Hugo de Burgh: We owe it to future generations of Brits to work with China

6 Jul

Professor Hugo de Burgh is Director of the China Media Centre. He is the author of China’s Media in the Emerging World Order, has held office in three Conservative associations, and stood in unwinnable seats several times.

China is our third largest market and the one with the greatest potential. China is the country with which we must work if we are to have any impact on the resolution of global problems from environment to nuclear proliferation. China can accelerate the development of African and Central Asian economies, mitigating the risks to Europe that come from population explosion there without adequate economic growth. China is the largest economy in the world and already influential in a majority of countries.

For all these reasons, it is patriotic and reasonable for British leaders to find a way to work with China, which they will only do if they understand China as it is. Among other eminent Brits who started with a morbid suspicion of China, I have accompanied Boris Johnson and Jeremy Paxman on extended visits, and watched the scales fall from their eyes as they understood the enormity of the challenges facing Chinese government and the absurdity of imagining that its leaders wasted a moment thinking about conquering the world.

The reverse is the case. They are determined not to be conquered by the world. In the past, China built a Great Wall to keep out foreigners; today China is initiating the Belt and Road initiative to secure their back as they restore their civilisation, threatened from the east.

Fantasising about regime change in China, some US politicians make outlandish accusations. Had they talked to a few Chinese punters, followed social media or watched chat shows on TV, they could not possibly claim that China is a totalitarian country. Had they read Pew’s surveys of public opinion they would realise that the Chinese are, overall, more satisfied with their governance than European citizens, to say nothing of the USA. And are you surprised? While Europe and the USA are beset by economic and political troubles, Chinese people see ahead of them only more wealth, health and social mobility.

We need to recognise that demonisation of China is a weapon with which some US politicians deflect attention from their own failings and reflect their commercial jealousy. Both our National Cyber Security Centre and GCHQ have maintained until now that Huawei’s involvement in the UK poses no security risk that cannot be managed. Otherwise why would the US trade Department last week reauthorize US companies to work with Huawei, even as Donald Trump bullies other countries not to?

Robert Zoellick, a US former Deputy Secretary of State, is among the calmer heads to remind us just how positive a collaborator China is: that it recognises climate change issues, is in the forefront of environment innovation and has worked hard on endangered species; cooperates with the IMF over stimulation; provides more UN peacekeepers than the other members of the Security Council combined.

He points out that between 2000 and 2018 China supported 182 of the 190 Security Council resolutions imposing sanctions on nations which violated international rules or norms; China collaborated on the Iran and North Korea proliferation treaties.

Zoellick is not given to dire warnings about how dysfunctional it will be if the West really manages to ‘cut China off’, but they are implied in his general remarks about China, restated at a recent Henry Jackson webinar. China, he reminds us, is the biggest contributor to global growth; the fastest growing market for United States products; no longer manipulates the exchange rate; and, in response to our pleas, has improved its legal system. All in all, Zoellick tells us that cooperation with China “does produce results” but we should not take China’s cooperation for granted, “it could be very different”.

At home in Blighty, those calling for “a reckoning with China”, demanding a COBRA-like committee to mull over retaliation, wanting to “hold China to account” should ask themselves whether our businesses, for many of whom China is their most important market, want matters to become “very different”.

As to Hong Kong, the whole world must be astounded at the descendants of nineteenth century imperialists sending out paper gunboats commanding that China order its affairs according to our desires. A long time ago as a student, I demonstrated against colonial rule and police corruption in Hong Kong, and can still feel the truncheon on my back. In the face of much more vicious violence than anything we democracy activists attempted, Beijing has been restrained. In Northern Ireland, when security deteriorated, the UK imposed direct rule and fiercely rejected US interference on the IRA side. Over Hong Kong, we should try to see how interfering former imperialists look to most Asians, let alone to Chinese.

There are aspects of Chinese policies that we do not like, just as there are aspects of US policies that we abhor. The China Research Group is right to be concerned about cyber security and human rights. The way forward is to deal with China as a partner in the solution of common issues, such as terrorism in Xinjiang and Afghanistan. We have always worked with regimes with different standards when it suits our national interest. And respecting and being respected by China is in our national interest.

