Sunday, 15 January 2017

Putting on the postman's uniform - a return to local leadership


In David Brin's book, The Postman, he describes how a man in a post-disaster USA dons the uniform and, as if by magic, is transformed into that same reliable and trustworthy working-class public servant. In exploring the importance of connections between places, Brin (in common with many other writers exploring a post-disaster world) touches on different forms of organisation. We wander from self-reliant little homes with tough but loving families through suspicious and fearful villages or towns to the most dystopic world of the Big Man and the warlord.

In all the book's places we see what many would see as a crisis of leadership. In some places there is no leadership beyond the family, an entirely independent pseudo-pioneer world - a sort of Farnham's Freehold without the casual racism. In others we see safety and security achieved at the cost of compliance with oppression - Zamyatin's We with tatty leather jackets. Elsewhere we glimpse the entirely lawless where, in a world of scarcity, the utility function drives human decisions to their logical conclusion. Here's Deirdre McCloskey in "The Bourgeois Virtues":
"The economist and historian Alexander Field has based a similar argument on biology. He notes that on meeting a stranger in the desert with bread and water that you want, you do not simply kill him. Why not? Sheer self-interest implies you would, and if you would, he would, too, in anticipation, and the game's afoot. Once you and he have chatted for a while and built up trust, naturally, you will refrain."
Or perhaps not if the utilitarians are right? In their world the task of the leader, or so it seems, is to decide - by whatever means - what is the greatest good for the greatest number and implement that good. Such, for all the deal-making, fancy words, thought leadership and opinionating, is the core purpose of those gatherings of great and good - Davos, Bilderburg, summits, conferences and think tanks. Such things are the manifestation, the logical conclusion of a philosophical tradition running from Plato through Mill and Bentham to A C Grayling: leadership from the wise.

The problem today isn't that we are entering some sort of dystopia but rather that the most essential part of leadership - that someone has to follow - has been lost in our desire to perfect the manner in which leaders lead and the things that they lead on. Here from the Millennium Project:




I haven't got the Davos agenda but, while the words may vary, this 'conscious leaders' agenda' pretty much covers what they'll talk about (other than how to get themselves more power and money of course - that's not on the official leaders' agenda). What we have here is the agenda but the problems for those leaders in Davos is that, especially for the political ones - plus those pompously titled thought leaders - it's the lack of followers that is the agitation. This is the 'populism' that is troubling so many of the great and good - for them it is, indeed, better characterised as 'unpopularism'.

The problem here is that these leaders, for all that they seem secure in their power, are uncertain how long this will remain the case. We were all pretty certain that Donald Trump wouldn't win the US presidential election - and we were wrong. We were less certain but assured by our leaders that the UK wouldn't vote to leave the Euorpean Union - and we were wrong. Elsewhere we've seen the President of France become so unpopular that he withdrew from any prospect of seeking re-election. In Spain and Greece social democratic parties are being replaced by radical parties of the left and the big losers to left and right in Holland, Sweden and Germany aren't conservatives but rather Europe's once dominant centre-left.

And the image above of the world and its problems? That is an image constructed by the centre-left - a reflection of big state, big government models for the future. It's not that the content is wrong but rather that the model assumes that the wise - Philosopher Kings - will provide the leadership and this leadership will be global. These are the people who Harm de Blij says live in a flat world, flitting effortlessly from place to place across the world and inhabiting a community where they genuinely feel like Tom Paine's citizens of the world. The problem is that 99% of the worlds population aren't in this flat world - they're, in de Blij's words, either locals living in the global periphery or mobals trying to get from that periphery to the core where they can have a better life.
"From the vantage point of a high-floor room in the Shanghai Hyatt, the Mumbai Oberoi, or the Dubai Hilton, or from the business-class window seat on Singapore Airlines, the world seems flat indeed. Millions of world-flatteners move every day from hotel lobby to airport limo to first-class lounge, laptop in hand, uploading, outsourcing, offshoring as they travel, adjusting the air conditioning as they go"
Such 'flat earth dwellers' understand the locals and mobals. After all they've listened to a thought leader speak, they've read a precis of the current academic research and they reviewed documents from a UN agency or two plus, for balance, Oxfam or some other NGO. The right noises about poverty, economic development, humanitarianism and growth drop from their lips. But they do not know these locals and mobals. Those people, the ones they see from the limo window, serving them tea in the hotel and marching angrily about how their livelihoods are threatened - they've stopped following these Philosopher Kings. Our 'flat earth dwellers' are no longer leaders but rather a bunch of folk who can see a lot of locals and mobals pushing against the glass of their bubble. And they are scared.

