Why is the Cummings situation so troubling?

May 25, 2020

For the last few days there has been little in the media other than Dominic Cummings. This is troubling for a number of reasons. On the one hand, Downing Street is briefing a story about a concerned parent behaving in a ‘reasonable’ (a bit word in the press conference today) way. Dominic Cummings drove his family from London to Durham because he was concerned, should his wife and he both fall ill simultaneously, that they would not be able to look after his four year old child. Cummings took a decision that his family were better placed to cope with this, and they were in Durham. So he drove his wife and child there. While he was there, but after 14 days, he took his family on a drive to check that he was well enough to drive back to London the next day, and that was when they were all seen in Barnard Castle.

I think there are at least three issues here.

First, why are we talking about this? The argument here is that, because an important advisor to Downing Street didn’t stay at home (the basic message which he may have been central to devising), this undermines the public health message which is central to government policy. We might say that in another era the media wouldn’t have reported any of this story, and advisors and politicians in the past got away with far worse. Or we might say there is a difference between the character and behaviour of an advisor and this value of this advice he or she is able to offer. However, there is a danger that Cummings’ actions being so widely known, and so widely debated, will undermine the public health message. That suggests it would be better if he were no longer advising the government.

Second, there are concerns that the story presented by Cummings’ still doesn’t hang together. I’m not sure I buy the Barnard Castle part of the story. What happened there seems at best misguided and at worst a basic breach of the guidance. It seems to me he made an error here, and should apologise. Maybe things wouldn’t have been so awful today had he admitted that. Others have pointed out other holes in the story.

Third, and perhaps most importantly, Cummings’ situation makes clear the differences in options that different people have in a time of crisis. I am fortunate enough to live in a big enough house to have space for my wife and I to be able to work separately from home. I have a garden, which means I can have a dog (or two). All of this helps with my mental health. Perhaps what grates with so many people is that Cummings was able to go and live on his father’s estate to isolate, still be separate from the rest of his family, and walk in the woods on the estate. He was able to up sticks and drive to that situation, away from his and his wife’s work without fear of them losing their jobs. He had options that most people lack. Cummings had a wider range of possibilities than most people, and decided to make use of them. In doing so I believe he made some errors along the way.

What I take from all of this is that it has made so clear that, even if you believe or not that Cummings’ broke the letter of the rules about COVID, he certainly had a range of options for coping with the virus that most people lack, and the confidence and ability to make use of them. My own view is that this whole mess makes clear that this virus impacts those with resources, and those without, in very different ways. Is that fair? I’ll leave that up to you.

Comparing COVID mortality rates: What do governmental and behavioural factors tell us?

May 23, 2020

Comparing international death rates from COVID is difficult because of different counting methods. However, we need to make some progress here, and work out why some countries have done better (and worse) than others. We are in the first draft of history, and what follows is an attempt to begin to start a debate about how politics has functioned. There are more detailed methods below, but given that most people will want to see results, we’ll start with them.

All the calculations below are based on COVID deaths per million of population as of the morning of 23/5/2020 (UK time).

Countries that have done comparatively poorly in terms of COVID deaths

Of the countries included in the sample here, three patterns of causal factors appear important, with the first two being more important than the last one.

First, where countries have high levels of smoking and drinking, and low levels of government executive power, they are 0.84 (out of 1) consistent with a higher COVID death rate. 10 countries are included in this solution.

Second, where countries have high levels of smoking and drinking, and low levels of unitary government, they are 0.79 consistent with a higher COVID death rate. 8 countries are included in this solution.

Finally, where countries have high levels of social expenditure combined with high executive power and low of unitary, they are 0.85 consistent with a higher COVID death rate. However, this solution covers two countries only, and one of the countries actually achieves a low COVID death rate – it is an inconsistent case (Australia). This sounds a bit confusing (how can one county out of two have a consistency of 0.85?), but it is based on looking at patterns of these two factors across all the 25 countries in the sample, and so the 0.85 consistency occurs across them.

The overall solution is 0.8 consistent and covers 0.71 of the cases (out of 1).

