Why everyone is so angry these days

I have moved house, as I have probably mentioned before.  This has taught me a great deal, but I also think I've learned something about the national mood.

Let me explain.  Without a telephone, I spent the first three weeks after moving in call centre hell, on a mobile phone.  Not one of the utility services have been able to handle the simple matter of somebody moving in or moving out.

Let's start with the phones.  BT (my new supplier) have been fine.  Reliable even, when they eventually acted.  But I am still wrestling with my previous phone company, ACN, which seems unable to accept that I wanted to end the contract when I moved house.  They sent me the wrong form to fill in back in August - unable to take any instructions over the phone - and are still refusing to cut off the phone at my old address.

Internet.  I've long regarded AOL as the most useless company I've ever dealt with.  They refused to shift my account to a new address unless I also bought phone services from them, which - having experienced their completely dysfunctional call centre - I was never going to do.

Water.  Southern Water sent me three identical letters in different envelopes informing me that my address doesn't exist/

Gas.  E.on has proved next to impossible to phone directly.  I've tried many times.  After hanging on for 40 minutes I eventually got through to the complaints department - to explain that they had lost my meter reading and had sent me an estimate so seriously wrong that the meter still hadn't reached the number they estimated for a starting figure.

"I'm so sorry you had to wait so long," said the complaints lady.

"Really?" I said.  "It's always like that, isn't it?"

There was an embarrassed giggle from the other end of the line.  "Well, yes..." she said.

An excellent article about the phenomenon was in the Guardian last week.

The point is that, for most ordinary people, this is what life is increasingly like.  We are constantly treated with contempt by 'rationalised' customer management systems which can't even manage simple shifts like a change of address.

Our public services are beginning to veer in the same direction, partly since the imposition of centralised targets under Blair and Brown, which add to the delusions of the senior managers.  They see the figures going up for those irrelevant aspects of the service they measure, and convince themselves that things are getting better.

Our privatised services have long since adopted the same rationalised systems: it is their justification for reducing costs - though actually I believe that tightly measured systems tend to spray costs onto other parts of the system.

It is one of the bizarre ironies that privatisation was heralded in the 1980s as the way to make systems work effectively - a potent justification for selling BT - but that is no longer the purpose.  Nobody believes privatised public services will work better any more.

My suggestion is that this agglomeration of dysfunctionalities is one of our main experiences of services of all kinds.  It causes a constant sense of betrayal - I don't believe that is putting it too strongly - and then rage.

I'm not suggesting that the rise of Ukip is somehow because their supporters have to hang on to call centres for long periods of time.  I am suggesting that the delusory contempt of the managers for the managed, in so many areas of life, may explain a little why everyone is so angry these days.

And make no mistake.  They are angry, and the failure of mainstream parties to get on people's side, and in a radical way, fuels a somewhat unpleasant mixture of xenophobia and threatens to give it political power.

The drawbacks of mental health targets

I see the Guardian is impressed with Nick Clegg's speech.  They didn't like everything - how could they? - but they were right that it was a speech of confidence from a leader, as they said, "at ease with himself".

I think this was right.  It was impressively delivered and it was a powerful case, uncompromising in some respects.  Even for someone like me who is instinctively nervous about 'split the difference' messages.  I'm not sure the case for a middle way could have been put better.

But then it was more than that.  The final line of the speech put this most starkly:

"The only party who says no matter who you are, no matter where you are from, we will do everything in our power to help you shine..."

That is the message of Liberalism in all ages and it was good to hear it.  But there was a story at the heart of the speech - the targets for mental health waiting times - and it has got a good deal of publicity.  It certainly is important given the appalling state of mental health services, but I am sceptical about the use of targets and seems worth saying so now.

I fully accept that, when the rest of the NHS has targets for waiting times, then any service which doesn't will get corroded.  It is a kind of beggar-my-neighbour approach.  I'm even prepared to except the idea, from the King of Blairite Targets Michael Barber, that very poor services need a shock dose of targets to start with.

But you only have to see what contractual targets are already doing to talking therapies in the NHS to realise there is a problem.  A recent report by Chester University set out some of the effects of the combination of Any Qualified Provider and Payment By Results (PbR) on psychological therapies.  They found that the combination of tariff structure “produces widespread perverse incentives for providers and perverse outcomes for patients.” 

These were that:

• The tariff and PbR becomes a factor in the decision to take patients on, and the type of treatment to offer them.
• There is a destabilisation and some deterioration in service and a destabilisation of provider organisations affecting their viability. 
• The pressure of mechanistic throughput of patients affects decision-making and quality. 
• There are financial incentives to misuse measurement scales within therapy to improve measured outcomes and trigger payments, when these measurement scales were not designed or validated as a payment method. 

