There’ll be no transparency in the NHS while the lawyers circle above
Complain about anything in an NHS hospital and you will face a wall of unknowing. Not sympathy, not a recognition of the mistake and certainly not an apology. This has nothing to do with a lack of care or humanity by NHS staff and everything to do with the scale of legal costs and fines faced by the NHS. The sums are now huge (£15bn in 2010 according to the Daily Telegraph, 3rd August) and rising fast, thus draining the funds that should be spent on front line care.
The reality is that transparency by the hospital (or whatever) will simply provide evidence for the ensuing law suit. If patients and their relatives are given more information about their treatment, then that too can be used in evidence.
Harold Wilson is to blame. When the NHS was set up, patients could not sue and everything was more open. Those are the days of caring we look back on with a warm glow. The reason they could not sue is because there is no contract between NHS and patient: the patient does not directly pay for NHS services, the state does. So the patient had none of the usual customer’s rights. Harold Wilson was lobbied by patients’ representatives saying this was unfair and they were entitled to recompense when things went wrong. The law changed and the patient became the customer with a right to sue for damages.
The unintended consequences are now plain: lawyers instruct NHS staff not to admit liability, or indeed anything. The costs to the NHS are not just the lawsuits but lawyer interference in management at all levels. Sweep the cock-ups under the surgical gowns and no one will learn from mistakes or even know about them.
I had personal experience of this when a famous London hospital nearly killed my uncle by not following standard hygiene procedure during his operation. The infection was serious and kept him in hospital for quite a while. My uncle did not want to make a fuss, still less sue, but I insisted on having a discussion with the surgeon. I hit a brick wall. Most people would have given up but eventually, after giving assurances that we would not sue, we met. He was accompanied by a young man whom I took to be a lawyer. He tried to write everything down until, by now quite cross, I reminded them that we were not suing. The meeting was entirely to ensure the surgeon understood what had happened, since we had no reason to believe he did, and to press him on how these things could be avoided in future. I got some satisfaction on the former and none on the latter which was, in fairness, not strictly my business. There was no apology.
The idea that mistreated patients deserve some recompense is now so ingrained that we are unlikely to revert to the pre-Wilson era. But the present system is lose-lose: it contributes to the problems such as those now exposed at Mid Staffs whilst simultaneously destroying the NHS budget and the costs are escalating. Following Mid Staffs all sides are issuing platitudes about transparency but, with the lawyers circling the sky like vultures, it will not happen.
One solution is to have a menu of damages that an ombudsman can award once the facts have been transparently exposed. In the event the hospital, or the patient’s representative, is less than open, the damages are doubled or eliminated following the more arduous investigation. Any hospital playing the odds, i.e. getting doubled too often, would be required to discipline, and possibly sack, the manager most responsible for the lack of transparency. In this solution, no lawyers would be allowed to participate on either side.
Reviewing the LSE Growth Commission
The London School of Economics' much-vaunted "Growth Commission" has finally released its report, after a year of discussion, debate and work. Unfortunately, the policies it advocates are unoriginal and underwhelming.
They focus on three areas of long-term investment, into human capital, infrastructure and innovation. All of these factors are, of course, conducive to growth. However, beyond that obvious, aggregated view, the authors fail to answer the question of which investment is right for growth; which human capital; which institutions are most conducive to growth.
For example, human capital is not some homogenous gloop to be imparted into the grey matter of students, but can be subdivided into a whole host of different skills and capabilities. Some of these skills will be conducive to productivity growth and innovation. Others will be useless. While improving school autonomy is admirable, the largest contribution of this report is to slap the term "flexible ecology" onto policies already being pursued. At no point do they explain that school autonomy is important because freer interactions allow employers and universities to demand and get the types of human capital that they need, rather than what a top-down state system foists upon them.
Similarly, physical capital in the form of infrastructure is not some magical panacea. While they identify the planning system as a key barrier to private infrastructure investment, the report's authors bizarrely recommend the creation of three new Quangos, one of which is a bank, and to automatically pay more for any infrastructure projects. Perhaps they might have stopped to consider that the implication of a faulty planning system is to reform it, rather than to add more bureaucracy, and pour even more money on the problem. The report's proposals again focus on merely increasing investment, with little regard for quality and sustainability.
