27 Comments on David Cameron at the RSA

Francis Gilbert on Mon, 17th Jan 2011 6:35 pm


Cameron’s agenda seems to be to remove a “multiplicity” of stakeholders at a local level, both in Health and Education. He appears to be concentrating power in doctor’s hands in the Health system, and doing very similar things with his Academies and Free Schools agenda in education by giving the “sponsors” of Academies unlimited power over what goes on a school. Private companies will and already are beginning to play a very big role in “facilitating” and initiating this process. By removing various stakeholders from being involved in decision making in our hospitals and schools — parents, teachers, unions, community members, councillors — we will see some very powerful people and companies emerging, making decisions for all of us. This is an attack on local democracy in the name of efficiency. By concentrating power in so few hands, the chances for corruption, bullying and malpractice will be greatly increased.

emma on Mon, 17th Jan 2011 7:44 pm


I agree he’s a great communicator but he’s a PR man for goodness sake – after reading the transcript, I agree that it all sounds utterly reasonable, but the truth is there will be irreparable damage caused and “ensuring those places with the biggest problems and least capacity don’t get left behind.” is of no interest to the Tories. I was at RSA for the nef Big Society event and Mark Easton’s words that Cameron has told the Whitehall mandarins to turn a deaf ear to the squealing that will ensue as the “power floods out of Whitehall” is scorched onto my consciousness

Tom Bewick on Mon, 17th Jan 2011 7:55 pm


I think this is pure pandering to the new political class of which, by virtue of your past, you are not a part. There is nothing New Labour about Cameron in subtance nor policy, only that veneer of upper class smugness and confident communication that comes from a very privileged background and private education – as you say, like Tony Blair! Real Public Service reform will only happen when policy wonks of all persuasions are prevented from patronising one group of producers over another. Labour put too much faith in statist apparatus (and apparatchiks !) like the PCTs and Tories think doctors will do a better job. Either way, both are no more than proxy consumers in the system and as we know from past bitter experience, one bunch of producer interests is no better than the last: users of public services will still get a raw deal. As a RSA fellow I applaud the PM being invited to make a speech; but as a loyal Labour Party supporter it sticks in the throat to see ex -advisers get so taken in by a Tory-led government that may score highly on the spin index, but will achieve absolutely nothing when it comes to building a fairer more socially mobile society. But then come to think of it Tony Blair didn’t do so much better at that goal either!

Andy Cowper on Mon, 17th Jan 2011 8:00 pm


Hi Matthew. Enjoy your blog, and was fascinated to know what you made of it. Cameron is a splendid communicator. But there are one or two, um challenges required to what he was saying. You nailed the risk that decentralisation exacerbates the problems in the poorest areas. I’ve raised some others here, if you have five minutes to lose – http://bit.ly/eKwhwe

Zio Bastone on Tue, 18th Jan 2011 12:24 am


Surely Being a brilliant communicator requires having something to communicate. On the evidence thus far, that something (no top down reforming of the NHS for example) doesn’t relate to the actions actually taken. So either Mr Cameron is a very bad communicator indeed or (the more plausible explanation) he’s a liar.

If I personally were choosing an exemplar of honesty, decency and moral purpose, I would not choose Mr Blair. But that’s another story.

Michael on Tue, 18th Jan 2011 12:51 pm


I am willing to believe that David Cameron’s intentions are well meaning, but the detail of the NHS reforms have been fixed without his involvement.
Polly Toynbee has written two articles this month in the Guardian which address these details and I recommend them to readers of the blog.

http://www.guardian.co.uk/commentisfree/2011/jan/17/free-market-bill-blow-nhs-apart

http://www.guardian.co.uk/commentisfree/2011/jan/03/tories-chaos-nhs-sack-lansley

ESP on Tue, 18th Jan 2011 4:12 pm


I am interested that you find Cameorn a ‘brilliant communicator’ and I think that may be true in the sense that actors playing parts are ‘communicators’. Personally, I find him narcissistic, smug and unbearably sneering. The ‘humour’ you note seems to me to be the typical Evasion of the Entitled – why answer a question when I can do a little jokey show-off performance instead? Worst of all, I find him devoid of content and totally vacuous. (Some similarities with Blair though I suspect Blair was more intelligent.)
I wonder if there are gender differences in this perception of ‘communication’? The “brilliance” is all in the expression of a traditional male heroic archetype. What interests me as a taxpayer (and therefore his employer) is: what are Cameron’s competences? They seem to be those of an averagely performing PR manager. It is straightforward to test competences – you only need to put people under pressure and watch how they respond. The first (fairly soft) test was on yesterday’s Today programme: he was flummoxed. Not in command of the brief and not quite bright enough to disguise that.

