Are these still happening?

I have only just noticed a question on this blog from 'Man in a Shed' asking whether these debates are still happening.

They are - and please do come along!

The only reason I haven't been blogging lately is that it's really difficult to chair the debates and take notes at the same time. Also I haven't publicised this site at all well!

Summary of May Debate on the NHS

Our panel of three "experts" (who claimed they weren't expert but if over 100 years of experience in healthcare doesn't make them experts, I don't know what does!) did a great job of pulling in a good crowd of about 20.

Michael Thorn, Mike Naylor and Dr. Andrew Nelson, introduced themselves and their topic with some controversial and provocative themes.

The NHS is the largest state employer in Europe, and eats about £60 billion per year of taxpayers' money. Dr. Nelson had brought with him a heavyweight prop - a huge tome listing the many thousands of drugs available for doctors to prescribe. He drew a contrast between the immediate post-war period - when the average doctor's bag contained a few all-purpose drugs and "a doctor's role was to bring people into the world and to ease their passing from it" - and today, when the huge variety of drugs and procedures has led to the growth of a vast army of nurses, administrators, managers and consultants around the doctors.

The NHS was portrayed as a "bottomless pit", with ever-increasing lists of treatments provided free at the point of use. IVF and forms of cosmetic surgery, for example, are sometimes provided for "free". Patients (or customers!) have unrealistic expectations from the NHS.

Bureaucracy - "the British disease"?

The BBC employs 27,000 people - more than all 4 of the US networks! The MoD employs more civil servants than soldiers! In keeping with this "British disease", the NHS employs a vast army of non-medical staff. Addenbrookes in Cambridge employs 2.68 non-medical staff for every patient, compared to 1.24 in a typical French hospital of a similar size.

Someone asked, if the medical staff know what needs to be done (a phrase often used), why has the profession been so quiet?!

Free for All?

"Neither the public nor doctors themselves appreciate the real cost of drugs and treatments".

The public does not appreciate the NHS and this leads to abuse of the system, and wastefulness. The fact that the NHS is "free at the point of use" sounds like a good idea, but it was never intended to be that way, even by Beveridge.

"Whilst most people will accept that when their car goes wrong, they need to shell out £500 on a new exhaust system, they don't think it is acceptable to pay out when their own health goes wrong".

Successive governments have set the public's expectations far too high. What is more, the NHS in combination with social services, encourages people to sit back and take life for granted in general.

Doctors also don't appreciate the cost of the treatments and drugs they are prescribing. In the absence of fund-holding at practice level, doctors don't appreciate the cost of brand-name drugs versus generic drugs, or the relative cost of basic and common treatments such as hip replacements.

Procurement has been "notoriously bad" in the NHS.

Fund-holding is a good idea, but in addition there should be doctors trained in medical economics and the business side of medicine, as a specific discipline. Otherwise, there is a risk that doctors get steam-rollered by the business managers.

Party Politics and the NHS

Are we too short-termist about the NHS? Should the NHS be a non-party, consensus issue, with a longer term strategy and vision which is agreed by all parties?

Politicians in general are terrified to criticise the NHS or propose cutting it down.

About one in ten British employees work for the NHS, so to criticise is to lose votes. (Gordon Brown's philosophy was described as "The more people are on your payroll, the more voters you have"!).

If privatisation is a dirty word for politicians to use, there are a few other suggestions about how it might work to take the NHS "out of politics". For instance, the BBC is managed by Charter, the rail industry is regulated, the Bank of England is independent. Perhaps, like for the pensions issue, an independent report should be commissioned (like the Adair Turner report), which might stand a chance of being independent of the political parties.

This sounds like a good idea, but in practice is likely to be impossible. Governments need to be involved in order to set the priorities for expenditure.

