Uncharted Territory

May 11, 2010

Adieu, AV

Filed under: 2010 General Election, Politics, UK — Tim Joslin @ 3:53 pm

What does Clegg think he’s doing?

The situation will probably have changed by the time I finish and post this piece, but, as I write, the Lib Dems are back in talks with the Tories, who seem to want a coalition to govern for a full term! That’s just not going to happen, guys.

If I was a Lib Dem, I’d not agree a deal at all. The Tories would just have to try to struggle on with a minority. The news-flow would be caustic for Cameron as his party shows weakness on a daily basis as they struggle to get legislation through.

Here’s one possibility: once Labour has a new leader they could ally with the Lib Dems and others to vote Cameron down on a confidence motion. But then refuse a dissolution (I assume this is allowed in the constitution), instead indicating that Miliband can command a majority. The Queen would have to ask him to form a government. This probably wouldn’t last long either, but would allow the Lib Dems and Labour to control the timing of an election and prepare with some populist legislation and executive action. Maybe they’d even get through a referendum on the Alternative Vote system (AV).

The trouble is, it seems to me that Clegg is a self-deluding fool. I therefore expect him to go into coalition with Cameron and destroy his party. The pretext will be “the national interest”, but the real reason will be the desire for power. Many Lib Dem voters who lean towards Labour or even tactically voted – together possibly a majority of Lib Dem support – will be long gone by the next election. And then there’s the risk that the Lib Dems will be seen to prop up an unpopular Tory government, or will be seen as hopelessly split on whatever issue brings the folly to an end.

And whatever happens, Clegg’s probably already lost the Lib Dems any chance of AV, let alone PR, for a generation.

Here’s why. Think about it. The Tories have said they will campaign against AV in any referendum they grant the Lib Dems. What incentive will Labour have to support the proposal? None. Sure, they might pay lip-service, since AV was in the Labour manifesto, but, unlike if they were in coalition with the Lib Dems, they will not expend political capital whipping their significant dissenting elements into line. And they’re hardly likely to spend a lot of money on a referendum campaign when they could be saving their pennies for the next election. I simply can’t see the Lib Dems winning a referendum on anything against the Tories, their toadying media supporters AND elements of the Labour party.

Especially after what’s happened since last Thursday. It’s same old, same old. Like many voters I might support the Lib Dems if I could just work out what they stood for.

Given all the talk of Lib-Lab tactical voting, I rather hoped we’d see Clegg talking to Brown first. By 6am last Friday morning I was able to sleep because I was contentedly absolutely sure the Tories would have around 10 seats less than the Lib Dems and Labour combined. I didn’t lose a night’s sleep willing on the Lib Dems to reach a position to prop up a Tory government.

It is simply ludicrous for the Lib Dems not to know who their natural allies are until after an election. Clegg may be a closet Tory, but whatever, the strategy is entirely wrong. In fact, it’s more than a strategy, it’s what the Lib Dems are, the way the party has been shaped over decades, so it’s not entirely Clegg’s fault. If we’re going to have PR, or even AV (which gives a slightly more proportional outcome in terms of MPs per vote), the electorate (and MPs of other parties!) needs to understand that the Lib Dems will ally with Labour (or the Tories), if at all possible. Only if the natural alliance is absolutely impossible should allegiances of convenience be considered.

We wouldn’t be where we are now if Clegg had campaigned on the basis of being a more moderate progressive party than Labour, so would seek to form a coalition with them. Or, if the party is really the wet wing of the Conservatives he should have made that clear. If any party wants to be taken seriously they have a duty to tell the electorate what they are voting for.

When the dust settles, I think the Lib Dems will find the voters are really quite cross with them.

Sorry, I’m in favour of electoral reform, but, in my judgement, the British people are simply not going to vote for an electoral system where only one vote counts – Nick Clegg’s.

A future of continual tawdry soliciting by the Lib Dems for coalition partners after every election is not a prospect that can be sold to the voters.

And why the hell the Lib Dems want a referendum they’re likely to lose is beyond me. They won’t get another chance for decades. I guess they simply haven’t thought it through.

Since the Lib Dems’ appeal during the election campaign was to break the two-party mould and usher in PR, I fear – no, I can feel it to be the case – that support is ebbing away from both the policy and the party advocating it. Don’t throw away those red-blue swingometers just yet.