The report is weakest on the most important aspect of economic growth: innovation. They identify a lack of capital for new entrepreneurs as the biggest problem. Predictably, their answer is to support current moves towards a government-run "Business Bank", to support new financial regulations, and for yet another Quango to be created to form industrial policy. Again, this is hardly original. All of this ignores the fact that government, and even supposedly sainted "independent" Quangocrats are notoriously bad at picking winners, and are likely to exacerbate any capital misallocations in the economy by diverting it away from viable innovations. The Commission's plan is basically to use taxpayer money to prop up unsustainable start-ups, towards an unclear and likely negligible impact on economic growth.
The LSE Growth Commission's report fails to see that institutions need to be conducive to choosing the right investment, not simply more of it. The value of an economy is only increased if people get what they actually demand. For all its imperfections, free exchange is still the best test of determining what people want, and which innovations are best at meeting those wants.
Ring-fencing is the wrong answer to the wrong question
The government is proposing to 'electrify' the ring fence around retail banking activities by warning them that they risk being forcibly broken up by the Bank of England if they try to get round the fence.
Ring-fencing is the wrong answer to the wrong question. Thanks largely to the rhetoric of Business Secretary Vince Cable, many people, including too many politicians who should know better, imagine that the financial crash occurred because of the failures of 'casino banks' – that is, the international investment banks. These, we have been told, crashed and brought down the retail banks that were attached to them. So to protect ordinary customers, we need to separate the two.
But as Miles Saltiel showed in an Adam Smith Institute report in 2011, it was not the investment banks that brought down the retail banks and threatened people's savings. The first banks to fail were the ex-building societies like Northern Rock that got out of their depth when they dropped their mutual status and started offering silly mortgage deals. Then it was the turn of the big banks who were buying mortgage assets – supposedly 'safe' retail-based business – that turned out to be rubbish.
Ultimately, it was politicians and regulators who caused the crash, by flooding the world with cheap credit and money for decades and then cutting back suddenly – as, again, John Redwood demonstrated in yet another Adam Smith Institute report. No wonder banks took risks that brought them down. And when the ex-building societies were offering 120% mortgages and other risky products, the regulators did nothing.
I certainly think that bank customers should know what the bank is doing with their money, so they can judge the risk they are prepared to take and balance safety against cost. But ring fencing does not cure any of the problems I have listed. What it might do is to deny the retail banks access to international capital, making retail banking more expensive for customers and continuing the problems faced by small businesses who cannot get loans. And since other countries have no plans to ring-fence their banks, Britain's financial sector will be setting itself at a self-imposed international disadvantage.
A dismal decade
One should 'Never make predictions, especially about the future'. However, it seems pretty certain to me that the next medium-term picture for the UK economy is bleak. There's nothing particularly novel here, but it's worth summarising the position.
From the fiscal perspective, the present government has made appalling progress with deficit-cutting: borrowing has increased, spending is still increasing and whilst growth-destroying taxes have risen the size of the state has not decreased. Apparently only 6% of the public realise that this is the case. Any hope of the UK being able to balance its budget let alone amortize any of its vast debt by running surpluses is years in the future. In the best-case scenario, an outright Conservative electoral victory in 2015 might bring the time and the will needed to eliminate the deficit but this is unlikely even if that is the result.
Unfortunately, the present government has portrayed the present situation as one of austerity when it is not - what 'pain' is being felt is from the reallocation of spending from one Department to another and to increased interest payments. It might be that a sensible left-wing government actually finds it easier to cut the deficit, like New Zealand's Labour, as they avoid accusations of being Tory 'toffs' or some such nonsense. However, the present Labour Party seem committed to fiscal recklessness, not to mention the dire prospects such a government would have for deregulation and supply-side reform. All the while, the Lib Dems claim credit for 'restraining' the Conservatives from cutting government, as if this were positive. Essentially, the UK's fiscal position seems unlikely to improve any time soon and government will continue to spend around 45-50% of GDP, a position seriously deleterious for growth.
On the monetary front, we seem committed to a policy of inflationism and dis-saving and the incoming Bank of England Governor sounds even more committed to loose monetary policy than the present. Inflating the national debt away may take the burden from politicians in having to make real spending reductions, but it has serious impacts on saving and capital formation and thus future economic growth and risks the formation of new asset bubbles.
Contrary to popular belief, the Thatcher-Major governments of the 1980s did not really reduce the size of the state but instead - in general - restrained its growth compared to the size of the economy. This economic growth was predicated on supply-side reform, particularly in privatisation and increased labour flexibility. The present government has tinkered but has not really delivered any substantial supply-side reform. What happened to the Great Reform Bill? Where is the slashing of Red Tape that we were promised? The 'bonfire of the quangos' was a flash in the pan and Big Government has continued whilst Big Society died.
