5 thoughts on “Swire accuses “some local politicians” of misleading the community on NHS and should apologise”

1. If there was any justice he would be having trouble sleeping because of his conscience over the way his party’s government is economical with the truth. But of course that presumes that he has a conscience and a moral compass, and after a decade or so of his MP-ship, there is no evidence of either of those – .though there is much evidence of his willingness to vote the party line and blow with the wind that comes from his government pals.

   I (and presumably many others) would assume that he is referring to Claire – who is obviously getting under his skin, though I have seen no evidence that she is being economical with the truth about the NHS – she always seems to have factual evidence to back up her rhetoric.

   Perhaps it is Claire that is causing his insomnia? At least we can hope it is. 🙂

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2. What you are seeing is more likely the Tory party answer to any criticism of their policy: Bluster, Filibuster, rubbish the opposition, mouth vague and meaningless platitudes. That way they can always say they tried to do something.

   It could be thought that the Tories are bent on privatisation of National Health. Why else introduce the nonsense of charging rental of public buildings? Many public buildings were acquired with public assistance (subscriptions), but Treasury believe that a site has an imputed rental value because it could have been sold to become a shop, or an industrial estate or …. If true, this is a fundamental error. A hospital has no rental value, and you cannot claim that it has. To do so is to introduce a false cost on the assumption that the building could be doing something else.

   In my view, the problem for Treasury is that health buildings tend to be in the middle of population centres because they were and are readily accessible for staff and patients. That means the sites are currently extremely valuable if you can manage to sell them off and shift the delivery of healthcare to out-of-town sites. Just like the supermarkets did up till 2013 – except that model is now failing (sic) – see Tesco and Sainsbury. That shift works fine if you are fit, able and can drive, except that the elderly and the ill cannot drive to the out-of-town site, but that is not a problem for NHS, just like parking charges, which could perhaps be seen as a pernicious tax upon the ill and upon their carers who dare to use up the valuable resource of land. Indeed, it is surprising that there has not been a revolution to remove taxes upon the ability to use services already paid for (I often wondered if my National Insurance payments really went to healthcare and pension) such as consulting my local authority or attending a hospital, and so on.

   Treasury (not the department of health, who in my view apparently are not in charge of their own agenda?) has a fixation over market testing. But whilst there is a viable National Health presence there is no possibility of having a private health service in competition because the National Health is so big and powerful if it could ever act coherently. Sadly, in my view, it does not. We can’t even agree on a single method for coding presentations and outcomes. We still do not have competition over cost (ignoring imputed building costs) of operations. We suffer (if Private Eye is to be believed) from a lack of consistent quality metrics and a service that appears to be in denial where failures occur. (Is it possible that this could reflect on the curious suggestion put about in some places that permanent officers cannot be criticised even when their actions are clearly in error?)

   In my view we do require a major reform to the NHS. Where I seriously differ from the current government is what the reform is to achieve. What I want to see is the introduction of outcome and cost comparisons, not from artificial numbers but a level playing field (dream on?) that drives us forward. I want to have metrics that ensure that best practice is rewarded and poor administration curbed. But not on the basis of artificial numbers and cloud cuckoo assumptions. On the basis of what is needed and not what is cosmetically pleasing.

   At the end of the day, and our seaside towns are committed to that by what in my opinion are insane developments contractually committed to the elderly instead of a balanced population, we need to know that we will not be abandoned to the cruel and unusual pursuits of a state that is willing to expose us to poverty after we have completed our side of the bargain, which was to pay our dues all our working lives.

   Judge for yourselves as to what the current positions are vis a vis the National Health, supposed (in my view) losses incurred and actual service delivery.

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   • Ah ha. A great explanation Conrad.

     First we had the planning policy outsourced to developers (how stupid is that???!!!!) which – surprise, surprise – came out with the NPPF which is extremely favourable to developers to the detriment of local democracy.

     Now we have NHS policy modelled on Tesco!!!!

     Honestly, if this was a novel you would call it far-fetched and unbelievable.

     Indeed it can easily be argued that privatisation of essential infrastructure is bad in the long term. Have any of the Tory privatisation deals of the past been good for the population?

     Steel was privatised and went bust because it couldn’t compete when privatised energy bills are so high in order to pay big dividends. Privatised energy companies are milking the ageing power stations for maximum profits and have failed to invest in new generation generators – so now the government is bailing them out with more of our money by building Hinkley-C.

     Privatised British Telecom is failing to deliver 21st century telecoms by milking its existing copper infrastructure whilst other less-well-off countries like Portugal are switching completely to fibre within 5 years.

