Yet again, the budget pushes the North a little further from the South

It's two nation Britain.

With growth forecasts halved to 0.6 per cent this year, and unemployment rising again in the north of England, this needed to be a budget for growth across the UK. Instead, the headline measures will do more to further inflate house prices and childcare costs in London and very little to boost regional economic opportunities. Meanwhile, further public spending cuts – not least in pay and benefits - will have a continued deflationary impact on many Northern towns and cities.

The budget has come on a day when unemployment figures show the North-South divide widening further – up by 10,000 people across the north of England in the past quarter compared with a 17,000 fall in London.

Measures such as the increase in the income tax threshold and the National Insurance allowance for small businesses will be welcomed by many but won’t have the effect of rebalancing the economy – rather, they will tend to benefit those areas where wages are higher and the business base is broader.

More significantly, measures to increase new house building are to be welcomed but there is a significant risk that making it easier for borrowers will simply prop up prices – indeed, inflate prices – rather than getting additional homes built. It is not clear that Help to Buy will generate additional new housing starts, beyond what would have been undertaken anyway (which will certainly not be the case for mortgage subsidies that are not linked to new-build) and the 15,000 new homes promised in the budget go nowhere near most estimates which suggest we need to build an extra 250,000 new homes a year to meet rising demand. Similarly, childcare changes will soon be wiped out as providers inflate costs with little additional provision.

Of those measures that will stimulate growth it is too little too late. It is encouraging news that the Chancellor has broadly endorsed the Heseltine report but with government sources suggesting that resources going into the "single pot" will be in the “lower billions” rather than the £49 billion Heseltine recommended – and even then not until April 2015 – this will hardly be a short-term stimulus.

The £3bn boost in infrastructure spending is something that IPPR North and many others have been calling for many months but will do little to help us catch the levels of capital investment spent in other nations and once again won’t land until 2015/16. Furthermore, we cannot hope this will boost regional growth when we currently plan to spend £2,595 per person on transport in London compared to just £115 per person in the north. Transport spending must be devolved more fairly to have a real impact.

With much evidence pointing towards the critical role regional economic development is playing in stimulating national economies across the developed world, this budget – however populist – will do little to restore the economic health of the nation and will ultimately be regarded as a missed opportunity.

But perhaps the bigger tragedy than this missed opportunity is the fact that regional prosperity hangs so much on central government decision-making at all. With greater fiscal decentralisation economic growth could be better tailored to the particular needs of local and regional economies and less dependent upon the big levers so clumsily wielded by chancellor after chancellor. Such reform is long overdue.  

Photograph: Getty Images

Ed Cox is Director at IPPR North. He tweets @edcox_ippr.

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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage