Health – We Know Zero

Again and again and again

27. November 2025 · Write a comment · Categories: Economics, Health, Media & Politics

On 20 November, the UK Covid-19 Inquiry published its second report and recommendations following its investigation into ‘Core decision-making and political governance’. The following day these were the headlines:

This contrasts with the Inquiry’s first report and recommendations following its investigation into the UK’s ‘Resilience and preparedness (Module 1)’ on Thursday 18 July 2024. Then the following day’s headlines looked like this:

Whereas the first report had recommended a radical simplification of the civil emergency preparedness and resilience systems, including:

A new approach to risk assessment;
A new UK-wide approach to the development of strategy, which learns lessons from the past;
Better systems of data collection and sharing in advance of future pandemics;
Holding a UK-wide pandemic response exercise at least every three years and publishing the outcome; and
The creation of a single, independent statutory body responsible for whole system preparedness and response.

The second report on the other hand merely reran the pandemic, pointing out where we went wrong on:

The emergence of Covid-19;
The first UK-wide lockdown;
Exiting the first lockdown;
The second wave; and
The vaccination rollout and Delta and Omicron variants.

And crucially who to blame for it. Its recommendations were far less specific and actionable in my view than those from the first report. And yet it got all the headlines, with glowering images of Baroness Hallett and pictures of Boris Johnson with head bowed.

The first report dealt with what we could do better next time and was virtually ignored. The second dealt with who to blame and it dominated the headlines. I think this neatly encapsulates what is wrong with us as a country and why we never seem to be able to learn from our own past mistakes or the examples of other countries.

This is not about defending Boris Johnson or any of his ministers. It is about realising that they are much less important than our own ability to sort out our problems and study any evidence we can to help us do that.

The NHS suffers from the same problem, as Roy Lilley has described here, too many inquiries and most of their recommendations ignored. Again and again and again. We choose to focus on the minor and irrelevant at the expenses of the major and important. Again and again and again. As Lilley says:

Until we make it OK for people to say… I made a mistake… we will forever be trapped in a Kafka world of inquiries coming to the same conclusions…

…If inquiries worked, we’d have the safest healthcare system in the world.

Instead, we have a system addicted to investigating itself and forgetting the answers.

It is part of a pattern repeated yesterday, focusing on the micro when our problems are macro. Rachel Reeves increased taxes by £26 billion in yesterday’s budget, which was much less than the £40 billion in her first budget, and yet still led to the BBC reporting “Reeves chooses to tax big and spend big” and the FT leading with “Rachel Reeves’ Budget raises UK tax take to all-time high“, and with this graph:

This is hilariously at odds with the message of what it was reporting last week:

The latter was obviously an attempt to head off a wealth tax, which appears to have been largely successful. Our averageness when it comes to tax, though, is supported by this graph using OECD data from Tax Policy Associates:

Our position in the middle of the pack will be little affected by what happened yesterday. And that and all the chatter about the OBR leaking it all an hour in advance rather drowned out the fact that there was relatively little additional spending (around £12 billion overall, a quarter of which was on the welcome removal of the two-child limit). The main point was to increase our “fiscal headroom” to £22 billion, ie the amount the Government can spend before they breach their own fiscal rules.

It looks like we are going to do what we are going to do, with fiscal headroom management masquerading as economic policy, and otherwise just sit around waiting for the next disaster. Which we will then have a big inquiry about to tell us that we weren’t remotely prepared for it. Which we will then ignore…and so it continues. Again and again and again.

Boxes

24. October 2025 · Write a comment · Categories: Actuarial, Birmingham, COVID-19, Health, Legal, Media & Politics, Regulation, Risk

*The warehouse at the end of* *Raiders of the Lost Ark*

In the year when I was born, Malvina Reynolds recorded a song called Little Boxes when she was a year younger than I am now. If you haven’t heard it before, you can listen to it here. You might want to listen to it while you read the rest of this.

I remember the first time I felt panic during the pandemic. It was a couple of months in, we had been working very hard: to put our teaching processes online, consulting widely about appropriate remote assessments and getting agreement from the Institute and Faculty of Actuaries (IFoA) for our suggested approach at Leicester, checking in with our students, some of who had become very isolated as a result of lockdowns, and a million other things. I was just sitting at my kitchen table and suddenly I felt tears welling up and I was unable to speak without my voice breaking down. It happened at intervals after that, usually during a quiet moment when I, consciously or unconsciously, had a moment to reflect on the enormity of what was going on. I could never point to anything specific that triggered it, but I do know that it has been a permanent change about me, and that my emotions have been very much closer to the surface ever since. I felt something similar again this morning.

What is going on? Well I haven’t been able to answer that satisfactorily until now, but recently I read an article by David Runciman in the LRB from nine years ago when Donald Trump got elected POTUS the first time. I am not sure that everything in the article has withstood the test of time, but in it Runciman makes the case for Trump being the result of the people wanting “Trump to shake up a system that they also expected to shield them from the recklessness of a man like Trump.”. And this part looks prophetic:

[Trump is]…the bluntest of instruments, indiscriminately shaking the foundations with nothing to offer by way of support. Under these conditions, the likeliest response is for the grown-ups in the room to hunker down, waiting for the storm to pass. While they do, politics atrophies and necessary change is put off by the overriding imperative of avoiding systemic collapse. The understandable desire to keep the tanks off the streets and the cashpoints open gets in the way of tackling the long-term threats we face. Fake disruption followed by institutional paralysis, and all the while the real dangers continue to mount. Ultimately, that is how democracy ends.

And it suddenly hit me that this was something I had indeed taken for granted my whole life until the pandemic came along. The only thing that had ever looked like toppling society itself was the prospect of a nuclear war. Otherwise it seemed that our political system was hard to change and impossible to kill.

