Political Economy

The people of Scotland have elected a government that, as part of its election manifesto, said that it would hold a referendum on Scotland leaving the UK. They should be allowed to do so unhindered by a panicking Westminster establishment.

However as everyone knows this referendum has no legal force. The legal locus for decision making in this respect is at the Westminster Parliament, created by the Act of Union in 1707 and the only body that can bring the Union to an end.

Should Westminster bring the Union to an end if the people of Scotland wish it? I believe that they should. We cannot talk about democratic government unless we allow “Government of the People”, which means “Government made by the People”.  In a democracy if the people of Scotland wish to change the form of their government then that democracy must allow them the right to do so.

However this split, if it occurs, will require a treaty, perhaps many treaties, to decide on many things. One of these things will be property rights, another will be the distribution of the national debt, another will be defence, yet another will be taxation and things like customs duties and so on.

All of these treaties will affect the wealth and future well being of the people of England and as a result not one of these treaties can be agreed without the agreement of the People of England through a, or a series of, referendums. If the People do not agree then the politicians will have to go back to the negotiating table. If there is no agreement then there will be no end to the Union!

Is this important? Are there likely to be areas of disagreement? Where are the sticking points?

The first one will be oil. Alex Salmond likes to claim that 90% of the oil is Scottish. As Robin Tilbrook pointed out in his blog “Some of it’s ENGLANDS oil” that, on the basis of international law, between 25% and 50% of the oil belongs to England and 100% of the gas is English. If Salmond is unable to agree a reasonable compromise of between 25% and 50% of the oil, and 100% of the gas, being English then the People of England should not approve the treaty.

Alex Salmond has refused to take on the £187bn of government exposure to the Royal Bank of Scotland’s bad assets. His claim is that as the regulation of RBS was in London it is London that must bear the cost. Now, the matter that brought down the RBS was the purchase of the Dutch bank ANB Ambro. Until that point the RBS was reasonably clear of toxic assets, clear enough certainly to be able to handle any problems with its own reserves. Who then encouraged this merger? Why the same Alex Salmond that refuses to take on the costs of his actions. The Financial Times (12/12/12) reports that in 2007 Mr Salmond encouraged Sir Fred to purchase ANB and wrote to him “It is in Scottish interests for RBS to be successful and I would like to offer any assistance my office can provide. Good luck with the bid”. In 2007 he also promised “a light touch regulation suitable to a Scottish financial sector”. As the Edinburgh MP, Alistair Darling, has said “The decisions that RBS made that got it into trouble were made in Edinburgh, not in London”. Any treaty on the breakup of the Union would have to transfer to Scotland 100% of of the £187bn exposure on RBS.

What else is there? One thing that needs to be examined are the payments to Scotland for running its affairs that have exceeded those made to England. This started in 1888! George Goschen, the then Chancellor, decided that Scotland should have its own source of funding. To begin with this was not a very good deal but as 1900 came and went the cash paid per head to Scotland exceeded that paid to England, very soon increasing to a fifth more and then to more than a fifth extra. Currently it is 19% more than goes to England. If Scotland has received, say, 20% more than England over, say, 100 years then it will have received a total of 20 times that given to England, in a year, during that period. Currently England gets £8,588 per head (2010-2011) so 20 times this is £171,760. There were 5.2 million (mid-2010) people in Scotland so this adds up to a total of £893.2bn in current money terms! Now Scotland’s population has been lower over the last century. If it has averaged half the current size then a fair estimate is £446bn in current money terms rather than £893.2bn. This is an enormous sum of money and over the years it has made Scotland the third wealthiest region in the United Kingdom. The poorer regions of England who have contributed to this Scottish wealth might reasonably think about the size of the dowry that Scotland is going to leave them.

The question of dowry leads us to the division of the national debt. this is probably fairest done by dividing it by population. To this should be added a portion of the £893.2bn identified above. What sort of portion. Well much of the UK’s debt is long term, which is why we are not worried about the markets attacking us. If this represent 12 years say, then it would be reasonable for 12% of the £446bn to be added to Scotland’s share, say £50bn. This could then be used to regenerate the North. It would be their dowry!

