NHS Accountability

 

I read that health spending now accounts for a whopping 45% of overall government expenditure on goods and services.  As more and more borrowed money is lavished on the NHS it is dismal to learn that the number of operations being performed is lower than before Covid even though there are 13% more doctors, 11% more nurses and 10% more support staff.  How much more to turn the ship around or have we, perhaps, reached the point when we should be saying enough is enough? If we, the hapless patrons of such a broken system, were shareholders of the providing company we should be calling the Chief Executive to account.  However, as we know, healthcare provision is cunningly devised to that it is very difficult to pin anyone down, particularly over poor performance.  Of course, the Government department responsible for “the NHS” is Health and Social Care.  However, The Secretary of State, Steve Barclay today, can easily slope his shoulders because responsibility for allocating resources in the world’s second largest healthcare system is vested in the publicly unaccountable (and largely invisible) Amanda Pritchard.  Apparently, in a behind closed doors meeting with her executives on 13 October 2022, Amanda Pritchard described the health service’s financial situation as, “a f****** nightmare.” If half of Government spending is, “a f****** nightmare,” why is no one being called before Parliament to explain?  There are 650 elected Members of Parliament who have a vital responsibility to look out for how our taxes are spent.  But just whisper the abbreviation, "NHS," and the silence becomes deafening.

The Latest Conservative Government

 

I have refrained from publicising my exasperation with the Conservative Party but, as the threat of decimation at the ballot box looms, I need to let off steam.  Rishi Sunak in charge and, arguably, we have got the leader we deserved.  Those who supported the new Prime Minister will be pleased with the initial direction of travel.  A Government of “all the talents” will repel accusations of nepotism and give a warm feeling to all who feel most comfortable in a technocratic consensus. But the relatively warm reception to the new Government so far disguises the gaping fault lines beneath the veneer of competence.  Will the National Insurance Rise be reinstated, should the promised rise in defence spending be rescinded, can we afford to pump even more money into health and social care without fundamental reform, how will we achieve resilience in energy and agriculture, is it not time to reassess the drive to net zero, how will we deal with the barrage of public sector pay claims, should we roll over on the Northern Ireland Protocol, are we serious about limiting illegal immigration and, even if we achieve consensus on all the above, can we actually implement anything in the face of the social media campaigns against everything? Far from steadying the Conservative Party ship, Rishi Sunak now faces an existential crisis.  Can all these tensions remain beneath the surface?  There is an argument that says we will be stuffed at the ballot box anyway so we may as well get all the bitter arguments out in the open and refit the ship when all the blood has been spilt and washed from the decks.  On the other hand, we could all put our differences aside and unite behind a message of responsibility and compliance with orthodoxy.  This is the appeal today – get behind Rishi and take the medicine or face extinction.  The “medicine” will involve, amongst other things, continuous retrenchment, falling living standards, cuts to hitherto sacred areas of expenditure, increasing social friction and, of course, more taxes.  But when you have been abusing your economic health for so long, bingeing on ridiculously cheap credit and printed money, surely we should expect an uncomfortable treatment plan?  Quite so but the only thing missing from Rishi’s diagnosis is the potential for recovery and hope for the future.  I think we would all take the medicine more readily if we could see a glimpse of what life could be like beyond intensive care.  If we are to stay the course, like any survival situation, we need hope that we can prevail in the end.  So Rishi, give us some hope and a vision for recovery –

 

When daylight comes, comes in the light,

In front the sun climbs slow, how slowly,

But westward, look, the land is bright.

 

Ian Harrow 1945 - 2022

Ian Harrow, who was a constant inspiration for this Blog and a highly stimulating companion, died this morning. Ian and I first met in 1956 when we joined Form 1 at Heaton Grammar School, Newcastle-upon-Tyne, thereafter progressing to the 6th Form after which our respective careers diverged and we lost contact for nearly 50 years. Having reunited about 13 years ago we have, until recently, met every week to discuss everything of importance.  This was published in the Spectator, 22 January 2022:

Last Word But One

The vanity of your insistence

that there is still time remaining

to speak what words can't say

on these most wishful of days

when, for you, the dying part is near

and still you want to believe

the conversations will go on

as you rest your hand

like the hallucination of a hand

on files that nurse the latest

shortfall in everything you made

                                                    - Ian Harrow

Mushroom's Conservative Leadership Vote

 

Mushroom has cast his vote in the, apparently, never ending mudslinging and self-destruction of the Conservative brand.  The Labour high command must be laughing all the way to the bank having saved themselves a fortune from their campaigning budget.  Meanwhile, Starmer’s speech writers have been presented with a treasure trove of embarrassing political faux pas, all to be deployed against the Conservative Party as the next election approaches.

In the early rounds of the contest, I constructed a matrix of essential and desirable criteria for leadership and marked off each prospective candidate accordingly.  Unfortunately, the candidate who emerged top of my scientific evaluation, Suella Braverman, failed to impress enough honourable members and didn’t make the cut.  Instead, as we are reminded by the always excellent Rory Sutherland, “we get to choose between someone who studied philosophy, politics, and economics at Lincoln College Oxford, and someone who studied philosophy, politics, and economics at Merton College Oxford.”  How lucky we are.  Sutherland remarks that he finds “the very idea of an undergraduate degree in politics alarming.”  He concludes, “it’s one thing to theorise on the basis of practice; quite another to practise on the basis of theory.” 

Quite so, and as the various hopefuls were eliminated the two remaining had managed to say something that ticked every box in my Excel selection matrix.  So much for science!