And then the pandemic came along and we saw government national and local digging mass graves and then filling them in again and setting aside vast arenas for people to die in before quietly closing them again. Rationing of food and other essentials was left to the supermarkets to administer, as were the massive snaking socially-distanced queues around their car parks. Seemingly arbitrary sets of rules suddenly started appearing at intervals about how and when we were allowed to leave the house and what we were allowed to do when out, and also how many people we could have in our houses and where they were allowed to come from. Most businesses were shut and their employees put on the government’s payroll. We learned which of us were key workers and spent a lot of time worrying about how we could protect the NHS, who we clapped every Thursday. It was hard to maintain the illusion that society still provided solid ground under our feet, particularly if we didn’t have jobs which could be moved online. Whoever you were you had to look down at some point, and I think now that I was having my Wile E. Coyote moment.

The trouble is, once you have looked down, it is hard to put that back in a box. At least I thought so, although there seems to have been a lot of putting things in boxes going on over the last few years. The UK Covid-19 Inquiry has made itself available online via a YouTube channel, but you might have thought that a Today at the Inquiry slot on terrestrial TV would have been more appropriate, not just covering it when famous people are attending. What we do know is that Patrick Vallance, Chief Scientific Advisor throughout the pandemic, has said that another pandemic is “absolutely inevitable” and that “we are not ready yet” for such an eventuality. Instead we have been busily shutting that particular box.

The biggest box of course is climate change. We have created a really big box for that called the IPCC. As the climate conferences migrate to ever more unapologetic petro-states, protestors are criminalised and imprisoned and emissions continue to rise, the box for this is doing a lot of work.

And then there are all the NHS boxes. As Roy Lilley notes:

If inquiries worked, we’d have the safest healthcare system in the world. Instead, we have a system addicted to investigating itself and forgetting the answers.

But perhaps the days of the box are numbered. The box Keir Starmer constructed to contain the anger about grooming gangs which the previous 7 year long box had been unable to completely envelop also now appears to be on the edge of collapse. And the Prime Minister himself was the one expressing outrage when a perfectly normal British box, versions of which had been giving authority to policing decisions since at least the Local Government (Review of Decisions) Act 2015 (although the original push to develop such systems stemmed from the Hillsborough and Heysel disasters in 1989 and 1985 respectively) suddenly didn’t make the decision he was obviously expecting. That box now appears to be heading for recycling if Reform UK come to power, which is, of course, rather difficult to do in Birmingham at the moment.

But what is the alternative to the boxes? At the moment it does not look like it involves confronting our problems any more directly. As Runciman reflected on the second Trump inauguration:

Poor Obama had to sit there on Monday and witness the mistaking of absolutism for principle and spectacle for politics. I don’t think Trump mistakes them – he doesn’t care enough to mind what passes for what. But the people in the audience who got up and applauded throughout his speech – as Biden and Harris and the Clintons and the Bushes remained glumly in their seats – have mistaken them. They think they will reap the rewards of what follows. But they will also pay the price.

David Allen Green’s recent post on BlueSky appears to summarise our position relative to that of the United States very well:

War Games

27. August 2025 · Write a comment · Categories: Climate Change, COVID-19, EIOPA, Health, Media & Politics, Risk

I watched The War Game this week, as it had suddenly turned up on iPlayer and I had not seen it before. It was the infamous film from 1966 on the horrors of a nuclear war in the UK that was not televised until 1985. It has been much lauded as both necessarily horrifying and important over the years, but what struck me watching it was how much it looked back to the period of rationing (which had only ended in the UK 12 years earlier) and general war-time organisation from the Second World War. It would be a very different film if made now, probably drawing on our recent experiences of the pandemic (when of course we did dig huge pits for mass burials of the dead and set up vast Nightingale hospitals as potential field hospitals, before the vaccines emerged earlier than expected).

But what about the threat of nuclear war which still preoccupied us so much in the 1980s but which seems to have become much less of a focus more recently? With the New START treaty, which limits the number of strategic nuclear warheads that the United States and Russia can deploy, and the deployment of land and submarine-based missiles and bombers to deliver them, due to expire on 5 February 5, negotiations between Russia and the United States finally appear to be in progress. However China has today confirmed that it does not want to participate in these.

In Mark Lynas’ recent book Six Minutes to Winter, he points to the Barret, Baum and Hostetler paper from 2013 which estimated the probability of inadvertent nuclear war in any year to be around 1%. This is twice the probability of insolvency we think acceptable for our insurance companies under Solvency II and would mean, if accurate, that the probability of avoiding nuclear war by 2100 was 0.99 raised to the power of 75 (the number of years until 2100), or 47%, ie less than a fifty-fifty chance.

That doesn’t seem like good enough odds to me. As Lynas says:

We cannot continue to run the daily risk of nuclear war, because sooner or later one will happen. We expend enormous quantities of effort on climate change, a threat that can endanger human civilisation in decades, but ignore one that can already destroy the world in minutes. Either by accident or by intent, the day of Armageddon will surely dawn. It’s either us or them: our civilisation or the nukes. We cannot both survive indefinitely.

The Treaty on the Prohibition of Nuclear Weapons (TPNW) was adopted at the UN in 2017 and came into force in 2021. In Article 1 of the Treaty, each state party to it undertakes never to develop, test, produce, possess, transfer, use or threaten to use nuclear weapons under any circumstances. 94 countries have signed the TPNW to date, with 73 full parties to it.