How much debt would Scotland have to take on? If that were calculated based on population then Scotland with a mid-2010 population of 5.2 million out of a UK total of 62.2 million would take on 8.4%, say £85 – £110bn of peak debt, which with the £5obn mentioned above could be £135 – £160bn

Clearly the English cannot leave it up to their politicians to put the interests of the People of England first. English politicians are so used to giving away the wealth, and the name, of England that they would even agree to give away England’s gold. Oops, sorry, they have already agreed to that haven’t they! So the People of England must start insisting NOW! that there will be no treaty agreed on any further changes to the constitutional set up in the UK without their agreement through a referendum.

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What I have found most amazing about the comments on Cameron’s veto is that very few of those participating, from BBC reporters, presenters and interviewers to the vast herds of unwashed politicians and their advisors,  is a complete lack of understanding of the part that financial markets will take in determining the future of the euro and as a result what needs to be done.

The fact that so many politicians, both in the UK and in Europe, fail to understand even the simplest of economic realities is of course why we are in the situation that we are in and the reason why it could yet all end in tears.

Prior to the summit the Germans wanted a treaty whilst the French did not.

The Germans were of course responding to the long-term requirements for stability with little understanding of the urgent need for significant short-term action, whilst the French, who do not want their deficit budgeting exposed to the full force of the European court, as a treaty would have required, were focused on the short-term requirement at the expense of long-term stability.

The British are not going into the Euro but were interested for reasons of trade and stability in both the long-term (changes to the Eurozone rules on governance) and the short-term (the big bazooka).

Not being in the Eurozone, nor having any intention of being in the Eurozone, there was absolutely no need for the UK to send its budgets to the Commission for prior approval. In spite of this Cameron was willing to enter into a treaty with such a requirement, provided it was made clear that the City was a key matter for the UK just as the CAP is for France and manufacturing policy is for Germany. This the French and the Germans refused to admit, to their eternal discredit.

The EU was already requiring the UK to soften its position on bank regulation (despite what the Sarkosy said) and the UK believes that the EU move is wrong-headed and will hasten the next financial panic, a belief in which I concur. The Tobin tax proposal was also seen as a problem. The Germans and French are not attacking the ability of London to rule its financial matters for the good of the EU. Their only intent is to continue the harm to London and the UK that has already occurred, to the benefit of their two countries.

What did others in the EU think in the run-up to the summit. An article in the 8th December Kindle edition of the Financial Times makes it very clear:

1. The president of the Commission called every EU head and warned them “that if they agreed to change the treaties they had better be prepared to deal with the consequences”
2. In Finland parliamentarians had prevented their government for agreeing to the treaty setting up the rescue fund.
3. In the Netherlands, which has a minority government, the pro-EU opposition parties threatened to call an early election if treaty changes were agreed.
4. In Slovakia, which is facing elections, “EU issues have become pre-eminent”
5. Ireland, which is desperately trying to appease Germany, did not want to have a referendum on the treaty changes.
6. In the UK, despite what the coalition has said, there would have to have been a referendum.
7. In Germany the Free Democratic partners in the coalition have said they would hold a referendum to block an element vital to the eurozone’s €500bn rescue fund,
8. The FT quoted one European diplomats as saying of a treaty change “Even if we would succeed, we may end up with a perfect treaty but no Europe to govern”.
9. In pre-summit meetings core eurozone countries urged reforms without a treaty or only limited ammendments, These included Belgium and Italy
10. Even Portugal wanted a short-term solution

So why were 25 heads of state backing Germany’s idea of a treaty? The answer of course is that they were sucking up to the Germans, hoping to gain through flattery, and at little cost to themselves, the benefits they could not gain for themselves. This has happened because Germany has benefited hugely from the Euro.

Before the Euro the Deutschmark was very strong and, as a result, Germany’s trade was more or less in balance. On the other hand the exchange rate of the Euro against other countries was an average of the various economies in the Euro and this would have been much lower. As a result Germany has benefited from a low exchange rate and its exports have boomed.

