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The NHS was hit hard by COVID. And no amount of appreciative clapping or painted rainbows could distract from the vulnerabilities which were exposed by the pandemic – or the challenges it created.

Some of those challenges – like the staggering backlog in patient care, or the huge mental and physical toll experienced by staff – will take years to overcome.

And anyone compelled to attend a hospital in the UK at the moment can see the evidence at first hand. Wards are very busy and staff are overstretched.

This is part of the legacy of a fast-spreading virus which killed 232,112 people in the UK and left an estimated 2 million suffering from the effects of long-COVID. It demanded urgent action from hospitals and health workers and brought immediate and widespread disruption to routine care, with appointments for elective surgery, cancer screenings and chronic disease management all delayed.

One 2024 study I worked on analysed appointment cancellations for cancer patients during the pandemic, and found that they waited an average of 19 days longer than before for rescheduled appointments. (Mortality rates remained stable though, indicating that the NHS effectively prioritised the most urgent cases.)

This kind of disruption has left the healthcare system facing a monumental backlog, with treatment waiting lists soaring to record levels. According to the British Medical Association, there are over 7.5 million people now on waiting lists (compared to 4.5 million before the pandemic) – and those waiting times are longer.

Cutting this waiting list is apparently one of the prime ministers’s priorities. But there is no easy fix.

The basic infrastructure of the NHS – the buildings, IT equipment, offices – is creaking, with outdated facilities, insufficient beds and a lack of specialised equipment. And one study suggests that capital funding – investment in assets that will be used for more than a year – for NHS trusts in England is down by 21% over the past five years.

This is primarily because the Department of Health and Social Care has been diverting long-term investment funds to cover day-to-day operational costs such as staff salaries and medicines.

Since 2019, £500 million of capital investment has been cancelled or postponed. And while overall NHS budgets have been growing, the increased spending has often been absorbed by inflation, rising demand and the need to address immediate pressures. This leaves little for infrastructure upgrades, new equipment or technological advancements.

The Health Foundation has warned that the lack of a long-term capital funding strategy could further jeopardise patient care in the future. Many NHS facilities no longer meet the needs of a modern health service, with some hospitals requiring complete refurbishment or replacement rather than just repairs.

And of course, treating patients is not just about equipment and buildings. Nurses and doctors are under extreme pressure, facing unprecedented levels of stress, burnout and trauma. A recent survey revealed that one in three NHS doctors are experiencing extreme tiredness, impairing their ability to treat patients effectively.

NHS key workers wave from inside Chelsea and Westminster Hospital, May 2020.
Guy William/Shutterstock

A similar number said their ability to practice medicine may have been negatively affected by fatigue, with some even reporting cases of patient harm or a near-miss incident.

Stressed NHS

And although the NHS workforce has actually grown over the past five years, it has not been sufficient to reduce waiting lists, deal with growing demand, or improve staff morale. Anxiety, stress and depression accounted for for over 624,300 working days lost in one month last year.

Without a healthy and motivated workforce, the NHS’s recovery efforts will remain severely hampered. Other contributing factors include increased demand for healthcare services, partly due to an ageing population and the growing prevalence of chronic conditions.

To address these challenges, the NHS needs a modernised approach to patient care. Research suggests that technology including telemedicine (online consultations) and AI-driven diagnostics, could streamline services and reduce waiting times.

Other possible steps include the expansion of community diagnostic centres, to ease access to tests, and screenings, to improve efficiency.

Overall, the pandemic has underscored the critical importance of a robust and resilient healthcare system. As the NHS navigates its own path to recovery, it must prioritise both immediate solutions to the backlog crisis and long-term strategies. This will require significant investment, but also a commitment to innovation and the wellbeing of healthcare workers.

The road ahead for the NHS will be tricky, but with the right measures in place, it could emerge stronger and more resilient than ever. The lessons learned from COVID should serve as a catalyst for transformative change, ensuring that the UK’s healthcare system is better prepared to face whatever the future may hold. Läs mer…

The UK prime minister, Keir Starmer, has announced plans to abolish NHS England, the organisation that oversees and manages the NHS in England, employing 19,000 people.

He declared he was bringing the NHS back under “democratic control” and cutting unnecessary bureaucracy by moving oversight of the NHS back into the Department of Health and Social Care (DHSC). This will reverse plans put in place by the Conservative-led coalition government in 2013 when it tried to “take the politics out of the NHS” by having NHS England as an independent body.

The NHS is the largest public sector organisation in England, seeing 1.7 million people each day including in patients’ own homes, local GP surgeries, pharmacies and hospitals. It employs 1.7 million people, is funded largely out of general taxation, and has an annual budget of about £190 billion.

The NHS is, however, one of the most centrally organised health systems in the world. This contrasts with many European and other countries where there is typically a national ministry of health to set strategy, with the detail of how this is implemented being left to regional and local councils, health authorities and hospitals.

Some analysts have suggested that the NHS has become even more centrally managed in recent years, but the truth is it has always been held very close by its political masters.

The NHS employs 1.7 million people.
Colin McPherson / Alamy Stock Photo

On the face of it, there are advantages to abolishing NHS England, allowing DHSC to focus on clarifying politicians’ priorities for how and on what NHS funding will be spent. These will include reducing waiting lists for operations, making it easier to get an appointment with a GP, and ensuring that emergency departments can deal quickly with patients without resorting to “corridor care”.

In turn, local NHS organisations such as integrated care boards (who among other things organise GP, dental, pharmacy and optometry services) and NHS trusts (who run hospitals, community, mental health and ambulance services) can concentrate on making sure these policy priorities are put into practice in ways that work best for local communities.

NHS England has a range of other important roles that will need to be reallocated, whether to an expanded DHSC or elsewhere. These include planning the training of healthcare staff, organising vaccination and screening programmes, purchasing medicines, and collating huge amounts of data about NHS activity and performance.

The government has also announced plans to halve staffing in the 42 local integrated care boards, so any move of former NHS England roles to this level will probably only happen if these local boards merge, which now seems likely.

The government appears therefore to have signalled another NHS management “redisorganisation” – something the NHS has suffered on a periodic basis, a consequence of its highly centralised and political nature. Research evidence is clear that management reorganisations struggle to achieve their objectives, causing instead significant distraction away from work to improve services for patients.

