Wednesday, 19 January 2011

Why I won't Condem the changes proposed in the NHS

Today, the government is publishing it's Health and Social Care Bill, which envisages the abolition of Primary Care Trusts (PCTs) and Strategic Health Authorities (SHA) and the transfer of most commissioning powers to GPs and responsibility of Public Health to local authorities.

For the last few years, I have sat as a Non Executive director on Northumberland Care Trust, our local PCT. When I read the coalition agreement and it said there would be no top down re-organisation of the NHS, I was relieved. Every year under Labour a new secretary of state would put forward a new minor tweak of the NHS which would cost a lot of time and money to implement.

Labour abolished the Tories internal market, as in their manifesto, then spent 13 years introducing it again. We had Primary Care Groups, then PCTs, then PCTs were merged into larger organisations (except in the North East where the boards weren't merged but management was!), SHAs were founded. Then there was Practice Based Commissioning, the compulsory provider-commissioner split, which saw my PCT have two boards, compulsory commissioning of private sector treatment centres (which has led to a private sector hospital in Washington which has not many patients but has to be paid for at 100% occupancy).

All this change was possible with an overall improvement in the standard of the NHS because there was a massive increase in funding for the NHS. It did lead to a massive (PFI funded) building spree and a genuine improvement in standards in the NHS. All during this time the NHS budget for drugs and treatments was outpacing inflation as medical science improved. Towards the end of the last government, the above inflation  increases stopped and it was clear that savings would ave to be made to keep pace with the above inflation increases in treatment and drug costs.

The government decreed massive savings in NHS management, which led to between 20% and 40% reductions in PCT management costs. This has had little effect, perhaps proving they were somewhat overstaffed before.

However, if NHS funding increases only keep up with inflation (and both Labour and the coalition government don't seem to propose anything more generous), you actually need to cut back in areas of the NHS. Obviously management charges are the obvious area. If you keep the SHAs and the PCTs you can't cut them back much more without them not working. I was very happy with the abolition of the SHAs (and had advocated it during the election) as they served little role in the North East and mainly just seemed to boss PCTs about, further reducing the sovereign nature of the PCT. I was a bit stunned by the abolition of the PCTs, it was a big bold step. I was pleased with the movement of public health to local authorities, which have accountability to local people (although PR for local government would increase that but that's another story!).

Labour say that the NHS shouldn't reform radically at a time of cutbacks in management. Ideally not but if we are to make further savings in management and not lose money for front line services, how else do you square the circle? I do not think it will mean a widespread abolition of the NHS model but hopefully it will be less of a nationally controlled "top down" NHS. That does mean there could be differential levels of provision locally. As a Liberal, I think that is a price worth paying for local accountability and decision making.

Monday, 17 January 2011

Rural Northumberland needs action on Fuel prices

Danny Alexander was right to mention work within the government on getting fairer fuel prices in rural areas where people have little choice but to drive and emissions are lower per mile travelled. As Local Authority budgets are pressed further, there will be increasingly less public transport (witness the decision to have no subsidised buses on Sundays in County Durham). Danny Alexander was particularly worried about remote areas such as his own patch in the Highlands where petrol prices are much higher than the norm. But any scheme must remember isolated parts of the North East, such as North and West Northumberland (Kielder is the most remote village in England and petrol is about 20p a litre more expensive on occasions).

As Ed Milliband has mentioned, this is hard to do but it is important consideration is given to creative schemes.

Sunday, 16 January 2011

After Oldham, let's look to 2015

After the Oldham East and Saddleworth by-election, where we grew our vote share and didn't collapse as a party, the Liberal Democrats have proved that they will not fade away and the front page of the Spectator, depicting a dying yellow bird, is a bit premature.

But unless we begin to build a distinct identity with the public again we will lose seats and influence nationally even if we get the same share of the vote. First of all, let me say that I would rather remove myself from politics than sanction a merger or permanent coalition with the Tories (or indeed the Labour party in the future). Britain needs a Liberal voice and we must provide it.

Oldham has shown that in Lib Dem – Labour marginals, as things stand, it is likely we will pick up a share of previously Conservative voters impressed at our fiscal responsibility in government (now we have proved we are not the irresponsible “tax and spenders” depicted by the media). However we will gradually lose the left wing fellow travellers who have voted for us, dismayed as they were with the awful New Labour project. Ed Milliband is now able to promise them a more left wing agenda. These voters have always been hard for us to retain. Their instinctive home is with the Labour party.

