There has been a ‘write-in’ campaign against the ‘intrusion’ of private sector providers into the NHS.
It’s an old ideological battle that dates back to when Barbara Castle was Secretary of State.
The reality is that most of our interactions with the NHS are through private providers because overwhelmingly our GPs are private contractors.

As it happens I‘ve received a batch of statistics from ministers which measure improvements in the NHS.
We are spending record sums on it, more in fact than any political party ever promised and our health expenditure compares favourably with other wealthy nations.
Notwithstanding to-day’s alarm from the GMC that our doctors are about to depart for the antipodes, the plain fact of the matter is that there are now more clinical staff -doctors and nurses- working in the NHS than ever before in its history. This includes an additional 50,000 nurses added since the last election.
In Local terms the statistics are that Hampshire & Isle of Wight Clinical Commissioning board has been allocated £3.43 billion for 2024/25.  In the Southampton University Hospital NHS Foundation Trust, which serves most of my parliamentary constituency, there were 124 more full-time-equivalent doctors and 274 more nurses in September 2023 than there were in September 2022.
I could go on, but all these statistics are all about inputs. What is of concern to patients is the outputs: the number of successful treatments and appointments. In this respect the NHS lags behind the performance of comparable healthcare systems in other wealthy nations where survival rates for many conditions are better and waiting times are shorter.
We kid ourselves with the mantra that we have the best healthcare system in the world. Were it so, it is surprising, that nowhere else in the World has anyone copied it.

Over my time in Parliament, in opposition and in government, numerous clinicians have come to give me their insights about NHS. With few exceptions however, they have been short on remedies to fix the systemic problems that they identify.

I am certain that politicians, irrespective of party, are amongst those least qualified to run the NHS.
Accordingly, the whole thrust of Policy from 2010 was to take the politics out of it through the creation of NHS England, a body largely independent of government. Let politicians determine how much the nation can afford to fund the NHS, but let the professionals run it.
Alas, such is the nature of our politics that whatever goes wrong in the NHS, ministers will get the blame. Increasingly they now find that, despite being blamed, they have few levers to pull -having handed so much of the power over to NHS England.

Symptomatic of our political focus, in Parliament I find that every week I am inundated with invitations to attend meetings and receptions organised by all-party parliamentary groups (APPGs) campaigning for more NHS resource for their own particular disease (there is such an APPG for every known medical condition, perhaps with the exception of rigor mortis). Badgering politicians is no way to determine clinical priorities.

As to my own remedy, I think the NHS is far too big to be manageable – it’s the world’s largest employer, its culture is too bureaucratic and too centralised, it needs to be broken up and made much more locally accountable; it must become much more flexible and nimble in using the private sector.
Wes Streeting, Labour’s Shadow Secretary of state says he won’t let ‘middle class lefties’ interfere with his own plans to make use of the private sector… Well, good luck with that.

Understandably, I’ve received a large number of emails regarding arms exports to Israel following the fatal attack on the World Central Kitchen relief workers.

Since 2015, the UK has licensed at some £500 million of military exports to Israel.   These have included components for F-35 stealth bomber aircraft, components for Israeli armed and surveillance drones, and military intelligence and technology.
The case for these arms sales is twofold. First, Israel is a strategic ally in an unstable region where UK vital interests are at risk. This is particularly so, with respect to Iran, the region’s principal troublemaker, and exporter of terror (as we’ve seen again just last week in London with an attempted assassination on an Iranian Journalist).
Second, modern Israel has, since its creation in 1948, had to fight wars launched by hostile surrounding states determined to end its very existence. It has also been subject to continuous terrorist attacks and hostage taking, of which the 7^th October last year was the most brutal. We would have failed in our obligation to our friend and ally had we withheld armaments with which to defend themselves.

