It is a distraction whether or not the prime minister utters the c-word today - or any other day come to that. The plain fact is there will be mega cuts. Two crucial questions are how big they will have to be to restore some sanity to the national accounts and when should they start?

A weekend poll shows the strong preference of voters for public expenditure cuts rather than tax increases. What I don't know, but will be crucial politically, is whether these are views based on today's phoney war over cuts or whether they are based on a more accurate appreciation of just how serious the position is.

This economic phoney war atmosphere has been made up from two contradictory forces. Voters have been bombarded with tales of extreme economic woe ever since Northern Rock bit the dust.

One of the prophecies was a recession as bad as that following the 1931 crash. In terms of national income falls that prophecy has already been borne out.

But we are now much richer so that cuts in national income fall on a much fatter body. Likewise, the government has been reflating, borrowing on a scale unknown before and printing shedloads of money. So many of us are still being protected.

At some time these policies will have to go into reverse and then there will be major economic hardship that could change the public's view on cuts. The question is, when will the cuts strategy be implemented? This debate has so far been won by those who argue that it is wrong to cut in times of recession. To do so would risk any recovery, they say. This is important, but only one dimension of what should be a two-dimensional debate. Not cutting now might also harm the recovery.

Each week the government unloads another shedload of debt on to the gilts market. There will be at least 38 more auctions between now and the expected date of the next election. Up until now the main buyer of this debt has been the Bank of England, which has been printing money to make these purchases. It has an Alice in Wonderland quality about it, doesn't it?

But the Bank has now declared a cessation to printing yet more money. Very shortly, therefore, the market will be tested on who is out there that wants to buy British government debt. All of the countries in the G8 group are also in the market selling debt and we will be trying to borrow a higher proportion of our GDP than any other G8 country.

Selling this debt will be far from easy. Long-term interest rates will inevitably rise, which will make borrowing capital more expensive and so harm any potential recovery.

One way of moderating the rise in long-term interest rates would be to convince the market that the government is serious about balancing the national accounts sooner rather than later and has published a plan to achieve that goal. Moreover, lower interest rates will mean that a smaller proportion of future national income will be impounded to both debt charges and repayment costs.

Britain is therefore in a lose-lose situation. To cut too early might harm a sustained recovery should that be forthcoming. Not to begin cutting soon will push up interest rates, which will not only harm any recovery but see a larger proportion of the country's future living standards confiscated to pay the money lenders.

For reasons that are obvious to readers of this blog, I favour an early cut strategy. For the gilt market to strike and not to buy future debt will have catastrophic economic and political consequences here. This is the real danger that has still to be registered in a tired and still very timid debate over public expenditure cuts.

It is predictable but deeply depressing. Up goes the cry that any review of NHS expenditure MUST result in cuts to consumers.

The debate on public expenditure cuts need to be focussed on output and not input. Over the first ten years of this Government's life productivity FELL in the public sector while increasing by 26 per cent in privately run organisations.

It is on this mega discrepancy that the debate should be exclusively concentrated. Going for a debate on cutting or non-cutting is simply a cop-out. It continues the error of public sector reform debate for as long as I can remember.

The NHS budget stands at £94.5bn - a tripling since 1997. If the NHS had delivered the same productivity as was registered for the private sector over the same period, they very same NHS output could have been gained on a total bill REDUCED by £26bn. The political kaleidoscope needs a radical shake up.

A first move would be to insist that the poorest performing hospitals equal the productivity of simply the current average. That move alone would save £2.4bn with no increase in resources.

A second move would be to insist that all hospitals perform as do the best units.

A third move would be to move the whole of the NHS in productivity terms to equal simply the average of the private sector.

A final move would be to ensure that the NHS leads the productivity league table of both public and private sector.

How do we make the most important changes in our health services since the NHS was established in 1948? It is by concentrating exclusively on NHS output rather than inputs.

Those who love the NHS have a duty to insist that this is the only debate in town. It will be a far from easy one to win but success will transform British politics.

The UK's population has now hit 61m and is growing twice as fast as in the 1990s and three times as fast as in the 1980s. On present forecasts the UK will hit 77m in 50 years' time and will outnumber France and even Germany.

Will it ever happen? Long term population forecasts are notoriously unreliable but, at the 20-year range, the Office for National Statistics has been accurate to within 2.5% in the past half-century. Its present forecast is 70m in 2028 and must, therefore, be taken seriously.

It is important to disentangle the two major influences: birth rates and immigration.

The birth rate in England and Wales is now 1.96 children per woman, close to the replacement rate of 2.1. This is partly due to immigration since women born outside the UK have 2.51 children on average compared to 1.84 for UK-born women.

Last year, for the first time in many years, natural change (births minus deaths) exceeded net immigration. But the full effect of immigration over, say, a 20-year period must take account of the children of those immigrants. A more sophisticated calculation of this kind shows that immigration accounts for nearly 70% of population growth.

It follows that immigration policy is critical to the future size of our population and is, of course, the only aspect of population growth that the government can directly influence.

Everyone agrees that we need some international migration to provide skills unavailable in Britain, at least until British workers have been trained. But what really matters for the population is how many people stay on and settle. The government's recent proposal to split economic migration from settlement is a major step forward.

But much more needs to be done. Net immigration must be brought below 50,000 a year if the population of the UK is to be held at less than 70m. If we want to stabilise our population at 65m we must get immigration into balance with emigration. That is the target of our Cross Party Group on Balanced Migration.

There is still a long way to go. Yesterday's figure of 118,000 net inflow was the raw data from the International Passenger Survey. The ONS will make adjustments to this for asylum seekers and those who change their intentions. These normally add 35,000 to the total so even in a deep recession we have net immigration of about 150,000.

There is no silver bullet to achieve the reduction we need. The first step is for both main political parties to commit themselves to restraining our population by limiting immigration and then building the necessary measures around it. This was the recommendation of the Select Committee on Economic Affairs of the House of Lords who reported in April 2008. We think that is the right approach and strongly commend it.

This blog first appeared on the Guardian's Comment is Free site.

I fear that many people could add their own experiences chiming in with the report the Patients' Association released today. The Association reports a consistent pattern of shocking standards of care that patients have experienced up and down the country. The Association believes that its report highlights the persistent unacceptable behaviour by nurses.

Their examples reflect my own experience. As my mother got frailer the numbers of trips to hospitals became more frequent.

It was when she was in Eastbourne Hospital that I first noticed how callous the attitude was of a whole group of nurses. Lunch had been served and the woman in the bed next to my mother had had a stroke.

As my mother ate there was terrible noise from the neighbouring bed. My mother encouraged me to go and feed her neighbour, and this I did.

The woman was paralysed and unable to reach her food. It was regularly placed there at meal times and then simply taken away uneaten.

The nurses commented how kind it was of me to feed the old lady. I didn't have the courage to tell them that it was their job; and that they had stood in a group gossiping, watching what I was doing. I was fearful that they would take it out on my mother if I did so.

Similarly callous and uncaring treatment was on display all too often in London hospitals. On one occasion I was walking down a mixed ward to clean my mother's teeth and was confronted by an old man who had fallen out of bed and somehow got his nightgown over his head.

His sounds of alarm were terrifying. I picked the very frail old man up, helped him back into bed, and proceeded to clean my mother's teeth. The old man's bed couldn't have been more than six feet away from a group of nurses who were trying to chat up doctors.

On another occasion my mother reported she had asked for a bed pan only to be told that staff were too busy. She should wet her bed and they would change her later. Not only was this incredibly humiliating for my mother but it must have led to more work later and higher laundry bills for the hospital.

Uncouth behaviour must have been part of hospital life through the centuries. Nursing reform I believe has made the situation worse.

The rush to professionalise nurses, and to make it a degree occupation, has brought significant changes in its wake. Nurses are now mainly trained in the classroom and not on the ward - so there are fewer people to help run a ward.

Making it a degree profession begins to change who is admitted to the nursing ranks.

Ticking the boxes to get a professional qualification is now weighted higher than the practical skill of caring, or indeed loving the patient.

That role, if it is performed at all, is likely to be performed by the ward orderlies. Composed largely middle-age mums this group has acquired many of the tasks that nurses feel are beneath the status of a profession, degree-carrying worker. But the orderlies are restricted in what they can do.

So patients have the worst of both worlds. A group of orderlies whose strict work routine forbids them from carrying out little acts of care for which it is absurdly judged that they are not trained to do, but many would like to do. And nurses, who have taken themselves upmarket in shadowing the role of the doctor.

There is no way these nursing reforms so called will be reversed. But there is a case for the Patients' Association continuing a campaign so that callous and wicked nurses are sacked. Hopefully the Association will also campaign for setting free the ward orderlies to do many of the tasks which previously nurses willingly undertook for their patients.

Britain will soon be in an era of unprecedented cuts in public expenditure.  Yet one item of expenditure is set to rise - our contribution to the EU.

