David Hare: How Javid can ensure the elective recovery plan for the NHS delivers

18 Feb

David Hare is Chief Executive of the Independent Healthcare Providers Network

“It’s NHS waiting lists, stupid” should be the mantra for all political parties as we head towards the next general election.

With NHS waiting lists at a record high – recent figures show 6.1 million are currently waiting – and improving access to NHS care consistently rated as the number one priority for the public, tackling the backlog in NHS treatment must be top of the to-do list for the Government/ a government in waiting.

This is especially sensitive since, from April, people and businesses will be paying more in National Insurance for the health service, and, not unreasonably, will want to see something tangible in return.

Tax rises are always controversial but with a cost-of-living crisis on the horizon due to rising inflation and energy prices, this new health and care levy represents yet another additional squeeze on people’s already-stretched finances – and one which the Government will come under ever increasing pressure to justify.

Last week Sajid Javid, the Health and Social Care Secretary, announced the NHS’s new “elective recovery plan” setting out how the NHS intends to tackle the backlog of treatment. The plan includes some important goals including eliminating the number of people waiting more than a year for treatment, with the anticipation that waiting lists will start coming down from 2024.

It also sets out how it will bring in more capacity to a desperately stretched NHS, including making more use of independent sector capacity and giving people greater information and choice over where they can receive their NHS care.

These measures are welcome and recognise the important lessons of how the Blair/Brown government successfully tackled record waiting lists in the 2000s. But how do we turn the plan into concrete action to make sure the public gets value for money from the new levy?

First, as this is essentially a question of demand for NHS services currently outpacing supply, let’s make it easy and straightforward for new providers to open up services for NHS patients.

There are currently over 400 independent healthcare facilities in the country with capacity available in every clinical commissioning group location. And like the establishment of “Independent Sector Treatment Centres” set up in the Blair years, new investment could swiftly be brought in to establish even more local services for patients to help bring down the waiting list.

Second of all is getting the finances right. The public will not be happy with billions of pounds going to the health service with no way of understanding what it has bought. It’s therefore important that the principle of “payment by results” or, more simply, “money following the patient” is retained so there’s a clear trail of where the additional money for the NHS has gone, and a real incentive for as much activity to be delivered as possible.

Third, to real see change in the NHS, there needs to be a relentless focus on driving down NHS waiting times with every part of the health system understanding its role. The plan published this week sets out some welcome ambitions to reduce the waiting list from 2024 and eliminate the number of people waiting over one year by 2023.

But while the public don’t expect miracles overnight, they are unlikely to be content sitting tight for two years before they see any tangible impacts on their access to care. Clear milestones setting out how exactly the NHS will get reach these targets are therefore needed to reassure people that action is being taken now to clear the backlog.

There’s no doubt that the health service has a mountain to climb in bringing waits down for patients and that those working in the health system have already moved mountains for their patients. But higher taxes for a materially poorer NHS is simply not an option for the Government. The hard work of delivery needs to start now.

Ryan Bourne: A government that wants to Build Back Better must address supply-side constraints on the economy

26 Jan

Ryan Bourne is Chair in Public Understanding of Economics at the Cato Institute.

Well, so long, “Plan B.” In jettisoning some of the most intrusive remaining Covid-19 restrictions, England (with the home nations to follow) could soon rival parts of the U.S. in being the most “normalised” policy environments in the developed world. Yes, mandatory self-isolation for those testing positive will remain, for now. But as with the vaccine rollout, Britain appears now to be leading the world into the new approach of “learning to live with the virus.”

This will bring with it an economic fillip, albeit disrupted in near-term statistics by Omicron. We have certainly been in need of one. Though headline GDP figures across countries can be misleading about the impact of the pandemic given measurement differences, an analysis by The Economist combining five indicators – GDP, household income per person, share prices, investment, and public debt – found that through September last year Britain had been the second most adversely affected major economy from the pandemic, behind only Spain.

In its ranking of 23 OECD countries, Britain was deemed third worst for the fall in household income (behind Austria and Spain), third worst for the decline in share prices (behind Chile and Spain), worst for the fall in investment, and second worst (behind Spain) for the public debt surge. With Covid-19 deaths per capita here relatively high – above all other major European or G7 economies except for the U.S., Belgium and Italy – we suffered a pandemic double-whammy of both poor health outcomes and a big economic hit.

Does analysing the change in these variables mislead about how the UK shapes up internationally after Covid? Perhaps. It’s not as if the public health crisis was the only thing happening during this time. And it’s important to remember that looking at changes to economic variables in the pandemic can hide that Britain entered it with significant structural strengths too.