None of this is to say that enlightenment liberalism is wrong or a problem. After all, despite the best efforts of some to suggest otherwise, capitalism has made us richer and is doing the same for those locals and mobals de Blij worries about. Rather it's to suggest that we need to rethink the model of leadership that is revealed at Davos and to recognise that this approach - consultative, knowledge-focused but still globally focused and top down - no longer fits what's needed.

At a board away day recently (from where I pinched that image of the world's agenda) a couple of almost throwaway comments struck me as important. The first of these was that we're moving to a self-service world, quite literally through the power of the smartphone in our pocket. Want to know where something is? Phone. Need a picture? Phone. Want to buy some car insurance? Phone. I forget where I read it but if your business idea doesn't work on a phone, don't bother.

Many of the presumptions about public services, transport, retailing and decision-making no longer apply. It's not that we don't still need leadership but that that leadership needs to be more dispersed, connected and local than what we see today. The economics writer, Tim Worstall taked about Bjorn's Beer Effect:
Instead they have what I call the Bjorn's Beer Effect. You're in a society of 10,000 people. You know the guy who raises the local tax money and allocates that local tax money. You also know where he has a beer on a Friday night. More importantly Bjorn knows that everyone knows he collects and spends the money: and also where he has a beer on a Friday. That money is going to be rather better spent than if it travels off possibly 3,000 miles into some faceless bureaucracy.
In a self-service world we need to look more at local considerations than at the systems needed to deliver services - the phone in your pocket can deliver those services and you can work it out for yourself. But you still want advice, help - dare I say it, leadership - but this should be at your scale: local, responsive and focused. Most of the world's problems - pretty much all of them with the exception of that huge asteroid - don't require a global response but require us, at most, to change our personal behaviour. This needs dispersed local leadership rather than grand gatherings in nice cities.

The second throwaway from my meeting was about how people work - specifically Generation Y and Z but I suspect this applies much more broadly - in a world where access to knowledge (and fake knowledge) approaches being universal. We heard a description of a noisy, confused room of young people discussing the task at hand, phones being consulted, everybody talking, groups forming and unforming - there's leadership here but not in the traditional, dominant, top-down manner that our Philosopher Kings would want. And the leader on one task is different from the leader on another task - all a bit like The Apprentice!

This again reflects the manner in which connectivity - something that mobile technology is bringing to de Blij's locals - now forms the core function in leadership. The leader is no longer in that high castle and, tomorrow, may step aside because a different person has stepped up to lead. All this suggests that the established power structures of representative democracy and bureaucracy serve less of a purpose - if we self-serve we don't need that big bureaucracy and, therefore, its great leader. And if we're connected, involved and engaged we have less need to choose someone else to do the connection, involvement and engaging.

We'll still need the public servant but that person won't be a president, chief executive or civil service mandarin. Rather that servant will be Bjorn having a drink on a Friday with his friends and neighbours or Claire playing Lego with the kids in the local pre-school. Someone who, to return to where we started, has put on the postman's uniform.

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Tuesday, 10 January 2017

You can call them what you like but London needs new suburbs


I appreciate that some folk want me to believe - against all the evidence - that the supply of housing for purchase is not connected to high rents and high property values. Thing is that, however hard you try with this, I still don't think that the essential truths of supply and demand are not applicable to the sale and purchase of houses.
Tragedy struck one of those artist residences last week when 36 people died after a fire ripped through the illegally converted Ghost Ship warehouse in Fruitvale during a concert.

The horrific event could lead city officials to go after illegally converted warehouses across Oakland, especially as evidence mounts that building inspectors knew of numerous problems with the Ghost Ship property but didn’t take action.
This is in one of the world's richest cities where illegal conversion, overcrowding and ridiculous rental values contribute to an almost wholly unnecessary housing crisis. Here's Scott Beyer:
The more pertinent point, at least for housing, is whether metros respond to such changes, or just sit on their hands…as the Bay Area has done. Between 2010 and 2015, the metro population grew by 100,000 people per year, but added only 20,000 units per year. Bay Area median home prices have thus predictably skyrocketed since December 2010 from $515,000 to $825,000.
So at any point in the last five or six years there have been at least 100,000 people looking for somewhere to live in and around San Francisco and only 20,000 homes plus the relatively few additional as a result of outward migration. The result is what we saw at Ghost Ship - overcrowding, exploitation and death.