The House of Commons library entry on TPNW poses a challenge:

It is the first multilateral, legally binding, instrument for nuclear disarmament to have been negotiated in 20 years. However, the nuclear weapon states have not signed and ratified the new treaty, and as such, are not legally bound by its provisions. The lack of engagement by the nuclear weapon states subsequently raises the question of what this treaty can realistically achieve.

It then goes on to state the position of the UK Government:

The British Government did not participate in the UN talks and will not sign and ratify the new treaty. It believes that the best way to achieve the goal of global nuclear disarmament is through gradual multilateral disarmament, negotiated using a step-by-step approach and within existing international frameworks, specifically the Nuclear Non-Proliferation Treaty. The Government has also made clear that it will not accept any argument that this treaty constitutes a development of customary international law binding on the UK or other non-parties.

There are 9 nuclear states in the world: China, France, India, North Korea, Pakistan, Russia, Israel, the UK and the United States. Israel recently conducted a 12 day war with Iran to stop it becoming the 10th. Many argue that Russia would never have invaded Ukraine had it kept its nuclear weapons (although it seems unlikely that they would have ever been able to use them as a deterrent for a number of reasons). So the claims of these nuclear states that they are essential to their security are real.

But is the risk that continued maintenance of a nuclear arsenal poses worth it for this additional security? For the security only operates at the deterrence level. Once the first bomb lands we are no more secure than anyone else.

Which makes it all the more concerning when Donald Trump starts saying things like this (in response to a veiled threat by the Russian Foreign Minister about their nuclear arsenal):

“I have ordered two Nuclear Submarines to be positioned in the appropriate regions, just in case these foolish and inflammatory statements are more than just that. Words are very important, and can often lead to unintended consequences, I hope this will not be one of those instances.”

But with a probability of avoiding “unintended consequences” less than fifty-fifty by 2100? That really doesn’t feel like good enough odds to me.

The End of the Professions?

24. July 2025 · Write a comment · Categories: Health, Professions

On Wednesday last week the report from the Leng Review into the safety and effectiveness of physician associates (PAs) and anaesthesia associates (AAs) was published. Although it concluded that:

Research on the safety and effectiveness of PAs and AAs was limited, generally of low quality and either inconclusive or demonstrated a mixed picture.

This apparently did not prevent Professor Leng from feeling able to go right ahead and make 18 recommendations. Neither did it prevent NHS England announcing the same day that it would be expecting all PAs and AAs in the NHS to immediately:

Take on the new names for their roles of physician assistant and physician assistant in anaesthesia respectively;
No longer triage patients or see “undifferentiated” patients.

The rationale for the first of these was the fear that PAs and AAs were being confused with doctors. That this has been addressed by immediately making PAs and AAs much more confusable with each other is just one of the many hilarious things about this report. They also appear to have forgotten to let the General Medical Council (GMC) know, as their website still looks like this:

Then there is the meticulously recorded bile directed at PAs and AAs and their capabilities throughout what is described all over the website as an “independent” report. There were several charts of the opinions of PAs and AAs about their ability to carry out their duties compared to those of doctors. Here is one of them:

The fact I feel able to describe this as mostly bile is the template job descriptions at Appendix 5 of the Leng report. The one for PAs in secondary care includes the following principal duties and responsibilities:

carry out assessments of patient health by interviewing patients and performing
physical examination including obtaining and updating medical histories (looks like B and E);
order and perform agreed diagnostic tests including laboratory studies and
interpret test results (looks like J);
perform basic therapeutic procedures by administering all injections and
immunisations, suturing and managing wounds and infections (looks like M);
help to develop other members of the multidisciplinary team by providing
information and educational opportunities as appropriate (looks like L).

So even the Leng Review appears to have concluded that many of the doctors’ opinions polled here are ridiculous.

Of course I am lumping all doctors together here because the Leng Review does for the most part. There is one sentence where it is admitted that senior doctors, including GPs, tended to be more positive than resident doctors, but this is not really quantified.

The Leng Review will not be the last of its kind. It has taken up the concerns of a threatened profession and worked with them to connive in the othering of another sub-profession (set up, as admitted in the Leng Review report itself, by the Department of Health under, in the case of PAs, a competency framework in conjunction with the Royal Colleges of Physicians and General Practitioners) rather than tackle the actual threats the profession faces. As Roy Lilley wrote:

The BMA can stand in the way, or stand at the front, shaping how technology and new roles like PAs can improve care, close gaps, and make healthcare safer and smarter.

History teaches us that you can’t halt progress by breaking the machinery or driving new careers into a cul-de-sac.

So why are the doctors, particularly resident doctors (formerly known as junior doctors), so offended by the use of PAs and AAs in the NHS? Is it really about safety and effectiveness? Or is it that the British Medical Association (BMA) has finally lost the trust of its more junior members after years of inadequate representation and now is throwing its weight around with the campaign against PAs and AAs and now the resident doctor strike in a desperate attempt to convince them that the reason they are paid less than PAs and can’t get a job after graduation is not the fault of the BMA, but that of the Government, PAs and AAs?

As the Leng Review admits:

Since the early 2000s, and in response to increasing workforce pressures, there has been a growing recognition of the PA role across the globe as a flexible way to address doctor shortages and improve access to healthcare. Today, PAs or their equivalents are employed in over 50 countries, although the role is often adapted locally to meet specific healthcare system needs.

Is it perhaps this very flexibility which is the threat here, when NHS England are already reviewing postgraduate medical training due in large part to resident doctors’ “concerns and frustrations with their training experience”?

The doctors are not the only threatened profession. According to The Observer this week:

The big four accounting firms – Deloitte, EY, PricewaterhouseCoopers and KPMG – posted 44% fewer jobs for graduates this year compared with 2023.

