Boris Tribute Acts

All new Governments want to do new things, but policy interactions are hard. Covid has allowed things to do at speed, because there was a singular strategic focus across Government and the NHS in the early stages of the pandemic when the initial response was being designed. That has not lasted.

Covid entirely aside, this Government has appointed a panel to examine Judicial Review, has issued a white paper on ‘planning for the future’, is reviewing Police and Crime Commissioners, and forthcoming plans to restructure local authorities to ‘devolve power’, using data to micromanage everything. There’s a lot to do… plus the afterthought of fixing social care.

I do not pretend to offer a coherent narrative here, but simply note that, again and again, a pattern emerges: Boris Tribute Acts

Defending a World Order Built on Rules?

There should be a theory of response to this Government, that what you do must be true, and be seen to be true, and seen to be lawful.

But to do that, we need to acknowledge history where the rule of law was stretched – Iraq, etc – and where public confidence was undermined akin to these decisions. The Rule of Law must be defended with a tenacity of defence which matches the same agility and commitment of those who would undermine it; but it is also often deeply unjust. Dominic Cummings blogs that all the (internal) legal advice he received at DfE was wrong; and it’s hard to disagree with the sentiment that you can get the legal advice you want.

It’s fine to change your mind based on new information or a better debate, it’s fine to be just flat wrong, but integrity requires transparency of changes; not just in government, but also beyond.

When Government abandons truth and justice as tests of their actions, it is up to civil society to remember that such steps are only temporary phenomena. The truth always comes out, eventually. Although it may take a decade or five, sometimes less, it gets there eventually.

Rule of Law

Response to the examination of Judicial Review has begun to focus on making lawful what the Government previously failed to do lawfully. The lawyers can argue over the nuance of the Royal Prerogative, but given Queen’s Consent (and the Consent of the Prince of Wales) will be required for the Bill to proceed, the opportunities for improvement of democracy may be greater than they initially appear. Will the Royal Household allow the Government to act unlawfully again? If not, and the limits to JR are purely on prerogative powers, what will the changes actually be?

Mayors, Local Authorities and Planning

The PM promised “tree lined streets” in new developments, but the photo of the new development on the cover of the planning white paper shows no grass, no trees, and is an… identikit estate.

If you want to see the worst of that, walk out of Cambridge train station and see what was built vs promised (it’s a repeating problem) – meanwhile the different responsible power structures resort to political bickering.

Cambridge is building houses, but it’ll work differently in the shire around Oxford (where they aren’t building houses close to the city). Cambridgeshire’s Mayor is also strangely fixated, Boris-style, on a tunnel for autonomous vehicles (which he insists aren’t buses). Will all Boris-style entities have something akin to the Garden Bridge?

The white paper also proposes new limits on the ability of councils to make decisions about their area, as a prelude to replacing some of those councils with Mayors for new unitary areas. In Cambridgeshire they also happen to be labour/libdem strongholds in a largely blue county – no opportunity is being missed to advance the Government’s agenda. Failing upwards as only ministers with failed reforms can, one leading candidate for the new Mayor covering Cambridgeshire is likely to be a former MP for the area: Andrew Lansley.

Police and Crime Commissioners

While a Home Office responsibility that the real world largely ignores, Theresa May’s plans for Police and Crime Commissioners didn’t really deliver on what they were supposed to do. In London, the Mayor was the PCC, and in Greater Manchester, the creation of a Mayor there replaced the PCC. As more areas get merged into Mayoral areas, the same should happen.

The individuals who became PCCs are not necessarily the highest calibre politicians, they could be considered Boris-style and Boris-competence without the support network of being Mayor of London or PM. Since they were formed, Cambridge has had one deputy resign due to “sex deceit”, and the last elected PCC resigned after sending a dickpic to a 50 year old woman. Boris Tribute Act indeed.

Devolving the NHS and Fixing social care

Individual councils, even at County scale or the new “Boris Boroughs”, are too small for meaningful health economies – too much of the health infrastructure is just outside the area. As Public Health England is broken up, the responsibilities for public health that were given to the councils will go back to the NHS, with some national advisory body for addressing offline harms. Focus and scrutiny of the NHS and public health plans will not be lacking… 

Social care is broken.