In the words of Kevin Rudd, the former Australian Prime Minister: Over 30 years China has pulled off the ‘the English industrial revolution and the global information revolution combusting simultaneously and compressed into not 300 years but 30’. There is a lot to learn and if we are to develop and prosper in the world ahead, we must be part of this. We should also celebrate that China’s rise is bringing better nourishment, greater life expectancy, education and security to hundreds of millions around the world.

Fulminating at China’s internal affairs and rejecting Chinese investment in order to please its commercial rivals will have no effect beyond signalling our impotence and arrogance; they are of no benefit to Britain and have no place in a long-term plan for Britain to prosper in the Asian century. Our government must develop a strategic approach to China. We owe it to future generations of Brits to work with China.

James Roberts: Big state spender Roosevelt shouldn’t be Gove’s new role model

1 Jul

James Roberts is Political Director of the Taxpayers’ Alliance.

Our de facto prime minister, Michael Gove, has been a busy man. On Tuesday, he was in the Commons explaining Mark Sedwill’s sudden departure. At the weekend, he delivered a much-vaunted address to the prestigious Ditchley Foundation, joining a long line of luminaries: Mark Carney, David Milliband, John Major, Chris Patten, to name but a few.

Sparing the blushes of the distinguished Ditchley crowd, Gove didn’t mention Brexit much. But what he did deliver was a rare tour de force about the challenges facing Western governments, delivered with daring incisiveness by the Government’s ‘Hand of the King’. If the ever-authoritative media talking heads (and rapidly-departing civil service barons) want to know what ‘hard rain’ that nasty Dominic Cummings has in store for them, Gove’s lecture was a good place to start.

He didn’t pull his punches. For the ‘Forgotten Man’, faith in the system has been broken, “compounded by cultural condescension and insulation from accountability”, with the policy-making elites in political parties and the civil servants in the dock.

Reasonable demands, or taxpayers’ money to be well spent on accessible public services that actually work have been ignored. The top tiers of mandarin management are stuffed with like-minded PPE-ists, dripping in self-reinforcing groupthink, preaching every form of diversity going – except diversity of thought.

Gove described with brutal accuracy the tendency to coalesce around a cosy Westminster consensus, perpetuated by media commentary and pressure group plaudits, with almost non-existent evaluation of real world delivery. But the government eco-system is dying – its credibility eroded away by constant deforestation to feed an insatiable 24 hour media cycle, the whims of easy-choices-only politicians and the childish tantrums of the Twitterati. The spirit of intellectual challenge has been driven out of the forest, with generic generalists climbing high and genuine innovators buried in the undergrowth.

He’s bang on. As Matt Ridley identified back in 2013, policy-making has long been broken: sometimes little more than a string of special interest spending demands; elaborated on by so-called experts; written into submissions by pedantic pen-pushers; approved by malleable ministers; and made into law by preoccupied politicians.

‘Doing something’ is the name of the game. If social media demands it, laws can be changed. If the media suggests it, money can be found. The Forgotten Man – that is, the taxpayers who pay for all this – be damned. Their preferences are secondary or even, as Gove suggests, absent entirely. A quick reference to ‘taxpayers’ money’ seems often enough to settle the consciences of Tory ministers, as they implement evermore expensive government intervention, because a hashtag told them to.

The TaxPayers’ Alliance knows calling this out doesn’t win you many friends: you can count on one hand the number of policy-makers willing to go against the grain. At DEFRA, lest we forget, Michael Gove was quick to join the chorus of environmentalist big spenders, navigating Theresa May towards a non-negotiable £1 trillion net zero commitment (which by our reckoning no government department has any idea of how to achieve). But then, there’s no zealot like a convert.

But a form of zealotry is exactly what government reform needs. The so-called ‘Rolls Royce’ civil service has broken down by the roadside. On that front, Gove wasn’t short on bold solutions. As our landmark polling last year with ConservativeHome’s columnist, James Frayne, showed, more than six in 10 working class taxpayers agree with the suggestion that we should move more central government offices and jobs outside of London.

Almost three quarters of them believe that all civil service jobs should be open to applicants without a degree, perhaps hoping to break the hold of the hapless humanities graduates. A hard-nosed look at value for money is vital, too.

