COMMENT

A global archive of independent reviews of everything happening from the beginning of the millennium


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Comment reviews respond to changing events in real time, like a blog.

Comment reviews:

OLEDs

An Alternative Hypothesis

Mutt's Dinner

Margaret Thatcher

Arbitration and the Press

Public Speech

Driverless Cars

The New Faustian Pact

Strands of Change

Winning the Sweepstakes

Social Authoritarianism

Less Inequality

Piketty and the Polar Bear

TUC Blues

Lidar and Planning Permission




Visited the bar? Then put your hands up and drive home slowly! RobotCar UK.

The big question (in early 2013) is: what mix of machine learning, onboard sensors, roadside electronic information provision and network connection do you use?

This third and later video is a bit more complex watched first time but it is certainly interesting. There is also a video covering similar topics about the Google cars.


AUDIO REVIEWS


MP3M0004/0313:
ADDRESSING MODERN FEARS
(A trial audio file)



Halloween Dogs






COMMENT 2014


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22 January 2014

New Towns and possibly one in the Thames Estuary

There is a view in the City that the supply side problems of Britain's housing situation are overstated. A reason given is that the commentariat is based in the south-east and looks at its own situation and that of its children.


Once you leave the south-east there is no longer an imbalance between supply and demand in the wrong direction.

Another reason, not advanced in the City, is that there has been a great deal of building of extensions to the existing housing stock over the past decade, particularly at ground floor level and in attics. Very roughly, for every new bedroom added an extra person has been accomodated. The number of new home starts do not reflect this addition to the housing stock. More intensive use of land has, nonetheless, pushed up its average cost and so the cost of building new homes.

New towns and new garden cities appear to be temporarily off the political agenda, as time is running out this side of the election to make a start on any, whether it be one to five within commuting distance of London or the Mayor of London's aeropolis in the Thames Estuary, but they will be necessary the other side of it as they offer the only real possibility of land for building being acquired at anything close to agricultural land prices with part of the saving being passed on in lower housing costs.

Institutional investment in property for rent is only really lining itself up for participation in new towns. Even were it desirable elsewhere (ad hoc revenue streams might be bundled together and securitised) there are no indications it will play a significant role.



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28 March 2014

Calling the result of elections


It is always a bit easier to call the result of a presidential election than ones between parties. You look for who is making both the right political and emotional appeal early on and you can also tell who is not.

Clinton, Obama, Chirac and Sarkozy were easy calls. Bush and Hollande were also predictable but later in proceedings.

There is, viewed from this side of the Atlantic, a paucity of potential runners saying the right things to become the next President of the United States so I'd probably opt now to put some money on Rand Paul who has not confirmed that he will run.

Senator Paul, a physician, has likened being in favour of a right to medical treatment to being in favour of slavery. I do not agree with this but the robustness and independence of a set of views that sees government as having no business in a whole range of things that should be exclusively or nearly exclusively within the personal domain of citizens is appealing.

As has been observed, he has a capacity to appeal to both Democrats and Republicans.


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31 March 2014

Inheritance tax replacement


Lord Warner, former Labour health minister and co-author of a report for the think tank Reform is reported today as saying:

Many politicians and clinicians are scared to tell people that our much-beloved 65-year-old NHS no longer meets the country's needs. Frankly, it is often poor value for money....

Revenue could also come from higher, hypothecated 'sin' taxes on alcohol, tobacco and gambling, and taxes on sugary foods because of rising obesity.

Just 3.5% of the annual 500,000 deaths lead to payment of inheritance tax. We must expect the elderly, after their deaths, to contribute more. NHS free entitlements, such as continuing care, could be reduced or means-tested and hotel costs in hospital charged, as in France and Germany.

This sounds like muddled thinking.

If it is poor value for money it should not be the automatic recipient of hypothecated taxes. Even if it does not compete for existing funding it should compete for the new.

