Health and care integration report card - could do better

Audit Scotland tries hard to use building language in their reports, but it was obviously a real challenge when it comes to health and care integration.

Audit Scotland has recently published their assessment of the progress with health and care integration in Scotland. Helpfully, as I was preparing a presentation for an English conference on how we tackle this issue in Scotland. You could be forgiven for missing this report as it came out on the day of the Brexit resignations.

As usual they introduce the report with a helpful infographic which captures the key challenges. Integration Authorities (IAs) manage a huge proportion of the Scottish budget (£9bn) and are supposed to achieve £222.5m of savings - an increase of 8.4%.

The positives are that IAs have started to introduce more collaborative ways of working and there are a number of case studies in the report that highlight best practice. This shows that the system can work, however, yes you knew there would be a but, “there is much more to be done”. 

The building language then starts to break down.

They main problem is that financial planning “is not integrated, long term or focused on providing the best outcomes for people who need support”. This is caused by the financial pressures on health boards and councils, compounded by health boards not including their acute services to the process of budget shift. Long term planning is difficult when budgets are set annually, with little medium term, let alone long term, strategic planning. However, an overall underspend by IAs of nearly £40m, does not inspire confidence either.

This doesn’t mean that there is no resource shift because the ISD cost data published yesterday shows a loss of 429 hospital beds. This data also shows that community services are getting more resources, with only a 0.1% increase in hospital spending as against 4.8% in the community sector. GPs have pointed to the fall in the amount devoted to GP services, but this may be related to service redesign. Either way, while there has been some shift from acute to community, progress is slow because of the overall financial position. 

The report also highlights a lack of collaborative leadership and strategic capacity, not helped by a high turnover in IA leadership teams and squabbles over governance arrangements. Cultural differences between partner organisations is another barrier to achieving collaborative working along with the necessary skills to work in partnership. This was predicted, and has been a problem all over the world (see Petch et al) with care integration.

Another lesson from the international evidence is that change cannot happen without meaningful engagement with staff, communities and politicians. Something the report says has not yet been achieved in Scotland. Honesty about the scale of change needed is indeed challenging, particularly when it can involve closing hospital services. Lengthy and technical IJB papers have not helped to engage members on these boards.

Workforce planning is crucial to the success of care integration. While the National Workforce Plans have now been published, they are still largely at the process stage, particularly in social care. There needs to be a better understanding of future demand, how this is likely to be met and what it will cost. Needless to say, Brexit looms large over this issue. Attempts by some IA leadership teams to promote the privatisation of services has not helped to build confidence. As UNISON surveys have shown, the procurement rules are not being followed properly. If they were, the two-tier workforce provisions (s52) would end this nonsense.

Data sharing and incompatible IT systems are another problem. There are too many local fixes rather than considering a single national solution. Interestingly, the report points to bringing staff together under one roof, rather than solely relying on IT. This is something that the Quality Care Commission recommended in 2015.

Many of the challenges facing care integration in Scotland can be fixed as local best practice shows. There are some national actions that can help, but there is nothing in this report that wasn’t predicted or points to unresolvable structural failure. The underlying problem is austerity - making big service change is doubly difficult when the budget simply isn’t keeping up with increased demand.

Commemorating the sacrifices of the First World War

This is a very special Armistice day, marking the centenary of the end of the First World War. It ends four years of anniversaries that commemorate the events of that terrible conflict.

There can be little doubt that we are more aware of the First World War as a consequence of the huge effort that has gone into events marking the centenary. Financial investment from the Lottery, Arts Council and governments have been supplemented by books, films, TV and radio programmes. But has that investment challenged some of the common myths, or done enough to recognise that the conflict didn’t just affect young white men on the western front? 

The Scottish Government’s Commemorations Programme has attempted to widen the subject with events covering the sinking of the SS Tuscania off Islay and the Quintinshill rail crash. A conference and exhibition celebrating the work of Dr. Elsie Inglis was an example of highlighting the role of women – the Serbian post office even produced commemorative stamps. However, despite these efforts, the abiding memory will be of Scots who died in the battles on the western front – important of course that those events were.

There has been an effort to acknowledge the role of the four million non-British soldiers that fought in the conflict – David Olusoga’s TV series and this week’s focus on the Indian Army are good examples. There has also been more about the home front and local histories. However, in the main, they have been drowned out - the western front, poppies and Tommies remain the most familiar iconography.

Other important fronts get very little coverage. I suspect very few people understand the role the Macedonian campaign played in ending the war, even though it involved two British Corps. With Serbian and French troops they advanced as far as Austria. Let alone the huge battles on the eastern front, Italy and the Middle East – and lesser-known campaigns in Africa and the Far East 

On many of these fronts, the war and its consequences didn’t end on Armistice Day. The crumbling of empires, the Russian Civil War and the related Polish-Soviet War went on until 1921. The Greek-Turkish War resulted in the ethnic cleansing of 1.6 million people. For many countries, November 1918 marks independence or the dismembering of their state. Hungary lost half its population and two-thirds of its territory. 