In mid-2019, The FT’s Chris Giles was able to write that incoming Chancellor Sajid Javid enjoyed unemployment at its lowest rate since 1974, with the share of 16- to 64-year-olds in work at close to record levels, inflation bang on target, average earnings growing at their highest rate for 11 years, and public borrowing modest. The biggest ongoing economic weakness then was clearly productivity – with GDP per hour worked around 15 per cent lower than seen in France or the U.S., after a decade of weak economic growth.

So the UK entered the crisis with many macroeconomic variables healthy. Even the shock of the pandemic has therefore left the country’s headline statistics looking largely unremarkable in comparison with other economies.

UK unemployment is still low by international standards, for example. At 4.1 per cent for September through December 2021, the UK’s rate was similar to the U.S., and bettered only by Japan (2.8 per cent) and Germany (3.2 per cent) within the G7. The employment rate for 16-64 year olds of 75.5 per cent, although still 1.1 percentage points below its pre-crisis peak, is similarly only exceeded by the Scandinavian countries, Germany, and the Netherlands within Europe and then Japan too in the G7.

Pandemic-induced disruption and rising energy prices (on the supply-side) and huge macroeconomic stimulus (on the demand-side) has left us worried about inflation and a cost-of-living crisis. But, again, this is not an affliction unique to Britain, belying the idea it is mainly caused by Brexit. At 5.4 per cent in the 12 months to December, consumer price index inflation was almost identical to EU-wide inflation (5.3 per cent), and lower than some countries within it, such as Germany. Compared to G7 countries, the UK was decisively average too, with only Japan and France with significantly lower rates.

On GDP, it’s true that – putting measurement differences aside – the UK had one of the biggest headline falls in output during the pandemic. GDP in Q3 2021 was still 1.5 per cent below the pre-crisis peak, with only Japan having suffered a worse performance among G7 countries. But the OECD expects faster UK growth going forwards. And as economist Julian Jessop has noted, it’s highly likely that the UK will be doing better than the eurozone in terms of GDP relative to its pre-crisis peak through 2022, although still lagging far behind the U.S.

What about the public finances? Well, up to September 2021, the IMF had calculated that the UK had the third biggest total Covid-19 fiscal support package, amounting to a massive 19.3 per cent of GDP, and so behind only New Zealand and the United States. It’s therefore no surprise that public net debt has surged to new highs in peacetime. And yet, within the G7, the only country with a gross debt-to-GDP level lower than the UK is Germany and the UK is slap bang in the middle of the seven for its projected primary budget deficit this year.

The after-shocks associated with Covid-19 might be felt for years to come, through disruption to demand patterns, experiments with more home working, a spatial reallocation of activity and lingering effects on attitudes to risk. But the UK’s broad macroeconomic situation is not dissimilar to that of many other comparable countries. And that should make us ponder a few lessons from elsewhere as we tackle the immediate challenges we face.

In particular, the country that has stood out in suffering a worse inflation problem than the UK is the U.S. – where households were showered with cash such that the government effectively delivered a money drop to households. So why the guys at the Social Market Foundation appear to be urging the Chancellor to introduce a £500 “Rishi Cost of Living Allowance” as if that’s a cure to inflation here is beyond me.

Unemployment spiked very high and then plummeted in the U.S. below all G7 countries bar Germany and Japan – showing the long-term virtues of flexible labour markets. If Britain wants to regain its full, robust employment performance of 2019, it should beware new policies prioritising worker “security” over continuing a liberal hiring and firing environment as things normalise.

But, most of all, the UK’s key economic challenge – weak growth – remains and becomes even more pertinent given Covid-19-induced constraints. The pandemic has tested to destruction the idea that macroeconomic problems can be solved by throwing more and more stimulus and “demand” at things. If the Government is serious about “Building Back Better”, it needs to do the hard yards in thinking about the supply-side constraints on the economy and how to turn more demand into real growth, rather than rising prices.

Covid and restrictions – the end of an era?

20 Jan

After an incredibly tense Christmas, while the Government – and world – waited to discover the severity of the Omicron variant, this January could have looked very different indeed. The NHS could have been overwhelmed; the UK might have been in a “circuit breaker lockdown”, as many on the Left wanted; and there could have been huge uncertainty about the country’s ability to deal with future variants.

Yet none of this nightmare scenario has, so far, played out. In fact, the UK’s outlook has never looked more positive in regards to Coronavirus. On Wednesday (should one have noticed, with all the news about “partygate”), the Government announced a completely new road ahead, in terms of managing the virus. 

England’s Plan B measures –  including mandatory face coverings in public places, Covid passports and advice for people working from home – are all to be dropped from next Thursday, as the Government moves to what’s called “Plan A”.

Speaking about the latest developments, Sajid Javid said “This is a moment we can all be proud of”, while cautioning that it’s not the “finish line”, as future variants cannot be eradicated. Instead, “we must learn to live with Covid in the same way we live with flu.” 