Adieu, AV, it was nice knowing you.

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April 9, 2010

Job Sums

I’ve been trying to avoid commenting on the General Election campaign, since it would be a huge distraction from far more important issues, but I can no longer ignore the absurd reasoning that’s making its way into the media.

Yesterday, the Guardian, bless their little cotton socks, tried, under the banner “Reality check”, to answer the question “Do national insurance rises cost jobs?” (if you follow the link, then don’t be puzzled – as usual, the online title is different to that in the print version of the paper). The Guardian’s answer is slightly to the “solid” side on a cute little dial that goes from “shaky” to “solid” – let’s call it “mushy”. They seem to think NI rises might cost jobs.

The article included some strange logic, most notably from Richard Dodd of the British Retail Consortium who apparently argued that “…in a competitive market, retailers will struggle to pass the tax on in the price of goods…”. The “competitive market” has nothing to do with it, since the tax will affect all employers. No-one has a new competitive advantage as a result of the tax.

The Guardian also failed to question why business leaders might be against an NI rise. The point is that increasing taxes (like other costs) reduce profitability (temporarily) because in general it takes time to raise prices and recover margins following an increase in costs. As clearly testified by Richard Dodd’s concerns about how “retailers will struggle to pass on the tax”.

But the Guardian’s piece made a bigger mistake – in fact they managed to completely miss the point. You can only answer a question like whether an NI increase will “cost jobs” by considering also what happens to the money raised by the tax. Taxes rob Peter to pay Paul, so if you can only evaluate the effect on any measure – in this case jobs – by looking at the issue in the round.

Since, as argued by the Guardian, the effect on (private sector) jobs of the NI increase is marginal and the money will be spent on retaining jobs in the public sector, then, if it’s the overall number of jobs in the economy you care about, you should be in favour of the NI proposal. The arguments put forward by the Tories and their business friends are misleading.

[I should say I don’t actually believe the prime goal of an economy should be to create jobs and I don’t believe the Tories or business leaders do either. The goal should be to produce as much as possible with as few resources – including people – as possible. Then we’ll all be rich and jobs will then take care of themselves. What I object to is all the dissembling. Having said that, unemployment is high and rising, so it’s not the best time to be bearing down on jobs. In other words, the trajectory Labour wants to put the economy on makes more sense to me than that which the Tories propose. We may as well, for instance, maintain staffing levels in the NHS – thereby saving and improving lives – and, in particular, continue to invest in the IT necessary for future efficiency savings, rather than have people sitting around on the dole].

Today’s FT gives us some clues on how many jobs would be lost by reducing public expenditure by an amount equivalent to that which would be raised by the NI increase. The FT appears to consider a slightly different question, i.e. the effect on jobs of additional public spending cuts in 2010-11 (i.e. this financial year), as proposed by the Tories. The point, which several BBC news bulletins have missed this morning, is that the NI rise only comes in in 2011-12. With the usual disclaimer that unless I’ve completely misunderstood something, in which case perhaps someone will be good enough to put me right…

And it’s surprisingly in the FT, where a “Cameron adviser discloses cuts detail” that the serious dissembling starts.

First, there’s an enormous howler. The article describes a proposal for £1-2bn in job savings by natural wastage this financial year, 2010-11. That is, during the year that’s already started. But the article appears to reckon on a saving of the full annual cost of the jobs – estimated to be £50,000 each – this financial year. Wrong. You can only reckon on that saving if the jobs disappear at the start of the financial year. On average they will disappear halfway through the year (actually later than that, because the Tories wouldn’t even be able to start until May 7th). So on average only £25,000 will be saved this financial year per job shed. Therefore, to save £1-2bn this financial year would require the wastage of £1-2bn/£25,000 = 40,000 – 80,000 jobs, not the 20,000 to 40,000 stated.

Note that if the jobs are lost other than by natural wastage there will be redundancy costs and less, or more likely negative, cashflow savings this financial year. Basically the Tories need to find 40-80,000 retirees or leavers this year who have not yet been accounted for. And whose jobs are so inessential that they don’t need to be replaced. Tough call, I’d have thought, when there aren’t so many other jobs out there to move to.

Furthermore, some of the cost savings are in things like office space, not salary. There’s always going to be a delay in realising such savings, because you can’t move to a smaller office every time someone retires and is not replaced.