And don't think that the UK's overheating cities - especially London - are any different. I've been reading Ben Reeve-Lewis's blog on Landlord Law for some while and some of his stories about exploitative, dangerous and overcrowded housing in our capital beggar belief. The problem is that, for all the shouting and rhetoric, we've our fingers in our ears on this issue, continuing to pretend that the housing can be put somewhere else - words like 'brownfield' or 'regeneration' are popular here - rather than where people actually need to live so they can get to the jobs our economy is providing.

Some time in the next week or so (right now we're told probably 16 January) the UK government will publish a 'White Paper' on housing. The content of this paper remains a matter of speculation but it has been strongly hinted that the need to build homes will trump the desire to protect open countryside on the fringes of towns and cities. To understand how the reaction from some MPs might run, we can look at the Neighbourhood Planning Bill currently before parliament:
In a Tory split over a planning bill, 15 backbenchers have tabled amendments which seek to protect land around cities and to increase the powers of local people to stop new development.

Conservatives rebelling on the Neighbourhood Planning Bill included Andrew Mitchell MP, who told HuffPostUK “I shall be questioning the Government’s commitment to the greenbelt in forceful terms” in the chamber.

Heavy-weight backbenchers Crispin Blunt, Nick Herbert and Nicholas Soames also opposed the Government’s plans. Soames tweeted on Monday that the “unspeakable behaviour of housebuilders” needed to be “dealt with”.
Now I know that these MPs mean well. They face considerable pressures from well-organised local groups largely opposed to any further development in the semi-rural exurbs they represent. But when the consequence of these actions is the sort of overcrowding that led to those deaths in Oakland, we perhaps need to start asking quite where we want to put our priorities. I've no particular desire to defend housebuilders but I don't consider them unspeakable - someone has to build the homes people need.

OK so you're asking how it is that the housing needs of relatively poor, often immigrant communities in central London can be met by building houses outside Crawley or at Sutton Coldfield? The answer lies in a hidden challenge facing our big cities - a generation of younger people wanting to do what folk do and get married, raise a family. Right now they can't do that - check out the sort of rented accommodation in central London and then ask whether you think is sensible or even possible to raise a family in such places? The result is that people don't get married and don't have families - here's the world's starkest example, the Bay Area of California:





Over 70% of households in San Francisco are childless. The situation in London is nearly as stark - about 64% of Inner London households are child free. As we move into suburbia - Outer London - the pattern changes with 27% of households consisting of couples with children. The problem is that the outer London suburbs are, as the children brought up in these plces soon find out, increasingly unaffordable.

Just as with San Francisco, there is a big difference between the growth in housing demand in London (about 60,000 per year) and the delivery of new housing (currently about 25,000). This would be fine if the housing need was being met elsewhere (i.e. in the South East beyond the Greater London boundary) but it seems not:
The 30 fastest-growing non-London local authority areas in percentage terms are almost all in the South-East (Table 3). Of those, 21 were below the national average in terms of their housing supply measured against household growth, and only five supplied enough homes to keep up with long-term need. These were Uttlesford, Dartford, Ashford, Aylesbury Vale and Slough. Collectively, London plus these next 30 areas expect to experience 38 per cent of England’s household growth over the next 25 years, yet they contributed just 26 per cent of last year’s housing supply.
This is the context for the Nick Soames complaint. He represents one of those places - Mid Sussex - that has, in part, to meet the pressure on housing need generated by the economic success of London and all the yelling about housebuilders won't change this fact. What MPs should be doing is discussing the nature of this new demand and considering how new suburbs can be built to house England's future families. There are lots of possible answers but nearly all of them, for these places in London's exurbia, require the use of land that is currently designated as 'green belt'.

The question for me isn't whether Nick Soames and others can stop all this terrible housebuilding (at a terrible cost to those future families) but whether they're actually doing their jobs. Have they met with the 'unspeakable' housebuilders? Sat down and talked to local planners about the issues and challenges? Discussed different options for meeting local housing need? Or are they just grandstanding in parliament to sweep up a few votes (that given Soames' majority he probably doesn't need)?