The public relations finesse of a monopoly healthcare provider benefiting more from people dying makes one shudder.

The demographic timebomb this author has missed is that when inheritance tax is eventually collected from more 3.5% of the population it will destroy hundreds of thousands of middle-class and working-class families.

The existing threshold, £325,000, is ten times less than you can bequeath in the US before paying equivalent taxes. Ordinary people who sell the family home to pay inheritance tax are most unlikely to be able to buy another or, if they do, lumber each successive generation with another half of a lifetime paying off mortgages. If families were allowed to keep their homes then the state could concentrate its help on families that did not have them rather than leaving in place a tax that will eventually leave more and more properties in the hands of the buyers of last resort because ordinary people do not have perfect finances - foreign investors and newly created vulture funds.

The politics of tinkering with inheritance tax are becoming far too complicated. It should be abolished soon and replaced by a recipient tax whereby anybody can receive bequests and gifts up to a lifetime total of £325,000, this limit applying in 2015, above which the recipient pays tax on the surplus. The giver or bequeather would pay nothing.

A commitment should also be made to raise this limit to £1,000,000 in 2016 or 2017, financed partly by the removal of reliefs by then. The electorate would then have a clear choice: re-elect the party or parties who make this commitment or go for the party that makes much noise about helping people whilst taxing them more.


The ideologies of excessive taxation no longer wash. A party that does not move on inheritance tax without discriminating as to who is making the bequest may be blamed and is a hostage to electoral fortune. One that does move and can deliver now will reap electoral reward.



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31 March 2014

Ascertaining cardiovascular health early

Though criticism is directed here at those who think cardiovascular health is about taking statins and blood pressure agents it has never been directed at practising cardiologists.

I went recently to an in-the-city presentation by Papworth Hospital about its work and it was excellent in all its aspects with no superfluous material of any kind.

The authors of the Reform report mentioned above state:

A new integrated 'National Health and Care Service' would pioneer a 'co-producing' health partnership between state and citizen, with annual personal health MOTs agreeing responsibilities over the year for both services and the individual. At the heart of this relationship would be an NHS membership scheme, charging £10 a month (with some exemptions) collected through council tax for local preventative services to help people stay healthy.

If any such proposal is ever adopted it is important that people should be able to opt out of it without any pressure being put on them. Immense amounts of expensive doctors' time is expended talking about cholesterol and operating machines measuring blood pressure rather than addressing questions in hand. 20 years ago you could usually be certain that patient and GP met with a common purpose: to defeat disease. Now confidence in GPs is diminished by first having to address a string of NHS directives and incentives that may have nothing to do with it.

People do not want flannel that passes for health advice and which may be in other people's interests more than theirs.

This does not apply to all but they would rather have an ECG than tablets. They would rather wear an ambulatory blood pressure monitor for a day than be fodder for directive compliance and practice bonus schemes. If they have the slightest symptoms like angina they might like a CT scan to search for calcium in the arteries. A marketing scheme charging £10 a month is not a substitute for these.



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2 April 2014

Air pollution

With high levels of air pollution registering today in Britain and scheduled to remain around for a few days it is time health authorities more explicitly recognized the dangers and stopped selling soft soap. Statins do not reduce mortality rates but air pollution is estimated to produce 30,000 excess deaths a year in Britain [2]. Acidic compounds in the air irritate lungs. Particulates cross from the lungs into the bloodstream causing heart disease as well as depositing tar in lungs and stimulating respiratory disease.

Future air quality standards are not yet the main issue; tackling the low hanging fruit of air quality improvement now is. Without increasing duties for hauliers, petrol must be made permanently cheaper to buy than diesel per litre. Owners of high frequency use vehicles - diesel trains, taxis, buses, coaches, lorries - that are found to be emitting too many particulates could do with further incentives to upgrade.