Although “living with the virus” has been the goal for a while, it seems to be the first time a minister has actually meant that this will happen. One of the biggest indications of this is that the requirement for people to self-isolate, when they have Coronavirus, is due to expire on March 24 – and that date may even be moved forward. Like the flu, people will get to decide themselves whether they leave the house.

What is one to make of the UK’s direction? The Prime Minister said that Plan A was possible because of boosters and how many people had followed Plan B measures, and that’s certainly true. Medical developments, from the vaccine to anti-virals, have put us in a much better position in terms of how we cope with the virus. We have the infrastructure (even the infamous Test and Trace system) and expertise, in place should there be more variants of the disease – or totally new pandemic to deal with.

Another reason why we are moving in this way is, of course, the Plan B rebellion – the largest that Johnson has ever experienced – in mid December. When the Government has typically experienced resistance, in terms of Covid measures, its fiercest opponents have been the Left and teaching unions. Yet the rebellion was a lesson that other voices matter; and can clearly become more problematic in the opposite direction. Should the Government introduce any harsher measures, without providing solid evidence, and combined with the fact that many MPs want to get rid of Johnson, then the Prime Minister will be in real trouble.

Lastly, one reason the Government may feel more confident about opening up is that “lockdown scepticism” – or, simply, scepticism around the power of tough restrictions – has become a less controversial position, both in media coverage and the political arena. Members of the public have seen for themselves – having watched countries with tougher restrictions experience high cases than those without – that there is no clear correlation between measures and virus control. In years to come, who knows whether the lockdown sceptics will be vindicated and, if so, by how much?

Either way – and this hasn’t been something people could say throughout much of the pandemic – everything seems to be heading in the right direction. Even if that changes, perhaps we can allow ourselves, at this time, a little optimism this year.

Alan Mak: The Government’s new NHS Reservists will ensure we adapt to today’s health challenges

14 Jan

Alan Mak is the MP for Havant. He introduced the NHS Reserve Staff Bill in Parliament to create the NHS Reserves in November 2020.

“Our NHS is the beating heart of this country” the Prime Minister stated after receiving his own lifesaving treatment for Coronavirus. His words reflected those of everyone in our country when it comes to the health service.

For many voters on the doorstep, the NHS remains a central issue they want us to focus on. YouGov tracks weekly the issues that are on the mind of the British public. Since the start of the pandemic, more than half of voters have consistently said health is one of the three biggest issues facing the country.

Therefore, as the party of government, it’s more vital than ever that we demonstrate our ability to manage and shape an NHS that can respond not only to today’s immediate demands, but which is also fit for the future. Adapting to societal change, innovating to meet patients’ needs, and reform to become more agile and productive are all key. These must remain key Conservative priorities, as they have been throughout our stewardship of the health service.

For over 40 of the 73 years that the NHS has been in existence, it has been under the care of Conservative governments. We have nurtured and transformed it from the fledgling organisation proposed during Churchill’s wartime administration to the £162 billion NHS that today deals with one million patients every 36 hours and 20 million hospital admissions every year.

Despite its growing and committed workforce, unexpected peaks in demand still arise. Whether it’s dealing with Coronavirus admissions, seasonal upticks, terrorist attacks, natural disasters, health and civil emergencies or major incidents such as traffic accidents, the NHS needs a flexible workforce.

We also need to continue tackling the backlogs caused by Coronavirus. The Health Secretary has rightly recognised we need to take action and as he said in his Conference speech “No government, no health secretary, no society can accept” an NHS waiting list that has been driven by pandemic pressures.

A commitment to innovation and ensuring the health service moves with the times are just two reasons why the Government has announced that the NHS Reserves will be launched as a new member of the NHS family. In November 2020, I proposed the NHS Reserve Staff Bill in Parliament, and I’m delighted to see the NHS Reserve Programme being rolled out across the country.

The new NHS Reserves will provide both clinical and non-clinical staff to supplement full-time NHS workers during times of high demand.

It’s part of the refreshing, reforming zeal the Health Secretary is bringing to the job. He wants to “embrace innovation and to build a truly modern” and “sustainable service for the future”. The NHS Reserves achieves this by building upon the work many NHS Trusts have already done throughout the pandemic through the return to work of thousands of former NHS staff.

Following the introduction of my bill in Parliament, NHS England launched initial NHS Reserves pilots. They proved popular, with 17,000 reservists already recruited from just eight pilot schemes. From April this year, the NHS Reserves Pilot will be expanded and fully implemented across all 42 integrated care systems in every part of England.

The Reservists provide NHS employers such as hospitals and trusts with a flexible but reliable workforce to supplement the permanent workforce and to help protect elective care.

While the priority for patients is ensuring that they have care when they need it, they also need to have the utmost confidence in the treatment they receive. The hallmark of the NHS has always been and always will be the quality of care received.