Figures dug out by Lord Vinson show that today's reports on our rising subsidy to the EU are wide of the mark - awful as the figures were.  The Treasury's Public Expenditure Statistical Analyses 2009 shows net expenditure rising from £5.4bn in 2007-8 to a whacking £7.9bn planned for 2010-11.  

By then MPs will be inundated by constituents fighting each cut in the monies going to public services.  I have stressed before that this needn't be the outcome.  If the public sector had the same productivity as the private sector, everything we buy today could have been procured at £58.4bn less. 

The Europhiles will need to be on their mettle to defend a record 46 per cent increase in taxpayers' money going to the EU over a three year period when belts are being tightened all over Britain. But the position is far worse than the near record £8bn contribution.  This is a net figure.  Britain will receive some of its much larger contribution to the EU back for approved programmes. 

Here, a British Government, who has raised the money from British taxpayers, will not be able to direct the money as they think best.  Our money will only be forthcoming from Europe providing we spend the money in the way the EU decides.  

There are two other news stories that have emerged today which again question the type of organisation to which Britain now finds itself signed up. 

One of Mrs Thatcher's Governments took powers to try and regulate video nasties.  We now find out that while the British Parliament passed the legislation to control the sales of these items, the British Government didn't tell Europe of its intent. 

It is the first time that I, as a legislator, have heard that those areas which are not directly controlled by the EU, are in fact indirectly controlled.  The Government is being forced to reintroduce the Thatcher measure and get EU agreement. In the meantime video nasties can be on sale without any restrictions whatsoever. 

As if to compound our sorrows, Panorama last night reported on the impact the working time directive will have on the quality of our life and the way we wish to lead that life.  Wardens of sheltered accommodation are being phased out as their existing contract is negated by the working time directive.

Panorama reported pensioners unwilling to lie down and take this cut in a standard of living for which they are paying.  Worse still will come in a few days when the working time directive will hit hospitals. 

Nobody is in favour of people being sweated.  But what was the crime of a warden of sheltered accommodation, gaining free accommodation, simply being on call, if they were around, if a resident got into difficulties?

Likewise changes have been necessary in the way we ran junior doctor regimes in hospitals. But come September 1 any of us using hospitals will immediately see the difference in the quality of care for which we have paid.

The Government's borrowing figures out today are worse than what it had planned, no matter what silk phrases the Treasury utters. At this rate the Government is on target to break through £200 billion in loans for this year, as I feared at the pre-budget report and despite counter statements.

The borrowing data gives the other side to the unemployment figures, which, at best, are contradictory. The income tax take, the levels of national insurance contributions and the returns from corporation tax give a picture of how the real economy is being wrecked by the recession.

July is normally a bumper month for tax receipts. Yet all three indices hint at how hard the recession is imparting on the economy.

Compared with July a year ago, the national insurance contributions are down by 1.1% and corporation tax is down by a staggering 38%.

Income tax returns, including capital gains tax, are 14% below what is was 12 months ago. Add to these figures a 10% increase in benefits spending and we have a picture of public accounts chaos.

For the first time under this administration, the Government is forced to borrow in the month of July in order to have enough revenue to meet July's liabilities. This month's £8 billion borrowing brought the borrowing total for the first four months of this financial year to almost £50 billion or nearly 57% of GDP, the highest since records began 30 years ago.

The cost of Government borrowing consequently rose, and with it the amount of our future income, which we are yet to produce, that will have to be foregone just to pay the interest, let alone the repayment, of record public borrowing.

So far the gilt market has been assuaged by the thought that a future Tory government may mean business in bringing a sense of order to the nation's accounts. But with many more months' figures like these, the market will need a much clearer picture of what action is planned by both the Government and the opposition if long-term interest rates are not to be pushed up significantly.

The Government will then face a cruel choice, whether it lets rates rise, so putting off the pace of the recovery, or it begins serious to cut public expenditure now, and in so doing, according to many economists, wrongly I think, delaying the start of the recovery.

With public borrowing coming in at £200 billion, and the printing of money as though there is no tomorrow, it is difficult to understand the reasoning of those voices who prattle on about the dangers of cutting public spending now. If these totals are not reflationary it would be difficult to know what would be.

Action will be forced soon in order to avoid the gilt strike.

The Independent on Sunday yesterday carried the '50 smuggest Britons'. How did they make this choice? The article was billed in the following terms:

'They are pleased with themselves, very often with no discernible cause, and our stand-in PM, Lord Mandelson, proved last week he is the Daddy of them all'.

