Natalie Elphicke: This must be the year in which the small boat channel crossings are ended

4 Jan

Natalie Elphicke is MP for Dover & Deal.

More than 28,000 people came into the UK through the small boats route alone last year. Many lives have been lost. What started as a trickle of boats and a few people has become a booming international criminal business, with ever greater numbers of illegal craft coming in day after day, month after month. Even on Christmas Day, the people smugglers didn’t stop plying their trade – putting even more lives at risk on the English Channel.

The range of departure countries is extraordinary and spans continents. Vietnam in the Far East, and the African countries of Eritrea and Somalia, as well as the Middle East: Iran, Iraq, Syria and more besides. Each of these routes has its own brokers and their own specialities. But they all have in common a clear belief that the UK is easy to break into and even easier to stay in.

Last year, records were broken on every measure. The record for the number of people arriving in a single day, for the number of unaccompanied young people arriving, for the number of people arriving in a month and a year (see here). It was a truly shocking year at the Dover border.

As the numbers have increased, so has the impact. Across the land, hotels, bed and breakfasts, old army barracks and rented housing were snapped up by the Home Office to house the equivalent population of a small town.

In addition, there’s the extra strain on GPs, schools, hospitals, skills and language training, as well as welfare payments. That doesn’t include the millions spent last year on new short-term facilities to hold and process migrants. The traditional facilities at Dover have simply been unable to cope with the numbers now arriving.

It’s not just a matter of money. It’s also one of national security. It is an uncomfortable truth, but one still the same, that not everyone who comes into our country through the illegal channel crossing route wishes us well.

People wanted for serious crimes, including those wanted by other intelligence services, have been detained in Dover as they tried to enter clandestinely by small boat. Not every person who lands on our beaches is picked up. Residents of coastal villages, such as Kingsdown and St Margaret’s, make regular reports of arrivals in the dead on night and in the early hours of the morning. Grown men knock on doors, hide in local woods where villagers walk their dogs, or are picked up by waiting cars and vans.

Beyond money and national security, there is also the question of fairness. It’s unfair to people choosing the right way to apply to come to the UK, when people are able to enter the UK illegally and remain. It’s also unfair to people seeking a way out of poverty, who want opportunity, and who are lawfully resident in our own country, including migrants and refugees who come into the UK through legal routes of entry.

Moreover, the bottom line is that no-one has to make these dangerous crossings. We need to be crystal clear about that. Every person getting into the water is already safe in France, which has an established and responsible asylum system. People are safe in many places before France too, both inside the European Union and elsewhere.

We also need to be clear that there are legal routes of entry into the UK. These are the routes that should be taken. Many people who are making the crossing are fleeing poverty, not persecution. They lack opportunity, not safety. The lure of the UK is predominantly economic. That’s why people borrow and save to pay to come to the UK. It’s an investment in their future.

And right now, there are hundreds of thousands of work visas up for grabs – in a huge array of sectors, including charity worker visas, seasonal worker visas, young persons’ mobility visas, creative workers’ visa, health and social care, HGV, and even amusement arcade work. You can come and work in the UK legally, and millions of people do. But you need to go about it the right way.

There are safe and legal routes for family members, too. Any person with a case for family reunion can make that case on behalf of their relatives in the UK and from the UK. There is absolutely no need for any close family member to be smuggled in at the dead of night.

It is absolutely right that the UK should help those most in need around the world and we do. But encouraging or facilitating people smuggling is not the way to do it. We need to bring an end to the small boat crossings and stop the dangers of people being in the hands of people smugglers and the risk of further deaths on the Channel.

This is the first of two articles by the author on small boats.  The second will be published on this site on Thursday.

Andrew Haldenby: If the Government truly wants to level up Britain, it must improve national health outcomes

22 Dec

Andrew Haldenby is co-founder of Aiming for Health Success, a new health research body.

What does “levelling up” mean for health and the NHS? The Prime Minister’s main speech on levelling up so far referred to differences in life expectancy between regions but stopped there. The forthcoming levelling up white paper could give health much more attention.

Improved health is key to rising local incomes and living standards. Poor health takes older people out of the workforce, reducing local incomes and buying power. It takes children and young people out of school and reduces achievement. From one generation to the next, it undermines the attractiveness of the community to employers.

New Aiming for Health Success research shows that the Red Wall seats have high levels of need in regard to long-term conditions such as asthma, COPD, coronary heart disease and diabetes. As the table above shows, the combined prevalence is close to 45 per cent of the population.

Prevalence of risk factors for disease is also very high. Obesity affects 14.2 per cent of the population and depression 13.8 per cent. This means that more than half of the population is affected by illness, for themselves or for their neighbours.

