I’m not sure what could possibly have reminded me of it, but I’ve thoroughly enjoyed re-listening to this classic album.

One of my New Year’s promises to you was to grow the economy and today we’re announcing the second round of allocations from our levelling up fund … [to] help deliver on that promise to boost growth.

Politics aside… I can’t pretend that anyone will remember the content of Sunak’s remarks more than the fact that he was breaking the law as he gave them.

But I also can’t pretend that I didn’t wince at “delivering on” a “promise.”

Promises are for making, keeping, or breaking. Courier bikes are for delivering on.

And seatbelts are for safety.

I hope I leave New Zealanders with a belief that you can be kind but strong, empathetic but decisive, optimistic but focused.

Politics aside, as a set of aspirations for any national leader, those are hard to argue with—heck, they’re good rules for life.

As the NHS continues to collapse, you will hear a lot over coming days about 7,000 ‘extra’ hospital beds—the number the Government has pledged to ‘create’ to reduce A&E waits. This appears to be part of a conscious strategy, perhaps best described as ‘political numberwang’: bandy around a big number, and political journalists seem to freeze, with perhaps the only follow-up being ‘and how are you going to pay for it?’

Matt Hancock was a master of this art. By counting individual gloves separately, despite them being neither sold nor used as separate items, he was able to quote ridiculous figures for the ‘number of items of PPE distributed’. His inflated numbers made little difference to social care staff left wearing ‘aprons’ fashioned from bin bags.

7,000 beds sounds like a lot—but is, in fact, about half of one percent of the total number of beds available in the NHS. It’s far less than the 12,000 NHS beds occupied on Christmas Day by people fit for discharge but for whom no social care placement was available. It’s also less than 20% of the 37,000 beds cut from the NHS over the period since the 2010 General Election. And there’s no answer as to how these will be staffed when we’re already 40,000 nurses short of a full complement.

You’ll also hear a lot about an ‘extra’ £14.1bn of support the Government has pledged over the next two years to help ‘tackle the backlog’. That’s a roughly 4% of the NHS budget—a fraction of the cost of inflation alone.

Numberwang cannot fix health and social care, and I’m not even sure it’s a successful strategy for propping up electoral support any more. We can’t go on like this.

A couple of days ago, Wendy and I took a taxi from our hotel in San Diego to the airport, very kindly paid for by our hotel. The taxi driver was a chatty fellow and struck up the traditional “going to the airport” conversation beloved of taxi driver across the world.

Wendy mentioned that she was from Northern Ireland, which led to all the usual questions: Is that part of the UK? Is all of Ireland in the UK? Don’t the Northern Irish fight with the UK? Is Northern Ireland part of Brexit?

But then: What do people in the UK make of Trump?

Now, I thought we were on safe territory here. We were in California. Even I, as an uninformed Brit, knew California to be a true blue Democratic state. No Republican presidential candidate has won California this century.

Nevertheless, I played it safe with a politely non-committal response, suggesting that while Trump wasn’t personally very popular in the UK, Brits respected the outcome of the election, and the country is so interested in his impact that he’s rarely out of the British newspapers.

The taxi driver’s equal non-committal, “he’s surely shaking things up,” didn’t give any immediate indication of the transgression I’d made.

It was harder to remain neutral on his follow-up: “So what have you thought about guns while you’ve been here?”

Wendy’s eyes widened slightly as I admitted that I’d been slightly uncomfortable to see so many people with guns, from policemen on the streets to the border control officer who’d stamped our passport. This, I explained, was very different to the situation in the UK.

“But police are armed in the UK, right?”

I explained that a small number of officers carry weapons, and that there are armed rapid response units, but that the average police officer on the street carries nothing more threatening than a truncheon.

I’m afraid, dear reader, that this provoked a rant from our driver.

Firstly: “So that’s why you have so many terrorist attacks!”

Secondly, he asked whether I have heard of the campaigns in the UK for wider gun ownership. When I admitted ignorance, he blamed “the liberals that control your media”.

Thirdly, returning to California, he described his incredulity at the fact that he, both in his capacity as a private citizen and as a professional taxi driver, was not permitted to carry a concealed weapon. He told us how he was once, some years ago, robbed when getting out of his taxi. This would not, he suggested, have happened had he been carrying a concealed weapon.