Many of these events have a bearing on the Europe we live in today. As Guardian columnist Natalie Nougayrede put it; 

“The point is not that a unified narrative should be imagined. Rather, it is that we would all gain from better awareness of the mosaic of European memories of 1918. The Europe we live in today still has its roots in that past.”

The same is true for the wider world. The British and French ended the war with even bigger empires in the Far East, Africa and the Middle East. These created the conditions for future conflicts and were certainly a poisoned chalice for Britain.

Our perspective of the First World War has changed over the years. In the 1920’s the monuments used the language of glory, honour, dominion and power. As the war poet, Wilfred Owen said: “The old lie: Dulce et decorum est; Pro patria mori”.

At the other end of the spectrum, I was brought up in the period of, ‘Oh What a Lovely War!’ and the ‘Lions led by donkeys’ view of WW1 generals. There have been some revisions of that view and lessons were learned as the war progressed and generals unlearned the lessons of the last war. The BBC ‘100 days to Victory’ series covers some of this.

The BBC History Magazine asked two historians of the conflict the question, Was it Worth It? 

As Professor Richard Evans says, it is not the job of historians to tell people in the past what they got wrong, but rather to explain how and why things happened. However, he reminds us that millions of British soldiers who fought in 1914 didn’t have the right to vote – so it wasn’t a war for democracy. He argues that it actually ended progress towards greater democracy in many countries and replaced it with brutal and corrupt dictatorships. Much of this was caused by the economic disaster that was another consequence of the war.

On the other hand, Professor Gary Sheffield argues that imperfect though the world undoubtedly was in 1919, it would have been much worse if there had been a German victory. Even if the Royal Navy kept Britain free from occupation, it would have faced the nightmare of a hostile continental Europe and the end of liberal democracies. 

Whatever view we take of the historical events, it remains the case that millions gave their lives in the conflict and afterward, for a cause that, at the time, most people supported. They made the ultimate sacrifice and it is right that we should remember them - red or white poppy, in the way we each deem to be appropriate.

Living Wage Week

This is Living Wage Week, another opportunity to promote the benefits of the real living wage and fair work more widely.

The week traditionally starts with the announcement of the new Living Wage rates, which this year have increased to £9 per hour and £10.55 in London. The Resolution Foundation has published a briefing on how the rate was calculated this year. Wider inflation was obviously a key factor in the increase. In addition, some policy changes act as a downward pressure on the rates, for instance, the increase in the personal tax allowance and additional childcare support. Other policy changes create upward pressure including the ongoing freeze in working-age benefits.

I was at the Living Wage Expo at the Tynecastle Stadium in Edinburgh yesterday. Peter Kelly from the Poverty Alliance reminded the audience of how much progress had been made with the Scottish Living Wage - £216m into workers pockets, 34,000 workers getting a pay rise and more than 1300 accredited employers. We should also remember that many other workers have benefitted outwith accredited employers, due to procurement and collective bargaining.

It was good to see a public sector employer (even if they try to hide the fact!), Scottish Water Business Stream, getting the employee choice award. The nomination included a positive statement from a worker who explained what fair wages meant to them and how it changed their perception of the employer. 

This theme continued with a panel discussion involving Heart of Midlothian FC staff. They all described how the living wage meant they could afford what most of us regard as essentials, like holidays, transport etc. One young worker in the hospitality department highlighted the difference between £5.90 on the age-related minimum wage and £9 on the real living wage. The motivation of these workers was very apparent. Well done Hearts - time for other football clubs to follow!

The Minister for Business, Fair Work and Skills, Jamie Hepburn MSP set out the Scottish Government's aim of making Scotland a Fair Work nation. He rightly made the point that more equal societies do better on all tests, not just economically. He accepted that Scotland could do more as there are still one in five employees who are not yet receiving the living wage. I would point him to procurement, where policy has not always been matched by best practice.

The Outstanding Leadership Award went to Standard Life Aberdeen, who I would agree have been real private sector champions, not just with the living wage. They make the business case for the living wage, and in their sector, the wider benefits of trust and how it is a good measurement of company behaviour.

The living wage isn't just about big employers. One of the real successes of the living wage movement in Scotland has been the engagement from hundreds of small companies. Sarah Roberts from Healthy Nibbles is a good example of such a company and she set out the benefits for her firm and their workers. Importantly she emphasised the wider fair work agenda of her business. Other SMEs that have become accredited employers this year and were recognised in the awards as well.

As women are disproportionately represented in low pay workplaces, the living wage is also important in closing Scotland's gender pay gap. Anna Ritchie from Close the Gap pointed to the similarities in the business case for tackling the gender pay gap and the living wage.

Tess Lanning from the Living Wage Foundation reminded us that the living wage campaign started as a community campaign. This is something the campaign in Scotland is seeking to build on with the living wage place initiative. Including outsourced workers has also been important to the campaign, which has encouraged innovation in the workplace and extended the living wage beyond the core workforce. A good example is South Lanarkshire Council, who won the anchor institution award. They have increased the percentage of the workforce across the council area who are paid the living wage using the levers available to every local authority. I would also highlight North Ayrshire Council who were quick off the mark to commit to paying the new rate this week.

