Brexit and the waning days of the United Kingdom

[Tonitrus]

An anonymous source claimed to have heard unnamed people talking in unnamed departments?

It was probably the Ministry of Silly Walks.

[Sheilbh]

An anonymous source claimed to have heard unnamed people talking in unnamed departments?

Obvs

[Tamas]

If the best government performance to emerge from all this will be Hancock then OMG we are fucked.

[Tamas]

Told ya:
https://www.theguardian.com/politics/2021/feb/04/dublin-and-eu-reject-call-scrap-northern-ireland-brexit-protocol-dup

Took us (well, the DUP) one bloody month to feel enough time has passed to reneg a signed treaty.

This whole Brexit business WILL be the ultimate end of the empire. Not just in terms of geographical disintegration, but also by the complete destruction of the respect and prestige enjoyed by Britain on the international stage.

[Sheilbh]

I mean that's kind of a given, no. One of the worst outbreaks and outcomes in the world doesn't suggest a great response.

And in fairness to him it may have been better if Hancock got his way more. We may only fully know once all the memoirs come out but from what I've read in the press Hancock has consistently been right, but lost battles in cabinet to Sunak, Williamson and, I think, Gove etc. The other person who was always pushing for earlier lockdowns and probably would have supported ensuring domestic manufacture of vaccines is, of course, Cummings

The big failures in the Health Department feel structural (the Cameron reforms), no real-term budget increases in the last decade and a long-standing emphasis on being efficient not wasteful which meant there was no capacity. But in the last year Hancock fucked up on test and trace, but got testing right by May/June and kept increasing it (on average we're now processing 600k tests a day) and (so far) vaccine development, procurement and roll-out. Compare that with Williamson's record over the last year, or Sunak's etc.

There are a couple of ministers I actually think have low key done very good jobs. Therese Coffey at DWP because there's been huge pressure on the welfare system and I am genuinely surprised that at no point did the systems fall over. But that's more the dogs that didn't bark.

[garbon]

Told ya:
https://www.theguardian.com/politics/2021/feb/04/dublin-and-eu-reject-call-scrap-northern-ireland-brexit-protocol-dup

Took us (well, the DUP) one bloody month to feel enough time has passed to reneg a signed treaty.

This whole Brexit business WILL be the ultimate end of the empire. Not just in terms of geographical disintegration, but also by the complete destruction of the respect and prestige enjoyed by Britain on the international stage.

Would you expect anything less from the DUP?

[Sheilbh]

Told ya:
https://www.theguardian.com/politics/2021/feb/04/dublin-and-eu-reject-call-scrap-northern-ireland-brexit-protocol-dup

Took us (well, the DUP) one bloody month to feel enough time has passed to reneg a signed treaty.

This whole Brexit business WILL be the ultimate end of the empire. Not just in terms of geographical disintegration, but also by the complete destruction of the respect and prestige enjoyed by Britain on the international stage.

Why are "we" the DUP? The DUP voted against the deal and NIP there's nothing new in that - they've always opposed it and voted against it.

Arguably that's a big issue for the NIP because in Northern Ireland majority solutions tend to fail. Any long-term solution needs cross-community support, not just majority support and the NIP doesn't have that yet - it could develop.

Domestically in Northern Ireland there was polling over the weekend (after the Article 16 incident) and the DUP have dropped in the polls by about 5% and Traditional Unionist Voice (who split from the DUP in 2007 over the decision to enter power-sharing with Sinn Fein) have gained 5 points. Within unionism, Arlene Foster is a moderate who was trying to make the NIP work but she's been weakened and more hardline voices are becoming stronger.

On that I heard a slightly worrying clip from local radio in Northern Ireland with a guy - I can't remember his org but he was linked to Loyalist paramilitaries - who was basically saying that Loyalists should, of course, only use political and constitutional force at the moment but in the future it may be "necessary" to use "physical force".

From what I can see it feels like the EU, UK and Ireland are being sensible and working together on this which is the best approach (plus increasing security around the ports without increasing them enough that the security becomes a target in itself).