These are the big beasts for finance and actuarial graduates and tend to set the market for everyone else, so these are big changes. Ian Pay of the ICAEW’s quote from the article is even more alarming:

Historically, accountancy firms have typically had a pyramid structure – wide base, heavy graduate recruitment. Firms are now starting to talk about a ‘diamond model’ with a wide middle tier of management because, ultimately, AI is not sophisticated enough yet to make those judgment calls.

A diamond model? That surely only makes sense for those at partner level currently interested in the purchase of diamonds? Sure enough, the article continues:

Cuts to graduate cohorts since 2023 have ranged from 6% at PwC to 29% at KPMG. According to James O’Dowd, founder of talent adviser Patrick Morgan, these are accompanied by senior employees being paid more and more job offshoring. Up to a third of some firms’ administrative tasks are carried out in countries with lower labour costs such as India and the Philippines.

So what happens when AI is sophisticated enough to make those judgement calls, calls which are often sophisticated forms of pattern spotting and which, quite frankly, AI systems are already much better than humans at in many cases already? Will the diamond model collapse still further into a “T-model” perhaps, with the very senior survivors being paid even more? Don’t expect labour costs in India and the Philippines to remain lower for very long as demand increases from their own economies as well as ours.

And the most important question? What then? Who will the senior employees who seem to be doing so well out of this at the moment be in 20-30 years’ time? Where will they have come from? What experience will they have and how will they have gained it when all the opportunities to do so have been given to the system in the corner which never gets tired, only makes mistakes when it is poorly programmed or fed poor data, and never takes study leave at the financial year end?

So Medicine, Finance and now Law. Richard Susskind has been writing about the impact of AI on Law, and with his son Daniel, on other professions too for some time now. The review of his latest book, How To Think About AI, has the reviewer wondering “Where has Reassuring Richard gone?”. In his latest book, Susskind says:

“Pay heed, professionals – the competition that kills you won’t look like you.”

So probably a threatened profession there too then.

In the 1830s and 1840s, according to Christopher Clark’s excellent Revolutionary Spring, the new methods of production led to “the emergence of a non-specialised, mobile labour force whose ‘structural vulnerability’ made it more likely that they would experience the most wretched poverty at certain points in their lives.” The industrialised economies changed beyond recognition and the guilds representing workers, with skills the need for which were being automated away, retreated to become largely ceremonial.

Then the divisions were those of class. This time they appear to be those of generation. Early career professionals are seeing their pay, conditions and status under threat as their more senior colleagues protect their own positions at their expense.

It remains to be seen what will happen to our threatened professions, but it seems unlikely that they will survive in their current forms any more than the jobs of their members will.

Humpty Dumpty and the Terrorism Act

07. July 2025 · Write a comment · Categories: Birmingham, Cartoons, Health, Legal, Media & Politics

*Illustration of Humpty Dumpty from Through the Looking Glass, by John Tenniel, 1871.*

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

’The question is,’ said Alice, ‘whether you can make words mean so many different things.’

’The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.”

This is the country we are now living in. Because 4 members of a group sprayed red paint on some aircraft and caused some damaged using crowbars at an Oxfordshire base, as part of a series of protests designed to end international support for Israel’s war in Gaza for which they have all been arrested and charged, the whole organisation has been “proscribed” following a vote of 385 votes to 26 in the House of Commons and the order subsequently signed by the Home Secretary, Yvette Cooper, putting it on a par with organisations like ISIS (a full list of the 81 organisations proscribed under the Terrorism Act 2000 and the 14 Northern Ireland organisations proscribed under previous legislation can be found here).

Proscription makes it a criminal offence to:

belong, or profess to belong, to a proscribed organisation in the UK or overseas (section 11 of the act)
invite support for a proscribed organisation (the support invited need not be material support, such as the provision of money or other property, and can also include moral support or approval) (section 12(1))
express an opinion or belief that is supportive of a proscribed organisation, reckless as to whether a person to whom the expression is directed will be encouraged to support a proscribed organisation (section 12(1A)) – this one was added by the Counter Terrorism and Border Security Act 2019.
arrange, manage or assist in arranging or managing a meeting in the knowledge that the meeting is to support or further the activities of a proscribed organisation, or is to be addressed by a person who belongs or professes to belong to a proscribed organisation (section 12(2)); or to address a meeting if the purpose of the address is to encourage support for, or further the activities of, a proscribed organisation (section 12(3))
wear clothing or carry or display articles in public in such a way or in such circumstances as to arouse reasonable suspicion that the individual is a member or supporter of a proscribed organisation (section 13)
publish an image of an item of clothing or other article, such as a flag or logo, in the same circumstances (section 13(1A)) this one was also added by the Counter Terrorism and Border Security Act 2019.

References are to sections of the Terrorism Act 2000.

In order to be proscribed, the Terrorism Act states that an organisation must have:

committed or participated in acts of terrorism;
prepared for terrorism;
promoted or encouraged terrorism (including the unlawful glorification of terrorism); or
be otherwise concerned in terrorism.

And terrorism is defined as:

the use or threat of action which: involves serious violence against a person; involves serious damage to property; endangers a person’s life (other than that of the person committing the act); creates a serious risk to the health or safety of the public or section of the public or is designed seriously to interfere with or seriously to disrupt an electronic system.

The use or threat of such action must be designed to influence the government or an international governmental organisation or to intimidate the public or a section of the public, and must be undertaken for the purpose of advancing a political, religious, racial or ideological cause.

As a consequence, 29 people were arrested under terrorism legislation for protesting about the proscription, including an 83 year old retired priest, arrested after appearing to be in possession of a placard. I assume it was the one shown here.

