Public policy

Leviathan

  • Health reforms in trouble

    Red light in the emergency room for NHS reform

    Apr 4th 2011, 16:19 by A. Mc | LONDON

    HOW serious are the intended changes to health reforms? Much sound, even more fury, but the noise so far stops short of a major reversal. In the Commons this afternoon, Andrew Lansley, the health secretary, spoke of a "Once in a generation opportunity to put the health service on a sustainable basis." Grand words, but Mr Lansley, far from heralding a generational shift, looks exhausted and is feeling the pressure of a series of media briefings which suggested that he is not good at selling his health reforms to the public. That is often code for not selling them well to the media but, either way, it's not good.

    One of the oddest things about the NHS uprising is that it features many people who must surely have known that the intentions of the Conservatives - more space for private providers and greater responsibility for GPs in commissioning services and overseeing their budgets - were laid out in the manifesto. The political problem is that the party had no intention of flagging it up in a campaign intended to exude reassurance on healthcare. An upheaval that comes as surprise is worse than one prepared for.

    The timing of the former health secretary Stephen Dorrell's intervention before the health select committee report is significant. Mr Dorrell has long made concerned noises about the reforms without being precise about what he thinks ails them. As chair of the health select committee has more intimate knowledge than most MPs of the plans. He believes the current proposals endanger the principle that NHS should be responsive to patients’ needs. David Cameron is planning a relaunch, the better to explain that the improved service will be more responsive.

    The Liberal Democrats, meanwhile,  have focussed their concerns on "accountability” - but that is very different from the accusation of consensus-busting about the nature of the NHS. Other critics on the left and Lord Tebbit (not common bedfellows) have objected more specifically to the "cherry picking" expansion of services private healthcare providers would be able to carry out - using staff trained by the NHS. Then add in the grassroots complaints about forcing primary care trusts to become GP consortia. That makes at least four different key accusations against Mr Lansley’s programme. It is doubtful, however noisy the opposition, that the coalition will want to retreat on all of these. But the longer they let the impression of chaos on all fronts mount, while failing to defend an embattled health secretary, the worse this will get. If Mr Cameron wants a partial U-turn, as all the evidence suggests, he should quickly make clear what he wants to ditch and what he is determined to keep. That’s the leader's job, when the red light flashes in the emergency room. 

     

     

  • Reforming the BBC

    Salami or amputation for the nation's broadcaster?

    Mar 14th 2011, 18:39 by A. McE | LONDON

    DO YOU prefer your cuts by amputation or salami slicing? It's a question that sorts one brand of manager in a cost-cutting era from another. Except at the BBC, where the intention seems to be to do both at once, therefore ensuring that neither is done with conviction. The corporation has just announced that it will not be cutting the Asian Network, one of the services it had recently earmarked for closure. A short consultation concluded that the alternative plan—launching a patchwork of services on the  hard-to-receive Medium Wave—would not adequately replace the service offered via the network.  Also, BBC audiences being highly  sensitive to any threatened reductions, the Network's listenership rose as soon as it was threatend with being disbanded. Result: Asian Network will continue to exist, but lose half its funding.

    At this time last year, a similar hokey-cokey was conducted on the future of 6 Radio, the indie-music station. It was to be closed in order to show the management was serious about pruning the BBC's sprawling output—and then wasn't. The BBC Trust, responding to indie-loving petition-gatherers, ruled against the management. The Beeb's cuts strategy looks indecisive, to say the least, and at worst chaotic.

    In essence, the argument reflects division between salami slicers. Chief among them is BBC director-general Mark Thompson who, having engineered a cuts deal with George Osborne on the eve of the last spending review, baulks at the immediate effect being seen to be an amputation of services. Where the Asian Network or 6 Radio was planned to go, might not one day BBC3 or 4 follow? This is a "legacy question," insiders say, for Mr Thompson. In order to avoid high-profile amputations, the cuts are being "work-streamed"—in other words, visited across the board by a league of senior managers.

    This has the effect of demoralising just about everyone, but it spreads the pain, and the blame. Leviathan wonders however whether Lord Patten, the incoming chairman of the BBC Trust, who set a robust tone in his appearance before the Culture Select Committee last week, will share the view that charcuterie is the best way to enact a major funding cut. With the exception of BBC online (undergoing a 25% cull) and the World Service, which has taken a major hit,  very few hard questions have been asked by BBC management of what services deserve to remain and which do not. The outgoing chairman declared that the salami slicing was now in endangering the quality of core programmes and that another approach was needed.  Lord Patten may wish to make a stronger case for amputation.

