Matt Oakley: Hancock’s tech revolution is key to reducing mental ill health among NHS workers

20 Aug

Matthew Oakley is the Director of WPI Economics and a former Treasury civil servant.

The Conservative Party won the general election on a platform committed to public service reform. Alongside 20,000 new police officers and a £33.9 billion boost to the NHS, the party’s manifesto also promised the construction of 40 new hospitals and 50,000 extra nurses.

But improving public services, including the NHS, is about more than just buildings and numbers. It is about people. The team manning A&E departments 24 hours a day. The hospital porters transferring patients from wards to operating theatres. The clinicians going above and beyond to nurse us back to health.

It is the task of any government to ensure that those who commit so much time, energy, care and empathy looking after us, are allowed to get on and do their jobs. Matt Hancock recognises this; in a speech given in 2018 he stated that of his top three priorities – tech, prevention, workforce – “workforce is the most important.”

This commitment to those working in the NHS has become even more important this year, when the UK went into lockdown to suppress the spread of Covid-19. Doctors and nurses in the NHS, alongside care workers, receptionists, cleaners, and paramedics, have been saving lives day in and day out on the frontline. It has been an extraordinary effort, which will have taken an extreme physical and emotional toll on many.

In a report I have authored, published today and commissioned by the technology company VMware, we identify the scale of the mental health challenge among the NHS workforce. Using data from NHS Trusts and the Health and Safety Executive (HSE), we estimate that more than 10 million working days were lost to poor mental health among NHS staff across the UK in 2019 at a cost of £3 billion. That’s the equivalent of every single worker in the health service taking on average seven sick days off work. Unfortunately, due to the impact of Covid-19, we can expect the 2020 figures to be even worse.

There isn’t a one-size-fits-all solution to the problem of tackling mental health among NHS workers. A wide-ranging strategy is needed, which includes improved management practices and raised awareness within hospitals of what best mental health practice looks like. But there is one area which will be absolutely fundamental to any improvement: technology.

A recent survey of NHS professionals showed that six in ten thought NHS IT was not fit for purpose, and in a BMA member survey four in ten respondents stated that their stress levels were significantly affected by inefficient IT and data sharing systems.

Some of the IT issues which confront NHS staff are totally unacceptable and reform is long overdue: it takes around 10 minutes to log on to many NHS systems, for example, with multiple logins necessary throughout the day. Some NHS Trusts have as many as 110 different IT systems in place, without any connectivity between them. This means constantly moving files of patient data from system to system or, as is more likely, using apps on personal devices such as Whatsapp to share patient details. These digital silos are slowing NHS staff down, causing unnecessary stress, and creating huge inefficiencies and security issues right at the heart of the health service.

Whilst these issues currently place real pressure on the time and workload of the NHS workforce, there are clear routes through which they can be tackled by improved technology. One such example is establishing a simple principle that clinicians should have the right information on the patient in front of them, on any device that they are using and at any time, with the security you would expect to surround personal medical records. It is a simple principle, but one that would fundamentally change the experience of many clinicians today: saving time, easing workloads, reducing stress and improving patient care.

Creating a strong digital foundation in every hospital in the country won’t just relieve the pressure on staff and enable them to spend more time looking after patients. Replacing outdated IT systems will kickstart the roll out of game changing technologies in the health service. This could mean artificial intelligence predicting demand for hospital beds, cutting edge robotics technology revolutionising keyhole surgery, and pioneering machine learning approaches identifying rare diseases.

The Health Secretary understands the pressing need for this reform. The government and NHS England have committed to providing a core level of digitisation in all hospitals by 2024. Many trailblazing hospitals have stepped up to the challenge and are leading from the front. Other hospitals, however, need help in the form of technological expertise and funding. We should provide them with the tools to allow them to update their IT backbone and enable their staff to carry out their jobs more easily.

The UK is a leader in healthcare and technology. If we can combine our expertise in both, then it will go a long way in improving the mental and indeed physical health of our dedicated NHS workers, which in turn will help all of us.

Daniel Hannan: Politicians can’t win. When they don’t give us what we want, we protest. And when they then do, we carry on.

19 Aug

Daniel Hannan is a writer and columnist. He was a Conservative MEP from 1999 to 2020, and is now President of the Initiative for Free Trade.

The exam fiasco is a neat demonstration of what is wrong with our administrative state, our media culture and, frankly, our own double standards.

A bad thing happens. We demand, in an angry but unfocused way, that Something Be Done – in this instance, that schools be closed. When confronted with the consequence of our own demand – i.e: that there is no way to be fair to exam candidates other than to let them sit the papers – we howl with protest.