The countries included in these three solutions, along with their political mapping (executive power and federal unity) is presented blow. Empty dots are other countries that are not included here:

In this we can also see three countries which have done relatively well in terms of COVID mortality – Australia, Austria and Japan. They appear because they have the same pattern of causal factors as countries which have done poorly, and so their success clearly depends on other elements. Australia, for example, may be related to strong border controls and early-lock-down, as well as relative geographic remoteness. We are never going to be able to account for something as complex as COVID with only four causal factors.

We can also see we are missing some countries which have done relatively poorly from the list above – including Great Britain. More on them below.

What do successful countries look like?

There are three solution terms for relatively successful countries.

The first combines high executive power with high unitary government, and covers 5 countries with a consistency of 0.69.

The second combines low social expenditure with low smoking and drinking and high executive power, and covers two countries only with a consistency of 0.84.

The third combines low social expenditure with low smoking and drinking and high unitary government. Again, it covers only two countries with a consistency of 0.81.

The overall solution has a consistency of 0.7 and covers 0.634 (out of 1) of the cases.

Again, we can produce a graph of the countries covered:

We can see there are fewer countries included in this solution than that for the high mortality graph – that is because the countries which have done well, in terms of the four causal factors included here, have less in common.

We can also see the appearance of ‘GBR’ at the top right of the graph – but also ‘CAN’ (Canada) at the bottom right – both of which have a pattern of causal factors which suggest they ought to have low rates of mortality – but empirically don’t. In other words, they are doing worse than we might expect.

What does all this mean?

This is an early analysis of an evolving situation, with relatively few causal factors. However, there are some conclusions we can draw.

First, the countries which appear to have the higher rates of COVID mortality also have higher rates of existing smoking and drinking. This goes against work done by Ben Goldacre and others and which is based on analysis of individual patients. This is an interesting tension – at a societal level, higher rates of smoking and drinking appear to be linked to higher rates of COVID death, but at individual levels, smoking appears to act in a small way as a protective factor. This is clearly a factor which is worth investigating further.

Second, lower levels of unitary government appear in two of the three solutions for higher rates of COVID mortality. This appears to point to the need for co-ordinated governmental action, and the weakness in some countries not to able to achieve this.

Third, countries with higher levels of unitary government appear to do well in terms of achieving low COVID mortality, with that factor appearing in two of the three solutions.

Fourth, countries with lower levels of smoking and drinking also appear to do better in terms of overall COVID mortality, again in combination with other factors, but with that factor appearing in two of the three solution terms.

Finally, we have Great Britain, which has governmental factors (high unitary government) associated with good COVID mortality, but has clearly done worse than it ought to have done. This is because of other factors which have offset this advantage. Although the GBR is graded as having high federal unity, it is perhaps open to question whether it has displayed this in its COVID response – with government struggling to achieve a coherent approach to testing, and to tracking and tracing those infected by the virus – especially in care homes. Perhaps this points to a lack of governmental capability in the face of a crisis, as well as to an implementation gap once the approach had been decided.

What did you do?

The above is the result of combining OECD data on smoking and drinking, along with Lijphart’s ‘Patterns of Democracy’ measures for unitary government and executive power, for 25 countries (which had data for both the behavioural and governmental factors), combined with data for COVID mortality per £1M people at 23/5/2020, using the data from https://www.realclearpolitics.com/coronavirus/ as a starting point, and checked against other sources.

Once this data had been compiled, it was analysed using Qualitative Comparative Analysis using the ‘QCA’ package in R by Adrian Dusa. Data was calibrated both graphically and through cluster analysis to establish crossover points, and then calibrated using the direct method. Necessary conditions were looked for, truth tables constructed looking for both consistency and PRI consistency, and sufficient conditions calculated. The intermediate solutions are presented above, but conservative and parsimonious solutions were also calculated, based on assumptions from OECD work that lower mortality rates from higher rates of social expenditure and lower rates of smoking and drinking. Even when these assumptions were relaxed (conservative and parsimonious solutions), they produced solutions very much in line with those presented above.

The case for investing in Higher Education in 2020/21

May 9, 2020

The COVID-19 crisis, according to the Bank of England, is leading to the biggest decline in economic output in modern times. In such a situation, just about every group in society will be calling to the government for help. The early signs are that the UK government is not especially receptive to calls from the HE sector for support. Here are some reasons why that might be a mistake.