Even furthermore, the cost in benefits of 40-80,000 people who would otherwise have had a public sector job to go to needs to be subtracted from the fiscal saving. Let’s be generous and assume that this has been taken account of in the £50,000pa annual cost of a public sector job quoted in the article. You can do your own sums if you want to assume the actual saving is less than £50,000pa (or less than £25,000 saving on average in the current FY, 2010-11).

Second, we’re discussing jobs in the overall economy. The FT article considers how the Tories propose to save an extra £12bn this financial year:

“Other cuts set out by Sir Peter include reductions in IT spending, yielding ‘potentially at least’ £2bn to £4bn. Renegotiation of contracts with suppliers of goods and services – which Sir Peter described as ‘not rocket science … it’s not about beating them up on price’ – would save about £3bn.

Cuts to ‘discretionary’ spending, such as consultants and staff expenses, should yield a further £2.5bn for 2010-11, he said. He declined to be drawn on a figure for property costs.”

Let’s see. Reductions in IT spending will cost jobs at IT suppliers, not all of them overseas. “Consultants” last time I looked were living, breathing working people as well. Reducing staff expenses would cost jobs indirectly as would renegotiation of contracts. The trouble is the lead time on renegotiation of contracts as well as “property costs” – realised presumably by selling offices – is months to years, so achieving the promised cashflow savings this financial year is implausible, to say the least.

I simply don’t find the Tory plans credible. They’d have more chance of getting my vote if they were actually honest about what they believed in. I remember Labour came to power in 1997 with a promise to stick to the Tory spending plans for the next two years. Cameron thinks he knows better. His position is contradictory – he said on the radio this morning that it was difficult for an Opposition to make spending plans, yet he’s confident he can make huge additional cuts this year. Cameron was once thought of as the new Blair. He now seems to have morphed into the new Thatcher. It seems to me that he’d give the economy the sort of shock treatment it received in the early 1980s. Steeply rising unemployment, an assault on the public sector and so on. Maybe it needed it then. I don’t know. But if it needs it now, perhaps Cameron should be making that case, not promising to save jobs when, at least in the short term, his policies are more likely to produce higher unemployment than would otherwise be the case.

Cameron is giving the impression that he can reduce public sector borrowing and unemployment this year and next compared to Labour’s plans. If he really believes this then he’s seriously wrong and not ready for the job of PM. If he doesn’t believe he can square the circle, then perhaps he should clear up the misunderstanding (or is he already planning to make his old chum George Osborne the fall guy when the Government can’t deliver?). The only other possibility is that he’s deliberately misleading the electorate.

January 20, 2010

Parking Paralysis (and Housing Horror)

As we head towards what promises to be a fascinating General Election, the absurd first past the post system has ensured the parties are united in their zeal to pander to Middle England. And Middle England, it seems, is consumed with localist fervour.

What is localism, anyway?

The politicians would have you believe that the first stop on the road to true democracy is to “empower communities”. That is, they assert the moral right of the current residents of a given area to make a broad range of decisions without reference to the general interest.

The idea that the primary unit of a complex modern society is a “community” of people living near one another is, of course, absurd. In fact, our personal networks – including families – are, in general, becoming more and more geographically dispersed. We have little in common with most of our neighbours, other than the area where we live.

Harking back to an outmoded idea of the community masks what is really going on. What’s really happening is that the political process is becoming more and more skewed towards vested interests and against the general interest.

Take housing, for example. This morning I heard the Housing Minister, John Healey, on the Today programme, promising to clamp down on “garden-grabbing”.

Let’s put to one side the fact that John Prescott was right: we need to increase housing density. Labour has caved in on this principle as the Tories have gradually captured local government. But below a certain threshold of population density local shops are not economically viable; nor is public transport. Pretty soon everyone’s driving to Tesco’s. And the same nauseating nimbys who prevented “overdevelopment” are complaining about the loss of local shops and whinging about “Tesco towns”.

I consider it absolutely ridiculous that I’m in London Transport Zone 3, but 10 minutes walk from a pint of milk and a newspaper. If there were a few more flats nearby and perhaps fewer large private gardens, maybe there’d be enough people in walking distance to sustain a local corner-shop. If it could get planning permission.

