Day 8, and I am still in Lancaster Hospital, having had my tendons sown back on to my left knee. A simple story of my lovely (less lovely now!), boistrous black labrador pulling me over on a steep slope.

I always felt avoiding the NHS at a bank holiday and in advance of a doctors’ strike was a sensible thing to do. It seems you don’t always have a choice…

So, what are my observations of the NHS at first-hand?

First, the staff here are lovely. Three cheers for Ward 37! They really care, and whilst I am sure some NHS staff do just the basics, not here.

Second, morale seems low with a disappointing level of confidence in the management of the Trust or NHS generally. Poor communication, endless management initiatives, and a lack of joined up practices or budgets undermine their capabilities to do the best job.

A small example of poor organisation. I got admitted Good Friday night, waiting only 3 hours for a bed. Nil by mouth for an operation that never happened, despite available surgeons, as no specialist radiographers on call over the Easter break. A second nil by mouth and still no relevant radiographers until Tuesday. Then, a third, and I was finally operated on on Thursday.

During the process, I asked whether there were radiographers elsewhere on call but out of the question. Budgets and records are ring-fenced by Trust, so there was no flexibility there. I asked to go home and come back to avoid bed blocking, but if I did I would leave the ‘system’ and be admitted as an out-patient in 2-3 weeks time despite the severity of the injury. The matron and surgeon strongly advised me to stay put.

To make things more difficult, when I am discharged tomorrow and slowly make my way to London, I have to take my records in paper form with me to UCL’s A and E department to get the required crucial follow up treatment. There are no transferable online records here.

My general ward is full of the elderly, many with dementia. It is sad to see, and the pressures on this basis are only going to rise. Lack of care at home or in homes is a clear factor. It is piling on the pressure. Many lament the demise of halfway house cottage hospitals, which were so beneficial for helping the elderly recuperate, and I simply do not understand why social care, not small boats, is the government’s top priority.

All against the backdrop of A and Es filling up partly due to lack of GP access.

I have seen at least some of the best (people) but often the worst (structural) of the NHS on view. Money, of course, is a factor, but so is a bloated NHS managerial class, siloed organisation and politicians who seem unable to challenge and prioritise a crucial yet failing public service.

As America’s 45th president appeared in a New York court for allegedly making illegal hush money payments to a porn star and others, breaking campaign finance laws in the process, it is worth remembering that in a functioning democracy, nobody is above the law, even Donald Trump.

Time for Trump to be held to account…

At a lunch party in the US last week, I suggested America feels like the 4th century AD Roman Empire… in decline. Nobody disagreed, even a couple of Republicans. Of course, it will remain the world’s premier superpower for decades, possibly centuries due to its military capabilities, but the increasingly polarised political discourse is fracturing society and undermining the ability of the US to govern itself.

The Democrats are not without blame, with splits between moderates and the hard left, but responsibility for this decline relies firmly with Trump and the supine GOP. Shame on them.

Trump is a known liar, without morals who lauds autocrats around the world, including Putin. How the GOP allowed him to take over their party, with his conspiracy theories, extreme language, contempt for the law, and refusal to accept his election defeat, is one for the history books.

But the consequences are stark. Increasingly extreme political debate is becoming a democratic threat.

Evidence of this is everywhere in opinion polls. A third of Americans do not believe Biden won his presidential election legitimately. One in five think political violence is justified on occasion. A third of voters would prefer autocratic rule over a weak, democratically elected leader. Two-thirds think US democracy is in crisis. Democracy is overwhelmingly the preferred form of governing but the headwinds opposing it are strong.

So, the solution? The GOP and MAGA crowd need to unite with the Democrats to remind the public it was democracy that made America great in the first place. Campaign finance laws need to be revised to cap election spending. State laws that undermine election officials and dissuade minority voters from participating in elections need to be withdrawn. Term limits need to apply to an increasingly politicised Supreme Court.

Umm… a very tall order. The crisis in American democracy is not going away anytime soon…

Happy Easter!

All of us agree, I am sure, that illegal immigration should be sharply curbed. The cruel trafficking of often vulnerable people to the UK’s shores via small boats and lorries is heart-breaking. It is a scourge of modern life and an issue for all of Europe.

Immigration may not be the vote winner Tories think it is…

However, even if one doubts the legitimacy of some asylum seekers, it is another issue to use a tone of language and introduce policies that, even tangentially, encourage racism. Our lovely Home Secretary, Suella Braverman, is certainly guilty of that. Using phrases over recent months such as ‘an invasion on our southern coast’ and ‘waves of illegal immigrants breaching our border’ supported by a ludicrous figure of 100 million is inflammatory to say the least.

