Archive for the ‘Politics’ Category

More on the Angus-Reid Poll

Tuesday, April 12th, 2011

The Angus-Reid poll I mentioned yesterday, puts “Yes” to AV ahead by 53% to 47%. It also includes national voting intention numbers:

CON 31, LAB 42, LD 11

Political Betting suggests that the cross-tabs allow us to distinguish between voters who voted Labour in the general election and those who have switched recently from the Liberal Democrats. If this is true, and they look like a distinct group, I wonder what the national voting intention really tells us, and if it tells us anything about voting in the council elections in May. I can think of three possibilities:

  1. The move to Labour is disaffection with us joining a coalition with the Tories (terminology alert; I usually say Conservatives, so the semiotics matter) but they would still naturally vote for us
  2. The move to Labour is a return to their natural party (i.e. the swing towards us was disaffection with Labour!)
  3. The group that has moved towards Labour is largely in the ABC1 social group, which leans “Yes to AV”, rather than C2DE (which is “No to AV” by 60% to 40%)

If 2) is true, then things could be very bad for us in May, so I hope instead that 1) is true and most will still vote Liberal Democrat. I think 3) is orthogonal and describes the composition of the group rather than saying anything about motives and likely voting patterns.

An interesting observation

Monday, April 11th, 2011

Over on Political Betting, Mike Smithson discusses the latest Angus Reid poll on AV and notes:

Another trend is that those Lib Dem voters from the general election who have switched to Labour appear to have helped boost YES.

Amongst current Labour voters YES has a comfortable lead while amongst those who voted for Brown’s party last May NO is ahead.

It makes me wonder about the durability of the swing from the Liberal Democrats to Labour.

Why Do Local Elections Matter?

Monday, April 11th, 2011

As local government elections (not to mention a referendum) are rapidly approaching, I want to briefly say why these elections matter much more than they have in the past.

The Localism Bill currently before parliament changes the balance of power between Whitehall and local government:

  • It devolves significant new powers to councils, giving councils more freedom and flexibility
  • It establishes powerful new rights for local people and communities to, for example, buy assets such as libraries, pubs and shops
  • It radically reforms planning, restoring democratic and local control
  • It returns decision-making powers on housing to local councils and communities
  • It gives local government freedom to attract local business by allowing a range of small-business tax breaks

So your vote matters: the councillors you elect in May will have more power to affect change that affects you and your neighbourhood than they have had in the past. If you don’t vote, you have no say!

On Tesco and Somersham

Friday, April 8th, 2011

On the local Facebook group, I was asked about my stance on Tesco moving to the village.

When I first heard about the possibility of them taking over the Black Bull, I was opposed but assumed they wouldn’t get planning permission for the change of use – which shows I knew little about planning law. Once I realised no permission was required, I felt it inevitable it would go ahead and all that could be done was to minimise the impact on the village.

But when I was asked “so what if it was Waitrose?” my gut reaction was somewhat different (I don’t usually shop at Tesco). This made me stop and think about why I was really opposed: was it just prejudice against a particular chain?

In previous posts, I’ve talked about the importance of amenities like shops and pubs in building strong communities, so the loss of a pub was obvious to me, as was the potentially detrimental effect that a supermarket could have on the viability of the other local shops. Also: increased traffic on the already busy High Street, parking in front of the supermarket to use cash machines, daily deliveries, waste disposal, etc. Negatives were easy to list.

However balanced against these, there are other factors. Some of these are positives like increased choice and a wider range of goods for shoppers, but others are principles: supermarkets should have freedom to improve their business (so long as it doesn’t impinge on others freedoms), and the existing local shops might perform better with some fair competition.

What I ultimately decided was that the real issues are that existing planning laws allow such a change of use without planning permission and that there is no involvement of the local community in such planning decisions.

This change of use issue feels particularly odd to me: a while back, the council wanted to move the bus stops on the High Street and needed planning permission to do so. I was particularly interested as the new position was immediately outside of my front door, but I didn’t object as it prevents cars parking in front of my house at the cost of a few buses a day. But the point of my rambling is that the overall impact of moving the bus stops was significantly lower than that of a supermarket moving in.