Gove namechecked numerous programmes, including his old chum David Cameron’s £1 billion National Citizenship Service, which could benefit from a proper quantitative analysis of success and failure. There should be nothing noteworthy about a politician taking aim at programmes, like the £920 million Troubled Families scheme or (Gove’s own) Pupil Premium, and asking if these really delivered for taxpayers. But in the punch-and-judy pantomime of the current political debate, this feels revolutionary.

The same can be said of some of his other policy proposals. In a speech so wide ranging it would usually have a Prime Minister worried, Gove called for  planning reform to fast track beautiful development, better use of data in the NHS, transparency on court and school results, reviews for failed anti-radicalisation programmes, interrogating defence procurement contracts and accountability on the impact of aid spending. Many of these things should be music to taxpayers’ ears.

But the implications of all this are far from clear. As the punters know, policy outcomes matter more than policy processes. Reviews often come to nothing. Promises aren’t worth the paper they’re written on. The devil’s in the detail. What does Gove actually want to achieve?

Does turning to more data in the NHS mean only allowing for government-made track and trace apps, which inevitably fail? Does it follow that reviewing a failed social programme results in it actually being abolished, and taxpayers getting their money back? Does accountability for aid spending mean cutting back the £15.2 billion cashpoint in the sky, or simply swapping money between dodgy dictators and wasteful NGOs?

he voters we polled wanted foreign aid reduced and reallocated to other priority areas such as the police, the NHS and schools. Very few people care how the sausage is made – they just want aid cut. But that’s an uncomfortable view in SW1, and incidentally not one that Michael Gove shares. It’s the same with the majority (68 per cent of C2DE voters) who backed abolishing the BBC licence fee. When he becomes inconvenient, or wants things that really upset the Westminster village applecart, the Forgotten Man is once again forgotten. Politicians just come up with better ways of ignoring him – the endless reviews and the broken promises.

In that sense, Gove’s speech could easily have been given by a much more fitting figure for the Ditchley Foundation: Tony Blair. Like Gove, he reached for the model of America’s big spending New Deal, under Franklin Delano Roosevelt. New Labour offered innovation, clever solutions and new public service delivery models, with a pledge and a commission for every occasion. Gove and his Cameronite contemporaries looked on in awe, while most Conservative voters were horrified at the economic paternalism, metropolitan condescension and fiscal vandalism of the Blair years.

Many still believed that reams of government data and endless initiatives can never outgun the free and rational choices of millions of individuals. Their ears still rung with the mocking rebuke of Ronald Reagan: “I’m from the government and I’m here to help.” Endless cash flow means that civil servants, not taxpayers, still made the rules. The TaxPayers’ Alliance itself was founded to take a stand.

Blair paid the price for ignoring his own voters, and taxpayers got sick of the Westminster consensus he created – ‘expert’ policy tsars, expensive PFI, and constant right-on crusades – arguably leading up to the EU referendim result in 2016. For a man so intimately involved in that campaign, Michael Gove may sadly be in danger of starting off down the same path. Replacing Oxford-educated experts with world-beating data whizz kids, or swapping a programme here with a review over there, won’t change the Blairite policy-making consensus – unless there is fundamental change of political intention at the top.

Britain’s forgotten taxpayers need Michael Gove’s intentions to be as bold as his analysis.

Luke Evans: My Coronavirus report from near the Leicester lockdown front line

1 Jul

Dr Luke Evans is a member of the Health Select Committee, and is MP for Bosworth.

As I sit down to write this week’s column I hope that you will excuse it’s slightly erratic nature and its stream of consciousness tone. Forgive me.

As a Leicestershire MP, the last 48 hours have been taken over by the news of the Government’s local lockdown of Leicester and, at first, considering the approach which should be taken should any of my own Bosworth constituency be included in the lockdown area; and subsequently what steps we may have to take locally now we know that we are not.

Over the weekend, rumours started circulating in the media that ‘Leicester’ might become subject to the first localised lockdown since the imposition of Coronavirus legislation. There is a cluster of outbreaks – which must be taken seriously.

Like many cities, ‘Leicester’ is quite difficult to accurately define. Did rumours relate solely to the local government area that is the ‘City of Leicester’, or could it include the suburbs which stretch out towards the rural areas which are covered by Leicestershire County Council’s jurisdiction, and of course the constituencies of our seven Conservative MPs?

I set out on Monday morning to do my due diligence by speaking with regional public health leads, our chief constable and the chair of our local resilience forum, to get the actual facts on the ground.

During the day, it became increasing clear that a local lockdown would be imposed imminently, and I was invited to a Zoom call with other Leicestershire MPs, the elected Mayor of Leicester, the Leader of the County Council, Dido Harding, senior leaders in Public Health England and Nadine Dorries, the Health Minister.

During the course of that conversation, it became quickly apparent that the data is worrying enough in Leicester to make a local lockdown was inevitable; with an R rate stubbornly stuck at one, it was clear that, unless something was done now, this outbreak could get considerably out of hand…and quickly. To be safe, lockdown would include parts of the county – potentially including my own constituency.

Although incidents of Coronavirus are showing a marked national trend downwards, it is obvious that this isn’t the case in parts of Leicester. Nationally, for every 100 people tested for Covid-19 – that is those displaying symptoms –  two receive positive tests; in Leicester, that figure increases to ten.

Leicester now accounts for 10 per cent of Covid-19 admissions nationally and, crucially, the trend is not downwards.

Clearly, it is important that we understand why the trends in Leicester are so different from the national ones. The health specialists were in agreement that it is not due to the national release of lockdown (otherwise you would expect hot spots popping up all across the country), so something else must be going on.

At this point, the uptick appears multifactorial, and plenty of work is going on to establish categorically what these factors are, but right now our focus is much more about practicalities and what to do.

How do we guarantee health safety, effective enforcement of lockdown, protecting businesses and support for livelihoods? How do we communicate all of this to the public, preventing spread and make best use of shared working?

Questions like these all immediately sprung to mind, and were evidently shared by all fellow MPs on the call.

Post-meeting, it was straight onto a statement from the Health Secretary, and then my first step was to speak with members of my team with a plan, followed by courtesy calls to councillors whose wards and divisions were likely to be affected and local leaders.

I’m very conscious that an MP never works on their own, and I very much rely on my team and local activists. I said in my maiden speech that healthcare taught me that “empowering those who can and helping those who can’t” is critical; this situation ably demonstrated this again.

In the wake of the Secretary of State’s statement, as you might expect, calls continued well into the night.

Yesterday morning started with a very early meeting with the Health Minister and Leicestershire MPs to digest the news, update and then talk about practicalities.

As Tuesday progressed, further questions come to forefront.

With worried residents, particularly those living in the city commuter belt, it would have been preferable if a map of the lockdown area had been produced far quicker than it actually was. There are many questions about how we can prevent those living in the lockdown area from visiting areas, including my own, where restrictions are being lifted this weekend.

Government was clear it was for local decision makers to decide the extent of the boundary, given that they are best placed to know natural geography, and how communities function in real life not just on a map. (The map is not the territory coming through here from last week!)

Ultimately, I see my role as being that of an honest broker in a fluid situation. I’m determined not to put information out because I want to be first with the news, but rather believe it is best to wait until updates are properly verified.

Instead, what are the worries of my constituents both regarding their safety and their livelihoods? My job is to do my best to secure both.

Over the course of yesterday, I had further meetings and calls with officials from the Department of Health, Home Office, Treasury and local leaders from the police, council and LRF, to name but a few.

Like any emergency situation faced, you want to deliver clear, accurate information, even if that maybe no further news, that is an imperative.

The situation reminds me of my early days as an A&E doctor. The relatives of a very sick patient will always want updates quickly, yet medical uncertainty about how the patient will respond is difficult, added to which the demands of my bosses might be altogether different; but at the end of the day you can lay out what you know, what you are doing and why, and how you expect the poorly person to respond.

The outbreak in Leicester city is no different….now we have two weeks to watch for signs of response, and I will continue to be communicating them to my constituents, working with all the teams involved to get the best outcome; a safe time to return the easing of lockdown.

Andy Street: Our blueprint setting out the economic ambitions of the West Midlands

30 Jun

Andy Street is Mayor of the West Midlands, and is a former Managing Director of John Lewis.

Last week saw the launch of a blueprint setting out the post-Coronavirus economic ambitions of the West Midlands. As a manufacturing heartland, where draftsmen drew up plans for everything from steam engines to Spitfires, blueprints are in our blood. They illuminate our history. This intentionally ambitious £3.2 billion business case draws a clear trajectory to our region’s future.