Until David Cameron, there was significant disagreement about how much should be spent, as a baseline, on the NHS. Several present were disappointed with David Cameron's policy statements on the NHS, suggesting that the status quo would prevail in terms of expenditure. He should be thinking more radically, and should not be afraid of accusations of "Tory Cuts". (Perhaps the Tories should embrace and adopt the phrase "Tory Cuts" and turn it to our advantage?).

Government's role should be to prioritise and define exactly what should be provided for "free". There needs to be some prioritisation, and so the NHS will not ever be entirely separate from politics.

Get Better Soon?

So is the NHS getting better, with all of Labour's extra investment? The consensus was almost certainly no. There was much anger and frustration at the incidence of MRSA ("are we going backwards in time?!"), the fact that bed occupancy of about 100% leaves the system unlikely to be able to cope with an epidemic such as Avian Flu, and the incompetence with which doctors' pay was calculated.

Big is Beautiful?

Perhaps the NHS should be split up geographically or by specialism, to make it easier to manage, more flexible and leaner. Its current size makes it difficult to manage change. However a geographical split would be difficult because of major equipment such as CAT scanners which need to be centralised and utilised almost 100%. Also splitting the NHS by geography would lead to inconsistency and arbitrage (travelling for treatments).

La Solution Francaise?

Much reference was made to the French health system (number one in the world, according to a survey 7 years ago, when Britain came 34th in the world).

"We have a conceit in this country that our health service is the best in the world, but it's not - we have a lot to learn from other systems".

The French system is one in which 75% of any medical bill is paid by the equivalent of National Insurance, but provision is not totally free. Waiting lists are almost unheard of.

Closing Words

So what did we agree upon? I think we agreed that doctors should be trained in economics. There should be more fund-holding. There should be fewer bureaucrats. Government should prioritise NHS funding more carefully (and very possibly cut it down). Total privatisation may be a step too far, but an increasing mix of private and public provision seemed to be the consensus. The rest is up for grabs.

May 22nd - Our Next Event

Our next event is on Monday May 22nd, at 7.30pm, as advertised.

The subject will be the National Health Service, so bring all your views with you, as well as any friends and family who might be interested!

I can confirm that this time, we will experiment with a slightly different format. We will have a Panel of three local experts.

Our Chairman will be Mike Naylor, who is the former Managing Director of Toshiba Medical. He will be joined by Michael Thorn, who previously worked as General Marketing Manager for 3M Healthcare, and Dr. Andrew Nelson, who is the retired senior partner of a major local GP practice.

They will bring their diverse views and insights to bear on this wide-ranging topic.

But don't feel you have to be an expert... Come along with some questions to ask the panellists and some opinions to express, and we hope to have a lively evening.

Update on Humfrey Malins, MP

I had the pleasure of sitting next to Humfrey Malins, our local Woking MP, at a dinner last night to hear Nirj Deva, MEP, speak.

Humfrey confirmed that he will definitely be coming along to our July and December discussions, and even showed me that they were written in ink in his diary!

I did also hear back from Jeremy Hunt, MP for South West Surrey, who can't make any of our dates, but was interested in what we did and whether to suggest the introduction of a similar thing in his own constituency.

Summary of April Debate on Iraq

A lower attendance than normal was no doubt due to the upcoming council elections. Apparently the activists were all out canvassing. How dare they!

We nonetheless had 12 people and a lively debate as usual, if a little less structured.

The main theme that came through was that none of us was clear about WHY Britain is in Iraq - both in terms of why we originally went in, and what the objective is now. Is it to make Iraq safe for Iraqis? Is it to secure our national interest in terms of energy security (ie oil)? Is it to make the Middle East safe? Is it to set an example of democracy for the rest of the Middle East and beyond?

A comparison was drawn with previous wars (WWI, WWII, the Falklands War...) in all of which cases there was a clear reason why we were at war. There was a clear and easily articulated "mission statement" which the public could buy into, and which also motivated the combatants. There is no such clarity of "mission" with Iraq, and therefore it is all the more difficult to set criteria to withdraw. Are we remaining in Iraq mostly out of guilt (the "we broke it, therefore we must fix it" mentality!)?