Where does this leave me? I still don’t like them moving here, particularly as I live on the High Street and experience daily the traffic problems. But I find my opposition is now based on the fact that supermarkets (not just Tesco but any supermarket) can buy local amenities such as pubs and convert them without planning permission or local approval. I am hopeful that the Localism Bill will help prevent such abuses in the future and, if elected, I would work hard to ensure local opinion is heard.

Does Social Mobility mean going to the Pub?

Thursday, April 7th, 2011

One of the key things that David Cameron has failed to articulate about his “Big Society” is that it is primarily about strengthening communities. Instead, he has stressed volunteerism. My own view is that most people who would volunteer already do so and he is flogging a dead horse.

There are other ways that communities can (and should) be strengthened. In modern society, we often drive to work, drive the children to school, drive to the shops, drive everywhere. This has led to a diminution in the day-to-day social interactions that are the foundation of community spirit and this loss has led to the sense of isolation many people feel.

Hence we should be looking for ways to reverse this trend and increase social interactions, particularly those where people from all walks of life interact.

There are limited places where this can happen: immediate neighbours, the pub, local sports, the local fete (and other local events) and local shops. I’ve deliberately excluded religion as we should not be in the business of promoting it.

Local planning and national regulation can help increase these opportunities for interaction and help ensure that people interact with a wide cross-section of classes:

  • By ensuring housing developments include a range of prices
  • By regulating the minimum unit price of alcohol we can encourage people to meet at the pub instead of binge-drinking at home
  • By funding sporting facilities and encouraging local teams
  • By funding village halls, though it isn’t clear to me what the urban equivalent would be
  • By ensuring local shops can thrive
  • By ensuring local banking and post offices are available

“Who-you-know” certainly helps with social mobility as your social network often determines the opportunites that are open to you. So the wider a person’s social network the more opportunities exist for social mobility.

In a real sense, that bloke you know down the pub can help you get along in life. Of course there are other things that matter, most obviously education.

PS “Big Society” has to be the worst articulated good idea ever. If you consider it – as I think DC intended it to be – as a tool for strengthening communities, then it is an idea we should support.

#Yes2AV tweets

Wednesday, April 6th, 2011

For fun, I thought I’d see if I could come up with a list of tweets that are either funny (or not given how bad I am at jokes) or explain something about AV:

  • #Yes2AV To vote, rank them in order. To count, successively re-allocate the smallest pile until you have a winner. A simple as 1-2-3!
  • #Yes2AV In a 4 horse race that goes 3 rounds before you get a winner, everyone gets 3 votes. But remember, a horse still wins
  • Moat cleaner required? Then just vote NO! #Yes2AV

I’m sure you can come up with better than these!

BMA response to the Bill

Tuesday, April 5th, 2011

After re-reading the BMA response, I find myself more in agreement with them than with our own list of essential amendments!

More on the conference motion

Tuesday, April 5th, 2011

In a post yesterday, I took issue with a few of the points in our conference motion, in particular 9) that talks about a “majority of councillors”.

Well, this had me wake up in the middle of the night and unable to sleep. I’ve now decided that Conference took the notion of “democratic accountability” way too far. Healthcare is as much an industry as is making paint. It is nonsense for a bunch of councillors to tell a commissioning consortium what to do as it is for a councillor to tell Dulux how to make paint. It also makes a mockery of two key goals of the legislation: to make healthcare physician-led, and to remove it from political micromanagement.

Adding a “substantial portion” of elected councillors (point 5), let alone a majority (as implied in 9) replaces national political interference with much more pervasive local interference.

However hidden in all this is the kernel of a good idea: having a councillor or two in a commissioning consortium is a good idea. It allows oversight, local representation, and a channel-of-last-resort for complaints. It also enables communications and easier integration of primary healthcare with the wider Public Health and Social Care services envisioned under the remit of local authorities.

It is also correct that the commissioning consortia need to be accountable, not just to patients but to the tax-payer who funds them and to professional bodies. However, these requirements don’t translate into a need for elected councillors. Instead, they require full transparency, patient consultation, complaints procedures, professional standards and fiduciary responsibility. And ultimately, sanctions for bad conduct.