First, Higher Education has a clear economic multiplier. Estimations of the size of this vary, but there seems to be a general consensus that every job in HE creates another job somewhere else in the economy, and that every pound spent on HE generates an additional £1.50 in output. So irrespective of your feelings about HE, it’s a good investment to spend money on it.

Second, it seems inevitable that such a decline in economic output is going to lead to a loss in jobs in the economy as a whole. In such a time, we have a choice of paying people unemployment benefit before they have had a chance to start their careers, or asking whether we would be better served by giving them better access to Higher Education instead. The second option means a more highly-educated workforce, as well as shielding people from events that were entirely outside of their control.

Third, if there is one thing COVID-19 has revealed to us, it is the importance of having highly-skilled and trained people in our public life. Although as a society we have lost a lot of the faith in experts we once had, we need them. We need them to be engaged in research to confront the global challenges we face. We need them to organise the delivery of protective equipment for our NHS. But we also need an informed citizenry which is able to engage with public debate and hold our governments to account. The quality of public debate around COVID-19 has not been all should have been. If our public leaders have fallen short, so often has our media’s response. Democratic life depends on strong engagement, a free and ethical press, and our political representatives being held to account. I fear we have not really seen this.

So there are good reasons for investing in Higher Education, even, and perhaps especially, at a time of crisis. However, HE needs to do some hard thinking as well.

It’s clear that many sections of our society don’t regard much of HE in strong regard. Some prominent commentators, via social media, have been highlighting examples of what they regard as academic irresponsibility and waste during the crisis. It’s clear to me that HE has to make a case for investment and relevance, but also that it might have to undergo significant change.

We need to do better in terms of making our teaching more accessible and more flexible. The full-time, students-attend-in-person model is still our default position as a continuity of school and college, but we need to show we can do more in other forms and formats. COVID has seen a significant expansion of online delivery (which raises its own problems in terms of what we are now calling digital inclusion), but has shown we can do things differently. We need to look at what we can learn from the last weeks, from more flexible programmes we already have, as well as what institutions such as the Open University can teach us. We need to offer our students more flexible and more accessible learning.

It is also clear that, because of the hostility shown to HE, it still has a case to make about its relevance and importance. In the UK, the ‘impact’ agenda has forced HE to think about how it can demonstrate relevance, and I’m proud that my own institution is well inside the top 100 of Universities worldwide in generating such impact. However, we need to make doubly sure that everything we do can find relevance in the world we work live in. The impact agenda is only one part of this – we all need to do more in engaging in the democratic process and showing the relevance of our work.

In sum then, investing in Universities is good for the economy, crucial in terms of investing in people at a time of economic and social crisis, and central to improving the functioning of our democracy. Universities have shown they can change already, but need to do more in terms of making our teaching more flexible and accessible, as well as showing the social good they generate. They are a central part of dealing not only with COVID-19 now, but also the social and economic consequences that are still to come.

COVID-19’s reminder of our fragility

May 8, 2020

As I write this (May 8th, 2020), in the UK there are VE celebrations and commemorations going on, and we remind ourselves the debt we owe to the generation that fought in the Second World War. We hope we will never again have to engage in whole-society warfare against others again.

VE day is occurring this year in the context of COVID-19, with the UK still in lock-down and with 30,615 deaths we can directly attribute to the virus, but with the number of people who have died probably in the range of 10,000 higher if we look at excess mortality during the period since March. Those numbers are both numbing and terrifying.

What the virus reminds of us is our fragility. Scientists are working flat-out to understand the virus, but we are still some distance from understanding the risks that involves, or why it affects particular groups as it seems to.

However, I think there is a bigger point about our fragility here as well. With all our ingenuity, our ability to make and remake our environment, and our advances in scientific understanding, we might sometimes believe we have reached a point where we can control our world and bend it to our will. The virus reminds us that is not the case. No matter how far our scientific understanding advanced, the world will always elude us to at least some extent. To quote Boltanksi, ‘while we can construct the project of knowing and representing reality, the design of describing the world, in what would be its entirety, is not within anyone’s grasp’ (On Critique, pp. 57-58).

