Politics
My report on the NHS diagnosed its dire condition. Now here’s the cure | Ara Darzi
When the secretary of state for health and social care, Wes Streeting, asked me to investigate the state of the NHS, I thought I knew what we would find. All of us who have worked in the NHS in recent years have known it was under pressure. But, as a surgeon, I am used to seeing just one piece of the puzzle. Hearing the experiences of millions of patients and staff across the country brought together left me shocked and angry.
If effective access and high-quality care are at the heart of the NHS’s social contract with the people, then it is routinely breaking its promise to the public. Too many people are waiting in A&E corridors or struggling to see a GP. Quality care should be the organising principle of the NHS. But my investigation has shown that patient care is stagnating or even declining. It is unsurprising that public trust in the NHS is at an all-time low.
And yet it is also clear to me that while the NHS is in critical condition, it can recover. Nothing I found drew into question the principles of a health service that is taxpayer-funded and free at the point of need. We have some of the best clinical talent in the world, we are home to groundbreaking medical innovation, and our staff are deeply passionate and committed.
Now the reality of what is happening inside the NHS is out there, we must begin the process of recovery. The time for looking backwards has passed. It is in that spirit that I have released a second piece of work – the final report of the IPPR Commission on Health and Prosperity – which I have co-chaired with Dame Sally Davies, former chief medical officer, for the past three years. Last week I focused on the diagnosis, but this final report turns to treatment.
Given this, it may seem ironic that the focal point for this piece of work is not the health service at all – but almost everyone and everything else. This should not come as a surprise. While we might spend a few weeks or, if we are unlucky, months of our lives in hospital, we’ll spend years of our life in work, school and in our communities. If we want to stem the rising tide of demand on our NHS, we need to look at what is happening beyond its hospitals and clinics.
This is the “pivot to prevention” that successive governments have talked about but failed to deliver on. This new Labour government cannot afford to make the same mistakes. Here is what Wes Streeting and Keir Starmer should do to ensure they don’t.
First, they should make healthy life expectancy a central focus of everything they do in government. Much like we have aspirational targets on climate, such as net zero, I propose we need a similar long-term, cross-government health target. Looking at what comparable countries have achieved suggests an aspirational goal would be to increase healthy life expectancy by 10 years by 2055. With that target established, we should then test government spending and investment decisions against their health impact at every fiscal event.
Second, the government needs to make health a cross-society endeavour. The state acting alone will not optimise our health. In particular, government will need to get businesses and employers on board; they have tremendous influence over our health. Sometimes this is positive – life-science innovation, good employment or health-creating products – and should be incentivised or scaled. But sometimes it is harmful – alcohol, tobacco, insecure work and online harms – and this should be discouraged.
Let me be clear: if a business profits at the expense of our health, it should pay the societal cost. Using levies to enshrine a “health polluter pays” principle would act as a powerful new incentive on the market, encouraging businesses to prioritise healthier products. Where they resist change, the tax they pay would be a valuable new source of revenue, providing billions of pounds that could be invested in prevention.
Third, we should use the revenue from health levies to invest in the foundations of good health. I think there is a particular case to invest in the health of our children. I am alarmed by the health challenges facing children – lower vaccination rates, rising numbers with severe asthma, high numbers of children who are overweight or obese.
Tolerating this would put long-term better health out of reach. Sure Start and free school meals – the former one of the proudest legacies of the last Labour government, the latter having been adopted by the mayor of London – are both well-evidenced ways to boost children’s health.
Health is a human right. But as I pointed out in my review, and as the IPPR demonstrates today, it is also vital to a strong economy. With record numbers out of work because of sickness, there is no path to either wellbeing or growth without prioritising health. That is a powerful platform for sustained, ambitious action by the new government.
Politics
Trump says Fed’s rate cut was ‘political move’
Republican presidential nominee and former U.S. President Donald Trump holds a rally at Nassau Veterans Memorial Coliseum, in Uniondale, New York, U.S., September 18, 2024.
Brendan Mcdermid | Reuters
Republican presidential candidate Donald Trump said on Thursday the U.S. Federal Reserve’s decision to cut interest rates by half of a percentage point was “a political move.”
“It really is a political move. Most people thought it was going to be half of that number, which probably would have been the right thing to do,” Trump said in an interview with Newsmax.
The Federal Reserve on Wednesday kicked off what is expected to be a series of interest rate cuts with an unusually large half-percentage-point reduction.
Trump said last month that U.S. presidents should have a say over decisions made by the Federal Reserve.