There was already “severe strain” among providers in the Any Qualified Provider areas for talking therapies, and it meant that they were taking on work against their professional judgement.

One anonymous large provider had been threatened with insolvency because the tariffs had been set too low and commissioners had been forced to recommission the service, at great expense.  It is true that the new arrangements had reduced the waiting list, but that had been a factor in the gaming by providers – with less demand, they were being forced to rely on the throughput of patients who might not really have needed the service.

One provider told the report authors:

“There is a distinct danger that I am aware of. In stepped care, if a client has only one session it is considered as no therapy and no payment. If it is two sessions, the therapy is considered completed and therefore the provider can claim a flat rate. It makes a slightly perverse model where some rogue organisation might be able to get a sizeable fee just by offering two sessions and claiming a flat fee. There’s a bit of a joke in some circles that ‘oh, all I need to do is deliver my two sessions’.”

On the other hand, so many providers were unable to meet the requirements of commissioning or could not afford the tariffs. Patients were also being rejected because they did not fit the ‘recovery model’, the timescale set down before therapies were supposed to be effective.

I understand that announcing waiting time targets for mental health has huge political and symbolic significance.  But it won't solve the basic problem, and we may find it gets in the way - as all these forms of administration-by-numbers tend to do.

Subscribe to this blog on email; send me a message with the word blogsubscribe to dcboyle@gmail.com. When you want to stop, you can email me the word unsubscribe

We need banks with boots on the ground

It is a nerve-racking business summing up a debate at a party conference. Will you be able to reply effectively on the podium? Will you think on your feet? Will you trip over the steps?

But I have worked a long time to formalise the Lib Dem commitment to community banks – and now they have.

I also took the opportunity to pay tribute to the work of Susan Kramer and John Sharkey and their colleagues in the Lords, who did the political spadework for this in recent years, and so successfully.

As I got off the platform (see what I said, from 2:36:10), I got a text from friend of mine who had been watching the debate from London (thanks, Emma) who said this:

“Since the recession, I’ve been able to borrow enough to buy a house, but [husband] still can’t raise a business loan from the bank, and he employs about 15 people. Bonkers isn’t it.”

It certainly is, and the story illustrates the peculiar way the centralised UK banking system has developed – designed primarily to fuel and profit from asset bubbles rather than financing productive business.

Still, Ian Swales did an excellent proposing speech and there was only a little opposition.

It now commits the Lib Dems to working for a new local banking infrastructure, alongside the big banks and the credit unions, which is capable of supporting small or medium and social enterprises.

I know only too well that this commitment won’t be taken seriously unless the party explains how – and now they do: the big banks will fund and mentor the new infrastructure, as they do in the USA.

The real argument will now be with people who say that challenger banks are emerging anyway. There are more than 30 new banks awaiting licences from the regulator. They will emerge.

The problem is that they will emerge far too slowly and mainly in the places which need them the least desperately – and which don’t provide the crucial element: an ability to asses local risk properly.

I’m not saying that the new generation of community and co-operative banks will look exactly the same as the old ones. They may not have bricks and mortar branches in the old style.

But we need an alternative to the current ‘drone’ style of banking, operated virtually from Wall Street or the City of London. When it comes to the kind of surgical lending we need locally, it is a hit or miss affair, often with civilian casualties.

What we need, and what we will get if the Lib Dems can turn this commitment into reality, is banks with boots on the ground.

Being authentic about runways

I remember that Howard Dean, briefly a contender for the Democrat presidential nomination, once said - or was it his adviser, I forget - that politicians need to go off message if they are going to come across as authentic.

This seems to me to be overwhelmingly true.  The politicians we trust are relatively uncontrollable.  But there is more to authenticity in politics, and part of it is the paradox of compromise.

Politics is all about compromise.  But it isn't just about compromise.  And therein lies the dilemma for the Lib Dems, and anyone else who really believes in diversity and the necessity of working with people you don't agree with.

Because politicians who just believe in compromise tend to come across as inauthentic, slippery and mildly devious.  To make compromises possible, they have to be real - which means they have to be uncompromising and clear about they believe.  They have to be clear about what they want.

This is all a way of congratulating the party for sticking to what they believe about runways in the south east, and about air travel generally.

Rather unexpectedly, Duncan Brack demolished the amendment designed to open the door to a runway at Gatwick - during the debate on the party's pre-manifesto in Glasgow - and did so overwhelmingly.