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3 April 2014

Given the constraints the Chancellor of the Exchequer has done well in holding down fuel duty so instead of changes to fuel duty it might be simply easier to reverse the bias in favour of diesel cars in the company car tax scales so that petrol cars were favoured. Though this could be made revenue neutral a saving in public health costs would accrue anyway.

The reason that there are next to no diesel cars in Japan and few in the U.S. is because there are no artificial tax incentives in favour of diesel as there are in Europe including Britain.



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4 May 2014

For reasons principally of improved air quality and then of increased vehicle diversity I would favour seeing more electric vehicles on the road. Given the current state of battery technology, though, the argument that they will displace internal combustion vehicles in quantity is not convincing.

If you live in a flat without a garage or in a house without a drive or a garage, an electric car is an awkward thing to keep charged.

So a good all-electric car like the Nissan Leaf costing maybe a quarter more than an equivalent internal combustion car is not going to displace too many of its competitors but an all-electric Nissan Leaf with driverless technology costing twice as much would do so as well as opening up new markets for automobiles [3].

You could then command the autonomous vehicle after use to take itself away the short distance to a charging point or to be used by someone else and your residence would be unencumbered by the need to provide parking space. This would be a mini-revolution in itself for the built environment.

For reasons of road safety, what is known as Intelligent Transport Systems, should also be developed in parallel. If the predictions of its proponents are fulfilled then they could reduce 70+% of road traffic accidents.

The set of technologies that could reduce road traffic accidents by 90+%, however, are those for driverless cars.

So whatever other developments are covered on these pages - in battery technologies, in electric vehicles, in Intelligent Transport Systems - the principal aim in this area is to do something to help bring about the advent of driverless cars.



Google's first passengers-only driverless car, announced 28 May 2014


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23 June 2014

Encouraging national innovation

It is interesting that Sir James Dyson writes today that:

The government might herald Silicon Roundabout, but the next Frank Whittle won't be found in Shoreditch. They'll be found tucked away in a research lab actually developing something tangible. With such a focus on the here and now it's more important than ever that we support inventors in bridging the gap between concept and commercialisation.

It is true that the next invention will not come out of Silicon Roundabout as one gets the impression that it is mainly using well known and well tried technology to sell something to the consumer market. Typically this might be a games app for use on a mobile phone or tablet. This is an essential part of the economy.

It also true that the next big invention will come out of a lab, probably in a university.

What is not always the case is that the inventors want to be the ones who do the commercialisation. If they do, by all means support them properly.

What needs to happen with lots of inventions is that details of the technology need to be put within the national public domain.

By all means if there is reason to keep something under wraps for years do so but then expect to say relatively little.

Like the course of true love most inventions do not follow a straight path from concept to commercialisation. Conceptualising about commercialisation is necessary first.

Tesla is doing this to the annoyance of quite a few. There are advances in battery technology, probably quite modest, at one end and the business of selling electric cars to the public at the other but it is the conceptualising of the commerce that is interesting.

The money men may call it a business model but what it constitutes is a further step of creativity that even the venture capitalists do not usually have.

A few months ago I heard the Crown Representative for SMEs at the Cabinet Office outline a not dissimilar idea. Part of the resource available to British business is the sum total of scientific, engineering and technical knowledge already published. This is searchable, should be searchable.

In educating people to be scientists, engineers, architects, doctors and so on you are teaching them to search for any knowledge they can handle and then quite possibly to be creative in conceptualising commerce from something they neither invented nor are the best to manufacture.

I know this very well from an area I have lifelong experience of - building materials. Discover a material that might be usable in building and there will a flurry of people trying to find applications.

Take the now essentially defunct material, glass reinforced cement, discovered and researched in Britain in the late sixties, seventies and eighties. Some of the research was particularly inspired. Given it was fire resistant (potentially an excellent replacement for asbestos), good in compressive strength, of generally good durability and sprayable into all kind of forms, it had real potential but there were few attempts to manufacture it in volume. Nor would it have been sensible for the researchers, who much enjoyed their work, to commercialise.