Let’s ignore the “community” narrative and instead consider what’s really happening with the “clamp-down” on “garden-grabbing”. What John Healey is really doing is strengthening the rights of neighbours over the owners or prospective owners of property – despite the fact that the size of gardens has marginal impact on neighbouring properties, or, for that matter, their value. If they reduce the size of a garden, those bogey-men, the developers, are not simply being bloody-minded. The market is telling them that the land has less value as a garden than as building. If the opposite was the case they’d increase the size of gardens.

Obviously, the reason why “building” is more highly valued than “garden” could have something to do with the lack of available housing in many parts of the UK. But clearly our leaders don’t see this isn’t a good enough basis for a decision. The visceral feelings of neighbours are obviously far more important.

A few weeks ago Secretary of State John Denham rejected plans for a development near Ealing Broadway station. He acknowledged that the proposed “scheme would comply with some specific development plan policies relating to the regeneration of Ealing Town Centre and would bring many benefits to the area”, including 567 homes, but judged that all this value was outweighed by his subjective judgement (in response to local concerns) that “the bulk, massing and certain aspects of the design of the scheme would be inappropriate in its surroundings. It would fail to preserve or enhance the character and appearance of the Town Centre conservation area and the setting of the Haven Green conservation area, as well as harming the setting of the Grade II* listed Church of Christ the Saviour.” One person’s fears about their “visual amenity” (an irritating phrase repeated ad nauseam in planning documents) trumps another’s need for somewhere to live.

Look, Haven Green is a mess. It’s simply not that pleasant a place. It could conceivably be improved by removing the buses which stop and indeed park (for driver breaks, I gather) on the diagonal road across the Green. A recent Ealing Council document (pdf) noted that: “A major consideration, as part of both the Crossrail and Arcadia redevelopment proposals, is the provision of better interchange with local bus services.” But Arcadia is not going ahead, and, if I understand the document correctly, Crossrail has no budget to pay for a proper bus station.

The planning process is bad enough, but nowhere is localism more evident than in the battle for control of scarce road space.

Ealing Council, to my horror, is also consulting on a dreaded CPZ (controlled parking zone), which would affect me.

OK, the proliferation of CPZs can be largely explained in terms of local government bureaucrat empire-building, but there is clearly at least enough tacit public approval to allow them to get away with it. Let’s therefore consider the CPZ in my novel terms of the “local” (or “vested”) interest and the “general” interest.

Before a CPZ is implemented in a given street, everyone has an equal right to park there. After its implementation, car-owning residents generally have absolute priority. In fact, often the schemes are implemented with the shocking inefficiency that non-residents can’t even use the space when it is unoccupied! (Schemes variously allocate a few metered bays or, better, allow metered parking albeit for limited periods and at limited times in residents’ bays).

So, in approving a CPZ, residents in effect extend their property a couple of metres into the road in one fell swoop!

Do they pay a fair price for this asset, though?

Of course they don’t.

Permits for residents’ parking on public roads are often less than £100 per year, and rarely more than a few £100s. The market value of such parking – determined by the rates in the few metered bays typically provided or in nearby car-parks – is usually at least several pounds a day – £1000s, not £100s a year.

It’s not just outsiders who, in effect, subsidise permit-holders. Residents who don’t run cars are massively inconvenienced, as is everyone when they have visitors, or use local services. Estate agents, for example, have problems parking when they quite legitimately want to show properties to prospective purchasers or tenants.

What CPZ schemes fail to take account of is that residents’ cars are part of the problem, and not the only injured party. Personally, it seems to me that there would be more social utility in reserving parking places for estate agents than for residents who just want to leave half a tonne of steel and moulded plastic outside their house for 6 1/2 days a week.

If we’re going to have CPZ schemes, then, let’s charge a market rate for the parking space – upwards of £1000 a year (and allow the option of paying a daily rate for those residents who park their car elsewhere most of the time). Then we’d reduce car ownership, spaces could be allocated to car clubs and for visitors and our parking problems would be much reduced.

What Ealing really wants, though, is not an ever-growing CPZ area. What’s happened is they’ve tried to solve the problem of commuters parking near Ealing Broadway and West Ealing stations. Entirely predictably, the small CPZs implemented have just moved the problem. Now they’re consulting on more CPZs. Nice work, if you’re in the CPZ implementation business.