Fourthly, he told us how Trump wants to allow anyone to carry a concealed weapon, and that this made him a great President. Our driver wasn’t sure that unrestricted concealed carrying of weapons would be allowed any time soon in California, because that state had “crazy laws” and a “corrupt Democratic governor”. He claimed that the Governor “hates guns and doesn’t want anyone to have them”.

Fifthly, he asks if we in the UK had ever heard of Crooked Hillary? “They call her that for a reason,” and one of the reasons is that she wanted to take away all the guns. Which would only lead to endless terrorist shootings like in the UK. He didn’t say that she should be locked up, but he might as well have done.

When I could get a word in edgeways, I pointed out that we had had no recent terrorist shootings in the UK. The driver said I was lying, that there was that arena attack in Manchester when all the kids were shot. I had no chance to point out that guns weren’t involved.

Sixthly, our driver told us that the many school shootings “around the world” were only being effectively tackled in the US, where upstanding citizens with guns shoot dead the shooters.

At this point, we pulled up outside Terminal 2 of Lindbergh Field and Wendy and I barrelled out of the taxi while thanking the driver excessively in a very British manner.

As he drove away, Wendy and I looked at one another and breathed. I think we were both in a sort of mild shock. The conversation made us reflect on how one can’t really have a sensible political conversation with someone whose factual frame of reference is so divorced from reality.

It made me reflect on the threat of “fake news” – a problem long before social media came along, but perhaps amplified by it. Continual exposure to counterfactual stories shifts one’s frame of reference, and make seemingly illogical conclusions entirely rational.

It made me reflect on how much more difficult political life must be these days: how can a politician ever thrive if their views are misrepresented even by their supporters and to their supporters? A politician cannot deliver on a promise they have never made, and cannot defend themselves against false accusations when every correction is percieved as a “cover-up”.

This conversation was something of an epiphany for me, helping me to see how broken this part of our society has become. In decades past, we lived in a world where the means of publication were (to all intents and purposes) controlled, and we could (by and large) distinguish fact from fiction. Today, anyone can publish anything, and few people have the will or means to verify any of it. We’ve moved from a world of limited reliable information to a world where every scrap of information is at our fingertips, but we can’t tell which morsels are fact and which are fiction. And yet, in a democracy, we rely on the population making that distinction accurately in order to make the right decisions for society.

I have no solutions to offer for any of this. In his book, Ryan Holiday suggests that subscription-based news is the answer, as it places value on truth over page views. The BBC likes to present itself as part of the answer. Tech companies sometimes suggest that the algorithmic triangulation of stories can play a role. People with minds more radical than mine might suggest that this is the time to find some other form of democracy than directly voting for a legislative representative.

I’ve no idea who is right. But in the course of one taxi journey, I’ve been convinced more than ever that an answer is urgently needed.

The taxi image at the top of this post is by Ad Meskens. It gives the slightly misleading impression that Wendy and I were travelling in a yellow cab, when in fact we were in more of van. The gun hoslter image in the middle of the post is by Takeshi Mano. Both images are used here under their Creative Commons licences.

An interesting article by Will Jennings and Christopher Wlezien in today’s Times Red Box pointed me in the direction of their recently published paper in Nature Human Behaviour on the accuracy of pre-election polling. Their conclusion, in a nutshell, is that polls are becoming better at accurately predicting the outcome of elections.

This gave me pause for thought: are polls designed and intended to reflect the outcome of an election? Or are polls about reflecting the views of the population at a point in time?

My hunch is that they are more often designed for the latter purpose. Most polls ask how people would vote if there were an election today. I’m not aware of any polls that attempt to correct for the typical post-election “honeymoon” nor the typical midterm “slump” in their efforts to better predict the next election result.

If my hunch is right, then it’s probably unfair to talk about poll “error” when the results of polls conducted well before elections do not match the election results. More importantly, it puts a different spin on their findings.

Assuming all other things are equal (which they are most emphatically not), then late polls better reflecting the outcome of an election suggests that they are better reflecting the views of voters. Assuming that this increased “representativeness” carries across the election cycle and that polls are measurements rather than predictions, then mid-cycle polls more accurately reflecting the final outcome suggests that the population’s views are becoming more intransigent. (In truth, I’ve no idea whether or not this fits their data, it just seems like it might.)