Dave Moxham from the STUC made the point that voluntary initiatives like the living wage are important in delivering real benefits to workers and promoting a different economic model. It supports the campaign for a higher statutory minimum wage and abolishing the age-related rates. Richard Leonard reiterated Scottish Labour’s commitment to a £10 per hour minimum wage this week.

Finally, I was very honoured to receive the Lifetime Achievement Award. It does seem like a lifetime since we kicked off the living wage campaign in Scotland, but actually, a lot has been achieved in a short time. Like others, I have burnt out a few PowerPoint projector bulbs pitching the case, but my role has often been to tear down fallacious legal barriers and find ways around EU and other procurement rules. There is still a lot to do, but the campaign is in good hands.

Let's make this the last major anniversary of rail privatisation

This week marks the 25^th anniversary of the legislation that privatised British Rail into a complex series of franchise arrangements. 

This is not an anniversary to celebrate. As Aslef’s Scottish Organiser Kevin Lindsay said; 

“Today is the 25th Anniversary of the great railway rip off, when John Majors Tory government rushed through the unnecessary, unwanted and plainly unworkable rail privatisation. It’s time for the UK and Scottish governments to take action and to return the railway to public ownership.”

Sadly, neither government appears to be heeding that call, which is supported by the other rail unions. A call that comes from the people who represent the workers who really understand the railway. The editorial in this month’s ‘Modern Railways’ paraphrases the Joni Mitchell song to say that the government has:

Looked at the railways from both sides now

From win and lose and still somehow

It’s life’s illusions they recall

They really don’t know railways at all.

The Scottish Government has the power to end this franchise early by using the break clause in 2020 which would see the franchise end in 2022. However, in a recent letter to the public sector bid stakeholder reference group, Transport Secretary Michael Matheson said he “fully expects the current franchise to continue to its planned expiry date of 2025”. 

The UK Government has commissioned the Williams Review - the Transport Secretary’s response to the fiasco of the May timetable changes. As the interim Glaister report concluded, ‘Nobody took charge’ – a clear recognition of the damage fragmentation has caused. The review will look at the ‘most appropriate organisational and commercial framework for the sector’.  

The timetable for the review is as slow as our privatised railway – steam trains were quicker on some routes! (an excellent solution in my personal view 😊  – with CCS of course!). A white paper next autumn and an unlikely implementation ‘from 2020’, which points to a few cosmetic changes. There have been 30 such railway reviews since 2007. 

So how are our railways doing?

There was a small 3% increase in freight traffic last quarter, but that was mostly down to an increase in coal traffic caused by a spike in gas prices. Hardly a sustainable future for freight. Some innovative work is being done on promoting rail for log transport in Scotland and sidings for timber boards and mineral water, but overall there are few signs of a significant shift to rail freight. For example, the lack of long crossover loops on the Inverness line makes rail 30% less efficient than it should be. We should remember that rail generates around 30% of C02 emissions of road haulage per equivalent journey, nearly 90% less small particulate matter (PM10) and up to fifteen times less nitrogen oxide (NOx). 

Passenger demand for rail remains strong. 23.9m journeys were made on ScotRail in the last reported quarter, up 1.5%. Passenger journeys increased 3.1% nationally last quarter, despite the timetable issues, possibly driven by a 15% increase in the price of car fuel.

Scotrail’s poor performance is rarely out of the news with punctuality reaching breach level for the last two reporting periods and significant fines. Their management of rolling stock has been equally shambolic, with the new Hitachi trains delivered 10 months late and their new refurbished High Speed Trains expected to be introduced without Controlled Emissions Tanks, meaning effluence will be discharged directly on to the tracks. While services have plummeted, fares have spiralled. As of next year, commuters will be paying 10% more for their ticket than they did at the start of the franchise. 

In parts of the industry, Scotland’s attempts at integrating trains and track through the ScotRail Alliance is seen as a move in the right direction, if not quite a template. However, all is not well at senior levels as reported in today’s Scotsman. They report one industry source saying: “There is a lot of discomfort about how much control of the railway has been handed to the train operator [ScotRail].”

It does at least highlight one of the benefits of devolution and the Scottish Government is calling for the devolution of Network Rail. There is certainly a case for that, although integration requires more than just trains and track and this focus on powers avoids the bigger issues.

Which leaves us with the question of ownership. 

Many industry figures argue that only when you have created a working railway network should you consider ownership. I don’t dispute the importance of structure, but the idea that this can be done without addressing ownership and accountability is fanciful. We have the ludicrous situation where the majority of our railways are in foreign state ownership, sending profits back to support their domestic rail operations. We should also recognise the impact the short-term profit motive has on the management of any service. Management culture and accountability is an important issue that the ‘structure before ownership’ lobby ignores.

The TSSA/Common Weal report is a useful starting point for a debate on the merits and methodology of creating a publicly run railway in Scotland. There are some legislative barriers that could be circumvented to avoid a franchise bidding process, although that would be complex and legally challenging. Labour’s commitment to bringing railways into public ownership across the UK, provides the best platform to take this forward and that should include a discussion about further devolution. A policy that the polls show has widespread public support.