We construct realities based on our knowledge of the world and through our powers to intervene in it. We can impose our will to some extent, through advancing scientific understandings and technologies that would have appeared miraculous to those who fought in World War 2. But the realities that we can create can never fully capture and control the world.

COVID-19 is so threatening because it is eluding us. We cannot yet create a reality that holds it sufficiently in place for us to impose our will upon it. We don’t know if it is safe to leave lock-down, or when it will be. We don’t know if there will be a vaccine. We don’t know for sure, if we fall ill with the virus, whether we will be able to generate antibodies which will make us immune in the future. We are fragile before the virus.

But in reminding us of our fragility, it reminds us that, for all we have achieved, the reality that we have created does not capture or control the world. And the world offers other challenges. In imposing our will upon nature, the risk of weather and tidal patterns changing and overwhelming us grows more prescient as the years go by. Similarly to the scientists who warned the UK government that we were not ready for a pandemic, we are not ready for climate change, and seem to still be doing little to try and prevent it. We can never control or fully understand the world, but we can do more to try and mitigate against the loss of human life that we now see so clearly can result from our own limitations.

Scotland and Europe

July 19, 2016

To work out Scotland’s place as a nation and within Europe we need perhaps to look at where we are now, and then where we could be going.

Scotland has had its own Parliament since 1999. Since then it has taken on an increased range of powers in areas devolved to it (including health, housing, law and order for example). As a result of the 2014 Independent vote, it is acquiring powers to set its own rates of taxation (which it has so far not used) and the ability to put in place its own benefits. It does not control immigration, defence or foreign policy. In the 2016 EU referendum 62% of Scots who voted, voted to remain, making it by some margin the strongest pro-EU nation within the UK.

Scotland feels different to England. The transport infrastructure works (when Scotrail aren’t on strike, and even then it still better than it is in England). Healthcare has not been subject to the repeated changes that England has suffered from, but the health of Scots is in need of improvement. School education has fallen behind where it ought to be. Higher education is free for Scots, creating a very distinctive feel to undergraduate courses that is less consumerist than in England. Towns and cities are less divided in Scotland – you see the full range of human experience much more readily than the more segregated approach down south.

And of course, Scotland is significantly more pro-EU than England. This might be down to the SNP managing to get its voters out in ways the English political parties failed to do. It might be due to Scotland being a beneficiary of EU funding (although that didn’t stop Wales voting to leave). It might be due to the SNP managing to be a counter-voice to whatever is going on in England, and so voting EU in Scotland being about contrariness. I’d also like to think it is about a recognition that Scotland might actually be more European than England – and with that a sense that Scotland has the potential to be a great Social Democratic nation in ways that England seems to have long abandoned.

So what about the future? Well there are some issues. Scotland is in the UK, and the UK as a whole has voted to leave the EU. Yes, the vote was itself a failed attempt by the Conservatives to deal with their own militant anti-EU wing. Yes, it was a campaign that showed all the very worst aspects of our media and which demonstrated the paucity of our political discourse. My own view is that we really need a vote on the terms of any Brexit negotiation before leaving the EU, as that is the only way to actually compare EU membership with something tangible. But assuming we don’t get that, Scotland is going to exit the EU along with the UK.

The next logical step would be for Scotland to demand another independence referendum, and the first Minister has already indicated that, if she believes that is in the best interest of Scotland (and I think the clue might be in her Party’s name), then that should happen. I worry about independence because Scotland is a small nation, and it seems to me that much of what it seeks to achieve in terms of social justice depends on risk pooling that might need to work on a larger scale than its 5 million souls. Equally, I worry about Scotland not yet having a strong view of what it wants to be if separate from the rest of the UK.

One view, expressed by Sir Nicholas Macpherson, is that Scotland could become a low-tax, small-state economy. I hope this isn’t on the cards. Along with low-tax tends to come low-skill, huge job insecurity and an economy based upon being cheaper than anyone else. That seems to go directly against the words of our First Minister so far, and would also go against the grain of Scotland’s links with Europe.

