Will the spending round crush urban growth?

Alexandra Jones welcomes funding for skills, but worries that grants to pay for councils and growth have been wiped out.

Everyone knew there would be very little money to spare in Wednesday’s spending round and Thursday’s "growth statement". The economy’s poor performance has put paid to any attempts to move away from "austerity" government, so departmental cuts of up to 10 per cent came as no surprise. Yet the big question for me was whether the Review – which, it’s worth remembering, doesn’t even get put into practice until 2015 – would start to signal an alternation in the balance of power, away from most decisions being taken centrally about how money is spent and towards more local decision- about how best to deliver jobs, growth and better public services for much less money. So did it happen?

The honest, if unexciting, answer is that it’s a mixed picture – the rhetoric is going in the right direction but Government still lacks a "place" focus in its approach to national policy, and many of the the decisions about devolution were fairly timid, with too much emphasis on central government control rather than local autonomy.

Take Heseltine’s Single Local Growth Fund. Heseltine suggested it could be as much as £49bn over four years; it ended up being £2bn a year for five years. While it’s good news that a direction of travel has been established, creating some degree of certainty for local enterprise partnerships (LEPs) wishing to make investment decisions, £2bn is hardly a ringing endorsement for devolution to local areas. Digging beneath the detail, much of the money is not new – about £700m has already been allocated to local areas for transport or the New Homes Bonus – and when you divide it between 39 LEPs, it's not a great deal of money, roughly the same as the nine Regional Development Agencies had in the mid 2000s. 

It is good to see skills money in there, however, and now it’s been created it will be difficult to put the localism genie back in the bottle – provided local areas deliver. The challenge for Whitehall as it finalises guidance about how the money will be allocated is to ensure that, even if the amounts are smaller than I had hoped, there is devolution of decision-making and that access to the funds do not involve local areas jumping through a lot of Whitehall-devised hoops.

It’s also unclear whether the welcome announcements on affordable housing, super-fast broadband and transport will respond to the needs of different places. The £3bn of capital investment to build 165,000 affordable homes, along with the £250m announced for more super-fast broadband are welcome and will make a difference in cities across the country, as will the vast number of inter- and intra-city transport schemes that were announced. My concern is that as we move from policy announcements to prioritisation and implementation, the significance of the differences between places will be missed by Whitehall departments. 

Finally, it was not a surprise that local government has again been hit hard by cuts, receiving a 10 per cent cut that Stephanie Flanders of the BBC suggested would amount to a 35 per cent cut in real terms for local government since 2010 (although the Chancellor argued that other measures meant that the "true" cut for local government would be 2 per cent in 2015/16). Combined with cuts in welfare, which will affect some city economies significantly, it will be very tough for many cities to manage their budgets giving rising demands for their services. 

To help them manage cuts more effectively, more action is needed on innovative measures that increase local autonomy. It was good to see confirmation of Manchester's Earn Back deal, involving Manchester keeping a proportion of the benefits generated by increasing local economic growth. It was also good to see additional money for Troubled Families, but I would have liked to see more steps taken down the road of "Community Budgets", allowing local areas to pool budgets across silos in order to deliver more effective, efficient local services in a way already demonstrated in pilot areas such as Manchester and Essex. 

So where does this leave us? I’m an optimist, so I still hope that as the detail emerges over the next few weeks and months this will show that government is putting "place" at the heart of its policy-making. In the meantime, in the two years before these announcements kick in, there’s still more to do to give greater freedom to cities with the capacity to deliver and provide greater support to those cities struggling with capacity, decline or both.

Alexandra Jones is the director of the Centre for Cities

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear