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It's not that I am usually a luddite. Nor do I necessarily mourn the fact that workers have priced themselves out of a job. But there is something very sad about the Telegraph's story that the Symington port family is to phase out crushing grapes by gangs of human feet:

Centuries of port heritage ended by family firm

The world's oldest and largest port producer is finally trampling on 2,000 years of agricultural history.

The Symington family, which has been making port since 1652, has announced that it will no longer crush its grapes under foot.

The saddest part is surely that:

While the robots are an expensive investment, they can do the job at any time of the day or night - and don't need the encouragement of an accompanying musician.

Will port wine ever be the same without the local folk tunes of Portugal being instilled into it at birth I wonder?

...let alone enforceable?

A row that has so far been played out in the pages of the august British Medical Journal has suddenly burst out onto the public stage as MPs have found constituents being told they will have to pay for their NHS treatment because they've paid for additional drugs or treatments, for example that the NHS doctor tells them may help but cannot be prescribed by them.

But is the notion that you can be barred from receiving the treatment your tax already pays for even legal? Apply the same argument to education, for example, and parents who pay for a few weeks extra tuition for their child would be forced to pay for the whole of their state school provided main stream education.

And even if it is legal, how is it enforceable? Should someone who buys some nutritional supplement that a friend recommends in addition to prescription drugs for their illness be forced to pay the full costs of their NHS treatment? Or is there some (arbitrarily?) set level - is it okay to buy an extra packet of over the counter drug but not a cancer drug that NICE won't allow you to have on the NHS even if your NHS doctor says it will possibly help over and above what they can do for you? And how do they know? Is it basically down to whether or not a private consultant requests your medical records from the NHS and the person receiving that request has to snitch on you?

Of course I can see there may be cases where it might be legitimate for the NHS to wash their hands of a patient who has paid for some additional or alternative treatment that actually compromises the care the NHS is trying to give that patient. But if it's complimentary to the treatment the NHS are giving, and only unavailable through them because of NICE, or budgets, or rules, that doesn't apply. Indeed, it would probably be saving the NHS money in the longer run - the quicker you are cured, or the more independent you are, because you have supplemented your treatment, the more resources they have to spend on people who cannot pay the extra, surely?

Again, the comparison with private education is interesting - if someone's additional private tutoring has made them better able to cope with their mainstream school classes in some way, the classroom teacher, surely, has more time to spend on others.

And if it's indeed just if it goes against the advice of the NHS,
should anyone who does not apply government sanctioned wisdom on
healthy living be made to pay for all NHS treatment because their
lifestyle is prejudicial to their health in some way? 

Or, perhaps, could it all be a case of corporate welfare - the NHS has "exclusive" deals maybe with drug companies that, say, give them discounts or some other kind of soft benefit even if only their treatment is used for a particular condition and if people opt to go for a competitor's supposedly better treatment the deals all fall apart. The NHS is riddled with protectionism, particularly in its procurement policies. And yes this itself locks out competition and keeps prices high.

The only real answer is that clinicians themselves should be allowed to select and prescribe their own choice of treatment that they think will help that patient get off their hands as soon as possible and let them get on with curing someone else. Surely that's the whole point of the NHS?

Tomorrow is the Lib Dems' South Central Regional Conference at Newbury. Since there is now a leadership election, and both candidates (I still hope for more but it's looking increasingly a remote possibility) will be there and will effectively make a first "hustings" in the campaign the other bbusiness of the conference may well get curtailed. I was hoping to have the floor in the Affordable Housing debate, so in case I do not get to speak after all I thought it worth while putting my three minutes' worth online. So here it is:

"Make no mistake, colleagues, I do not believe it is ultimately possible to have sustainable, equitable and affordable housing without radical land reform, by which I usually mean Land Value Tax. There is no shortage of land - if all of us in this region lived at the same density as the population of Singapore or New York City we'd all fit easily onto the Isle of Wight. And, by and large, there is also no real shortage of housing; the vast majority of households in housing need are in fact housed somewhere, just it is often either beyond their means, hopelessly cramped, or both. And yet up to 45% of our housing stock is UNDER-occupied while 2-3% is over crowded. Only LVT can solve this kind of mismatch. And trying to build ourselves out of the problem in popular areas is going to do nothing longer term for regional equilibrium as it increases the capacity in, for example, the south east, to absorb yet more of the rest of the country's economic activity.

But there's another, more localized, land reform that could help. It's party policy, though hasn't received much promotion or support, and our local councils do not seem to be encouraging it terribly enthusiastically. Community Land Trusts are a practical and immediate measure that party members can take home from here today and get their members and councils working on. A Community Land Trust is a vehicle established to hold land on behalf of a defined community - it could be a city, an individual neighbourhood, a rural parish or a countty-wide umbrella organization. The idea is that we acquire land, either through the planning process, by outright purchase or donation by philanthropic land owners (there actually are such creatures!) and lock it up in a trust. This way we do not need to pass the cost or developed value of the land onto the buyers of the housing we build on it, built, always, with community buy in and if possible self-management of the specification and design process.

We then bundle the whole development up and turn it over to a "Mutual Home Ownership Society" which the occupiers join by paying a share of the borrowing used to develop the properties. The share they pay is based on what they earn, not the housing they need and they don't pay any extra rent as with shared ownership schemes. If the development is itself large enough, we hope the incomes across all the households involved will between them cover the repayments, and each gets a share they can sell when they want to move on based on the proportion of the borrowing they have committed to, plus (or minus I suppose these days) an adjustment based on an agreed local property index. When they want to sell up, they need to find a buyer for their share. If the incoming household has not as high an income, they can place the balance of their share with other member households whose incomes have risen since they joined - and who by the terms of their lease are bound to buy additional shares when required up to a commitment of around 30% of their household incomes.

The model can be tweaked for use in many different scenarios - a small scale rural exception site where there is as yet no subsidy for developing social rented housing, an urban development where we want 100% affordable - as in sub-market - housing instead of 50:50 posh:poor for the same land cost, or even an existing mature suburban neighborhood willing to club together, pool the new found wealth of their existing housing equity and take charge themselves of the regeneration of their neighbourrhood, instead of leaving it to the buy-to-let absentee landlord or the local developer of flats crammed into the corner plot.

Schemes can be financed by conventional borrowing backed by the freehold land value, or, we hope, by a new vehicle christened an "Open Capital Partnership" which would allow ordinary investors to yield an index linked return for investing in their local communities. As a side-bar at that point to finish with, we might want to look at Building Society legislation: being a mutual ownership system many of us CLT promoters would like to work with mutual financing organizations, but your local Newbury Building Society tells me they are prohibited by law from investing in something that is not an individual taking out a mortgage for a single house, despite the movement's origins as mutual savings clubs building local neighbourhood housing."