Is there another policy that might make more sense than the inefficiency of selling the public parking space asset at a discounted rate to residents who think they own “their” road? It is entirely legitimate to discourage car rather than bus or shoe-leather use by commuters. Why not, therefore, consider a congestion-charge scheme for non-residents coming into the centre of Ealing? One might hope that some of the London congestion-charge infrastructure could be fairly cheaply deployed just in the centre of Ealing. I’d suggest vehicles entering and leaving are monitored and the software programmed to charge only for those non-residents who stay in the area more than, say, an hour, since the objective in this case is not to penalise through-traffic but relieve pressure on on-street parking.

Perhaps it will take PR to slow the tide of localism. Certainly though, until the political process weighs the general interest more carefully against vested interests, our society will continue to be held back by dysfunctional and misguided decisions.

October 28, 2009

NHS Nutters

Filed under: Healthcare, NHS, Politics, UK — Tim Joslin @ 10:48 pm

The British electorate would be well advised come next June to forget about traditional political affiliations and whether or not we “need a change” and choose their next Government on the basis of the apparent sanity of its leadership.

Unfortunately, the British electorate is unlikely to take my advice and will instead elect a party which admittedly does boast some front-bench talent. But the wit of William Hague and wisdom of Ken Clarke will have to play second-fiddle to the Etonesque eccentricity of Messrs Cameron and Osborne. The key word in their bizarre philosophy is “localisation”.

Here’s a headline: “Tories vow to save money by scrapping national NHS database“. Having spent billions so far, this would seem a remarkably drastic step. The Tories are responding mainly to concerns about patient confidentiality, it seems. Instead of a centralised database, “Stephen O’Brien, a shadow health minister, said that the Tories would instead decentralise IT provision in the NHS, allowing trusts to buy their computer systems provided that they were compatible with others in the health service.”

Now, it seems to me that one reason the NHS IT project has overrun is because it is so monolithic. It would have been much less risky in many ways to set standards so that disparate systems could communicate, and implement them locally. But I see why a “key part of the programme involves the clinical records for every patient being stored on a ‘personal spine information service’.” If you have local systems, the data exchange issues are much greater.

One of the major benefits of computerisation is that patients’ records can be called up wherever they happen to be. And there’s also a huge benefit of computerisation in that the data is so much easier to “mine”. I read today of a careful study on migraine-sufferers. “Link between migraine and stroke” said the Independent. Worrying, so I read further:

“Young women who suffer from migraines with visual disturbances and who smoke and take the contraceptive pill are at a higher risk of stroke, research suggests.

Migraine doubles the chances of a stroke if accompanied by aura (temporary visual or sensory disturbances) according to the research, published online in the British Medical Journal.

Other factors that heighten the chances of a stroke include being younger than 45, a smoker and using contraceptive pills containing the hormone oestrogen.

Researchers led by a team from Harvard Medical School said there was no evidence of an increased risk of stroke among people having migraine without aura.

About one in five people suffer from migraines, with up to a third having an aura. The authors pooled the results of nine previous studies on the link between migraine and stroke to come up with the findings. “

Maybe the drugs prescribed for the migraines have caused the strokes – especially as my impression is that not so many years ago you needed the aura to call it a migraine and qualify for the drugs. Who knows? Hopefully the medical sleuths are on the case.

Anyway, my point is that with a comprehensive national database – however it’s implemented – you wouldn’t need elite medical professionals to determine correlations of this kind. School-level statistics skills would be sufficient. The big pay-off from an NHS database is this sort of data and the resultant medical progress. You want to work the database. That, I suspect, is why a centralised design was chosen. (And I haven’t even mentioned Shipman – detecting similar individuals would surely be worth the cost of a few computers).

How do the Tories deal with this issue?, I wonder. This is what their report has to say (apologies on their behalf that parts of the key passage are barely comprehensible gibberish):

“In order for patients to reap the benefits of information technology in relation to their healthcare, there must be a change in the way information technology is supported: the Executive must not regard health informatics [they’re using this grandiose term confusingly – to me at least – to mean all NHS IT services, whereas I’d use it specifically to refer to knowledge engineering] as a tool to extract data [as if it’s being stolen – isn’t language great?] from the National Health Service but as a way of organising health and social care information around the needs of the patient [as if sharing data across the system isn’t in patients’ interests]. Systems must be able to deliver clear benefits to the care of the patient and the work of the clinician in delivering this care. They must not be seen by clinical staff as solely [sic – really, would they?] systems for data collection. The dataset mentality – where the bulk of data collected bears not [sic, I presume they mean “no”] relevance to patient care – should be abandoned. Clinical systems should be built to focus on the patient, not the disease, procedure, specialty or service providing care. These requirements should be met by developing appropriate views on the patient-focused record according to the context in which the patient is seen.”