The organisation’s website now displays the following message:

Co-founder of Palestine Action Huda Ammori is seeking to bring a legal challenge against the Home Office with a hearing for permission to bring a judicial review set to take place during the week of 21 July. Meanwhile a new group has suddenly appeared, armed with a fresh supply of red paint and targetting Time Logistics (which they say supplied one of Israel’s biggest weapons companies) lorries near Birmingham.

And the name of the new group? Yvette Cooper.

Financial consequences

03. July 2025 · Write a comment · Categories: Economics, Health, Media & Politics

According to Pat McFadden, a Government minister, there will be “financial consequences” to the decision to modify the planned cuts to disability and health-related benefits in order to win the vote on the welfare bill. There certainly will be for people receiving these benefits.

The changes to the bill in order to get it voted through will still:

reduce the health element of the Universal Credit for new claims from £97 to £50 per week from April 2026 and restrict payment to claimants over the age of 22, although now the benefit will continue to increase at least in line with inflation;
possibly re-introduce some of the restrictions to eligibility for personal independence payments following a review.

But that does not appear to be what McFadden was talking about, as he went on to list a number of taxes the Government would not raise. Instead the financial consequences comment sounded more like the empty threat of the playground bully when his victim has unexpectedly given him a bloody nose and he is trying not to lose face. Because nearly all of the newspaper coverage of this event appears to have been focused on this reputational aspect rather than on the fiscal significance of the changes:

In my last post, I referred to Harvey Whitehouse’s excellent Inheritance – the Evolutionary Origins of the Modern World, which included this definition of gossip:

When we lived in small communities, in which everybody knew everybody else, news consisted mainly of socially strategic information about who was hoarding wealth, who was telling lies, who was sleeping with whom, who was stealing, who was free-riding, and so on. In most of these newsworthy stories, there would be transgressors and victims, and news purveyors and consumers would be very sensitive to the reputational consequences of this information. The common term for this is gossip.

So by focusing on the reputational consequences of a welfare bill in the House of Commons, these newspapers are preferring to present a story which affects the livelihoods of up to a million people as if it were gossip. This approach is justified by the media as something the public are interested in and therefore something we will buy. Our bias towards stories about reputational consequences, even of people we do not know or are ever likely to meet, is therefore used against us and the world gets a little less understandable with every gossipy take of a more complex story. This has other implications (or perhaps what McFadden would call “consequences”): the rest of the day’s news seemed to revolve around whether someone had been mean to the Chancellor of the Exchequer and made her cry.

And the actual financial consequences? Well, the BBC made much about the impact of the Chancellor’s tears on the bond and currency markets. Morningstar went further and claimed that investors had saved the Chancellor’s job by forcing the Prime Minister to support her very publicly after failing to do so initially. The unspoken assumption is that the markets control the economy and all we can do is have gossipy conversations in our impotence about whether Rachel, Ed, Wes, Liz or Angela are up or down this week.

This is self-fulfilling: we can be as powerless as we decide to be. Or we can realise that the way we run our country and society is up to us. The £5 billion all of this is supposedly all about could be raised in any number of ways: slowing down the quantitative tightening programme the Bank of England is set on, a policy of selling bonds before maturity not adopted by the European Central Bank or the Federal Reserve in the United States, or any of a number of suggestions made by Richard Murphy which would have been focused on the top 10% of earners. Instead we went after the disabled first. Noone forced us to. We did it to ourselves.

Perhaps we should all be a little tearful about that.

The Redistribution of Space

10. April 2025 · Write a comment · Categories: Birmingham, Climate Change, Health, Media & Politics

My 60th birthday celebrations, a couple of years ago now, centred around train journeys to the South of France and then onto Madrid. The highlight was (pictured above) spending a large part of my birthday, in mid October, on a huge deserted beach at Narbonne and being able to comfortably swim in the sea. So much space.

And the trains also seemed so much more spacious. I travel a lot on trains in the UK, with sometimes comedically little space. And I am not just talking about space in terms of leg room in European trains, but also whenever you want to walk over to the restaurant carriage on the upper floor of a double decker train to improve the views, with a bar and an array of kidney shaped tables dotted around the carriage to eat hot meals at, before ambling back to your seat. Mental space is much greater too, with fewer announcements and partitions between passengers to reduce the amount of conversation bouncing around the carriage. I had several 5-6 hour journeys over the two weeks I was away, and they were without exception very relaxing experiences.

So enough travelogue. What point am I making? It is the importance of space.

I think of other things where my view of it has been affected by the space attached to it. Take swimming, for example. I spent three of my formative years (aged 3 to 6) in Singapore where my father was stationed with the RAF. We swam outdoors at the Singapore Swimming Club every afternoon and lived in flats right next to a beach. Swimming was all about space – on my back staring up at the limitless sky, or mask and snorkels on and face down to explore the depths of the pools.

Back in the UK, it has never been anything like the same experience. I have swum in pools in village schools in Yorkshire, council pools in Cheltenham and Witney, the pools built for the Youth Games in Sheffield, a private school’s tiny pool in Oxford where I did my bronze survival badge. Endless school outings with compulsory swim caps and cold water. I have swum in lakes and spent probably more time in the Cherwell than was strictly healthy, sometimes deliberately, sometimes because the canoes we were given at school were designed to be manoeuvrable rather than stable. I have swum in decaying metal structures in spa towns and pools fed by spring water with no heating in the Peak District. I only discovered body boarding relatively late and the joys of doing it for much longer in colder seas with a wetsuit even later (last year). I also spent a fascinating morning with the Wild Woman of the Wye, Angela Jones, learning how to swim safely in the river in our current polluted times. And it certainly feels like the decline in swimming quality in recent years extends indoors as well as outdoors. The Wyndley or Beeches Leisure Centres near my part of Sutton Coldfield just don’t hold much appeal for me. Sure there are bodies of water there, but nothing to lift your spirit while using them and the constraints, in terms of the narrow time slots and even narrower lanes you are confined to, are the very opposite of my earliest experiences of water. I am lucky enough to be able to afford the local David Lloyd Centre, with much less pressure on their pools, in particular their excellent outdoor pool in Birmingham, which is miraculously underused. On a day with bright sun, with the birds singing and a light breeze rustling the trees just enough to drown out the industrial hum from next door and push back the smell of solvents, I can sometime almost imagine I am back in the Singapore Swimming Club.

