Archive for the ‘Politics’ Category

Liberating the NHS

Monday, April 4th, 2011

Continuing my look at the White Paper. I’m slowly arriving at similar conclusions to our conference motion (though I disagree with several of the points in that motion; more on that in another post). I’m also looking at this in the context of the BMA response, which also makes sensible suggestions.

Anyway, let’s look at the first section: “Liberating the NHS”.

Our Values

Not much to argue with here. This section makes it plain that the vision is a service that is fair, equal, and free at the point-of-use. It also identifies the following necessary improvements: removal of political interference, additional autonomy, transparency and accountability.

The NHS today

Stripped of the seemingly mandatory praise for the NHS, this section is fairly damning of its performance:

“Compared to other countries, however, the NHS has achieved relatively poor outcomes in some areas. For example, rates of mortality amenable to healthcare, rates of mortality from some respiratory diseases and some cancers, and some measures of stroke have been amongst the worst in the developed world”

“… the NHS has high rates of acute complications of diabetes and avoidable asthma admissions; the incidence of MRSA infection has been worse than the European average; and venous thromboembolism causes 25,000 avoidable deaths each year”

“The NHS also scores relatively poorly on being responsive to the patients it serves. It lacks a genuinely patient-centred approach in which services are designed around individual needs, lifestyles and aspirations. Too often, patients are expected to fit around services, rather than services around patients.”

To me, this section highlights two things. First, the national myth of the NHS, which surrounds it in a rosy glow and isolates it and its staff from criticism, is deeply flawed. Second, the NHS desperately needs reform. By some measures I’ve seen, we’ve underinvested over the last 25 or so years by >£250bn! [Grr, where did I read that? I'll link to the source if I can find it!]

Our vision for the NHS

The callout box is great, highlighting the need for a service that is patient-centric, clinician-driven, with quality and outcome targets, reduced inequalities, better geographic (localised) organisation and sustainability.

I have concerns over the reality of cost-savings from the restructuring proposed. In the past, these have often been illusory, with serious failings in the implementation of well-intentioned reforms. On the plus side, the proposed legislation is radical and the restructuring profound, so cost-savings may well be real.

Improving public health and reforming social care

Another good idea, addressing a deep lack in the NHS: overall public health. It also covers the need to integrate this with social care (it sets out a timetable for reform of social care).

The transfer of local health responsibilities from PCTs to local authorities makes a lot of sense! Public health covers not just primary and social care, but environmental and infrastructure issues (for example: refuse, education, communications, housing, sports facilities, etc) which necessarily belong to local authorities.

The financial position

Not much to say . . . this section reiterates the need for structural reform and cost savings in administration, but sets this against a backdrop of increased (real terms) spending. It also calls for much increased productivity. Let’s wait and see how this translates into reality. Call me cynical.

In summary: the vision outlined here accords well with liberal principles, though as always, the devil will be in the details of the implementation. Next up: “Putting patients and the public first”.

The Health and Social Care Bill

Monday, April 4th, 2011

After someone on the Liberal Democrats Facebook page asked what my view was on pushing ahead with the cuts to and the reform of the NHS, I decided to read the whitepaper Equity and Excellence: Liberating the NHS and the Health and Social Care Bill.

My first impression is that the whitepaper shows none of the weasel words and compromise often seen where there is serious disagreement and feels like a coherent whole. So I think Andrew Lansley and Paul Burstow share a common vision for the NHS. As a consequence of this, the bill is far more radical than anything in either party’s manifesto!

This will be a series of posts, as there is a lot of material to digest. In this first post, I’m going to focus on the intent of the legislation, drawn largely from the summary of the white paper.

Putting patients and public first

It’s difficult to argue with any of this. What I think is noteworthy:

  • Strengthens localism, based around local authorities
  • Clear intent to reduce inequalities

Improving healthcare outcomes

  • Great shift from process oriented targets to outcomes!
  • Nice focus on openness, responsibility, and above all outcomes

Autonomy, accountability and democratic legitimacy

This feels like one of the key sections to me. It seems clear there has been a meeting of minds over the need to remove the NHS from political interference and put healthcare into the hands of patients and clinicians.

  • Devolution to commissioning consortia. This is great in principle but I have concerns that finance isn’t a core skill of clinicians. However, addressing this is a question about mechanisms – the intent is great.
  • Intent on legitimacy is good, but the single statement on the responsibilities of local authorities feels a bit weak. There is no statement on legitimacy of consortia, which is an issue: patients must have an input.
  • It’s not clear that making all NHS trusts become foundations is either good or bad. However, I’ll roll with this for now as simplification feels good.
  • The clause on the Monitor has a problem: the duty to promote competition must make it clear that quality of outcome is prime not cost. I’m also slightly worried about the mention of “efficiency” though it is subsidiary to “effective”

Cutting bureaucracy and improving efficiency

This section feels like standard stuff that every government paper includes, but the intent is correct. In particular, it feels like there is a good shift towards localism versus centralised Whitehall control, which might for once translate to real savings.