Migrating all responsibility for social care into the Department of Health and Social Care is a good start, but there will need to be some local delivery. If local authorities are being reformed, and DHSC is taking back what was previously devolved to NHS England, then it is likely that Government will do multiple things at the same time. Breaking up NHS England with ‘regionalism’, and putting the NHS and social care together under the powers of the Boris Tribute Acts to give them something to do.  That doesn’t mean it’s a good idea.

It might seem like a good idea from a hands-off PM in number 10, but it matters who areas elect and appoint; and that track record is not good, and responsibility for failure and privatisation gets devolved.

When the local authorities are reformed or restructured, that is a once-in-a-generation step change which can also comments new data responsibilities to provide data to the HSCIC, along the lines of the norms for systems for GPs, which in the long term could evolve into a qualities and outcomes framework for social care.

Commercial competition has led to a lot of wasted staff time and resources – how many companies service people in the same street on the same day, then travel further to their next appointment? As we enter phase 2 of the pandemic, addressing this issue will become increasingly urgent as travel of care staff is minimised.

Plans connecting up

Blaming the public only goes so far, but the creation of Boris Boroughs might push the restructure problems until after Boris has declared victory and gone on to his next wife.

Giving the individual with strategic responsibility for policing the powers over social care will likely lead to perverse incentives which criminalise those who would otherwise receive support from the social care budget, taking people who should receive care (which costs the Mayor money) and dumping them into the MoJ budget area titled “prison”.

The Government also has to get all their priorities through Parliament – it has a majority of 80, but the degree of competence is ‘marginal’ in various areas. At what point do some of these changes become things that they give up to prioritise other areas?

Tempting as it will be for civil society to focus on one silo, and the above structure shows how disconnected they can be, in any of these issues the primary problem is the successors and imitators of the current Government: the Boris tribute acts who lack the sheer chutzpah and intelligence of their role model. 

A net assessment of all changes suggests only some will go forwards – Do you trust Boris Johnson’s Tribute Act to adequately fund your nursing home? What does this Government prioritise?

This Government has shown that it values itself over the law that underpins public trust in Government. If it succeeds, the Boris Johnson Tribute Acts will copy it. Perhaps their theme song will be “Who do you think you’re kidding Mr Johnson?”

posted: 20 Sep 2020

Welcoming data protection friends to the cultures of the NHS

No one* goes to work for the NHS intending to cause harm.

It’s easy to argue that Palantir are evil, and that they should have no place in the NHS, but that’s not going to change anything. Especially in a public health emergency.

Companies like Palantir – and especially ‘AI mercenaries’ Faculty – should be kept at barge pole distance (~20ft), not because they’re bastards, but because they’re seen by the public as bastards.

The job we face is not to build tech, but to help patients.

And that will be impossible if your product works best with a continuous high body count.

Unfortunately, the extent to which this Secretary of State and his staff will care is unclear. Their primary measure is to protect the system, not about staff or patients.

Just like all of the NGOs rushing into the health field, everyone else has shown up to help too – each one of them bringing the toolkit they were holding at the time the pandemic started.

Arguments against Faculty, Google DeepMind, or any of the other companies involved cannot and should not rest on morals; they must be substantive, properly evidenced and articulated in real world terms. It isn’t enough to be legally right.

People choices

Just as there is a range of competencies in civil society, there’s a range in all other sectors. 

When Facebook makes decisions, everyone knows that they’re doing what’s good for Facebook, whatever they claim their reasons to be.

DHSC/NHSE make no better decisions than Facebook, Palantir, or DWP – people are, after all, only human. 

People do not make better decisions due to their public office. Witness the unreformed, ‘institutionally ignorant’ and racist view which is slowly pervading everywhere in government…

DHSC makes decisions that are good for DHSC; Number 10 what’s best for Number 10 (today) – and Number 10 always wins.

The deaths of one in ten people in care homes are just one consequence of that approach.

We’ve met civil servants who are exceptionally talented at their (current or previous) jobs. There are also some who should never have been let into the building

But, given the immediate crisis, there are too many decisions to make and there’s a massive overstretch of political leadership within decision-making inside DHSC, so appointing people who can work with the existing team may be helpful. But the unit of accountability is this team.

While it is legitimate to put in place Ministerial (political) accountability to lead the testing operation in DHSX, they gave it to the Chair of NHS Improvement.

And when individuals do make decisions, often they would prefer to be entirely insulated from the consequences of those choices – for which the best way is by not knowing, or by not believing those who do know.

For the best example of that, see PMQs today

posted: 18 May 2020