Left hands and right hands

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The new UK government isn’t the first to talk about wanting to change the NHS from a sickness service into a health service, with more emphasis on prevention rather than cure. And it won’t be the last. Nor will it be the first to talk the talk but fail to deliver – and yesterday’s announcement by Starmer has impending failure written all over it, for at least three reasons.

The first is that many of his proposals – worthy and sensible though they might be – are necessarily long term. For sure, tackling obesity and reducing the consumption of sugar and junk food will reduce the demand for health care, but even if assorted campaigns and new legislation to do those things are both implemented consistently over many years and succeed in achieving their aims (and neither of those things are guaranteed), the impact will be negligible at first, only building up to a significant level over a decade or two. They do nothing to address the crisis facing the NHS now, which doesn’t have the resources to tackle that crisis.

Secondly, whilst they are entirely correct to be placing more emphasis on primary care in the community, there is a little problem of chickens and eggs. In previous attempts at health reform, we’ve seen health boards cutting the numbers of hospital beds on the basis that care would be better provided in the community. But what we’ve not always seen is a corresponding increase in the provision of that care in the community. Any approach which depends on cutting first in order to free up the funds for the required investment in community care is inevitably going to make the problem worse in the short term – even if they do eventually get around to improving the community care element, rather than just banking the savings. The investment needs to come first, but the statement that there will be no new money until after the reforms have been implemented is setting the whole approach up to fail from the outset.

Thirdly, it looks a lot like silo thinking, as if the NHS can reform itself in the desired ways in isolation from all other policy decisions. What they say they want to achieve needs a ‘whole-of-government’ approach, and it won’t work if other departments (and especially the Treasury) are pulling in a different direction. The most obvious and immediate example concerns the effect of poverty on health care. We know, from study after study, that poor health and poverty go hand in hand. It isn’t just a case of poverty ‘causing’ poor health; it isn’t quite as simple as that. But a lack of money can limit lifestyle choices – giving people a choice between heating and eating, for example, can lead to people choosing the cheapest rather than the healthiest options. Educational level is another factor in such choices as well, of course – and we know that the level of education is also closely associated with levels of income.

Taking a deliberate decision to withdraw funding from some of the most vulnerable pensioners without assessing the impact, and taking a deliberate decision to leave hundreds of thousands of children in poverty are not decisions taken by the health secretary. But they are decisions which will directly impact the demand for health services in the very short term. By a margin which it is impossible to calculate accurately, they will make things worse. It is, or should be, the job of the PM to ensure that his ministers are working to a joined-up agenda, but allowing one minister to take decisions which will increase the demand on health services whilst instructing another not to increase the supply of those services underlines that it’s not a job which he is currently performing.

There is a lot for which he can justifiably blame his predecessors, but none of that excuses deliberately making things worse.

Defining what news is

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There is an old adage in journalism that ‘man bites dog’ is more newsworthy than ‘dog bites man’. The point, of course, is that it’s the unusual which is of interest, not that which happens daily. But defining what is usual or what is expected is not always an easy matter; it depends on our frame of reference and our expectations based on our own priors and prejudices.

The Guardian today headlines one story as ‘Up to 50 Labour MPs could rebel over cut to winter fuel allowance’. The framing presents that as being unusual and unexpected. But the converse is that other Labour MPs are going to go along with the government proposal in the vote this week. There was a time when, based on the man bites dog analogy, the headline would have been ‘350 Labour MPs to vote for reducing pensioner incomes’. It would have been news – unusual, out of the ordinary, surprising even.

Starmer chooses to hide behind the formulation that he can guarantee that the annual increase in the state pension “will outstrip any reduction in the winter fuel payment” and Labour MPs are being encouraged to repeat the same line. Well, yes, that’s true – but it’s mathematically flawed. An increase of £400 less a cut of £300 is, indeed, still an increase – but the net increase is less than the rate of inflation. The bottom line is still that a Labour government is deliberately planning to reduce the living standards of most pensioners, and no fudging of the figures can disguise that intent. It says a lot about what the Labour Party has become that voting to reduce pensioner incomes is regarded as normal, and the unusual, the ‘news’, is that a handful of Labour MPs might decide to sit on their hands.

Wishing carefully

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The problem with being tough for the sake of being seen to be tough when taking a decision is that the more people criticise, the easier it is to underline just how tough the original decision was. All those people piling in to offer advice to the Chancellor on why her decision on the winter fuel allowance was silly, unnecessary and downright mean are merely reinforcing her original motivation which, I suspect, was nothing to do with saving money and everything to do with deliberately taking an unpopular decision just to show how tough she could be. The suggestion by the Guardian’s economics editor that she would be wise to reverse a “mean and politically inept” decision is absolutely right, but irrelevant if performative meanness is the objective.