Party managers are worried, of course, that the vote will look like a betrayal if future coalition negotiations end up forcing some kind of agreement on the Gatwick runway.  This is certainly true (though it suggests that maybe they would have been wiser not to have brought it up in the first place). But if the party pre-negotiates its position on everything beforehand, the even greater danger is that it will end up with a flabby set of compromises - with no authenticity.

I do find it bizarre that the political establishment has simply accepted the airport lobby case that they need new runways.  There has been little or no resistance from an economic point of view - no examination of Heathrow's bloated operation, no genuine study of needs and wider costs.

So, yes, I'm proud of the Lib Dems for refusing the kowtow.  There will be no end to airport expansion in the south east - a kind of driver for economic centralisation - unless we take the political decision to stop.  Otherwise every extra terminal needs another one, every extra runways means pressure for one more.

Wander around the impoverished neighbourhoods of Southall, under the relentless Heathrow flight path, and you will be able to see the sacrifices we force on the poor - now and, all the more, as the climate changes - just for more intensive reliance on air travel..

Which brings me to the climate change debate.  Nothing is so depressing than the failure of humanity to rise to the challenge of tackling a changing climate.

In fact, it is so depressing that I'm beginning to wonder if the political language has to change too.  I detect a reluctance to use the term, to join in the debate at all, for fear of revealing ourselves as angry pessimists - authentic, perhaps, but in the wrong way.

But if we need to change the dialogue on climate change - to shift to reducing our wasteful energy, to providing prosperity more widely - we shouldn't assume that somehow we forget about the original objectives.  However you describe it, extra runways - yet more take-offs and landings to feed the huge shopping centres of Heathrow and Gatwick - is a staggering waste of resources.

Lib Dems may not get the seats they need to resist successfully, but it is at least authentic to set out what you believe.  And they have.

The transformative force of civilising women

I am in Glasgow, theoretically to hand over my crown as Lib Dem blogger of the year last year to this year's winner: the granddaddy of the Lib Dem bloggers, Jonathan Calder.  Unfortunately, being habitually late for everything, I missed the awards - but it is still much deserved and I wish I'd been there.

I also came here, partly, to speak in the debate on public services.  I have blogged in similar style about public service flexibility, and how it goes beyond narrow choice, many times before and I won't try anyone's patience by repeating it now.

The debate was two and a half hours long and, as I watched and listened, I realised that the party was about to change in a far-reaching way that I hadn't realised before.

Time after time, I found myself watching, highly effective, articulate and powerful women future candidates for parliamentary seats which the party either holds or could hold.

There was Helen Flynn (Harrogate), Jane Dodds (Montgomeryshire), Layla Moran (Oxford W), Kelly Marie Blundell (Guildford), Vikki Slade (Mid Dorset), Julie Porksen (Berwick), and of course Julia Goldsworthy (Camborne) who introduced the debate.  I could go on (these are just the ones who spoke in that debate).

If the party wins these seats, and they certainly could - they have all been Lib Dem seats within the past decade - it will transform an overwhelmingly male parliamentary party into something else.

Very quietly, and without a great deal of agonising about it in public, the party has gone about choosing women for many of their most winnable seats.

There are a number of cliches about the presence of women in politics which I don't entirely buy.  I tell myself that there is nothing intrinsically different about women once they are in Westminster.  The system takes over.  But there is another part of me that doesn't quite buy this either.

If these women are elected - the generation born in the 1970s and 80s - they will be a hugely impressive, articulate and civilising intake.  I don't know what they will do to the country, but they will transform the Lib Dems.

The re-alignment of the Right

The phrase 'Re-alignment of the Left' began with Jo Grimond in 1956.  It happened briefly when the SDP split away from the Labour Party in 1981, but the Left then contrived to align itself back into its old dysfunctional shape.

For some reason, you almost never hear the phrase 'Re-alignment of the Right'.  Yet, listening to David Cameron's speech yesterday, with the ghost of Ukip peering over his shoulder, convinced me that that may be what is happening.

The Conservative Party is an uneasy alliance between two elements which have little in common - the old-fashioned conservatism of family and community, and the new conservatism of markets and big business.  Sometimes a broad Cameronian rhetoric of moderation can hold the two sides together; sometimes it can't.

The last time they came apart spectacularly was during the early years of the last century - half of them backing protectionism and 'imperial preference' and the other half a kind of liberal commitment to trade, with a rump around prime minister Balfour where they had, as one of them put it, "nailed my colours firmly to the fence".

The Ukip insurgency seems to be uniting one kind of conservatism - suspicious of foreigners - from across the parties, against the other kind.  Business lobby groups are in despair.  Something is about to shift.

So when former Cambridge MP David Howarth argued in the latest Liberator (not online) that there is no constituency for Jeremy Browne's vision of a new kind of free market Liberalism, there is a 'yes, but...'