There is also no good reason for the catchment area of a commissioning consortium to be co-terminous with a local authority. Given living and commuting patterns, in many cases I suspect that it is non-sensical. It certainly inhibits specialised commissioning consortia which may require large, regional catchment areas. It also feels deeply illiberal.

As a consequence of this midnight epiphany, I find I disagree with the thrust of points 4 to 9 inclusive. On accountability of the consortia, that is the section I’m reviewing next, so I may yet change my mind on some of this.

Improving healthcare outcomes

Monday, April 4th, 2011

The next installment of my series on the Health and Social Care Bill. I’m still ploughing my way through the white paper . . .

Improving healthcare outcomes

I think the first sentence of this section bears repeating:

“The primary purpose of the NHS is to improve the outcomes of healthcare for all: to deliver care that is safer, more effective, and that provides a better experience for patients.”

How can you argue with that? The section continues with a thoughtful discussion of targets. The key phrase on removing process-oriented targets is “These targets crowd out the bigger objectives of reducing mortality and morbidity, increasing safety and improving patient experience more broadly“. There is more on targets, but sensibly focussed on safety, outcomes and patient experience.

Another key section talks about replacing the relationship between politicians and professionals with one between patients and professionals, reinforcing the removal of political interference.

The NHS Outcomes Framework

This section states the intent to provide separate frameworks for the NHS and for Public Health (and Social Care) and then outlines the NHS Outcomes framework and how it translates in to a commissioning outcomes framework for consortia.

This framework will cover effectiveness (i.e. outcome), safetly and patient experience. The consulting process and the goals and focus (outcomes, safety, and experience) of the framework seem sensible.

Developing and implementing quality standards

This section outlines what quality standards for care will be implemented, the expectations on these standards, and the timescale for rolling them out. It envisions some 150 quality standards over the next five years. At the time of publication, three had been implemented (on stroke, dementia, and prevention of venous thromboembolism). The example shown (on the prevention of thromboembolism) has seven quality statements and looks sensible (but really I’ve not that much idea as I avoid most medical stuff as it is just too icky and I’m rather squeamish).

Overall, the goals and timescale look reasonable, though I can’t assess what fraction of common clinical pathways are covered by 150 or so individual standards.


A short section on the importance of research. While the statements here are admirable, the brevity of the section highlights the woeful lack of scientific knowledge within government! I would really have expected an outline of a framework and some tentative goals (though this is always tricky with research – you never know quite what you’ll find).

Incentives for quality improvement

A complex section on development of payment systems, currencies, and tariffs. I’m not sure I fully understand this yet, and need to read it carefully. On first reading, it seems to promote payment for quality over mere cost but I’m unclear how the payment systems work and whether this intent to provide quality of outcome incentives will or can work. I’ll revisit this after talking to a few who may know!

Overall: Looks sensible, and other than what I think is my own lack of understanding, I can’t find much to quibble about. Oh, yes I can: we need more people with at least a basic understanding of science in government!

On the conference motion

Monday, April 4th, 2011

A quick aside. In my previous post, I said I disagreed with some of the points in our conference motion. Here’s the list, and my reasoning:

3. Secretary of State to remain responsible for the final decision, if needed, when major service changes are opposed by local democratic scrutiny bodies on behalf of their community.

If we are serious about devolving decision-making to local bodies, this seems odd. The whole point of localism is to allow local decisions. The point might be okay if it defined “major service changes”.

8. The commissioning function (i.e. not back office functions) to be carried out directly by public authorities rather than subcontracted to non-public bodies; using public sector staff and employing the skills of existing PCT staff

Why? The commissioning function should surely be carried out by the Commissioning Consortia, otherwise what are they for?

9. Unless Commissioning bodies have a majority of councillors, there must be scrutiny of all commissioning decisions by local elected councillors either through the local authority, Overview and Scrutiny Committees, or Health and Wellbeing boards (which must have a majority of councillors to fulfill this role)

My concern here is that commissioning bodies remain clinician-driven, not local political entities – one clear goal of the legislation is to remove political interference. It is fine for commissioning bodies to include councillors but the majority should be clinicians.

16. Complete ruling out of any competition based on price for tariff-based services (and not just at the point of referral or the point of patient choice);

Why? If all else is equal (e.g. quality, timeliness, etc), why rule out price?