The data also show that the level of need is higher in the Red Wall than in other parts of the country. The combined prevalence for long-term conditions is around 37 per cent for England as a whole.

These demands point to new services delivered through expanded primary care teams, led by GPs, rather than the over-stressed hospital system. Some local patients are in a revolving door of repeated hospital admissions and very poor results. A&E attendances are twice as high in Red Wall areas.

New services can include personal and intensive programmes for the occupational health of adults, traditionally underserved by the NHS. As a long-term COPD patient said to the research authors: “We are in a rut.”

New programmes would be for people in all age groups who want to get into work including both younger people and over 45s who want to stay in their jobs. They would collaborate with local fitness centres and leisure centres and where needed could involve counselling as well as advice on diet and activity. They can be helped by GPs through social prescribing as a complement or alternative to traditional medicines.

Too many young people in the next generation are growing up with poor health and poor confidence. The child obesity rate at 10-11 years old is 31 per cent in low-income communities. With poor health goes a high absence rate and low school achievement, all of which affects retention of teachers.

Primary care teams can work with local schools and colleges to design some attractive new programmes with additional funding via integrated care systems. These would fund local sports events and organise internships and visits to local sports teams. They would help with reading and maths skills as well as testing for any sight or dyslexia problems. They would show children that somebody minds how you perform and wants to help you to do better.

Local voluntary groups such as the Scouts and other youth groups could also be encouraged to expand their activities. Helping younger people also has positive effects for older people as they can take pride in their positive energies and achievement.

These programmes recommended above could produce results in less than two years. They would increase the local sense of achievement and show results from local initiative. They would also help with the very serious and usually ignored problem of high crime rates among young people.

Speed of delivery is key. In the last few days, Conservative MPs such as Anne Marie Morris have asked in Commons debates why NHS capacity has not been increased in order to help the service cope with the pandemic and prevent lockdowns. Ministers may point to the programme of refurbishment of 40 hospitals but these are massive projects not due to complete until eight years from now on the very best estimate.

To put it another way, two general elections will likely come and go before the refurbishments come on stream. Primary care improvement can happen much more quickly, as well as being more cost efficient and tailored to the needs of the Red Wall.

The other key step to increase capacity is to redirect funds from the NHS to social care and other providers. Care home standards in Red Wall areas are falling and there is a shortage of home care support. As new national figures showed last week, over ten per cent of hospital beds are occupied by people that are medically fit but cannot be discharged. Eliminating that number would be the equivalent of building 25 new hospitals overnight.

A national programme of hospital refurbishment does not speak to the needs of the Red Wall. Boost the new primary care and social care to make a difference before the next election, Prime Minister.

Red Wall seats included in this research

East Midlands: Bassetlaw, Ashfield, Bolsover

North West: Workington, Leigh, Heywood and Middleton

North East: Sedgefield, Bishop Auckland, Blyth Valley

Yorkshire and the Humber: Great Grimsby, Wakefield, Don Valley

W Midlands: Dudley North

The two variables that will predict the extent of the NHS winter crisis. And what we can do about them.

16 Dec

Over the last few weeks, and in the months preceding, there’s been a huge amount of media coverage about the NHS’s “looming winter crisis”. “The NHS staffing crisis is killing people – and this winter it will be even worse”, reads one paper, and you can expect fears to increase as we head towards January, when demand for health services normally peaks.

Clearly there are reasons to be worried about what lies ahead, due to multiple pressures on the NHS, which has been put on its level of emergency preparedness due to the Omicron variant. There’s the strain caused by the “twindemic” of flu and Coronavirus, both of which flourish in winter; the fact that millions of non-Covid procedures, including operations, have been scrapped to ensure that GPs and otherwise can focus on urgent needs and vaccinations; and there are staff shortages too. It’s estimated that the NHS has a shortfall of up to 100,000 employees in total, with vacancies for medical practitioners rising 15 per cent in the last year and seven per cent for nurses. 

Are we about to head into one of the worst crises on record? When I ask Dr Raghib Ali, Senior Clinical Research Associate at the University of Cambridge and a consultant at Oxford University Hospitals, where we are on a timeline of events, he replies “If you mean [by a crisis] ‘will the NHS not be able to deliver all services, as was the case in both the first and second waves, then that is likely – in fact, it’s already happening to an extent because some elective services are being cancelled in some places.” He explains that “the NHS is under a lot of pressure now because of non-Covid… we’re much, much busier than we were certainly in the first wave and, to an extent, even the second wave.”