Right across England we need a more mature debate about housing development. Not the polemical ASI "scrap the green belt" debate but rather one with local communities about how much extra housing they'd be happy with and where it might go. After all most of those people have families, they know how expensive housing is these days and they want their children and grandchildren to have the joys of home ownership. Instead the dumb voices of the CPRE and assorted BANANA groups are allowed the space to say that all the housing need can somehow be met on brownfield and regeneration sites in the big cities.

What we need isn't new skyscrapers in London (or for that matter in Manchester, Leeds or Birmingham) but new suburbs - you can call them garden cities if that floats your boat - where families can come to live, grow and thrive just as did their parents and grandparents.

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Monday, 9 January 2017

Great technology but lousy business - the urban farming revolution that isn't


There's an article in the New Yorker about 'vertical farming' - this is the use of redundant urban spaces to create farms:
No. 212 Rome Street, in Newark, New Jersey, used to be the address of Grammer, Dempsey & Hudson, a steel-supply company. It was like a lumberyard for steel, which it bought in bulk from distant mills and distributed in smaller amounts, mostly to customers within a hundred-mile radius of Newark. It sold off its assets in 2008 and later shut down. In 2015, a new indoor-agriculture company called AeroFarms leased the property. It had the rusting corrugated-steel exterior torn down and a new building erected on the old frame. Then it filled nearly seventy thousand square feet of floor space with what is called a vertical farm. The building’s ceiling allowed for grow tables to be stacked twelve layers tall, to a height of thirty-six feet, in rows eighty feet long. The vertical farm grows kale, bok choi, watercress, arugula, red-leaf lettuce, mizuna, and other baby salad greens.
Pretty interesting stuff especially when you look at the technology involved where the production system uses a tiny proportion of the water typically used to grow those baby salad greens. Indeed this sort of technology holds out considerable opportunity for the further intensification of high added value salad vegetable production - anyone driving through the Fens will see the polytunnels and greenhouses that might form the basis for this technology, especially in a world where water is more expensive, to really make a difference.

The problem is that urban spaces really aren't the best places - even with multistorey production - to do such a business. Here's a clue:
The AeroFarms clamshell package (clear plastic, No. 1 recyclable) appears to be the same size as its competition’s but it holds slightly less—4.5 ounces instead of five. It is priced at the highest end, at $3.99. The company plans to have its greens on the shelves soon at Whole Foods stores and Kings, also in the local area. Greens that come from California ride in trucks for days.
So we've a product that is significantly more expensive that the more traditionally produced product. Even were a tighter ship to be run it is unlikely that AeroFarms will be able to compete with the mass production in California leaving it with a niche market of people who want to buy 'local' production.

This vertical farming requires the acquisition of expensive urban real estate and a significant capital investment just to grow stuff for a niche part of a niche market for salad vegetables. The idea that this sort of production will somehow release current agricultural land for rewilding is pretty much nonsense. The plant in New Jersey featured in the article will have cost some $39 million (including nearly $9 million in government grants) to create a little more than an acre of vertical farmland - right now agricultural land in New Jersey sells for about $10,000 an acre.

The technology here is genuinely exciting but, even in run down urban areas, there is no way that vertical farming on expensive real estate is the solution. And this is before we recognise that businesses like AeroFarms focus on agricultural products with pretty much the highest margins - salad leaves for yuppies - rather than on the sort of production that dominates arable farming in the USA: corn, wheat, potatoes, barley and so forth. Lovely technology but lousy business.

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Sunday, 8 January 2017

Capitalism will save the world (if we let it)


We need to understand - and this isn't an argument for any variety of Brexit merely stating what will be - that global economic growth, driven for much of the great boom fuelled by us stopping with the world war rubbish, won't be coming from Europe or the USA.
28 March 2012 was a big day for mankind, according to some statisticians. It was the first day in modern history that developing countries were responsible for more than half of global GDP, up from 38 per cent 10 years earlier. This convergence makes sense. If people have freedom and access to knowledge, technology and capital, there is no reason why they shouldn’t be able to produce as much as people everywhere else. A country with a fifth of the world’s population should produce around a fifth of its wealth.
The success of global capitalism - of those greedy, rapacious business people exploiting stuff - is palpable. Levels of poverty - real grinding poverty, less than a couple of dollars a day - are now lower than at any time in human history. So my fellow capitalists, take a second out to pat yourselves on the back. Because it's not socialism, not the actions of government employees and not the decisions of politicians that has achieved this wonder. We did it, us capitalists. We got those poor people out of poverty. And left to our devices not only will the remaining 10% of really poor people be saved from that poverty but millions of others who are poor by our western standards will also clamber up onto that shining mountain that is our fabulous consumer society.