Hamas is a terrorist organisation dedicated to the complete destruction of Israel and its replacement with an Islamic State of a particularly unpleasant kind. Hamas is also the Government of Gaza. Therefore, a proper and lawful retaliation by Israel in response to the 7^th October attack by Hamas, inevitably involved a military assault on Gaza with brutal consequences for non-combatants. Hamas will have been well aware of these consequences when it planned its attack on Israel. Furthermore, Hamas’s military doctrine has always involved using its civilian population as a human shield. That is why it operates from schools and hospitals. And that is why it ordered the population not to comply with Israel’s warning to evacuate south of Wadi Gaza before the first Israeli Defence Force incursion into Gaza City. The ghastly misery of Gaza is first and foremost a calculated result of the actions by Hamas, with the intention to radicalise and recharge fighters for another generation.
In my estimate Israel has fallen for Hama’s strategy of radicalisation by its wholly disproportionate response and apparent disregard for non-combatants, with all the possibilities now  arising from a new generation full of hatred.

Notwithstanding some pretty suspect casualty statistics from Hamas-controlled sources, and some frightfully shoddy reporting by the BBC and others, nevertheless we can see from our own TV screens, from independent reporting, from the experience of aid workers, and from the dire reports by the United Nations, that the suffering of the civilian population is intolerable.
For months UK diplomacy, together with the USA, has sought to restrain Israel. We have demanded more access for humanitarian aid; we have demanded military operations which take much greater care to protect civilians and reduce collateral damage. We have deployed all the influence that we have as friendly powers. There comes a time however, when we have to do more than say that we are very concerned, or even very cross. At some stage we have to hold Israel to account for its misjudgements and the way that it is operating.
I think that a temporary suspension of our arms sales would now be a salutary, if not overdue, way of indicating to Israel the measure of our dismay.

Further to what I said in this column on 14^th March :Voting on Assisted Dying (desmondswaynemp.com)
The US State of Oregon is often held up as the example of ‘best practice’ for a jurisdiction that has enabled assisted suicide.

It has released its data for 2023. Some of it rather disturbing.

The full report is at Oregon Death with Dignity Act: 2023 Data Summary but here are some highlights

Complications: Just under 1 in 10 deaths had complications (9.8%) including 8 regurgitations, 1 seizure, and 1 listed as ‘other’. However, no data was provided for 72.2% of the total 367 deaths in 2023, meaning the form was left blank by the healthcare provider present. 

Reasons for Applying: Since 2017, on average 52.1% of applicants have applied because they felt like a burden. Interestingly, ‘Inadequate pain control’ ranks far lower as a reason for wanting an assisted death. 

Length of Death: Oregon has sadly set a new record for the longest assisted death. In 2023 it now stands at 137 hours – 5 days and 17 hours after ingestion.

Mental Competency: A tiny 0.8% of applicants were referred for psychiatric evaluation. This means only 3 people the whole year were queried for having sound mind to make the decision to end their life. 

 

I don’t think any of this is an advertisement for what is euphemistically now referred to as ‘dignity in dying’. Putting ethics and principles to one side, can the process of ingesting lethal drugs ever be straightforward?

*

As a wild swimmer I have a particular interest in the Environment Agency’s statistics for spills from storm overflows published today. The bald figures are quite disturbing but, having swum 4 times per week throughout the reporting period, I’ve never come across a turd and I’ve never been ill.
There has been a 56% increase in sewage spills in 2023 compared to 2022. How do we know this?
We know it because 100% of storm overflows are now continuously monitored. In 2010 when Conservatives came into government only 7% of them were monitored. Previous administrations weren’t even collecting the data and so had no handle on the size of the problem. Now we know and we can take effective action.
Storm overflows are a legacy of our Victorian sewage system where rainwater drains into the same sewers as our lavatories. But not all storm overflows result in a sewage spill, that only happens either by accident or, when deliberate, to avoid sewage backing-up to our lavatories.
Because the system is shared with rainwater, to be fair, the weather is bound to be a major factor influencing the statistics. 2023 was the 6^th wettest on record, compared to 2022 which was the 8^th driest.
The Government requires the water companies to make the necessary investment to end sewage spills. There has been a fourfold increase in inspections with 500 additional staff to carry them out.
Since 2015 the Environment Agency has concluded 60 prosecutions resulting in £150 million of fines from the water companies.