Overall, I like the intent of the white paper, with the caveats given above. That is, I’m concerned that:

  • Financial management isn’t a core skill of clinicians so they’ll need financial advice.
  • It feels like there is too little on democratic accountability. In particular, there is no statement on the accountability of the commissioning consortia.
  • While promotion of competition is good, at present there is nothing that makes it clear that competition over quality of outcome is more important than cost.

In summary: apart from the caveats above, I like the intent of the bill: patients-first, clinician-run, devolved from Whitehall, with patient choice. My gut feel is that my caveats will be (at least partially) addressed in the next few weeks during the “natural break” in the legislative process!

Transition to a Green Economy – revisited

Saturday, April 2nd, 2011

After the terrible earthquake and tsunami in Japan and, in particular, the ongoing events at Fukushima, I’m going to briefly revisit the topic of zero-carbon energy.

Have these events changed my opinion that nuclear power should play a significant role in our future energy supply? No. To quote Lewis Page of The Register “Operating nuclear power stations is not just very safe, or safer than other methods of generating power. It has to be one of the safest forms of activity undertaken by the human race.”.

This may be a controversial view, but when you look at the outcome of the Tōhoku earthquake, some 28,000 people are estimated to have died. In comparison, any deaths from Fukushima would pale into insignificance (not that I expect any). It should also be remembered that no modern design would have ANY of the problems experienced at Fukushima, which is a 1960′s design, built on a site with fundamental weaknesses (seawall too low, no provision for site inundation, no provision for regional infrastructure collapse). Again, no modern design would have these flaws.

In fairness to TEPCO and the Japanese authorities, the site WAS prepared for both earthquakes and tsunamis. But it was designed in the 1970s before plate tectonics and megathrust earthquakes were properly understood . . . I’ll be very interested to see over the next months and years whether they had had plans in place to upgrade (or close) the site.

The main thing Fukushima highlights for me is the woeful lack of understanding of science within the media. ALL the early coverage of the events was riddled with sensational alarmist reporting which even a minimal understanding of science and a bit of googling would have quashed.

It’s Official!

Saturday, April 2nd, 2011

I am now the Liberal Democrat candidate for the Somersham Ward of Huntingdonshire District Council. Expect to hear more about this and about Yes2AV over the next few weeks.

The 2010 Autumn Conference

Thursday, September 23rd, 2010

Well folks, I’ve just got back from my first ever Liberal Democrat party conference. I have to say it was more fun than I expected and I met lots of interesting people. The Guardian has a decent write-up of the conference. There is lots of coverage of the conference out there: some accurate, some not. In general, if a story talks about “unease” or “conflict” it doesn’t mirror my experience.

Transition to a Green Economy 3

Thursday, June 3rd, 2010

Before I get going, I want to make an assertion: we should be investing more in low-carbon energy sources rather than compromising on lifestyle!  Many plans for reaching a low or zero carbon economy assume significant degradation of lifestyle, particularly travel.

Personally, I don’t want to return to a world where travel is the preserve of the rich.  I want a world where people have access to simple, cheap, personal and international transport and where people have many electrical and electronic devices in the home.  So I want to show that this is possible and feasible!

So let’s reassess the need for that extra 187GW. Will we really need that much?  Clearly if we compromise on lifestyle, savings can be made.  But I want to examine whether this number accounts for known trends I previously glossed over.

I derived the figure from estimated 2012/13 production (~95GW) and the proportion of GHG emissions produced by electricity generation, transport and heating. This calculation still holds, but I missed several factors.

  1. Population growth. I assumed essentially zero growth. In reality, our population is expected to grow, with ONS projections putting the population as high as 71.6 million by 2033 – i.e. 16% growth.  Presumably these extra people will need electricity, so I’ve underestimated significantly.
  2. Increased numbers of electrical / electronic devices per household.  As should be obvious to everyone, there has been an explosion in the numbers of electrical and electronic appliances over the last 30 years.  I expect this trend to continue as more people buy additional computers, printers, TVs for other rooms, etc.  However, I think this is likely to be offset by increased efficiency of these devices.   For example, LCD TVs are much more energy efficient than plasma, and LED-backlit TVs are even more so.  As technology improves, it will use less power (I know, it’s my job!).
  3. Standby efficiency of electrical / electronic devices.  Current devices have very high standby power, by some estimates this accounts for about 8% to 10% of household consumption.  The technology exists to reduce this to almost zero.  As people’s behaviour is difficult to change, legislation on the standby power of new devices seems the best way of achieving this reduction.
  4. Increased efficiency of domestic lighting.  Roughly 19% of electricity (18GW) is used on domestic lighting, most of which is incandescent.  Incandescent bulbs are about 5% efficient, so with 100% efficiency this could be reduced to 900MW.  Current low-energy bulbs are about 30% efficient and LEDs are about 80% efficient, so it seems reasonable to assume <5GW will be needed for domestic lighting (assuming a reasonable uptake of LED lighting).  This adds up to a saving of ~13GW (about 7%).
  5. Increased thermal efficiency of housing.  At present, only 8% of housing is rated in bands A – C for energy efficiency and62% is rated in bands E – G.  As space heating accounts for ~60% of household energy demand, any improvement here will significantly reduce the electricity demand.