As Mayor of the West Midlands, it’s my job to attract as much investment as possible. Rishi Sunak’s bold and decisive actions – notably through the furlough scheme – have provided unprecedented economic support for jobs during lockdown. Now, demands on the public purse are high. All investment must be fully justified, diligently used and – crucially – deliver real results. Every penny counts.

Our region was the UK’s fastest growing outside the capital until Covid-19 struck, and as a hotbed of export, manufacturing, construction and professional services, we play a key role in the UK’s economic success. This new blueprint lays out a powerful business case for how continued investment can spark rapid and sustained recovery, not only for us here but for UK PLC.

Our ambition is deliberate because the stakes are high. Research suggests we could be hit harder than most by the lockdown. When coronavirus struck, the West Midlands was in a strong economic position, with record employment figures and productivity growth well ahead of the national rate. However, our economic mix – dependence on manufacturing and business tourism, as well as a significant contribution from universities – leaves us vulnerable.

By following the blueprint we have drawn up, the Government can demonstrate its commitment to ‘levelling-up’ by backing the people of the West Midlands to deliver.

We need to do everything we can to get back on our feet quickly and return to the levels of success we were enjoying before the outbreak hit. That means driving a rapid economic recovery, safeguarding more than 135,000 jobs while building thousands of new homes. It also means learning the lessons of the financial crash of 2008/09, and listening to business.

Investment is crucial. However, while we need significant investment from the Government – £3.2 billion over the next three years – this is broadly in line with the £2.7 billion investment we have secured since 2017, which supported strong economic success here.

Our business plan is to build on our success and on the investment we have already attracted from Government, while leveraging much more private and public sector investment locally, including from our universities.

The blueprint sets out a business case for investments, while outlining the economic benefits they would deliver. For example, it directly supports our automotive sector by harnessing clean technology and electrification. A major investment package, including £250 million towards a Gigafactory producing state-of-the-art batteries, will unlock 51,700 green jobs.

The building of HS2, next year’s Coventry City of Culture festivities and the Birmingham 2022 Commonwealth Games present opportunities to create jobs for local people. By accelerating major infrastructure investment and supporting the recovery of the tourism and cultural sector we can unlock 33,000 jobs.

Then there is the West Midlands’ growing reputation as a hotbed for health research. By investing in healthcare innovation we can protect 3,200 jobs, while improving the health of our population.

Improving transport, housing and digital infrastructure will play a key part in a rapid recovery, while laying the foundations for future economic strength. We can build better transport and digital links to drive productivity and create thousands of jobs in construction. Schemes include extending rail, metro and bus routes, with cash for enhanced digital connectivity and to accelerate fibre connectivity in deprived areas. Reopening long-closed railway stations will better connect people to employment opportunities, attract investment into once-isolated areas and improve productivity.

The West Midlands has pioneered the regeneration of brownfield sites to tackle the housing crisis, while protecting the environment. We even have our own regional definition of ‘affordable housing’ applied at planning level by the West Midlands Combined Authority. We want to build 35,000 new homes – 15,000 of which will be affordable – with a focus on housing key workers. Plans include using a £200m investment package to regenerate derelict eyesores and £24 million for a new National Brownfield Institute in Wolverhampton, which will be a centre of excellence for land reclamation.

Investment to equip people with the skills needed for the future aims to help get them back into work. This includes helping 38,400 young people obtain apprenticeships and work experience, retraining 20,000 workers for in-demand sectors such as health and social care, logistics and business services, and upskilling 24,000 for jobs for the future.

Finally, we want to back the region’s businesses with support schemes – including helping them navigate their way through the post-lockdown world – creating or safeguarding 43,900 jobs.

This ambitious business case is based on our region’s experiences not only of recovering from the last downturn, but on the successes of the last three years. The blueprint has been developed as a team effort between the region’s local enterprise partnerships, universities, business groups and local authorities.  Crucially, some of our biggest employers have also shared their insights about how the region can play its part in securing a strong national recovery, putting central investment to good use.

For the UK to fully recover, all of its regions must recover too – creating a stronger country with a more robust, balanced economy.

Jackie Doyle-Price: It’s time to establish a firm future for pharmacies – the unsung heroes of the coronavirus crisis

26 Jun

Jackie Doyle-Price is a former Health Minister and is MP for Thurrock.