Here on planet Earth, reviewing a decision taken in haste without a proper analysis or understanding of the likely consequences would be seen by many as a sign of strength and wisdom, but on planet Westminster, a U-turn is axiomatically a sign of weakness, regardless of how sensible it might be. I suspect that nothing will make her change her mind: whilst continued noise merely strengthens her resolve, silence would remove any pressure on her to change course. The sensible thing to do is demand change, but demanding change makes it less likely, and not demanding it makes ‘no change’ a certainty. “That’s some catch”, as Joseph Heller might have put it.

Maybe the deliberate leak of the fact that the pension is likely to be increasing by £400 a year next April because of the triple-lock will be enough to silence the mathematically challenged, although the more aware will realise that that was going to happen anyway, and a triple lock which protects the basic pension is meaningless if the government then claws most of the increase back elsewhere. Quite apart from the fact that that increase won’t be received until after the bills which the fuel allowance is intended to mitigate have already been paid. Adding prestidigitation to toughness might look like an expansion of Reeves’s otherwise limited skillset, but only if we don’t see the hands moving.

There has been one suggestion that Reeves should simply reframe the proposal as a measure to address a perceived imbalance between generations, and use it to appeal to the young. Blaming one demographic for the problems of another is certainly continuity Toryism of the sort which seems to appeal to Labour these days, and might even work electorally. It doesn’t, though, help to achieve a harmonious and balanced society and its practical (as opposed to political) impact is negligible.

The government have now promised that there will be a formal vote on the question next week. Perhaps Reeves will have a change of heart and back down; perhaps enough Labour MPs will find that they do indeed have a backbone and vote against it. But the likeliest outcome currently appears to be that the government will use its massive majority to win the vote, and that large numbers of Labour MPs will find themselves voting for something which will reveal only that party loyalty triumphs over conscience and principle. Those Labour MPs who’ve demanded a vote may yet come to understand the meaning of being careful what they wish for.

Not criminal enough. Yet.

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With the elimination of Priti Patel from the Tory leadership race, the party has lost what, on the face of it, appeared to be one of their best chances of continuing the run of selecting only the naughtiest of candidates for the top post. Being sacked for conducting her own foreign policy and being found to have bullied civil servants (even if let off by her then boss) are the sort of misdeeds which ought to have elevated her to the top of the list given her party’s recent predilection for rogues and rule-breakers. She might have been pretty nasty in her period as Home Secretary and rather too fond of Farage, but amongst the Tory Party membership those were supposed to be assets.

Whilst May’s naughty doings – or at least the ones she owned up to – were limited to running through a farmer’s wheatfield, her successor set the bar high for those who would follow. And Johnson, of course, did indeed set a really high bar. Being sacked for lying – twice – being involved in a (failed) plot to beat up a journalist, making up stories for newspapers, to say nothing of being fined for breaches of his own Covid regulations: it was a tough act to follow. Whilst his successor, Liz Truss, had what has subsequently been revealed to be a somewhat tenuous grip on reality, to say nothing of a weird obsession with cheese, she really couldn’t compete. That was probably one of the factors in the brevity of her tenure in the role. Sunak did rather better, being fined for both breaching the Covid regulations and the seat belt law, even if his household benefitting from non-dom tax rules didn’t amount to a crime in the eyes of the law (I wonder who made, or failed to change, the law?).

Given Jenrick’s past record in relation to the Covid regulations (even if he somehow escaped a prosecution or fine) and granting what some might think was dodgy planning consent to a Tory donor, he is justifiably leading the field after the first round of voting. It’s not exactly on the Johnsonian scale, and may owe more to the so-far apparently clean character of the competition. But if any of the other four are serious about wanting the job, they need to either come clean about any past misdeeds, or get out there and start committing some. They can hardly expect the diminishing Tory membership to vote for someone who might turn out to be a fine upstanding citizen after all. Any expectation that they can win on that basis is showing a colossal misunderstanding of the values of the party they seek to lead.

£16,000 is a whole pile of new shirts

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There is an old joke from the Soviet era about Brezhnev showing his mother around his world. He showed her his enormous office and his luxury Kremlin flat, and then took her by chauffeur-driven limousine to see his country house on the outskirts of Moscow before showing her pictures of his dacha on the Black Sea coast. When he finished, his mother said, “It’s all very well, Leonid – but what happens if the communists ever get back into power?”. It’s not only dictators and would-be dictators who can be swayed by the trappings of office; it can happen even in so-called democracies like the UK.

