Category Archives: Britain

Britain, Economic, Financial Markets, Government, Society

Brexit, oil prices and global trade: factors hindering economic recovery

ECONOMIC

DESPITE the uncertainties surrounding Brexit the range of expectations for UK growth for 2019 is relatively narrow – between 1 per cent and 2 per cent. A recent poll found that no economist expected an outright contraction next year; nor did any expect a boom. Rather, the most likely scenario is for growth of 1.5 per cent, which, the Bank of England believes, is around the UK’s new lower trend rate. The International Monetary Fund (IMF), which has also refreshed its global forecasts, expects roughly this same rate of growth in Britain to persist over the next five years.

The Brexit saga is probably the most obvious risk facing the economy. Whatever one’s view of the longer-term Brexit effect, a “no-deal” outcome could lead to the economy plunging into recession, while a “good deal” could boost confidence, investment and consumer spending and thereby economic growth. But Brexit is far from the only risk in town.

Indeed, there are plenty more global concerns that may yet scupper the recovery. After all, the British economy – unlike the United States and other relatively “closed” economies – is highly dependent on the outlook for global growth. And across much of the world forecasters see growth slowing over the coming years, even without some of the more disastrous risk scenarios crystallising.

What are the key global risks that might come back to bite the UK? First, there’s China. Many think of China as being a source of cheap imports but it is also Britain’s sixth largest goods export market. On one measure, published by the IMF, China overtook the US as the world’s largest economy in 2014, so attempts to reduce its debt pile after many years of spending could present a significant threat to global growth.

Fiscal largesse in the US is boosting growth there, but as President Trump’s splurge comes to an end the economic hangover could spread far beyond its shores. On this side of the Atlantic, the European Commission is likely to complain about the high budget deficits planned by Italy’s populist government, providing another source of market stress. Then there’s the issue of protectionism. Global tariffs have fallen significantly since the interwar period and remain low even after recent increases between the US and the EU/China. Even if these moves do not directly affect Britain, an escalation in trade disputes could yet be the precursor to weaker global confidence and exports, both to the UK’s detriment.

Oil prices could become a destabilising global force. Prices have fallen a little over the past few weeks but remain high at above $80 per barrel. Had strong global demand been the cause, that might have provided a counterbalance. But when prices rise because of supply constraints net oil importers such as the UK suffer increased costs with no improvement in demand conditions.

Higher energy prices also tend to leak into general price inflation. For now the inflation genie remains in the bottle, with rates of inflation across the G7 in a tight 1 per cent to 3 per cent range. But past above-trend rates of economic growth alongside unemployment rates at their lowest in a generation suggest upside risks to inflation. If not met with rising wages, that would reduce household spending power and could also prompt central banks to raise interest rates more quickly. Not only does that directly curtail domestic spending but for those countries that have taken out foreign currency loans (such as Turkey or Argentina) rising global interest rates push up their repayments and the risk of more widespread emerging market panic.

Recent moves in equity prices reflect all of these concerns; the FTSE 100 index fell to below 7,000 to a six-month low earlier this month. Investor concerns relate to the fact that neither central banks nor government exchequers can be sure their armoury is sufficient to deal with another crisis, should one arise. Banks may be more resilient now but they may not be the source of the next economic downturn.

Brexit is one of many global concerns that have increased the risks of another downturn in Britain and beyond. These risks will require careful navigation by policymakers if another downturn is to be avoided.

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Britain, Europe, NATO, Nuclear Weapons, Russia, United States

The nuclear détente withdrawal makes the world far more dangerous

ARMS CONTROL TREATY

TENSIONS between the world’s two nuclear superpowers have reached a level not seen since the early 1980s.

During an election rally in Nevada, President Trump said that Russia was cheating on the 1987 arms control treaty. The treaty banned land-based cruise missiles in Europe.

An agreement had been made back in 1987 between Ronald Reagan and Mikhail Gorbachev – leaders who trusted each other enough to take a decisive step in ending the arms race which had been a key feature of the Cold War for the previous four decades.

Now Trump, in response to Putin’s cheating, is saying he will pull out of the treaty altogether. And the world is back to the hair-trigger situation faced before détente introduced arms control between East and West.

The fact is that the new highly-mobile missiles which Russia have developed undoubtedly make the world a far more dangerous place. And Donald Trump’s aggressive chest-beating response risks making an already fraught situation worse.

