My wife’s gone to the West Indies…..
Over the years I have had a number of criticisms of my blog; too political, too opinionated, too little about the RSA, too much about the RSA, much too much about me. But one of the first was a Fellow who included in a lengthy list of my misdemeanours the allegation that I had ‘used the Society’s website to make jokes’. This was a reference, I think, to an early post in which I proudly clamed to have made up my own witticism.
Anyway, time has passed; it is a Friday, the sun is shining and we need something to take our minds off a failing economy, the collapse of Westminster democracy and the threat of an attack by North Korea.
The prompt was my father ringing me, as he often does on a Wednesday, for a joke to use in his Radio 4 programme ‘Thinking Allowed’. The subject was gambling and although he ended up using a different gag, his request led me to discover the following:
I visited the Dalai Lama’s country to go greyhound racing
Tibet?
No, I just like dogs
This is a variance on the classic
My wife’s gone to the West Indies
Jamaica?
No, she went of her own accord
When I worked at ippr a few years ago, between renewing the democratic left and finding innovative paths to social justice, we spent an afternoon inventing our own versions:
My sister’s gone to the capital of Indonesia
Jakarta?
No, she took the plane
Gradually these became more elaborate:
My brother sells electrical accessories in the largest city in Yorkshire
Leeds?
Yes, and plugs and chargers
And contrived:
My wife’s testing a new product in Poole
In Dorset?
Yes, she thinks it’s great
So, here’s a weekend challenge to my reader (happy birthday for yesterday, mum); invent your own ‘wife’s gone to the West Indies’ joke. The best one gets free Fellowship of the Society (but, not really).
Mr Lansley’s tough assignment: the update
As promised: my update on the speech this morning. We had a packed audience for Andrew Lansley and a very good question and answer session.
I have characterised the basic New Labour model for public service improvement as a combination of pressures from the centre (funding, strategy, regulation), from the side (contestability, freedom for providers) and from the bottom up (patient choice and voice).
In essence Andrew’s position is that we should have less pressure coming from the top and more from the side and bottom, and that we need, overall, to trust professionals in a context of open information and patient choice. I suggested in my questions that this was an evolutionary rather than revolutionary approach. Andrew didn’t disagree although he insisted that his approach was ‘radical’. (Question to note: why does no politician wants to admit to not being radical?)
There was an interesting discussion about targets which led to two quite tough questions for Tory policy. Andrew emphasised a move from ‘process targets’ to outcomes for the NHS and implied that the overarching health outcomes for a Conservative Government would focus on public health issues like obesity, smoking and alcohol abuse. This begs two questions:
1) How do you stop outcome targets turning into process targets when they are implemented? So, you might say that patient satisfaction should be the key objective (as Andrew did and as the Government itself has committed to), but if you then find that patient satisfaction is a function of certain measurable aspects of the service (for example the time a GP spends with a patient) the temptation is to make this the proxy target. After all long waits – which some would argue was not the most important problem facing a health system – became the priority because they were what the public said they cared about most.
2) If the Government moves from NHS related to public health targets it is in essence shifting from things over which it can exercise direct influence to those which are much more complex and difficult to influence. Whether the public, or media, will accept such an accountability framework is an open question.
RSA website users will shortly be able to listen side by side to Alan Johnson and Andrew Lansley – who have both spoken here in the last few weeks – and form their own judgement.
You can watch my brief interview with Andrew after the event here.
Matthew Taylor interview with Andrew Lansley
Mr Lansley’s tough assignment
Shadow Health Secretary Andrew Lansley is speaking here in a couple of hours. I will post again after I’ve heard what he has to say. He has a tough job. In a system as big as the NHS there will always be problems, but Alan Johnson has less to worry about than any of his recent predecessors.
Patient satisfaction rates are at an all-time high, long waits – for so long the scourge of the NHS and the target of its critics – have been virtually abolished; improved scrutiny and data collection has made it much harder to hide bad practice and failing management (which was previously rife); and there is even progress on hospital infection rates. At a time when the public and the media are loath to give Whitehall any credit, there is a general acceptance that the Department of Heath is managing the threat of swine flu effectively.
Of course, the real challenge facing the NHS is the coming squeeze in public spending. Will a system which has been developed in the context of substantial real term increases cope with standstill budgets? I don’t know whether Mr Lansley plans to broach the spending issue today but it’s difficult to see the upside for him of doing so.
The Conservatives have to plug away on health – emphasising their commitment to the founding principles of the NHS and to tackling health inequalities helps to cement their moderate, modernising image. But health has slipped down the voters’ list of priorities – the number telling Ipsos-MORI it is the most important issue facing Britain is as low now as it has been for over twenty years.
Andrew Lansley will no doubt say this morning that he wants to challenge the Government on its record on the NHS, and, of course, there are things that could be a lot better. But the reality is that Gordon Brown would like nothing more than for health to be the battleground of the next election.