Sorting this legacy is going to take time, but this is the first government to get the measure of it and address it

The criminal Justice Bill will shortly return to the Commons for its report stage.
The difficulty for any government bill is that, as far as its scope permits, it may become a ‘Trojan Horse’ attracting amendments that it was never the Government’s intention to include when the bill was originally drafted.
The current bill was never intended to be an Abortion bill, but New Clause 1 at report may well make it so.
This clause would make it lawful for a woman to end her own pregnancy at any stage right up until birth. Clinicians, pregnancy services and any healthcare settings  however, would remain bound by our present abortion laws which currently restrict terminations to within 24 weeks of pregnancy (except where specific exceptions apply). Given that 40% of abortions now take place at home with self-administration of what is referred to as ‘telemedicine’, the measure would introduce a two-tier system whereby a woman, acting on her own, can lawfully dispose of her unborn child right up until just before it would actually be born.
Personally, I find the prospect grotesque. I am not alone: Current polling indicates that only 1% of women support abortion up to birth. On the contrary, 70% actually support a reduction in the lawful time limit from the current 24 weeks.
Those who demand absolute rights over their own bodies, neglect the fact that, where abortion is concerned, two bodies, two lives, are involved.

Given that this ‘Pandora’s box’ has been opened in New Clause 1 of this bill, those of us who have deep misgivings about the permissive nature of the current law will make our own attempts at amendments. We will seek to reduce the permitted 24-week window to a more realistic level in line with modern medicine’s ability to sustain life outside the womb, and we will seek to end the discrimination against Downs babies which currently allows them to be aborted up to 40 weeks.

 

I’ve had some angry emails about the National Audit Office report government’s alternative plans for housing asylum seekers, having already evacuated 100 hotels.  The NAO claims it will actually cost the taxpayer £46 million more than the hotels by accommodating those waiting for asylum decisions on barges or former RAF bases

This is a rather shoddy piece of analysis because it includes all the set-up costs rather than just comparing the running costs of hotels against the alternatives. A fair comparison of all the costs would need to be made over the entire lifetime of the usage, or reasonable assumptions about it.

Furthermore, the NAO has missed the political dimension of the policy. The public was scandalised at the use of hotels to accommodate people who had arrived here illegally and there is public demand for a more ‘spartan’ approach to the nature of the accommodation than which is commonly provided by hotels.
It is all very well for citizens of Ringwood and Fordingbridge  emailing me to complain about the policy, when our New Forest towns have not had their hotels requisitioned to accommodate disproportionate concentrations of young male asylum seekers, as have so many less fortunate towns,  with all the pressures on public services which follow.

I am very surprised to have received some indignant representations about the Chancellor’s announcement, during his Budget speech, that £1 Million was being set aside for a memorial to Muslim soldiers who fought for the Imperial Forces of the Crown in two world Wars.
On the contrary, I think it is entirely appropriate to remember them as loyal soldiers of the Empire. As the wartime generation passes, it is important that we remind future generations of out glorious past.
This is particularly important, when so much of our public discourse is dominated by the security threat posed by a radical Islamist minority. We should recall that our people struggled together in great and honourable endeavours against tyranny and injustice. People who are proud to be British, and who happen to be Muslims, must not be tarnished by a tiny minority.
We need to remember that 400,000 Muslim soldiers fought for us in WWI and 1.5 million in WWII.
They shared our defeats and our victories, they were injured, died, and won gallantry awards in our finest hours. We will Remember Them

More on Assisted Death

I’ve written about assisted dying in this column on several occasions over the years:

Esther Rantzen (desmondswaynemp.com)

Assisting Suicide (desmondswaynemp.com)

MAID (desmondswaynemp.com)

Assisted Dying -Again (desmondswaynemp.com)

Bob Marris MP’s Assisted Dying Bill (desmondswaynemp.com)

I’ve also debated the subject in Parliament, in our great universities, and with constituents. I revisit it again for two reasons. First, the Commons Health select Committee, after a thorough inquiry has produced a thoughtful and  very balanced report on the question which can be found at

Assisted Dying/Assisted Suicide (parliament.uk)