Since the Covid-19 crisis began, pharmacies have been the face of healthcare on our high streets. While GP’s surgeries have closed their doors, 11,500 local pharmacy teams have stayed open, putting their lives at risk and working tirelessly to ensure the public can still access critical services and life-saving medicines.

Responding to extraordinary circumstances, many former pharmacists have returned to the frontline, and we have seen pharmacies open early, stay open on bank holidays and close late to meet increased demand. They have delivered millions of prescriptions to the most vulnerable, and provided face-to-face consultations to keep pressure off our hospitals.

We need to recognise their hard work and sacrifice – and get behind this less glamorous but critically important part of our NHS. Five pharmacists have already died of the Coronavirus, and many still cannot access sufficient PPE.
In the longer term, the virus will drive a reassessment of the role that pharmacies play in our NHS – but only if we can prevent thousands from being forced to close due the costs of staying open and address the need for better a funding system.

Since the outbreak began, pharmacies have spent upwards of £3,000 a month extra on staffing and £1,000 on safety and security costs. In a relatively low-margin sector, where more than half of pharmacies were in deficit before the crisis began, not recouping these costs will drive many to the wall.

The £350 million Government loan is a sticking plaster – repaying it will make many pharmacies non-viable. I am calling on the Government to turn this loan into a payment for our local pharmacy heroes.

This would be the first step in putting pharmacies on a viable financial footing. The second step will be to re-examine the pharmacy funding formula to ensure that they are appropriately financed. It matters because pharmacies are not only the unsung heroes of the coronavirus – they may also hold the keys to the long-term sustainability of the NHS.

As we look at how we organise and provide healthcare in a post-virus environment, we have a real opportunity to unleash the real value of a network that reaches into every part of the UK. 95 per cent of us live within 20 minutes of a local pharmacy and 1.6 million people visit one every day.

Pharmacies have a huge and still largely untapped role to play in supporting increased demand for healthcare driven by an ageing population, the obesity crisis and rapid advances in medical technology.

They already provide a large range of healthcare services, delivering a million flu jabs annually, providing access to emergency contraception, diabetes and obesity management, heart health MOTs, and help for the 24 per cent of adults who take three or more prescribed medications.

But many people are still not aware of how their pharmacies can help them. We need to raise their profile and make them the first port-of-call for non-critical ailments, so we can take more pressure off doctors and A&E. Pharmacies could also play a much greater role in prevention and public health – two keys to the future of the NHS. Post-Coronavirus, we need to look again at what our pharmacies can do.

We also need to start viewing them differently. The NHS establishment has often been somewhat leery of pharmacists, seeing them as a commercial partner rather than a critical part of the NHS family. Hopefully seeing our pharmacists step up during Covid-19 has put pay to that kind of thinking.

I am delighted to have been chosen as the new Chair of the All-Parliamentary Group on Pharmacy. Let’s put our cross-party support behind the unsung heroes of the coronavirus – and recognise that they are at the heart of our healthcare system.

Maria Higson: The Coronavirus has already changed the NHS. Now it can be changed more for the better. Here’s how.

26 Jun

Cllr Maria Higson represents Hampstead Town ward in Camden. She works professionally as a strategist for a major London teaching hospital.

As the Covid-19 crisis moves to its next phase, the conversation is already turning to restarting elective care, and the lives taken indirectly in shutting these essential services. However, with ongoing pressures exacerbated by the impacts of the virus, now is a unique opportunity to innovate healthcare provision – not simply to go back to a system which was already struggling to cope.

Public goodwill towards the NHS has never been higher. If the weekly clapping (accompanied by cheering, pan-banging and bell-ringing) doesn’t show this, the speed at which 750,000 citizens volunteered is surely a strong indicator. The idea of awarding the NHS the George Cross is neither unwelcome nor surprising.

This goodwill is not misplaced; the NHS has stood up to the test of the Coronavirus with aplomb. To take just one example: by April 3rd, the necessary workforce, equipment, and space for over 2,500 additional adult critical care beds was found – an increase of over 50 per cent on pre-virus UK levels (and this excludes the Nightingale hospitals). This precious resource has provided headroom throughout the crisis, with over two thousand beds reported as available during the peak.

However, once the crisis is over and the media has moved on (following in the footsteps of Brexit coverage), what next for the NHS?

