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The illusion of choice
An ongoing onslaught by David Cameron has been that the state became too big through Labour. Yesterday, somebody remarked on Twitter, “BREAKING NEWS: Cameron to replace top-down bodies with top-down bodies”.
Three policy developments, the English Baccalaureate, NHS corporate restructuring and the Big Society, arguably provide evidence for a ‘top-down’ approach which actually encourages the state producing less rather than more choice.
The English Baccalaureate
In a less than successful interview recently on Victoria Derbyshire’s show on Radio 5, Michael Gove explained to the listener his perception of the “English bac” scheme.
Michael Gove recently promoted extensively an English baccalaureate qualification to recognise the achievements of GCSE students who complete a broad course of studies. The “English bac” apparently would not replace GCSEs, but would be a certificate to reward pupils who pass at least five of the exams, at grade C or above, including English, mathematics, one science, one foreign language and one humanity. OFQUAL has previously criticized the over-reliance of this qualification on GCSE results, but presumably will be given greater powers to oversee the diploma.
One wonders how Einstein or Bach would have coped under a system. More worrying is that it is the Government (or rather Michael Gove’s elite) who are imposing a value set on what they think is important in education on the rest of the education system including comprehensive school teachers. They are giving parents and headteachers little choice in this in fact, nor possibly OFQUAL in whether it’s a good idea or not.
Corporate restructuring in the NHS
My second example concerns a massive issue, which is indeed being sold to voters as reducing the state and increasing choice. Nothing could potentially be further from the truth.
The NHS in England is to undergo a major restructuring in one of the biggest shake-ups in its history. A huge new NHS (independent) Commissioning Board will oversee GP commissioning, sitting above as many as 500 consortiums (sic) of GPs to set standards and hold the groups to account.
Furthermore, it is proposed that this new system also will give patients more information and choice. “HealthWatch” will be set up to compile data on performance. Experts in this area have long criticized that the quality of data concerning benefits (often mixed up with outcomes) has been extremely poor, such that it could be dangerous if GPs use these data to guide their commissioning policy. This is a longstanding problem which is not addressed by the NHS corporate restructuring, which is estimated to cost £3bn in its first year.
The BMA and the King’s Fund seem to have had no choice in this, and how much choice is actually given to real patients and GPs is yet to be seen.
The Big Society
My final example concerns what possibly is the flagship policy of the Conservatives.
According to the Big Society’s own website,
The Big Society is a society in which individual citizens feel big: big in terms of being supported and enabled; having real and regular influence; being capable of creating change in their neighbourhood.
Again, the Big Society is sold as creating ‘an enabling and accountable state’. However, the Big Society as a whole might be fairly innocuous if it simply was an extension of the volunteering, pro-bono practices which are longstanding; or indeed a development of social enterprises policy.
The unique selling point of the Conservatives’ approach to the ‘improvement of society’ is in fact its focus on venture capital, which is a point hardly ever addressed.
Venture philanthropy , also known as philanthrocapitalism , takes concepts and techniques from venture capital finance and high technology business management and applies them to achieving philanthropic goals. It has a strong focus on measurable results: donors and grantees assess progress based on mutually determined benchmarks. There is also a high involvement by large corporate donors with their grantees. For example, some donors will take positions on the boards of the non-profits they fund. Critically, the venture capitalists are the ones who choose where they wish to spend the money.
Do financially-strapped worthy projects in the community get a chance to participate in this choice?
Conclusion
I feel that all these examples demonstrate a ‘top down’ approach to government picking winners, giving an illusion of choice.
This is a big painful pill for Labour to swallow as it is David Cameron’s PR team who fill the airwaves with the message that the State is too big, with the assistance of their Liberal Democrat accomplices. The Coalition is also busy spending our money implementing these ubiquitously unpopular schemes with little consultation. I am confident that they will be ultimately punished for this faulty ideological rhetoric, once the public realize they have been spun a tissue of lies, as they have been with the economy.
David Cameron is wrong on the NHS corporate restructuring for these reasons
In an interview where David Cameron tried to tell John Humhrys he was wrong, Humphrys identified that Cameron was showing no leadership on the bankers.
The interview can be heard here:
http://news.bbc.co.uk/today/hi/today/newsid_9363000/9363655.stm
David Cameron is wrong about the NHS restructuring for the following:
It is wrong simply to focus on outcomes at the treatment end; much more could and should be done at the diagnosis end (health policy analysts find outcomes useful, but what they’re actually measuring are objective benefits). Much of the fundamental issue for the next decade will be the early diagnosis of the disease especially cancer, and there needs to be some focus on the efficacy of screening methods at the other end too (e.g.for colon cancer, breast cancer, COPD).
It is no good just talking about length of survival times, because there has to be a proper analysis of the quality-of-life and well being of patients with chronic morbidity including dementia.
The Doctors were not asking for the changes – the BMA is opposed to it, and to my knowledge the Royal College of Physicians shows little interest in it in a very positive direction. The King’s Fund certainly think it is a calamity.
2-3 years is a very short time to produce ‘the biggest reorganisation’ in the first time; it will involve £1.4 bn in the first year. John Humphrys was right to correct the figures that Cameron produced on the basis of actual evidence from the Kings Fund.
Satisfaction is at an all time high now with the NHS – this cannot be divorced from the record spending by Labour in the last parliament.
David Cameron denied the NHS IS getting better. This must means that he thinks that all aspects of it are getting worse. THIS IS A LIE.
John Humphrys asked that the NHS was in fact changing to a Federal Health Service. Cameron saying that there are already regional variations is frankly irrelevant. Humphrys is correct saying that an analogy between GPs and free schools is an extremely poor analogy; I am shocked that David Cameron is idiotic enough even to suggest it.
There’s no point Cameron trade-union bashing, as there are many ordinary nurses, doctors and other health-professionals who are non-Labour members who are highly critical of his insane policy.
If Andrew Lansley is so well respected, why does the whole of RCN disagree with him? The man is not well respected amongst the health professionals.
Dr Shibley Rahman Queen’s Scholar; BA (1st Class), MA, Bachelor of Medicine, Bachelor of Surgery, Doctor of Philosophy, Diploma of the Membership of the Royal College of Physicians (MRCP(UK)); FRSA, LLB(Hons).
Member of the Fabian Society.