Open letter to next UK PM

The UK has suffered more than two decades of bad leadership, and it needs to change if it is to survive as one of the world’s top countries. As things look at the start of 2010, we will soon be replacing a very bad government with a merely bad one, and that will not do.

Conservatives say they want to invest in high speed rail, protect the NHS, hold public pay for a year, and be green. Oh dear.

Rail travel in the UK is still based on 19th century technology and it is long overdue for replacement by a 21st century system. All round the world, there are trials of rapid transit systems based on small pods, driven automatically on light rail. Such a system can deliver extremely responsive transport, with each pod holding only a few people, going to their specified destination almost as soon as they want to leave. Performance engineering says that such a system can use rail at up to 80% occupancy. That would be several times as good as even London Underground’s Central Line at rush hour, and 200 times the level achieved by regional railways. Regional rail is plagued by signalling problems and broken down trains, but a pod-based light rail system would use inter-pod signalling and pods would be able to push other along, solving both of these problems at a fraction of the price of yesterday’s poorly designed signalling systems. We don’t need a high speed rail network using antique trains. We need a proper 21st century rail network that is more energy efficient, faster, more reliable with lower congestion, and more responsive to individuals’ needs.

The NHS is similarly afflicted by yesterday’s solutions. The conservatives say they will protect its funding from cuts, but it is perfectly possible to reduce costs and improve performance at the same time. In an age where a PC can outperform a GP in diagnosis, and a robot can outperform the highest skilled surgeon in operating, we are paying our doctors the highest wages in the world for some of the lowest performance. Wards are filthy, and mistakes and negligence needlessly kill tens of thousands of people every year. Misguided centralisation and micromanagement policy has wrecked the potential of IT to deliver enormous savings, while out-dated outsourcing contracts have resulted in cleaning companies leaving wards dangerously dirty because profit motivation has replaced dedication to the patient. Management in the NHS manages to remain village class in spite of world class funding. The NHS should not be protected. It is long overdue for a roots-up replacement by a properly designed health care system based on the needs of the population and delivered by proper use of both people and technology where they are best suited. This would cost a fraction of today’s NHS and be far more effective.

Public service wages shouldn’t just be held steady for a year, they should be greatly reduced and many public sector workers laid off or redeployed. In almost all areas, public service wages are too high compared to wages for equivalent work in the private sector. High pensions based on the last few years of salary have encouraged departments to promote people to high levels just before they retire, so that as many people as possible benefit from the scheme. The result is that taxpayers are paying almost as much in pensions as wages for many public sector workers. In spite of higher wages and much higher pensions, public sector workers are often poorly skilled compared to their private sector equivalents, work fewer hours, and take more sick leave. They are generally also much better protected from consequences of poor performance. The public sector includes a large number of jobs that could be cut. There are too many quangos doing work that is unnecessary or executed so poorly that it is useless. These should also go.
What is needed throughout the public sector is a wholesale reappraisal of terms and conditions, with wages aligned continuously and automatically with the 40th percentile of private sector equivalents, both in wages and pensions. All jobs throughout the public sector should be reconsidered  in terms of need, with proper checks for duplication of roles. Any jobs that are found to be unnecessary should be eliminated. Panels made up of taxpayer representatives other than public sector workers should have a veto on the creation of any new jobs. This would cause enormous resistance but needs to be done and would result in a much better public service all round.

The welfare and employment system needs to be redesigned. It should be just and fair throughout. No-one should ever be so poor that they can’t afford basic essentials of life, nor should anyone over be better off on benefits that by taking any job on offer to them. Minimum wages should be realigned so that full time work enables a basic standard of living above that possible by living purely on benefits. Taxpayers should not have to support inefficient or greedy businesses nor low prices for products that only some people want to buy. Today’s market includes a great many products that have effectively been produced at taxpayer subsidy, but products that can’t make it in the market without exploitation of workers or taxpayers shouldn’t make it at all. Once minimum wages are set, welfare will be needed by far fewer people. Recipients of incapacity benefit should be re-assessed properly and if they are capable of any kind of work, even part time, they should be transferred to job-seeker’s allowance, which should also be set at a level that supports only a very basic standard of living, delivering an incentive always to take any work on offer. When people start work, their pay should be subjected to a gradually rising tax rate, and their entitlements to benefits reduced gradually as their wages increase, so that everyone will always be better off working. Other benefits should be appraised and the same principles of fairness and incentive applied throughout. Welfare should never be an alternative lifestyle, but should instead be a robust safety net.