It was in fact the designers of buildings who came up with applications, disseminated publicity materials for use, got reviews written and tested in real life situations. They drove much of the commercialisation but they neither invented nor manufactured the material.


A building with external GRC panels shortly after construction

Enlighten as to the nature of technologies that can be applied, as is the case with the ones being used in Silicon Roundabout, and someone will find an application.


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30 November 2014

To the above might be added something Lord Rees said recently:

Likewise, scientists shouldn’t be indifferent to the fruits of their ideas – their creations. They should try to foster benign spin-offs – commercial or otherwise. They should resist, so far as they can, dubious or threatening applications of their work, and alert politicians when appropriate. We need to foster a culture of ‘responsible innovation’, especially in fields like biotech, advanced AI and geoengineering.

But, more than that, choices on how technology is applied – what to prioritise, and what to regulate – require wide public debate, and such debate must be informed and leveraged by ‘scientific citizens’ – who will have a range of political perspectives. They can do this via campaigning groups, via blogging and journalism, or through political activity. There is a role for national academies too.

A special obligation lies on those in academia or self-employed entrepreneurs – they have more freedom to engage in public debate than those employed in government service or in industry. (Academics have a special privilege to influence students).



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11 July 2014

Financing the NHS

Former Labour health minister Norman Warner has been been back at it recently pushing his idea of turning the NHS into something like a club where you pay £10 a month to be a member and all with a left-leaning slant that leads one to wonder whether he is some kind of stalking horse for Andy Burnham's ideas. Mr. Burnham, good at making political statements about healthcare, has frequently been left trailing far behind, first by Andrew Lansley then by Jeremy Hunt, when it comes to tackling its detail. Someone producing the detail for him would not be a surprise as he has not articulated a great deal.

Given 50% of the population would struggle to pay this charge, it is a non-starter.

Given about 20% of all taxation is already spend on healthcare, this mechanism of paying a second way might be the last straw for some of the other 50%. It would be like the BBC both receiving a license fee and accepting paid advertisements on air. Either you do one or the other but not both.

Personally, I am not in favour of charges for accessing NHS GPs despite being a lifelong virtually nil user of general practice (and pharmaceuticals).

Free access to GPs means diseases can be caught early.

If an alternative, competing network of private GPs grew up charging Continental rates for consultations - about £30 a go - that would be a positive development but still most unlikely in Britain. The cost of premises in London make it unviable there and outside London the number of people willing to pay might be too slight. It is an idea worth trying outside London because it would serve as a comparator - appointments might prove to be much prompter, for instance.

If Lord Warner's proposals are intended to soften people up to the idea of paying for NHS GP consultations by disguising it as a membership scheme, it is misguided.

The only tolerably fair way of charging for NHS GP consultations that springs to mind is if everyone had a swipe card which they swiped after a consultation. If one were a higher rate taxpayer that year one would be charged a fee added to the tax bill for the consultation. If not, no charge would arise.

The doctors would not know who had paid, and rightly, but they would have to expect that occasionally someone would blow their top and say they were getting little for what they had paid. This would impose a certain discipline on general practice and is probably the main advantage.


Charging less than 20% of people for access would hardly solve an NHS funding problem which will manifest itself sometime in the next parliament.

If rising demand for healthcare can be taken as a given for a few years, the other problems that the NHS presents to the lay observer are safety, attitude, accuracy of interpretation of diagnostic tests, staffing quality, staffing levels and funding. (A discussion of external care is excluded here).

The biggest stride made in the last half decade in the NHS has undoubtedly been the acceptance and implementation of the Francis report. This advances the safety agenda. The government should be congratulated for this.

On attitude there is a rush against time to bring about change. Patients need to call the shots more never forgetting the near 20% of taxation that goes partly to fund NHS staff's livelihoods. The new head of NHS England appears to be signalling a move towards treatment tailored to the patient's actual requirements and wishes. The potential danger is a laziness that produces a patronising tailoring rather than a fully consultative tailoring.