  • Schools and hospital reform

    Such good reforms: and such small portions

    Feb 28th 2011, 18:07 by A. McE | LONDON

    TWO stories in the newspaper this week demonstrate the potential pitfalls of the government’s public services reforms, in the run up to the coalition’s ambitious White Paper on the subject, about to be unleashed on Whitehall. They might be summarized under the old Jewish joke about an unsatisfactory dining experience: "Such bad food—and such small portions."

    The first is the parental Golgotha of National Offers Day, when pupils find out which secondary school they have been allocated a place at from September. In the most competitive parts of the capital (which also contain some of the most competitive parents), the number of pupils getting their first choice is as low as 60%. That makes for a lot of dissatisfied educational customers—of precisely the sort the Conservatives targeted to gain support for their Free School reforms.

    But the number of such schools planned to open in September is currently predicted to be around 12. Only 8 have formal go-ahead so far. It’s true, this is early days and local planning hurdles and lack of readily available school sites are constraining the pace of the Free School scheme's advance. But the government will soon come under pressure to show that its ideological attachment to the project can deliver a sizeable number of places in the kind of rigorous school many parents want and cannot find in the state sector. If it can’t, Free Schools will seem to many like a nice idea: just not one relevant to their needs.

    Now take the other full-frontal attack on Leviathan: NHS reform and specifically the pledge to let GPs commission care directly. It is intended to cut down bureaucracy but the British Medical Association complained this week that an outfit entitled the NHS Commissioning Board, which will oversee spending, would end up back in control of what consortia can and cannot do under their own steam.

    Simon Burns, the health minister, argues with this interpretation, but it would not be the first time an advance in freeing services from political control ended up back under the control of officialdom. Still, it’s an irony that the BMA, which has never shown a robust appetite for reform, should now appear worried about the changes not being radical enough. Perhaps they're concerned about the portions.

  • Question Time for the BBC

    "Question Time" should not be a quango

    Feb 16th 2011, 11:52 by A. McE | LONDON

    THE BBC is in some uproar over plans to move "Question Time", its discussion programme, to Glasgow. It has already lost its present editor, who doesn’t fancy a relocation. The programme’s presenter, David Dimbleby, is also unkeen, saying that it is "like trying to report on Holyrood from London. You have to be around swirl of Westminster life." It’s the tip of an argument about the corporation's commitment to boost regional representation by moving programmes to the regions. Whatever the intention, the result has often been to add cost and cumbersome logistics to programme-making.

    Now it emerges that staff will have to be flown from Scotland to London to brief Mr Dimbleby. Has the BBC stopped to analyse the growth in its carbon footprint from farming out programmes which have no intrinsic reason to be made outside the capital? Here is a pressing matter for the BBC Trust's new chairman (due to be appointed in the next two weeks) to address. Of course the BBC has a duty to reflect and comment on life in the regions and nations and to ensure its programme diversity covers the whole country, not just London. Also, having invested in vastly expensive buildings in Salford and Glasgow, it clearly feels the need to do something with them (though there may be other commercial answers to that problem).

    But existing requirements and programme diversity do not mean that the present policy is the right one—or that it should be continued without further scrutiny. The stumbling block, according to BBC executives, is existing guidelines from Ofcom, agreed under the last government, which specify quotas of output to be made outside London. The media regulator in effect required the BBC to behave like a government quango, dispersing jobs and production, and the BBC duly obliged. Now, with severe cuts to make and a Tory culture secretary saying that he expects Ofcom to play less of a part in policy decisions and stick to regulation, the arrangement needs to be looked at again—both by Ofcom and the BBC, when it gets its new arbiter.

  • Cameron's crusade

    The reform wars begin in earnest

    Feb 11th 2011, 16:45 by A. McE | LONDON

    WHETHER they're believers in the Big Society or just dedicated deficit-slashers, members of the British government are sounding rather more worried this week about the backlash their plans to cut public spending has provoked. From Liberal Democrat councillors declaring their anomosity to the reforms (inconveniently for Nick Clegg as he defends his volte-face on tuition fees), to Dame Elizabeth Hoodless's warning of the dangers to the charitable and voluntary sectors, a policy intended to galvanise localities and push decision-making away from the centre is instead causing problems to pile up on the government's doorstep. 