To understand why, we must look at how Putin has broken his treaty obligations.

The Intermediate Nuclear Forces (INF) treaty banned Russia from having any land-based intermediate nuclear missiles with a range of more than 300 miles. Sea-launched missiles were allowed, however – the theory being that they were more difficult for Russia to hide because the submarines and warships from which they were launched could be tracked and monitored by the West.

As a result, instead of the lumbering land-based SS20 missiles which worried the West so much in the 1980s, Russia has concentrated over the decades on developing much smaller missiles that can be launched from the sea. Such missiles, albeit without nuclear warheads, were used to devastating effect against rebels in Aleppo in Syria.

What Putin’s technicians have now done is to adapt these Kalibr sea-launched systems to make land-based cruise missiles capable of being transported by small trucks. They can be moved across country at 50mph and it would be impossible to track every one of them – making a surprise attack technically possible.

And the missiles, which fly under the radar, have been fitted with supersonic boosters which makes them practically impossible to intercept. This puts a vast swathe of NATO countries, including Britain, theoretically in the firing line.

 

WHY this is so disturbing is that it fits into Putin’s tactical strategy. Today’s Kremlin chief is ruthless, but worse he runs a Russia much less moribund than the wheezing Communist colossus of the 1980s. Putin’s armed forces are much leaner and meaner than in those days.

War in the 21st century has been practised already from Syria to Ukraine and in cyberspace. Putin knows he doesn’t need two million badly trained soldiers to be sacrificed in the trenches.

If it comes to war, he’ll need the best cyber-sabotage, the most effective special forces and, crucially, unstoppable medium-range nuclear missiles. Which he now seems to have acquired, despite the treaty.

This is why Trump has reacted so vigorously. Playing the tough guy also plays well to his core supporters, and he faces mid-term elections in two weeks’ times.

The trouble is that by dropping the Intermediate Nuclear Forces (INF) treaty now might suit Russia better in the coming years than the US. While for America the INF treaty has been a useful bulwark against nuclear escalation and proliferation, Putin’s strategists have chafed at the restrictions INF imposed on them.

By ripping it up, Trump will be criticised by European leaders – Germany was the first US ally to do so, with foreign minister Heiko Maas urging Washington to consider the consequences both for Europe and for future disarmament efforts.

All of this will delight Putin because it plays into his divide-and-rule approach to Europe.

More worryingly, if Trump does dump the INF agreement, there will be nothing to stop Putin’s generals from building and refining as many of these new faster-than-sound land-based nuclear missiles as possible.

Other nuclear powers, especially China and probably India and Pakistan, will want to buy them if they can’t build their own.

This technology is so easy to hide, swift to deploy and difficult to stop that it steeply increases the chances of a successful surprise nuclear attack. Worse still, without the trust between the US and Russian leaders that existed in Reagan and Gorbachev’s day, diplomacy is on a hair trigger – as in the worst days of the Cold War.

President Trump has declared he wants to make America safer, but we should fear he has made the world an even more dangerous and tense place. According to Mikhail Gorbachev, pulling out of the historic US-Russia arms treaty now “endangers life on Earth”.

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Britain, Government, Society, Technology

Artificial Intelligence (AI) is the future of the NHS?

HEALTHCARE

TIME is money, and for the NHS crucial in how it operates. A government which cannot get waiting lists down, for example, risks public ire. Gaping chasms in service provision would mean shelling out on locum doctors and private procedures.

Commonly, the government bows to popular pressure and loosens the purse strings, which might involve unpopular tax rises.

Yet, there is another way – one that would put an end to long waits, understaffing and bed-blocking. Artificial Intelligence (AI) could transform the NHS into a lean, hyper-efficient, cost-effective modern medical system. It may sound far-fetched and even sinister, but the age of automated medicine is already upon us. The question is, will we benefit from it or retreat through lack of will or vision?

Some 40,000 patients in London have signed up for this brave new world. They are registered on GP at Hand – a chatbot, or online conversation simulator, capable of screening symptoms and referring patients either to a GP for diagnosis or another service.

Babylon Health, developer of the technology, announced earlier this year that the latest version of its app could diagnose ailments with at least as much accuracy as a GP, in some cases more.

