Charlotte Alldritt

Things I know from Ken Clarke. And other short stories.

In Healthcare on May 26, 2011 at 5:54 pm

Ken Clarke has been attracting a lot of media attention of late.  Until the Prime Minister intervened to reassure us that all rape is serious, Mr Clarke’s suggested typology whipped up considerable furore.  The veteran Cabinet Minister is used to controversy though.  As Secretary of State for Health under the last Conservative government, Clarke was instrumental in creating the NHS internal market of the early 1990s.

Displaying a tad more political deftness, Clarke’s approach was pragmatic but determined.  A gradual reform process of pilots and consultation wasn’t even on the table.  Addressing the British Medical Association (BMA) he said, “If I do that, you buggers will sabotage it”.

Lansley might have learnt a thing or two from his Cabinet colleague; he’s now just conceded that his ‘legislative pause’ is creating confusion and uncertainty.  The increase in volume and intensity of opposition (e.g. from the BMA, the Kings Fund and even Professor Steve Field, moderator of the NHS listening exercise – ‘Future Forum’) shows that too long a pause gives time for the other side to rally.

If allowed, opposition voices will continue to use this listening exercise to shout down any potential for reform during this Parliament.  This would be bad news for the Coalition, and the NHS, for three reasons:

  1. Politically it looks very weak – the government cannot be seen to back down again after a string of u-turns.  The Conservatives also will want to galvanise the post-AV Coalition power balance whilst the Lib Dems are still shrunken and divided.
  2. Ideologically the Conservatives are committed to a competitive, market based health system.  Most believe in an NHS free at the point of need, but the party’s entire reason for being is to allow market forces to determine the nature and shape of our society.  Including our public services.
  3. Financially the NHS is verging on complete meltdown.  Forget our ageing population, long-term conditions and increasing expectations by 2020 or 2030 (although these are real and important), the NHS is struggling to keep up with rising costs that are outstripping inflation today.  When some of London’s flagship hospitals face insolvency (e.g. St George’s and Imperial College Trust) you know we’re in trouble.  My colleague, Professor Nick Bosanquet, has argued that the system will wake up to this reality sooner than we might think – by 31 October 2011 in fact.  The current system is sacred, but unsustainable.

Health policy guru, Simon Stevens (formerly adviser to Tony Blair and the Department of Health) says the way out of the current listening limbo-land is to find agreement on which “parts of the new reforms are genuinely likely to help ‘future proof’ the NHS“.  (Read his excellent interview with Health Insight here.)  He’s right.  While the NHS is performing better than ever, the question is how sustainable it is.  Unprecedented productivity savings are required of the NHS by 2015, and even then we’ll be running to catch up.  The longer term effects of our changing society will then start to creep in, compounding problems all the more.

Unfounded cries of privatization and the perils of competition abound, distorting the process of genuine public debate.  We’ve had a listening exercise.  We now want a presentation of the case for change with a clear communication of how the reforms will do what we need – to drive up quality and drive down costs.

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Marginalised, but not isolated

In Uncategorized on May 23, 2011 at 8:21 pm

Economic uncertainty continues to be the public’s top worry.  A poll by Ipsos MORI (12th May) shows that even after a 7% point fall since April, 55% of the public still rate the economy the most important issue facing Britain today.  With unemployment the next most important (27%), it seems the public isn’t reassured by the recent improvement in unemployment figures*.

This morning I listened to Rt Hon Iain Duncan Smith MP talking about the Coalition’s strategy to get people off benefits and into employment.  The “Universal Benefit and Work Programme” he said, “are two sides of the same coin” in getting more people into work.  By reducing the current array of work-related benefits to one, the Universal Benefit is primarily designed to simplify the system and to make work pay (…really this time).  Meanwhile, the compulsory Work Programme will see intense invention based around people’s individual barriers to work.

Iain Duncan Smith is particularly worried about people furthest from the labour market, those typically with a disability, drug addiction or complete lack of any basic skills.  He’s not so worried about the 75% of unemployed people who get themselves back in work within 6 months.  The distinction is important.  Those people with a history of work, for whom the idea of being out of a job is inconceivable, will bear the effects of unemployment – financial, social, and psychological.  But it is these factors that drive them back to work in the first place.