The Germans of course think that this is down to them but in reality it is a transfer of wealth to Germany from, not only all other Eurozone countries, but any country to which Germany exports – legalized theft if you will. Germany should be willingly using the wealth it has extracted from the others to back them up now that the bad times have come. But like all robbers this is not going to happen easily. Hence the crowd of fawning sycophants in the Hall of The Robber Baron telling her how great her ideas are and how, if only it wasn’t for that little weasel, they would happily be going along with it. Liars, liars, liars.

If Cameron’s strategy was to bring down the euro and the EU it is clear that his best strategy would have been to agree, softly, to the Treaty and then engage in months of vicious negotiating not only fighting for relief for the City of London and UK manufacturing but also for the inclusion of clauses that would get right under the noses of the president of the Commission, Finnish parliamentarians, opposition parties in the Netherlands, the Slovakians, the Irish, the German Free Democrats and European diplomats, before floating it off onto a sea of hostile referenda and parliaments.

To his credit Cameron did not take the “European” option as the French, German and many others would have done. Instead he showed a degree of honesty and integrity which is quite lacking in European politicians, showing them up for the cynical and dishonest bunch that they are; and for this he has incurred their eternal enmity.

In saying this I am damning Cameron with faint praise. He has shown that at heart he is a European, despite his sometimes heated rhetoric against it; he has shown that whilst the playing fields of England might be a sound foundation for going to war to save the Europeans from a tyranny they are incapable of stopping themselves, they are entirely irrelevant for engaging in politics with them; that at heart he does not have the best interests of England or the people of England at heart; interests that are best served by leaving membership of the EU.

He has instead committed the worst political blunder of his life; he might have saved the Euro! On the other hand the long known weaknesses of the eurozone and their equally long predicted outcomes have come to pass. But it is the same old crew who connived in the eurozone deception and caused the current probem who are still in charge. Will they succeed this time. Well pigs might fly but it won’t be a pretty sight.

The Europeans, who have got what they wanted all along, but none of whom were brave enough to vote for it at the summit are going all out to pin the blame on the UK, presumably because they all secretly think that they cannot succeed and they will be able to blame Cameron. Will Mr Cameron expose the lying and lack of integrity of European politicians when he makes his statement to Parliament on Monday? Will he claim, rightly, that he did more than anyone at that summit to secure the best chances of saving the Euro? Will he make very clear to Parliament that the eurozone now has the best chance of success it will ever get? Will he make it clear that the European politicians are men and women without honour, their word is never to be trusted and their lack of interest in anything except their own advantage at the expense of England’s makes them unfitted to be allied with now, or in the future. Will he call for a referendum on Europe NOW!

Well that pig will not fly! Instead we risk being tied to a Europe of no growth for a decade. Outside the EU we can develop and engage in innovative approaches to growth and social justice. Inside the EU we will remain subject to the dead hand of corrupt and deceitful European politicians.

 

 

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Seven score and eight years ago a man spoke to dedicate the cemetery on a battlefield which had seen over 46,000 casualties including nearly 8,000 killed.

He pointed out that the living could not dedicate that place since the dead had already consecrated the ground with their blood. The living, rather, had to dedicate themselves to the unfinished work for which the dead had died.

That work was to ensure “. . . that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.”

The man was Abraham Lincoln, President of the United States of America and the battlefield was that of Gettysburg, the key battle in a civil war that saw a total of over 210,000 killed in action so that his nation “. . . shall have a new birth of freedom”.

Lincoln was not the first person to enunciate such a  belief. In 1830 the Senator Daniel Webster in a speech described the federal government of the USA as “made for the people, made by the people, and answerable to the people,”

So freedom is protected by the correct form of government and Lincoln tells us how to distinguish such a government from others. Do we, the People of England, have such protection for our Freedom? The answer is not difficult to deduce.

Government of the People

Government “Of the People” is government “Made by the People”. It is government hewn from the people and it has in all times and in all places been a government that People have had to fight for.  In January 2007 a poll for Newsnight showed that 61% of the People of England wanted a devolved Parliament for England. In April 2010 an ICM poll showed that 68% of the People of England wanted a devolved Parliament for England.