Everyone in this country knows that they will receive the highest compassion, support and care from our world-class doctors and nurses. So it’s vital that whether care is provided by regular staff or a reservist it should be the same high quality. That is why the NHS Reservists will have the skills, knowledge and experience necessary to provide care and treatment, night or day, 365 days a year. Through the NHS Reserve system they will be given training and in-role experience to keep qualifications up to date, just like their Armed Forces counterparts.

As a Conservative family, we should be proud of our party’s stewardship of the NHS. I hope the creation of the NHS Reserves will show that once again it is us Conservatives that are leading the way when it comes to thinking about how our health service adapts, innovates, and thrives in response to new challenges. Whilst the Covid-19 outbreak has brought so many negatives, the new NHS Reserves can serve as permanent and positive legacy that we can all support with pride.

As the Prime Minister said the devotion, duty and love of those in the NHS makes it the organisation it is today. We have the opportunity to build a better NHS through those who are willing to serve as NHS Reservists, giving it the flexibility it needs to provide care no matter the pressures on its service.

I hope ConservativeHome readers will consider signing up as NHS Reservists in the future.

Emily Carver: The decision to mandate masks in classrooms is utterly indefensible

5 Jan

Emily Carver is Media Manager at the Institute of Economic Affairs.

To his credit, the Prime Minister has stuck to his guns and refused to follow the devolved administrations and bring in tougher rules.

This is a rational decision. We know that Omicron has proven to be milder than previous variants, and despite a surge in the number of people in hospital “with Covid”, the speedy roll-out of booster jabs has kept the number of patients on ventilators low. Indeed, the latest data shows that the number of people in ICU has in fact fallen in recent weeks and it not tracking the rise seen last winter. While pressure on the NHS is severe, it is manageable.

Even Professor Neil Ferguson, who predicted last month that there could be 5,000 Omicron deaths a day (over three times the peak last January) has admitted that this wave is “substantially less severe” than previous ones, and that he is now “cautiously optimistic” Omicron cases are plateauing among 18 to 50-year-olds in London, the age group that has been driving the recent wave.

Yet, despite the fact we are so very far from worst case scenarios (and Ferguson’s best-case scenario), the Government has decided that it is proportionate to demand children wear masks throughout the entire school day. It is now once again “recommended” for all secondary school pupils in England to wear masks eight hours a day, with only a short break for lunch.

Politicians have argued that mask-wearing is a small price to pay to keep schools open. The opposition has also parroted this line. But they’re not paying the price. It is not office workers or MPs who are being forced to don a sweaty, germ-ridden mask all day.

And where is the evidence that mask-wearing will slow down the spread of the virus, keep schools open, or indeed save lives? Surely there must be an extremely high bar to justify a “recommendation” that will impact children’s learning and quality of life?

According to the Health Secretary, the guidance is based on two assessments. First, the evidence that Omicron, though milder, is highly infectious. And second, that an “observational” study of 123 schools undertaken by the Department of Education supports the use of face masks in schools – a study which is yet to be published.

One of the major criticisms from those sceptical of the Government’s approach is that it has failed to communicate or publish cost-benefit analyses for its ever-changing patchwork of Covid rules and regulations. You would have thought that, when seeking to intervene in children’s lives, the costs should be even more meticulously assessed?

Anyone who has ever worn a face mask will know they inhibit basic social interaction. This may not be as important in some professions, but in schools it is essential. Only in November, Sir Jonathan Van-Tam defended the Government’s decision not to mandate masks in schools. He said they can be “quite inhibitory to the natural expressions of learning in children, involving speech and facial expressions. It’s difficult for children in schools with face masks”. This will be worse for those with special educational needs, or for the growing number of children already suffering with their mental health. Has his view changed?

It seems the Government is more interested in being seen “to do something”, even if that means children are scapegoated. Indeed, in a meeting of the Education Select Committee meeting, children’s minister Will Quince admitted that there was “very limited evidence as to the efficacy of masks in educational settings”, but that mask mandates would be used as a “precautionary measure” nonetheless.

Considering this, it’s hard not to see this weakly-evidenced intervention as anything more than a political decision used to appease those who would rather keep schools closed. Certainly, if the decision were left up to the teachers’ unions and some councils, schools would remain shut to most pupils, and teaching would continue online-only.

We’ve heard in recent days from the NASUWT that remote learning is “the only sensible and credible option at this time to minimise the risks to those working in schools and to safeguard public health”. The leadership of the NEU has warned its members that it is not safe for them to return to school until mid-January at the earliest and has even provided template letters for their members to refuse to go back to work.

Then there’s the added problem of the Government’s own increasingly unworkable Covid self-isolation rules – rules which are wreaking havoc on our public services.

Not only are head teachers fearing up to a quarter of staff will be off work in January, but one in ten NHS workers are out of action, rail services have abandoned popular routes, and councils have scaled back rubbish collections. Economists have predicted that the impact of one million people now estimated to be self-isolating could knock several percentage points off GDP, amounting to billions of pounds.