The problem is that in Lib Dem – Labour seats, a shift as described above will result in a similar result to that in Oldham – i.e. a similar level of the vote to the Lib Dems but a higher Labour vote. That is because in the crazy world of FPTP (and still to a certain extent in AV), a vote transfer between the top two parties is worth twice as much as a vote “squeezed” from the third party.

In Lib Dem – Conservative seats, we will lose some votes to Labour but may find Conservative voters less motivated to get us out. The end result is less certain but it still poses a challenge to us.

To succeed, we need to give people a reason to vote for us and get new supporters. The Conservatives will be able to stand on the record of the coalition and offer their voters a more full bodied Conservative government. We will be able to put the myth to bed that we are a bunch of amateurs who can't be part of government and can point to successes in government. On it's own, this is not enough. If people want to vote for the coalition, they will usually vote Conservative.

At the next election, we need a distinctive message and some distinctive policies. I believe that we need to build upon our hard won reputation for making hard choices but also emphasise the fact that we have fought for fairness – i.e. measures that help the poorest in society have more opportunities for them to advance their lives. In addition it is essential that we work on radical measures to reduce the power of the central state by passing power to local communities. So I would argue for an fiscally conservative agenda combined with a highly socially liberal agenda.

What this means in terms of policy is debatable. But I have a few thoughts. Economically, we should commit to never having a structural deficit and for national debt to be reduced over every economic cycle. Socially we need to continue to push for a pro-work benefits system, a removal of the regressive council tax and considerable investment in infrastructure and education.

Constitutionally, I think we should give local authorities much more tax raising ability and only use the central government grant to equalise spending power (to remove problems like East St Louis in the USA, where the council had virtually no income and couldn't even collect the rubbish). Policing, public health, local infrastructure, business promotion, benefits administration and planning should be fully devolved and the DCLG and BIS should be scrapped at a national level. If House of Lords reform hasn't happened we should campaign for it and whether the AV referendum is won or not, we should push for a properly proportional system at all levels of government.

Of course 2015 is a long way away and our record in government will only be clear in a few years but we will only do well with distinctive policies.

Friday, 14 January 2011

Oldham East and Saddleworth: my post mortem

Well first of all congratulations to Debbie Abrahams for winning the Oldham East and Saddleworth by election yesterday. She comes across as a nice enough sort and I wish her well in her crusade to never break a political promise (I presume the Labour party manifesto will never be construed as such a thing!)

I gave a few days of my time to support Elwyn Watkins, the Lib Dems excellent candidate and am naturally disappointed by the result. he would have made a great MP and been a real character in Parliament.

Over at there is a fairly good article looking at why Labour won but I would just make a few observations:

- The great news is that Phil Woolas's career is over, his literature was disgusting, trying to stir up racial hatred. I was staggered that Ed Milliband appointed him as shadow immigration minister with the leaflets he put out. The Labour party should have suspended Woolas immediately, not waited for a court to decide. Elwyn has already achieved more as a candidate than many backbench MPs do in their whole career. He has reminded candidates that they have to tell the truth in elections or face the consequences. Saying that, I was surprised how little traction the issue had on the doorsteps. The fact that it was the first such conviction in 99 years and their former MP was a convicted liar unfortunately confirmed peoples opinions that all politicians are liars. A bad thing we need to prove wrong.

- The Lib Dems came together and worked as a team - contrary to reports that we are horribly divided and about to cease to exist, the Lib Dem activists came to Oldham in their droves. There was a great sense of togetherness and I met some old friends and some great new people. For many of our newer members, this was their first big by-election and I hope they "enjoyed" it. Our party is very resilient and full of great people.

- Elwyn did not lose this election, the party did. In normal times Elwyn Watkins would have walked this election, he is genuinely popular in the area and Mrs Abrahams is relatively unknown. Our collapse in popularity at the moment was moderated to some extent by this and the result was respectable rather than disastrous. To be honest I didn't even find Labour voters that enthusiastic about their party, most  people are not that keen on a lot of us at the moment!