Ali believes that there are a number of variables that will influence what January looks like. One is how big the backlog is of a) the people who avoid coming into hospital around Christmas and b) those currently staying away, in their own “voluntary lockdown”.

The crucial factor, though, is how effective vaccines are against hospitalisations for the Omicron variant. In short, the less effective, the more hospital beds will start to fill up. Ali says that we should have the hospitalisation data in around one to two weeks, which will mean SAGE – and the Government – is far more able to predict what kind of winter the NHS is in for, and whether it should take preventative measures.

Should the worst outcome prove true (that hospitalisations increase rapidly as a result of Omicron), expect Keir Starmer to use this to argue that the Government did “too little, too late”, even though he knows Boris Johnson would have an extremely challenging time trying to get any more restrictions through (judging by Tuesday’s vote). Were the Labour leader to be granted a vote on the measures, which he’d probably vote through, he could still take the view that they were introduced too late or not enough, as a means to knock the PM.

When I ask Liam Fox, also a doctor, about where we are in the “crisis” timeline, he says we have a chronic problem of under capacity. “I think the question we have to ask is why is it that the NHS seems at almost all times of the year now to be in what we used to call a winter crisis, and what does this tell us about the capacity of the system and the way it’s being run?” 

Fox cites two major factors that are destabilising the system. One is that “the NHS runs at a bed occupancy rate that is too high” which “leaves it lacking resilience” if demand changes suddenly (e.g. Covid patients increasing).

The other is medical practitioners’ “lack of ability to discharge patients who don’t need to be in hospitals” partly due to the closures of community hospitals and respite care – particularly in the 90s. He says that “we’ve been obsessed with increasing high-tech medicine, without considering convalescence as a concept”, which is – in turn – leading to imbalances in healthcare.

Similarly, Ali believes that part of dealing with NHS pressures means working out how to physically discharge patients (who have been medically discharged), who don’t have support afterwards. He believes that key to solving this is better funding for social care; and that this would be economically wise, too, as the cost of hospital beds being taken up by medically discharged people is probably more than the cost of paying social care workers more (who can look after them).

The Government has made a start on tackling this area. Hotels have been transformed into temporary care facilities, for one, and workers from Spain and Greece have been flown in to take care of patients. It seems ministers are well aware of some of the main ways to relieve the strain on the NHS, but they will come under pressure to create reforms for the long-term.

In conclusion, it’s impossible to predict whether the NHS was justified to move into its highest level of emergency preparedness, mainly due to the unknowns about the Omicron variant, which – in the best case scenario – could be highly transmissible, but less severe than others. There’s also the booster jab programme, whose success could radically change the situation. But the Government does know what structural remedies can help it avoid, as one paper put it, “the worst winter.”

Roger Gough: Levelling up. We need to move from country deals to county relationships.

1 Dec

Cllr Roger Gough is the Leader of Kent County Council

Levelling up, seen initially as a nebulous, impressionistic concept, is starting to take shape. In his speech in July, the Prime Minister emphasised the importance of counties as well as traditional urban and industrial areas, in achieving it. Michael Gove heads a new levelling up department. The White Paper is reportedly imminent.

The Guardian is not the typical place for a Conservative government’s foundational text, but Neil O’Brien’s October article established four key elements: strong local leadership; growth in the private sector and in living standards; extending opportunity and good public services; and restoring local pride.

Why did the Prime Minister put such a focus on counties? In part, because shire counties, even in the south east, are not homogeneously leafy and prosperous. The ‘core cities’ focus of much development and regeneration policy in recent decades has, whatever the other arguments in its favour, neglected smaller towns, rural and coastal areas.

In addition, counties can operate at a big, strategic scale while carrying a strong sense of identity and accountability. In some cases, though not all, they share boundaries with other major public services. It is a strong combination.

All of this is true in spades for us in Kent. With a peninsular geography, a history stretching back to a Saxon kingdom, its Garden of England identity and a population bigger than eleven US states, it is a big and distinctive place. People take pride in living here. Historic Kent – made up mostly of the Kent County Council area, but also Medway unitary authority – is coterminous with the emerging NHS Integrated Care System as well as police and fire.

And Kent has its own profound needs for levelling up. On most indicators, the county comes close to the national average. However, this average masks a gulf between centres of prosperity (many, though not all of them in the London hinterland) and deep deprivation, especially in a number of coastal communities. By levelling up living standards and life chances within Kent, we can not only provide a huge economic and social boost to local towns and communities; given the size and scale of the county, we can make a significant contribution to levelling up nationally.