I don’t know whether that is true or not, but it certainly feels like it might be. I feel like things are reaching a point where people are no longer willing to engage with alternative political views, let alone change their own view. On social media, in particular, I see people who didn’t have had a clearly defined political view five years ago now suggesting that those with differing political views necessarily have malintent. This goes for both sides of the political debate. This never seems a particularly good strategy to me – I don’t think many people have their views changed through the hurling of insults!

The picture at the top is by RachelH_ on Flickr, used under Creative Commons licence.

There are roughly half a million beds in residential or nursing care homes in the UK.¹ Private providers operate almost all of these beds (90%) though the sector isn’t particularly lucrative: the average operator draws a profit of less than £5 per resident per day. Most beds are funded either in full (40%) or in part (10%) by local authorities. The NHS pays for a few (5%).

Central Government funding to local authorities was cut by 25% per person over the period of the last Government, though these cuts were not uniformly distributed across the country. This came on top of smaller reductions in funding over the previous five years. As a result, local authorities had much less to spend on social care. The number of day care places plummetted by 50% over a decade. About 20% fewer people received local authority funded care in their own home. And, partly as a result of this, the number of older people in residential or nursing care homes rose by more than 20%.

Over the next five years, we will see a perfect storm in social care for elderly people. The number of people aged over 75 is predicted to grow from 5.3 million today to 6.1 million in 2020 (a virtually unprecedented rate of increase, almost double what happened over the last five years). Yet Central Government funding to local authorities is to be cut further. Funding is being reduced while demand is predicted to increase more than ever before.

The burden will fall on the NHS, as it is in NHS beds that people often wait for care home places. The absurdity of this is that the average per-night cost of staying in an NHS hospital is three times greater than the average care home cost.

Yet there is another insidious factor imposed by Government which will push this situation from ‘substantial problem’ to ‘perfect storm’.

Most workers in residential and nursing care homes are paid minimum wage. By 2020, this will rise fromt £6.50 to £9.

Few could argue with giving hard-pressed workers a living wage. But given that average care home profits are less than 21p per patient per hour, care homes cannot maintain their current charges while increasing staff wages by £2.50 per hour. Yet they cannot raise their fees because Government cuts mean that local authorities can’t pay.

So what happens when care costs increase and funding decreases? First, care is cut: HC-One, Britain’s third-largest care home provider, is already training carers to take on highly skilled tasks which were previously done by more experienced and expensive nursing staff. But, since the cost of those carers is also increasing rapidly, this is only a stop gap solution. As Southern Cross, previously the UK’s largest care home provider, showed in 2011: care home providers can and will collapse.

As care home companies collapse, the supply of care home beds collapses with them. More elderly people get ‘stuck’ in NHS beds, at much greater cost to the taxpayer, and much greater risk to their own health.

And, to add extra thunderbolts to the storm, the number of NHS beds is decreasing rapidly: by nearly a quarter over the last ten years, with no sign of slowing. In this context, an increase in elderly people needlessly occupying NHS beds due to a lack of social care will cause the NHS to grind to a halt.

The underlying problem here is that the Government fails to understand that protecting NHS funding does not protect NHS services. Health and social care are two arms of the same beast: cutting one leaves the other with more to do. Yet the long-term solution isn’t obvious: there are limits to the burden of tax people are willing to carry to fund health and social care services.

The forecast is for bigger storms ahead.

It’s said that so-called ‘shy Tories’ swung the General Election: those people who are unwilling to admit to pollsters that they vote Tory for fear of a negative response, but who put their cross next to a Conservative candidate’s name in the privacy of the polling booth.

‘Shy Tories’ is basically a shorthand for a particular form of social desirability bias. When asked questions by pollsters, we may be unwilling to admit views that we think might upset pollsters. After all, most people like to please people.

Online polls, so the theory goes, should be less susceptible to social desirability bias because they remove the imposing pollster from the equation. Peter Kellner, President of YouGov suggests:

One of virtues of online research is, or should be, that it allows respondents to submit their views with complete anonymity, as there is no stranger watching over them or listening to their answer.

Or should be. An important caveat given that YouGov, online pollsters, were as wrong in their General Election predictions as telephone pollsters.