Do we, the country where parliaments were invented. have a Parliament for England? No! Have the political elite in England said we will get such a Parliament? No! Do we have “Government of the People of England”? No!

Government by the People

“Government by the People” is the people governing themselves via the election of a representative that will do what the people want. Do we have such representatives? No! Why not? There are many reasons. The first and most important reason is that Edmund Burke, MP for Bristol, said in 1774 in a speech to the electors that he could vote in the House as he chose and not as they wanted, a vote mark-you that had been given him by those electors. Burke was hardly an objective observer in this and as a piece of self-serving claptrap this one has been religiously parroted by MPs ever since. Burke did not believe in democracy and is claimed as a founder of modern Conservatism.

Secondly few MPs actually have the integrity to vote according to their own opinions. Instead they hand their vote over to their party in return for a continuing flow of cash, perquisites and honours! Thirdly most MPs are not voted into office by a majority of those who vote. To get 40% of the vote is considered good and this of course usually represents less than 30% of the electorate.

Do we, in England, have MPs who represent their voters? No! Have the political elite in England said we will get such MPs? No! De we have “Government by the People of England”? No!

Government for the People

And so we come to the final act. I have already shown that in England we do not have “Government of the People”. I have shown that in England we do not have “Government by the People”. Do we have “Government of the People, by the People” in England? No!

So, do we have “Government for the People of England”?

In 1975 when the referendum on remaining in the Common Market was held I listened carefully, as did many, to the views expressed. We were told we needed to remain in the Market because of  trade despite the fact that we had a trade deficit with them of £2bn. Well now the Market is a Union and we have a trade deficit with the rest of the Union of £36bn. This deficit is equivalent to exporting some 1,000,000 jobs to Europe.

In the 13 years of Labour government from 1997 some 1.67 million jobs were created in the UK but 1.6 million of those jobs went to people with no prior connection to the UK. It appears therefore that the UK government has provided 2.6 million jobs to the world. The jobs that remain are increasingly part-time, minimum wage and unskilled. Recent data has shown the trend has continued and will continue, particularly since the coalition government has set no restrictions on the so-called Mode 4 immigration. This is where a company from another country is allowed to set up in the UK and bring in all its labour from its own country. These workers will be paid minimum wages plus a tax free living allowance. The Tory party will of course be the grateful recipients of political donations from these “UK” companies. UK workers will receive only the dole that has been much reduced by the Tories.

Will MPs work to protect and grow the number of meaningful jobs open to us? No! Will the political elite in Westminster allow us in England to get the jobs we need to lead satisfying and creative lives? No! Is this “Government for the People”? No!

A broken Democracy

In England we do not have “Government of the People”. We do not have “Government by the People”.  We do not have “Government for the People”. We live in a broken democracy where our freedom is compromised and not, as the Prime Minister would have us believe, a broken society where our property is compromised. Indeed the Prime Minister is currently driving this broken democracy deeper and further than anyone before.

Is it possible to fix the problem, to regain our freedom by instituting “Government of the People, by the People, for the People”? The answer is yes, but only if the a range of policies like the following are adopted. It cannot be fixed by adopting one or two of these policies, such as creating an elected upper chamber or adopting a parliament for England. It cannot be fixed by adopting policies but implementing them in such a way that they will not work. For example Cameron’s promise to make it possible for voters to recall their MP is going to be implemented by creating a committee of MPs to decide if one of them should be “thrown to the wolves”! Such a committee will only be used to punish an MP who has annoyed the party leaders!

So here is the list:

Government of the People

• A devolved Parliament for England with a government and First Minister.
• A smaller House of Commons and elected Upper Chamber to take on the role of a federal Parliament responsible for reserved matters.

Government by the People

• Power for the voters to recall a sitting MP for re-election
• Devolving additional responsibilities to the County level and its elected Mayor.
• Increased use of the referendum so that voters can decide what is done.
• Reform of the voting system to ensure that 50% is required for election

Government for the People

• A referendum on leaving the EU
• An end to mass immigration
• An immigration system that ensures that jobs are not taken from the People of England and that immigration is run effectively.
• Protection for companies from takeover and closure by foreign companies

A Party that Will

There is one political party that does have all of these policies, and more. It is the only party that has as one of its objectives the institution of “Government of the People, by the People, for the People.” That party is the English Democrats.