As we discussed it, the question broadened.... Why do we have a foreign policy at all? What exactly is the objective we are trying to achieve?

We discussed the relative lack of commitment to fighting for democracy among the general public, among the press (who are making a very big deal out of 104 British deaths in Iraq, when more have died in Northern Ireland, and many times more have died in previous wars), and even among the armed forces themselves. Have we "gone soft" as a nation? Are we complacent about democracy, so that we are no longer prepared to fight for it?!

We discussed the strategy that we might adopt in Iraq, in order to stop the fighting. One suggestion was to consolidate those areas that are not violent, and invest in those areas, to set an example to those areas where there is fighting. Perhaps we should talk down the violence, which the press are keen to talk up and exaggerate.

We talked about what might have worked to prevent the current situation. Some felt that we should have gone in with more troops on the ground (the US is short of infantry troops, apparently), or that we should have considered replacing the Saddam Hussein regime with a Monarchy (under which previously there was apparently peace and prosperity in Iraq). We acknowledged sadly that we are now in a difficult position - whereas Saddam Hussein could control the country by terrorising civilians, we can't do the same, even though it might be effective!

So what should we do now? Some thought we should bring in many more local or regional troops (eg from Egypt and other Middle Eastern countries). Others thought we should bring in democracy gradually (over 20 years), starting with the elite, rather than bringing it in instantly.

We discussed whether there were votes riding on Iraq as a policy area. Perhaps there is an incentive to develop credible and differentiated policies on Iraq, since Muslims (as a group in general) could be considered natural Conservative voters, but the immigration policies of the Conservatives have put them off. A sensible, sensitive, well-thought-through set of policies on Iraq might appeal to Muslim voters. We all agreed that - regardless of the Muslim vote - if the Conservatives could articulate a clear objective in Iraq this might be the beginnings of a policy that could be sold to the electorate, and would differentiate Conservatives from Labour.

However there was certainly little sympathy in the room for the idea of following the Lib Dems into a policy of withdrawal. All appeared to agree that we had a duty to stay for the time being.

Summary of March Debate on Taxation

The debate coincided with Budget Day, appropriately.

To introduce the topic, I handed out a sheet of paper showing 2 pie-charts - one showing government annual expenditure and another showing the sources of taxation. It was taken from the same day’s Budget document.

We noted that expenditure was forecast to exceed taxation revenue by £36 billion during 2006/07. (This will generate extra National Debt that would generate extra interest payable to add on to the current £27 billion per year).

I also picked out some statistics from a recent Sunday Times article entitled “Taxes hit all-time high”.

Various people expressed surprise that tax revenues had risen from £271 billion in 1997 to £490 billion now – surely significantly more than the inflationary increase!

We generally agreed that taxes seemed to have risen in real terms by much more than inflation, and also that other measures of the cost of living had also risen by more than inflation – such as housing costs, power, etc. The official inflation measure does not (it was felt) really reflect increases in the cost of living.

We felt that the subtleties of taxation were difficult issues to communicate with the public, and that there was not much public debate about the right level of taxation to maximise government revenues and the wealth of the nation. For instance, it might be that a lower rate of taxation is optimal because it incentivises wealth-generation and therefore maximises government revenues in the medium term. There is also not much public debate about what government is for, and why we pay taxes in the first place.

Opinions included:

"Government should be there to provide basic services, but in reality we get enhanced services and pay much more for it than it would cost to provide basic services".

The most basic services of all are food, shelter and clothing, and yet the government does not directly provide any of these – so why should it provide other services?