[garbon]

https://www.theguardian.com/business/2021/feb/04/uk-banks-given-six-months-to-prepare-for-negative-interest-rates

UK banks given six months to prepare for negative interest rates

The Bank of England took a step closer to introducing negative interest rates for the first time on Thursday, after it gave lenders six months to prepare for such a move.

Threadneedle Street's monetary policy committee (MPC) voted unanimously to keep the official interest rate at historically low levels while it agreed to set the deadline for banks to prepare themselves after policymakers said they were ready to make negative lending rates part of their toolkit.

According to the minutes of the MPC meeting, officials were split over asking lenders to put in place the measures needed to facilitate negative rates on loans and mortgages, with some fearing it would signal to investors that the central bank planned to move ahead in the next few months.

But the committee agreed that to include a cut in interest rates to below zero in the raft of measures available to policymakers, lenders would need to put in place the technical requirements allowing them to implement it at short notice.

There are fears that negative lending rates, which are expected to lower borrowing costs for households and businesses, would force high street banks and building societies to offer negative savings rates.

Savers would suffer a loss of income and pension funds, which also rely on deposit savings, would also be hit.

Officials said the balance of risks in the economy, mainly from new variants of Covid overwhelming the benefits of the current vaccination programme, meant it needed to keep rates low. The negative lending announcement came as MPC members voted unanimously to keep the official interest rate at the historically low level of 0.1%.

GDP is expected to fall by about 4% in 2021 Q1, in contrast to expectations of a rise in the November report.

However, the Bank expects growth to bounce back as the NHS vaccine programme takes effect and schools, universities and most businesses return to more normal levels of activity.

The Bank's quantitative easing bond-buying programme was left unchanged at £895bn after pumping an additional £150bn into the economy at the outset of the second lockdown in November.

Earlier this week, the chairman of the Building Societies Association said cutting the BoE's lending rate to below zero would force institutions to subsidise savings rates to keep them positive, leaving them no option but to recoup the costs from higher mortgage costs.

Mike Regnier, who is also the chief executive of Yorkshire building society, said introducing negative rates would hurt consumers and the wider economy.

"I fear this would have the opposite effect from supporting the economy, as rates would go up for borrowers as banks protect their margins," he said.

The BoE base rate, which was cut to 0.1% last March as the UK prepared to go into its first lockdown, is the cost to high street lenders of borrowing money from the central bank, which they must to offer mortgages and loans to households and businesses.

Time to move money abroad?

[Sheilbh]

Incredibly grim perspective on the December re-opening. Given the age profile of deaths in January, 75% of those who died would have had a vaccine dose by now

And this was entirely predictable and actually quite widely predicted

[Sheilbh]

I saws this headline and had palpitations - but this actually all sounds like a very good idea. The Lansley reforms were an absolute disaster and one of the (many) catastrophic legacies of the coalition years

Boris Johnson planning NHS England overhaul, leaked paper shows
Plans would put end to David Cameron policies seen as step towards privatisation of the NHS
Molly Blackall
Sat 6 Feb 2021 12.56 GMT

Boris Johnson is planning a radical overhaul of NHS England, as he reverses controversial privatisation policies introduced by David Cameron, a leaked document suggests.

According to the draft white paper, the government is planning to reduce the role of the private sector in NHS England and give the health secretary greater control.

NHS commissioners would not be required to put contracts out to tender, which can draw competition from competing health groups. Instead, a new policy would leave the NHS and local authorities to run services and encourage them to work together more effectively.

The health secretary would also take more direct control over NHS England, with the plans putting emphasis on reducing bureaucracy and improving integration between the different departments of the NHS.

NHS Improvement, the health service's spending watchdog, would also be scrapped and folded into NHS England.

The plans would put an end to controversial changes introduced by Cameron's administration in 2012, which were seen as a step towards the privatisation of the NHS.