But generally when you attempt to venture outside you find the constraints are even greater than those at Wyndley swimming pool. According to the Right to Roam campaign group we only have access to 3% of rivers in England. Meanwhile the Outdoor Swimming Society are campaigning for swimming access to reservoirs.

On land we have slightly more access, but half of the land area of England is owned by around 1% of the population. As Guy Shrubsole points out:

The aristocracy and landed gentry still own around 30% of England, whilst the country’s homeowners own just 5% of the land. The public sector owns around 8% of England; the country’s 24 non-Royal Dukes own a million acres of Britain.

I can only redistribute some space in my direction, on a train, in a pool of water, by paying more than most can afford for those experiences, and allowing me to behave like a non-Royal Duke for a short time.

This has huge implications for carbon sequestration of course, with, for example, 60% of deep peat owned by just 124 landowners. These landowners are not looking after it very well either, with upland peat being degraded as a result of moorland burning for grouse moors, and lowland peat in the Fens and elsewhere being damaged through drainage for intensive agriculture. As a result, England’s peat soils are now a net source of carbon emissions rather than a sink, leaking around 11 million tonnes of CO₂ annually. The Government has committed to protecting 30% of land in the UK for nature by 2030, but is itself hugely constrained by the concentrated ownership of land.

So our land is like our swimming pools: tightly constrained by the narrow time slots and narrower lanes most of us are allowed access to. We are being stifled by the property rights of a tiny minority.

The Economics of Laughter and Forgetting

27. March 2025 · Write a comment · Categories: Actuarial, COVID-19, Economics, Health, Media & Politics, Prediction, Risk

https://parliament.assetbank-server.com/assetbank-parliament/images/assetbox/b26cd8f5-538e-4409-b033-f1f02aea6821/assetbox.html

Milan Kundera wrote his The Book of Laughter and Forgetting in 1979, a few years after moving to France and the same year he had his Czech citizenship revoked. His books had all been banned in Czechoslovakia in 1968, as most of them poked fun at the regime in one way or the other. The Book of Laughter and Forgetting was no exception, focusing, via seven stories, on what we choose to forget in history, politics and our own lives. One of the themes is a word which is difficult to translate into English: litost.

Litost seems to mean an emotional state of feeling of being on your own suddenly brought face to face with how obvious your own hopelessness is. Or something to that effect. Kundera explored several aspects of litost at length in the novel. However, for all the difficulties of describing it exactly, litost feels like a useful word for our times, our politics and our economics.

I want to focus on two specific examples of forgetting and the sudden incidents of litost which have brought them back into focus.

The first, although not chronologically, would be the pandemic. There are several articles around suddenly about the lessons we have not learnt from the pandemic, to mark the fifth anniversary of the first lockdown. Christina Pagel, backed up by module 1 of the Covid-19 Inquiry, reckons:

Preventing future lockdowns requires planning, preparation, investment in public health infrastructure, and investment in testing, virology and medical research…

She takes issue with some of the commentary as follows:

But the tenor of reporting and public opinion seems to be that “lockdowns were terrible and so we must not have lockdowns again”. This is the wrong lesson. Lockdowns are terrible but so are unchecked deadly pandemics. The question should be “lockdowns were terrible, so how can we prevent the spread of a new pandemic so we never need one again?”.

However the stampede to get back to “normal” has mitigated against investing in infrastructure and led to a massive reduction in testing and reporting, and the Covid-19 Inquiry has given the government cover (all questions can just be responded to by saying that the Covid Inquiry is still looking at what happened) to actively forget it as quickly as possible. Meanwhile the final module of the Covid-19 Inquiry is not due to conclude until early 2026, which one must hope is before the next pandemic hits. For which, as the former Chief Scientific Adviser and other leading experts have said, we are not remotely prepared, and certainly no better prepared than we were in 2020.

It is tempting to think that this is the first major recent instance involving the forgetting of a crisis to the extent that its repetition would be just as devastating the second time. Which is perhaps a sign of how complete our collective amnesia about 2008 has become.

Make no mistake, 2008 was a complete meltdown of the core of our financial system. People I know who were working in banks at the time described how even the most experienced people around them had no idea what to do. Alistair Darling, Chancellor of the Exchequer at the time, claimed we were hours away from a “breakdown in law and order”.

According to the Commons Library briefing note from October 2018, the Office for Budget Responsibility (OBR) estimates that, as at the end of January 2018, the interventions had cost the public £23 billion overall. The net balance is the result of a £27 billion loss on the RBS rescue, offset by some net gains on other schemes. Total support in cash and guarantees added up to almost £1.2 trillion, including the nationalisation of Northern Rock (purchased by Virgin Money, which has since been acquired by the Nationwide Building Society) and the Bradford & Bingley (sold to Santander) and major stakes in RBS (now NatWest) and Lloyds. Peak government ownership in these banks is shown below:

If you read the Bank of England wacky timeline 10 years on from 2018, you will see a lot about how prepared they are to fight the last war again. As a result of this, cover has been given to actively forget 2008 as quickly as possible.