So far, the small number of county deals that may be announced at the time of the White Paper have reportedly been quite individual and bespoke (full disclosure – Kent is not one of them, though like most counties we have been exploring the implications of levelling up and county deals with government). The White Paper should, however, establish more common parameters, even if there remain (as there should) elements that reflect distinct local needs and identity.

The building blocks of devolution deals seen in mayoral combined authorities provide a starting point: transport, business support and economic development, adult education. I would extend the latter much further into the wider area of skills; not only is this an area in which Kent has significant gaps to close, but the damaging effects of nationally driven policies and funding streams in undermining local collaboration and generating mismatched skills to the needs of local business are well documented. Locally, we have built strong partnerships that can deliver.

On transport, we need to deliver the shift from counties just being a highways authority to becoming a full transport authority. It is neither fair nor sensible that metropolitan areas are able to fully integrate transport when the need for better integration is starker in more rural areas, where a lack of affordable transport between towns and communities limits connectivity and economic opportunity, and sustains dependency on car usage for quality of life. For both transport and economic development, there is a need to switch to devolved funding settlements over a number of years rather than the current merry-go-round of bidding systems.

Delivery of infrastructure is also vital, even if a little separate from levelling up strictly defined. For counties (and especially a county such as Kent, which has had exceptionally high rates of housing growth) the detachment of planning and infrastructure over the last decade, and the funding and distribution of developer contributions have not worked.

Hopefully, the rethink of housing projections by the new Secretary of State will ease some of the pressure on south-eastern counties; but that remains to be seen, and where development does take place, the need to deliver properly funded infrastructure first, remains a clear articulated demand from our residents. The logical conclusion from all this is the need, not only for changes to the developer contribution regime, but for a more strategic approach to spatial planning.

Delivering on net zero and on climate change resilience and adaptation presents distinctive challenges in predominantly rural areas, ranging from the viability of public transport to vulnerability to flooding. Kent and Medway have developed robust and far-reaching plans, but a comprehensive approach to the issue will have to draw together transport, strategic planning, skills, economic development and more.

Finally, county deals should be the catalyst for a new strategic partnership between national government and local leadership, so that when a matter of local importance also has national significance, the two can address the issue together systematically.

For Kent, that is our border with the continent and the massive volume of trade, as well as passenger traffic that passes through it and across the Short Straits. This has been and remains a point of vulnerability for both the county and the country, seen most sharply (and for some Kent communities, traumatically) when the French authorities closed the border in the days before Christmas 2020.

National and local authorities worked together remarkably effectively to prepare for the end of Brexit transition. Now, however, there is no one deadline to work to, but a series of continuing changes at the border, and an ever-present vulnerability to disruption with some of the special measures and capacity available a year ago no longer in place.

That effective local-national operational partnership to deal with a specific event needs to take on a standing, strategic form. This can then develop the measures (in road and border infrastructure, lorry holding capacity and much else) to reduce the vulnerability of both Kent and the UK to shocks and disruptions in the Short Straits.

None of this simply makes asks of national government; it presents challenges for counties too, above all in terms of governance and capacity.

The first is sometimes taken as code for a directly elected or mayoral model. But it need not be so; some of the arguments (stability, convening power, accountability) seem to be set up against a straw man of weakly-led councils, perhaps under No Overall Control. The reality is that much council leadership is at least as stable and durable as national leadership (and much more so than typical ministerial tenure) and a large strategic authority can convene very effectively.

Less talked about is the question of capacity; that councils are able to discharge a stronger strategic role when they face huge budget and managerial pressures from demand-led services such as adult social care and children’s services. There is no simple answer to this, but councils have to make a conscious choice to commit money, time and thought to this when all those resources will feel more than spoken for already.

The corollary is that county deals have to be a relationship with the whole of government, not simply with individual departments; it is only through this that central government will be able to understand and support the choices that councils have to make.

Andrew Gimson’s PMQs sketch: “Is everything OK, Prime Minister?”

24 Nov

There was a better turnout of Tory MPs this week than last, and they raised a cheer when Boris Johnson came to the Despatch Box.

But the cheer sounded faintly ironical, and Sir Keir Starmer looked much happier than he usually does, and also more dangerous.

In place of the pious, up-tight, North London human rights lawyer, we had the man in the pub, enjoying the chance to tease a loud-mouthed regular whose claim that “nobody would have to sell their home to pay for care” had just been exploded.

“No, Mr Speaker,” Boris Johnson protested, and gave a longish reply which included the words “deferred payment”, but which did not quite seem to dispose of the charge made against him.

“I see they turned up this week,” Sir Keir said as he gazed with a smile at the Tory benches. Soon he was remarking of the PM in a relaxed tone, “who knows if he’ll make it to the next election”, and wondering, “if he does”, how he expects “anyone to take him and his promises seriously”.

