I’ve received many e-mails on Transatlantic Trade and Investment Partnership (TTIP) and the impact on the NHS. People are right to be concerned about any major trade agreements, especially one opening up economies to multinationals (who frankly haven’t helped themselves in this battle over the years). However, there is no risk to the NHS of being forced to open up for private American firms to run.
Nick Clegg addressed this issue at Lib Dem spring conference
The letter from Cecilia Malmstroma, the EU Commissioner in charge of the TTIP negotiations, to the Government about TTIP and the NHS is also available here
Yesterday’s Comprehensive Spending Review will have been well analysed by all the papers and commentators with lots of questions about whether the cuts are “fair” or not and if they are necessary at all.
What was more interesting to me (or dismaying) as an economist (but very much lapsed one) was the extent the political aspects decided the economic decisions. This is never unusual but given the unique financial situation interesting.
2010 Comprehensive Spending Review being delivered
I won’t touch on if the cuts are necessary or not except to say that as Labour were overspending when the economy was in a boom, therefore not saving for a rainy day, when the recession struck our borrowing rocketed and we ended up with the worst structural deficit of the G20, and gave us less room to carry out some of the fiscal expansionary policies of other countries such as Germany and France.
So on the political aspect, the key was the Prime Minister was determined to stick to as much of his electoral promise as possible, this makes sense politically to ensure manifesto promises were being kept. However, this causes a few economic problems:
- NHS, one of the largest government spenders, was ringfenced
- This meant other departments cuts had to be increased
- Universal benefits were not looked at
- I really felt, as Vince Cable said, that everything must be reviewed (this was in relation to tuition fees) then the idea of the well off receiving Winter Fuel Allowance, free TV licences, free bus passes and even a state pension to be absurd. However, the grey vote are more likely to vote and have strong lobbying powers so this was always a dangerous territory
- Income tax would not increase, under any party
- One way to fill to ensure spending could be protected, but seen as deeply unpopular, even though it could pay for Higher Education and protect some of the social housing
- Due to the above welfare was targeted, which although needs to be reviewed, was taken further than expected
- The child benefit political hit was in exchange for the Liberal Democrats hit on tuition fees, even though tuition fees was much more symbolic to the Liberal Democrats than child benefit to the Conservatives
So what did I make of it?
Well I really felt the Conservative need to protect the NHS and universal benefits restricted the options available. I would have:
- Ringfenced no department except International Development (peanuts in the grand scheme of things)
- Scrapped universal benefits for well off pensioners
- Put a little bit more money into capital investment projects
- Ensured a coherent plan on housing, both private and social, as the new proposals are clever in encouraging more housing associations to build property at commercially viable rates, there is no proposal to ensure enough housing does get built. One of the key problems of the past 30 years.
- Probably would not have brought forward the rise in pension age for everyone to 2020, fundamentally wrong for women in their 50s.
I was a little surprised that more was not made of the fact:
- Total government expenditure is still rising to 2014/5
- The rate of growth is declining
- Total public sector expenditure as a % of GDP will be at the same level as 2006/7.
The problem with all the above points is the NHS is growing in real terms so everyone else gets less of the pie. What I can’t work out now is how we’ll get enough money to increase the income tax threshold again, although it is in the coalition agreement so should happen.
I had the privilege of being asked to see one of the workshops at Rivendell Mental Health Clinic this week. It was a computer workshop run twice a week for 3 hours where old Council computers are wiped clean, refurbished then sold onto the public.
It enables those who have done computing courses at the centre to put them to practice in a safe and unpressured environment. There was concern from members of the workshop about the future of the facility as the Psychiatric department is being moved. Rivendell also hosts other workshops such as crafts, arts and gardening sessions.
Many of those using the facilities are on the road to recovery and love what is there as some are still in treatment, but others are actually working and like somewhere they can be with people who understand them. The computer workshop is also a stepping stone to getting patients back into the world of work.
Mental health disorders take many different forms and affect people in different ways. Schizophrenia, depression and personality disorders are all types of mental health problem. Diseases such as dementia generally develop in old age, whereas eating disorders are more common in young people.
The more I’ve seen of mental health issues, the more I realise:
- How much it is a hidden / taboo subject even though up to 1 in 4 people will suffer from a mental health problem at least once in their life
- Those who need help are often left to seek it themselves, rarely are they offered help
- The pressure for politicians to ensure that those who have the quietest voice / visibility in society are properly represented.
- The grey area of responsibility in public services for mental health e.g. the difference between a personality disorder – not the responsibility of the NHS, and mental health – NHS responsibility.
I recently met with Inspector Dave Shaw and Sgt. Tim Harper at Bromsgrove Police station and we covered many topics ranging from crime rate to local cannabis farms but a couple of things stood out:
- The work the police does with the local housing trust (BDHT), community groups, such as The Trunk and with the community via PACT (Partners and Communities Together) meetings. A lot of police work should obviously be on catching criminals but it was a good example of prevention and really getting to the causes of the problems. All solutions the Liberal Democrats back.
- The grey area of mentally unstable individuals and where the responsibility for them lie, it’s not always clear whether someone has a mental health issue or a personality disorder. The distinction is necessary, as with one definition the offender will be treated differently and by the NHS, otherwise its a police matter solely. The Liberal Democrats are proposing better mental health treatment on the NHS and those convicted of criminal offences.
On my last point, after my meeting I mentioned the mental health grey area to a youth offender worker who agreed it was very complicated but also that the worse thing you can do to those who have mental health issues is to lock them up with no treatment.
Meeting Inspector Dave Shaw
n.b. I should clarify that if an individual is classified as mentally ill then they are treated under the NHS, if it’s a personality disorder, then the NHS are not obliged to deal with them.