The Secretary of State is most interested in the groups in society for whom work itself is inconceivable.  Where three generations of families might have never worked, or – as he suggests – where people have no concept of what it is to get up in the morning at a regular time, let alone be ‘work ready’.

In the case of the first group, the majority, traditional economics of financial incentives matter: costs of travel to work, childcare and benefits all go into the trade-off of whether to work or not for a given wage.  Social factors play a considerable part, but the decision making process can be modelled as a rational choice given individual circumstances and preferences.

For the second group, the hardest to place in sustainable employment, their situations are more complicated and the standard economic textbooks outdated.  Just when the policy makers want to rely on their model most it fails them as deeper social and cultural factors now subsume the individual rational choice process.

I asked the Secretary of State how he was proposing to address these cross-cutting, social and cultural barriers.  What use is an individual cost benefit analysis of the discounted value of employment (I used the convoluted jargon to hammer home my point) if whole communities, social networks, cultures and norms exist to support the notion that the labour market is simply not relevant or even necessary?  More importantly, how can these networks and communities be utilised so that the values and habit of work spread to become the norm?

Unfortunately it seems the DWP has done some great work on the traditional economics surrounding benefits and their incentive structures, but only to solve a problem they are little interested in (i.e. helping those who are largely driven to get back into work themselves anyway).  Meanwhile, in tackling their most troubling and costly concern they neglect the social context at root.  The Work Programme might be aimed at some of the most marginalised people in society, but they are not isolated individuals.  In or out of work, we are all connected to, and fundamentally influenced, by each other.

*Their concerns are perhaps vindicated by the second consecutive rise in the numbers claiming Job Seekers Allowance over the same period.

Pot, kettle, orange: why Clegg rings some alarm bells

In Transparency, Uncategorized on April 16, 2011 at 3:55 pm

Poor Nick Clegg.  His big AV deal breaker has turned out to be as much of a wash out as a wet Wimbledon weekend.  Forget a great debate on the future of the British constitution.  Instead it’s a choice between Colin Firth and Eddie Izzard’s ‘Yes’ vote or James Cracknell and Darren Gough on the ‘No’ campaign. 

It was perhaps inevitable that AV would be brushed under the carpet.  Clegg knows he can’t push Coalition politics too far – especially when the Prime Minister so strongly opposes the idea.  Despite their dismal performance in the polls (down to 10%), the Lib Dem leadership know AV is a battle they actually can’t afford to win.

So it’s with a certain irony that Clegg has tried to rally a bit of faux pre-election excitement.  This morning he accused Labour of putting “politics before people, politics before communities, politics before jobs” and “where there should be policies there is opportunism.”  Tempted as I am to point out pot, kettle, orange…Clegg went on to raise a serious issue – that of local government and accountability.

Lib Dem councils such as Sheffield, Portsmouth and Bristol, he says, have minimised redundancies and protected libraries and Sure Start centres while Labour have taken a “slash and burn” approach, closing community facilities.  Speaking more tentatively about Tory controlled councils, Mr Clegg claims that Lib Dem councils are taking a more responsible approach to cuts.

The truth is that is it is very difficult to tell.  Lack of transparency and local accountability means that there is little visibility on which councils are managing to maintain public service outcomes, and which councils are forcing those in greatest need to bear the greatest cost of budget cuts.

Earlier this week Secretary of State for Communities and Local Government, Eric Pickles, announced his list of data demands on local councils.  But whether this data is to be made publicly available in an intelligible, readily comparative form is another matter.  How do we know whether councils are “keeping pain to a minimum”?  How do we know if our local council is achieving value for money?  How do we know whether they are doing better or worse than the previous incumbents?

Local government shouldn’t be an exercise in box-ticking or bureaucratic merry-go-round.  But high quality open data needs to be available to voters so they can hold all parties to account.  Without such transparency, the mudslinging politics of old will continue and the endorsement of celebrity will have ever greater sway.  Nick Clegg might be on the side of ‘alarm clock Britain’.  But alarm bells are certainly ringing for me.