The Fed chair and the other six members of its board of governors are nominated by the president, subject to confirmation by the Senate. The Fed enjoys substantial operational independence to make policy decisions that wield tremendous influence over the direction of the world’s largest economy and global asset markets.
Politics
Sue Gray’s salary isn’t the problem – it’s the backstage power struggle Starmer cannot afford | Simon Jenkins
The most remarkable feature of the Sue Gray saga is not how much the Downing Street chief of staff earns, but how little Britain’s prime minister does. Keir Starmer gets just £166,786, which is about £3,000 less than Gray. But then she gets less than many permanent secretaries, not to mention the consultants and lawyers Whitehall is crawling with these days. Besides, as we are tired of hearing, Starmer gets dazzling benefits in kind.
A second feature of the saga is its mess. Just 12 weeks into the rosy dawn of a new Labour era, Downing Street is enmeshed in a spat more typical of a regime on its last legs. Starmer has spent his time in office telling Britons they face a shambles, requiring a clampdown on public spending. The new army of special advisers – approximately 70-strong – is duly being paid a relative pittance, but one that has been fixed by a boss who decided to take a thumping pay rise. To put it mildly, this suggests poor political judgment. As one insider joked, Gray is the only pensioner likely to do better under Labour.
Fixing the machinery of Downing Street is the first crucial job of a new prime minister. Starmer has hit the ground stumbling. It is customary for those closest to the leader’s ear to be a circle of trusted friends ready to act as his alter ego. This was true back in the days of Thatcher and certainly of Tony Blair. When Blair came to power, his senior aide Jonathan Powell said to expect “a change from a feudal system of barons to a more Napoleonic system”. What he meant was a downgrading of the traditional civil service hierarchy, one of permanent secretaries with the cabinet secretary at their head. Instead, government was conducted more informally, from “the sofa”, as Kenneth Clarke dismissively described it.
This had benefits. Under Thatcher, the civil service acted initially as a brake on change, but she eventually gathered loyalists round her and bent the system to her will. Although she still listened to advice, as when in 1988 she did a U-turn on NHS privatisation. Under Blair, media management from the sofa overwhelmed policy. Foreign Office advice on Iraq was suppressed, and Blair made his greatest mistake with the invasion of that country. Since then, the balance in Downing Street between politicians and officials has become ever more informal and sometimes fractious. It reached its nadir under Boris Johnson and his maverick aide Dominic Cummings.
A measure of the disruption was that internal pressure succeeded in evicting Cummings, but when dissent occurred under Liz Truss, it was politics that evicted the head of the Treasury, Tom Scholar. In the case of Gray, it seems that an early victim of her boisterous style will be the cabinet secretary, Simon Case. She is already reported as controlling access to security briefings, appointing close allies as civil servants and pushing her pet building projects. This may be fine if you can keep it secret, but not if those round you keep leaking.
Gray was a civil servant who became a political adviser. They are different professions. Civil servants have spent their careers working together, with Downing Street and the Cabinet Office at the peak. They are supposedly discreet suppliers of truth to power. Political advisers are rarely used to big organisations. They are mostly the beneficiaries of party patronage, thinktanks and the murky world of lobbying. Some fit in; others do not.
The most recent grit in this machine has come from the growth of the No 10 Policy Unit, staffed by special advisers. Its proclaimed purpose is to keep Whitehall to the manifesto straight and narrow. But it inevitably cuts across similar units in departments, also staffed by advisers. It was war between the two top units – and Cummings’ reported desire to have Treasury advisers dismissed – that forced Johnson’s chancellor Sajid Javid to resign. So critical is this relationship in the realm of economic policy, that Starmer’s No 10 unit has apparently been downgraded. It will reportedly be just “a point of contact” on economic policy, “more like the nervous system than the brain”. We await the outcome with interest.
It is easy to adapt Tolstoy and say that every unhappy Downing Street is unhappy in its own way. But unhappiness starts at the top. Starmer must now support Gray to the hilt. She must at least have her own colleagues loyal to her – and to her confidences. At the same time, prime ministers have clearly strayed too far in the direction of Blair’s Napoleon. Second opinions must get through to a leader making decisions, even if the civil service must ultimately obey and deliver. Dissent should not take the current form of media leaks and disloyal gossip.
There has to be virtue in a well-established architecture of public administration. So much of this has now broken down. That is why there must be a tilt back to the tradition of a formalised and articulate civil service, with the cabinet secretary at its apex. The satire Yes Minister portrayed civil servants as subjecting the ambition of ministers to pragmatic reality. It had its virtues, and the civil servants did not always win. It is worth a repeat.