Except now various people are arguing that the risks of the next financial crisis are increasing again. The FT reported in January on the IMF’s warnings (from their Global Financial Stability Report from April 2024) about the rise in private credit bringing systemic risks.

Meanwhile Steve Keen (one of the very few who actually predicted the 2008 crisis) in his latest work Money and Macroeconomics from First Principles, for Elon Musk and Other Engineers has a whole chapter devoted to triggering crises by reducing government debt, which makes the following point:

A serious crisis, triggered by a private debt bubble and crash, has followed every sustained attempt to reduce government debt. This can be seen by comparing data on government and private debt back to 1834.

(By the way, Steve Keen is running a webinar for the Institute and Faculty of Actuaries entitled Why actuaries need a new economics on Friday 4 April which I thoroughly recommend if you are interested)

Which brings us to the Spring Statement, which was about (yes, you’ve guessed it!) reducing government debt (or the new formulation of this “increasing OBR headroom”) and boosting GDP growth. Watching the Chief Secretary to the Treasury, Darren Jones, and Paul Johnson from the IFS nodding along together in the BBC interviews immediately afterwards, you realised how the idea of allowing the OBR to set policy has taken hold. Johnson’s only complaint seemed to be that they appeared to be targeting headroom to the decimal point over other considerations.

I have already written about the insanity of making OBR forecasts the source of your hard spending limits in government. The backdrop to this Statement was already bad enough. As Citizens Advice have said, people’s financial resilience has never been lower.

But aside from the callousness of it all, it does not even make sense economically. The OBR have rewarded the government for sticking to them so closely by halving their GDP growth projections and, in the absence of any new taxes, it seems as if disabled people are being expected to do a lot of the heavy lifting by 2029-30:

Part of this is predicated on throwing 400,000 people off Personal Independence Payments (PIPs) by 2029-30. According to the FT:

About 250,000 people, including 50,000 children, will be pushed into relative poverty by the cuts, according to a government impact assessment.

As Roy Lilley says:

We are left standing. Abandoned, to watch the idiocy of what’s lost… the security, human dignity and wellbeing of our fellow man, woman and their family… everything that matters.

As an exercise in fighting the last war, or, according to Steve Keen, the wars successive governments have been fighting since 1834, it takes some beating. It was litost on steroids for millions of people.

So what does the government think these people are going to fill the income gap with? It will be private debt of course. And for those in poverty, the terms are not good (eg New Horizons has a representative APR of 49% with rates between 9.3% APR and maximum 1,721% APR).

And for those who can currently afford a mortgage (from page 47 of the OBR report):

Average interest rates on the stock of mortgages are expected to rise from around 3.7 per cent in 2024 to a peak of 4.7 per cent in 2028, then stay around that level until the end of the forecast. The high proportion of fixed-rate mortgages (around 85 per cent) means increases in Bank Rate feed through slowly to the stock of mortgages. The Bank of England estimates around one-third of those on fixed rate mortgages have not refixed since rates started to rise in mid-2021, so the full impact of higher interest rates has not yet been passed on.

So, even before considering the future tax increases the FT appears to be expecting, the levels of private debt look like they will shoot up very quickly. And we all know (excluding the government it seems) where that leads…

The Government Knows Zero

13. March 2025 · Write a comment · Categories: COVID-19, Demographics, Economics, Health, Media & Politics

*Successive OBR forecasts of % changes in GDP year on year since the pandemic https://obr.uk/publications/*

This blog has a long history with the OBR, which I won’t go into here, although you can get a sense of it from this. It was the reason the blog is called We Know Zero. However I find myself returning to talk about them once again in the light of some of the Government’s latest spending (or removal of spending) plans.

Daniel Susskind had this to say about the role they are currently playing for the Government, to determine whether it is going the right way to achieve economic growth:

This was never meant to be the OBR’s purpose. Set up in 2010 by George Osborne, then chancellor, it was designed to solve a different problem: that the official UK public finance forecasts were not credible. The Treasury had a strong incentive to massage these numbers into better shape, whatever the political make-up of the government. And the belief was that an independent statistical authority would be free of that temptation. To that extent, the OBR is a success story: its forecasts do appear to be less biased.

At this point I need to stifle a snigger: less biased than what? I think it may not have a political reason for bias, but their methodology is like train tracks as I have maintained since this blog started in 2013: if you lay them out in a particular way then, even if you don’t want to call it bias, that is the way the train will run (to misquote Yes Minister). It may be statistically unbiased, in the same way that someone who misses a penalty past each post (I am sure that this analogy has nothing to do with my team going out of the Champions League this week) has, on average, hit the target.

However I agree with Susskind that the OBR was certainly never set up to advise on policy. As he goes on to say:

With that in mind, the idea that the OBR somehow knows enough to take each UK government policy and state its impact on growth to a single decimal point is fanciful. Yet that is what it will attempt to do at the end of the month, with immense practical consequence. A reduction of 0.1 percentage point in the OBR’s potential productivity growth forecast, for instance, is estimated to create a hole of £7bn-£8bn in the public finances — that is the equivalent of the entire budget of Defra.

Or the foreign aid budget or disability benefits or…the list looks likely to go on.

In an open letter this week, 17 major charities including Scope, Trussell Trust, Citizens Advice, Mencap, Sense, the Joseph Rowntree Foundation and the RNIB urged the Government not to cut the Personal Independence Payments (PIP) and the Limited Capability for Work payment, saying:

Scope’s analysis of government figures shows that without PIP, a further 700,000 more disabled households could be pushed into poverty. Life costs more for disabled people. Huge numbers already live in poverty as a result of these extra costs. The impact of any cuts to disability benefits would be devastating.