Indy Neogy on Tue, 18th Jan 2011 5:18 pm


I applaud you in getting the RSA into the conversation. I hope that you can influence them more than they use you (and by extension the RSA) as a fig leaf to cover up the reality that their chosen method of devolution seems likely to end up with a small number of large corporations making decisions about patient care.

Margaret Bowker on Tue, 18th Jan 2011 6:32 pm


A very good speech by the Prime Minister and an appropriate place to make such important statement. I was particularly interested in the National Health section, health and care reform. It is going to be demanding to implement all these new ideas and people will feel anxious and sceptical, but I was impressed by the test programme presently being run. Another 89 pathfinder groups came forward yesterday on the day of the speech, now there are 141 GP consortia groups, working on behalf of 50% of the country and improvements are being reported. Groups are taking feedback from patients to fill screening gaps and others are modifying prescriptive care for the elderly in care homes with reductions of almost a half in hospital admissions. I’ve seen test runs and pilot schemes before, but this is massive. The main query that comes to mind at the moment, no doubt there will be others, is – will the concept of public involvement seen in the PCTs be transferred to these new Consortia?

matthew taylor on Tue, 18th Jan 2011 6:55 pm


Thanks for all these comments, inlcuding from my old colleague Tom B. I am due tomorrow to be debating NHS and other organisational reform on Today so I will make sure to read the links from Michael and Andy, I have written a little more about Cameron’s way of speaking in my latest post

Noel Douglas on Wed, 19th Jan 2011 10:30 pm


How strange. David Cameron, whose Party were not elected outright, a millionaire with no idea of what life is like for ordinary people, a man who is presiding over the destruction of the welfare state and screwing the public to transfer even more money and assets to his already obscenely rich friends in the banks who have wrecked our societies is described by Matthew in terms that bear no relation to reality “when you listen to him you are likely to be at least half convinced and to hope that his confidence is well grounded.” Really? he comes across as he his a PR spiv and a lying one at that.

Matthew I realise you were part of a government of war criminals that started the process of privatising our public services, but you are an intelligent man, are you really such a Liberal that you can’t see that the privatisation of the NHS and education which is about to happen has no ‘shades of grey’? There is nothing ‘fair’ about what this government is doing, like cutting the funding for art and humanities in Universities by 100%, they must be forced from office at the earliest opportunity before the UK is nothing but Shopping Malls and Reality shows, and as Chief Executive of the Royal Society of the Arts its is sad that you cannot defend them.

Our society needs imagination, it needs innovation, our Planet needs justice and massive change that stops Climate Change and benefits ordinary people not the rich, this government is taking us in the opposite direction, back to the 19th century.

World Spinner on Sat, 22nd Jan 2011 4:35 am


David Cameron at the RSA | Matthew Taylor's blog…

Here at World Spinner we are debating the same thing……

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Livy on Sun, 23rd Jan 2011 6:26 pm


Noel:

…Matthew I realise you were part of a government of war criminals that started the process of privatising our public services…

Oh please.

Apart from producing a completely out of order, ill-informed, broken record of a cheapshot, you’re spewing the kind of pedestrian phrasing and bleeding heart lefty venom that will never result in another Labour government, let alone a position where we look like a credible alternative to a Tory one. Labour, too, have to get their act together and understand the balance between short term skirmishes and long term positioning; there can be no tactics without strategy.

It will be five years before public consciousness catches up to the scolding hot reality that simmers slowly in the media and even slower over polenta and Pinot Noir at an Islington dinner table, but hopefully this kind of 1950’s sentimental outlook on public services will be one thing that can fade into the ether. Come off it, Noel. We’ve basically privatised unemployment; outreach programmes for skills and business training are run by firms that do great work putting people back into jobs and self-employment. Similarly, private providers who offer drug rehabilitation and mental health services have been invaluable contributors to the prison service, where a disturbingly high proportion of offenders have addictions or counselling needs.

Does anybody really believe any longer that the state can do everything? Get real. We even outsource war.