The IoS assured its readers that it had deliberated long and hard over who should feature in their 50 'cats that got the cream'.

One of these, high up in the table, is Simon Cowell. The IoS bills him as 'the man who owns the TV show which makes the stars who make the records which Simon sells by the truckload'.

That is one description of him. But there is another, much more flattering reading of his abilities.

He thrives in a host of talent-spotting shows by being brutally frank. Goodness knows why most of those appear wish to appear. Some of them must be chosen because they are so inept, and one hopes they can put their lives together quickly enough after the audience has ceased laughing at them.

But Simon Cowell's strength, as I see it, is not simply in allowing and indeed encouraging people to make fools of themselves, his specialism is being frank about their talents.

Part of his appeal is that this sort of character, that used to be common in all different stages of our lives, is now almost absent. People are not told early on that they are wasting their time and that their talents could be better used in other directions.

It seems to me we don't want less of what the IoS describes as ‘the smug Mr. Cowell'. We want more, although not necessarily of him, but of the brutal truth that he brings to his role as decision maker.

One can but imagine how different the British economy would have been if employers had had his insight, and backed it with the necessary ruthlessness, in ensuring that British manufacturing modernised. Instead of earning their pay, all too many of these employers took the quiet option, took the money and never confronted their labour force with brutal truths about international competition for a country so dependent as we are on international trade.

Likewise wouldn't the Labour Government have turned out so differently had Tony Blair had the courage after John Smith died to tell Gordon Brown to challenge him? Instead of being brutally frank, telling Gordon that he welcomed a challenge and that he would humiliate him - as I believe he would have done - the weak compromise was born of an inoperative power sharing agreement which crippled the last three Labour governments.

So three cheers for Simon Cowell. The PLP could do with someone of his abilities to tell them what the options are if the party is not to collapse into a mega electoral defeat next year.

On Saturday, I visited Wallington, a National Trust property in Northumberland. It was one of the homes of the Trevelyans and was given to the National Trust by Sir Charles Philip Trevelyan a Liberal, and then a Labour politician. His brother George Macaulay Trevelyan, was perhaps the greatest and certainly the most successful historian of his day.

I also visited Craigside - the house that Lord Armstrong built for himself for what was once a wonderful view over Northumberland's stunning countryside. I say was because the National Trust has allowed horrible conifers to grow so the view that Lord Armstrong saw is now literally cut off.

This is not a plea for the National Trust to cut back some of these conifers to restore the site to what it was in Lord Armstrong's day, although that would not be too bad an idea. It is rather to comment on the darkness of both houses.

Saturday in Northumberland was a proper summer so that, at times, sunlight would have lit up both houses. But both establishments appeared dressed for a funeral. In Wallington, in particular, blinds were drawn in some rooms, to keep out the natural light.

The house does not have fine pictures as do some great country houses and other establishments. But there are personal collections of considerable interest.

The best room for paintings was what is called Lady Trevelyan's Parlour. Here there are works of Edward Burne-Jones, by Turner, by John Ruskin, Lord Leighton and William Bell-Scott.

The room was so gloomy that it was impossible to see the paintings as visitors were moved through a very limited corridor with most of the room roped off on both sides. The Trust offered a plastic folder so that in the semi-darkness visitors could "see" what was on the walls. One could not properly see the pictures oneself.

When we came out into bright sunlight to have coffee, I read the guide which told me who the artists were of the pictures I couldn't see. We went back and asked for readmittance.

Here is one of the great strengths of the National Trust. Each room was well attended and the two volunteers staffing the door were only too pleased to allow us back in to see whether we could spy better what we now knew to be the paintings.

More farce was to follow. Once back in the room, I discovered from the plastic folder that one of the paintings behind the door was by Roger Fry. But the door was open and the area in front of it was roped off. Try as I may to hold on to the door, and get my head around it to get as near as I could to the Fry painting, I could not see the work, even in outline. What I could not see on the wall I went back to view in the plastic folder.

What is the National Trust up to? Anyone can understand why a room would be screened from bright sunlight. But even in an English summer that sunlight rarely lasts for the whole day on the same room.

For the first time in my life I came away with a different view about the National Trust. I watch gangs of tourists, from the UK and abroad, being taken round London with their guides holding up umbrellas yelling about moving on to the next site. It is like a military operation. The parties seem happy enough to move and tick off another building from their itinerary.