The Price of Freedom

Now here is the rub. It is your freedom and your government that I have been talking about. The good news is that you can do something about it. The price is your time and your interest. If you are concerned that your freedom is compromised then join the English Democrats, donate to their funds and get active in any way you can. There are a wide range of opportunities such as forming a county or constituency branch, or joining one if it already exists, leafleting, letter writing, standing in elections, writing articles or blogs, helping to run facebook, twitter and web sites. The list is almost endless.

Its Your Freedom. You Do Something About It.

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Goave’s White Paper “The Importance of Teaching” is based on England’s falling position in the PISA league tables. Note that the problem is not falling performance, that has remained basically the same, but other countries have improved.  PISA (Programme for International Student Assessment) is an OECD programme to measure performance of 15 year old’s. PISA is not a value-free test of knowledge in the English sense. It  is designed to support and embed the OECD culture and values. (The hidden curriculum of PISA – the promotion of neo-liberal policy by educational assessment by Michael Uljens 12.7 2007). So the English performance may just be bloody-mindedness! Certainly in tests like TIMMS, which take as a starting point the national curricula of countries, and which do use value-free tests, England has been performing well.

One of the features of the PISA league tables is the outstanding performance of Finland who are at the top of the table. This surprised even the Finns who in 2000 when PISA held its first round of tests were dissatisfied with their educational system outcomes and were contemplating major changes. Since then Finland has done well despite the fact that research has shown a 25% drop in cognitive (thinking) ability of its students over that time. So PISA clearly does not measure thinking ability.

Apart from basing his White paper on Finland Goave is also enamored with Free Schools along the lines of those in Sweden and the USA.

But Per Thulberg, director general of the Swedish National Agency for Education, said  “This competition between schools that was one of the reasons for introducing the new schools has not led to better results. The lesson is that it’s not easy to find a way to continue school improvement. The students in the new schools have, in general, better standards, but it has to do with their parents and backgrounds. They come from well-educated families.” - Reported in guardian.co.uk, 9th February 2010.

So Goave’s White Paper is looking more and more like a big girl’s blouse. What is he to do?

The answer is to do what Westminster politicians have turned into a fine art – Fiddle the Figures!. In another blog The English Bac I showed that Goave’s new measure had little educational value and was designed simply to show in four years time that his policies had worked – even though they had not.

However this left him with a big problem. Currently schools are measured on their CVA (contextual value added). This measures the improvement over earlier achievement levels adjusted for things like deprivation, students in care, first language and so on. This is instead of just measuring schools on their raw GCSE results where schools in leafy suburbs will always do better than, for example,  inner city schools with high immigration levels.

Why is it necessary to get rid of CVA? Ministers will give all sorts of reasons, all of them rubbish. The real reason is the one Per Thulberg gave. Free schools attract middle-class parents whose children will do well, even with poor teaching. Those left behind in the old school will not do as well no matter how good the teaching. The CVA measure would show the free school is not adding much in educational terms and that the old school is adding a lot, so proving what an expensive scam the Free Schools are.

The key point here is that the new measures are guaranteed to show that Goave’s policy is a success – even if it is not.

Is this sort of scummy behaviour from a government minister acceptable? No!

Is this sort of scummy behaviour from a government minister fit for purpose? No!

Is this sort of scummy behaviour from a government minister decent and honest? No!

So who will end up crying. In a just world it should be Goave. That might just happen. Research, based on 500,000 pupils, published in the journal ‘Significance’ (of the Royal Statistical Society) concluded that 40% of the difference in students’ education results were down to the family. The rather limited family intervention programmes tend to be successful at raising standards. So who is handling the government research into this? Why, according to a story in the news last year it is Mr Cameron! Very wise Dave, make sure your name is on the successes.

In the real world however it is going to be the poor and disadvantaged who will end up in tears. The Nasty Party are back!