Instead, an alternative is to look to Scandinavia and to work toward a high-skill, high-investment economy. A country that respects public services and invests in them. This is going to mean taxes go up. But I believe Scotland has the infrastructure – and the standard of living – to support this. Equally, if we are to address inequality and move towards social justice, there is little more powerful than progressive taxation to address that. It will mean significant investment in our schools and in improving health services, hopefully without the repeated drives to reorganise them seen in England. It will also mean devolving powers to local areas and giving them the resources to effect real change. This seems to me to be something Scotland can achieve if its government sets its mind to it. A distinctive anti-austerity message that is pro-European and very different to what is going on in England.

If Scotland is able to make a case in these terms, then I’m sure it would be welcomed into the EU in the future. But in the meantime Scotland can be European by remembering its links to European ideas of social justice and by putting in place a clear plan for achieving them. The Scottish Parliament already has sufficient powers to achieve this, so it can be done irrespective of any future independent referendum. It would also make a much stronger case for independence if Scotland was able to show itself to be even more different to England in terms of its approach to taxation, welfare and public investment, and through this difference, be able to show its concern for European social justice. Now that really would be a vision for Scotland in Europe.

 

The failures of our governments

July 7, 2016

In the wake of the long-awaited publication of the Chilcot inquiry in the decision to invade Irawq, the newspapers in the UK today are full of stories of government failure. Perhaps the most biting is the linking of the decision to invade with that of the generals of World War One – the suggestion that we are ‘Lions led by Donkeys’.

Chilcot has laid bare the decision-making style of the Blair government. We are left with the view that the decision to invade was made well before the government ever admitted it, and that the intelligence upon which it was based was deeply flawed. The report suggests that the invasion was premature, with other options still being available. It suggests that the process by which the legality of the invasion was established was not a good one, and asks questions about how Cabinet government was organised more generally. It expresses the strong view that there was no credible plan of what to do after the invasion.

Perhaps we need to locate this story in some context. First, the Blair government had done some pretty extraordinary things by 2003. Blair had intervened personally to get the Northern Irish peace process on track, and secured an historic agreement. Blair had also used his influence to get Clinton (and NATO) to get involved in the war in Kosova, and we should not forget that, even though that intervention was too late, Blair’s intervention saved many lives. After this, of course, came the election of a new US president who Blair appears to have been concerned to be seen to be working with. And the horrific events of 9/11.

One story of context, perhaps then, is of Blair, on the back of his successes in intervening abroad (and closer to home), coming to over-estimate his abilities. By 2002/3 he was not short of confidence, with foreign policy success to point to and a dominant electoral position at home. He was also establishing a relationship with a new president in a complex foreign policy environment. This was the era of policy ‘delivery’ – of being seen to get things done.

The factor I think that is most concerning though is the ability of the Blair government to be able to make foreign policy largely as it saw fit. The is a structural feature of the UK Parliamentary system – with a large Parliamentary majority, the government has considerable power to do as it likes. We have few checks and balances (the Queen can in theory refuse to sign Bills, but to do so would provoke a constitutional crisis, and the House of Lords can be eventually over-ruled if it objects).

I’m afraid the decision to invade Iraq is the most awful representation of a more general problem. Our governments, if they have any kind of majority, are able to pass really dreadful legislation and put in place really awful policy. Parliament isn’t good at stopping bad decisions because the whip system forces MPs to vote in line with their parties rather than really scrutinising the proposed changes. Equally, we push far too much business through Parliament for decisions to be subject to sufficient scrutiny. My own research suggests that the debates that do take place are not deliberative in the sense of trying to actually work to find the best policy solution. Instead they are often partisan and superficial.

The decision to invade Iraq did not involve legislation, but was debated in Parliament. The debate was held at the last minute, and, we now know, the decision to invade was based on poor intelligence. It is hard to see how this resulted in good decision-making.

The more general problem then, is that government is often able to pass poor legislation which isn’t scrutinised well. Governments aren’t made to work through the available options. They aren’t forced to for research evidence. New Secretaries of State often push through hugely expensive changes and reorganisations with little other than faith underpinning them – look at the changes to the NHS, to the benefits system, and to schools. These have cost billions and billions and were changes often based on little more than someone in power having a big idea.