The pressures faced are as stark as ever, and the macro-trends are concerning. The UK population age 65 and over is due to grow 45 per cent by 2050; the average health spend of this additional 5.7 million people will be over four times as much as those aged 0-64. The potential impact on public health expenditure is enormous under any scenario, and that’s before considering the social care implications of our ageing population.

Covid-19 adds long-term pressures both directly and indirectly. Of the thousands of intensive care survivors, up to 45 per cent may require rehabilitation support. In parallel, projections show up to two million people becoming unemployed following the crisis, with serious implications for physical and mental health. We will also need to contend with the backlog of elective care not provided during the pandemic.

Given existing, predicted and Coronavirus-related pressures, we cannot simply insist that the NHS goes back to its old practices; we need our non-virus healthcare services to resume, but in a different way. However, if we really want change in our healthcare services, we need to do more than talk about “transformation”; we need to truly shift the mindset of politicians, professionals, and the public to NHS services.

During Covid-19, service innovation suddenly became possible at break-neck speed. For years, the NHS has been calling for a greater prevalence of remote consultations, allowing patients to be seen quicker and without the risk of attending hospitals; where these had previously been resisted, they have now become commonplace. The NHS App – launched and rapidly expanded under the tech-loving leadership of Matt Hancock – saw a 111 per cent increase in registrations in March 2020. Patients have embraced new service models; this shift needs to stick long after the Coronavirus is over.

The causes of this recent rush towards remote care are clear: closed services, constricted travel, and concern of contracting the virus in healthcare environments. However, as these drivers subside, we need to consider what was stopping people from shifting to them pre-virus.

A core issue of remote GP consultations is that residents can still only register with one practice at a time – which means that signing up to an app-based service such as Babylon cuts you off from face-to-face GP care completely.

However, an app can’t measure blood pressure, take samples, or listen to your chest (at least not yet). Surely the most effective model for an individual’s care would be a hybrid one, in which remote appointments could be used where possible, with the back-up option of requesting a visit to a local surgery; this is not an option under the current restrictions. The one-registration rule was created to allow for a single location of health records, but now that technology allows people to hold their own records – readily accessible on their mobiles – it’s time we scrapped it.

Whereas remote GP services are readily available but not necessarily taken up by patients, remote hospital outpatient services are often not even available as an option. Many hospitals have started to implement new models such as telephone or video appointments and community clinics, but the pace of change pre-COVID was frustratingly slow.

In 2019, the Shelford Group of leading hospital trusts wrote that change should be driven, in part, at regional and national levels. Whilst many hospitals have created innovative solutions, it is prohibitively expensive to expect each organisation to invest individually in the development and implementation of these schemes. The national Outpatients Transformation Programme – still yet to be formally established – must be an NHS priority, either to provide much-needed support to existing partnerships or to lighten the load by sharing best practice and cost.

Funding and resources will need to both enable and follow these new structures. Critically, there will be a large infrastructure cost. The ‘NHS England Med Tech Funding Mandate’ makes organisations responsible for investing in innovation expected to deliver same-year savings, but central funding schemes must be increased and made more readily accessible for major investments.

Implementing new technologies will require a workforce with additional skills and an open conversation between professionals and politicians to tackle our existing workforce shortage.

It will also require a shift in where the workforce sits. The benefits of at-home consultations will only be maximised if follow-up care can also be done in the community or even better in the home as well. In February 2020 just 21.1 per cent of nurses and health visitors worked in the community – down from 24.2 per cent in February 2010. A lack of community nurses contributes to the centralisation of care into hospital settings. We must act to reverse this trend.

Finally, we cannot expect all models to work first time round – successful entrepreneurs often have failures amongst their successes, and we need to give the NHS room to take risks as it improves. One anaesthetist summed up much of the issue in describing the need for “permission” (and a common understanding of it) to try new ways of doing things, and the average tenure of an NHS Trust CEO is just three years – not enough time to implement a major transformation. Politicians need to provide professionals with the air-cover to innovate.

Of course, these are just some of the changes needed to help our NHS services to survive. To truly alleviate the pressure, we need to improve public health, and Boris Johnson is absolutely right to be launching a national anti-obesity drive. However, whilst we’re starting on that journey – which will surely be decades-long – we must continue to protect our NHS past Covid-19 by ensuring it is free to make the step-change towards sustainability it desperately needs.