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So says the National Museum of Afghanistan. If you go and visit the current exhibition at the British Museum you will get some idea of how ancient this culture is http://bit.ly/fzBANs.

The Taliban famously tried to destroy the culture by destroying its artifacts and inflicting their strict version of Islam on the country. Whilst much was destroyed the curators of the museum secreted the objects away that are now on display. They were only able to bring them back on display in 2003 once NATO had driven the Taliban out.

Afghanistan has had numerous groups come and go over the millennia.  Some of the golden artifacts on display were over 4000 years old and belonged to a bronze age civilization with what appear to be links to Mesopotamia.

The Greeks arrived under Alexander the Great and built the great city now known as Ai Khanum. This city was lost in antiquity and was replaced by a local civilisation, then by Persia, India, the Mongols and so on.

But however courageous are the curators of museums the Afghan culture or for that matter the English culture will not stay alive unless it stays alive in the hearts and actions of the people.

The Labour plan to crush English culture by allowing wave after wave of mass immigration to swamp our schools, to change the way of life of the people of England, to denigrate the very name “England” will not be ended by the wholly inadequate measures of the coalition government.

The policies of the English Democrats will do this. Having a devolved parliament and government of England, with fiscal devolution on devolved matters, will allow the English culture to be protected and promoted just as the Scottish culture is in Scotland and the Welsh culture is in Wales.

A referendum to leave the EU and the end to all mass immigration will allow immigration on the basis of fitness for the job and for a limited period only when no local people can do the work.

The removal of all illegal immigrants and a strict application of the convention on asylum which requires refugees to settle in the nearest safe country to their own will reduce the excessive demand being placed on hospitals, schools and housing.

Giving local people priority in housing will not only return natural justice to the social housing market, it will make England a less desirable place to emmigrate to.

Putting an end to multiculuralism and expecting everyone in their public life to respect and follow English values and ways of doing things, including speaking English for all residents, will protect and expand English culture.

Putting an end to political correctness will mean that the large amounts of money spent, and wasted, in this area can be directed towards the less well-off young and elderly.

The suspension of the European Human Rights act and its replacement by a sensible English variation will allow the deportation of immigrants and asylum seekers, who commit crimes, to their country of origin. In a number of cases this will cause those intent on criminality to think twice about their actions.

Policies like these are often branded as racist by knee-jerk anti-English groups. But actually not one of these policies is based on racial or ethnic criteria. English Democrat policies are based on a cultural identity. Englishness resides in the heart and so can be adopted by any person of good will.

If you want to preserve the culture of England as a living thing, as a matter of the heart, rather than an artifact in a museum, the Conservative party will not do this, the Labour party will not do this,  the Liberal-Democrats will not do this nor will UKIP, not the Greens and certainly not the BNP.

Only the English Democrats are wholly committed to the fundamental proposition that “A Nation stays Alive when its Culture stays Alive”. Vote English Democrats on the 5th May.

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In the past years there has been much research around the world into what creates high quality health care. A seminal event in this field was the publication in 2006 of “Redefining Health Care: Creating Value-Based Competition on Results”, by Michael Porter and Elisabeth Teisberg (http://www.hbs.edu/rhc/).

Whilst being, to a large degree, US centric this book’s core message is applicable to any health system in the world. Indeed, as Porter makes clear, every piece of their recommendations are being used successfully somewhere in the world but in a piecemeal fashion.

The book has put together the work that has been done in the last decades on quality, worldwide, with the tools Porter created for analysing strategy. The outcome is a health system that is surprisingly different from what we are used to today but which is implementable, when there is a will to change for the better. So what is it?

What is value in health care

In business terms value is simply the quality, as perceived by the purchaser, of the service purchased divided by the cost of the service. In health care

Value =     Health Outcomes (or Results)/Cost of the whole cycle of care

The outcomes measured depend on the medical condition and are adjust for the difficulty or complexity they present.

