Crunch time for the Liberal Democrats –The NHS Bill and electoral oblivion

The tuition fee debacle was bad. But at least there was a reason, if not an excuse. Neither major party was committed to removing tuition fees. So whoever the Liberal Democrats ended up in Coalition with it was unlikely that the party was going to be able to honour its pledge. The hand was no doubt badly played, but the outcome was going to be nothing other than politically damaging.

This time there is no excuse. The Conservatives may claim that their manifesto refers to extending GP commissioning. But this passing reference is a threadbare justification for the enormous changes being proposed. And how many electors actually read the manifesto? If they bought the story at election time then it was more likely to be Cameron the compassionate Conservative reassuring them that the NHS was his top priority, that it was safe in his hands, that there would be no top down reorganisation, that it wouldn’t be privatised, etc., etc., etc. That these reassurances were not worth the breath required to produce them seems increasingly apparent. Significant chunks of the electorate have interpreted the Government’s plans as taking an axe to their beloved NHS.

The Dorries distraction

What is Nadine Dorries for?

Obviously she is very much for reducing the number of abortions. And, it would appear, is the willing purveyor of any amount of nonsense in pursuit of her objective. Today Channel 4’s Factcheck blog has her bang to rights. Dorries has made a number of apparently evidence-based claims in a newspaper article about the damaging effects of abortion. It turns out that the claims are less than scrupulous in their handling of the relevant evidence. Critics would no doubt say this isn’t the first time Dorries has been exposed in this way.

But in many ways being charged with abusing evidence is irrelevant. Dorries, one would surmise, isn’t really interested in the evidence one way or the other. My guess is she feels that deploying evidence is a way of giving an argument rooted in zealous religious belief a veneer of credibility and respectability. She’s just not very good at it.

More interesting is the vested interest argument being used against Marie Stopes and BPAS.

Pressing on with NHS Reform – a less than rational process

The central question in the current debate over the Government’s NHS reforms is whether the “listening” exercise taking place during the recently discovered “natural pause” in the legislative process is genuine or symbolic. Concerns that the exercise is cosmetic will only be fuelled by an article in yesterday’s Guardian which cites a letter from David Nicholson, the Chief Executive of the NHS, who suggests that the implementation process should press ahead and that there is a need to “maintain momentum on the ground”.

The article includes a quote from Hamish Meldrum from the BMA who states that the BMA has:

… always maintained that changes in the NHS must not anticipate the legislative process and lead to irreversible decisions.

I’ve no idea whether the BMA have always maintained this position. But this quote highlights something very significant about the way policy is currently developing in this field.

Is Cameron’s missing majority really the root of his problem?

Over at the Telegraph today Benedict Brogan posted an interesting piece under the title David Cameron isn’t a winner – and that’s where his problems begin. The thrust of his argument is clear from the title: Cameron’s failure to secure any sort of majority last May fundamentally weakens his position. Cameron is aware of this, Brogan argues, and that awareness infuses the whole business of government.

On closer inspection the rest of the piece turns out to be a rather loose collection of observations regarding things that are going wrong or not working very well. Or, as Brogan styles it, ‘the incidences of chaos are multiplying’. Anyone keeping even half an eye on the way policy is developing would agree that incidents that could appropriately be described as chaotic are not hard to find. But has Cameron’s lack of a majority got anything to do with it?

The mundane malfunctioning of markets – a tale of life and death

We are currently awaiting the fourth visit from a well-known high street electrical retailer to fit a new hob in our kitchen. The first two visits led to a new hob being fitted, only to discover that the new one was faulty. The third visit occurred on the wrong day. No one was at home. When my partner phoned to point this out the company had no record of the booking. They couldn’t revisit on the date we’d agreed (today) because there were now no available spaces. So they are coming next week. Fourth time lucky?

Clearly this is not the end of the world. Rather more salad is being eaten than is normal for this time of year. And there is more oven-based cooking than typically happens. But it isn’t a disaster.

This is the mundane reality of markets. They don’t always work very well. And sometimes the consequences can be considerably more significant.

Bluster and belief: Blue-tinged policy in health and housing

Today brought us two contrasting news stories which give further insight into the approach to policy making under the Coalition government. Today’s Guardian contains an interesting piece by Ben Goldacre on the reform of the NHS (available here), while the BBC have been carrying an item – triggered by a statement from the CIEH – about the problem of poor standards in the private rented sector in England, where it is estimated that 1 million properties are dangerous to live in.

What is interesting about these two policy areas is the way in which “evidence” features in the policy process and what leverage it has over the direction of policy. The contrast is sharp.

Magical markets and medical muppets

You don’t come across that slightly touching, naive market fundamentalism quite as often now as you did a few years ago. The financial crisis and its aftermath has increased the circumspection of some market advocates, at least for the moment. One place you do sometimes come across the dogmatic view of markets is among those who live in former state socialist and communist countries. The other would appear to be the Coalition government.

I quite regularly have the opportunity to discuss the relative merits of the state, the market and points in between with citizens from transition and developing economies coping with the legacy of state socialism. While some have a sophisticated understanding of the issues, others could perhaps engage with the complexities a bit more deeply. There is a strand of very simplistic thinking which sees the public sector as fundamentally corrupt and markets as a solution to most of society’s ills. The former view may be born of bitter personal experience, but it is treated as an inherent characteristic. Markets, on the other hand, have almost magical properties.  They are the repository of dynamism, entrepreurialism, efficiency. Markets are reified and deified. The idea of private sector inefficiency, monopoly or villainy doesn’t compute. Even when the post-transition society they live in might reasonably be characterised as a kleptocracy.

So what about the Coalition?

An informed view on health reform (a comment on a comment)

Guardian Cif posted a fascinating comment piece the other day under the title To avoid NHS privatisation, Lansley must change course. The author is clearly well-informed and provides a thoughtfully balanced assessment of the need for change. She demonstrates a sound grasp of the risks associated with a rushed or botched approach to reform. The piece argues that unless the Government is very careful there is a risk that people’s genuine concerns about Andrew Lansley’s fundamental reorganisation of the NHS – that it is in fact an attempt to privatise the system – will turn out to be well-founded.