Politics
Biden Fed Jay Powell meeting Oval Office
Chairman of the Federal Reserve Jerome Powell (left) meets with President Joe Biden in the Oval Office on May 31, 2022.
Saul Loeb | AFP | Getty Images
President Joe Biden on Thursday said he had “never once spoken” to Federal Reserve Chair Jerome Powell while he was president.
But the pair, joined by Treasury Secretary Janet Yellen, met in the Oval Office on May 31, 2022 to discuss inflation, photos and videos from the meeting show.
The president made the inaccurate claim during remarks at the Economic Club of Washington, D.C., the day after the Fed announced a decision to cut interest rates by 50 basis points.
Touting his own respect for the independence of the central bank, Biden said “By the way, I’ve never once spoken to the chairman of the Fed since I became president.”
Asked about the apparently inaccurate recollection by a reporter at Thursday’s White House press briefing, Council of Economic Advisors Chair Jared Bernstein said Biden had been referring only to discussions about interest rates.
“The president was saying that he has not spoken to Chair Powell about interest rates,” said Bernstein. “He did not pressure Powell and has never done so.”
But the error undercut Biden’s critique of Republican former President Donald Trump, who has threatened to challenge the independence of the Federal Reserve if he is elected to a second term.
“Unlike my predecessor, I respect the Federal Reserve’s independence as they pursue its mandate to bring inflation down. That independence has served the country well,” Biden said Thursday.
“It would also do enormous damage to our economy that independence was ever lost.”
Even in his 2022 Oval Office meeting with Powell, Biden stressed the importance of the Fed’s independence in addressing inflation.
“My plan to address inflation starts with a simple proposition: Respect the Fed. Respect the Fed’s independence,” Biden said at the time. “My job as president is not to not only nominate highly qualified individuals for that institution, but to give them the space they need to do their job.”
Trump, the Republican nominee for president, said in August that presidents should “have at least [a] say” about the Fed’s decisions on interest rates.
“Yeah, I feel that strongly,” Trump said at a Mar-a-Lago press conference on Aug. 8.
“I think that in my case, I made a lot of money, I was very successful, and I think I have a better instinct than, in many cases, people that would be on the Federal Reserve or the chairman.”
The Wall Street Journal reported earlier this year that Trump advisors were putting together a plan that would inject Trump into the Fed’s interest rate decision-making process, if the Republican returns to the White House in January.
Politics
With a lust for freebies and hobbled by infighting, Labour look like the Tories 2.0 | John Crace
During the last election campaign it was hard to escape the impression that, whatever his other faults, Rishi Sunak just wasn’t very good at politics. The charge sheet included getting drenched announcing the election and leaving D-day veterans on the beaches. And insisting that black was white: that he was stopping the boats, that the economy was in good shape, that the Tories were on course for victory.
Just a couple of months later, it very much feels like Keir Starmer and Labour are saying: “Hold my beer.” Keen to prove that they, too, are amateurs at the political PR game. It’s almost as if there is something about being in government that makes fools of everyone. Though few would have imagined that Labour could manage it quite so quickly. A period of grace would have been more fitting.
Take the freebies. And Keir has. The Arsenal tickets. The Taylor Swift tickets. The suits. The designer glasses. The clothes for his wife. Starmer’s big shtick was that he was going to do politics differently. The antidote to Tory corruption and scandal. A man who could be trusted. He was one of us. So why put himself in a position where you can so easily be criticised by the rightwing press?
If you want to set yourself up as a model of propriety then you can’t start making exceptions. Especially not so early on. A couple of years in and people may not notice so much. You have to be above reproach. Yes, it might be a loss not to go to the football. And you might resent having to buy a few more suits for yourself. But that all rather goes with the job. Being prime minister may be a career highlight for a politician but you have to take the downsides.
Perhaps Starmer has been too honest for his own good. Maybe he should have been more like Boris Johnson. Keir has made himself accountable by listing his freebies in detail. We know exactly where all the money went. With Boris we are largely in the dark. He took whopping gifts from all sorts of undesirables and we aren’t entirely sure of the details. Being prime minister was a licence for Boris to cash in. No one expected any different from him. He never pretended to be on the side of the angels.
Then there is the question of Sue Gray’s pay. You could say that someone should have suggested that Sue drop £4,000 in salary just for appearances. So she earned less than the prime minister. Maybe throw in a clothes allowance and an events expense account to make up the difference. No one will notice. Surely. I guess she is a tough negotiator. One of the reasons she was made chief of staff.