I think that is as quantitative as I can get!  Population growth will add ~16% to the total required; standby efficiency improvements will reduce it by ~8%; use of LED lighting will reduce it by ~7%.  That is, these factors roughly balance out.  This leaves improvements in housing, where I can’t find any good estimates.

One concrete thing we can do is on labelling of devices.  When the EU energy label for “cold” appliances was introduced in 1999, it improved the average efficiency of these by 15% in 15 months (see here, box 4)!  Introduction of similar labels for TVs, computers and other items should have a similar noticeable effect.

In summary, I think I’ll stick with my initial estimate though it is fraught with uncertainties.

Transition to a Green Economy 2

Friday, May 28th, 2010

Before I talk about where can we get 187GW of low-GHG capacity, I think it is worth outlining the carbon cost of all the methods.  The numbers below are for the complete life-cycle of the plant, from extraction of raw materials an fuel through to decommissioning costs:

  • Coal:  >1,000g/kWh.  800g/kWh can be achieved with gasification technology.  200g/kWH may be possible with Carbon Capture and Storage.
  • Oil: 650g/kWh.
  • Nuclear: ~5g/kWh
  • Wind: ~5g/kWh
  • Wave and tidal:  25-50g/kWh.  High due to large amount of steel required
  • Solar-cells: 58g/kWh.  High due to extraction of silicon from sand.

For bulk generation, I’m going to rule out water and solar-cells as they are significantly worse than both nuclear and wind.  For small local systems, solar-cells are useful; I’m less convinced by wave and tidal.

This leaves nuclear and wind as the two low-GHG options.

There are two options for new nuclear power stations: the AP1000 and the EPR (the ACR-1000 and the ESBWR were initially considered but the proposing companies withdrew them from consideration).  The AP1000 and the EPR have both completed phase 3 assessments by the government and both have moved to phase 4 (completion June 2011) with recommendations for design changes.  For now, I’m going to look at the numbers for the EPR because it has a higher capacity (1650MWe versus 1154MWe) and is European.

For offshore wind, the largest wind-turbine is 10MW, from Sway in Norway.  Most other large turbines (onshore and offshore) are in the 5MW range.

Before you moan that I’m obviously pro-nuclear because of how much detail I provided compared to the amount for wind, I did this because nuclear power is contentious!  Wind is not contentious and there are several suppliers.

There are three extreme scenarios for generating the full 187GW from low-GHG sources: all-nuclear and all onshore or offshore wind:

  • Using the EPR would require 114 reactors.
  • Using 10MW offshore wind would require 18,700 turbines (covering roughly 1,000 square kilometres).
  • Using 5MW onshore wind would require 37,400 turbines (covering roughly 2,000 square kilometres).

Hopefully this demonstrates that both approaches have issues!  With nuclear, the main issue is public concern over safety; with wind, public concern about aesthetics.

That feels like enough for now (and I need to go to work:-)).  Still to come: cost, sites, and transition from current situation, carbon sequestration, etc.

Transition to a Green Economy

Thursday, May 27th, 2010

Given our commitments to moving to a “carbon free” economy, I thought I’d take a break from Europe and look at some of the implications of this.  I think they are much bigger than people realise.

Let’s start with the big picture. 65% of our greenhouse gas (GHG) emissions are from three sources: electricity generation (28%), non-electric heating and hot-water (16%) and transport (21%).

There is one more large contributor, which is combustion and other processes in industry which accounts for a further 19%, but I have no idea what to do with this so for now, I’ll ignore it!

Conversion of electricity generation to low-GHG sources is an obvious target, and non-electric heating and transport can also be reduced to almost zero by use of low-GHG electricity sources.

So what does this mean for electricity generation? By 2012/13, the UK aggregate power station capacity will be ~95GW.  Of this, 10% will be nuclear (9.5GW) and ~4% will be wind (~4GW).  The remaining 86% (~82GW) will be from high-GHG sources (which accounts for that 28% figure above).

To cover the requirements for non-electric heating and transport, we would probably need to double our aggregate electricity generation capacity.  This is a difficult calculation to make as the differences in efficiency are difficult to assess.  For example, petrol or diesel engines are considerably less efficient than power stations, but replacing them with either battery power or hydrogen adds other inefficiencies.  So I’ve made the simple assumption that these roughly cancel out.