Actually, it’s not just the words I’ve highlighted which are gibberish, the whole thrust of this paragraph is completely barmy. Call the men in white coats. Several of the individual sentences make little sense, but I can find no way of avoiding the conclusion that the Tories want to throw out many of the enormous benefits of computerisation. Cameron apparently elaborated the full mad starey-eyed “vision” at the Tory Party conference:

“Now I want you to imagine how we’d have gone about [updating NHS computers], if we’d had the chance.

We would have said: today, you don’t need a massive central computer to do this.

People can store their health records securely online, they can show them to whichever doctor they want. [I love this bit – not if you’re in a coma, you can’t].

They’re in control, not the state. [Puerile, absolutely puerile].

And when they’re in control of their own health records, they’re more interested in their health, so they might start living more healthily, saving the NHS money. [Yeah, well, now I know the doctors are going to wait for me to come round so I can log them on to my medical records, I’m certainly going to do everything I can to avoid entering hospital horizontally].

But best of all, in this age of austerity [oh, please], a web-based version of the government’s bureaucratic scheme services like Google Health or Microsoft Health Vault cost virtually nothing to run. [Probably ‘cos they’re crap as Gerald Ratner would have said].

So this is where some really big savings could be made.”

Well, exactly. I can save the tube fare if I walk 8 miles to central London.

David Cameron, of course, is a direct descendant of Thatcher – as if through the intervention of some kind of incubus – and for her “there was no such thing as society”. This is now dressed up as a philosophy of “localisation” – the heading in their report is “8 action points to bring about localisation in NHS IT” – who could possibly be against that? Well, I am, if it means that I don’t benefit from the medical experience of others, and the outcome of any treatment I have is not used for the common good. Hey, why not go the whole hog and give up on the blood transfusion service? We could all have our own private blood-banks.

My experience is that the NHS is already far too localised. GP surgeries are a law unto themselves. Take registering. My local GP, first of all, only accepts registrations up to 4pm, despite being open until 5; they require two proofs of address + photo-id; and, worst, refuse to let you take a form to fill out and bring back when you get there and find you don’t have the right id, so you find when you eventually do come to fill it out that you don’t have all the information required (NHS number and former GP surgery address). Plus, they’re just plain rude with it. Our taxes are paying for an army of these receptionists, who have no medical training whatsoever. This is where we should find our first cost-savings when we finally get our records out of the 1940s, off paper and onto magnetic media.

My recent experience of trying to register with a new doctor (having moved recently) agitated me so much that I thought I’d try to find out how I should be treated.

Well, try as I might, I could find nothing on the NHS website. Surely, I thought, GPs surgeries benefit hugely from being part of the NHS, there must somewhere be a detailed set of obligations as to how they should go about their business. In the end, I thought, I’ll drop them a line. But this is what I found:

“Since April 2009, the NHS has run a simple complaints process, which has two stages.

1. Ask your hospital or trust for a copy of its complaints procedure, which will explain how to proceed. Your first step will normally be to raise the matter (in writing or by speaking to them) with the practitioner, e.g. the nurse or doctor concerned, or with their organisation, which will have a complaints manager. This is called local resolution, and most cases are resolved at this stage.
2. If you’re still unhappy, you can refer the matter to the Parliamentary and Health Service Ombudsman, who is independent of the NHS and government. Call 0345 015 4033”

This is simply not fit for purpose. Neither of these options is appropriate.

Here’s the first paragraph of “Things to think about when you’re complaining” (from the NHS complaints page):

“If you decide to make a complaint it’s important to consider what you want to happen. Are you content with an apology, do you want action to be taken against a member of staff, or do you want a change to the system? Whatever action you’re seeking, make this clear.”

Well, someone, somewhere has realised that I might want “a change to the system”. So why has my ability to complain been “localised”? My only recourse it seems is to write to the Department of Health.

For the record, I would have thought the GP surgery registration process should follow a clear set of rules so as not to exclude those unable to attend during the day and expedite the registration of new arrivals to the area.

Otherwise, the right to choice in the NHS is somewhat limited.

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