The word ‘mercenary’ is pejorative, but what really is a ‘mercenary’ other than a market system in military service? Western liberal democracies use markets to make your life easier. They do it to satisfy your unreasonable, lefty, entitled, contradictory demands of government. The sociologist Charles Moskos was fond of mentioning how in the Princeton class of 1965, from which he graduated, 450 of 750 graduates served in the military, where as now, out of approximately 1,000 who tend to graduate each year, fewer than five serve in the forces. Neither the US nor the UK can run their militaries and plan operations abroad without reliance on private security companies, effectively ensuring that a relatively small proportion of parents (who put politicians in power) have to worry about their 19 year old sons sleeping in a ditch in Afghanistan while clutching an SA80.

Funnily enough, if the deluded left of the left began to support compulsory military service it’s possible that recent conflicts they opposed may not have taken place. (I stress ‘may’) It’s a reasonably intelligible claim that were the children of policymakers to share in the burden of fighting wars, fewer would be fought.

As for the NHS, there are legitimate concerns over cream skimming down the line, and it remains to be seen whether GPs will be effective paper pushers or whether a certain amount of the workload gets farmed out to people shafted from the PCTs. Fair enough objections. But we can no longer go on with such a blindingly irrational attachment to the sacrosanct status of the health service when we see on a daily basis what its failures are; failures that are used by the Americans as evidence for why ‘rationing’ of healthcare is bizarre, and why they didn’t want to go down this road and include a public option their reform bill.

From personal experience I have seen the difference in the quality of care when the people responsible for it had a vested interest in seeing me get fit and healthy. GPs provide nothing more than an intermediary service. They refer us to better doctors than themselves, doesn’t work nights, weekends or the 18 hour days of hospital staff, and then draw an obscene salary of 100k a year from the same taxpayers who they treat as irritants on a conveyor belt.

Hilarious.

We’re so “tolerant” in this country of so much c**p, for no reason other than the fact that we always have been.

Indy Neogy on Sun, 23rd Jan 2011 7:59 pm


Given this is an RSA blog, I applaud Livy’s desire to avoid personal insults overtaking the policy debate.

However, it is a shame that Livy doesn’t extend this sense of high standards to the evidence in the debate. The plural of anecdote is not data.

I have had the good fortune to spend some years in the past studying health systems from around the world. A number of them are advanced by different parties, from different philosophic viewpoints, as systems we should emulate. (Taiwan and Switzerland are often mentioned from the right of the political spectrum.) What is notable about the current reforms is that in detail they do not seem to constitute a move towards a coherent system that resembles those, but rather seems to start with the principle that enabling greater cream skimming will attract private companies who will magically improve outcomes.

Critiques of the current system are valuable, but we should not be railroaded into believing that any old random policy change will improve matters.

Livy on Mon, 24th Jan 2011 3:14 pm


Indy:

The plural of anecdote is not data.

Fair.

And thank you.

The point I was trying to make was, for reasons passing understanding, the NHS is an extremely emotive issue for British people, and if its proponents can rely on making emotionally charged arguments devoid of empirical evidence then so can I.

… seems to start with the principle that enabling greater cream skimming will attract private companies who will magically improve outcomes.

I’m not sure they say or even secretly believe this to be the foundation of their reforms. It’s more likely that they’re starting with the principle that our survival rates for heart disease and cancer are worryingly lower than those of our comparable European neighbours, and this can no longer go unanswered.

It’s been allowed to go unanswered for so long partly because of insane sentimental attachment to a concept rather than a service; partly because of the size of the payroll; partly because quality levels are already geographically uneven in their distribution, which ensures some people get great care and feel no need to fix what isn’t broken for them.

…we should not be railroaded into believing that any old random policy change will improve matters.

I don’t disagree.

ESP on Mon, 24th Jan 2011 5:31 pm


Livy,

“I’m not sure they say or even secretly believe this to be the foundation of their reforms.”

I’m afraid many of them do (in private) and certainly most of their private sector supporters do.

“It’s more likely that they’re starting with the principle that our survival rates for heart disease and cancer are worryingly lower than those of our comparable European neighbours,”

What is most worrying is that the politicians (and I include Lansley) either lack sufficient understanding to enable thm to critically evaluate and interpret the data or they DO understand the data and are happy to make extremely misleading statements about what it means,

The fact that intelligent British people are emotional about the NHS is a reflection of its importance to them. Emotion dirves decision-making and should do so..
Many British people are emotional about the Royal Family. Why is Cameron not taking a top-down ruthless, radical, urgent approach to reforming it and privatising it? I’d be happy to sell off its various functions to the highest bidders. I reckon that the Chinese goverment probably has the cash to buy it. Let;s get on with it – we’re all in this together and, even if some people think it’s nice to have, this country can no longer afford a monarchy due to the legacy of bankers’ gambling addictions.