This doubling of capacity means we will need an additional 95GW of low-GHG sources in addition the to conversion of 82GW to low-GHG sources.  Also, the 9.5GW of nuclear needs replacement soon.  In total, over the next 20+ years we need to build ~187GW of low-GHG capacity.   This is an immense task!

To give you an idea how big, our biggest power station (Drax) generates 3.9GW, so we need to create roughly 50 times this in low-GHG capacity!

I’ll talk about the options in the next post.  Suffice it so say for now that I think nuclear is very much on the table.

Opinion Formation

Monday, May 24th, 2010

Given what I just wrote about Europe and the task we face in turning opinion around on Europe, I thought I’d better talk about opinion formation: who swings public opinion, and how they do it.

It is widely accepted (see this for example) that there is a two-step process in opinion formation; rather than being directly affected by the media, people are more influenced by exposure to each other.  In particular, a small group of “opinion leaders” (perhaps <10% of people), who have highly-connected social networks, are critical to the process.

So who are these opinion leaders?  Interestingly, even popular bloggers only have roughly the same influence as columnists; opinion leaders generally exert their influence by direct interpersonal contact.  Opinion seems split on whether there is anything “special” like education, class, or profession about opinion leaders, but it seems safe to say that they are well-informed on the subject in question, have large interpersonal networks, and talk about the subject!

So – if like me – you want to swing opinion, research the topic and talk about it.  But be careful: I have a dreadful tendency to bore-for-Britain once you get me started:-) And I’m sure this has a pretty negative effect on opinion formation!

Parliament, European Style

Monday, May 24th, 2010

Let’s start with a question.  Do you know who your MEP is?  Some among you will immediately notice a problem with that question: MEPs are elected using a proportional system (the D’Hondt version of party lists), so you have more than one for your region.

Another question.  Presuming you are a Liberal Democrat and have found an MEP you like in your region’s delegation, what party is they are a member of?  No, not Liberal Democrat.  I mean what European party do they represent?  Like me, did you have to google to discover it is the European Liberal Democrat and Reform Party and that  they are part of the Alliance of Liberals and Democrats for Europe?

And another.  When you voted, which party was your first choice?  Liberal Democrat, right?  So not the party your first choice will sit with in the European Parliament!

I’m sure some of you reading this knew the answers, but if you’re here, you’re probably an activist.  The average voter almost certainly can’t answer these questions.  Which highlights a very significant problem for the European Parliament.  To be a democracy, you need a demos – a pan-European pool of voters, voting on common issues.  Right now, people vote on national ideology and party, not for pan-European political parties; there is no European demos.

Worse than this, though some are ardently for or against Europe, the vast majority of voters are apathetic.  This is illustrated by turnout at European elections which was an abysmal 34.7% in 2009.  That UKIP have 12 out of 78 MEPs shows that a fair proportion who turned out to vote did so as a protest.

For a party that largely supports Europe (but I must stress wants significant reforms), this can’t be good news. We face a massive challenge between now and the next European elections in 2014.  While it is not realistic to create a true European demos in four years, we must make voters care.

We must make the common sense case for Europe – that there are things done better together than apart – and show the relevance to voters’ everyday lives.  We must also stress our desire for reform.  Critically we must debunk the myths; I addressed the size of the bureaucracy in a previous post but there are others, not least the myth of an all-powerful European super-state.

There are glimmers of hope.  Some European parties are starting to campaign on a Europe-wide platform, with common issues.  That we are in government, though with a largely eurosceptic party, will help.  It gives us a better platform to highlight the achievements and also to demonstrate that our support for Europe is not blind: we want significant reform, including repatriation of some powers (for example the Working Time Directive).

On reform, simple application of political liberalism and economic liberalism throws up some obvious targets: the Common Agricultural Policy is deeply economically illiberal; the Commission, though the engine room of the EU, fails almost every test of democratic accountability; and much of EU social policy is better addressed nationally.

In some ways, Conservative euroscepticism will help us.  EU institutions have undergone what feels like a perpetual revolution; with The Coalition commitment to referendums for any new treaties or for further transfer of power to Europe these institutions have a chance of stability.  With stability, they should (with help from us) become more familiar to voters and help dispel the myth of labyrinthine complexity.

In summary, we must:

  • Make the common sense case for Europe
  • Debunk the myths that surround Europe
  • Ensure the stability and accountability of European institutions
  • Demonstrate our desire for (and ability to) reform by working with the Conservatives; delivering one significant reform must be our minimum target!

Back to some questions.  Who introduces legislation?  Not the parliament; the European Commission has legislative initiative and proposes all legislation.  This and the relation of the Commission to the other bodies later.