The jobs for us all is to stop the usual idiots - protectionists, socialists, Marxists, trade unions, aid workers, NGOs - from preventing capitalism from making all the world richer, happier and healthier. Let's do it.

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Tuesday, 3 January 2017

Immigration is a success. Integration is a disaster.


Immigration is a success. Britain is a richer place with a stronger economy because of immigration. We have kept the wheels from falling off our health and care system, maintained the provision of cheap fruit and vegetables, slaughtered a lot of chickens and built the world's greatest financial sector on the back of immigration.

Immigrants are more likely to be working, less likely to be claiming benefits, contribute more in tax than they take out and bring a bewildering variety of new experiences to our great nation. Immigration is not the cause of NHS crises, the lack of school places or the shortage of housing - short-term policy-making and a daft planning system are far more to blame for all this. And compared to similarly poor communities, immigrants commit less crime.

So why is immigration such a problem? How did migrants and refugees arriving in the UK cause such an outcry and, in part, contribute to the decision to leave the EU? Are the British incorrigibly racist? Is it the result of the drip drip of nasty bigotry from dubious newspapers? Or is there some other reason such as lousy public policy?

Let's begin with a couple of myths. Firstly, "it was the media that did it".
The referendum was won on a drumbeat of anti-foreigner sentiment. It’s the same tune being played by demagogues in every corner of the globe. It’s the same tune that was played in the 1930s. It’s the same old beat that rises in volume when people are afraid. In the UK, it’s echoed by a rabidly right-wing press and unchallenged by a flaccid establishment media. Mixed by a band of unscrupulous liars and political zealots, it has become a tsunami of bile that has downed and drowned a once great nation.
Now I don't want to get sucked into the vortex of the Brexit debate but the gist here - from LSE economist John Van Reenan - is that the driving force for Britain's 'anti-foreigner sentiment' was that 'rabidly right-wing press'. This is pretty much received wisdom amongst the intelligentsia but is just baldly stated, no evidence is presented to substantiate the argument that the British people - and the English working classes in particular - have been led by their ignorant noses by a corrupt and Fascist press working hand in glove with those 'unscrupulous liars and political zealots'.

This just isn't true. Not that the press is innocent or perfect, it's a long way from that, but that Van Reenan has cause and effect in the wrong order. The Sun, Daily Mail and Express are commercial enterprises - they exist to make money for those who own them. This means they deliver what they think the public wants, they are like the advertisers they depend on for income - mirrors of society not the creators of society's mores or values.

The second myth is that the problem comes from the values of immigrants - most specifically that these are in some way not compatible with nebulous and vague 'British values'. We talk about honesty, decency, respect for the law, family and so forth as if these ideas only exist as values in the UK, that somehow immigrants - Muslims in particular - don't share these essentially fundamental views about behaviour. Now, while I'm happy for core values to be part of what we teach children and young people, I don't see that you can isolate a particular set of values and say they are in some way exclusive to Britain.

To suggest that, for example, Islam doesn't contain these values is to misunderstand that faith entirely. For sure different emphases are evident - more stress on justice than on rights for example - but these are nuances within those values not a different set of values. It's true, however, that these higher order values are a damn sight easier to elevate when we are economically successful and secure. And it is here, at least in part that the problem with immigration starts. Just as there is a tendency (not always without reason) for immigrants to see their status as a factor in their poverty, there's also a feeling among the poor communities where migrants arrive that these new arrivals contribute to the poverty of those already there. The lump of labour idea may be false but it is emotionally appealing.

So if it isn't media manipulation or differences in values and only partly economics, what is the reason for the rise in what Van Reenan calls 'anti-foreigner sentiment'? It seems to me that the problem is one of culture combined with a terrible failure of public policy. In economic terms immigration is brilliant and, for us successful folk with good jobs and good incomes, something of a boon but in cultural terms immigration over the past thirty years has been a disaster. We have left established communities across Britain - and particularly in England - with the feeling that, at best, their culture is something to be sneered at and, at worst, that it's based on bigoted, racist, Little Englander attitudes that have no place in the modern world.