The 2012 model moved some power from the health secretary to NHS England, introduced clinical commissioning groups, which had control over local healthcare provisions, and built a greater role for the private sector in healthcare.

The leaked document, published in Health Policy Insight, said these changes had "in some cases hindered integration between providers", adding that "in practice, the NHS has not operated as the market intended by the 2012 Act".

The new plans say the private and voluntary sectors will continue to have an "important role" but that their influence will be limited.

"Where competitive processes can add value they should continue, but that will be a decision that the NHS will be able to make for itself," the document says.

The plans also detail the need for greater focus on integrated healthcare with more emphasis on "healthy behaviour and prevention".

"The Covid pandemic demonstrated plainly that this broader approach to health and care is not only desirable, but essential. We have seen first-hand how different groups have been impacted in different ways by Covid-19, and how wider factors play a part in our health outcomes," the document says.

The plans have been welcomed by the former health secretary Jeremy Hunt, who said that they marked a "very big change", but "the right change".

"The big difference between now and then is the growth in older people who need much more joined up care. Last year was the first year in history where, across the world, there were more over-65s than under-fives. Older people have much more complex needs ... that need to be addressed with a programme of care not just a single visit to a hospital," he told BBC Radio 4's Today programme, adding that the plans should allow "the joining up of care between local authorities".

But he also said there needed to be greater scrutiny for private bodies working with the NHS.

"If we are going to allow local monopolies to come back in the NHS, we need to make sure, in the details of these reforms, there's a proper accountability mechanism," he said, similar to Ofsted's role in the education sector.

The shadow health secretary, Jonathan Ashworth, said that reducing the role of privatisation in the NHS was very important, but that the reforms must also improve patient outcomes and reduce waiting times for treatment.

"The Lansley changes were disastrous ... and we pleaded with the government at the time not to do this, so it doesn't surprise me that now they've now come along and said we recognise those changes were counterproductive," he said.

He questioned, however, whether now was the right moment to restructure the NHS as it grappled with unprecedented pressure from the coronavirus pandemic.

"NHS staff are feeling ground down. Is this really the time for another structural reorganisation? And fundamentally what is the aim of these reforms?" he asked.

" This is a big task, and if government is going to embark upon this, it has to be clear what their destination is. Are these reforms going to improve outcomes for patients? That's the standard by which they will be judged."

A spokesperson for the Department of Health and Social Care said it was "rightly considering where changes need to be made to help us build back better" and that the "full details will be set out in due course".

[Tamas]

As usual, the devil will be in the details because "we don't need to do tenders we'll just decide who gets the contract" can be more efficient but also a hotbed for corruption and inefficiency.

[Sheilbh]

The NHS used to be the sole provider within that ecosystem. So there were no tenders because the NHS was the provider. There were moves under Major and Blair to introduce an "internal market" where NHS bodies could basically tender out work internally. The theory behind that was that as individuals didn't have a healthcare market so couldn't choose provider this would introduce market at a higher level - in theory the better providers within the NHS would be rewarded and the focus would be on patients (as opposed to producer interests).

Lansley took that to another level - early in the pandemic I said the NHS had all the downsides of being decentralised and centralised with none of the positives of either and that's the Lansley reforms. Basically it produced this very complex organisation structure of Clinical Commissioning Groups within the NHS (led by GPs) who commissioned the services they wanted, it meant there was no real single leadership tier within the NHS - the Health Secretary's role is a lot weaker than we'd expect - which is a big issue if you need make major changes or face a major system wide challenge (like a pandemic ) and there was a lot of marketisation. The theory was that doctors, not politicians should be in charge and that by making NHS providers compete with the private sector it would improve standards. I think it's actually meant, as I say, there's no central leadership because the system is very fragmented and the private sector has been cherry picking the profitable bits of healthcare as providers.

I get what you're saying about the risk but I think actually going back to a system where the NHS can decide whether or not to tender for a service and whether or not it's an area where the private sector can be useful would be far better and it would also be very good if we moved from the pure competition model to drive up standards to one focused on cooperation. As Jeremy Hunt says I think this is particularly important with an ageing population because different services are in different bits of government and need to work together.