Life and death issues hidden by the fog of indignation
Filed under: Credit crunch, Politics, Public policy, The RSA
Yesterday I suggested that the big problem with politics is neither MPs’ expenses nor the conventions of the constitution (although I am a reformer), but the content and tone of the conversation between the people and their representatives. There is something febrile and disconcerting about the state of public opinion. A few days ago I described an arc of indignation starting with Ross and Brand travelling through Fred Goodwin and Sharon Shoesmith and landing now on MPs. Daniel Finkelstein is, as always, very sharp on this today.
In this atmosphere what chance is there for enlightening debate about the challenges facing our country and the world? In yesterday’s FT, Gideon Rachman made a powerful point: countries facing severe economic downturn and fiscal crises have to make hard choices. This happened in Latin America around the turn of the century and it is already happening in some Eastern European countries; for example, Estonia has cut public sector pay by 10% while Hungary has raised the retirement age and cut pensions by 8%.
It may be because the people of these countries had a strong memory of harsher times that they were willing to accept tough measures as the price for getting back on track. Can we imagine such resigned fortitude emerging from our own indignant, intolerant and self pitying public discourse?
The big danger here is that by putting off hard decisions today we will make the pain tomorrow longer and deeper, and that our economic and financial problems might then turn into a social and democratic crisis. Our apparent inability to have a grown up discussion (a politics of citizens not clients) also reduces the possibility of creative thinking.
In a fascinating talk here this morning- jointly hosted by Policy Network and the RSA 2020 Public Services Trust - the Director of the Dutch Scientific Council for Government Policy, Professor Anton Hemerijck, laid out the core arguments of his forthcoming book on the welfare state in Europe after the financial crisis. Among a wealth of data and analysis, I was particularly taken by his five dimensions of welfare state recalibration. These are:
• Functional: what should the welfare state do? For example in the UK we have reduced entitlements for HE students but increased them for under fives
• Normative: what are the duties and values underpinning the welfare state? For example, in the last two decades across Europe, there has been a growing emphasis on responsibility, with a shift from supporting people out of work to seeking to get them back to work
• Distributive: who gets what? For example, there has been a general shift in thinking from redistribution being primarily about class to focussing on distribution across the life cycle
• Institutional: how is the welfare state organised? David Cameron (in contrast to Margaret Thatcher) presumably thinks retrenchment will be done better if more responsibility is decentralised
• Referential: who do we compare ourselves with? Over the years there have been various fashions in economic and social policy; enthusiasms for Japan, Germany, the US and Scandinavia have come and gone (it is a rule of comparative policy that just when the world’s experts agree that a country has the perfect system that system promptly starts to collapse). But which national model will be seen as the best for coping with recession and retrenchment?
This is a rich agenda for debate. Call me out of touch but I can’t help thinking it may be just a little more important for us than whether ministers should get tax relief for accountancy services.
Democractic reform: we still aren’t having the right discussion
David Cameron’s lengthy Guardian essay about democratic reform is welcome, even if there isn’t much in it that is both new and a concrete commitment. As a long standing supporter of electoral reform, I also supported Alan Johnson’s call this weekend for a referendum on the day of the next General Election – indeed, I advocated exactly this policy in my blog a few days days earlier.
While it is important to debate the rules and procedures of politics I continue to believe that the bigger issue is the content of democratic discourse. My first RSA annual lecture, back in 2007, was about ‘pro-social strategy’. This is what I said:
“The way we do politics not only reflects but reinforces a loss of confidence among citizens and communities about solving problems ourselves. The most disabling aspect of political discourse is the paradox (exploited by the news media) that Government is seen simultaneously as omnipotent and incompetent….
By creating a vibrant debate about common problems, aims and responsibilities, pro-social strategy seeks to reinstate democratic politics as the process by which citizens give permission to their representatives to act on their behalf.
This shift in thinking is not simply about rolling back the state or taking politicians down a peg or two. The implications for government are not so much about its size but as about its ways of working. The implications for politics are not so much about politicians letting go as about citizens taking hold.’ Pro-social politics’ would not be seen in terms of conflict between us (citizens) and them (politicians). Politics would be about us and us and us.
‘Us’ because it would be about what we as citizens want to achieve and what we need to do to achieve it.
‘Us’ because it would be about recognising the different interests, views and resources of different parts of society and accepting the challenge of reconciling these differences rather than simply asserting our own demands and resenting any attempt by politicians to sort it out.
‘Us’ because this would be a process in which we would need to confront more fully the truth that we each of us have our own conflicting interests, views and aims. The apparent incompatibility of our own individual preferences is a growing characteristic of modern policy problems. For example, we want to fly cheaply and protect the planet, to see our children as home-owners but to protect the green spaces around our towns and cities……”
As Ben Page from Ipsos-MORI often says ‘the British public demand Swedish welfare provision on American tax rates’. The real problem with politics is not the expenses claims of MPs, nor even the power of the Executive, it is that we are unable to have a grown up conversation about the challenges which politicians can only resolve if we work with them: notably, public spending restructuring, population ageing and climate change.
We the citizens are stuck in a bad place; increasingly unwilling to be governed but not yet willing to govern ourselves. Proposals for reform should be judged by whether they are likely to move us towards a more realistic and responsible democratic discourse.
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