If the Government is serious about children’s education, maintaining a functioning economy and finally learning to live with a virus that is clearly going nowhere, it must rethink these rules. It is clearly unsustainable for working people who are asymptomatic, or who are suffering only mild symptoms, to isolate for seven whole days. And if keeping schools open is the priority, sending teachers and children home for an arbitrary period if they test positive for a virus is no longer defensible. Especially when for most the symptoms are now akin to the common cold.

Considering Omicron is less severe than some feared, and the impact of staff absences is so high, the argument for shortening the isolation period has significantly strengthened.  While it looks like the Government is continuing with its painful policy of encouraging the continuous testing of asymptomatic adult and children, it must at least reconsider its arbitrary isolation rules – reduce the number of days or better yet move to a test and release system to hasten teachers and children back into the classroom.

It’s time for the Government to weigh up the benefits and costs of its Covid policies – and leave children alone.

The Government’s testing system is not the disaster it’s being portrayed as

4 Jan

In the lead up to Christmas, and indeed afterwards, there have been numerous news stories about the Government’s testing programme grounding to a halt. “PCR Covid testing labs are overwhelmed”, reads one headline. Another paper points out that the sole distributor for lateral flow tests/devices (LTDs) closed over Christmas, despite having 2.5 million kits. The message is clear: everything is a disaster!

Anecdotally it’s not hard to spot that there’s a problem with tests (and I say this as someone who has had a cold in the last week, and been unable to check it’s not “that”). The most visible signs are the queues of people in pharmacies trying to get LFDs, even though many of their stocks have also run out.

And these shortages create a whole range of issues, from scientists being unable to accurately monitor Covid in the population, to people walking around with suspected symptoms while hunting for tests, to members of the public being unable to go to work (should they need an LFD result to attend a premise).

That the nation has run dry on tests is not entirely surprising. This has come about largely as a result of 1) Christmas, when everyone wanted to check they were safe before going home to see loved ones and 2) the rise of the ferocious Omicron variant. But could the Government have done more here? Was it ill prepared, in fact?

That is certainly the charge Labour has used against ministers, keen to exploit what is already considered a crisis. Speaking of pharmacy shortages, Wes Streeting, the Shadow Health Secretary, said “Why on earth did the government not prepare for this and ensure alternative options for delivery were secured?” before accusing it of being “asleep at the wheel”.

His view was echoed by Leyla Hannback, Chief Executive of the Association of Independent Multiple Pharmacies, who reportedly warned the UK Health Security Agency that demand for tests was “getting really high” around the Christmas period.

It’s also said that the Government wasn’t prepared enough in terms of expanding Britain’s manufacturing capacity for tests. One paper suggests ministers shelved plans for onshore manufacturing – in short, awarding British business – due to fears about being accused of having a “chumocracy” culture again, with contracts awarded to China instead.

Whether this is true or not remains to be seen. But let’s roll with the main accusation levelled at the Government, which is that it was “asleep at the wheel” about rising demand for tests. This seems to me fairly hyperbolic – to put it mildly – when we still have one of the best testing systems in the world, with around 1.5 million carried out each day in Britain. I rather think our disappointment with the testing system reflects how high our expectations are for it, having become accustomed to a fast and efficient service.

The Government is being even more ambitious it in the future. It wants to increase supplies of LFDs to around 200 million along with 42 million supplies to be sent directly to UK pharmacists, and given its previous history ramping up capacity, expectations should be high here too.

One of the harder questions it might have to face – should there be unprecedented demand again – is how people should be prioritised for tests. Sajid Javid, the Health Secretary, has said that the Government would “need to constrain” the supply, which might come in the way of better guidance on who should be most entitled to LFDs. Recently, laboratories took up another suggestion for how to ease the system – they stopped checking PCR tests for people with a positive LFD result.

Either way, clearly a lot is going on behind the scenes to get past any issues. On a personal note, during the course of this article I managed to order LFDs and get a PCR result (negative) at 6.40am the next day, so it’s surely a sign of better things to come. At the very least, it is far from a disaster.

Viva the vaccine passport rebellion

10 Dec

What a week it’s been for the Government. With the furore around whether or not Downing Street had a party – or three – the Electoral Commission’s verdict on Boris Johnson’s wallpaper and the arrival of his and Carrie Johnson’s baby daughter, the media has had no end of things to write about.

Unfortunately for the Government, much more negative attention is on its way, due to a growing Conservative rebellion around Coronavirus vaccine passports, which, on Wednesday, Johnson announced would be implemented in England (in what some have called a “diversionary tactic”). 

Although Conservative MPs have been generally supportive of measures to combat Coronavirus, from the Emergency Powers Bill to curfews, something about the passports has pushed them to their limits.