And then, inevitably, there is Brexit. Current EU rules would not allow a future Labour government to reinstate a national rail monopoly. The EU Commission’s Fourth Railway Package would astonishingly foist the UK model on the rest of the EU. There are also problems with EU Single Market rules on procurement and State Aid, which Mick Whelan of Aslef has outlined in the Scotsman and Scottish Left Review. 

Others argue that there are ways of introducing greater public ownership within EU rules as is done in Spain, Netherlands, Germany and Italy – using separate state-owned companies. Although even this retains the market framework. 

While more work is needed on the detailed structure and Brexit implications, the direction of travel towards an integrated railway under public ownership should be clear. Mick Whelan sums up the case this anniversary week when he said; 

“Privatisation has, demonstrably, failed to deliver. Fares have soared, rolling stock got older, and our trains are more crowded. Private companies talk about investment and risk. But there is no private investment – the money for investment comes from the taxpayer – and there is no risk because the companies hand back the keys when they can’t make the profits they want.”

NHS Scotland faces huge challenges, but don't forget the underlying causes

"The performance of the NHS continues to decline, while demands on the service from Scotland's ageing population are growing. The scale of the challenges facing the NHS means that decisive action is needed now to deliver the fundamental change that will secure the future of this vital and valued service.”

If this was said by a politician it would be dismissed as political rhetoric. In fact, it was said by Caroline Gardner, Auditor General for Scotland, when launching this year’s overview of NHS Scotland.  The report does not make happy reading and ought to be a huge wake up call.

The main message is that the NHS in Scotland is not in a financially sustainable position. NHS boards are struggling to break even, relying increasingly on Scottish Government loans and one-off savings. The report was prepared before the Health Secretary accepted this reality and announced that these loans were to be written off. 

Health boards did achieve an unprecedented £449m of ‘savings’, but many of these are one off savings and that is not sustainable. In 2017/18, 50% of all savings were one-off (non-recurring), up from 35% in 2016/17, and 20% in 2013/14. In 2018/19, eight boards predicted at the start of the year that they would be in deficit at the end of the year.

Although health funding has increased over the past decade, funding per head of population has increased at a slower rate. We should also remember that ‘real terms’ is based on the government’s optimistic view of inflation, which has little basis in reality for the economy as a whole, let alone higher health inflation rates.

The financial position is unlikely to improve soon as health costs are projected to increase. Scotland’s ageing population means that more people will be living longer with multiple long- term conditions. Other cost pressures, such as increases in drug spending, are also projected to intensify and there is a significant maintenance backlog. Some progress has been made in reducing agency staff and medical locums, but they have still increased by nearly 40% in the last five years.

There is a medium-term health and social care financial framework, but the auditors are as unclear as everyone else how this relates to the government’s financial strategy. This was part of the analysis recently published by John McLaren and highlighted in Brian Wilson’s Scotsman column. In particular, this analysis shows that Scotland is expecting to make double the efficiency savings than in England.

The report also highlights declining performance. The NHS met only one of eight key national performance targets in 2017/18, and performance actually declined against all eight. No board met all eight targets. NHS Lothian did not meet any targets. NHS Grampian, Greater Glasgow and Clyde, Highland, and Tayside each met one target. 

In the final quarter of 2017/18, 93,107 people waited more than 12 weeks for their first outpatient appointment, an increase of 6% on the previous year. The number of people who waited more than 12 weeks has increased by 215% in the last five years. People waiting more than 16 weeks increased by 16% last year, and by 558% over the last five years. People waiting more than 12 weeks for an inpatient or day case procedure increased by 26% last year to 16,772 people, and by 544% over the last five years. 

Those who do receive treatment continue to rate their care and the staff who deliver it highly. Staffing levels are at their highest level, but vacancies remain high, particularly long-term vacancies. Huge challenges are on the horizon, including Brexit. Sickness absence has increased and nearly half of staff report in the staff survey that they couldn’t meet all the conflicting demands on them.

As always with these reports, the analysis of where we are is stronger than the solutions. Auditors like process and the report recommends a number of changes to these. In fairness, it is not the Audit Scotland’s job to address the challenges – it is the Health Secretary who has to lead on this. And, as they say, any solution has to start with an understanding of the challenges.

In financial terms, much will depend on the Scottish Government receiving additional funding from the Barnett consequentials of English health spending. However, this report rightly warns that we don’t yet how the UK Government plans to fund increases in English health expenditure and the options chosen may affect the amount available to the Scottish Government. 

The report also highlights the number of leadership vacancies, joint posts and confused governance. We have new layers of planning, but it is unclear what progress is being made. The limited training, skills and performance management of non-executive board members are highlighted as a concern in the report. There was a review of targets and indicators last year, but no progress on the recommendations.

The report highlights slow progress in health and care integration while recognising the challenges. It welcomes the workforce planning initiatives, but recognises that these describe processes, not what the medium to long-term workforce will actually look like.

We should not forget the underlying causes of many of the pressures on the NHS – health inequalities. We had another warning on this today in the EHRC report ‘Is Scotland Fairer?’. Sadly, this probably won’t get as much consideration as the Audit Scotland report, but it is crucial to understanding the pressures on our NHS. The report highlighted differences in educational attainment, health, work opportunities and living standards among social groups and concluded that progress has stagnated.

