bursaries to train our own people up to fill the shortage occupations. Also tax incentives for firms to automate like the 100% write-down you had going for capital investments.
You’re right about the need for opening up training places for Doctors and Nurses. That is constrained by a combination of the Treasury and the BMA. However, in many cases the immediate impact of reducing the over supply of Labour will be rising wages with the commensurate rise in prices. Some companies will close under the pressure, some will be forced to innovate. There is no magic wand. Successive governments have corrupted the labour market for too for the correction to be painless. One of the most frustrating things I find is the phrase that is used by business, politicians and media, “UK people will not take these jobs” without finishing the sentence, “at these wages”.
Spot on! The Tories or Reform have 5 years to do some serious thinking and explaining about how this will be done and what the trade-offs are. Pros: more affordable housing, less pressure on infrastructure and public services, council houses and other benefits reserved for British citizens, preservation of British culture and identity, rising wages in some jobs. Cons: inflation in some areas, higher costs for public sector, some firms will go under, probably some low-end services (hand car washes, Deliveroo, some coffee shops and marginal restaurants etc) will disappear, more imports (as some food and goods will not be cost effective to produce here), quite a few less well known "universities" will shut, harder to get elderly care and nursery places.
The absolute last thing the health service needs is more university places for medical students; there is a huge oversupply of qualified doctors who can’t find employment because the actual bottleneck is at the post junior doctor/pre consultant stage, because the supply of postings is arbitrarily restricted by the government and the BMA. This has then lead to a shortage of senior consultants to train said qualified doctors, making it tricky to remove the bottleneck in the short term even if you wanted to!
Thanks Ned, this is the sort of knowledge I am talking about. I would like to see the Tories come out with a proper plan that says: "in order to cut foreign doctors by 50% we would first need to do x, y and z. In order to reduce the demand for foreign nurses by ...." and so on.
Precisely - I think these sorts of multi-level problems (where you first need to solve x, to solve y, to solve z several years down the line) are a real political comms challenge. There’s simply no patience among the general public and commentariat to tolerate anything other than direct solutions to direct problems
Don't by any means agree with everything you write here (particularly on Higher Education!), but was very pleased to see this morning that you had managed to hang on.
Don't by any means agree with everything you write (particularly about Higher Education!), but was very pleased to see this morning that you had managed to hang on.
Thanks for the blog Neil - I think there may be more (economic/social/electoral) value in putting the next £1 of spending into local government rather than the NHS, but this seems a relatively uncommon view. Am I crazy on this?