     Privatised rail infrastructure continues to suffer from poor performance and lack of investment.

     My business background includes both working for privatised utilities and on both sides of outsourced (i.e. privatised) IT. And I have yet to see a successful long-term situation.

     When you privatise or outsourced, increased costs are an inevitable consequence – to pay the dividends to shareholders and to cover the increased costs of governance. Which means both higher prices and less money for investment. Indeed to get buyers for shares or bidders for outsourcing, guaranteed profits are an essential part of the deal – which in turn means soft regulation. In other words, we sell off the family silver and then pay through the nose to be able to use it as it becomes more and more tarnished and unusable.

     But if we look back to history, all the best and most civilising institutions have resulted from a public investment in moral/ethical visions and not from privatisation.

     This government has lost the plot – not only will they be remembered as the government that gambled with democracy, playing fast and loose with the truth (i.e. lying through their teeth) resulting in a decision to leave the EU based on promises that can never be delivered, BUT ALSO they will be remembered as the government that dismantled (perhaps) our finest institution through a privatisation dogma that has no relevance to health care.

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     • The problem this all tried to address, was, in my view, how do you persuade public sector employees to be efficient and productive? Going all the way back to the 1960’s there was the question of what is there to motivate conscious improvement of public sector services? Even in the Second War it was demonstrated (Volkswagen) that the military could make an efficient production system, but the Civil Service could not. And, allowing for C Northcote Parkinson, it was shown that government and administration have become increasingly inefficient over time. And this was before the entry of professional lobbying – those boys were amateurs!

       The only answer of the Thatcher (and subsequent) administrations was exposure to market forces. It was impossible for government backed schemes to go bankrupt, so the only way to get efficiency was to make a situation where inefficiency would conclude with bankruptcy. But to do that you must privatise!

       So enter the realm of privatisation. To add to your list Paul, you might include British Rail (some say because Ernest Marples wanted to profit from road distribution?) and British Telecom, and British Gas, and goodness know how many other electricity and water utilities.

       You are, in my view, correct to conclude that the profit motive is all about self and nothing about self-regulation. So the doom of a privatised arrangement is that it operates to the detriment of the customer because it has to satisfy the demands of management (and what some would argue are excessive salaries and ridiculous pension payments – only matched by the public sector with their pension schemes that are breath-taking when compared with what an ordinary moral could ever achieve privately) and secondly the desires of the shareholders (although it is not clear what exactly they have invested and whether their investment really matters.

       But to get back to my first point. How do you make and measure efficiency in public sector organizations that have no actual competitors? How do you stop public sector organizations from growing on the basis of incompetence (or, worse still, deliberate avoidance) because there is nothing to force them to become more productive. Long ago Zero Based Budgeting was invented to try and stop ratchet budgeting – because we spent x last year we obviously need x plus 10% to do the same job this year. Nothing about efficiency because exactly who scrutinises the figures? Oh we can’t make a profit out of this because our bloated costs would never be tolerated by industry, but they are not a competitor so why does it matter.

       These things are now only exposed when PFI costs are identified as being entirely ludicrous.

       So, with your background, could you bring forwards a mechanism for forcing the public sector to be more in line with what some would characterise as the real world? Just a thought, not a criticism. I reserve that for officers who cannot be criticised, especially when they may do as they see fit but somehow or other believe they are above criticism. Is it possible that there is a tyranny of the unelected, just as company directors feel above the criticism of shareholders?

       TTFN

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     • The profit lever in market forces is just one way of measuring efficiency.

       Forcing the public sector to be more efficient without privatisation is easy (in theory at least – unless of course it has been tried and failed)…

       Establish a way of measuring the efficiency of the organisation;
       Pay the senior officers based on their organisation’s position in the efficiency league table.

       Of course you need to make sure that the efficiency measurements are the right ones and to make sure that they cannot be gamed by the organisations concerned – and make the senior officer’s personally responsible for sticking to the rules with big losses of pay (backdated) if they break them – and reward / punish them as a team as then they will police each other.

       For an explanation of why we have got into this mess, please read the central government handbook also known as Yes Minister / Yes Prime Minister. There are usually many secrets in government that they want to avoid getting out into the public domain – and these are useful “bargaining chips” (by which of course I mean what is essentially blackmail) to ensure that senior officers get an outcome which benefits them rather than the public.

       If we had absolute transparency, so that there were no dirty secrets, then we would have to be more accepting of minor mistakes (because otherwise we would have no ministers or civil service) but at least we would know where we stood and decisions would be taken in the genuine best interests of the public.

       Which is one reason that FoI is so important (and also so impotent).

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