In summary, this report pulls together many of the warning signs that have been around for some time. Nothing in the Audit Scotland report should detract from the great outcomes that NHS Scotland staff deliver every day in difficult circumstances. Neither do they indicate that the system is fundamentally flawed. However, the report does lay bare the challenges facing NHS Scotland and the focus should be on real action to address them and the underlying causes of poor health.  

Real action on mental health in the workplace

Poor mental health affects half of all employees, but only half of those who experience problems talk to their employer about it.

I have been working with an employer on improving their approach to tackling mental health in the workplace. Their sickness absence statistics highlighted a growing problem and a management consultant produced a plan. The safe response from many Chief Executive's would be to tick the box and report the action taken to the board. Credit to this organisation that they didn't do that. The CEO wasn't convinced that the actions proposed would tackle the scale of the problem and asked me to review the plan.

The hard-nosed case for taking real action is economic, with mental ill health-related absences costing at least £26 billion per year. However, the human cost is even greater for the sufferer and their families, with the ultimate human cost being loss of life through suicide.

In some ways, the increase in reported mental health absence is a positive sign that the stigma is reducing. A British Chambers of Commerce survey showed a 30% increase in the last three years and a 33% increase in the length of absences. Even in NHS Scotland, between 2015/16 and 2017/18, the number of stress-led staff absences has rocketed by 17.6% - the equivalent of more than one million working days lost.

However, another survey undertaken by BHSF indicated that 42% of UK employees who have called in sick and claimed they were physically unwell were actually covering up a mental health issue. Another estimate by the ‘Time to Change Employer Pledge’ says, 95% of employees calling in sick with stress gave a different reason.

It’s not just absence either. Surveys show that poor mental health affects performance in the workplace including concentration, decision making, avoiding certain tasks and conflict with colleagues and customers.

Given the moral and economic case for acting, what should employers and unions do?

The plan I reviewed had a number of worthy elements. There was some awareness training for managers, but not for front-line staff. They also planned to deliver mindfulness events and relaxation sessions. The fundamental problem was that the plan largely ignored work as a factor in poor mental health. The focus was on individual behaviour and health, rather than looking at the impact the employer was having on mental health. In other words, it was a reactive rather than a preventative approach to mental health at work. 

Most poor mental health is the result of a combination of problems at work and personal life, with work alone causing problems for a quarter of staff. While most staff recognise they have to address their mental health problems, they need a supportive work environment with well-trained line managers and an organisational response.

The positive news is that the issue is getting much greater attention and there are a range of resources to help employers. The ‘Time to Change Employer Pledge’ encourages a health check and sharing best practice across a growing number of employers - although some argue this doesn't go far enough. The CIPD has a number of useful guides as well as survey data. They broaden the issue to address ‘well-being’ at work. The mental health charity Mind has a range of resources and can help with training. Trade unions, including UNISON and Unite, run awareness or mental health first-aid courses for their stewards. UNISON also has a useful bargaining guide.

The employer I have been working with now has a comprehensive mental health at work plan, which starts with clear objectives that form part of the organisation’s strategy, not simply an HR add-on. It shows how they will identify the well-being of staff and the causes of poor mental health in the workplace. Then the measures they are taking to tackle the work-related causes and the support available inside and outside the organisation. Finally, how the plan will be evaluated.

We should also not forget the wider policy imperative to address poor mental health. As TUC research points out, while employment rates of disabled people with mental health problems have increased, they are still at very low levels. The economy cannot afford to miss out on the skills and talents of these people.

Taking serious action to tackle mental health issues in the workplace requires more than a few cosmetic initiatives. The good news is that more employers and trade unions recognise the problem and are prepared to take meaningful action to effect change.

Communities or regions?

Boundary change in local government is usually shunted into the 'too difficult' box, for good reasons. Local identity can get everyone excited. I painfully recall spending three days at Boundary Commission hearings while local historians made submissions on why the boundary was wrong and the proposed name even worse! In the current financial environment, boundary changes also invite a 'deckchairs on the Titanic' response.

The Scottish Government's current Local Governance Review is therefore understandably cautious. The first stage is looking at the less controversial issues of engagement, which will no doubt highlight the ways councils could do this better. The second stage is supposed to look at structures and powers, albeit in a voluntary encouragement manner, with the backstop of legislation in 2020.

There has been some interest in doing things differently. For example, Borders Council has suggested a merger with the health board, even if the council appears keener than the health board. They are at least largely coterminous, but placing acute services within the council has its challenges. Some years ago the island councils looked favorably on the idea of all-purpose authorities, but the idea was quietly dropped and never made it into the recent legislation. The Royal College of GPs has suggested shifting social care in the other direction, into health boards.

The Scottish Government is keen on the idea of regions, using Ayrshire has an example of a voluntary merger. While the three councils in my home county have undertaken some limited shared services, there are few signs that they want to go the whole hog. The government is rightly sensitive to the charge that they are centralising services, with regional education collaboratives just one recent example of this. While health board reorganisation has been parked for now, the language is increasingly about regional plans. COSLA, on the other hand, has consistently made the case for devolution to go further than Holyrood.