Welfare should also be linked to a person’s history of paying into the system. Too many payments are made to economic migrants who have never contributed anything. Obviously we must protect everyone from extreme poverty, but it is fair that people who have contributed should have a higher entitlement to support when they are down on their luck.

Other laws should also be changed so that people who are prudent and save should be rewarded, not punished.

Being green is another of the Conservatives’ claims to power. Of course government should educate people and incentivise care of the environment. But that doesn’t mean throwing money at every passing green cause without proper analysis. A good many green policy errors have already made the environment worse. The environment cares nothing about politics, and it is imperative that government relies on proper scientific studies for its inputs. Payment of research grants should not depend on the meaning of the data produced, but on its accuracy and on the quality of scientific research on which it is based. Scientists should be free to do science, and politicians should use the inputs wisely to produce policy, testing it on an ongoing basis via the scientific method. Before major investments, government should properly consider the alternatives, including those likely to arrive over the appropriate time-frame. So for energy policy for example, we should evaluate the costs of solar farms in the Sahara desert using 2020 solar technology and include those in comparison with other solution sin the same time-frame, rather than necessarily going with those that are cheaper today. This and other related technologies in transport and industry should also be factored in to environmental models as far as energy consumption and the associated emissions are concerned. Since the future is different from today on many factors, models should not assume that the future is the same as today, but take into account likely changes as far as possible.

The justice system needs to be redesigned. Today, penalties bear little relation to the magnitude of the crime, so that leaving a bin lid open can result in a higher penalty than shoplifting or mugging. A complete re-apprasial of crime and punishment is needed, with punishments set on a sliding scale that reflects the impact of the crime more sensibly. Fines that can be levied by non-court authorities should be severely limited in size and scope. Punishments should automatically rise on second and subsequent offences so that career criminality is deterred. Criminals should void other rights while they are committing their crimes. Prisons should be very basic in terms of accommodation and lifestyle, again making them places to avoid. Any right to early release should depend on exceptionally good behaviour, rather than being the norm.

The electoral system needs to be changed to one I described in my previous blog, redesigning democracy for the 21st Century, which give MPs voting weight according to the national representation for their party. This is a proportional representation system that still allows good local representation without disadvantaging groups that are spread more evenly throughout the country as the current system does.

If all the above recommendations were to be implemented, the UK would have a cheaper and better public service, better health, better transport, better justice, and be a safe and pleasant land, where living responsibly would be very rewarding and pleasant. If the new government avoids tackling these issues, our country will continue to slide, becoming an unfair, unjust and unpleasant place to live, with a poor standard of living for all.

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10 responses to “Open letter to next UK PM

  1. Interesting post. Unfortunately your lack of any numbers or citing studies renders most of your points sounding a bit weak. You bash on the NHS and say things like “a PC can outperform a GP in diagnosis” but provide absolutely no evidence for this.

    I like some of your ideas but you’d be better focusing on fewer areas where you’ve actually done your research or have an expert view on.

  2. I didn’t list lots of citations for AI v doctors since it is quite a long time since the first superior AI system. Now there are lots, and it would clog up the blog and make it much less readable if I were to cite every piece of input to my thinking. Most people are familiar with google so it renders the need for citations pretty obsolete now.

    re doctor v AI, less than one minute on google turns up the first citation: http://ieeexplore.ieee.org/Xplore/login.jsp?url=http://ieeexplore.ieee.org/iel2/953/7714/00323624.pdf%3Farnumber%3D323624&authDecision=-203

  3. This is why citations are useful. You say “a PC can outperform a GP in diagnosis” but that article says it is “to assist a GP” and it “exceeds that of the GPs, and it reaches the level of performance of the eye specialists”. So a specialised system can help a general practitioner to reach the same performance as a specialist? I wonder if it would be possible to have a system that is as general as a GP but with the specialised knowledge, obviously for far cheaper as you’ve stated above.

    I don’t think or agree that Google renders citations obsolete as it’s important to know where you are citing from. The IEEE? The Daily Mail? The Wakefield report? You could write a huge post based on the latter and, without citations, it would not be obvious that your arguments are no longer valid.

    I’m afraid for someone who seems to value science so highly, you don’t seem to make much use of scientific principles in your writing.

    • Ouch! I make a big distinction in my writing between formal articles and blogging and other informal pieces. My academic writings include full citations for any work I have referenced.