So perhaps social desirability bias exists online just as much as elsewhere. Perhaps. And there’s an intriguing piece of evidence from, of all places, Netflix, which described this week putting much greater emphasis on recommending shows based on what people actually watch, as opposed to how they rate individual shows. Todd Yellin, Netflix‘s VP of Product Innovation reports:

Most of our personalization right now is based on what they actually watch, and not what they say they like, because you can give five stars to An Inconvenient Truth because it’s changing the world, but you might watch Paul Blart: Mall Cop 2, three times in a few years … so what you actually want and what actually say that you want are very different.

Is rating something highly because it’s changing the world rather than because you actually enjoyed it a form of social desirability bias? I reckon it probably is. I reckon it’s an attempt to make ourselves feel more educated and ‘worthy’.

And if we fake our Netflix ratings, conning only ourselves, why wouldn’t we equally fake our responses to online polls?

My friend James O’Malley argues on his blog that 16- and 17-year-olds should be given the vote as it will help to tackle the seemingly undue attention given to old people by political parties:

By increasing the potential pool of voters at the bottom, it affects the potential electoral mathematics that the parties have to do to maximise their votes. If there are more young people who can vote, it tips the scales back towards the young. Pensioners might be reliable voters, but if there were an extra 1.6 million (ish) young people on the electoral register might be a greater motive for refocusing policies and priorities.

I’m undecided on whether 16- and 17-year olds should be allowed to vote―I see good arguments on both sides―but I think that James’s specific argument is wrong for reasons mathematic and democratic.

First, the maths. For the purposes of these back-of-the-envelope calculations, I’m using ONS projections for England (as that’s what I have at hand), defining the “youth” vote as 29-and-under,¹ and defining the “grey” vote as sixty-and-over.

Currently, the “youth” vote accounts for roughly 20% of eligible voters, versus roughly 29% for the “grey vote”. Giving the vote to 16- and 17-year olds would move these percentages to about 22% and 29%: that is to say, it wouldn’t make much difference. And the difference is lessened further by the fact that most people agree that the “youth” vote is less likely to turn out than the “grey” vote.

But, of course, the real imbalance in the “youth” versus “grey” votes isn’t in 2015. The population is ageing: the scale of the imbalance today is nothing to what the scale of the imbalance will be in the future.

If we fast-forward a couple of decades to the 2035 election, ONS projections suggest that the “youth” vote (as currently defined) would make up roughly 18% of the electorate, versus 37% of the electorate being “grey” voters. Giving 16- and 17- year-olds the vote rebalances this a titchy bit (to 20% and 36% respectively), but this difference is really so little as to be meaningless―the imbalance remains far greater than it is today.

My second problem with James’s argument is democratic. He reckons that the makeup of the electorate needs to be changed to better ‘balance’ it in age terms, because generational disputes cause problems in our country. As an example:

The old, who own property want the value of their homes to continue to increase, whilst it would be better for the young people who Ed Miliband calls “generation rent” if property prices were to fall, so that buying a house can become even a remote possibility.

But, surely, to suggest that’s a problem is profoundly undemocratic! We have decided that the best way to run our nation is by the majority electing representatives who they think will best serve their interests. The majority of the population is ageing. We shouldn’t go around thinking of ways to “fix” the result to better reflect youth interests because the youth is in the minority.

If we stick with our current form of representational democracy, then, for the foreseeable future, our politics will continue to be determined by the “grey” vote as it is the “grey” vote which makes up the largest part of the electorate. The different electoral turnouts between the generations certainly exacerbate the problem, but they are not the source of it.

Having said all of that, there is a problem here. Actually, it probably is unreasonable for the electorate to become so imbalanced: not generationally imbalanced, but gratuitously imbalanced between net financial contributors to the state and net financial users of state services. It’s hard to see how a state can function when politicians essentially only have to appeal to those who use the state’s services (especially the elderly), and have to appeal less to those who (by and large) pay for it (largely the working aged). It becomes perfectly logical for politicians to whack up tax rates or borrow with little regard for the future.

Of course, this probably won’t actually happen. It’s more likely that the “grey” vote will be effectively capped at a certain size as people work longer, as neither the state nor individuals can afford to pay for pensions which increasingly approach or exceed the length of an individual’s working life. And, of course, outrageous levels of tax and spend would provide a good incentive to improve low turnout in the younger section of the electorate, which would provide a degree of rebalance in and of itself.