Where politicians fear to tread, academics can sometimes charge in. A recent example of this comes from two academics at the University of Sheffield. They argue that rationalising the number of councils is happening elsewhere in Europe, driven by economies of scale. The problem with this argument is that Scotland already has the most centralised local government in Europe.

They have redrawn the boundaries based on travel to work areas, calculated by using an algorithm - after all, it works for Amazon! This gives us 17 councils rather than the current 32.

This is all very entertaining, but as with any computer model, it depends on the assumptions. In particular, why are travel to work areas a sound basis for organising local services? I live in Troon and work in Glasgow. I cannot think of a single person in my town who thinks local services should be run from Glasgow. Co-operating on some strategic services like the railways perhaps, but libraries, bins etc. - I think not. I accept that there may be a stronger argument in relation to the leafy suburbs of our cities - but even I am not that brave!

The Labour MP for Wigan, Lisa Nandy, has made a strong case for towns to be the building block for local government. She is the founder of the Centre for Towns and sets out why the city region concept doesn't work for her community. She also makes some important links with austerity and disenchantment with the political process.

James Flynn draws on Labour's latest pitch for towns as another argument against city regions. He argues that devolution may be working for cities, but not for towns. He says:

"Bypassing an imposed mayor and instead boosting the power and responsibility of local councils seems more sensible. There is no logical argument to say your local council is a “distant elite” when it meets at the local town hall."

 
I have considerable sympathy for these views, which also apply to Scotland. In my paper for the Reid Foundation on public service reform, I outline the concept of community hubs, built around real communities, not the largely artificial council boundaries we have today.

None of this actually requires boundary changes, but it does require politicians to understand that Scotland is not our local. We may be a small country, but we have at least 100 diverse communities. That is where power needs to be devolved to, always allowing for cooperation on some strategic services. The way forward is to deliver services at the lowest practical level, in a way that best meets the needs of communities.

Carbon Capture and Storage

There is broad cross party support for Carbon Capture and Storage (CCS) as an important component of our climate change strategy. The problem is turning policy support into action, in our so called energy market. 

I was in London today, participating in an interesting discussion on these issues. I have spent some time, with others, over the years trying to persuade a string of energy ministers and energy companies to adopt CCS, with little success.

CCS is the process of capturing and storing carbon dioxide (CO2), typically caused by burning fossil fuels in power generation and heavy industries, before it is released into the atmosphere. It can be used post-combustion by capturing the gases, or pre-combustion, which involves converting the fuel into a mixture of hydrogen and CO2. It generally captures around 90% of emissions.

Once the CO2 has been captured, it is compressed into a liquid and then pumped underground to be stored into depleted oil and gas reservoirs or coalbeds. Something we have plenty of in Scotland and the North Sea.

The CO2 can be used to produce commercially marketable products, known as carbon capture storage and utilisation (CCSU). Some are reasonably well established like enhanced oil recovery (EOR). Others are still being researched.

CCS is the only technology that can help reduce emissions from heavy industries - essential for tackling climate change. When combined with bioenergy technologies for power generation (known as BECCS – bioenergy with carbon capture and storage), CCS has the potential to generate ‘negative emissions’, removing CO2 from the atmosphere. The potential downside is that these technologies can be expensive, at least until scaled up. 

Some environmental groups are concerned that these technologies will be used as an excuse for climate change inaction, or to allow companies to continue to burn fossil fuels. However, the IPCC report published this week is clear that we may not be able to limit warming to 1.5C without removing carbon dioxide from the atmosphere, and that means CCS. We certainly cannot afford to close it off as an option.

There are more than twenty large scale CCS plants globally. In the UK, a £1 billion competition to develop CCS was dropped in 2015 after a long delay, losing the UK's early research advantage. The Clean Growth Strategy of October 2017, renews a commitment to the technology, with promised investments of up to £100 million. As the Permanent Secretary at the energy department put it giving evidence to MPs earlier this year:

"We think it is very likely to play an important part in the overall effort to decarbonising the economy at the lowest cost. Lots of international studies, as well as our own studies and scientific work here, show that CCUS is likely to be a key part of the overall solution."

However, he went on to say:

"This is much more about innovation. We are not, at this stage, talking about actual deployment of a live, fully functioning, fully scaled CCS project."

In other words, little actual action to create the scale we need to meet climate change targets. There is a small stick involved in energy generation - by 2025 the government will phase out coal burnt in power plants not fitted with CCS.

The Scottish government is supportive of CCS in its energy strategy, but it isn't in a position to fund a full scale project. It is to fund a feasibility study - the Acorn Project aims to create a CCS project at St Fergus in Aberdeenshire. It is also supportive of developing Hydrogen, primarily as a replacement for gas used in heat, plus some transport options. Hydrogen gas at scale will, at least initially, require natural gas (methane) as the source feedstock and as such in order to be low carbon, CCS will be a necessary system requirement. 

It seems clear to me that CCS remains an essential component of any climate change strategy. Scotland is well placed to take a lead, but this has to be on a much larger scale than is currently envisaged. A collective international effort is also needed to speed up research, development and deployment of CCS.