Patronised by a lawyer! Johnson does not like having to testify to his own seriousness, so instead set out to show that Sir Keir cannot be taken seriously, having campaigned against HS2.

“Mr Speaker,” Sir Keir rejoined with another infuriating smile, “I think he’s lost his place in his notes again.”

Soon he added the question put to Johnson by a journalist after the Peppa Pig speech: “Is everything OK, Prime Minister?”

How Johnson would have enjoyed this, had the roles been reversed, and he was the one quoting the most wounding taunts from recent days.

As it was, he just had to soak up the punishment and indicate by his smiling demeanour that he was not in the slightest bit hurt by these jibes.

Beside the Prime Minister sat Rishi Sunak, the Chancellor of the Exchequer, in a black mask which made it impossible to see what he thought of his leader’s difficulties.

Richard Holden: It’s time for the Government to make more of Tory MPs’ achievements and fewer errors itself

23 Nov

Richard Holden is MP for North West Durham.

BBC Studios, Newcastle-Upon-Tyne

Everyone gets that it’s the job of the Her Majesty’s Opposition is to oppose, but its leader seems to have taken this to another level in recent weeks.

Not long ago, Keir Starmer was calling for HS2 to be scrapped. Now he’s saying it’s not going far enough. Captain Hindsight is probably wishing that he’d had a touch more foresight on this one.

At the same time, Labour deride the £96 billion investment in new rail infrastructure in the midlands and north as a ‘betrayal’. They conveniently skirt the markedly different records of the main political parties: Labour in 13 years managed 63 miles of new and electrified track. The Conservatives have managed over 1,000 miles, with hundreds of miles more of new and electrified track on the way.

All the above is important – but to my constituents feels too often like political knock-about. I endured it on BBC Politics North East this weekend up against Labour’s Ian Lavery. The record is useful for highlighting Labour’s duplicity, but not much else. And I can’t quite understand how the Government ended up wrong-footed on some of the biggest investment in the big picture in decades.

Drill down a little, and what my constituents are after is regional connectivity. Trains connecting major cities – the spine of the network – are great, but if you’d can’t plug into one of those hubs then who, in an area with no trains and a limited bus service, cares if it’s happening?

That’s the message from so many parts of the country who are interested in what’s happening to the ribs off the spine: they want to see some meat on them. For my constituents, it’s the real test on public transport delivery in our local areas – particularly in relation to buses, which the Government is doing so much work on – not the Westminster dance that the media obsess over.

This week, the Bubble has turned its collective attention towards Health and Care Bill – which delivers on another of our commitments, of the kind that governments of all shades have dodged for decades.

For this MP, the Bill also contains some important measures that I’ve been campaigning on for over a year that you won’t see splashed broadly across the mainstream media.

The Department of Health has taken up the mantle of my private members bill from the last session, and is going to ban so called virginity testing not just in England and Wales, but across our United Kingdom.

I cannot tell you what this means to campaigners from IKWRO Women’s Rights Organisation, Karna Nirvana and MEWSO – and their supporters – who have been banging the drum for change for years on women’s rights in this respect for years.

Too often, we think that issues around women’s rights have been solved, but it’s clear that there are major areas in which that just isn’t true. Banning the pseudo-science of so-called virginity testing is a good step in this area, and I have received assurances from Ministers that we’ll see hymenoplasty banned, too, in this piece of legislation – with amendments to be introduced in the Lords along the lines of my probing ones that have been backed by many MPs in the Commons.

Sajid Javid has been a true champion in this field, too, and picked up the mantle of ending under-18 marriage while on the backbenches . My colleague Pauline Latham has taken this on following Javid’s move back to the Department of Health and Social Care, and the initiative looks likely to progress soon.

With so much of the social policy debate space being taken up by arguments around trans rights in recent years, we too often forget that there are major issues around the rights of women and girls that need to be sorted out, too.

Another prime example is the campaign being led by Alex Stafford and Nick Fletcher down in the Rother Valley and Don Valley – demanding action in response widespread allegations of grooming gangs and child sexual exploitation in their towns and villages. The local Labour authorities have been, yet again, slow to act.

Time and again, when it comes to the rights of women and girls, it’s Conservative MPs leading on these battles. Fights that have been abandoned by Labour MPs (with some notable exemptions) who, long ago, became sadly too frit to take on the most socially conservative elements of British society.

On the ground in our constituencies and in Parliament, it’s backbench Conservatives leading the charge in so many areas – from levelling-up and fighting for better connectivity to the rights of women and girls.