Tens of Conservatives, including Dehenna Davison, Andrew Bridgen and Johnny Mercer have tweeted their disapproval of vaccine passports (which have been introduced in Scotland and Wales), with William Wragg, a member of the Covid Recovery Group, being so brazen as to call for Sajid Javid to “resign” over the latest measures. Expect a mega rebellion on passports on Tuesday, when they’ll be voted on, with talks of up to 100 MPs rejecting the plans.

The Government’s justification for passports has been the quickly-spreading Omicron variant, which has prompted it to unleash its “Plan B” set of restrictions. This includes asking people to work from home when they can from next Monday, as well as making masks compulsory in many indoor settings; two requirements that have received much less, albeit some, criticism compared to passports.

Part of the reason why MPs may have become more concerned about these is the events elsewhere in Europe, which have brought into sharp focus how illiberal restrictions can become. Austria’s decision to make vaccines mandatory has been a wake up call – to say the least. The more cynical will say that some MPs are simply using passports as an opportunity to kick Johnson when he’s down, having disapproved of his policies for a while.

My own view, in regards to the introduction of vaccine passports, is one of mild disbelief that the Government ever contemplated them in the first place, never mind that Johnson said there should be a “national conversation” on mandatory jabs. 

There seem to be far more arguments against passports than those in favour (many of which are based on emotional reasoning – “well I like the idea” – and a desire to conform – “well France has done it”). They are divisive, literally separating society into two; don’t completely stop transmission; no one knows where the cut off point for such passports should be (flu?) and will make life complicated and miserable, with large economic consequences. The Night Time Industries Association has already said passes have caused a 30 and 26 per cent trade drop-off in Scotland and Wales, respectively.

Perhaps the most worrying thing, though, is we simply don’t know the long-term impact. Passports are one giant experiment, which we have discussed with all the seriousness of whether someone should change bank accounts.

In general, vaccine passports seem to symbolise a wider issue with the Government, in the Covid wars, which is that it hasn’t completely decided how to be “Global Britain” yet. Post-Brexit it has the opportunity to show the world a different approach to the pandemic; one that respects civil liberties, and isn’t so far away from Sweden’s more relaxed strategy. Instead, we seem to be “Herd Britain”, constantly keeping an eye on what France and Germany are up to, with a view to emulating them.

Either way, something has changed in the equation. The crucial question next week is how the Government groups the votes on “Plan B”. If MPs can vote on vaccine passports as a lone category, it makes it far easier for the idea to be shot down. On the other hand, if vaccine passports, masks and working from home are placed into a single “Plan B” vote, the Government might find all of its plans in disarray; as Bridgen warned “I will vote against any legislation that sees [passports’] introduction“. That, or it’ll be easier to sell to Labour, which is pro restrictions. Whatever the case, we need a cut off point as to how far measures can go; viva the vaccine passport rebels, I say.

Sarah Ingham: People voted to take back control of Britain’s borders – the time is well overdue for some political will

26 Nov

Sarah Ingham is author of The Military Covenant: its impact on civil-military relations in Britain.

This weekend brings the First Sunday in Advent, the start of the liturgical year in the Christian calendar.

For most of us, it signals that other annual rite – the Countdown to Christmas. Shopping! Santa! Sleighbells in the snow! And endless lists: cards to be sent, presents to be given, food to be shopped for. It’s little wonder that those responsible for producing lunch or dinner on the 25th collapse into a Quality Street-Netflix coma on the sofa on Boxing Day.

‘The more the merrier’ is the plucky response to the arrival of unexpected guests. It is Christmas, after all. Time to eat, drink and be merry. There’s plenty of room around the table (‘budge up’) and the garden chairs can be brought in from the shed. Extra roast spuds mean no-one will notice any shortage of turkey, but if it looks like guests might go short, FHB.

Family Holds Back brings us to the vexed issue of immigration, dominating the headlines again with the tragedy in the Channel on Wednesday.

Although immigration is an area of public policy that affects each and every citizen, governments throughout this Elizabethan age have allowed it to become so seemingly intractable that they have frequently appeared to give up on it – or to make maladroit interventions such as the Hostile Environment strategy.

Never mind the 2005 ‘Are You Thinking What We’re Thinking?’ series of election campaign posters, what on earth were the Coalition thinking in 2012 when it signed off the Hostile Environment as a good idea? In 2018, this was blamed for the Windrush Scandal, which continues to cause misery for those affected and blight the reputation of Conservatives.

Further entangling immigration with the always sensitive issue of race is not the most sensible way of resolving a problem which frequently troubles so much of the electorate. This concern peaked in 2014 and stood at around 45 per cent in the months leading up to the June 2016 Referendum, according to IPSOS-MORI’s regular Issues Index poll. After the vote for Brexit, voters were no longer so bothered. As an issue worrying them, it plummeted to 10 per cent in late 2019, the lowest level since March 2001.