Boris Johnson was, of course, famous for the extent of his freeloading on ‘friends’. From holidays to weddings, from wallpaper and furnishings to somewhere to live: all were fair game for a man rarely known to pay for anything very much himself. It’s an attitude not limited to Tories, however; Keir Starmer also seems quite happy to enjoy the benefits of the job as well as accepting a range of gifts and freebies from friends and supporters, as Owen Jones discussed in the Guardian last week. It’s not on the same scale as Johnson, nor does Starmer seem to suffer from the same degree of casual indifference to properly and accurately declaring things. There is no suggestion that any rules have been broken, to use the much-loved response of politicians caught doing something which might look a little bit dodgy to some people. But that merely outsources the issue to those drawing up the rules.

It does raise some questions of judgement. Why does someone being paid £128,000 a year need someone else to buy him £16,000 worth of ‘work clothing’? (Even more pertinent to many of us, how would one even set about spending that much on clothes for the office anyway?) And whilst there’s no suggestion of corruption – no hint of any direct quid pro quo – why would someone even want to buy shirts for such a well-paid friend? There is a somewhat shadowy area between a corrupt relationship and a wholly professional one, and expensive gifting falls right into it.

It’s the same issue which led to the downfall of Vaughan Gething here in Wales. It isn’t about being corrupt, it isn’t about doing favours for the donor, and it isn’t about breaking any rules. It is about the potential perception that someone who gives expensive gifts to someone in, or with the potential to be in, a position of power might just have some sort of unvoiced expectation associated with it. It’s about whether someone on a high salary who doesn’t even have to fund his own clothing out of it might have at least a little difficulty in understanding how much difference a loss of £300 in income might make to a pensioner on a low income. Above all it’s about why someone in that position can’t even understand why anyone might ask questions about such gifts. Judgement is about more than following the rules.

Monsters under the bed

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Apparently, the whole structure of the UK’s economy was in dire peril of complete and immediate collapse unless the government implemented means testing for the winter fuel allowance. Yes, the money markets were all demanding a raid on the income of pensioners, and threatening a run on the pound, increases in interest rates, and an economic crash if their demands were not acceded to. At least, that’s what the leader of the House of Commons told us yesterday, so it must be true.

The funny thing is that most of us know people who have the odd few pounds invested in premium bonds or other government savings products, and none of them seem to have been clamouring for an attack on pensioner income. Nor as far as I am aware were the pension funds who own so much of the government’s ‘debt’ demanding that those who benefit from their funds should have their income arbitrarily and suddenly cut. I doubt that those companies who also own part of that ‘debt’ were really demanding that the spending power of 10 million of their customers should be cut. And it seems highly unlikely that those foreign governments who own part of the ‘debt’ in order to facilitate trade with the UK cared much one way or the other. Those money markets of which the government is so terrified end up looking more akin to the monster residing under the bed of a small child than a real and present danger, particularly when the savings involved are, at best, marginal.

But the phrase ‘at best’ is doing a lot of work there. Apparently, the government believe that stopping the payment of the allowance to all pensioners who aren’t receiving pension credit will save around £1.4 billion a year. That’s a lot of money for any of us as individuals, but little more than a drop in the ocean for the UK government. And stung by the criticism, the government are mounting a campaign to persuade those who are eligible for pension credit but not currently receiving it to apply now. We can fairly easily calculate that the cost of restoring the fuel allowance to the roughly 880,000 households involved will be somewhere around £200 million. Add on several millions for the cost of the advertising campaign, and the saving is reduced to a little over £1 billion. Still worthwhile if you’re looking to cut government expenditure? Not so fast.

If all those 880,000 households claimed the full amount of pension credit to which they are entitled, the bill for pension credits would increase by up to £2.1 billion. The same pensioners are currently not claiming housing benefit to which they are also entitled – another £1.3 billion. So if the government’s advertising campaign is a runaway success (and that’s what they say they want), they will have spent an extra £3.6 billion in order to save £1.4 billion. It could be, of course, that they are not being entirely truthful in saying that they want people to claim pension credit, and expect their campaign to fail. Government ministers being less than truthful is hard to believe, I know, but we can’t discount the possibility. On the other hand, if we make the assumption that they are being honest, that leaves us with an inexplicable mathematical quandary. Failure to make the £1.4 billion cut would lead to economic collapse, but spending an extra £2 billion plus would not. Labour’s grasp of basic arithmetic turns out to be no better than that of their predecessors.