At a national level, it feels like the Government is missing chances to highlight the good work that such Conservative MPs are doing. And that it is making a few too many unforced errors – especially when it comes to selling the positive changes we’re making for the country.

We got Brexit done. We’ve delivered the fastest and one of the most comprehensive vaccine programmes of any developed nation, and supported jobs and business through the pandemic. Employment is now higher than pre-pandemic, and we’ve got record vacancies in the economy. We are now delivering record investment in our transport infrastructure, our NHS and, at the same time, have a clear plan to get waiting lists, debt and taxes falling in the medium term. Conservative MPs are leading the way on major issues of social policy on the national level and in their communities – working day and night to deliver the investment they need.

The Opposition hate it and are led by a central London lawyer who does not understand, never mind connect with decent working Britain. And the media are, naturally, interested in the people rather than the policy. But we’ve got a great story to tell. No one will do it for us. It’s time to regain the initiative, and relentlessly make the case for conservatism.

Jeremy Hunt: My move today to ensure that we train enough doctors and nurses for the future

23 Nov

Jeremy Hunt was Health Secretary from 2012-2018, and is MP for Surrey South West.

Today, I am hoping to persuade the Government to change the new Health Bill to deal with the workforce crisis in the NHS.

As Health Secretary, I came to realise that extra money for the NHS and care system will never have the intended results unless there are enough trained staff to do the work needed.

Since it takes seven years to train a doctor and three years to train a nurse, this problem cannot be solved overnight: you need long term planning, which is all too often absent from our system.

My amendment to the Bill does not require the Government to spend a penny of extra money – but simply to publish regular, independent estimates of the number of doctors and nurse that we should be training in every specialty.

To date, the Government has resisted, on the basis it is ‘not necessary’. The facts tell a different story: the Royal Colleges say that we need 500 more obsetetricians, 1400 more anaesthetists, 1900 more radiologists, 2000 more midwives, 2-2,500 A & E consultants, 2, 500 more GPs and 39,000 nurses – and that we need them right now.

Overall, we have 93,000 vacancies in the NHS. Our brilliant frontline staff are starting to leave their jobs because of what is called ‘burnout’ – and the more that happens, the worse the problem gets for the people left behind. The pressure, particularly in emergency care and general practice, is now unsustainable.

Some will quite reasonably ask whether I could not have done more on the issue when I was Health Secretary. The answer that is I did – setting up five new medical schools and increasing the number of doctors, nurses and midwives we train by 25 per cent, the biggest single uplift ever.

But that decision, announced in 2016, has not yet led to a single additional doctor on the frontline because of the seven year timescale involved. That is why we need a better approach.

Inevitably in spending negotiations between the Health Secretary and the Chancellor, the number of doctors we will have in a decade’s time is less of a priority than immediate challenges such as the pandemic backlog. Exactly that happened this autumn when, even after the Budget, the settlement for Health Education England, which funds training, has not been settled.

So we need a new discipline in the system to make sure that we are always training enough doctors and nurses for the future. In the past, immigration was a ‘get out of jail’ card on this one but no longer: the World Health Organisation says there is a global shortage of two million doctors and 15 million nurses. We are not the only country with a backlog.

Some in Government are worried that it will cost more if the new body recommends a big increase in the number of doctors we train. The truth is the opposite: we spend about the same as France as a proportion of GDP on health as France and Germany, but with many fewer doctors per head – because we pay through the nose for locums. Every extra doctor we train will help bring down our annual £6 billion pound bill for locum and agency staff.

I have pressed the case in Parliament with the Prime Minister on three occasions now, including at last week’s Liaison Committee when he promised to consider it. The change has been recommended by 50 NHS organisations including every Royal College and even the BMA who were not, let’s be honest, my greatest supporters when I was Health Secretary. It has been recommended in countless select committee reports.

I have total confidence that this change will be made because it is the right thing to do, but every month or year we wait is an additional period of despair for NHS staff. We cannot solve the workforce crisis in the NHS overnight – but we can at least give hope that a long term solution is in place. Surely after the two years we have just had, that is the very least we can do.

David Gauke: Oomph and optimism don’t always vanquish the doomsters and gloomsters

22 Nov

David Gauke is a former Justice Secretary, and was an independent candidate in South-West Hertfordshire at the recent general election.

Being in Government is fabulous. You get to decide what to do and then can implement those decisions, making (what you hope) is a positive difference to large numbers of people. It is what politics should be all about.

This power is not, of course, unqualified. I was fortunate to have nine years as a Minister but, throughout that period, the Governments in which I served faced significant Parliamentary constraints (in turn, a Coalition with the Liberal Democrats, a small majority and finally a minority Government) as well as a precarious fiscal situation, especially in the early years. We were not always able to do what we wanted.