We discussed that council tax is used by central government to manipulate voters’ perceptions of their local governments (which are clearly run by various different parties, not all by Labour), and therefore to shift the blame for taxation, by reducing the bundle of services paid for by central government, and effectively forcing local government to increase council tax and “look like the bad guys”. But this is a difficult message to get across to the electorate, especially when council tax is one of the few taxes which voters actually get a bill for, so they are more conscious of it than of other forms of taxation.

Perhaps it would be interesting if everyone got a “personal tax statement” and could see what taxation they personally paid. This might make people more conscious of the tax implications of the policies they vote for. This is obviously quite difficult, but instead it might be possible to launch a website (similar to the Carbon Emissions websites) where you can answer a few simple questions about your personal circumstances (eg your salary, how much you drive, how much you smoke/drink, where you live, etc) and you can see how much tax you currently pay, and how much you would have paid in 1997 (for comparison). This might be quite a good pre-election tool for the Conservatives to promote?

We discussed the personal impact of the taxation system on our own life decisions and those of our families. One of our group was a recently-retired man who considered returning to teaching in his late 50s, but decided that the extra workload was not worth the after-tax salary, compared to the benefits he would get otherwise.

The fact that some of the English tax burden effectively goes to Scotland and Wales was also discussed. Cynically, this could be seen as Conservative constituencies subsidising Labour constituencies to ensure that they remain Labour constituencies!

We raised the possibility of a flat rate tax with no other taxes, like some Eastern European countries, but this was thought to be too big a change to be possible in any short term timeframe, and also it would not allow the opportunity for government to influence behaviour (eg smoking, drinking).

A final suggestion was that the government should not be providing services directly, but should leave much more to “the market” whilst spending taxation on giving voters access to choice and good advice about how to use the market and make the best choices for them.

Sadly the debate was not as well attended as previous debates since it clashed with an important council briefing on electioneering for the local elections. There were 8 attendees for the first part of the debate, plus a further 6 attendees who arrived later.

Summary of February Debate on Education

Summary to follow.

Summary of January Debate on Pensions

The discussion was attended by 22 people, with a (commented upon) good mix of ages, with at least a third of the attendees under age 35.

I gave a short factual introduction to the topic, and Tony Branagan chaired the following discussion, which was free-form but very lively.

How had the "pensions problem" come about? Had previous governments failed us by not investing contributions made by taxpayers? No, not really, because the "pay as you go" system set up in 1947 prevented this - the contributions were needed to fund the pensions of the first pensioners directly.

There was a general consensus that the mix of invested (self-funded) and "pay as you go" pensions provision needed to change in favour of invested.

Led by some of the older members, there emerged a view that a large part of the pensions "problem" was that nowadays the younger generation did not have a "savings culture" and should be encouraged to save more for their pensions. There was some very lively debate about what had caused the "instant gratification" society, whether the current government's "nanny state" policies (eg the Pension Credit was widely cited as contributing to the problem) or whether state benefits in general were too generous, or whether the fault was with the failure of the education system and/or parents to "teach" a savings culture. There was some doubt about whether a "savings culture" could be taught, and there was a general consensus that the existence of the welfare state contributed to a disincentive to save in general (compared to when some members and their parents had grown up), but that obviously some welfare state was still desirable!

At this point the younger members present protested at the suggestion that it was "all their fault" (!) and that their non-saving for pensions was in some way irresponsible. It was pointed out that young people often had other valid financial priorities other than pensions, such as education and buying property, although we did agree that many younger people were not saving enough.

Proposed solutions to the pensions problem ranged from better education (although there was some doubt as to whether this could work), through the setting of rules so that banks could not make it easy for customers to get into debt, right through to the "rolling back" of the welfare state, so as to create an incentive to save and also to free up more money for pension provision. It was also suggested that easing the burden of taxation would eventually create more opportunity for individuals to save.

There were mixed feelings about compulsory savings for pensions. Some thought this was too "nanny state" an approach and others thought it was (sadly) a necessary step. It was pointed out by one of our group, who was the administrator of a large company pension scheme, that it was currently not in the interests of many companies to promote or incentivise their pension schemes to employees, and that this needed to change.