This contraction of concern suggests that, while the association between race and immigration looms large in the minds of policymakers – often to toxic effect – most voters are able to decouple the two issues.

Indeed, the electorate could well suspect that invoking racism has long been a convenient if cynical means by which politicians close down any debate on the immigration, perhaps in the forlorn hope that the problem will go away. This was reflected by Gordon Brown during his mask-slipping encounter on the 2010 campaign trail with ‘that bigoted woman’.

In voting to end free movement of people in the Brexit Referendum, voters showed the country of origin of those people was pretty irrelevant. Belgium or Brazil or Benin, who cares? To paraphrase the PM, they issued their instruction: they wanted Britain to take back control of our borders.

Earlier this month, YouGov reported that immigration is once again back among on the public’s agenda, with 73 per cent saying the Government is handling the issue badly. Ministers must brave opponents’ inevitable if hackneyed accusations of ‘dog whistle politics’ (ironically, itself a dog whistle for accusations of racism) and exert some political will.

Voters are alarmed, not just by the tens of thousands of migrants landing on Britain’s beaches in the past year, but by the latest terrorist attack in Liverpool on Remembrance Sunday. The suicide bomber, a failed asylum seeker, was able to game the deportation system for seven years, not least by faking conversion to Christianity. Adding to disquiet is what appears to be an act of hybrid war against the West: the recent weaponization of migration by Belarus, who encouraged migrants illegally to enter the EU via its borders with Poland and Lithuania.

In squaring up to confront immigration, ministers could do worse than re-read the 2019 General Election manifesto. Even the most hardened Corbynista could not object to a system that aimed to be ‘firm, fair and compassionate’. The current apparent free-for-all is grossly unfair to almost everyone apart from people smugglers, but especially to the 27 migrants who drowned off the French coast on Wednesday.

With net migration to the UK standing at 313,000 in the 12 months to March 2020, policymakers should be asking themselves whose quality of life worsens thanks to the current unplanned mess. Hint: it’s not, for example, the residents of Surrey’s ritziest gated communities, who can access private schools, private hospitals, private dentists, private doctors, private carers for their old age and private security guards. Former Prime Ministers with extensive property portfolios also escape the adverse impact of too many people chasing too few resources.

To permit such massive influxes from overseas without providing commensurate public services is have spent the past two decades expecting the vast majority of the British public, whatever their ethnic background, constantly to budge up. Successive governments have not bothered to get in the extra spuds; Family Holds Back seems to have been the overarching policy response – if one indeed exists.

The Conservative party is the party of immigrants, many living the British dream who make a positive contribution to the country. Despite missteps like the Hostile Environment, we are the party of hope, not hate.

The time is long overdue for a government with a near 80-seat majority and a Cabinet which includes Sunak, Patel, Javid, Zahawi and Raab, not to mention ministers Sharma, Badenoch, Cleverly and Kwarteng to take control of immigration

Javid said there would be “no going back” on lockdowns. The Government’s Plan B makes it easier for him to stick to his word.

21 Oct

There’s no going back”, were the words of Sajid Javid, the Health Secretary, in June this year when he was asked about the possibility of more lockdowns.

At yesterday’s press conference, however, members of the media seemed to have other ideas. As Javid laid out the Government’s Plan A – to deal with the challenging winter months ahead – he was grilled on whether harsher restrictions should be introduced. There’s been growing alarm around the number of people testing positive for Covid in the UK, which has recently risen to over 40,000 daily cases, and whether the Government should act faster now.

It is banking on a vaccine booster programme to weather the winter storm. Plan A involves offering additional Covid jabs to around 30 million people, offering healthy 12 and 15-year-olds a single vaccine dose, as well as freely distributing PCR and lateral flow tests. Another important element of Plan A is encouraging free flu jab take-up, as this is something that can put a huge strain on the NHS.

Key to Plan A’s success, as far as the Government is concerned, is public compliance. “We’ve got the jabs, we need the arms to put them in”, said Javid. The message was clear: do your part and we won’t need tougher restrictions. It’s one that the public has heard a few times before.

In general, anyone watching might have had a sense of déjà vu about the Conference. It is not the first time the Government has been optimistic about dealing with winter pressures (we all remember Christmas last year). Similarly, media questions have hardly changed, often hinting that the most drastic interventions should be quickly introduced.

So what can we expect in the months ahead? The big unknown variable is how the NHS will cope with Covid cases and flu, the latter of which is likely to be particularly troublesome – due to people’s immune systems not having been exposed to winter bugs under lockdown. At the same time, the NHS will have to deal with a huge backlog of patients who weren’t seen under pandemic conditions. 