On the other hand… things could get worse more quickly. We’re seeing national and international narrative opinion increasingly extending the length of childhood. We’ve already seen in the UK a major shift in legislation pushing the end of childhood (in terms of, for example, school leaving and consumption of cigarettes) from 16 to 18. There is increasing scientific evidence that key elements of development, particularly emotional development, continue until the early 20s. UNESCO considers our period of “youth” to continue until 25. The African Youth Charter considers it to continue until 35. In this context, it’s not inconceivable that a future government might choose to increase the voting age, not decrease it.

❧

To summarise: give 16- and 17-year-olds the vote if you want. But do it for good reasons, not because you want to “fix” the outcome of elections in a way that will matter little and matter for a short time. And go and read James’s post, too.

Answer me this: what happened to waiting times in A&Es in England last week? To help you answer, here are some tweets published by reputable news organisations today:

A&E waiting times in England improve to their best level since November, figures show http://t.co/N2ib5ttFyO pic.twitter.com/YVALTkJ9qW

— BBC News (UK) (@BBCNews) January 23, 2015

A&E waiting times in England improve http://t.co/mQtiuk12yc

— The Guardian (@guardian) January 23, 2015

NHS England pays tribute to staff after figures show slight reduction in A&E waiting times http://t.co/PNOq2Yyv9Y pic.twitter.com/mvQfNX3eHS

— ITV News (@itvnews) January 23, 2015

A&E waiting times improve but fail to hit target http://t.co/cC7NO055aB

— PoliticsHome (@politicshome) January 23, 2015

A&E crisis: Waiting times improve for second week running http://t.co/tNTEYstIx6 pic.twitter.com/jWk9FKELmH

— Telegraph News (@TelegraphNews) January 23, 2015

You would be forgiven for thinking that waiting times had reduced. You would be… possibly right, possibly wrong. The correct answer is that we don’t know. Performance against the weekly A&E waiting time targets—which is what all of the above are actually reporting—tells us nothing about the waiting time in A&E.

As an aside, before we get into this properly, I should clarify that “waiting time” doesn’t mean what most people think it means. The “waiting time” referred to in these statistics is the total time a patient spends in A&E, from the moment they walk in the door, to the moment they walk out again (whether that is to go home, to go to a ward, to go to the pub, or wherever). That’s not what we think of as “waiting” in common parlance: while you’re with the doctor, you are—in statistical terms—still “waiting”.

The NHS doesn’t report on waiting times, only on the proportion of patients seen in less than four hours. When the reporters wrongly say that A&E waiting times have improved, what they actually mean is that a greater proportion of people entering A&E are leaving again in less than four hours. This tells nothing about the amount of time people wait on average.

Imagine an A&E department that sees only five patients: A and B have minor injuries, and are seen and treated within 30 minutes. C and D need a more complex set of investigations, so end up being in the A&E department for 3 hours. E needs a very full assessment and ultimately admission; as a result, E ends up being in the department for a total of 5 hours before a bed can be found. The average time these patients spend in A&E is 2 hours and 24 minutes; 80% of them were discharged in 4 hours.

Now let’s say that someone puts a laser-focus on that 80% and says it’s unacceptable: whatever the cost, it must be brought down. So the department tells the nurse that used to do the “see and treat” job (which served patients A and B so well) that she must help with only the most complex patients, because they are breaching the target.

The same five people with the same five injuries now come into the revamped A&E. A and B have minor injuries, but now must wait alongside everyone else. They hang around for 3 hours. C and D need complex investigations, but these are slower to start because of people with minor injuries clogging up the queue. They are discharged after 4 hours. The new complex patient team deals with patient E slightly faster, getting her up to the ward with seconds to spare before the four-hour deadline.

100% of patients were seen within 4 hours. The hospital’s management is overjoyed! The BBC tweets that A&E waiting times have decreased: 100% of patients are seen within four hours instead of 80%. Politicians become a little self-congratulatory.

Yet… what has actually happened? The average waiting time has increased from 2 hours and 24 minutes to 3 hours and 36 minutes. 80% of patients are waiting longer than they did before.

And that is why—whatever the news tells you—we have no idea what happened to A&E waiting times last week. The average time could have doubled; it could have halved; it could have stayed precisely the same. We simply do not know.