Because the long-term prospect is to re-align the Right so that the old curmudgeons in Ukip take over the rump of the old Conservative Party, and the modernisers, moderates, small enterprisers and open traders join the Lib Dems.

There is a 'yes, but' here too.  Because it provides an opportunity for Liberals to claw back the original meaning of 'free trade' from the conservatives and advocates of turbo-capitalism.

Free trade as it was originally understood, developed by liberals for Liberals, was the right of free people to trade with each other, communicate with each other and be hospitable to each other.  It emerged out of the anti-slavery movement as the antidote to the kind of economic bondage which faced former slaves in the Deep South or former serfs  in Russia.

It was not what it has become: an assertion of the right of the powerful to ride roughshod over the powerless.

It was originally an antidote for monopoly; it has become a justification of it.  In the Re-alignment of the Right, if Liberals embrace it - and make the intellectual running - that has to change.

It is a historic opportunity for Liberalism to take back control of a concept which they invented.  I'm rather looking forward to it, especially if we can re-align the Left at the same time.

Subscribe to this blog on email; send me a message with the word blogsubscribe to dcboyle@gmail.com. When you want to stop, you can email me the word unsubscribe

Two expensive paradoxes of the politics of the NHS

Let's call it the Westminster Paradox, shall we?  I can't believe it has always been true, but it is definitely true now.

It is this.  Westminster politicians constrain themselves in a whole range of ways in their understanding of what they can change - they are constrained by international trade treaties and treaty obligations, by a creaking economic belief in 'trickle down', and the overwhelming need to carry on with the economic consensus of the 1990s.  It sometimes seems as if they dare change very little.

On the other hand, get them on a conference platform, get them talking about the NHS and they sound staggeringly and unrealistically powerful - 'grandiose', the psychologists would call it.

Ed Miliband promises the finance for another 30,000 more NHS staff, unaware perhaps that the finance is the least of the difficulties here - you can't just conjure up 30,000 professionals in a year or so.  Are they in training?  Are they already trained and wanting to hear his bugle call?  Or will his people go out to the developing countries and offer enough money to their newly trained professionals and ship them over?

David Cameron promises seven-day-a-week GP surgeries, at the same time as his Chancellor promises continued austerity - at a time when primary care is shuddering under the impact of extra costs passed on by private NHS contractors and the peculiar by-product of contract and target culture and payment-by-results.  Where will these new GP surgeries emerge from?  Where will the extra doctors come from?  Are they in training?

The answer is that they are not, at least on that scale.

But then Cameron has realised - as we all have - that the issue of getting an appointment with your doctor is going to be one of those key election issues that can sink a sitting government.

It has a symbolic value for middle England, despite the fact that - in practice - many of the most imaginative practices have managed to find solutions.

In the Blair years, this would have been solved with a vacuous piece of sticking plaster - a 48 hour target, which gave people the right to see a GP in two days if they needed to.  Targets always have perverse ways of making the situation worse and this one did so especially - soon you could only get an appointment within 48 hours, no earlier and no later, and practices hoarded their appointments in the most bizarre and irritating ways.

But we have a different kind of target these days, called something else.  Also, there is no doubt that surgeries need to expand their horizons, and to take back responsibility for the disastrous out-of-hours care, which was taken away from them in the equally disastrous pay agreement under the Blair government in 2004.

But then, where is the money to come from?  Contracting out the out-of-hours service has been so disastrous that handing it back to GPs would cost a small fortune, just in increased insurance costs.

We also need to know rather better whether demand is actually rising in primary care and why.  My own sense is that this is, at least partly, the result of target and contract culture.

This has tended to go hand in hand with contracting out to the private sector, but it actually has no necessary connection.  The problem isn't which sector delivers healthcare, it is what happens inevitably if you try to define the numerical outcomes which a contractor is responsible for delivering, and to squeeze the cost at the same time.

By chopping deliverables up into figures that are easy to measure and report on, all the rest gets lost - and the resulting costs land on the NHS as a whole.  Staff find themselves under pressure to minimise their broad efforts, except where it relates to crossing the numerical thresholds.

See my book The Tyranny of Numbers about the perils of too much measurement.

None of this would matter if you could actually measure the full range and depth of what a good health professional does, but you can't.  Anecdotal evidence suggests that doctors who build a relationship with patients deal better with risk - the patients need less reassurance and the doctors commission fewer tests.

Actually, nobody as far as I'm aware has tested this hypothesis - mainly, I suppose, because it flies in the face of current assumptions.

So there's another paradox.  The more you focus on narrow costs and numerical deliverables, the more costs go up.