You could have been forgiven in thinking that all this was in the past. Boris Johnson won a very comfortable majority in 2019, and he has always been clear that “austerity” was behind us. This was a “Take Back Control” Government that was going to deliver on the people’s priorities. Enough of the stalemates and gridlocks, the dither and delay. Now it was time to get things done.

What the last three weeks has shown, however, is that the limits on the powers of government have not gone away. All of a sudden, there are six instances when the constraints have become very visible.

First, the Government’s current travails began with the woeful handling of the Paterson affair, about which I wrote on this site a fortnight ago. The Parliamentary manoeuvre which it attempted – establishing a new cross-party committee – required other parties to participate.

Sensibly (and entirely predictably), the other parties refused to participate, leaving the Government with a problem. In addition, the whole proposal was so obviously objectionable that there was a sizeable Parliamentary revolt from the Conservative backbenchers, with the Government’s majority reduced to just under 20. These two Parliamentary factors meant that the Government had to abandon its approach.

Fiscal considerations have played a role in the second third cases which emerged last week. The Government’s plans for rail and, in particular, the abandonment of the eastern leg of HS2 and the scaling back of Northern Powerhouse Rail has provoked much opposition.

As Tim Pitt, a former Treasury Special Adviser, has pointed out, capital spending for the forthcoming years is remarkably high by historic standards, but the Government still has to make choices. Ministers have reached the conclusion that there are better ways of spending this money than delivering on their promises on these two projects.

This might be a reasonable assessment (I questioned the business case for the eastern leg of HS2 when I was Chief Secretary to the Treasury), but the problem is that these promises had been made and reiterated by the Prime Minister.

The row over social care is also tricky. Even after the announcement of an increase in National Insurance Contributions (which will become the Health and Social Care Levy), there are still choices to be made, and the Government has chosen to take a tougher approach to the means test than expected.

Personally, I think the Government has got its priorities wrong on social care (I believe that we should ask more from those with large estates who face social care costs), but any government has to make choices. Again, the problem is that the new approach falls below expectations.

In both cases, the Government cannot prioritise everything (even if it has a tendency to promise everything). Tough choices have to be made.

Of growing political salience is our fourth example: migrants crossing the Channel in small boats. This is the sort of thing that was supposed to stop with Brexit, apparently (for reasons that have never been clear), and it leaves the Government unusually vulnerable to an attack from the Right.

What could be more damaging to it is the sense of powerlessness. It is not obvious that the Government knows what to do about the problem, hence we have a different story each day as to what could be done (including processing asylum applications in Albania, which came as a surprise to the Albanians).

No Government could find an easy solution to this issue. Some might try building a close and co-operative relationship with the French; this Government tries haranguing them instead. It is not clear that this is working.

Whilst we are discussing diplomacy, the ongoing negotiations over the Northern Ireland Protocol demonstrate that this Government does not always get what it wants (even in the oven-ready deal that it put at the heart of its general election campaign and which it has ever since tried to rewrite), and this constitutes the fifth case.

By the looks of it, the Government is backing away from triggering Article 16, which is just as well. This would have resulted in a trade war which would have disproportionately damaged the UK economy and left us isolated from the EU and US. After a lot of huffing and puffing, the Government looks as if the role of the European Court of Justice is not quite so central, after all.

The sixth and final example is the non-appointment of Paul Dacre as chair of Ofcom. Having clearly encouraged him to apply, refused to accept his rejection by the interview panel but changed the remit of the role to increase the chance of him being viewed as appointable, the Government went to great lengths to get their man.

Dacre, however, has declared that he has had enough and withdrawn his application, complaining about how someone “from the private sector who, God forbid, has convictions” was never going to be accepted by the civil service “Blob”.

As it happens, the original interview panel was predominantly made up of people from the private sector. and it would be entirely reasonable if they concluded that Dacre’s strong “convictions” sat uneasily with chairing a regulator that holds the ring on broadcasters’ bias. An independent public appointments regime is a necessary check and balance and, ultimately, the system worked as it should have done.

Bring these cases together and a pattern emerges. The Government wanted to protect Owen Paterson, build the eastern leg of HS2 and the cross-Pennine rail line, ensure no one has to sell their house to pay for social care, stop migrants arriving here in small boats, remove the jurisdiction of the European Court of Justice in Northern Ireland, and appoint Paul Dacre as Chair of Ofcom. For one reason or another, it is not able to do any of those things.

