Evidence abounds, however, that some officials at the Education Department, motivated both by ideology and by a bureaucratic desire for control, played a crucial role in sabotaging the government’s education reforms. ‘I have never known any other civil servants quite like these in the Education Department with such a view that they Daily Mail, 12 July 2010 This week, we will start to see whether the coalition government really will put our money where its mouth is. It now has an unrivalled opportunity to reform the NHS. Public service repair lies at the very heart of the Tories’ agenda. They have also been warning the public for weeks now of bloodcurdling cuts to public spending, with so far only minimal protest. The LibDems are bolted into the project; the Labour Party, which is behaving with all the finesse of a wrecking ball, currently appears determined to bolt from reality altogether. As Hilaire Belloc might have put it about the reform programme, ‘the stocks were sold, the press was squared, the middle class was quite prepared’ (well, as much as they will ever be). Today, the Health Secretary Andrew Lansley unveils his NHS White Paper. Yet, unfortunately, rather than showing the way to the promised land of radical reform, he appears to be trapped on the treacherous slopes of Mount improbable. His first problem is that the astronomical £100-billion health budget has been ring-fenced against the cuts being planned for the rest of the public sector. Supposedly intended to protect the NHS, its real purpose is actually to protect the Conservative Party from attack by the Left as ‘the nasty party’. But it is all too likely to hold back the change that health provision so desperately needs. For the unprecedented spending increases of recent years have largely disappeared into the back holes of NHS salaries and pointless bureaucracy, with relatively little improvement to front-line services. Lansley claims that he will now spend this money far more wisely. For example, he proposes to make a bonfire of health quangos. Such bodies are indeed often worse than useless. But they are nevertheless small beer, and their abolition will make scarcely any impact on NHS spending. his reported showpiece proposal is to hand control of budgets and commissioning to GPs, with power taken away from primary care trusts and strategic health authorities. Oh dear. The last thing that’s needed right now is yet another massive reorganisation, which may well incur even greater costs. According to Professor Chris ham, Chief Executive of the King’s Fund independent health charity, it could mean yet more paperwork — and that GPs would be likely to demand more money for the additional responsibilities, as we saw in the controversy which followed their self-aggrandising contracts not so long ago. It also surely runs the risk of fragmenting the service, since GPs will try to look after their own clinical patch rather than the general good. And this gets to the crux of the problem. A national service needs to offer unified provision throughout the country in order to be seen to be equitable. That means inescapably top-down government control. Any attempt to outsource accountability for taxpayers’ money means the service is no longer run in the interests of all but for the benefit of producer groups, such as GPs, who would be controlling the purse strings. But too many patients already lose out. What’s desperately needed instead is to give patients that control. After all, isn’t devolution of power to the public what Prime Minister David Cameron’s ‘Big society’ is supposed to be all about? That means replacing the NHS altogether, either by a voucher scheme or a continental-style social insurance model. Cameron has deemed the NHS to be sacrosanct, primarily for political reasons. he is probably also emotionally attached to it on account of the care with which it treated his disabled son ivan during his short life. We can all deeply sympathise with such feelings. But others of us have had less happy experiences with the NHS — particularly the way in which too often it treats the elderly poor with neglect or contempt. The key to these distressing experiences is that patients — or their families — cannot control their care because they don’t control the purse strings. Doctors and nurses are thus accountable not to patients but instead to NHS managers and Whitehall. Moreover, if GPs are given responsibility for the health budget, their overriding ethical duty to each patient will have to be balanced against their responsibility to the wider community. And these obligations may be in conflict. The only fair solution is for the individual patient to drive the process of healthcare provision. Stephen Dorrell, the Tory chairman of the Commons health select Committee — and who cannot remotely be called a heartless Right-wing caveman — has proposed that the NHS should be replaced by a voucher plan for patients to buy their own treatment. As he says, many suffering from a long term condition have a better idea of what to do about it than their local GP. Moreover, far from being ‘fair’, the NHS favours the middle class which has the sharp elbows to play the system. Only some kind of voucher or social insurance system gives power to the poor to enable them to lever upwards the often rotten standards of treatment with which the NHS currently fobs them off. The Coalition has the right instincts. But through political timidity or intellectual confusion or a combination of the two, it is not allowing itself to think the unthinkable about the NHS and other public services — and is thus risking the very failure it dreads. The history of the past three decades has been one of repeated attempts to reform public services. indeed, the NHS has been subjected to near-continuous reorganisation for much of its existence. However well-intentioned or apparently imaginative, all such attempts are doomed to failure unless the fundamental problem is acknowledged — that taxpayer-funded public services administered by central government don’t work. Spatchcocking on to this system initiatives designed to shunt responsibility downwards merely moves centralised control a little lower down the administrative food chain. Both Lansley and the Education secretary Michael Gove are having to work with one hand tied behind their backs because of an overabundance of political caution. Yet such timidity will not protect them from the hounds of public service hell. Gove’s much-vaunted ‘free schools’ will not actually be free of central controls over profit-making or academic selection. Yet despite the less than radical scope of his reforms, he has already found he has stepped into a minefield. His modest proposal to cancel rebuilding or refurbishment plans at 700 schools blew up in his face when he inadvertently presented misleading information supplied by his civil servants — after he had accused the relevant quango of incompetence and profligacy. With the blame game in full swing, it’s not clear where responsibility for this particular debacle actually lies. But as if this wasn’t bad enough, suddenly Tory MPs have succumbed to epidemic Nimbyism as they too turn upon the hapless Gove in order to protect the school building projects in their own back yard. The danger now is that all this sound and fury being whipped up over Gove’s reforms will cause the Coalition to lose its nerve altogether for fear of even worse storms ahead. But ministers should realise that the only way to come through such concerted resistance is go even further in the direction that is being so loudly challenged. Both Lansley and Gove should use every instance of reactionary opposition to ratchet up the radicalism. Significant change has to be coherent and uncompromising. Half-baked reform which cringes from controversy will inevitably end in failure. In for a penny, in for a pound after all. And as we all know, these are currently in very short supply.
Monday, 12th July 2010
Gove on the rack -- but who put him there?
11:28pm
Reading today’s Sunday Telegraph claim that the new Education Secretary Michael Gove was to blame for the débâcle over the misleading details of the cuts in the school rebuilding programme put me in mind of comments I recorded in my 1996 book about education, All Must Have Prizes.Ruminating upon the never-ending war of ideological attrition being waged by the education establishment upon the very concept of a liberal education -- and consequently upon the life chances of countless thousands of British schoolchildren – I wrote:
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Monday, 12 July 2010
July 12, 2010
The half-baked plan to reform Britain’s health service
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