In simple terms the adoption in the 1980s of a policy based on multiculturalism led to a complete failure of integration and sowed the seeds of today's 'anti-foreigner sentiment'. And once the feeling that the great and good considered immigrant cultures to be superior had established, it was a short step to concerns about immigrants taking jobs, stealing our women and generally ruining everything that's good about England. Public policy seemed to say that bangra was more important than brass bands, that Christmas should be turned into 'Season's Greetings', and the last night of the proms was a slightly sleazy exercise in jingoism. Strategies to 'celebrate diversity' featured every kind of imported culture and none of the home grown stuff. Integration failed because public policy deemed it unnecessary.

Nobody is suggesting here that English culture - and specifically English working-class culture - is somehow superior to cultures from elsewhere, merely that it ours and it deserves more prominence as the culture of the people who already live here. We tend to think that "when in Rome" refers to abiding by local laws but, while this is true, it goes a lot further - it's about respecting the mores, values and culture of the people you've come to live amongst. Multiculturalism, for all that it was well-meant, resulted in some immigrant groups feeling that this no longer applied.

None of this is to suggest that racism and xenophobia doesn't exist. Rather it is to say that multiculturalism is a failed policy that has contributed more to our current attitude to immigration than the media, populist politicians or misunderstandings about values. To go back to where we started, in economic terms immigration is a success, The problem is that in cultural terms we've allowed it to be a disaster. And unless we begin to give a greater prominence to indigenous culture and especially the culture of those some sneeringly refer to as 'the left behind', we will continue to face these problems.

Immigration is a success. We are all richer for people coming here and contributing to Britain's economy. We should direct our efforts to integration rather than pretending that closing the borders will solve the problem. Back in June I listened to some people express their concerns about immigration. Except, as I pointed out, their concerns weren't about immigrants but about people who were born here, for whom Bradford is just as much home. This makes it all our problem and not one solved by immigration control. It's multiculturalism that has failed us not immigration.

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Monday, 2 January 2017

Some reasons why your website is rubbish


Grandpa rambles about his website (which isn't rubbish):
A week or so ago I mused about web sites and how horrible some were.
The minute I read this I cried "yep". Especially corporate websites.

So here's a few things that are important (not that I'm an expert or anything as vulgar as all that).

1. White Out body copy. Just don't do it. Ever. This isn't an aesthetic comment but one about legibility - as an older person with the deteriorating eyesight that often entails I simply can't read it easily enough to be bothered.

2. Running copy across pictures. Yes, you all do it and, just like white out body copy it's hard to read. And if you can't be bothered to make your site legible why on earth should I bother to read it? Indeed, before you press publish perhaps you should get  half-blind old coot to try and read your beautiful site?

3. Hiding the contact details. Am I the only person who is a tad suspicious when I have to scroll down to a contents listing (probably in nine-point white copy on a pale blue background) in order to find the means to contact you?

4. Making me use a crap form to contact you. I know it's tidy and convenient (for you) but it isn't what folk want. And it's worse still if you don't include a telephone number.

5. Not having a real world address. A bloke once gave me his business card. Colourful, designer-ish and shiny. No address, no landline. Just a mobile number. Precisely what sort of confidence does this give me I'm not going to get ripped off?

6. Why isn't the stuff people want on your landing page? I mean it's lovely, you've spent loads on design and what not but at no point have you apparently thought about why someone's visiting. Half the time it's like having a shop where the windows contain the company logo, pictures of the directors and the chairman's latest letter rather than any sort of product. I'm not there to read a blog about your team building day, I'm there because I might be interested in what you might - you never know - want to sell me.

None of this stuff is new. Back in my direct marketing days all these things (along with more white space, asking readers to actually do something and talking to them not to some vague third party) were beaten into copywriters with especially knobbly shillelaghs. It seems that, yet again, making stuff pretty and technically whizzy has triumphed over making it what the potential customer wants.

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"We need safe spaces..." - how the NHS ducks the big questions


I can't remember the precise moment or why the subject came up but some point in 2016, in a meeting with NHS folk, something along these lines was said: "we need safe spaces to discuss the real challenges facing the health and care system". What they really meant was that some subjects are just to difficult to discuss other than in a carefully protected space - protected, that is, from the public. This answer is a reminder that our populist, planned health system is facing something of a crisis.