The last point was something I was thinking of a lot when I was in hospital because the man on the bed next to me was elderly and had been in hospital for months - in part, I think, because he was quite lonely and didn't want to leave - but the big issue they had was actually getting him into appropriate accommodation which is a responsibility of the local council and they were trying their best and he turned down a couple of places while I was there. But I think there's probably lots of ways we can get the NHS and social care or sheltered housing to work a lot better together (especially if social care providers aren't bidding against each other for an NHS contract).

[Tamas]

Have their been studies into the efficiency of the NHS (the previous "less-privatised" especially)? It is quite clearly in a far better state than its Hungarian counterpart, but there the sort of self-contained "send in the tax money and we'll spend it" system has created a lot of problems and inefficiencies I think.

And the reverence the NHS is held in here, I would not be overly surprised if it was sacrilege to ever suggest budgets were wasted - which in turn would meant they probably are. I am not saying whatever the last reforms were helped with any of that, or with anything in general, just wondering.

[Sheilbh]

Have their been studies into the efficiency of the NHS (the previous "less-privatised" especially)? It is quite clearly in a far better state than its Hungarian counterpart, but there the sort of self-contained "send in the tax money and we'll spend it" system has created a lot of problems and inefficiencies I think.

There was a study done by the Commonwealth Foundation in the US which compared various healthcare systems. Of the ones they looked at the NHS was the best or one of the best on fairness, care process, ease of access and administrative efficiency. It was one of the worst of those measured on healthcare outcomes such as surviving

And I think that is actually roughly where the British public are. They want fair, free, universal healthcare that is relatively decent and relatively cheap. So we spend less on the NHS than any big Western European country, or the US, or Australia or New Zealand spend on their healthcare systems. I think it is very efficient - but if you had a different model like social insurance in continental Europe or just spent more you would probably get better results. It delivers a lot of bang for its buck comparatively - but the other side of that is I think Brits are still slight outliers in basically having a "be happy with what you get" attitude to healthcare.

In many ways I think the NHS is the last link to that wartime and 1945 Labour government model.

And the reverence the NHS is held in here, I would not be overly surprised if it was sacrilege to ever suggest budgets were wasted - which in turn would meant they probably are. I am not saying whatever the last reforms were helped with any of that, or with anything in general, just wondering.

Yeah. I think criticism of the NHS is very difficult in this country, any suggestion of looking at other models is career-ending for politicians and I think that's because the model we imagine as an alternative is the US system. We are very ignorant of European models, but I think the same hinders the debate in the US what they imagine is the NHS when they think of socialised healthcare.

This is why I'm not sure we'll get answers from a public inquiry into the pandemic. I think there's mistakes made by the NHS as an institution, separate from government, as well as structural issues from the Lansley model etc and I think it'll be difficult to draw them out because I don't think the public want to hear any criticism of the NHS. We see this with various care quality scandals in the NHS - for example recent reports on why mortality has been so high in maternity wards, or the Stafford hospital scandal, Alder Hey organ or Bristol heart scandals. There is always a reaction against criticism as talking down the NHS or a prelude to privatisation especially with a Tory government.

It is the flipside of the NHS being the last legacy of 1945 - I think it's still the last 1940s style "person in authority knows best" public service and it can be very difficult to push against what the doctor or consultant is saying and, like any other institution, there is a tendency that it closes ranks in the face of criticism. From experience in my family mistakes can be made and those relatives were working class women from Liverpool or the Isle of Man who were very reluctant to be "pushy" against a doctor and ignored when they were.

So it's nuanced - I think it's a good public service, I think it's run and staffed by overwhelmingly well-motivated people but I think it behaves like any other institution that people believe in and protects its own and I think it's politically very difficult to reform or make accountable. In a way the Major-New Labour reforms around an internal market were an attempt to introduce accountability but it's not clear they necessarily worked.

[Tamas]

Very informative, thanks.