We don’t blame ourselves, obviously. Nor do we blame those who made it impossible for schools to reopen: teachers’ unions, hostile councils and, indeed, reluctant parents. Nor yet do we blame the people who actually drew up and applied the grading system. No, we focus all our anger on the politicians – the same politicians whom we insisted should “step back and trust the professionals”, should “let teachers get on”, should “stop using our kids as a political football”.

It’s the same story every time. Voters demand that technical agencies be free from political interference, but then rage at ministers when those agencies screw things up. Thus, in an inversion of Stanley Baldwin’s quip about the press barons, ministers have responsibility without power.

There is, for example, an unwritten media rule that, whenever failures in procurement by Public Health England or the NHS are reported, these bodies must always be called “the Government”. The verbal trick allows us to draw a distinction between public sector officials (who are presented as undervalued heroes) and politicians (who are vaguely assumed to be malevolent as well as incompetent).

No one suggests that ministers were directly involved in the procurement failures, any more than that that Gavin Williamson personally drew up the grading algorithm (which drew on input from hundreds of interested parties, including the teaching unions, who were perfectly happy with it). No one needs to point to anything specific, because politicians enjoy the automatic disbenefit of the doubt.

It has long been a convention in this country that ministers carry the can – a good and necessary one. The problem is when ministers have had nothing to do with the can until it is thrust into their hands.

Let’s go back to those grades. Most of us will have come across cases of individual injustice. A young friend of mine, who was top of her year, had had 15 A*s at GCSE and was predicted 4 A*s at A-level, knew as soon as she learned how the algorithm had been drawn up that she was likely to be penalised (one of her predicted A*s was in further maths, so she understands how these things work).

Her school – not an underperforming inner city comprehensive, but a successful private girls school – had had two dud years in two of her subjects, and she knew that no computer would award her the grade that she would have achieved in the exam itself. Sure enough, the algorithm did its work and she missed her university offer.

People in her situation were rightly furious. A computer model had deleteriously altered the course of their lives. Those on the other side – of whom there must have been a great many, since results overall rose this year – naturally attributed their good fortune to themselves rather than to the system. That is how these things work.

When ministers stepped in to redress the grievances of the losers, they created new losers. They reversed years of work against grade inflation and gave many students artificially high marks. The losers thus include those who took their exams last year or will take them next year, those who took them this year and would have done well without the boost, and, not least, universities which now face an administrative nightmare.

As Phil Taylor reminded us on this site yesterday, the algorithm had in fact worked in most cases: “Indeed, 88 per cent of students had got their first choice university place on results day. The number of 18 year olds going to university was at a record high, as was the number of disadvantaged students set to attend”.

My point is not that the U-turn was wrong. My point is that all our options were bad once we had made the calamitous decision to close schools – despite the fact that there has still not been a single identified case of anyone catching Covid-19 from a child anywhere in the world. The time to complain was then, not now.

I know I have banged on a great deal about the hopelessness of our quango state, but the past six months have made my case for me. It’s not just the obvious incompetence of PHE and NHS administrators. It’s every unelected agency, from an immigration service unable to deport illegal migrants to our super-woke police constabularies.

In a powerful article for The Atlantic, Tom McTague argues that “Britain was sick before it caught the coronavirus.” His article, which sets out in pitiless detail our various cock-ups, has had a huge impact, reminiscent of the gloom provoked by the valedictory despatch of our Paris ambassador, Sir Nicholas Henderson, in March 1979, which unflinchingly set out the mess that Britain was then in.

In fact, though Sir Nicholas didn’t know it, Britain was on the cusp of a national revival. Its administrative state was failing, but the country as a whole was not. In the 1980s, free to pursue their ambitions, the British outperformed every European economy and resumed their place at the world’s top tables.

Now, as then, we should avoid the mistake of thinking that the failure of our bureaucracies denotes a general national failure. Going into the Covid-19 crisis, we were a prosperous and successful country, leading the world in biotech and artificial intelligence, higher education and the audiovisual sector, legal and financial services. We face a specific and remediable problem, not a general decline.

The good news is that, even before the pandemic hit, this Government was determined to tackle the quangocracy. Back in January, that might have seemed a slightly recherché and eccentric priority. Not any more.

Politicians should indeed carry the can – over the electoral cycle. Ministers must by now be aware of how rusted and useless the machinery of state has become. They have four years to fix it.

Alan Mak: Reform capital allowances and R&D tax credits to fire up investment and create jobs

1 Jul

Alan Mak is MP for Havant and Founder of the APPG on the Fourth Industrial Revolution.