In his major review of the NHS for the new Labour government in September 2024, Lord Ara Darzi – a former Labour health minister – highlighted the urgent need for more skilled and effective managers to support NHS staff in restoring and improving the service after years of economic austerity and the challenges of the pandemic. This seems to run counter to recent announcements about “cutting bureaucracy”.

With careful planning, there is, however, potential for the abolition of NHS England to lead to a slimmer DHSC (more akin to some of its European counterparts) with a smaller number of well-resourced and managed integrated care boards who could effectively steer, support and monitor local NHS trusts and primary care services.

In 2002, Alan Milburn, then secretary of state for health in Tony Blair’s government, issued a white paper called Shifting the Balance of Power Within the NHS. Milburn is now a leading figure in the Starmer government’s health team, so it is perhaps not surprising that we have these new plans to slim the policy centre, shift power and decision-making more locally, and enable stronger accountability to politicians and the public.

What is likely to happen?

What will matter as much as what is done is how these changes are made. The government has Lord Darzi’s clear and comprehensive diagnosis of the NHS’s problems. It now needs to prioritise what should be done first and what can wait, and has made a good start on this with its recent planning guidance to the NHS.

What will be much more difficult will be to decide exactly how to reduce and then abolish NHS England – doing this in a way that ensures important roles are moved smoothly to DHSC, integrated care boards and NHS trusts.

History is not encouraging. There is a big risk that NHS managers will find themselves focusing too much attention on handling a major reorganisation when they (and patients) would rather they concentrate on improving services.

The government clearly wants to hold on to setting policy direction for the NHS while letting go of the detail of implementation to local level. But ultimately, it will be held to account by a population impatient for improvements to NHS services. Läs mer…

Sir Keir Starmer, the UK prime minister, announced on March 13 that the government will move to abolish NHS England in the next two years. During this period, the government plans to bring its functions under the UK’s health ministry, with the aim of bringing the health service “into democratic control”. What does this mean, and what difference will it make?

When the NHS was established in 1948, part of the aim was to make the local health problems of patients across the country the concern of the national government. The plan succeeded. Today, the NHS is politically highly important – it matters enormously to patients and the public, and has one of the largest spending budgets in the UK.

At the same time, it is technically difficult to manage, with local needs and opportunities and complex organisation that are hard and sometimes inefficient to manage centrally.

Striking the balance between delivering high-quality patient care and addressing the technical complexity of doing so is a continual challenge for governments. The solution chosen as part of the 2012 health and welfare reforms was to establish NHS England as an organisationally independent government body to provide technical and operational leadership for the NHS – leaving ministers insulated from those day-to-day issues and free to set an overall strategy.

The government’s decision to abolish NHS England marks a change back to direct ministerial grip on the system. This may reflect high public concern about the NHS and pressure on its services, as well as a desire by the recently elected government to exercise more direct control over the health service.

How does this compare to other health systems?

The NHS has long been an unusually centralised system. Although the English NHS covers more than 55 million people, it has historically been run by central government, which this change reinforces.

In contrast, although Spain has a similar NHS-style system, the Spanish health system is run by the 17 regional governments through their departments of health, with the largest covering 8.6 million people.

Europe’s other large national health system, in Italy, now also has a decentralised system. The national government sets the overall principles and benefits, but the actual services are under the control of regional governments.

Italy also has a decentralised health system.
Massimo Todaro/Shutterstock

These decentralised systems strike a different balance between political control and operational management, by bringing them together at a more local level.

If the UK government was to extend its aim of bringing the NHS into democratic control by taking a similar decentralisation approach to other NHS-style systems in Europe, what would this look like?

The NHS already has 42 integrated care systems at the local level. These already work with upper-tier local authorities, such as county councils, and are mostly aligned with their boundaries, but are under the control of central government.

Other countries already decentralise their health systems to similar levels. In Sweden, for example, the 21 counties are responsible for financing, purchasing and providing their health services, under the democratic control of the county councillors. While there might be questions about the capacity of local government in England to take on such a role, experience from elsewhere shows that it should be possible.

Compared with those decentralised systems, the abolition of NHS England is a relatively minor change. It puts ministers more directly in charge of the English NHS, but does not change the basic structure of the service nor its control by central government.

Examples from other countries suggest that if the ambition is to bring the health service more into democratic control, there are options for much more profound change. This would strike a whole new balance between political control and local management. Läs mer…

Prime Minister Mark Carney and his cabinet have been sworn in, ending Justin Trudeau’s time in office and paving the way for a spring election. Canadians are soon heading to the polls as they watch American democracy crumble.

United States President Donald Trump recently argued “he who saves his country does not violate any Law” as he ignores Congress and the courts, governs by executive order and threatens international laws and treaties.

Read more:
Is Donald Trump on a constitutional collision course over NATO?

Once stable democratic institutions are failing to hold an authoritarian president in check.

What lessons are there to protect Canadian democracy as the federal election approaches?

President Donald Trump sits inside the presidential limousine as Elon Musk, waits for his turn as they arrive at Palm Beach International Airport on March 7, 2025, in West Palm Beach, Fla.
(AP Photo/Manuel Balce Ceneta)

Elites lead the way

First, it’s important to delve into how so many Americans have become tolerant of undemocratic actions and politics in the first place. It’s not that Republican voters first became more extreme and then chose a representative leader. Rather, public opinion and polarization are led by elites.

Republican leaders moved dramatically to the right, and the primary system allowed the choice of an extremist. Republican voters then aligned their opinions with his. Trump’s disdain for democratic fundamentals spread quickly. Partisans defending their team slid away from democratic values.

Canada’s more centrist ideological spectrum is not foolproof against this type of extremism. Public opinion can be moved when our leaders take us there.

Decline can start slowly and then accelerate. America’s democratic backsliding in the first weeks of Trump’s second presidency follows the erosion of democratic norms over decades. Republican attacks on institutions, the opposition, the media and higher education corrosively undermined public faith in the truth, including election results.

Trust in government is holding steady in Canada, however. That provides an important guardrail for Canadian democracy.