Meanwhile Roy Lilley looks at those cuts from the NHS end of the lens. I don’t agree with his assessment of the IFS, but there is nothing else here to argue with:

Currently, 2.9 million working-age adults are claiming disability benefits, an increase of 900,000 from pre-pandemic levels, with 500,000 attributing their main condition to mental health issues.

Lilley asks why this is, comparing the mental stress attributed to the pandemic with that of the Blitz. He then cites a study by the Tavistock Institute:

While, in the post war years, mental health issues were still stigmatised, post-war policies focused on social security and housing aimed to reduce economic stress that so often is the contributing factor to poor mental health.

We have done a lot to reduce the stigma of mental health issues, but:

I question the policies. Social and economic factors. Job insecurity and financial stress must be the key factors that have a negative impact on mental health well being.

Back to the Trussell Trust, who have been running a campaign for a while now to guarantee everyone the essentials to live on. As they say:

More than three quarters of people on Universal Credit and disability payments have already gone without essentials in the last six months.

Back to Lilley, who as I said, is primarily concerned with the NHS:

Since 2019 the NHS has experienced a 36% increase in patients seeking mental health services.

As he goes on to say:

Labour’s plan to cut benefits won’t solve the problem. It’ll very likely make it worse.

Policies cutting the root causes of people needing benefits, like safe homes and decent jobs would seem much more sensible.

Unfortunately Lilley’s “if there is one organisation worth paying attention to” IFS believe that OBR forecasts should continue to underpin the Chancellor’s spending decisions. I couldn’t disagree more.

That means constraining the Government to act as if all it knows is what the OBR knows. Which is precisely zero.

One must always try to be as radical as reality itself

04. February 2025 · Write a comment · Categories: Actuarial, Climate Change, COVID-19, EIOPA, Health, Risk

The Charybdis is a swirling water feature in the temperate house at Savill Garden. It was designed by Giles Rayner in 2006. https://funandgames.org/web/wp-content/uploads/2020/09/The-Charybdis_Savill-Gardens_9257-2-scaled.jpg

This is a quote attributed to Lenin (courtsey of Branko Milanovic’s X account, where a gentle exchange about whether it was genuine ensued), which seems perfect for the moment we are in.

It was back in 1998 that George Monbiot first pointed out that no sector was as wedded to PFI deals as health. The famous example in Captive State of the Walsgrave hospital in Coventry, knocked down and replaced by a smaller hospital at much greater cost, was just one of many. It didn’t occur to me at the time, but the wider lesson from these early examples, borne out by everything we have seen since, is that privatisation, in whatever form (and, after all, what is PFI but the privatisation of a funding source), always solves a smaller problem than the one you have. The history of privatisation in the NHS has been a series of smaller easier problems dealt with in some cases very efficiently by the private sector (although the efficiency only ever seems to increase the profits of the private companies concerned rather than reduce their price). As it has been in transport (with rail franchises yo-yoing in and out of state control whenever the ask becomes too complex for the train operators taking them on), and utilities, mail services, etc etc.

And the size of the problems that the private sector can take on would appear to be getting smaller.

Take insurance. Ann Pettifor highlights this week what Petra Hielkema, chair of the European Insurance and Occupational Pensions Authority, has to say about the future of the sector in the FT. Apparently he told them that governments and banks will struggle to cope with the soaring costs of natural catastrophes such as floods and wildfires. More households will be unable to insure their homes and the mounting losses from natural disasters could destabilise banks. Two things he said were particularly striking:

“I think it is the biggest risk facing society, frankly” and “Member states — they can’t cope with this.”

There is now talk of an “insurance death spiral“, where insurance premiums shoot up, those least likely to claim drop out, and insurers are left with exclusively “sub-prime” risks on their books (should sound familiar to anyone who has read about the causes of the 2008 crash). In the US, there are obviously problems in the Californian insurance industry which look like causing some degree of financial contagion, but also a particular focus on the health insurance industry as a result of the way Obamacare was implemented.

This contrast between public and private ownership of problems struck me while I was reading the excellent report from the Institute and Faculty of Actuaries and the University of Exeter on climate change: Planetary Solvency. By taking the approach that an insurance company would take in determining its risk appetite and then seeing if its risk exposure matched up to it, it occurred to me that the reason this had never been done before for global climate change was that any insurer would have left such a market years ago on the basis of a brief initial analysis of the problem. Something that a private insurer can always do with any problem.

What if, instead of the NHS being threatened by covert privatisation, the threat is that even the smaller problems private health is currently solving within the system get handed back to the NHS? Because that is the difference. During the pandemic, the threat was that the NHS might not be able to cope with the surge in very ill people and that many would die without care as a result. The reason large parts of NHS operations were repurposed and we were all urged to “flatten the curve” was because, ultimately, there is noone the NHS can hand the responsibility back to and their resources are measured in hours of the right people available to work for them rather than pounds spent and so have a hard physical limit. Although there were significant failures as the Covid Inquiry is currently exploring, the NHS as a whole did not fall over.

However, neither did the US system, because an insurer merely withdraws from a market which might cause it to. It has no responsibility to the system as a whole.

As one MIT researcher responded to being asked about the lessons for the US system of the pandemic:

“The pandemic has revealed the American health care system to be a non-system.”

So it seems to me that arguments about privatisation and nationalisation are a bit beside the point. We have big problems, getting bigger every day, which absolutely have to be solved and limited physical resources with which to do so. Unfortunately His Majesty’s Opposition are still trying to disentangle themselves from the wreckage of Tufton Street’s “thought leadership”, risking a Trumpian climate change denying, health service privatising Reform Party replacing them, and His Majesty’s Government appear to have no idea what they are doing.

So reality does feel pretty radical at the moment. We need to be equally radical in our response to it.

We Know Zero