Tailoring will cost money but the change must move on apace so that the NHS earns its spurs to deserve greater funding.

It cannot continue as at times in the recent past and expect the negative headlines to stop. Of course, most know that most of the staff are doing well for the patients but excellence also needs to be reached.


When the spurs have been earned then the funding answers can be delivered.

The solution that seems to create the least dissension is an eventual increase in National Insurance contributions.

It might increase accountability more, too, if National Insurance were reclassified as solely an NHS tax, shuffling off other elements of social security onto general taxation.


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31 August 2014

On the limit, the legal profession knows that politics has primacy over law. Politicians make the laws. Judges do, too, but at a very slow rate. This primacy is maintained partly because politicians understand the detail of law making.

From around 2004 onwards Labour abandoned almost wholly political primacy over the banking and medical industries substituting weak and ineffective bureaucratic checks. These industries to some extent hijacked politics to their purposes. This was partly because Labour had no one who could understand these industries or would trouble themselves to learn the detail. The omissions snowballed into the very lax regime that produced mid-Staffordshire and the banking crisis.

The banks were steadied in 2008 with little real change being imposed but the coalition has been the real saviour of the NHS. Whether Labour should be trusted again with the NHS and banking so soon is open to doubt given the paucity of detail it has provided about what it will do with these industries.

Is the mooted merging of the NHS and care a costly back door nationalisation of the latter?

How can regional banking work given the ineffective competition policy regime favoured by Labour when it was last in power?


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23 September 2014

An answer to the mystery of why Labour went into the last election promising to cut spending on the NHS became more apparent today.

It intended to let hospitals fend for themselves. If they needed capital investment they would have to use their own resources or use the Private Finance Initiative.

Further evidence of a bias against funding hospitals emerged at today's Labour Party Conference. From the paucity of detail given, it emerged that Labour now supposedly is going to hire a further 8,000 GPs and 20,000 nurses (at a annual salary bill of at least £1.5 billion per year for just these two categories of staff) but not a single hospital doctor and with no indication of any additional funding of treatments in hospitals if some of the additional nurses are to work in them rather than in the community or in GPs practices.

PFI was invented in John Major's time, was very sparsely used by his government and never used by him to fund the NHS. The great majority of PFI contracts in existence were signed off by the last two Labour Secretaries of State for Health.

Already England's ratio of hospital doctors to nurses is one of the worst in Europe though the government is making efforts to ensure better coverage by at least having more senior doctors in hospitals at weekends.

Labour's shadow health secretary also conceded on a radio programme today that he was in favour of cutting the number of hospital beds in order to treat in the community.

More treatment in the community is fine but there is now a limit to how many hospital beds can be taken out of the system.


Some of the advantage in outcomes that many Continental health systems hold over the NHS is due to spare capacity in their hospitals.

With little increase in capacity across the spectrum of NHS hospitals, more staff will have to work at weekends to increase throughput and efficient turnaround and this will mean more payments to hospitals.

A greater emphasis on treatment whilst staying at home rather than in hospital is desirable but delivery will be dependent on both a greater respect of patient autonomy and spending to set up new arrangements.

The new CQC inspection regime seems to be showing that much care in institutional frameworks outside hospital is not meeting best practice standards.

Standards can be brought up and money can be spent to do so but were Labour's national health and care service to be ushered in one has to ask in advance will hospitals be deprived of funds to bring the unnationalised care sector within the orbit of the state?



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24 September 2014

Labour abandons NHS hospitals to their own devices

Following the Labour leader's speech yesterday which signally failed to support NHS hospitals in navigating the future financially, the total absence of any words rectifying the omission or even mentioning future support for NHS hospitals by the shadow health secretary in his speech today indicates Labour's intention if it comes to office: hospitals must fend for themselves.

The NHS is safer in David Cameron's hands.



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Comment 2015