The cost is the cost over the whole cycle of care which has number of stages which, with some possible quality indicators for each stage, is shown below:

1    Monitoring/Preventing – Prevention of illness, early detection
2    Diagnosing – Correct diagnosis
3    Preparing – Early & right treatment for the patient,
4    Intervening – less invasive treatment, fewer complications, mistakes & repeats
5    Recovery/Rehab – Faster & more complete recovery, less care induced illness
6    Monitoring/Managing – slower disease progression, less need for long-term care.

Measuring across the whole cycle is important because choosing the wrong intervention, let’s say the cheapest one, may well increase costs in recovery or rehab or long-term management of the condition with frequent return to A & E to sort things out. These costs may be much higher than the cost saving at the intervention stage. Porter reports that in Taiwan, for example, they have reduced the time (and hence the cost) of a GP visit to 3 minutes, which is just enough time write a prescription. As a result the cost of drugs has ballooned and so have the number of GP visits, to an average of 20 per year per person!

Measuring outcomes is not an issue. Recording cost is not an issue. But doing both across the whole cycle of care, for one patient, for one incident of care is very much the issue as it will require the IT systems to do so – and we all know what happens to government backed IT systems.

How should we organise to deliver exceptional health value?

It will come as no surprise to some in industry that this will only happen when there are specialist units that treat a sufficient number of patients a day to acquire the experience and expertise to improve what they do.
Take the example of severe headaches. Those who get them will know how disabling the are. In West Germany they decided to set up a specialist unit with, in one place, the neurologists, psychologists, and physical therapists all of whom were passionate and deeply interested in curing severe headaches. This unit set up affiliations with an imaging unit, an in-patient hospital unit and with additional neurologists that were all similarly passionate about curing severe headaches.

To begin with costs went up as the centre was established but are now 25% lower for the whole cycle of treatment than they were before the change. This is not because the cheapest treatments or the cheapest imaging services or the cheapest consulting neurologist are used. It is because there are fewer hospitalisations and fewer returns to the specialist centres. The quality of health outcomes has increased whilst the cost of providing them has decreased, because of the increase in quality and not because someone has gone on a cost cutting spree.

Primary Care

The organisation of primary care will also have to change. Sixty years ago when fewer conditions were recognised, fewer effective treatments available and when half of us were dead before we were 70 it was possible to think of the heroic GP who could treat each and every medical condition presented to him/her. That is no longer true. That means that either GP practices will have to develop specialist units within them, and become very big so that consequently there will be fewer of them, or  each practice will have to specialise. This means that we might easily have to go to several GP practices over the course of a few years and not just one, as at present. GPs will be paid according to the quality of their part in the cycle of care, not cording to the number of patients on their list.

So why is Lansley Irrelevant?

Well to begin with he has fallen straight into the trap of believing that value for money is increased by reducing costs. He has gone for the £20 billion reduction in expense without realising that increasing quality of outcomes is the only sure way of reducing cost and the only way of doing this is to measure quality and cost over the whole cycle of care.

Secondly he is irrelevant because fiddling around with who commissions health care will have no effect on quality of health care unless the whole structure of the English NHS is changed to a structure that is designed to, and focused only on, improving quality. The cost reductions will come about because high quality means, in the language of industry, less rework, fewer warranty claims and totally satisfied customers.

Thirdly he is irrelevant because he is pinning his faith on GPs who themselves are going to have to make major changes in order for this higher quality health care to come about.

Fourthly he is irrelevant because, as Porter has noted, health professionals love working in these new structures once they realise that they are now enabled to work at the limits of their ability doing what they went into health care for in the first place – making people well!

Fifthly he is irrelevant because he is planning on bringing in private organisations, ostensibly to improve quality, but in reality to reduce cost based on an old and outdated view of how to produce high quality health care.

Finally he is irrelevant because he has spent 12 months wasting his time, and that of his civil servants, in putting together a 500 page Bill to do something that is not going to give the result wanted instead of seizing the opportunity he was presented with to make a truly significant increase in the quality of health care in England.

The lesson for Lansley, and the coalition government is, in the words of the quality guru Phil Crosby: “QUALITY IS FREE” (http://en.wikipedia.org/wiki/Philip_B._Crosby)

GHTime Code(s): nc nc nc nc nc nc