The chatbot was tested against 100 patient scenarios and assigned questions from the Royal College of General Practitioners (RCGP) membership exam, the assessment all GP trainees must pass to be fully accredited. On its first attempt, the chatbot achieved a pass rate of 81 per cent, which Babylon has been keen to contrast with the average score of human GPs – 72 per cent.

 

THE next generation of GPs could look more like an animated robot that pops up on your smartphone or other electronic device. GP at Hand cannot prescribe medicine, for now, but the scope is there to develop products such as this into an autonomous all-round primary care service. In the GP surgery of tomorrow, the app will see you now.

Dr Ali Parsa is founder and chief executive of Babylon. He says his company’s product makes primary care more affordable and accessible but not everyone is convinced of the case for robot-GPs.

The RCGP is by no means Luddite but it makes sceptical noises when asked about AI annexing large parts of the primary health terrain. Every day the NHS delivers care to more than a million people across the UK, taking into account the physical, psychological and social factors that impact on a patient’s health. When formulating treatment plans, medical practitioners consider the different health conditions a patient is living with and the medications they might be taking. Some may say that no app or algorithm will be able to do what a GP does.

Much of what GPs do is based on a trusting relationship between a patient and a doctor. Research has shown that when GPs have a gut feeling something is wrong with a patient they are frequently right, even where there is a lack of obvious clues to a diagnosis.

Despite such misgivings, momentum is with the tech pioneers. A world of choices is opening up. Apps and chatbots are putting control in the palm of our hand and, once patients get a taste of choice, they will not give it up easily. In fact, they will only want more.

The hospital operating theatre is also at the vanguard of the medical tech revolution.

The da Vinci robot, in use in parts of Scotland, replaces the surgeon’s scalpel with a computer console. The surgeon guides robotic arms, which perform all the necessary moves. This allows operations to be carried out more quickly, less invasively, and patients can be discharged in days.

In the future, surgical robots could be controlled so remotely that the finest surgeons in the United States perform the most arduous operations on patients thousands of miles away in some of the world’s poorest countries. Eventually, surgeons could be removed from the equation – or see their role changed to one of programming and overseeing fully autonomous surgical bots.

Technology is also our best defence against some of the biggest killers out there. Consider, for instance, the work of Memorial Sloan Kettering, the leading US cancer clinic, who have combined with computer giant IBM. Together they have developed Watson Oncology, which runs a patient’s symptoms through a database and arrives at the optimal treatment plan.

At the high-end of oncology, this may reduce the time spent selecting the right treatment from months to minutes. In a field where time is a matter of life and death, programmes such as Watson allow doctors to share information, begin therapies sooner and, it is hoped, improve survival rates.

Imagine what such a system could do for priority waiting times and survival rates in the NHS. The effect would be transformative. It would be a game-changer and life-saver.

In Scotland, meanwhile, the mental health crisis has finally been acknowledged and even assigned a dedicated minister, but progress can only be described as achingly slow.

Support for those who suffer from depression, anxiety and other related conditions still takes too long to access and too many frontline staff know too little about the subject.

Cognitive Behavioural Therapy (CBT) is scientifically proven to treat severe anxiety, but for many health boards across Scotland this form of promising treatment simply isn’t an option, or if it is waiting times can be as lengthy as 18 months.

Of course, for every troubling experience with the NHS, others will have nothing but praise for the care received. But when it comes to mental health services, the NHS still has a lot of work to do.

Once again, AI provides part of the answer, this time in the form of Tess – a mental health chatbot designed by San Francisco start-up X2AI.

 

ITS founder Michiel Rauws drew upon his own struggle with depression to devise a bot that talks, listens and processes information like a therapist. Already being trialled in Canada, Tess is more than a Q&A programme: she records patients’ symptoms, emotions and experiences and stores them for future mental health episodes.

Tess remembers which stressors are likely to bring on a panic attack in a given patient and recalls what helped to lift another patient’s mood during their last depressive incident. Patients who lack the time, finances or confidence to see a regular (human) therapist can pull out their phone and be supported instead by Tess.

Such apps could give the healthcare industry the upper hand in the treatment of mental ill-health. For the NHS, it could dramatically cut waiting lists and buy the health service time to retrain medics to deal with mental health patients.

The tide of progress is rapid but turbulent, too. You need not be a clinical expert to recognise the dangers inherent in a dreamy techno-utopia of automated medicine.