Whilst I don't think a major economic or fiscal collapse is likely, it is not beyond the bounds of possibility. The Coalition government are not seriously pursuing any of the reforms necessary to bring about economic growth: a proper programme of major fiscal consolidation combined with sweeping supply side reform and underpinned by sound money. Labour's policies score even worse. In brief, the next ten years and beyond seem to offer the UK prospect of mild (or perhaps more serious?) stagflation.
For the elucidation of the Tax Justice Network: yes, let's abolish corporation tax
The Tax Justice Network is patting itself on the back for having survived a decade of securing government grants. In their little self-congratulatory note they make this point:
Proponents of tax competition have never answered the crucial question of how far it should be allowed to go before it compromises the functioning of a viable and equitable tax regime. Taken to its logical extreme, unregulated tax competition will inevitably lead to a race to the bottom, meaning that governments will be forced to cut tax rates on corporate profits to zero and subsidise those companies choosing to invest in their countries.
I can't see that not charging tax is a subsidy but still: for the rest of it, yes, that actually is the point. Corporation tax is an extremely bad tax, for two very different reasons, and we'd all be much better off if the same revenue (assuming that we do indeed want to collect that same gargantuan amount of the economy to be spent through government) were raised in some other manner.
The first reason corporation tax is a bad tax is because of deadweight costs. All taxes destroy some economic activity. Things that would have been done in the absence of taxation are now no longer done in the presence of it. This is why we tax booze, fags and petrol: to reduce the amount of smoking, drinking and driving. But, as this OECD chart shows, different taxes have different deadweight costs. That is, some destroy more economic activity than others per £ of tax revenue raised. And corporation tax destroys more economic activity than almost any other form of tax (well, except for the entirely stupid Robin Hood Tax). Thus we would very much like people not to charge corporation tax but to get the necessary some other way: taxing land, property or consumption for example. This has nothing at all to do with whatever wonders will be financed with the tax collected: we are talking purely about how much destruction accompanies certain forms of taxation themselves.
Do note that a large part of the TJN's purported concern is with the poor countries. Exactly those we would want to be striving for the least destructive tax system possible. They really are grasping for all the economic growth they can get: thus corporation tax is doubly contra-indicated. Although, for some reason unknown to myself or anyone else sentient, they keep insisting that said poor countries should be charging more and more corporation tax.
The second reason why corporation tax is a bad idea is that it's a disguised tax. Yer averge schmoe in the street thinks that it's the companies paying it: when of course it isn't. It's some combination of shareholders and workers who do. What influences the balance there is how large the economy is (the smaller, the more the workers) and how open it is (the more open the more the workers). And again the TJN is insistent that it's got to be the developing economies that charge companies more corporation tax. Developing countries are by definition small ones. And given that we are talking about foreign capital being invested they're also, in the context of this argument at least, entirely open. Thus the burden of the corporation tax the TJN insists upon is really being carried almost entirely by the wages of the workers. Indeed, Joe Stiglitz once pointed out that this burden can be greater than 100% of the revenue raised.
So the TJN are stating that the corporates must be taxed more: when the sentient among us realise that actually the burden is upon the poorest of the poor: workers in developing nations.
The above being the double reasons why zero corporation tax, most especially in poor and developing nations, would be such a good idea. All of which leaves me slightly flabberghasted. The TJN has actually managed to get something right:
Taken to its logical extreme, unregulated tax competition will inevitably lead to a race to the bottom, meaning that governments will be forced to cut tax rates on corporate profits to zero
Yes, that's the point.
Corporation tax is a bad tax and we want less of it. Most especially in poor and developing nations.
That with a corporate tax rate of zero hundreds of thousands of highly paid accountants and lawyers will have to go and do something productive with their lives is just an added bonus.
Inequality's going to shrink on its own. Don't screw up by trying to do something about it.
I know, I know, inequality in the UK is claimed to be at the root of all evils. And we neoliberals are supposed to have been promoting it for our own ends. Possibly cackling with glee as we did so.
And if truth be told I have indeed been cackling at the results of our dastardly neoliberal actions. As I've pointed out repeatedly the last 30 years have seen the largest reduction in human poverty in the history of our species. Billions have progressed from starvation to a petty bourgeois three squares a day. Indeed, this has been a change of such titanic proportions that global inequality is falling. And yes, there has been a price for this: the rise in in country inequality. A price that I think is eminently worth having paid.That the global top 10% mark time (even if the global top 0.1% continue to power ahead) while some goodly portion of the 90% catch up does not dismay me in the slightest.