      On the AI stuff, I have read numerous articles in the last several years that suggest that AI systems can now out-perform GPs. Like most people, I don’t keep records of everything I read unless it is for an academic article, so I have long since forgotten the precise sources, but remember the conclusions and that they were from credible sources. There were many, not just one, and today is the first time I’ve seen this IEE one, though it adds weight to the case. I’m sure you can find plenty of more relevant citations on google if you are interested. There will be lots of them.

      You can trust that I apply the same rigour to my thinking regardless of the destination.

  4. “a robot can outperform the highest skilled surgeon in operating”

    I’ll need to see a citation for that, as a quick google and a trawl through the lancet finds numerous references to assistance, fine surgical control etc but not actual replacement of medical expertise.

    With the current state of the art, suggesting that robots could replace surgeons is like suggesting that a head-mounted magnifying glass could replace a stamp collector.

  5. Sure, 3 seconds on google this time: http://news.bbc.co.uk/1/hi/health/7234794.stm makes my point perfectly, illustrating that even a student using a robot can do a much better job. That is the key point here. The robot is doing the actual surgery, and the human is reduced almost to a managerial role, instructing the robot, which filters out the noise and wobble. This suggest to me that high-cost surgeons will be replaced in due course by low-cost technicians, maybe even nurses. We will not have to pay top dollar for humans to do a job that can be done more precisely by cheaper humans plus machines.

  6. The key notion your entire argument rests on is that the cheaper student+machine will be able to replace the expensive surgeon. Firstly, the specific role that the machine fulfils is something akin to a flight simulator or a HUD. The understandable scarcity of cadavers means that a lot of medical procedures can’t be accurately walked-through, especially when the patient has a particular hip-socket geometry that has to be taken into account.

    The only solid claim, then, is that use of this system turns trainee surgeons into surgeons faster than before. It’s a great learning aid, but not really a citation that proves your point.

    Using a virtual overlay for surgery is a wonderful example of the augmentation of human ability, but it’s dangerous and offensive to extrapolate this beyond the point of absurdity. You would be on far surer footing to suggest the introduction of pilotless commercial passenger aircraft – this is one area where machines are both capable and proven. Another point you may find to your favour is the resounding success of computerised call centers.

  7. http://en.wikipedia.org/wiki/Robotic_surgery clearly lists higher precision as one of the advantages of robotic surgery over human. Tremor is reduced and smaller incisions are needed so patients recover quickly. Current robotic systems are still expensive but technology always starts off expensive and rapidly reduces in price. http://www.proteus.cisti.nrc.ca/highlights/2007/0710robot_e.html shows how high precision is enabled via robotic technology for brain operations too. http://www.authorstream.com/presentation/jesudass-283995-robotic-surgery-09-hari-venkatesh-science-technology-ppt-powerpoint/ is also very interesting.

    The previous link, http://news.bbc.co.uk/1/hi/health/7234794.stm is highly relevant:
    “The reason for using students in the study was to show that even students, with the right technology, can achieve expert levels straight away.

    “More importantly, we’ve also demonstrated that no patient has to be on an inexperienced surgeon’s learning curve.

    “This could significantly improve a patient’s health and wellbeing and ensure they do not have to undergo repeat operations.”

    Thus, costs are reduced and patients benefit since they don’t have to undergo repeat operations.

    Indeed, robots are used extensively elsewhere for good reasons, but I think that using them more in health care will improve our health significantly. Initial costs may still be high, but will inevitably reduce, and I for one will certainly welcome the higher precision they enable if I ever need a brain op. I’ll also welcome more use of AI in diagnostics, having come close to death twice due to wrong diagnoses by human doctors.

  8. Again, your links and the points your arguments rely on all refer to the augmentation of human surgeons, so I apologise for not being clearer with my point.

    I agree that surgical robots may have the potential to operate with higher precision and less tremor than human hands, HOWEVER there are three options for what controls the robot.

    1) The Singularity.

    2) A student with a copy of gray’s anatomy open on his Kindle.

    3) A traditionally trained brain surgeon who’s using the robot instead of a scalpel.

    Which one would you like behind the controls?

  9. I’d prefer 4) a brain surgeon who was trained using the system above instead of using me for practice, and using a highly computer enhanced picture, to guide a precision robot-manipulated scalpel with the surgeon’s tremor filtered out. The surgeon wouldn’t be using it if it didn’t do a better job.

    If the point you are making is that robots don’t yet operate completely autonomously, fine. I agree. They upskill humans, or downgrade the human skill required, whichever way you want to look at it.

    But interesting and fun though this debate is, I think my blog points remain valid, that robots provide higher precision and use of appropriate technology reduces costs. Now, I really have to get on with my work :) You can have the final word if you like. Thanks for your input.

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