Supporters wait for President Donald Trump to depart in his motorcade from the Trump International Golf Club on March 1, 2025, in West Palm Beach, Fla.
(AP Photo/Alex Brandon)

The dangers of courting the far right

There are also lessons for our political parties. To maximize their seats, Republicans accepted extremists like Marjorie Taylor Greene, but soon needed those types of politicians for key votes.

The so-called Freedom Caucus, made up of MAGA adherents, forced the choice of a new, more extreme, leader of the House of Representatives. This provides a clear lesson that history has shown many times: it is dangerous for the party on the political right to accommodate the far right, which can quickly take control.

Once established within the ruling party, extremists can hold their party hostage.

At a recent meeting of the Munich Security Conference, Vice-President JD Vance pushed European parties to include far-right parties, and Elon Musk outright endorsed the far-right Alternative for Germany party.

Austria recently avoided the inclusion of the far right in its new coalition, and now Germany is working to do the same. As Canada’s Conservatives look for every vote, courting far-right voters and candidates risks destabilizing the system.

United States Vice-President JD Vance addresses the audience during the Munich Security Conference at the Bayerischer Hof Hotel in Munich, Germany, in February 2025.
(AP Photo/Matthias Schrader)

Can it happen in Canada?

How safe is Canada’s Westminster-style parliamentary democracy?

The fusion of legislative and executive power in parliamentary systems like Canada’s seems prone to tyranny. America’s Constitutional framers thought so when they designed a system with separate legislative, executive and judicial branches that could check each other’s power.

They clearly did not imagine party loyalty negating the safeguards that protect democracy from an authoritarian-minded president. The Constitution gives Congress the power to legislate and impeach, limits the executive’s power to spend and make appointments, gives the judiciary power to hold an executive accountable and contains the 25th amendment allowing cabinet to remove a president.

But when one party controls the legislative and executive branches during a time of hyper-partisanship, these mechanisms may not constrain an authoritarian. Today, Republican loyalty has eroded these checks and balances and American courts are struggling to step up to their heightened role.

Supreme Court Chief Justice John Roberts and associate justices Elena Kagan, Brett Kavanaugh and Amy Coney Barrett listen as President Donald Trump addresses a joint session of Congress at the Capitol on March 4, 2025.
(AP Photo/J. Scott Applewhite)

Although counter-intuitive, parliamentary systems like Canada’s are usually less susceptible to authoritarianism than presidential ones because the cabinet or the House of Commons can turn against a lawless leader.

Still, if popular, authoritarian leaders can still retain their party’s support — and then things can slide quickly. The rightward pull of extremists seen in the U.S. House would be more dangerous here since the Canadian House of Commons includes our executive.

Guarding against xenophobia

Lastly, Canada should be wary of xenophobic rhetoric.

“America First” is not simply shopping advice. It began as an isolationist slogan during the First World War but was soon adopted by pro-fascists, American Nazis and the Ku Klux Klan. These entities questioned who is really American and wanted not only isolationism, but racist policies, immigration restrictions and eugenics.

Trump did not revive the phrase accidentally. It’s a call to America’s fringes. Alienating domestic groups is a sure sign of democratic decline.

“Canada First” mimics that century-long dark theme in America. In combination with contempt for the opposition, it questions the right of other parties to legitimately hold power if used as a message by one party.

Conservative Leader Pierre Poilievre during a news conference in January 2025 in Ottawa.
THE CANADIAN PRESS/Adrian Wyld

Also, asserting that “Canada is broken” — as Conservative Leader Pierre Poilievre often does — mimics Trump’s talk of American carnage, language and imagery he uses to justify extraordinary presidential authority.

Such language erodes citizens’ trust in democratic institutions and primes voters to support undemocratic practices in the name of patriotism. Canadian parties and politicians should exit that road.

Ultimately, institutions alone do not protect a country from the rise of authoritarianism. Democracy can be fragile. As a federal election approaches in Canada, it’s important to know the warning signs of extremism and anti-democratic practices that are creeping into our politics. Läs mer…

Prime Minister Mark Carney and his cabinet have been sworn in, ending Justin Trudeau’s time in office and paving the way for a spring election. Canadians are soon heading to the polls as they watch American democracy crumble.

United States President Donald Trump recently argued “he who saves his country does not violate any Law” as he ignores Congress and the courts, governs by executive order and threatens international laws and treaties.

Read more:
Is Donald Trump on a constitutional collision course over NATO?

Once stable democratic institutions are failing to hold an authoritarian president in check.

What lessons are there to protect Canadian democracy as the federal election approaches?

President Donald Trump sits inside the presidential limousine as Elon Musk, waits for his turn as they arrive at Palm Beach International Airport on March 7, 2025, in West Palm Beach, Fla.
(AP Photo/Manuel Balce Ceneta)

Elites lead the way

First, it’s important to delve into how so many Americans have become tolerant of undemocratic actions and politics in the first place. It’s not that Republican voters first became more extreme and then chose a representative leader. Rather, public opinion and polarization are led by elites.

Republican leaders moved dramatically to the right, and the primary system allowed the choice of an extremist. Republican voters then aligned their opinions with his. Trump’s disdain for democratic fundamentals spread quickly. Partisans defending their team slid away from democratic values.

Canada’s more centrist ideological spectrum is not foolproof against this type of extremism. Public opinion can be moved when our leaders take us there.

Decline can start slowly and then accelerate. America’s democratic backsliding in the first weeks of Trump’s second presidency follows the erosion of democratic norms over decades. Republican attacks on institutions, the opposition, the media and higher education corrosively undermined public faith in the truth, including election results.

Trust in government is holding steady in Canada, however. That provides an important guardrail for Canadian democracy.

Supporters wait for President Donald Trump to depart in his motorcade from the Trump International Golf Club on March 1, 2025, in West Palm Beach, Fla.
(AP Photo/Alex Brandon)

The dangers of courting the far right

There are also lessons for our political parties. To maximize their seats, Republicans accepted extremists like Marjorie Taylor Greene, but soon needed those types of politicians for key votes.

The so-called Freedom Caucus, made up of MAGA adherents, forced the choice of a new, more extreme, leader of the House of Representatives. This provides a clear lesson that history has shown many times: it is dangerous for the party on the political right to accommodate the far right, which can quickly take control.