As an example of this analysis about inequality, here's Dean Baker:
But if technology and its demand for high skills are not to blame for the rise in inequality, then we have to look elsewhere for the culprits. One obvious source is globalization. Millions of manufacturing workers have lost their jobs to low-paid workers in Mexico, China and elsewhere. Some argue that this is a natural, inevitable market process. But it is not. It is a policy choice. Yes, there are tens of millions of people in the developing world who can perform the same tasks as our manufacturing workers for a fraction of the pay.
This has put downward pressure on the wages of our own low skill workers and explains that rise in in country inequality. However, this is just about to change. As China goes through its Lewis Turning Point:
China is on the eve of a demographic shift that will have profound consequences on its economic and social landscape. Within a few years the working age population will reach a historical peak, and then begin a precipitous decline. This fact, along with anecdotes of rapidly rising migrant wages and episodic labor shortages, has raised questions about whether China is poised to cross the Lewis Turning Point, a point at which it would move from a vast supply of low-cost workers to a labor shortage economy.
As and when China becomes a labour shortage country (2020, 2025 they say) then wages there will soar. Wages soaring for 1.3 billion people is of course good for 1.3 billion people. But it also relieves some to most of the pressure on the wages of our own lowly paid. Thus we can expect the pay of our own lowly paid to rise, reducing inequality.
Another way of putting this is that low wages in China caused some to most of the rise in inequality here. As Chinese wages rise that cause, thus the inequality, will go away.
The point being that if inequality is one of those things that you do worry about it is going to lessen anyway in the coming years. There's no need to do anything to make it happen. It's simply a natural by-product of China getting rich. And as India, Indonesia, sub-Saharan Africa, follow in those footsteps then inequality in the UK will diminish markedly. Which brings us to a strange place really.
If you want to reduce inequality in the UK you should be gunning for the industrial development of the rest of the world. For as other countries develop the downward pressure on UK wages abates. Which is, of course, the true deceit of the neoliberal plan for the New World Order. That we all of us get stinking rich. Cunning, eh?
Private schools are revolutionising developing world education. If only UNESCO would admit they exist
A so-called ‘fact sheet’ on education in Nigeria published by UNESCO in October 2012 suggests that Nigeria has some of the worst education indicators in the developing world. For example, since 1999, the number of out-of-school children has increased from 7.4 to 10.5 million, which means that Nigeria now has the largest number of out‐of‐school children in the world. Unfortunately, these statistics fail to take into account the thousands of unregistered low cost private schools that exist across Nigeria and the millions of children who attend these schools. Consider, for example, the following findings from a census of private schools in Lagos State carried out by DFID in 2010-2011:
The table shows that the vast majority (88%) of schools in Lagos State are private and they cater for 57% of all enrolments. Most of these schools are owned by individual proprietors and serve low income families. The report therefore concludes that ‘the education landscape in Lagos is dominated by the private sector, with the majority of pupils attending private schools of all types’. Critically, 74% (8,952) of these private schools are unregistered and therefore not included in the official statistics. If the average number of children in these private schools is 114 then this would suggest that over 1,000,000 children in Lagos State alone are not out of school but attending unregistered fee paying private schools.
Further research carried out by DfID in Kwara State also estimated that there could be a possible 417,600 private enrolments, compared with the official school census from 2010/2011 which only recorded 157,327 children in private schools. This would add another 260,000 children who are not out of school but attending unregistered fee paying private schools. There are thirty six states in Nigeria and my guess is that if similar research was carried out in each state then the total number of out of school children would be dramatically reduced to a fraction of UNESCO’s original figure of 10.5 million - which is clearly bogus and in no way, shape or form reflects the reality on the ground.
So what could possibly explain such an extraordinary level of incompetence on behalf of UNESCO? First, UNESCO benefits from exaggerating the extent of the so called global education crisis because they are the international agency tasked with solving the problem. Without an education crisis and UNESCO would quickly become redundant. Second, by widely exaggerating the number of out of school children, this also allows UNESCO to point the finger at Western donors for failing to meet their funding commitments. This also helps to deflect attention away from the enormous problems facing government education sectors across the developing world including rampant corruption, teacher absenteeism and an almost unbelievably low level of learning - problems which UNESCO have failed to address over the previous half century.