There were mixed feelings, too, about the prospect of delaying the retirement (or state pension) age, but largely the participants were positive about this as a solution (perhaps because many had already retired!). I pointed out (although not as a complaint) that a 30 year old woman today would retire 7 years later than her 60 year old mother (because of the gender equalisation and the Turner report, if implemented). But I had to concede the point that young people today tend to enter the workforce later because of gap years and spending a longer time in education, so that much of the "later retirement" effect was actually shifting the working age.

Frequently Asked Questions

This posting is designed to cover the whats, wheres and hows of our group.

What happens?
We meet every month, on a different day of the week, to discuss political themes for about an hour and a quarter. The format will vary but we will usually have some kind of short introduction to the topic, either by myself or by another volunteer, and then we will open up to a lively debate, chaired by myself or by someone else.

Where is it?
It's held at Churchill House, Chobham Road, Woking, Surrey GU21 4AA. The meeting room is on the top floor. Churchill House is at the Woking town end of Chobham Road, just next door to the Lorna Doone Dental Surgery.

What time does it start?
It starts at 7.30pm and tends to wind up at about 8.45pm (following which there is usually a pub contingent who carry on in the Wheatsheaf Pub on Chobham Road).

What does it cost?
There is a voluntary charge of £2. You don't have to pay it, but it helps us to cover photocopying and other administrative costs.

Who comes?
We welcome members of the Conservative party and also non-members, friends and family. We tend to have between 15 and 25 people at each event (so far), and there is a good mix of ages.

Do I have to speak?
Not at all. If you like you can just listen to the discussion, but we hope you will feel like putting your opinion forward.

How much should I know about the topic?
Nothing or everything. It is brilliant to have experts along, but if you are not an expert you may still have an opinion, and it is a chance to quiz any experts that we may have in the room. The idea is to improve our knowledge of political policy, so that we are better informed, and also to feed back our group's opinions to Conservative Party Central Office, so that they can take our views and ideas into account when policy-making.

Can I suggest a topic?
Yes - email the Woking Conservatives office at office@wcca.org.uk, and mark the email for Helen, and I'm always happy to receive suggestions.

Can I get involved in organising?
Please do! Again, email me and let me know if you are interested in organising, introducing or chairing events. I am always looking for keen volunteers!

Is there a mailing list?
Yes, there is. To get on it, to get reminders of monthly events and any updates, email the office on office@wcca.org.uk and mark the email for Helen.

Local MPs

I'm pleased to share that Humfrey Malins, the local Woking MP, has provisionally agreed to come along to the July debate on Immigration & Asylum (on which he is a real expert, having been on the front bench on these topics), and also the December debate on Law & Order.

I have also emailed Jeremy Hunt, the Conservative MP for South West Surrey, to invite him to the debates on the NHS (in May) and on Britain's Minorities (in October). He is currently Shadow Minister for Disabled People so should have some interesting things to say on either topic. I'll let you know when I get a reply.

Calendar of Events for 2006

Here is a list of all the meetings planned for 2006:

Mon 23 Jan - Pensions - Crisis, what Crisis?
Wed 23 Feb - Education, Education, Education - what chance for our kids?
Wed 22 March - Taxes - to cut or not to cut?
Thurs 20 April - Iraq - where next for Britain's involvement?
Mon 22 May - The National Health Service - to solve the unsolvable?
Wed 21 June - Energy and the Environment - what's the right balance?
Wed 26 July - Immigration and Asylum - an end to chaos?
Thurs 24 Aug - Britain in Europe - in, out, shake it all about?
Mon 25 Sept - Personal Freedoms - does nanny know best?
Tues 24 Oct - Protecting Britain's Minorities - what price should be paid?
Wed 22 Nov - The British Political System - time for a change?
Thurs 21 Dec - Law and Order - in the dock