But all this is not really the point. The issue is why the Labour party is indulging in open feuds with itself by leaking the story in the first place. We were promised a government of service and yet it already appears to be totally dysfunctional. It’s as if Starmer has taken the Tories as his role model. How did it come to this that half of the No 10 top team hate the other half? And vice versa. Couldn’t someone have just got in a therapist? Or at the very least established a workplace culture where people talked to one another? Or – and here’s a thought – pay junior staff the proper rate?
Still, Keir isn’t entirely a slow learner. There’s a tradition that prime ministers do a round of regional radio stations on the Thursday before a party conference. But after the last two years, when Liz Truss and Sunak had an hour they would rather forget, Starmer decided to reset the format to pre-recorded outings where he hoped there would be less room for disaster. All the interviews would be released at 5pm when he hoped no one would be watching.
So it was left to the business secretary, Jonathan Reynolds, to do the morning media round. An experience he would rather forget. Reynolds comes across as a decent man but too much more of this and he will find himself Labour’s answer to Mel Stride. The minister who gets to do the rubbish jobs that no one else will. In future, on days like this, I am sure he will learn to put his phone on mute and not take calls from the No 10 comms team. It’s early days, I suppose.
On Times Radio, Aasmah Mir cut to the chase. Why did Starmer accept so many freebies? Reynolds forgot to engage his brain. It was like this, he said. Politicians get invited to events all the time and it would be rude not to go. It was the way people tried to engage with decision makers. Sure thing. That’s why it was vital for Boris Johnson to accept a freebie to Evgeny Lebedev’s party in Italy. And a Taylor Swift concert is a prerequisite for stopping the winter fuel allowance.
It very much sounded as if he was talking about the perks of the job, said Mir. Oh no, replied Reynolds. Far from it. Perish the thought. Just that politicians worked extremely hard and deserved a little downtime. Especially if they didn’t have to pay for it. The thought occurred that if Starmer was desperate to see Arsenal he could have afforded the cost of a seat with the corporates. It was just strange that all these dazzling freebies were never offered to the rest of us.
Over on Sky, Kay Burley was outraged by the size of Sue Gray’s salary. One wonders what Burley’s wedge is. I’m not sure she would get out of bed for £170,000. She would consider that an insult. But I’m sure that’s not the point. Even so, Reynolds still couldn’t think straight. Why not just say that Dominic Cummings and other Downing Street heads of staff would have been on a similar sort of salary if you allowed for inflation. The same people outraged now were not outraged then. It could just be that £170,000 is the going rate for the job and that it is the prime minister who is underpaid. A thought.
So the nonsense will continue into the Labour party conference starting this weekend. And Labour really doen’t have anyone to blame but itself. Freebies and staff pay should have been headed off ages ago. And maybe it doesn’t matter if we have a government that is bad at politics if it gets the big calls right. After all, the chances are we’ll be talking about something else in a month’s time. Head down and onwards and sideways.
Politics
Home Office urged to scrap long, expensive and ‘racist’ visa route | Immigration and asylum
A long and expensive visa route for immigrants has been called racist after analysis showed most applicants who feel forced to go through it are people of colour.
The “10-year route” visa is used by hundreds of thousands of people who are not eligible for other immigration schemes because of a lack of income or professional qualifications. Many work in low-paid jobs, such as cleaning or care work. Other common routes to settlement in the UK take five years.
According to freedom of information data obtained by the charity Ramfel, there are 218,110 people on the 10-year route.
Guardian analysis of Home Office data showed that all but one country in the top 10 nationalities who felt forced to use this route were those with predominantly minority ethnic populations. The top five were Nigeria, Pakistan, India, Ghana and Bangladesh. Overall, 86% using the route were from Asian or African countries, while 6% were from Europe.
People seeking to gain a visa via the 10-year route must renew their leave to remain with the Home Office every 30 months, meaning four renewals. The fee for each renewal is £3,850. The Home Office can grant a fee waiver but many requests are refused.
According to a 2023 report on the 10-year route by the legal advice and support service Greater Manchester Immigration Aid Unit (GMIAU), the thinktank the Institute for Public Policy Research and the charity Praxis, the most common way of covering the fees was to borrow money, leaving many people in debt and struggling to pay for basic living costs.
A 41-year-old woman from Ghana said she was struggling with the 10-year route. She has a British child, who was born in 2017, and was granted leave on the 10-year route in 2018 after applying. But she was several weeks late in applying to renew her leave in March this year and has become an overstayer awaiting a new decision from the Home Office.