Second, because the Leader of the Opposition, Sir Keir Starmer, has announced that he will let Parliament vote on the matter.
But Parliament does not need his consent or permission; Both Houses have mechanisms to secure a vote, when they want it.
In the Commons we last voted on it in September 2015, then we rejected the proposal to legalise it by 330 votes to 118.
That opportunity arose on a private member’s bill. Had there been sufficient appetite for a re-match, another private member’s bill could have been presented; Or, alternatively, an amendment could have been tabled to a suitable Government bill. Another option would have been a division under the ‘ten-minute rule’ procedure -often a very useful test of the opinion within the House. Indeed, there is nothing to stop Sir Kier giving one of his Opposition days over to a motion on the subject. Or the back- bench Business Committee could schedule a  motion for decision.
The point is that Parliament does not have to wait on the Government in order to debate and vote on questions that it considers important.
Of course, were a vote supporting a change in the law to be successful, then Government time and co-operation would be required, in spades, in order to get the detailed legislation through. I’m certain that there is no Government enthusiasm for to giving up such time and effort to this complex problem, at an inevitable  cost to its other legislative priorities.
Equally, notwithstanding the apparent public support for changing the law, I suspect that most parliamentary colleagues, recognising the difficulties that such an enormous change would represent, and seeing the experience of those jurisdictions that have embraced it, themselves shrink from it.

Budgets, or as they are increasingly designated in Newspeak. ‘fiscal events’ need to be judged in their historical context. They are, after all, designed to have a lasting effect on our prosperity in the long term. This isn’t always the case, as we discovered with Kwasi Kwarteng’s autumn statement, all which was largely reversed within weeks.

Yesterday’s budget needs to be judged in the context of events dating back to 2010 when the Coalition Government inherited the most disastrous state of the public finances in peacetime, and a recession worse than any since the 1930ies. Incoming Treasury ministers were left a leaving note by their predecessors announcing that ‘there is no money left’.
Of absolute necessity, there followed the most significant cuts in public expenditure in order to ‘fix the roof’ as the  Chancellor, George Osborne put it, and which he accused Gordon Brown of not doing during the much more advantageous economic circumstances that he had inherited in 1997 – when “the sun was shining”.
The Coalition’s financial policy was dubbed ‘Austerity’ by the opposition and it was predicted that it would lead to mass unemployment. On the contrary, as Jeremy Hunt boasted yesterday, it generated 800 new jobs per day, for every day that Conservatives have been in government since 2010.
And It put UK economic growth ahead of the other G7 wealthy economies.

Without the successful delivery of that financial policy, Britain would never have been able to access the billions that were needed to keep employment and the economy stable during the pandemic and to weather the economic impact on energy prices delivered by Russia’s invasion of Ukraine.
Without the ‘headroom’ created by the Coalition’s policy we would have faced the most disastrous of outcomes from either of those shocks to the economy.

That we were able to deal with them by hosing them with money, now provides the immediate context for this present budget. The phenomenal costs of business support and furlough, together with the eye-watering bill for subsidising energy bills are the explanation for the level of taxation being at a peacetime record: Record sums spent to get the economy through a pandemic and Russia’s war required record taxation.
The task of the Chancellor yesterday was to use what little room to manoeuvre that he had, to plot a path to lower taxes and reduced debt without spooking the markets.
In my estimate, he made a reasonable fist of it with a second recent reduction in direct taxation.

No doubt, my critics will complain that I have omitted two important factors from the context in which this budget fits: Brexit, and the short-lived Truss premiership.
I addressed the economic outcome of Brexit previously in this column Brexit Freedom Day (desmondswaynemp.com) . In a nutshell, our relatively good performance in growth, inflation and interest rates compared to the EU suggests that Brexit is not part of the problem.

I remember well, that was on a train to Oxford to defend the Government’s record at the University debating Union when I heard the news that Kwasi had been dismissed and that the measures that he had set out were to abandoned. Clearly it was a poor wicket on which to go out to bat.
The spike in interest rates, most unwelcome to those of us with mortgages, were on the way up in any case, and their trajectory has been similar to those experienced internationally.
As I said here at the time Two fingers to Socialist Dogma and Envy (desmondswaynemp.com)
I approved of all the measures individually and I want to see them all implemented as soon as possible. Kwasi’s mistake was to spook the markets by attempting them all at once, and at the same time as announcing the most generous energy subsidy entertained by any jurisdiction.

The modest measures set out yesterday are designed to get us to the same desirable high growth  
destination to which Kwasi aspired, but -this time- by a secure route.