Improving Britain’s productivity is key to both our economic recovery after Coronavirus and enhancing our global competitiveness post-Brexit. The best lever for firing up Britain’s productivity is incentivising more investment in the latest IT and software, new plant and advanced machinery – all proven catalysts of growth and efficiency. Failure to direct billions of pounds into these fundamental building blocks of our economy will hold back our recovery.

The State cannot be expected to do all the heavy lifting, especially given the Government’s substantial spending commitments to help the country through the lockdown and beyond. Instead, it must be businesses that take the lead, especially SMEs who have traditionally made up the “long tail” of unproductive companies.

Rather than a safety-first approach of hoarding cash, postponing investment and hunkering down, businesses must be incentivised to invest more in the coming months. This must be an economic recovery powered by bold investment decisions that create jobs, upgrade technology and boost productivity.

The dampening effect on capital expenditure (capex) and investment caused by Coronavirus is already large and destructive. One investment bank estimates that £23 billion has been slashed from this year’s capex budgets already, whilst the Bank of England predicts a 26 per cent drop in business investment for 2020. In 2009, as the financial crisis erupted, the fall was 16 per cent by comparison. Some of the country’s biggest employers such as BP and HSBC have already started cutting investment.

In practice this means IT systems and software – now at the heart of every business – being used for longer. Machines normally replaced every decade will have their life extended. Trucks and vans will be allowed to age. Outdated buildings that offer no room for new employees will be kept on. Research and development (R&D) could stall.

Reductions in investment not only have negative consequences for our country’s GDP, jobs and productivity, it also damages our capacity for R&D and our reputation as a nation that innovates for the future – key to our leadership of the Fourth Industrial Revolution.

Reforming and adapting two existing incentive schemes – the Annual Investment Allowance and the R&D Tax Credit – would have a major impact in reversing this decline in business investment and productivity.

Introduce a new Annual Investment Allowance ceiling for green or digital investments

Capital allowances enable a business to deduct the cost of qualifying items from their profits, lowering their corporation tax bill. This incentivises investment in key productive goods from machines to laptops.

The Annual Investment Allowance (AIA) is the annual cap on such deductions and its level has varied dramatically in recent years from £25,000 in 2012 to £500,000 in 2015. Until December 2018, the AIA was £200,000 but it was raised to its current £1M level from January 2019. The £1 million level is due to expire this December.

To encourage a green recovery and investments that focus on digitisation, the AIA could be allowed to fall back to the previous £200,000 ceiling, except for certain types of capital expenditure that achieve environmental or digital goals which would still benefit from the £1 million special ceiling. Replacing a diesel-powered machine on the factory floor with one powered by electricity, or digitising a production line by adding new software powered by artificial intelligence (AI), could be examples of investment that would be rewarded by the new special AIA ceiling.

Alongside the introduction of a special £1 million ceiling, the scope of what can be claimed through capital allowances should also be expanded to take account of the growing digital dimensions of every business. For example, digital tools purchased on a subscription basis (such as monthly website hosting costs) should benefit from relief not just one-off investments in physical goods (such as buying a new machine).

Increase R&D tax relief rates for SMEs and widen the scope of the reliefs

R&D tax reliefs support companies that work on innovative projects in science and technology, and enables the cost of qualifying projects to be reclaimed from HMRC. They’re especially effective for digital start-ups, who get a tax break and much needed cashflow back for critical work.

From April this year the relief rate is 13 per cent, but the lion’s share of R&D tax relief is claimed by large, research-intensive businesses. SMEs can currently claim up to 14.5 per cent in certain circumstances, but incremental increases such as this do not have a dramatic effect on investment appetite.

Often the most cutting-edge innovation, especially in the digital sphere, is carried out by small teams and growing start-ups – not just multinationals. To encourage more micro businesses and SMEs to pursue more R&D, new and much higher rates of relief should be introduced. For example, a rate of 25 per cent for SMEs with fewer than 150 employees, and 35 per cent for SMEs with fewer than 50 employees.

What qualifies for relief must also be broadened to include more of the digital tools that software developers use, including software testing tools and data analytics software. In addition, cloud storage fees, user experience development work and the cost of buying data sets needed to train algorithms for AI-driven start-ups should also be tax deductible.

Britain is currently 19th out of the 37 industrialised nations in the OECD when it comes to R&D investment, spending 1.7 per cent of GDP against the OECD average of 2.4 per cent. To match world leaders including Germany and Japan, who invest over three per cent, we must urgently update and expand our R&D tax relief regime.

This is the second in a three-part series on how to boost our economy after Coronavirus.