The U.K. Government has a key role to play, but it appears only to be interested in tinkering around the edges. The failed energy market will simply not deliver on the scale required. So, it is time for a planned energy strategy, with public ownership at its core, that can take the necessary action.

Reshaping electricity

Is the electricity sector facing major disruption due to technological innovation, including the falling costs of renewables and energy storage, along with tougher environmental policies and regulatory reform?

Antony Froggett argues in a Chatham House report that as technology and installation becomes cheaper, non-hydro renewables accounted for 61% of all the new installed power capacity across the world in 2017. While the construction of wind and solar was initially stimulated by decarbonisation policy, now it is driven by economics. As renewables continue to be deployed, they become ever cheaper to build and install. Solar is already at least as cheap as coal in Germany, Australia, the US, Spain and Italy. By 2021, it is also expected to be cheaper than coal in China.

However, integrating this new power may become costly. Centralised coal or gas power stations, can more easily be switched on and off to ensure supply meets demand. This is more challenging when renewables are involved, as the sun doesn’t always shine, and the wind doesn’t always blow.

Electricity storage systems could be a key part of the solution and the development of electric vehicles, to address climate change and localised pollution, should drive down the price of batteries. Similar batteries can be used for home storage linked to solar panels.

Digitalisation is likely to be another disruptive change. Smart meters allow energy firms to better monitor and understand their customers, which enables even more flexibility. Algorithms like those already used by Google and Amazon could result in energy supplies tailored to individual households and times of day. Blockchain technology could also enable a peer to peer energy market, allowing neighbours to sell excess power to one another.

Before we get too carried away there are a few challenges. A Westminster parliamentary group recently reported that people who have smart meters installed are expected to save an average of £11 annually on their energy bills, much less than originally hoped. As many of us warned, the piecemeal rollout has been hit by repeated delays and cost increases, with suppliers now almost certain to miss the 2020 deadline. I have a none too smart meter that doesn't work because I switched supplier - and I am not alone. 

The relentless rise of renewables is also not guaranteed. The International Energy Agency (IEA) has reported that fossil fuels increased their share of energy supply investment for the first time since 2014, to $790bn, and will play a significant role for years on current trends. Investment in coal power dropped sharply, but was offset by an increase in oil and gas spending. Fossil fuels’ share of energy investment needs to drop to 40% by 2030 to meet climate targets, but instead rose fractionally to 59% in 2017.

As the New Economics Foundation has highlighted, the number of new solar installations per month in the UK has plunged from an average of over 9,000 between 2010 and 2016, to under 1,000 at the end of 2017. The decline correlates with the Government’s slow suffocation of the Feed-in-Tariff over the last seven years. When these changes were being prepared, the UK government were made well aware of the consequences, yet stubbornly decided to proceed.

Squabbling in the renewable industry won't help to drive a coherent government strategy either. Iberdrola, who own ScottishPower, has voiced its frustration at the UK Government blocking onshore windfarms from competing for renewables subsidies and have attacked technologies like tidal lagoons as, 'Moonshot green technologies'. The company behind the proposed Swansea scheme responded by saying; “Having once bemoaned the incumbency of fossil fuels, it’s disappointing that some in the renewables sector have adopted this bad habit” - ouch!

Offshore wind clearly has significant potential and is a proven technology. Plans to lease the seabed to encourage a new generation of offshore wind farms in Scotland's waters have been published by Crown Estate Scotland. This has the advantage of putting the leasing income into the public purse, rather than big landowners.

The IEA also reported that governments are increasing investment in energy markets, either directly through state-owned firms or indirectly via investments policies and regulation. Firms like ScottishPower are often short of capital investment, which makes them reluctant to back technologies that are not proven to be economically viable. 

This is where Scottish and National Investment banks have a role to play as well as direct public finance. The public policy question is why should we use public money to 'nudge' big power companies, when a public sector operator could do the same job, within a planned energy strategy?

Tackling austerity

The Autumn 2018 UK Budget will set the spending envelope for public services for the coming years, although Scotland has some flexibility with half the budget now decided by the Scottish Parliament.

A new report from the New Economics Foundation (NEF) highlights that the decade of austerity so far has arguably been the worst economic policy error in a generation. As a consequence, living standards have suffered substantially. The isolated effects of discretionary cuts have suppressed gross domestic product (GDP) by a cumulative 15% between 2010/11 and 2017/18, or £10,000 per household. These cuts have coincided with the slowest increase in life expectancy since the 1970's.

Public services, and the pay of those who deliver them, have born the brunt of austerity. These services are in most need of a spending boost and should be foremost in the Chancellors mind. The NEF model finds that unless the government changes course, the chancellor’s recent claim that there is “light at the end of the tunnel” will amount to hollow rhetoric. In June, the UK government announced a further £20.5 billion for the NHS by 2023/24. But outside of this, overall spending on services is currently on course to see no average increase at all. Furthermore, if the UK government rolls forward its current protections for areas such as police and defence, then in the absence of new money this will have to be funded by further cuts to services elsewhere. As a consequence, budgets for non protected services could see an average real terms cut of 2.1%, or 4.1% per capita, during the first half of the 2020s. The Scottish Government has similar priorities, so this is also likely to be the position in Scotland.