The picture of Braverman laughing in Rwanda is also chilling. Exporting illegal immigrants to a country with a dubious human rights record is an ugly policy, and no government minister should be pleased with it, even if they think such measures are a necessity. Should the courts allow such flights, the policy hardly seems to make much of a difference either, with a current capacity of 200.

Housing illegal immigrants in barracks and on boats is another example of dog whistle politics, attempting to appease Red Wall voters and the hard right generally, two groups that, in reality, have little in common. Add to that, nimbies who live near barracks talking of their fears of potentially dangerous people being housed nearby and it all feels deeply uncomfortable for a humane country. Government rhetoric is partly the reason for it.

Under Sunak, we are now finally pursuing a policy of cooperation with the EU which, of course, particularly in relation to France, is the only solution to sorting illegal immigration in the longer-term. Theresa May knew this years ago.

In the meantime, if the Tories keep pursuing a ‘nasty party’ approach to the issue of ‘small boats’, it may well rebound on them. Labour’s opinion poll lead is still very wide, and they must be clear favourites at the next election. Even voters who dislike immigration generally might find it within themselves to swerve away from the Tories’ approach and focus on other issues. If, for nothing else, to protect their conscience.

This week, as I sit in New York, the US and UK seem mirror images of each other politically with regard to the treatment of their former leaders.

Over here, rumours abound that Donald Trump is about to be arrested over hush money payments to the porn star, Stormy Daniels. Apparently, he wants to be dragged to court in handcuffs to galvanise his fan base. Pink fluffy ones, I guess… You couldn’t write the script. News channels are full of it, but surely the most ardent Trump supporters must be getting tired of the soap opera. His rival, DeSantis, is playing it brilliantly, sort of highlighting bias against Trump whilst citing he can’t speak about the details due to inexperience of paying hush money to porn stars…Trump is furious!

Of course, Trump faces much more serious legal challenges, not least from the State of Georgia for allegedly trying to illegally influence the 2020 presidential vote. His opponents wish this was the first confirmed court case since sleeping with prostitutes and paying them off is sort of priced in with Trump.

Then, over to the UK, where Boris Johnson testified in front of the Commons’ Privileges Committee for allegedly misleading Parliament on parties in Downing Street during the Covid pandemic when the rest of us were in lockdown.

Watching Johnson’s testimony, he was very testy and defensive, and, frankly, unbelievable. I was particularly struck by the hostility of questioning from Tory members of the committee. Meanwhile, simultaneously, a vote on Sunak’s new Northern Ireland agreement with the EU passed easily in the Commons despite former PMs, Johnson’s and Truss’s opposition. It has been a good week for Sunak.

Both Johnson and Trump, populists who have always treated the truth with carelessness, are getting their just deserts and there is a growing sense they are busted flushes. Their influence is waning and those who believe in upholding standards in public life should rest easier this week.

More evidence that the Tories are getting their act together or at least their leadership is. This was a solid, sometimes compassionate budget with well trailed measures on devolution, pensions, energy costs, and childcare.

In particular, it is a laudable aim to get more people into the workforce as the over 50s go awol. There are many deeply unhelpful longer-term consequences of the Covid pandemic, and this is one of them. It undermines productivity, tax revenues and creates labour shortages, which ultimately are inflationary. Let alone the consideration of the health benefits of staying active…

Tories back on form…

However, longer-term problems remain unaddressed as a General Election looms, and a now competent Tory administration runs out of time. There was an interesting article in this weekend’s Sunday Times about the lamentable management by Whitehall of the nation’s major infrastructure projects. Examples of poor stewardship, notably HS2 and an NHS IT system unfit for purpose, are manifest. Apparently, there are 235 major projects costing £678 billion underway, and only 24 are on time and on budget. Yet there are no solutions to improving any of this, which is a major additional barrier to sorting our productivity problem.

And then there is the issue of dealing with the UK’s finances for the long-term. We failed to invest when interest rates were low and now have no money. Conventional Treasury orthodoxy (Truss actually had a fair point here) dominates. We also still hand too many tax breaks to the rich.

It is hugely sensible to lift the cap on pensions saving to encourage more older participants into the workforce, but why hand out tax breaks at the highest marginal tax rates? Even George Osborne wanted to do something on this. Then, the triple lock on old age pensions, which, generationally, deflects an efficient allocation of scarce capital.

Meanwhile, a 6 per cent rise in corporation tax will damage small businesses, particularly service sector ones with little need for capital expenditure.

Tory voter bias continues to rule but this country requires radical, more centrist solutions to fully rejuvenate the economy after the self-inflicted wounds of Brexit and an erratic fiscal policy. It will be the next government’s job, and today, unfortunately for Sunak, it probably won’t be Tory.