Would software have built-in assumptions in favour of retaining a patient and therefore not making necessary referrals? How does AI replicate a doctor’s ability to spot warning signs of which a patient is unaware? Could an app, with enough autonomy and data, begin to play God and ration care according to a patient’s financial burden on the system or estimated longevity?

That’s not to mention the inevitable teething problems when any major tech programme is rolled out – except, with people’s lives on the line, mistakes cannot be undone with the click of a button. Then there are concerns over data security and patient privacy. Theoretically, patients could game the algorithm to jump the queue for a hospital referral or to access unnecessary prescription drugs.

These are among the primary hurdles which AI advocates must overcome, but most have a technological solution and can be tweaked out of the system as they arise.

More difficult is convincing those wary of the technology. Yes, AI could be the saving of the NHS – but for patients not au fait with apps and data and bespoke digitisation, all this talk of robotic surgery and GP chatbots may be confusing and unsettling.

Some are quite content to pop along to visit the GP they have been seeing for 40 years and do not relish the brave new world of Dr Finlay’s Chatbot.

AI has the potential to transform the NHS, but it must be implemented in an equitable way that enhances traditional GP services and doesn’t benefit some patients at the expense of others. Some patients love technology, whilst many others don’t. The health service must ensure that its use does not inadvertently widen healthcare inequalities.

Undoubtedly, this is going to take gradual reform, patience, and lots of public information programmes. The human dimension – of patient and doctor – must remain at the heart of the NHS ethos.

Ultimately, however, change is inevitable and technological innovation is arguably the NHS’s best chance of avoiding managed decline. Not only can it slash waiting times, reduce bed-blocking and improve patient care, technology is an answer to an increasingly unsustainable funding model.

Using AI to bring patients fast, cutting-edge treatment finally opens up an honest debate about cost. The private version of the Babylon app offers a free symptom checker but charges £4.99 monthly for unlimited access to a real GP. Included in the price are consultations via text message or video chat software FaceTime, 12 hours a day, seven days a week. One-off check-ups cost £25.

If the NHS can commission apps that meet all the basic requirements for primary healthcare consultations or outpatient services – reducing waiting times and freeing up staff in the process – there is a powerful case for offering patients the choice of faster care subject to a modest monthly fee. The principle of “free at the point of use” would continue, while such a scheme of rolling payments would not be very different from National Insurance, only voluntary.

Here is why the inherent conservatism of the public sector, quietly grinding its teeth up until now, would burst forth in full, Nye Bevan-quoting indignation. Such charges would be “a betrayal of the NHS”, “back door privatisation”, and all the other maledictions cast in the direction of even modest reform. There would be marches against a “two-tier NHS” and petitions for every smartphone in the land to be smashed to pieces.

It will take a great deal of political will to overcome vested interests and guide new ideas through the swamp of dirigiste group-think that passes for health policy in the UK. Any attempt to secure the long-term future of the NHS through reform, innovation and efficiency is met with wails of odium. Far from saving the health service from the evils of the profit motive, the reactionaries make it more likely the service will eventually collapse.

The Healthcare Quality and Access Index, the annual measure of the world’s best medical systems, places the UK 23rd.

This puts us behind Slovenia, with its mandatory and voluntary insurance tracks, and Sweden where patients must stump up co-payments to see a GP, visit hospital or even use an ambulance.

The NHS, while a proud national achievement, is nonetheless not the best healthcare system in the world – not even close.

 

CONFRONTING the reality – and setting aside sentiment and hysteria to accept that, across Europe, universal insurance-based models provide superior quality of care – allows us to ask some taboo questions. Could the NHS be made more cost-efficient, clinically effective and patient-friendly by introducing (modest) co-payments and fees for certain services?

Does AI hand us a laboratory to test patients’ receptiveness to charges? Will digital innovation steamroll over barriers to increased private sector involvement in health provision?

This is the real technological revolution in healthcare. An outdated model of funding and provision may not be able to withstand the momentum of rapid change, rising patient demand, and even buy-in by clinicians. If the NHS accepts the need for change, it can reform of its own accord and harness technology to safeguard Britain’s universal healthcare system for generations to come.

If it digs in its heels and puts roadblocks in the way of progress, it makes it all the more likely that the health service will have to undergo radical, painful surgery down the line. Allow the NHS to drift down that path and it will have a great deal less influence over where it ends up.

An NHS powered by AI could compete with some of the finest healthcare systems in the world. It would be speedy, nimble and sustainable.

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