Once established within the ruling party, extremists can hold their party hostage.

At a recent meeting of the Munich Security Conference, Vice-President JD Vance pushed European parties to include far-right parties, and Elon Musk outright endorsed the far-right Alternative for Germany party.

Austria recently avoided the inclusion of the far right in its new coalition, and now Germany is working to do the same. As Canada’s Conservatives look for every vote, courting far-right voters and candidates risks destabilizing the system.

United States Vice-President JD Vance addresses the audience during the Munich Security Conference at the Bayerischer Hof Hotel in Munich, Germany, in February 2025.
(AP Photo/Matthias Schrader)

Can it happen in Canada?

How safe is Canada’s Westminster-style parliamentary democracy?

The fusion of legislative and executive power in parliamentary systems like Canada’s seems prone to tyranny. America’s Constitutional framers thought so when they designed a system with separate legislative, executive and judicial branches that could check each other’s power.

They clearly did not imagine party loyalty negating the safeguards that protect democracy from an authoritarian-minded president. The Constitution gives Congress the power to legislate and impeach, limits the executive’s power to spend and make appointments, gives the judiciary power to hold an executive accountable and contains the 25th amendment allowing cabinet to remove a president.

But when one party controls the legislative and executive branches during a time of hyper-partisanship, these mechanisms may not constrain an authoritarian. Today, Republican loyalty has eroded these checks and balances and American courts are struggling to step up to their heightened role.

Supreme Court Chief Justice John Roberts and associate justices Elena Kagan, Brett Kavanaugh and Amy Coney Barrett listen as President Donald Trump addresses a joint session of Congress at the Capitol on March 4, 2025.
(AP Photo/J. Scott Applewhite)

Although counter-intuitive, parliamentary systems like Canada’s are usually less susceptible to authoritarianism than presidential ones because the cabinet or the House of Commons can turn against a lawless leader.

Still, if popular, authoritarian leaders can still retain their party’s support — and then things can slide quickly. The rightward pull of extremists seen in the U.S. House would be more dangerous here since the Canadian House of Commons includes our executive.

Guarding against xenophobia

Lastly, Canada should be wary of xenophobic rhetoric.

“America First” is not simply shopping advice. It began as an isolationist slogan during the First World War but was soon adopted by pro-fascists, American Nazis and the Ku Klux Klan. These entities questioned who is really American and wanted not only isolationism, but racist policies, immigration restrictions and eugenics.

Trump did not revive the phrase accidentally. It’s a call to America’s fringes. Alienating domestic groups is a sure sign of democratic decline.

“Canada First” mimics that century-long dark theme in America. In combination with contempt for the opposition, it questions the right of other parties to legitimately hold power if used as a message by one party.

Conservative Leader Pierre Poilievre during a news conference in January 2025 in Ottawa.
THE CANADIAN PRESS/Adrian Wyld

Also, asserting that “Canada is broken” — as Conservative Leader Pierre Poilievre often does — mimics Trump’s talk of American carnage, language and imagery he uses to justify extraordinary presidential authority.

Such language erodes citizens’ trust in democratic institutions and primes voters to support undemocratic practices in the name of patriotism. Canadian parties and politicians should exit that road.

Ultimately, institutions alone do not protect a country from the rise of authoritarianism. Democracy can be fragile. As a federal election approaches in Canada, it’s important to know the warning signs of extremism and anti-democratic practices that are creeping into our politics. Läs mer…

All governments, it seems, are destined to go to war with Whitehall. The administration of Keir Starmer has been in power only nine months, but there are clear indications ministers are frustrated and dissatisfied with civil service performance.

They have so far avoided the temptation to publicly vilify Whitehall officials for the government’s inability to deliver rapid progress. There is no repeat of the rhetoric that a hard rain is about to fall on the civil service, as Boris Johnson and his chief adviser, Dominic Cummings, threatened in the aftermath of Brexit.

Yet it is obvious that behind the scenes, senior figures in the Starmer administration believe the civil service is not functioning as it should. We’ve seen a flurry of announcements on reforming the machinery of government.

The Cabinet Office minister, Pat McFadden, unveiled plans to subject officials to performance reviews, while removing poorly performing civil servants from their posts. The prime minister made it clear he wants to cut back quangos (notably scrapping the health agency, NHS England) and ensure ministers, not regulators, take significant policy decisions.

Meanwhile, there is a determination to unleash artificial intelligence, ensuring public sector productivity improves. Starmer believes the British state has become “flabby”, slow-moving and ineffectual.

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The apparent disconnect between ministers and the bureaucracy is scarcely surprising. Before coming to power, Labour had detailed plans to make British government “mission-orientated”.

The Starmer administration declared in its first king’s speech that “mission-based government” would entail “a whole new way of governing” addressing “long-term, complex problems”. This mission mind-set is exemplified by the American general George S. Paton: “Never tell people how to do things. Tell them what you want them to achieve and they will surprise you with their ingenuity.”

Missions are intended to galvanise UK government, involving the whole of society in the drive for once-in-a-generation reforms without micro-managing from the centre.

At the outset, there was too little appreciation among officials of the challenge that mission-orientated government posed to traditional ways of working in Whitehall. Starmer’s first chief of staff, Sue Gray, was determined to emphasise a return to reciprocal partnership between ministers and mandarins given the turmoil and instability that afflicted British government in the Johnson/Liz Truss era.

Yet the prime minister now appears more focused on change than continuity. The implications of mission-orientated governance are potentially transformational.

Mission-led government in a nutshell

The concept of mission-led government essentially rests on four principles:

Bringing a long-term, strategic perspective to policy development. Missions focus on long-term goals for society, instead of short-term targets or milestones.
Breaking down silos across the public sector. Different government services and agencies work together on missions, ensuring issues do not slip between the institutional cracks.
Giving professionals working on the front line of public service delivery greater agency. The idea is that fewer rules and edicts mean staff can respond to pressing challenges, adapting organisations accordingly.
Incorporating ideas and insights generated outside the civil service, challenging the traditional monopoly over policy and implementation. Missions involve external organisations at the outset.

The reality on the ground

Each of these ideas are important, yet there is too little recognition of the significant challenge they pose to the culture and practices of Whitehall.