Austerity is of course a political, not an economic choice. NEF's illustrative scenario for keeping up with demand pressures in health, social care and schools services would cost an extra £14.6 billion (or 4% of overall resource DEL) per year by 2023/24. Crucially, they show that these illustrative scenarios are realistic and fundable. 

The good news for Labour's commitment to end austerity, is that new figures from the British Social Attitudes Survey shows that the public’s support for tax rises is at its highest level for 15 years. 61% would accept tax rises to pay for the NHS, up from 40% in 2014 and 31% in 2010. Support for spending more on retirees is down over 20 percentage points in a decade, while support for generosity towards those on low incomes has been rising since 2011. 

This is welcome because it means public opinion is catching up with both demography and economic reality. As the Social Metrics Commission report highlights, 9 out of 10 people living in poverty are in working families, and half of them are families where someone is disabled.

The Resolution Foundation Director makes the point in his Labour Conference blog that we will need to bite the bullet on taxes, at UK level and in Scotland. As the chart below shows, we have largely (and rightly) funded an increasing share of spending going on health and education by hugely shrinking our military spend. But there’s not much military left to shrink - other than capital spending on Trident! 

Labour's internal issues have tended to dominate the coverage of conference this week. However, the leadership has been crystal clear that austerity is a political choice and it is not Labour's approach. The evidence from the reports highlighted above, shows that an alternative strategy is economically viable and it has broad public support. 

Reflections on a worthwhile career

This month I retire from my job at UNISON Scotland. I have worked for UNISON and its predecessors for almost 38 years, and a lay official for 4 years before that. The memoirs might be a retirement project, but I thought I would share some reflections on what I believe has been a worthwhile career.

The right-wing press, and occasionally those in the movement, like to portray trade unions as dinosaurs, resistant to change, or the 1970’s carthorse. They usually mean resistant to cutting pay and conditions to profit bad employers, which we certainly are! However, it is probably true that, internally at least, trade unions change slowly – but change they have.

I joined NALGO on my induction into local government and as it was a new workplace, the organiser got us to elect a ‘workplace representative’ in NALGO parlance. As a Labour Party CLP Secretary, my colleagues viewed me as the obvious choice, although I am not sure the branch officer viewed matters in that light! The last branch secretary was also the Establishment Officer (HR Director) and I suspect many in the branch still agreed with the views of the first NALGO General Secretary, who in 1910 said, “Anything savouring of trade unionism is nausea to the local government officer and his Association”.  

I went on to become Assistant Branch Secretary and an early case involved a woman in the Chief Executive’s Department who was passed over for promotion in favour of a junior and far less experience male colleague. He was a member of the council’s masonic lodge and days later the Staff Side Secretary popped into my office to enquire how I was getting on, ‘Not much in that case Dave?” he asked. 

Lunchtime drinking was something I struggled with coming from a sports centre job and reflected a mostly male culture. NALGO’s membership newspaper when I joined, ‘Public Service’, had a regular feature (often on page 3) called ‘The prettiest young recruit’. I kid you not, even for the 1970’s. 

So, the modern trade union movement might not be perfect, but it has changed, not least in its more diverse workforce and modern systems. As the teams I manage have poured over KPI’s, the balanced scorecard and Gant charts, it is literally a world apart. 

The campaigns we run, the way we organise and bargain have also changed. Sometimes by necessity, but also from invention. We learn from every generation that has joined our ranks.

What makes this job really worthwhile is making a difference to people’s lives, in the same way as most UNISON members in public services do every day they go to work. I was once asked at a school presentation, what was your proudest achievement? My immediate thoughts turned to pay deals, avoiding redundancies, pension schemes, legislation and much besides. 

While these are huge and helped thousands of members, it is always the individuals that you remember. I represented a young clerical worker early in my career, who had been sacked. Years later she saw an article I had written in a local government journal and rang up to ask if I was the same Dave Watson who saved her job. I asked her what she was doing now and she was the Assistant Chief Executive of another council. Apparently, at every induction course, she told the story of how her career would have ended at 18 years of age had it not been for a union official finding grounds to give her a second chance. And as she told every new member of staff, ‘That’s why you should join the union’. 

I once told that story to a headhunter who was offering me a job as a management consultant. The job involved selling and then implementing their latest management fad, before starting the whole process all over again. It paid almost double my union salary and he couldn’t understand why making a difference mattered that much. He thought I was just negotiating a bigger package. He finished by saying he hadn’t met many people like me. My response was that he should spend more time in our movement, where every day thousands of staff and activists go that extra mile because they know they make a difference to workers lives.

I sometimes joke that I should have been a history professor. But the truth is, while an interesting hobby makes anyone a more rounded person, I doubt I if I could look back with the same sense of achievement. 

I have most certainly not always got it right. It is also a job with often long and unsocial hours that has placed a strain on my personal relationships. None the less, our movement is full of great people, doing amazing things and I hope I have played a small part in that story. 

My advice to those students starting out in life, is to choose a career where you can make a difference. I have had that privilege – so can you.