It doesn’t have to be this way. Perhaps we need to reverse the logic of our legislative system. One approach would be a precautionary one where any changes would have to be shown, through research, to be necessary beyond any reasonable doubt, before being legislated for. Another approach would be to restrict government to a limited number of Bills per year, but to structurally ensure that they were debated fully, based on research based on pilots, and with free votes for MPs who were expected to not only engage with the debates, but show that they did so through their contributions. That would move us rather closer to something approaching a deliberative process.

Such processes would almost certainly have avoided the invasion of Iraq. But they would also save billions of pounds in careless and reckless changes to public services and the country, very little of which actually results in much by the way of benefit.

 

The turkeys, the farmers and Christmas

June 27, 2016

Once upon a time, a group of farmers couldn’t decide whether to have Christmas or not. It had been a long time since the last Christmas. It was a lot of bother. Some of the farmers liked it, some did not. As they couldn’t agree amongst themselves, they decided to ask the turkeys. So they did.

Some of the farmers said that, if we had Christmas again, the white turkeys could get rid of some of the turkeys with different coloured feathers. The farmers said ‘The turkeys with the different coloured feathers aren’t like you. They have made the farm a worse place and we can’t afford them. This is called ‘getting back control’.

Some of the farmers said that, if we had Christmas again, the turkeys would have more money spent upon them. The farmers said ‘If we have Christmas, then we will spend more money on looking after you’. They put a big sign up on the wall of the farm saying how much more money they would spend.

The farmers who didn’t want Christmas told the turkeys that Christmas would be really bad for the turkeys. They got their farmer friends to say the same thing. They got their famous friends who weren’t even farmers to say the same thing too. The farmers who wanted Christmas said the farmers who didn’t want Christmas were just trying to scare the turkeys.

So the turkeys voted. Just over half the turkeys voted for Christmas, and that meant the decision applied to them all.

On the day after the vote, bad things began to happen. The farmer in charge went missing from the farm. Some of the white turkeys started being very rude to the turkeys with different coloured feathers. They said they weren’t welcome on the farm any more. The farmers who promised extra money for the turkeys said they didn’t really mean it. The sign promising extra money to the turkeys disappeared.

Then it turned out that Christmas was really expensive. So there was less money for everyone. Some of the turkeys who voted for Christmas said they didn’t expect it to happen – they were just angry with the farmers and wanted to put them to extra trouble. Some of the turkeys who voted for Christmas said that they didn’t actually expect Christmas to come – that they didn’t realise that other turkeys would vote for Christmas too.

But Christmas was coming now. Even though no-one was in charge at the farm, the knives were being sharpened, and the cranberry sauce prepared. It was only then the turkeys of all colours realised what a mistake they had made.

The morning after the EU referendum

June 24, 2016

Today is a day in which we must choose our words carefully – something some of those prominent in the referendum campaign seem to have lost sight of. But we also need to try and work out what has happened, and what it means. Here’s a first try.

First, let’s be clear about why this referendum was called. It wasn’t because there was a big national mood for a vote on membership of the EU. It is because the Conservative Party were engaging in one of their periodic in-government feuds over EU membership (remember John Major resigning in 1995 over similar battles) and reckless promises being made about offering such a vote should the government win a majority in 2015 (which they didn’t believe they would). That’s the old history here – but we should remember why the vote happened in the first place.

The ‘remain’ campaign focused on the economic consequences of leaving, with most (but not all) senior government figures making that case. Again, this is odd, in that if the economic consequences of leaving we so catastrophic you’d have thought it was a bad idea for us to be having a referendum. At least some of this seems to coming true as both shares and the pound are falling significantly this morning.

The ‘leave’ campaign found its trump card in immigration. It is easy to dismiss those who voted leave as intolerant, or even worse, racists. Happy, satisfied people don’t blame others for their predicament though. It is very noticeable that many of the areas of the country that have received most EU money ended up voting heavily to leave. Why did that happen?

One explanation is that the major political parties have been battling over the centre ground for so long (a legacy of the 1990s) that they forget about everyone else. And many, many people – at least the two million needed to turn the EU referendum to one voting for remain – haven’t seen their living standards rise for two decades. The major employers in their areas have left, either having been bought out by overseas companies which subsequently left, or having been left behind by an increasingly service-based economy. It is not hard to see why you might, in those circumstances, blame immigrants for your situation. We know that wages have been bid down in some areas of the country because of immigration. We didn’t do enough to help people who have lost their jobs and livelihoods in the last thirty years – all the more tragic as this is likely to this leading to their lives becoming shorter and far less fulfilled. This inequality helps none of us, and is an easy source of discontent onto which must nastier claims about people from other countries can be grafted.