UK central government does not do strategy well – and the past 15 years have witnessed a cull of what strategic capability there was. Day-to-day operational management and cost-cutting has long been prized over long-term thinking.

Breaking down silos is necessary, yet difficult to achieve. The problem isn’t so much the mindset or recalcitrance of civil servants, but the prevailing system of parliamentary accountability.

Ministers are responsible for the public money that has been allocated to their department. This reinforces boundaries and makes shared working across departments less tenable. No government has resolved the problem of how to achieve joint working on key programmes with the right blend of incentives, including shared budgets.

Moreover, civil servants, like ministers, are reluctant to give frontline staff greater autonomy. There is a culture of mistrust after 40 years of public management reform.

There is also a prevailing belief that many public sector professionals are ultimately self-interested. Leaving professionals at the front line to get on with implementation is an attractive proposition, but difficult to achieve given Whitehall’s instinct to impose rules, regulations, oversight and monitoring.

Constitutional arrangements are central to civil service reform.
Shutterstock/Adam Cowell

Meanwhile, many in Whitehall believe giving a voice to outside “interest groups” potentially corrupts the policy process. Officials view the ideas of thinktanks as flimsy and insubstantial (in fairness, proposals such as universal credit originated by the Centre for Social Justice in the late 2000s scarcely stood the test of time).

None of this makes change in central government unattainable. But it emphasises that all governments need a concerted strategy for reform, including being willing to devote political resources, as few recent prime ministers have done.

And, if the Starmer administration pursues a genuinely mission-orientated approach, it must confront the fundamental question of the constitutional relationship between ministers and civil servants. This is an issue successive governments have avoided since the late 1960s.

There is a compelling argument that in delivering missions, senior officials ought to be publicly accountable for delivery, as is the case, for example, in New Zealand. Yet that would require the doctrine of ministerial responsibility to be overhauled. Many will agree it is an unhelpful facade that should have been dismantled a long time ago anyway. Läs mer…

The UK government has published its planning and infrastructure bill, a cornerstone of its strategy for growth. The bill aims to “get Britain building again and deliver economic growth” and includes the hugely ambitious target of building 1.5 million homes in England over this parliament.

The bill is ambitious in scope – 160 pages long and very technical. But what does it promise exactly?

On infrastructure, it outlines reforms to limit vexatious repeat use of judicial review to block development. There are also some measures for a stronger electricity grid to ease the move towards renewable energy. While the plan to reward people living near new pylons with £250 off their bills grabbed headlines, just as important are measures for energy storage to level out peaks in demand and supply.

On the planning side, planning departments will be allowed to charge more to those making applications. This should speed up decisions by funding more planning officer roles. But there are no measures to increase funding for drawing up local plans. This is important because councils often fall behind schedule in producing these. And where there is no up-to-date plan, there is a danger that developers will push through controversial proposals.

The bill also provides for more decisions to be delegated to planning officials rather than planning committees – this means council staff rather than elected representatives. This already happens for smaller planning applications, so is not entirely new. But it does raise concerns about democratic scrutiny.

The government argues that local democracy will not be undermined, as planning officers will be making their decisions in the context of democratically approved local plans as well as national legislation. But this could be misleading, unless planning authorities have the funds to update local plans regularly.

There are also changes to existing development corporation legislation, to support the building of new towns. Particularly welcome is the responsibility on development corporations – government organisations dealing with urban development – to consider climate change and design quality. This is in order to hit net-zero targets and avoid cookie-cutter housing estates.

Other measures are aimed at ensuring appropriate infrastructure is built to serve these new towns.

Read more:
Why building new towns isn’t the answer to the UK’s housing crisis

There are changes planned too on when compulsory purchase orders can be used to buy sites that are broadly to be used for the public good. This could be for affordable homes, health or education facilities, for instance. It would work by reducing payments to the actual value of the land rather than its “hope value” (when landholders hold out for price rises once planning permission is granted).

There is also a commitment to creating a nature restoration fund, which the government hopes will overcome some of the delays to approving new housing caused by potential threats to wildlife.

The fund will aim to unblock development in general rather than specific sites, as happens at the moment, and will pool contributions from developers to fund nature recovery. Where there are concerns for wildlife, experts will develop a long-term mitigation plan that will be paid for by the fund while allowing the development to go ahead in the meantime.

Will it work?

As a professor of urban and environmental planning, the question for me is will the bill encourage development to progress more speedily? Almost certainly – probably mostly in terms of bringing forward improvements to critical national infrastructure schemes such as the electric grid. For residential development, some incremental speeding up is likely as developers crave certainty in planning decisions.

But on their own, these measures are unlikely to be enough to provide the 1.5 million new homes set out in the government’s target. They offer nothing to tackle critical bottlenecks in terms of both labour and materials. It is also difficult to see the target being met without much more government involvement – by building social housing in particular.

Will the bill result in better quality development? There is surprisingly little in the plans about improving design quality, other than in development corporation areas. This is disappointing, and a missed opportunity to ensure that developers raise their game in residential building and neighbourhood quality.

And might it override local democracy? Arguably yes, but in practice not as much as some critics might argue. Most of the reforms are finessing existing practices, such as delegated powers to planning officers. Much depends on what the national government guidance turns out to be.

The biggest concern is that it might increase invisible political pressures on planning officers by councillors and senior officials. It would have been good to have seen more measures to protect their independence and professional judgement.

Hopefully the bill will speed up delivery of nationally important schemes for critical infrastructure. This means things like modernising the electricity grid and removing repeated use of judicial review to block a development. These elements should create jobs sooner and support economic growth.

Where the bill will make absolutely no difference is in improving living standards for people with older homes. This bill is focused on new builds and has little to offer those hoping for support in retrofitting ageing housing stock with more energy-efficient features or creating green spaces in areas where new development is increasingly in demand.

Development should be compatible with nature restoration.
Nick Beer/Shutterstock

Despite some of the ministerial bluster about removing red tape, much of the content of this bill is not about removing planning regulations. It is much more about improving them. Some measures will work better than others, but overall, given the government’s electoral mandate to deliver growth and protect the environment, this is a reasonable balancing act.