    It needs a clearer strategy and a better approach to dealing the backlash. David Cameron is not the only leader to find public-sector reform to be one of the most labour-intensive and emotive activities to manage. Germany's former Chancellor Gerhard Schröder admitted in his memoirs that the backlash to the Hartz reforms wore him down. Tony Blair spoke of "scars on my back" from his own attempts to reform the state. Mr Cameron cannnot for ever remain above the fray.

    As a student of recent Tory political history, he is well aware of the mismanagement of the poll tax under Margaret Thatcher. A measure intended to make local councils more accountable ended up triggering a powerful counterattack on central government, resulting in the shredding of her authority. That is why tensions over the Big Society (which we discuss in detail in this week's issue) are so potent. Too much emphasis on Big Society localism, instigated alongside the cuts, could result in Mr Cameron being seen as the Number 10 slasher. Too little, and his vision of a less mighty state, supplemented by more individual and voluntary associations, will falter. So far the tone of this argument has been polite. That won't last.

    Should the government step in, for instance, if council chiefs cut services for disabled children, while hanging onto highly paid officials? Some proponents of the Big Society, such as the social entrepreneur Danny Kruger, think it should insist that front-line cuts are matched by personnel reductions. So far though, Mr Cameron's team is loth to put Whitehall's boot into councils whose cuts may be motivated more by politics, and a desire to make the government look bad, than a sincere effort to cut costs. But how long can they hold out without stepping up the fight?

  • Our new public-policy blog

    Leviathan awakens

    Feb 9th 2011, 17:31 by by A. McE | LONDON

    A NEW blog on public policy, reform and the fate of the Big Society might as well start with a presumption, and there is none greater than taking its title from Thomas Hobbes's "Leviathan", described by the English political philosopher Michael Oakeshott as "the greatest, perhaps the sole, masterpiece of philosophy written in the English language".

    Granted, Thomas Hobbes’s classic 17th-century introduction to the social contract did not delve into public-private partnerships or local service delivery in the era of deficit reduction. Nor can we say how Hobbes's attachment to authoritarian monarchy would have survived the diluted might of modern royal families. But in its magnificent scope (its subtitle is "Matter, Forme and Power of a Common Wealth Ecclesiastical and Civil"), Hobbes's epic work considered some of the same questions that attend Britain's coalition government today, in its quest to bind Leviathan. How does the state relate to individual instincts and competing drives? Which powers should we cede upwards to Government; and which should we keep for ourselves as individuals?

    The prospect of "bellum omnium contra omnes" (a war of all against all) is not a threat as present or chilling in a 21st-century democracy as it was in Hobbes's time, the era of the English civil war. But the battle of interests and how to reconcile them prosperously (for the Common Wealth) and peaceably are as relevant as ever.

    Today’s Leviathan is changing before our eyes. The considerations of how public goods are distributed, and the role of government and its limits, have come under fresh scrutiny as the coalition seeks to reshape public policy by redefining the role of the state and seeking new ways of promoting collective endeavour, without the hand (or the money) of central government as the motivating force. The fate of that undertaking will be a journey this blog will have the pleasure of charting, while soliciting your views, recommendations and objections along the way. The daring nature of changes being undertaken by the British government in reshaping the state and what it does (and does not do) make Britain a template that other governments are watching with interest—whether or not they choose the same path. 

    Hobbes is a philosopher who does not invite adoption by modern politicians, perhaps because he is so uncompromising and is taken, out of the context of his time, as a ruthless authoritarian. Yet at a time when so many of the big arguments concern the application and limits of law, his voice echoes though the debates we conduct about individual freedoms versus the remit of legality. The "greatest liberty" of civil subjects, he tells us, derives from the "silences in the law". In a week when multiculturalism is once again heating the debate in Britain, a thinker who demanded that allegiance to the state supersede loyalty to a religious faith might well have reflected that his Leviathan has proved to be a long-lived creature indeed.

About Leviathan

In this blog, our public policy editor reports on how governments in Britain and beyond are rethinking and reforming the state's role in public services, the arts and life in general. The blog takes its name from Thomas Hobbes's book of 1651, which remains one of the most influential examinations of the relationship between government and society.

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