In Scotland discontent has been channelled more positively into nationalism. The BBC map of voting shows Scotland as a sold ‘remain’ voter. The Scottish people seem to blame immigrants less, and have hope in independence, which now has to be back on the cards again as the nation has voted so differently to England. Scotland shows that inequality can be directed into a more positive movement, something from which England needs to think about urgently in terms of devolving national governance.

This morning I feel most sorry for colleagues and friends from Europe who live in the UK and who will be wondering what their future holds. We need to find compassion for those who have lost their livelihoods and standards of living over the last twenty years, and who blame immigrants for this. But we don’t need to put even more people in that position.

As I write this I see the Prime Minister has declared he will step down in mere months. Financial markets are judging our vote result badly. What we must now do, assuming no further vote will follow, is to address the reasons why so many millions feel so disaffected. Blaming others for our problems doesn’t take us very far. We have a lot of problems that are of our own making – right across England and Wales there are millions of people who don’t see much of a future for themselves. Nigel Farage suggests the vote is one against Big Business. That is very much not the case – I fear that those governing the UK will now remove labour rights which originated in the EU, and push us into an even more extreme version of a flexible labour market, with lower pay and less rights, than even before. That won’t address the problems I’ve outlined above. I wonder who those who will lose out will find to blame next time?

The EU referendum debate – the arguments for and against

June 13, 2016

The EU referendum has been billed as the single most important vote given to the public in a generation. Two official campaigns exist – one urging us to consider ‘Britain stronger in Europe, with the other simply claiming we should ‘Vote Leave’. Videos have been compiled, letters written to newspapers, celebrity endorsements sought, speeches made.

In the month of May 2016 a range of speeches and other, longer statements and letters from both campaigns were made. Ten were collected from the ‘Britain stronger in Europe’ website and nine from that of ‘Vote Leave’. They were then  examined statistically to aggregate the key themes that each side is making using cluster analysis – which looks for words that are likely appear at the same time. This gives us a clear idea of the key ideas each side is using, and the way they are assembling their arguments. What do we find?

The Vote Leave campaign has five thematic clusters of ideas. The first is concerned with freedom and democracy – suggesting that both will be enhanced by us leaving the EU, which is often described as an unaccountable and elitist. The second argues against European Court of Justice and its ability to prevent the deportation of criminals. The third cluster of terms is less organised, arguing generally against the Prime Minister in relation to energy and gas prices, and against the security concerns the ‘Britain stronger in Europe’ campaign have raised. The fourth cluster of ideas in the Vote Leave campaign are around economics, making arguments about exports and economic growth rates, as well as unemployment, and casting  doubt on ‘Britain stronger in Europe’ predictions about a loss of growth should the country vote to leave. The fifth cluster of ideas brings together arguments about wage pressures resulting from increased immigration and the struggle for families they can lead to. The top five key terms from this cluster, along with their relative weights within it, are shown below.

Figure 1 – Vote Leave, Cluster 5, top 5 terms.

eu blog chart

‘Britain Stronger in Europe’ has data that coheres around four main clusters. The first explores how Britain should remain because to leave would harm the environment and investment in Britain more generally. The second cluster of ideas are around worker’s rights, especially for women, and around the guarantee for more equal pay that the EU ensures. The third cluster of ideas is based on agreements and the co-operation that the EU offers, and the costs of leaving for the economy. Finally, the last cluster is about how the referendum offers a clear choice for the British people with a clear decision ahead of us, based on the fact available, for us to vote to remain.

As such, the debate in May seems to be taking place on rather different footings. The Vote Leave campaign is about freedom and democracy, with Britain Stronger in Europe talking about worker rights. The Vote Leave campaign talks about the EU as being unaccountable and elitist, but with Britain Stronger how it offers us access to co-operation and trade agreements. Vote Leave is arguing against the economic case being made by Britain Stronger, which the latter maintains is compelling, whereas in a wider context Vote Leave is making a case for spending the EU contribution on the NHS instead. Vote Leave is talking about immigration, but Britain Stronger seems largely to be staying away from that issue, suggesting instead that the facts of the debate are clearly in favour of us remaining.