It’s unlikely to deliver much growth in its own right, but as an enabler of growth, it is promising. More worrying is whether it will lead to poor-quality housing built at pace and massive scale to inadequate energy-efficiency and design standards. This would fail to deliver on net-zero and biodiversity ambitions. It is very much a minor win for facilitating growth, but for nature it is nothing more than maintaining the status quo. Läs mer…

Keir Starmer’s government is expected to announce a host of cuts to sickness and disability support in the coming days. The UK’s ageing and increasingly unwell population has led to what has been described as “unsustainable” and “indefensible” spending on benefits.

As researchers of poverty and welfare reform, we find it both shocking and sadly unsurprising that, after more than a decade of cuts to social security, the government seems to have once again decided that austerity is the answer to the economic pressures they are facing.

We have spent many years documenting the real harms created by reforms to social security. It was disappointing to hear Starmer describe Britain’s social security system as an expensive way to “trap” people on welfare, rather than helping them find work.

The expected proposals are intended to incentivise people into work, by reducing the generosity of support offered to people claiming disability-related benefits. But in reality, many of the measures already implemented to reduce spending by cutting or capping benefits have pushed people further away from the labour market.

The relationship between welfare and work is more complex than it first appears. Around 37% of people on universal credit are currently in work.

Approximately 23% of those out of work are engaging with advisers whose job is to support them back into the labour market. The majority of the rest of universal credit claimants are people who are not expected to be in work – often people who have health challenges that make it difficult for them to work most jobs.

The UK’s social security payments cover a much smaller proportion of the average wage than most other countries in Europe.

A single person’s allowance on universal credit is £393.45 per month if they are 25 or over, while under-25s receive £311.68. This averages out at less than £100 a week to meet all essential living costs, bar support with housing.

Disabled people received additional support in the form of personal independence payments (Pip) or disability living allowance if you live in England, Wales or Northern Ireland, and adult or child disability payments in Scotland.

This support is designed to help people meet the additional costs that come with disabilities and long-term health conditions. It is not means-tested, and is available to people in employment as well as those not currently working.

Ministers are expected to make it more difficult to access Pip, freezing its value so this does not rise with inflation, and to reduce the amount of universal credit received by those judged unable to work. These proposals are likely to face strong opposition from many Labour MPs.

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Currently, if people are not able to engage in paid work for long periods, they are entitled to an additional payment through universal credit. This amount – equivalent to approximately £400 a month – could go down. The problem is that this is already not enough to live on, and often necessitates going without essentials, such as food or electricity.

Families with dependent children receive additional support through child elements of universal credit, and through child benefit. But this support is subject to caps – the controversial and poverty-producing two-child limit, and the benefit cap, which restricts the support any household can receive where no one is working or claiming disability benefits.

Our research has shown that these restrictions do not work. The two-child limit is not helping families get into work, and nor is it affecting whether families have more children.

The benefit cap harms mental health, pushes people deep into poverty, and increases economic inactivity. Both policies are punitive and, in our view, need to be removed.

Other reforms to disability-related social security have left people hungry, pushed people into economic inactivity, increased depression, and may have even raised the suicide rate.

Getting Britain working?

The government is trying to solve the wrong problem. They are focusing on those who are out of work, when it is increasingly clear that one big reason people with disabilities are not in employment is because work environments have fewer roles they can fill.

While spending on disability-related support has gone up in recent years, the overall welfare bill has not. On top of that, the proportion of people who are not in work and who are claiming disability-related social security is actually about the same as it has been for the last 40 years. Indeed, the fact it is so low, given population ageing, could be read as good news.

Research shows cutting access to benefits does not necessarily get people into work.
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There have also been wider changes in the labour market. There has been a rapid decline in “light work”, like lift attendants, cinema ushers, or low-physical exertion roles in factories. As work environments have become more intense, people with disabilities have found it increasingly difficult to stay in work.

So, what would work to entice more people into work? The truth is we know far more about what does not work than what does.

The best evidence we have right now suggests that making it more difficult to claim social security and placing more strenuous work-search requirements on claimants will simply push people with poor health (particularly mental ill-health) further away from the labour market.

The welfare narrative

Behind the cuts currently being trailed is a popular but ill-founded logic which views social security as the cause of the country’s economic woes. Welfare itself is seen as the problem, with whole generations supposedly left parked on what is depicted as too-easy-to-claim and too-generous support.

But this narrative grossly misrepresents what it’s actually like to try and claim social security. It is, in fact, notoriously complex. Often, this complexity is intentional.

Making accessing social security difficult is not necessarily (or always) about meanness, but this “nasty strategy” is a product of a system that assumes that many people are not eligible for the support they claim.

The system has always assessed eligibility for benefits, but the way these assessments have been done in recent years has often been experienced as degrading and dehumanising. On the flip side, some have claimed that people are not being assessed regularly enough, and suggest that some people who have claimed benefits in the past may now be fit to work.

Where this is true is unclear, but the failure to reassess is also a product of cuts to this system – so taking more money out will not address this problem either.

Britain’s social security system has been stripped to the bones: it provides neither security nor enough support to those who receive it, and is ripe for reform. But the reform required is not of the type Labour is proposing, which will succeed only in further decimating what little remains of our social security safety net.

This article was co-published with LSE Blogs at the London School of Economics. Läs mer…

Nearly a hundred years ago, a hastily crafted spaceship crash-landed in Smallville, Kansas. Inside was an infant – the sole survivor of a planet destroyed by old age. Discovering he possessed superhuman strength and abilities, the boy committed to channeling his power to benefit humankind and champion the oppressed.

This is the story of Superman: one of the most recognizable characters in history, who first reached audiences in the pages of Action Comics in 1938 – what many fans consider the most important single comic in history.

As a historian of American immigration and ethnicity – and a lifelong comics fan – I read this well-known bit of fiction as an allegory about immigration and the American dream. It is, at its core, the ultimate story of an immigrant in the early 20th century, when many people saw the United States as a land with open gates, providing such orphans of the world an opportunity to reach their fullest potential.

Taken in and raised by a rural family under the name Clark Kent, the baby was imbued with the best qualities of America. But, like all immigrant stories, Kent’s is a two-parter. There is also the emigrant story: the story of how Kal-El – Superman’s name at birth – was driven from his home on Planet Krypton to embrace a new land.