Before we go on to talk about the challenges we can't discuss in public we have first to talk about money. I had a Twitter exchange with someone recently where I asked what she meant by 'adequately resourced' in the context of the NHS. The answer, as these things often are, was something of a cop out but was at least better than the more usual response to such questions - a response typified by this piece of populist cant from Tim Farron:
Farron said voters had reached the stage of not believing the NHS’s problems could be solved through efficiency savings and might be willing to pay more if they were convinced it would go to the health service.

He said he did not want to pre-empt the conclusions of an independent panel formed by the Lib Dems, which will look at possible taxes to help the NHS.
In varying forms this is the default response to concerns about our health system - more taxes, more resources. The problem is that, for all that sticking a ring-fenced penny on income tax sounds good, it goes nowhere to making the NHS more sustainable. Bear in mind that, despite the claims of its founders, the NHS has required above inflation increases in funding throughout its existence meaning that it now spends approaching £120 billion out of those taxes.

In one respect our health system needs that extra cash - as Jonathan Portes pointed out recently the proportion of GDP spent on health has fallen and we do spend less per capita than other places (significantly so than the USA). But when you open the NHS up, every single element within the system will tell you that with a little extra cash they can solve this or that problem. Indeed most of those individual bits of healthcare systems - the non-clinical as well as clinical - will tell you that right now they are starved of cash meaning that people might die.

So maybe we do need more cash. But first we need to huddle in that safe space and discuss some more fundamental things about the NHS. By way of example, West Yorkshire has eight or nine general hospitals (I forget the precise number but it doesn't matter for this discussion). All of them are seen by their local community as "their" hospital and the popular expectation is that the general means they do everything that community needs. The question we need to ask in that safe space isn't how do we get more cash for those hospitals or what services do we cut to stop them overspending. No the questions are more fundamental - does West Yorkshire need all those hospitals, are they in the right places, do the facilities meet modern needs or public expectations?

We might ask, for example, why Leeds has two huge general hospitals with real access issues right bang in the city centre? Should we be finding a greenfield site somewhere more convenient and building a new large hospital? And do all those hospitals need to have high support accident units, heart care centres and cancer wards or would it be a better service to have specialised units?

I don't know the answer to these questions - or indeed to thousands of other questions about health and care provision - but I do know (because I've been given a privileged peep inside the system) that the NHS simply isn't discussing these issues at all. Mostly for fear of adverse public reaction but also because the planners within the health system are driven by issues of sustaining what's already there rather than by more fundamental questions about structure and organisation.

There's a further problem, one stemming from the very top of the NHS (indeed from the World Health Organisation), which is the belief that the drivers of rising costs are lifestyle factors especially smoking and obesity. Even when the health systems own statisticians point out that longevity is the problem, we still get strategies founded on the idea that being fat and liking a fag is the problem. This is where the proposals for limiting access to surgery come from (like this one from York) - they don't really address the problem, they're usually overturned and they make it look like the Clinical Commissioning Group (CCG) is doing something.

It seems to me that the NHS, for all the "Our NHS" and "Save the NHS" rhetoric, isn't really all that good. OK, I'll grant that it's better than a system such as that in the USA which manages to be both very expensive and to leave out great chunks of the population from effective care, but there are other approaches - Sweden, France, Holland, Singapore - that might offer some ideas about how we might improve our health outcomes. The UK has a very centralised system that is painted to look like a dispersed and localised system. As the recent round of reorganisation - called Sustainability and Transformation Plans in that jargonistic NHS way - has shown, the idea of local control or direction is anathema to the system's bureaucracy.

The Tim Farron solution - whack up a few taxes - sticks a slightly bigger plaster over the wound but doesn't address the fundamental problems (just as allowing councils to stick up council tax a bit more does solve the care crisis) in the health system. We have a health estate that was mostly designed by Victorians (to which we've added a lot of prefabs) and a structure that would do the Soviet Union proud - right down to the endlessly revisited five-year plans. Until we actually use that safe space we mentioned to discuss the real problems of the health system the NHS will carry on lurching from self-generated crisis to self-generated crisis. And worse, populist politicians like Tim Farron will go on waving the NHS's problems about as a cheap source of votes.

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