Does this reveal that the Government is close to collapse? No, it does not. Governments do not always get their way and, as I have written elsewhere, I think the great likelihood is that Boris Johnson will lead the Conservatives into the next election (and, as it happens, I think he will probably win it).

To some extent, this is all just reality reasserting itself. Being in Government is fabulous, but it is also hard. It involves trade-offs and prioritisation and compromise. Not every problem is solvable; not every call can be answered. You do not always get your way.

The problem for the Prime Minister is that much of his considerable voter appeal has been to dismiss the pettifogging concerns of the doomsters and gloomsters. Complexity is for wimps. So-called problems are merely trivialities that can be overcome with a bit of oomph and optimism.

This certainly raises expectations. As these six recent examples demonstrate, however, it does not reflect the realities of governing. Eventually, reality – whether political, economic or diplomatic – prevails.

Emily Carver: Our nation’s biggest shortage may not be HGV drivers or turkeys, but optimism

13 Oct

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

We Brits love to catastrophise. If we’re not fretting over Christmas turkeys, we’re brawling at the petrol pumps. Meanwhile, Insulate Britain campaigners are gluing themselves to the motorway in fear of a climate Armageddon. Situation normal. We clearly like a good disaster – or, at least, the prospect of one.

Over the course of the pandemic, there’s been an insatiable appetite for bad news (not helped by large parts of the media who are incentivised to stoke panic). Indeed, our national state broadcaster continues to play on fears that children still aren’t safe in schools, despite vanishing evidence to the contrary – the risk of death from the virus is estimated to be one in 481,000 children.

Then there are those who, even now, can’t accept that we have left the European Union (and that the chances of us re-joining are even lower than Nicola Sturgeon giving up her dream of breaking up our own Union). In their view, our woes – from pandemic-induced HGV driver shortages to the energy crunch – are all down to Brexit. 

It seems that every problem we face is a “crisis”, but does the reality really warrant this level of angst? 

Doubtless the economy faces a multitude of challenges. Labour shortages, a rise in inflation, and a cost-of-living squeeze have all led to claims that we are heading for a “winter of discontent”.

Couple this with long-term, long-standing concerns, such as a healthcare system that is creaking at the seams, a social care system that desperately needs reform, and a record tax burden only seems to be heading in one directionit would be disingenuous to suggest we’ll sail through the next six months.

So, a dose of optimism: many of the ghastly predictions that have been splashed across our front pages, thankfully, have so far been proven incorrect. 

We were told by the Office for Budget Responsibility that the jobless rate could reach levels not seen since the 1980s. Even a cautious reading of yesterday’s strong employment data – which puts last month’s jobless rate at 4.5 per cent – show that is highly unlikely to come to pass.

It’s still early days, and many workers have just entered post-furlough limbo, but it looks as if we may have managed to see off the threat of mass unemployment.

Not all of those who lost jobs during the pandemic will become HGV drivers or baristas. But our flexible labour market should allow swift matching for many. As for the ongoing supply chain issues, we are far from Soviet-era bread shortages with the corresponding rationing.

This is not to deny a problem exists, but nor will Christmas dinner without pigs-in-blankets grind our economy to a halt. And it is a global issue, a predictable consequence of lockdowns and we’ve had an economic rebound far swifter than many foresaw.

Misery may sell newspapers, but after 18 months of stop-start-stop lockdown restrictions, perhaps the message should be that human ingenuity and the power of private enterprise have helped prevent economic collapse – indeed the vaccination can be seen to be, in many ways, a victory for capitalism.

While catastrophising may give some of us sleepless nights, it can do something far worse to politicians. Certainly, concern for the future of our planet is natural and worthy. We should consider ways in which behaviours can be adjusted to mitigate certain risks. But climate alarmism has left policymakers itching to do something and, partly as a result, our energy market has become an unholy mess.

We are now heading into COP26 against a backdrop of spiralling energy prices and accusations that government isn’t being honest with the public over the cost of Net Zero. The Chancellor himself admitted at Conservative Party Conference “You can’t put a figure on it”.

But insisting that our country is going to go to hell in a handcart leads to bad policy and forgets one crucial thing: the ingenuity of businesses and individuals to overcome seemingly insurmountable obstacles.

If we’ve learned anything from the past year and half, it’s that we have the capacity to overcome adversity – from scientists who speedily devised a vaccine that will likely save millions of lives, to supermarkets that corrected their disrupted supply chains in record time, to small business owners who adjusted their business models to survive lockdown.

While I’m not quite advocating the bombastic, it’ll-be-alright-on-the-night attitude of our Prime Minister, let’s stop panicking. The world isn’t going to end – even if we do end up having to swap our turkey for chicken come December.