Finally, UNESCO’s legendary anti-capitalist bias used to manifest itself in direct hostility to all forms of private sector involvement in education. Today, their opposition is much more civilised – they simply turn a blind eye to the remarkable growth of private schools for the poor across the developing world and instead continue to preach to the world in blissful ignorance and in a complete state of self-denial.
We don't need repatriation from the EU – we need de-patriation
The debate over the UK's relationship with the EU has stepped up. The PM has adopted the position of negotiating with the EU with the threat of an in-out referendum in his pocket. Personally, I think Cameron is just about in the right position, in theory. As Eric Pickles has argued, quite sensibly, EU membership should be on a cost-benefit basis. If it is clearly the case that withdrawal would benefit the general good more than remaining in the EU we ought to withdraw and vice-versa, regardless of any special-interest privileges.
Whether Cameron can make this work in practice is unlikely. After all, the EU is a large and growing bureaucratic institution with many vested interests operating within it - bureaucratic powers are unlikely to be ceded any more easily in Brussels than they are in Whitehall.
The finer points of the political debate notwithstanding, there is definitely something missing from the debate. On the one hand, there stands a massive, wasteful, unresponsive bureaucracy led by profilgate politicians in hoc to special interests. On the other hand, there is the EU. The problem with the EU is not that it has absorbed powers which should be vested in Whitehall but that these powers are vested in any government whatsoever. The principle of subsidiarity should be extended to its ultimate conclusion - the proper authority for all bar a few aspects of socio-economic life must rest with individuals, not governments be they local, national or supra-national. What the UK and the EU needs is not repatriation of powers but (to coin a clumsy neologism) 'depatriation'. There is no point removing powers from Brussels and handing them over to politicians and bureaucrats in the UK. These powers should simply be handed back to where they belong, in the hands of individuals.
I would be very happy to be a fully paid-up member of an EU and even a Eurozone that, say: operated a sound, gold-backed currency, ferociously enforced fiscal discipline, liberated markets, open doors to trade and migration, drove privatisation and de-regulation across all areas, decriminalised drugs (well said the Lords, on that subject) and generally pursued free-market and classical liberal policies.
Sadly, that's just wishful thinking but it is not as if the British government under any party is likely to follow this course either. On balance, especially given the nature of many EU governments and societies and the EU itself, it is probably more likely that this would occur under a UK government than under a federal EU one even if the UK's track record on this score is fairly poor. Ultimately, Britain faces a Hobson's choice between large and profligate EU governance and large and profligate British government whilst under present conditions it is saddled with both.
If we paid for doctors we'd forget the stiff upper lip
This week a medical journal reported that the British 'stiff upper lip' contributes to its low cancer survival rate. It seems that people simply don't want to bother the doctor when they feel ill. So their cancer goes undiagnosed, and the chances of survival diminish.
I know the feeling. I am registered with an NHS general practitioner, but now I usually go instead to a private doctor when I am ill Yes, it's expensive at £100 a go. Yet I find myself going to the fee-for-service doctor more than I ever did to the 'free' NHS one. It's not that I'm sicker. I am just more inclined to go.
Why? Well, there are costs other than money. With the NHS doctor, the first problem was getting through to the surgery on the phone. The line nearly always seemed to be busy. When you did get through, you could rarely get an appointment within the next two days. You did not know which doctor you would see. When you were seen, and discovered you needed antibiotics, the doctor would be reluctant to prescribe them. If you did coax out a prescription, you would have to traipse along to the chemist and wait to pick it up. Add up all that time and hassle, and visit to the 'free' NHS doctor became very expensive indeed.
For my £100, though, I get a phone that is answered immediately, an appointment the same morning, the doctor of my choice and, if I need medicines, they are handed to me there and then. Job done.
But there is something other than mere financial and time/effort cost in this equation. I reckon that there are many people with more serious conditions than my niggling cough. I can well see that, when medical services are rationed by queuing rather than by price, responsible citizens like me might well figure that we don't want to waste the doctor's time when there are much more deserving folk. It's another reason why I found myself simply not going, when I should have done.
I have no qualms at all, though, in going to my private doctor. It is a straight commercial transaction: I want medical treatment, this person is prepared to sell it to me. The price clears the market, and no other patients of that doctor are denied appointments or told to come back in three days. And I am treated as a valued customer rather than a necessary inconvenience.
Just maybe, if people were expected to pay for general practitioner services, they might forget the stiff upper lip and demand the medical care they actually needed.