That origin story reflects the heritage of Superman’s creators: two of the many Jewish American writers and artists who ushered in the Golden Age of comic books.

Jewish history…

A card from 1909, found in the Jewish Museum of New York, depicts Jewish Americans welcoming Jews emigrating from Russia.
Heritage Images/Hulton Archive via Getty Images

The American comics industry was largely started by the children of Jewish immigrants. Like most publishing in the early 20th century, it was centered in New York City, home to the country’s largest Jewish population. Though they were still a very small minority, immigration had swelled the United States’ Jewish population more than a thousandfold: from roughly 3,000 in 1820 to roughly 3,500,000 in 1920.

Comic books had not yet been devised, but strip comics in newspapers were a regular feature. They began in the late 19th century with popular stories featuring recurring characters, such as Richard F. Outcault’s “Yellow Kid” and “the Little Bears” by Jimmy Swinnerton.

A few Jewish creators were able to break into the industry, such as Harry Hershfield and his comic “Abie the Agent.” Hershfield’s success was exceptional in three ways: He broke into mainstream newspaper comics, his titular character was also Jewish, and he never adopted an anglicized pen name – as many other Jewish creators felt they must.

Shoppers and vendors outside of haberdasheries on Hester Street in a Jewish neighborhood of New York’s Lower East Side around 1900.
Photo by Hulton Archive/Getty Images

Generally, however, Jews were barred from the more prestigious jobs in newspaper cartooning. A more accessible alternative was the cheaper, second-tier business of reprinting previously published works.

In 1933, second-generation Jewish New Yorker Max Gaines – born Maxwell Ginzburg – began a new publication, “Funnies on Parade.” “Funnies” pulled together preexisting comic strips, reproducing them in saddle-stitched pamphlets that became the standard for the American comics industry. He went on to found All-American Comics and Educational Comics.

Another publisher, Malcolm Wheeler-Nicholson, founded National Allied Publications in 1934 and published the first comic book to feature entirely new material, rather than reprints of newspaper strips. He joined forces with two Jewish immigrants, Harry Donenfeld and Jack Leibowitz. At National, they created and distributed Detective and Action Comics – the precursors to DC, which would become one of the two largest comics distributors in history.

It was at Action Comics that Jerry Siegel and Joe Shuster, two second-generation immigrants from a Jewish neighborhood in Cleveland, found a home for Superman. It would also be where two Jewish kids from the Bronx, Bob Kane and Bill Finger – born Robert Kahn and Milton Finger – found a home for their character, Batman, in 1939.

Jerry Siegel and Joe Shuster, creators of Superman, pictured in the 1940s.
New Yorker/Wikimedia Commons

The success of these characters inspired another prominent second-generation Jewish New Yorker, pulp magazine publisher Moses “Martin” Goodman, to enter comics production with his line, “Timely Comics.” The 1939 debut featured what would become two of the early industry’s most well-known superheroes: the Sub-Mariner and the Human Torch. These characters would be mainstays of Goodman’s company, even when it became better known as Marvel Comics.

Thus were born the “big two,” Marvel and DC, from humble Jewish origins.

…and Jewish stories

The creation and popularization of superhero comics isn’t Jewish just because of its history. The content was, too, reflecting the values and priorities of Jewish America at the time: a community influenced by its origins and traditions, as well as the American mainstream.

Some of the most foundational early comics echo Jewish history and texts, such as Superman’s story, which parallels the Jewish hero Moses. The biblical prophet was born in Egypt, where the Israelites were enslaved, and soon after Pharaoh ordered the murder of all their newborn sons. Similarly, Superman’s people, the Kryptonians, faced an existential threat: the destruction of their planet.

Moses’ life is saved when his mother floats him down the Nile in a hastily constructed and tarred basket. Kal-El, too, is sent away to safety in a hastily constructed craft. Both boys are raised by strangers in a strange land and destined to become heroes to their people.

Comics also reflected the feelings and fears of Jews in a moment in time. For example, in the wake of Kristallnacht – the 1938 night of widespread organized attacks on German Jews and their property, which many historians see as a turning point toward the Holocaust – Finger and Kane debuted Batman’s Gotham City. The city is a dark contrast to Superman’s shining metropolis, a place where villains lurked around every corner and reflected the darkest sides of modern humanity.

Some comic artists and writers used their platform to make political statements. Jack Kirby – born Kurtzberg – and Hymie “Joe” Simon, creators of Captain America, explained that they “knew what was going on over in Europe. World events gave us the perfect comic-book villain, Adolf Hitler, with his ranting, goose-stepping and ridiculous moustache. So we decided to create the perfect hero who would be his foil.” The comic debut of Captain America in 1941 featured a brightly colored cover with the brand-new hero punching Adolf Hitler in the face.

In later generations, characters penned by Jewish authors continued to grapple with issues of outsider status, hiding aspects of their identity, and maintaining their determination to better the world in spite of rejection from it. Think of Spider-Man, the Fantastic Four and X-Men. All of these were created by Stan Lee – another Jewish creator, born Stanley Martin Lieber – who was hired into Timely Comics at just 17 years old.

With so many of the most popular comics written by New York Jews, and centered in the city, much of New York’s Yiddish-tinged, recognizably Jewish language made its way onto the pages. Lee’s Spider-Man, for example, frequently exclaims “oy!” or calls bad guys “putz” or “shmuck.”

In later years, Jewish authors such as Chris Claremont and Brian Michael Bendis introduced or took over mainstream characters who were overtly Jewish – reflecting an emerging comfort with a more public Jewish ethnic identity in America. In X-Men, for example, Kitty Pryde recounts her encounters with contemporary antisemitism. Magneto, who is at times friend but often foe of the X-Men, developed a backstory as a Holocaust survivor.

History is never solely about retelling; it’s about gaining a better understanding of complex narratives. Trends in comics history, particularly in the superhero genre, offer insight into the ways that Jewish American anxieties, ambitions, patriotism and sense of place in the U.S. continually changed over the 20th century. To me, this understanding makes the retelling of these classic stories even more meaningful and entertaining. Läs mer…

A state law signed Feb. 28, 2025, removes gender identity as a protected status from the Iowa Civil Rights Act, leaving transgender people vulnerable to discrimination. The rights of transgender people – those who present gender characteristics that differ from what has historically been expected of someone based on their biological sex traits – are under political attack across the United States. There are now hundreds of anti-trans bills at various points in the legislative process.