However, we have also seen radically improved treatments for Covid-19. Not does the UK have an excellent supply of vaccines, but new drugs have been developed to combat the virus. The Government’s antivirals taskforce has secured 480,000 courses of Molnipiravir, for instance, which – in trials – has reduced the risk of hospitalisation or death for at-risk non-hospitalised adults with mild to moderate symptoms by 50 per cent. This is an extraordinary achievement, which will make the winter months easier.

It doesn’t seem completely out of the question that the Government might have to escalate its measures – should the NHS find itself under strain for the aforementioned reasons – but it’s worth remembering that Plan B is not as drastic as it has been portrayed. It includes mandatory face coverings and advice for people to work from home, for instance. Perhaps its most controversial element is mandatory vaccine passports, but overall, it is not as strict as some of the initial lockdowns.

And so, the Government has given itself leeway here; presenting Plan B as the tough option. It is something it can introduce, should the calls for it get louder, much more easily than initial lockdown instructions. Around the promise of there being “no going back”, Javid may be able to stick to his word.

Andrew Haldenby: GP shortages won’t be fixed any time soon. So Johnson must embrace doctors’ move to digital.

1 Oct

Andrew Haldenby is Director of Aiming for Health Success, a new health research body.

Speaking last week, Boris Johnson said that it is “only reasonable” that people can have a face-to-face appointment and that some patients will “suffer” otherwise.

The Prime Minister was responding to campaigns run by both The Mail and The Mail on Sunday. The Mail’s five-point manifesto calls for face-for-face appointments to be the default. Going further, The Mail on Sunday has demanded that “all patients are once again seen face-to-face by their GPs”.

Two days previously, Sajid Javid took a very different line. In a speech on the “power of technology”, the new Health Secretary said that while not everyone wants a virtual appointment, “some people do”. The benefits of this and other technologies are “enormous”. He concluded that “we need to give people choice, and take the opportunities that these new technologies provide”.

Javid followed the line taken by his predecessor. Last November Matt Hancock, the then Health Secretary praised GPs for updating their ways of working and allowing more telephone consultations which were convenient for many people. At that time 45 per cent of appointments were by telephone or video which, he said, “feels about right to me”.

The question has political interest because governments need consistent positions, especially on the most sensitive issues such as health. But more importantly than that, the Government’s support or opposition to change in the NHS will determine whether it can make any real progress on the backlog, without further tax rises, in the next few years.

The facts favour the Health Secretary over the Prime Minister. As the graph shows, face-to-face appointments have been the most common mode of consultation throughout the pandemic.

They have also been the most common mode in every month except for April, May and June last year, at the height of the first wave, when face-to-face and telephone appointments were equal. The Mail can call off its campaign – face-to-face remains the default mode of consultation.

Another key fact is the Government’s success or failure in recruiting new GPs. The Mail wants Ministers to honour the 2019 manifesto commitment to employ “6,000 more doctors in general practice”. It won’t happen.

In 2015 another Health Secretary, Jeremy Hunt, pledged to recruit 5,000 more GPs by 2020, on top of the then 27,500. Six years on, numbers have actually fallen to 26,800 as GPs have retired earlier or moved to part-time.

If the Prime Minister thinks that a small army of new GPs will soon arrive to take a new wave of face-to-face consultations, he is badly advised. The truth is that general practice is a limited resource that has to be used most effectively.

The very good news for Ministers is that general practice is in the process of taking a historic step forward in its ways of working. Traditional general practice had many strengths but also major weaknesses. GPs offered a ten-minute consultation regardless of patient need. Patients typically reported their medical history in the consultation which took up much of that time. GPs spent time with patients with relatively minor concerns who could have been better seen by nurses or other staff.

These barriers are being overcome. One key change is to use technology to capture a patient’s medical history in advance, over the internet. Patients now send two million of such “e-consults” to GP surgeries every month, up from around 100,000 before the pandemic.

This already makes much better use of GP’s time because they no longer have to spend time in consultations transcribing patient histories. In addition, current trials are using artificial intelligence to read that information and direct the patient to the right place – whether GP, another member of practice staff, pharmacy, A&E or self-care if that is appropriate. The realistic hope is that GPs can make significant clinical decisions on 12 or 15 patients per hour rather than six. This would solve the problems of delayed diagnosis that is a large part of the backlog problem.

Johnson may respond that this is all very well, but in the short term many people have been shocked by a shift in the GP offer that they weren’t expecting. In other circumstances, these new ideas would indeed would have been introduced over a longer time and with more reassurance. But if he lets these concerns become a veto on change, he will make it extremely hard for the Government to make progress on the backlog.

Javid has the right line. By far the best choice for the Government is to work together with GPs to reassure the public that face-to-face consultations are available and, crucially, that they want a different and better NHS to emerge post-pandemic rather than simply turning the clock back to December 2019. Making the case for change in public services is always a political challenge but in this case it is one well worth making.