But this contest is much more than a political game.  As Allister Heath points out in the Telegraph today, we are faced with, “looming power cuts, rocketing bills, water shortages, dysfunctional public services, sky-high taxes and a failing economy.” Heath, dammingly, blames, “a quarter-century of political, intellectual and moral failure in which most of our political class has been complicit.”

Oddly, the looming crises, offers an opportunity to choose a different path to the technocratic consensus of cakeism and political compromise.  Of course, neither candidate has dared to suggest that we should spend less, least of all on the NHS money-pit.  However, it seems clear that more of the same will not do – we must take the chance of doing something different.

I like Rishi Sunak but I have concluded that he is one of the technocratic consensus and that his solution of squeezing inflation whilst reassuring the work-shy that help is always at hand will not work and will be a certain recipe for defeat for the Conservative Party when the next election comes.  Of course, Liz Truss does not have a magic wand for inflation and the economy but she does seem to have the breadth of vision to, potentially, enact some more radical polices to increase growth and productivity from which economic equilibrium may be restored.  With the election still 2 years away, there is still time to restore the reputation of the Party.

But the game changer, for me, is that Liz seems to have appreciated that we need stand up to Russia and treat China more firmly than hitherto.  She seems to appreciate that this means spending more on defence – not just repeating the meaningless NATO target of 2% of GDP but serious expenditure to fund the military capability we need to promote our foreign policy.

So everywhere I look I judge that we could not be any worse off by giving disruption a try concurrent with beefing up our defences in an uncertain world.  It’s Liz for Mushroom.

RAF Order of the Day

 Following a complaint by a member of the Green Slime, the SAS has told special forces personal  to cease using demeaning and humiliating nicknames such as “Rupert “ or “Doris,” Accordingly , in the Royal Air Force, the practice of referring to Army Officers as, “Pongos” is to cease forthwith.  In future,  all Pongos are to be referred to as Army Officers. 

Lose - Lose for the Conservative Party

Whatever happens next in the Boris Johnson story, it seems, the outcome will be lose-lose for the Conservative Party.  Either the Prime Minister limps on, in which case the populist knee-jerking designed to keep him in power will continue at the expense of coherent conservative policy, or he will go and replaced by someone else from the cast of nonentities apparently waiting in the wings.  Declaring an interest, I had better admit that my judgement in predicting the worth of recent Prime Ministerial candidates has been hopelessly wrong – how could I have imagined May as a unifying force or that Johnson would lead us to the sunlit uplands of post-Brexit opportunity?  Fortunately, the cast have little to recommend themselves so, unless someone with the apparent good sense of Lord Frost can be persuaded to join the race, I will refrain from trying to pick a winner.  What on earth could any of them change that would reverse the fortunes of a demoralised membership? Indeed, the winning candidate will turn out to be a loser since it will be a case of suicide for the Conservative party, replace Johnson or not.

Whilst, as I say, I won’t venture an opinion on any of the candidate’s potential for success, I will point out why one of them, in particular should be disqualified at the starting gate.  I refer of course to Tom Tugendhat and his violent studs showing challenge on Roger Scruton when the great philosopher was grossly wronged and misrepresented by George Eaton of the New Statesman. Conduct unbecoming of an Officer and a Gentleman.

A Royal Memory

 

I have never, unfortunately, had the honour of an introduction to the Queen.  Of course, a framed scroll on my office wall reminds me that Elizabeth II, by the Grace of God of the United Kingdom of GREAT BRITAIN and NORTHERN IRELAND and of Her OTHER REALMS AND TERRITORIES QUEEN, HEAD of the COMMONWEALTH, DEFENDER of the FAITH, addressing me as “Our Trusty and Well Beloved,” appointed me as an Officer in the Royal Air Force.  On the eve of the Platinum Jubilee celebrations I recall, about the time of the Silver milestone, the closest I came to Her Majesty.

The late 1970s were turbulent; industrial action including petty wildcat strikes was widespread, inflation was rampant, unemployment was pitifully high and the economy bumped along on the bottom as Great Britain lived up to he title of “the sick man of Europe.”  Wages lagged well behind prices, particularly in the Armed Forces.  It was said that a front-line fighter pilot earned less than a guard on the London Underground, whether at work or on strike.  At Royal Air Force Marham, where we happily stationed at the time, the Station Commander was shocked to receive a letter from a highly qualified Corporal technician begging the Group Captain to support his application to be released from his engagement because, on his present wages, he could not meet the basic outgoings for his family. Nevertheless, even as we approached the “Winter of Discontent,” morale was surprisingly good and was boosted when Her Majesty paid an official visit to the Station.

For those of us not scheduled to meet the Queen during the tour, the highlight of the day was an official lunch in the Officers’ Mess attended by the Station executives, Officers, and their Ladies.  Lunch was delightful and went like clockwork, thanks to the superb Mess staff we had in those days.  After lunch, unusually, Her Majesty consented to joining the Station Executives for a group photograph.  Peter Beer, OC 57 Squadron at the time but formally and Equerry to Her Majesty was probably responsible for pulling strings and setting up the selfie of a lifetime!

So there we were, arranged in pleasing order at the West end of the Ante Room, with 5 of us standing at the back and 4 seated at the front with a vacant seat in the centre, all ready for her arrival.  Her Majesty duly arrived and took her place.  Immediately, the Corporal photographer pressed the shutter release and took one step back to indicate that his work was done.

“Is that it,” inquired Her Majesty?

“Yes Ma’am,” replied the Corporal, adding, “I’ve been told to get it right first time.”

“I think you’d better take another one,” replied the Queen, “just in case don’t you think?”

A wonderful memory of a very special day and I hope you have a lovely weekend Ma’am!