Livy on Mon, 24th Jan 2011 9:48 pm


ESP:

Well…to begin with, what the hell do I know? I’m just a musician.

But you ignore two fundamental issues from which we cannot progress onto a reasonable dialogue until addressed. Firstly, why is the labour market necessarily morally objectionable, and secondly, why are we so reluctant to acknowledge the fact that heavy disparities in care already exist? (I’m attempting to refrain from the clichéd use of ‘postcode lottery’ here)

The proportion of GDP spent on healthcare has less of a bearing on performance than we’ve been allowed to believe; Japan is only the seventh highest spender, yet consistently tops or comes second in criteria of life expectancy rank, infant mortality rank, cancer mortality rank and WHO ranking. As weird as this might sound, even though universal coverage is also correlated with social equity, the UK delivers a poor level of social equity despite having universal provision (see Julian le Grand, 2007)

Emotion drives decision-making and should do so…

…I’m sorry, but could you possibly elaborate on that?

You cannot tell me that the emotional drive for universal coverage, the admirable egalitarian passion and human inspiration that conceived of the NHS, ever intended for the state to become the third largest employer in the world, lagging only behind the Chinese Red Army and the Indian Railway. Too many vested interests are what make reforms difficult and drown out intellectually coherent arguments of efficiency.

No offence, but it’s exactly this kind of thinking that’s holding us back. Thinking that isn’t based around the minutiae of policy details but on over-politicising heath care. All too often, ESP, politics is the problem; it allows emotional volatility to get in the way of rational discussion, and Labour are as guilty as the Tory politicians you mention who, “understand the data and are happy to make extremely misleading statements about what it means”. The left have cynically encouraged a sense of romanticism over a particular public service for deeply partisan reasons, when they know all too well how drastic some of its problems are.

There is absolutely no way the public would be so nonchalant about their tax receipts paying out 100k wages for GPs if they weren’t emotionally manipulated into believing it was a good idea.

Many British people are emotional about the Royal Family

…Don’t even get me started on that one.

Why is Cameron not taking a top-down ruthless, radical, urgent approach to reforming it and privatising it?

Because you know why. Don’t get me wrong, I found your proposal involving the Chinese fairly amusing. But the state earns a great deal of money off the back of the Royal Family, and no mechanism exists to overhaul something so incredibly complex in a way that wouldn’t be prohibitively expensive and time consuming. Not to mention the whole host of constitutional questions around it, including whether the Queen could actually be Head of State under your proposed idea or whether the mere price of removing the ‘HMS’ lettering from every naval vessel would make us wince.

Livy

ESP on Mon, 24th Jan 2011 10:38 pm


Livy

“Emotion drives decision-making and should do so…”
was just me paraphrasing David Hume.
You know, the Enlightenment chap…after all, the RSA is supposed to be about a 21st Enlightenment (I support that) so let’s get a genuine deep understanding of Enlightenment to inform our discussion.

As to your other comments, I’ll just pick one because I am tired/exhausted of trying to fight the nonsense that emerges from this imbecilic government without seeing much support from those who should be standing up and fighting the coalition’s immorality. Let’s pick the one about reforming the Royal Family:
“no mechanism exists to overhaul something so incredibly complex in a way that wouldn’t be prohibitively expensive and time consuming. ”
Very funny! I could almost believe you made that comment to subvert – is it really more complex, expensive and time-consuming thane destroying the NHS?

Livy on Tue, 25th Jan 2011 12:13 am


ESP:

…just me paraphrasing David Hume. You know, the Enlightenment chap…after all, the RSA is supposed to be about a 21st Enlightenment…

Oh really? Tell me more, Obi Wan…

Afraid I’m not a member, fellow, or whatever it is of the RSA. Something tells me you’d just love me at cocktail parties.

…without seeing much support from those who should be standing up and fighting the coalition’s immorality…

If Labour fights everything the coalition does under the righteous assumption of moral authority from glass house positioning, labelling every public service reform and spending cut as ‘ideological’… then that is how we will lose.

From here on the real locus of the debate, the place where the battle will be fought, won or lost will be around ‘power’, and it’s equitable redistribution, rather than 15 year old arguments steeped in the mire of party member tribalism which political leaders have to begrudgingly pacify.

Very funny! I could almost believe you made that comment to subvert

God this is getting tedious. Yes…it’s why I previously made the point about the sheer size of the NHS payroll. The Royal Family and the NHS are not comparable institutions; we depend on one for gossip and bank holidays; on the other, our lives depend.

is it really more complex, expensive and time-consuming thane destroying the NHS?