It may have been a mess of the Tories’ own making, but the Northern Ireland Protocol needed sorting, and Sunak has done that.

Grown up politics finally on show…

He corrects the mess left by Johnson with an attention to detail, thoroughness, transparency, and level of good faith, which has been all too rare in recent Prime Ministers.

It would be suicidal for Johnson and the extremities of the Tories’ ERG to oppose this new Windsor Framework. In particular, if the former PM cuts up rough, in the process putting himself before Party and before the country yet again, it will be the end of his political career once and for all and rightly so. In a way, though, this deal ends Johnson’s ambitions to be PM again anyway since it simply reminds everyone what a dishonest hash he made of his rushed Brexit deal in the first place to win the 2019 election.

The DUP surely can’t resist either. The relative high level of poverty in Northern Ireland exacerbated by the lack of home rule and Johnson’s protocol cannot continue. It would be electoral suicide and gift Sinn Fein further electoral success, potentially leading to an even more insurmountable border in the North Sea… They have reacted cautiously so far but, for this dour grouping, that is positive!

In Sunak, you saw a grown-up politician yesterday, free of Tory factionalism, pragmatically building relationships with our largest single market and powerful ally in an uncertain world.

Oh, to witness Sunak’s attention to detail without theatrics. Oh, to see the long overdue mutual respect between two key allies, UK and the EU, on show again. Oh, to witness a prime minister caring about international law and the long-term reputation and future of the UK unhampered by divisive, self-destructive ideology.

If the last seven years of post-Brexit misrule weren’t solely the fault of the Conservative Party, it would almost be enough to bring former moderate Tory voters back into the fold again…

We know what today’s Labour Party is not. It is not anti-Semitic. It is not in favour of Jeremy Corbyn standing as a Labour candidate. It is mostly not unpatriotic. It is mostly not in favour of public sector strikes but negotiated settlements. The list of tepid stances goes on.

More policy specifics needed…

We know what it is for. A series of missionary positions were announced today; growth, making the UK a green energy superpower, safer streets, an improved NHS, raising education standards. Laudable aims with a long-term approach advocated, but details to follow.

After today’s speech by Starmer, are voters any clearer where Labour really stands on tax and spend, poorly delivered public services including the NHS, business friendly policies, levelling up, immigration, a renewed relationship with Europe? Are they for the individual versus the State or vice versa?

Labour’s lack of definition is ok for now, but not as we get closer to the election. The Tories will raise their game and, with plenty of money to back them, will uncover the discrepancies at the heart of Starmer’s Labour Party, not least a focus on his backing of Corbyn for 4 years.

You will know what the Tories stand for; Brexit, public sector reform, ultimately the goal of lower taxes, and some element of social conservatism. And an unforgettable reputation for general economic incompetence, which Sunak will struggle to overcome. They really can’t get away with the goal of halving inflation by the way which, statistically, will happen anyway!

None of this may matter, of course. The public is heartedly sick of the Tories currently, Starmer’s dull competence is rightly in vogue, and luck seems to be with him. Not just the Tories’ implosion but Nicola Sturgeon’s imminent departure must surely be worth a few extra Labour seats in Scotland.

Is this enough? Probably, but if I were Labour, I wouldn’t take the risk. Time to listen to that old master, Tony Blair, one feels and deliver some memorable specifics now.

He may be approaching 80 and looking and sounding his age, but President Biden has barely put a foot wrong since taking office in January 2021.

His presidency did not have an auspicious start with a rushed exit from Afghanistan without consultation with allies. Biden was meant to signal a new approach to international relations, but it felt very much ‘Trumpite’ business as usual at the time. Still, he always advocated a withdrawal from Afghanistan, never supporting additional resources in the region under Obama, so perhaps we should have been less surprised.

Since then, however, Biden’s unsung presidency has been hugely successful with a string of legislative successes at home. He passed a $1.9 trillion post-Covid rescue plan which has contributed to the creation of over 6 million jobs. He re-joined the Paris Climate Accords and passed the Inflation Reduction Act driving aggressive action on climate change with the aim of cutting US emissions to half of 2005 levels by 2030.

He passed a long overdue Bi-Partisan Infrastructure Law, upgrading rickety infrastructure across America. If that was not enough, a Bi-Partisan Safer Communities Act requiring those under 21 to undergo enhanced background checks was the first, albeit modest, gun control law victory in three decades. He has cut medical costs for ordinary Americans and appointed more moderate federal judges at this stage of his presidency than any president since JFK.

All this against a tiny minority in the Senate which has grown by one since the better than expected mid-terms. By focusing on the Republican Party’s extremism, the Democrats gained in the Senate and restricted losses to only a small number in the House of Representatives.