But why?

Reasons given usually center on protecting children, protecting cisgender women’s rights in bathrooms and sports competitions, and on removing funding for gender-affirming care. Some efforts appear to stem from fear-driven motives that are not supported by evidence.

Bias against trans people may not always feel like bias. For someone who believes it to be true, saying there can only be biological men who identify as men and biological women who identify as women may feel like a statement of fact. But research shows that gender is a spectrum, separate from biological sex, which is also more complex than the common male-female binary.

We are social psychologists who study and teach about the basic social, cognitive and emotion-based processes people use to make sense of themselves and the world. Research reveals psychological processes that bias people in ways they usually aren’t aware of. These common human tendencies can influence what we think about a particular group, influence how we act toward them, and prompt legislators to pass biased laws.

Root of negative views of transgender people

Social psychology theory and research point to several possible sources of negative views of transgender people.

Part of forming your own identity is defining yourself by the traits that make you unique. To do this, you categorize others as belonging to your group – based on characteristics that matter to you, such as race, age, culture or gender – or not. Psychologists call these categories in-groups and out-groups.

There is a natural human tendency to have inherent negative feelings toward people who aren’t part of your in-group. The bias you might feel against fans of a rival sports team is an example. This tendency may be rooted deep in evolutionary history, when favoring your own safe group over unknown outsiders would have been a survival advantage.

A trans person’s status as transgender may be the most salient thing about them to an observer, overshadowing other characteristics such as their height, race, profession, parental status and so on. As a small minority, transgender people are an out-group from the mainstream – making it likely out-group bias will be directed their way.

Anti-trans feeling may also result from fear that transgender people pose threats to one’s personal or group identity. Gender is part of everyone’s identity. If someone perceives their own gender to be determined by their biological sex, they may perceive other people who violate that “rule” as a threat to their own gender identity. Part of identity formation is not just out-group derogation but in-group favoritism. A cisgender person may engage in “in-group boundary protection” by making sure the parameters of “gender” are well defined and match their own beliefs.

Once you hold negative feelings about someone in an out-group, there are other social psychological processes that may solidify and amplify them in your mind.

The illusion of a causal connection

People tend to form illusory correlations between objects, people, occurrences or behaviors, particularly when those things are infrequently encountered. Two distinctive things happening at the same time makes people believe that one is causing the other.

Some superstitions result from this phenomenon. For example, you might attribute an unusual success such as winning money to wearing a particular shirt, which you now think of as your lucky shirt.

If a person only ever hears about negative events when they see or hear about a transgender person, an immigrant or a member of some other minority group, then an illusory correlation can form between the negative events and the minority group. That connection is the starting point for prejudice: automatic, negative feelings toward a group of people without justification.

Of course, it is possible that individuals from the group in question have committed some offense. But to take one individual’s bad deed and attribute it to an entire group of people isn’t justified. This kind of extrapolation is the natural human tendency of stereotyping, which can bias people’s actions.

‘That’s exactly what I thought’

Human minds are biased to confirm the beliefs they already hold, including stereotypes about trans people. A few interconnected processes are at play in what psychologists call confirmation bias.

First, there’s a natural tendency to seek out information that fits with what you already believe. If you think a shirt is lucky, then you’re more likely to look for positive things that happen when you wear it than you are to look for negative events that would seem to disconfirm its luckiness.

If you think transgender people are dangerous, you are more likely to conduct an internet search for “transgender people who are dangerous” than “transgender people are victims of crime.”

There’s a second, more passive process in play as well. Rather than actively seeking out confirming information, people also simply pay attention to information that confirms what they thought in the first place and ignore contradictory information. This can happen without you even realizing.

People also tend to interpret ambiguous events in line with their beliefs – “I must be having a good day, despite some setbacks, because I’m wearing my lucky shirt.” That confirmation bias could explain someone with anti-trans attitudes thinking “that transgender person holding hands with a child must be a pedophile” instead of “that transgender mother is showing love and care for her kid.”

Finally, people tend to remember things that confirm their beliefs better than things that challenge them.

Confirmation bias can strengthen an illusory correlation, making it even more likely to influence subsequent actions – whether compulsively wearing a lucky shirt to an anxiety-inducing appointment or not hiring someone because of discriminatory thoughts about the group they belong to.

Moving past biases

Awareness of biases is the first step in avoiding them. Setting bias aside allows people to make fair decisions, based on accurate information, and in line with their values.

However, this is not an easy task in the face of another social psychological process called group polarization. This phenomenon occurs when individuals’ beliefs become more extreme as they talk and listen only to people who hold the same beliefs they do. Think of the social media bubbles that result from interacting only with people who share your perspective.

Efforts to stifle or prohibit educators’ and librarians’ ability to teach and discuss gender and sexuality topics, openly and fairly, add another challenge. Education through access to impartial, evidence-based information can be one way to help neutralize inherent bias.

Montana state Rep. Zooey Zephyr, who is transgender, in discussion with a colleague.
AP Photo/Tommy Martino

As a final, hopeful point, social psychological research has identified one strategy for overcoming intergroup conflict: forming close contacts with individuals from the “other” group. Having a friend, loved one or trusted and valued colleague who belongs to the out-group can help you recognize their humanity and overcome the biases you hold against that out-group as a whole.

A relevant and recent example of this scenario came when two transgender state representatives convinced their fellow lawmakers to vote against two extreme anti-trans bills in Montana by making the issue personal.

All of these decision-making biases influence everyone, not just the lawmakers currently in power. And they can be quite complex, with particular in-group and out-group memberships being hard to define – for instance, factions within religious groups who disagree on particular political issues.

But understanding and overcoming the biases everyone falls prey to means that optimal decisions can be made for everyone’s well-being and economic vitality. After all, psychology research has repeatedly demonstrated that diversity is good for the bottom line while it simultaneously promotes an equitable and inclusive society. Even from a solely financial perspective, discrimination is bad for all Americans. Läs mer…