I know…It’s difficult to imagine given how little the technicalities of this affect our day to day lives, but all the constitutional questions and legalese form an incredibly vast minefield. If we were going to invent a whole new country tomorrow then yes, you’re right, and we probably wouldn’t have a Royal Family.

Besides, nobody’s talking about ‘destroying’ the NHS. But I suspect if you believe that a criticism of UK health care amounts to that, then I’m probably not good enough to convince you otherwise.

ESP on Tue, 25th Jan 2011 12:22 am


Ah, Livy, now I understand – you make many peculiar assumptions about me that are not true..
Here’s the truth:
1. I am very much a stranger to cocktail parties
2. My comments have no connection with the Labour Party (or any other political party for that matter). I hope that I am allowed to be an active involved citizen without being “party political”.
Here’s an idea: think about what I am actually saying rather than what you project I am saying.

Livy on Tue, 25th Jan 2011 9:17 am


…was that an emotional outburst?

To be fair mate, I started out talking about this in policy terms, you turned it political, and my whole point is that politicising this debate is not only dangerous, but it subversively politicises the public whether they are party members or not. “Fighting the imbecilic government”, and “fighting the coalition’s immorality” sounds fairly political.

You’ve not responded to the more detached questions I’ve raised over value of markets in the public sector and weaknesses of the current standard of healthcare we receive, which is the real issue. A debate that gets drowned out because of left leaning sentimentality.

But yeah, the cocktail party thing is a prime example of the kind of thing I find hilarious in my head but fails to translate into real humour. Fair enough.

ESP on Tue, 25th Jan 2011 10:12 am


“You’ve not responded to the more detached questions I’ve raised over value of markets in the public sector and weaknesses of the current standard of healthcare we receive, which is the real issue”
I think we jave a moral repsonsiblity not to engage in the debate on the terms constructed by those who want to destroy the NHS. For an expert viewpoint, I recommend that everyone reads anything by Allyson Pollock that they can lay their hands on, including her recent letter in the bmj. Then come back and let’s discuss “the market” in more depth.

The point I make about the immorality and incompetence of the Coalition is not a party political point; I happily criticised New Labour immorality and incompetence too. This lot are in power (god help us) and I really don’t want to collaborate with them by playing along on their terms, I want to get rid of them by subverting and opposing every piece of nonsense that they spout.

Livy on Wed, 26th Jan 2011 4:48 pm


I think we jave (sic) a moral repsonsiblity (sic) not to engage in the debate on the terms constructed by those who want to destroy the NHS…I want to get rid of them by subverting and opposing every piece of nonsense that they spout.

Forgive me, ESP, but you come across as somebody who has never read any of the arguments against their own position.

We will get nowhere by demonising Tories.

Easy as it might be…and even hysterically funny at times. But ultimately, we have a problem of attitude in public discourse, and this thread is a dispiriting example of it.

You’ll often find that knowing you might be wrong will often make what you say more likely to be correct than something said by an opponent who couldn’t fathom the possibility.

Understand your opponents. Consume the material they consume. Appreciate the reasoning, and indeed conviction, behind why they believe what they believe. Start from there, and the how actually seems to become a possibility.

It’s not so much about providing a solution as it is forming a beginning, but I’ll settle for that in the immediate term; my Tory friends reciprocate, and have begun to appreciate the delusional sentimentality behind some of the things I propose. After a heated and admittedly too well lubricated four hour exchange down the pub on Friday night, (yeah..I totally waxed him) I even saw him give change to a homeless fella outside.

ESP on Wed, 26th Jan 2011 10:24 pm


Livy, mate, firstly I think we may be boring everyone else – and sidelining Matthew – by taking over this blog…
Maybe it’s my unclear expression but somehow you seem to keep attributing motivations to me that I do not have.
So…being oppositional and subersive does not mean direct aggression …. think Gandhi, for example. It does mean being true to a principle which requires not wobbling and always standing up to BS.
You assume that I do not understand the Tories. You may be surprised to learn that I have been professionally very close to the Party machinery and the Top Chaps. I live in their world, I know them only too well and am thoroughly cognisant with their skills, approach and viewpoint. That is the basis for my concerns.

Livy on Wed, 26th Jan 2011 10:35 pm


Livy, mate, firstly I think we may be boring everyone else…

…That’s no way to speak to a lady…

But it’s still the most sensible thing either of us has said so far. I wouldn’t worry though, nobody would have bothered reading this far anyway.

OK, I’m fine with calling it a day too.

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