Biden’s approval ratings languish but inflation needs to continue to come down and many of his legislative achievements will take time to bear fruit. He is certainly well placed to stand again if his health holds up and the Republican’s addiction to Trump and extremism generally continues.

Biden’s response to Russia’s invasion of Ukraine has been outstanding…

But it is Biden’s response to Russia’s invasion of Ukraine that really stands out. Leaking Russian actions in advance has brilliantly helped President Zelenskyy and the West generally win the propaganda war. He has ensured America leads a united West against Russia both morally and with a huge commitment to delivering arms to Ukraine, understanding that a Putin victory is a long-term global threat to all democracies. His visit to Ukraine today was masterly in its timing and substance.

Could you imagine the state of the world if Trump was still President or indeed another extreme Republican? Whatever your politics in the UK, we should applaud this elderly incumbent and sincerely hope he stays around to guide America on its current path.

It says a good deal about today’s Tories that the pro-Brexit, Thatcherite PM, Rishi Sunak, is seen as a moderate force towards the Left within his Party.

Sunak’s tenure has probably come too late to save the Tories…

Why? Because Sunak believes in sound finances, only cutting taxes when the country can afford it; because he believes in building strong relationships with our European allies as he seeks a solution to the Northern Ireland Protocol; because he objectively believes in probity in government regardless of Party loyalty, which led to him rightly leaving Johnson’s Cabinet. Incredible.

Sunak is manifestly competent, but many in his Party are not. Despite a paper majority of over 70, he can barely muster enough support on any, even remotely, controversial issues. Many of his MPs have given up the ghost, and Red Wall Tory colleagues were never schooled in the art of Party loyalty anyway. Staring defeat in the face, there is no fear in upsetting their Front Bench as they threaten revolt. The fleeting opportunity of ministerial advancement is seen as pointless. Sunak is dragging the train as they say. And it shows.

Then there is the probity of his Cabinet. When you are asking voters to pay record amounts of tax, you cannot have a Party Chairman subject to a fine from HMRC for not paying sufficient personal tax out of ‘carelessness’ in his complex tax arrangements. Dominic Raab, the Justice Secretary, is facing 24 counts of alleged bullying. And then the former PM, Johnson, has been caught using his BBC Chair appointee to help broker an £800,000 loan when in office.

You can’t write the script. Starmer does not have to particularly shine to take apart this seemingly tired, out of touch Tory government. Sadly, for Sunak and loyal Conservatives, Sunak’s tenure has probably come too late, and the faces of his troubled and troublesome backbenchers show it.

To answer the question of an earlier blog, it is now very much 1997, not 1992.

I know… I know… never talk about religion… but this is not strictly about what individuals believe, rather it is about organisational failures and poor leadership generally. It is at the heart of the decline of the Church of England, even taking into account the overall pressures from an increasingly secular society.

A damning view that the Church of England is ‘sinking in its own irrelevance’…

Let’s begin. Out of 85 million who identify with the Anglican Communion, 25 million are represented by the Church of England. Yet denomination membership in the UK has halved from 3.4 million in the 1960s to 1.6 million in 2020 and regular attendance at Church of England services has fallen by 40% to 600,000 since 2009. Incredibly, only 14% of the UK’s population identifies with the Church of England. The grim list of statistics goes on.

The barrier to a solution to this decline, of course, is that numbers are religious power and of the 85 million Anglicans globally, many are based overseas with very different views on a variety of issues, most notably social liberalism. In an attempt to keep everyone on board, successive Archbishops of Canterbury have often sat on the fence on controversial issues to keep the church together. It therefore stands for less and less.

It has certainly hastened the decline of Anglicanism in the liberal West. It has led to the Church following rather than leading on a range of social issues, appearing out of touch, old fashioned and, in some cases, downright cruel. It is, in a damning recent quote, ‘drowning in its own irrelevance’.

And this has culminated in a hopelessly contorted position on gay marriage in churches announced this week. Whilst a majority of the UK population supports same-sex marriages wherever, including a majority who identify themselves as Anglicans, Church of England bishops, after five years of debate (!), have just refused to back gay marriage in churches but still back clergy blessings of civil same-sex marriages. This comes from an organisation that only allowed the ordination of women priests in 1992 and female bishops in 2014…

The distinctly anaemic current Archbishop of Canterbury, Justin Welby, believes in keeping his views on same-sex marriage secret whilst in post. What sort of leadership is that?

Deep down, the Church of England’s approach is never going to solve the rift between theological conservatives and pro-equality progressives.

Despite the power in numbers of followers, is it time for honest debate and a possible Anglican split? The time for sitting on the fence is surely over on key issues wider society has already resolved in its own mind. Otherwise, the Church of England will continue to sink.