But does the National Trust realise that, if Wallington is anything to go by, visiting one of these great buildings is being changed significantly for the visitor. Is one going to be given enough light and be able to get near enough to exhibits to enjoy their splendour? Or are we moving to the foreign tourist guide party where quick squeaks from guide operators take visitors on to the next room and then the next building?

The selection of the next MP for Totnes by open primary throws a much needed life-line to our drowning political parties. It will in retrospect rate much more highly than the establishment of a supreme court which has caught the attention of some commentators.

Political parties are dying, but they play a crucial role in delivering representatives and responsible government in this country. The choice of candidates allows people to elect representatives who roughly match their views. Party discipline ensures that the majority party can be held responsible for its programme at a general election. Our system of democracy is now dependent on the party system for without political parties it is difficult to envisage how representative and responsible government can be made effective.

But from their post-war peak public interest in political parties has disintegrated. Many of the safest Tory and Labour seats have only a handful of activists running their affairs. All three main political parties have attempted reforms to involve the wider public, but none of the parties have so far been prepared to surrender power to their new recruits, let alone to a wider group of the electorate.

Last year, I called for a system of open primaries in safe seats. One or two such primaries have been tried by the Tory party in hopeless seats, but while the experiments were interesting, and gained not too bad a turn out, the open primary could not really decide anything.

A third of seats shared between both major parties return a candidate of the same party label at every conceivable election.

Under this new system, the dominant party would have control of who the candidates in the primary would be and in Totnes they opened up to all interested parties.

The party drew up a shortlist of three. The Mayor was nominated and so was the leader of the council. But so too was a local doctor who wished to become involved in politics because, only by helping to change the country's drug policy, did she believe she could offer local addicts the chance of a better life?

I am writing this blog before we know the results of the poll in Totnes when the whole constituency could decide who they wished to see as the next Tory candidate, and therefore the next Member of Parliament. But even if the outsider - the doctor - does not become the candidate, it is now going to become increasingly difficult for other political parties in safe seats not to follow the Totnes example.

Other changes will follow too. Once these open primaries catch on my guess is we will see more unopposed returns at general elections. If the electorate has been given the chance to vote in the primary - and everyone in Totnes got a postal ballot - then those parties without a chance of winning are unlikely to put up candidates in the general election.

I also believe we will move fairly smoothly to a two tier type party membership; there would be the core activists which will of course continue to remain important in safe seats. But thereafter the membership will become blurred. In safe seats where the electorate choose their candidate, I would guess that many voters who would not normally support the dominant party in the area would nevertheless help raise funds and participate in events to support who they will feel is "their" candidate.

There will be lots of other consequences which we now cannot even envisage. But the bravery of the Totnes Conservative Party in holding an open primary marks the death of the old party system. Long live the party system.

The Government today makes a major move towards the objective for which the Cross Party Group on Balanced Migration has been campaigning since its inception. It intends to break the automatic link between people coming here to work and, thereafter automatically, gaining citizenship.

The Government has a points-based system to determine who comes here to work. A committee headed by Professor David Metcalfe adjudicates where there are skills shortages in the economy and sets a points-based system to reflect these vacancies.

While the system has resulted in a decline in immigrants coming to work it has only indirectly operated on the numbers of people becoming citizen and thereby growing our population. It is the growth in population that is the major challenge.

The UK population will, on the Government's own estimates, grow to over 70 million in less than a quarter of a century. 70% of this growth will be due to migration. This increase of 7 million is equivalent to the building of 7 new Birminghams.

Recently the Home Secretary has reported not to be losing any sleep over this gigantic increase in the numbers of people in the UK. He may not be losing any sleep but he has certainly been spending his waking hours to good effect.

Announcing the new scheme today the Government has admitted that it is not so much the numbers of people who come here to work and service our economy that are the problem but the number who wish to stay on and wish to become citizens. The Government intends to break the automatic link between working here and becoming citizens by introducing a points system for citizenship.

This is a first crucial move, but it is only the first. A points system alone will not stop Britain's population surging towards 70 million and then growing still further. If the Government is intent on controlling the growth in the population it needs to cap the numbers of people who can become citizens.

The UK population today stands at 61 million. To prevent the population hitting even 65 million by 2025 requires that the number of new individuals granted citizens to be no greater than the numbers of people leaving the country. On past form any increase in the population by immigration affects only England and within England the south-east is the area experiencing fastest growth.

I doubt whether it has escaped the Government's notice that, while the northwest have many marginal seats, most marginal seats are south of the Wash.