Because of her late application, she has lost the years accrued and has to restart the 10-year route from day one. “This immigration route is brutal. It makes me feel like I’m in a prison. I want to go to university and qualify as a nurse but I can’t do that until my immigration status is sorted out. The government should at least change this route to five years, not 10,” she said.
A GMIAU spokesperson said: “These numbers confirm what people on the 10-year route already know: it is a racist policy. People are being driven into debt, forced to choose between paying thousands of pounds in visa fees to keep their legal status and keeping their families fed and warm.
“Ten years is far too long for anyone to wait to settle. The route must be scrapped. A good place to start would be to cap all routes to settlement at five years.”
Nick Beales, of Ramfel, said: “The 10-year route is an enduring legacy of the hostile environment. Like many other Conservative policies from this period, the racist intent is clear, with African and south Asian nationals far more likely to be placed on this arduous and often brutal route towards securing permanent immigration status.”
A Home Office spokesperson said: “In cases where a family does not qualify for a five-year route, but where refusal would breach obligations under the European convention on human rights, the Home Office places them on a 10-year route. Neither the race, ethnicity, nor nationality of an applicant is a factor in the decision to place individuals on this route.
“We encourage all individuals to apply for any visa renewals prior to their leave to remain ending in the UK.”
Politics
Domestic abuse experts to be embedded in 999 control rooms
Domestic abuse specialists will be embedded in 999 control rooms in England and Wales as part of the government’s pledge to halve violence against women and girls in a decade.
The measure is part of “Raneem’s Law” in memory of Raneem Oudeh, 22, and her mother Khaola Saleem who were murdered by Ms Oudeh’s estranged husband in 2018.
The government also announced a new domestic abuse protection order pilot that will order more abusers to stay away from victims and impose tougher sanctions if they fail to do so.
Home Secretary Yvette Cooper said victims “need to know the police will be there for them” and if they come forward, any report “will be treated with the seriousness and urgency it deserves”.
“Failure to understand the seriousness of domestic abuse costs lives and far too many have already been lost,” Ms Cooper said.
The aim is for specialists with expertise in domestic abuse to be on hand in control rooms to ensure victims get a fast response from officers on the ground and are quickly referred to support services.
The scheme will be piloted in select police forces from early next year. Details on which forces are taking part in the pilot have not yet been announced.
Ms Cooper described the new measures as “vital” and “a personal priority for me”.
She told the BBC’s Laura Kuenssberg in January about her plans for the measures, which Labour also proposed in February.
Almost 100 domestic abuse-related offences were recorded by police every hour on average last year, the government said.
On the night Ms Oudeh and her mother were killed, she rang 999 multiple times, but officers failed to reach the two women in time.
In total, 13 reports were made to the police about concerns for her safety – but no arrests were made until it was too late.
An inquest found police errors “materially contributed” to their deaths. West Midlands Police has since apologised to the family.
Nour Norris, Ms Oudeh’s aunt and Mrs Saleem’s sister, said having domestic abuse specialists in control rooms would “save lives by making sure no warning signs are ignored, unlike in Raneem’s story”.
“Their suffering and the way the system failed them is something I will never forget,” Ms Norris said. “What started as a quest for justice for my family became a mission to improve outcomes for all domestic abuse victims everywhere.”
Ms Oudeh’s estranged husband, Janbaz Tarin, was jailed for a minimum of 32 years in December 2018, after admitting to the murders.
In another effort to protect women and girls, the government also announced a new domestic abuse protection order pilot that will start in November.
Police already have the power to legally order abusers not to contact or go within a certain distance of victims for up to 28 days.
The pilot will introduce no maximum time limit for orders, impose electronic tagging of offenders and require perpetrators to notify police of any change in name or address.
The new orders will cover all forms of domestic abuse, including violence, stalking and controlling behaviour.
Breaching an order will be a criminal offence punishable by up to five years in prison.
Victims and other third parties such as charities will also be able to apply directly for an order, rather than having to rely on police and criminal courts.
The new domestic abuse protection orders will be piloted by officers in Greater Manchester Police, the Metropolitan Police (South London Borough Command Unit) and British Transport Police.
Refuge, the charity which supports survivors of domestic violence, welcomed the changes but called for “far more detail on how these plans will be implemented and how staff will be safely recruited, vetted and most importantly trained”.
Refuge’s interim chief executive Abigail Ampofo warned that police rarely act on breaches of existing protection orders, making them often “worth little more than the paper they are written on”.
“We need a real sea change in internal policing culture and the police forces’ response to domestic abuse overall,” said Ms Ampofo.
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