What this suggests is that the Vote Leave campaign is appealing to freedom, democracy and putting an anti-EU message forward, alongside suggesting immigration can be reduced and employment made more secure, if we exit. There are often strong emotions involved in these issues. The Britain Stronger campaign, on the other hand, is trying to mobilise a vote based on economic data and warnings of economic costs should be leave, while at the same time trying to appear more rational and less emotional. Whether Britain Stronger’s lack of engagement with some of the big issues of the Vote Leave campaign – freedom, democracy and immigration – will harm it in the vote itself, remain to be seen, but surely the message to remain in the EU needs to engage with bigger ideas.

 

Criminalising clinicians is not the answer to care failure or neglect

November 18, 2013

It has been widely reported in the last few days that doctors, nurses and managers will face jail if they neglect patients (see for example http://www.theguardian.com/society/2013/nov/16/doctors-face-jail-if-patients-mistreated). Press coverage has suggested that this links back to both the Francis Report into Mid-Staffordshire and the Berwick Report into patient safety (the former is correct, the latter, not really, as I’ll come back to). The idea is that, by putting in place criminal sanctions, a deterrent will be put in place to prevent the wilful neglect of patients. I think this is the wrong way to go about this.

The NHS does have a problem in terms of care provision. Part of this is sheer scale – when you have that many organizations all of which are providing NHS care, there will be some clinicians somewhere not doing a job. They may even be engaging in wilful neglect. But sadly, there will be poor care somewhere. The question is, how can minimise poor care as much as possible?

The government plan to make neglect a criminal offence depends upon such an offence being a deterrent. But just about the most robust finding we have in psychology is that, if you want people to do things better, you should appeal to their intrinsic motivation rather than by putting in place extrinsic rewards or sanctions. In more everyday language, if you want people to do a good job, you should appeal to people’s pride in doing a good job rather than trying to pay them to do it, or by threatening them if they don’t. This finding applies double when you are dealing with highly-qualified professionals. We want our clinicians to do a good job, so we need to have systems in place that appeal to their pride in caring, not trying to pay them to do it better, or threatening should their care standards fall. Of course we need systems in place to hold clinicians to account for the care they provide – but threatening them with jail really isn’t the answer.

A key question for me is why does bad care happen? How is it that people who became carers with probably the best of intentions end up neglecting patients? The answers are not straightforward. It can be the result of having to work in dreadful circumstances, brought on by a lack of resources and dreadful leadership. It can be the result of gradually falling standards due to the tolerance of poor care from others. We need a great deal more research to really understand what happens when care fails. But threatening people with jail should they fail to provide good care on the grounds that it will act as a deterrent ignores how and why bad care was being provided in the first place. It assumes that carers are making rational decisions to neglect patients, when the real situation is always more complex and difficult than this.

A second key question is whether the principle of prison-based deterrence ought to apply to our policymakers. If we are going to prosecute carers, then why aren’t we prosecuting government ministers for neglect in policymaking, leading to an NHS reorganization that was not based on research, which wasted billions of pounds, fragmenting care, and demoralising staff? If the government are so sure that deterrents work, why aren’t they making themselves subject to them too? Or is it, perhaps, that by sending a few lowly-paid nurses to jail (as has happened at Mid-Staffordshire, under existing health and safety laws) we can pretend we have dealt with care provision problems and move on, rather than looking harder and thinking this through more carefully?

Francis did recommend that neglect of basic standards be a criminal offence. Berwick was much more circumspect – I read his findings in suggesting that, only in extreme cases should criminal proceedings be used, as expressing the bare minimum agreement with Francis rather than supporting the earlier report. Berwick talks instead about the collective responsibility of care teams, and about supporting carers – the language of punishment isn’t really a part of his report. I think he was right in this. By appealing to the reasons why people became carers in the first place, by supporting them in their jobs, and making sure they have the resources they need to do their job, then we have the best chance of minimising neglect and reducing care failure. Sending people to jail won’t help.