- Labours by-election machine has now improved and is matching our previously peerless campaigns department. They put out some quirky but good literature and had a lot of good voter ID, matching us for the first by-election in a long time. Andy Burnham has said the party is trying new techniques to be more informal with voters. The Lib Dems need to raise our game again. Saying that, the campaign team led by Dave McCobb did a great job in holding our vote share.

- The Tories did not throw in the towel but still got squeezed. They are not brilliant at campaigning in these kind of events and I predict they will not win a by-election whilst they are in government. The Lib Dems may still be able to win the odd one but it will be hard.

-This election was all over the place. Voters were changing preferences a lot at the moment. The electorate is more fickle or thoughtful (depending on how bitter you are!) and does change preferences more. This demands more of an effort to persuade them of your cause. Our vote share increased marginally but the Tories share collapsed. But this was not a linear swing. We lost some voters to Labour and gained some from the Tories (as did they) but one vote lost to the Labour party from the Lib Dems is worth two votes from the Tories in our crazy FPTP system.

- Among the minor parties, UKIP spent big and edged out the BNP but did so by pushing a very right wing anti immigration agenda. Is their future to be "BNP lite" perhaps? The BNP were the cause of the only agreement I had with Labour activists in the field. They are scum and just gang up like school kids, shouting and swear at people. All very intimidating and not the way to do well! Finally, the English Democrats must win the "Bootle" prize (named in honour of the rump SDPs disastrous showing in the bootle by election in May 1990) for being discredited by coming behind the Monster Raving Loony Party.

Sunday, 2 January 2011

A century of delay - time to act

2011 is the centenary of the passing of the 1911 Parliament Act, which curtailed the power of the House of Lords to delay money bills passed by the House of Commons. It was part of a concerted attempt to assert the powers of the democratic part of the Parliament over the undemocratic element of it by the radical Liberal Government of the early 20th Century that brought us the state pension, properly funded state schools and National Insurance. This change came at a considerable price to the government of the time and since then people have not been very keen on touching Lords reform with a bargepole.

It is a national embarrassment that this country, which flatters itself as having the "mother of parliaments", is one of the least democratic in the western world. Our second chamber is now a combination of hereditary privilege and patronage. It is embarrassing that when we lecture other countries on democracy ours is so rotten. The House of Lords was an anachronism in 1911 and is a corrupting influence now. There are arguments on how a selected chamber is effective but it is immoral that people can make our laws without us being able to boot them out.

I am passionate that we need to reform the House of Commons, of which the forthcoming AV referendum is a part, but actually the House of Lords is far more pressing. Since 1911, various royal commissions have looked at this issue, with the purpose of delaying reform.

I am told that Nick Clegg will shortly launch consultation on an 80% elected House of Lords. That is better than nothing but it is vital that it happens with the speed that issues (which the Tories support) such  as equalised constituencies have been given. History like this shows that change like this only happens when it is pushed through with urgency.

For the record, I think it is vital that the House of Lords retains its revising nature but it is vital that it gets a different mandate. A fully proportional method of election on a fixed term different from that of the House of Commons would give some balance from the "other place". Hereditary peers and bishops must stop being automatic members (they are welcome to run for election!). Then we might start to become a proper democracy, about fifty years after the rest of Western Europe.

Saturday, 1 January 2011

"Honest Dave" breaks his manifesto commitment

No not that Dave, I am referring of course to Dave Anderson the MP for Blaydon and my opponent in the general election in May. Dave spent a lot of time during the campaign saying that he was an honest guy and has been amongst the first Labour MPs to stick the boot into the Coalition government when one of the two parties has had to compromise on manifesto policies.

During the election he regularly lauded his parties manifesto and just before it, voted for a referendum on having a referendum on the Alternative Vote. His party was the only one to pledge support for the AV voting system. Now Dave has come out as an opponent of AV. He favours the unfair current system, First Past the Post, which elects MPs who have less than the support of half their electorate. The North East has a high level of anti fairer voting reform Labour MPs. They think all the MPs should be Labour regardless of the public's view.

To be fair most sensible Labour MPs support the change. Ed Milliband and most of the cabinet are backing the Yes2AV campaign. As the Labour Yes campaign said recently "It is a shame that some Labour MPs who so recently stood on a manifesto supporting a referendum on the Alternative Vote have chosen short term tactical gain above the long term interests of the voters and the Labour Party." Quite.