Who is the radical – Mr Gove or Mr Lansley?

The original script for the new government was radical reform of education and steady as you go for the NHS. Mr Gove spoke with racy and fervent language of the new schools he wished to allow. Mr Lansley spoke more quietly about the need to have real increases in spending for the good old NHS, year in, year out.

This started to change before the General Election. Suddenly we heard of radical plans afoot to change the NHS after all. Out would go a lot of the national and regional bureaucracy. In would come much more local and GP control. Out would go the Primary care trusts, in would come GPs buying the hospital services their patients needed.

Since the Election the balance has shifted again. Mr Gove knows that the powers of his office are limited to change behaviour. The pace of change of types of school does rightly depend on the pace at which individuals, charities and others wish to set up new schools, and the pace at which existing schools wish to change to Academy status. A long journey begins with one step. Mr Gove never intended to have for profit companies owning or running schools,and never wished to introduce academic selection to more schools. There were always strict limits to the radicalism.

Meanwhile over at Health it looks as if the plans for change are far more wide ranging. All the English NHS will be converted to the GP purchaser model. All over the country PCTs and other Health Boards will be swept away.

Radical is one of those words that is often used as praise. I think myself radical is neutral. Radicalism may be excellent, because it produces a better tomorrow. It may be bad, because it messes up something that was not too bad. My point today is not that one of these Ministers is right and one is wrong, or that radicalism is either good or bad in itself.

The important point is the spin is not the same as reality. It looks, so far, as if the Health policy will be more radical. There is likely to be more fundamental change to the roots of the system, than with the Education policy. When we come to assess how it all works, we need in each case to see if the varying degrees of change were the correct ones for the task in hand, to produce better public service. What does it take to raise standards in all state schools? What will ensure good quality prompt care for all who need NHS treatment? I invite your views.

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32 Comments

  1. JohnnyNorfolk
    Posted September 6, 2010 at 9:08 am | Permalink

    Let the people at the sharp end do their jobs with minimum intervention. Those that make major mistakes should be sacked, after due process of course.

    Move as much as possible out of direct state control. Freedom for people to do their job is what it is all about and they must take the rap is they get it wrong.

    Put the users of the service at the centre of all that it done not the providers.

  2. John
    Posted September 6, 2010 at 10:37 am | Permalink

    Another top up for the embalming fluid of the NHS, more rouge on the cheeks of the corpse, another heave of the wheel, bring back matron, toss some more money into the coffin, poke the cadaver – see it moved! It IS alive!

    After 40 plus years of "reform" when will the diagnosis be accepted, the NHS has Norwegian Blue Syndrome? It's dead mate.

    Time for something completely different.

    • Stuart Fairney
      Posted September 6, 2010 at 2:27 pm | Permalink

      Brilliant!

    • Morningstar
      Posted September 10, 2010 at 11:35 am | Permalink

      Time for something radical – like abolishing employee NI (and cutting hugely Employers NI) as the contract for its introduction has been broken by successive governments !

      On its abolishment make people aware that the money they now have in their pockets should be used for insuring ones self and family for health and unemployement cover – and let the markets control the cost.

      The 'still collected' Employer NI should then be used to purchase a basic level of cover for all 'privately uninsured' children with a basic cover. The need for all "welfare state" quango's would be negated. All parents would have to fund their children until they earn their own living – with no state hand outs for the 'cant be bovvered' 'I'm bored' generation ! working hard and learning at school would then become important again. (Yes I would reform schooling in radical ways too ! But off topic.)

      The country can no longer afford 'cradle to grave' cover – for everyone (especially the non contributing members of society). Palliative care should still be offered free for those who neglect their responsability (see – I'm not totally uncaring !)

  3. Corin Vestey
    Posted September 6, 2010 at 10:39 am | Permalink

    Education appears to be the lightning rod for Heath at present. Perhaps though we hear more about the left's struggle to defeat the Gove reforms than we do about the struggle to halt the Lansley reforms. Either way, it seems to me that the problem with Gove approach is that it is incremental and time is something that we do not have. Allowing schools to dictate their own entrance criteria is a step too far for someone like Cameron but even he could have found the conviction to allow businesses in – there would have been a wall of money coming in to the sector which would have offered more parental choice more quickly, galvanised the existing state and academy schools or reform to lose out, and weakened the obstructive power of the unions and the rest of 'the blob'.

  4. Corin Vestey
    Posted September 6, 2010 at 10:39 am | Permalink

    (continued from above)

    The approach that Gove has chosen or has been forced to take is nonsensical: "We believe that 'parental choice' (actually scary old competition of course) will improve school standards, but we won't kickstart our reforms and weaken resistance to them by allowing currently external competitive forces to provide the schools and renovations the Treasury can't afford to provide and my Ed Sec is being castigated for failing to produce."
    This is the kind of critical thinking one gets from a Prime Minister who believes in localism and remaining a member of the EU.

  5. Stuart Fairney
    Posted September 6, 2010 at 11:14 am | Permalink

    What does it take to raise standards in all state schools?

    For the provider of the service (say the headmaster) to be directly, immediately and locally responsible for his product (i.e. education), free to accept or reject business (i.e pupil applications) and for the purchaser of the product (the parents) to control to which school their money goes and critically, to be able to withdraw their business at any point, (funded perhaps by education vouchers).

    Thus schools will be responsive to local needs or they will not exist. I submit this is a better system than currently exists, one which is easily achieved, and one which is utterly unthinkable to our useless moribund major parties.

    • nonny mouse
      Posted September 6, 2010 at 3:50 pm | Permalink

      Competition relies on there being more supply than demand and on the freedom to move between suppliers.

      With schools there is a limit to the number of school places and to what schools are close enough to where you live. Most people won't have the luxury of finding an alternative school with both a free place and better service that is close enough to their home for their children to travel to easily.

      >>What does it take to raise standards in all state schools?

      – Less interference from LEAs and unions and more local control by headmasters.
      – The ability to hire and fire teachers more freely
      – Better teacher training, including more diversity in teaching methods.
      – Better curriculums, more focused on the needs of the future careers of pupils, be they university or work.
      – More variety in teaching. Proper vocational training for non-academic pupils rather than pushing them towards useless university courses.

      • Morningstar
        Posted September 10, 2010 at 11:59 am | Permalink

        You forgot to metion the removal of 'multiple choice' from exam papers. The removal of Calculators from exam rooms (yes kids can use them outside but MUST understand how to DO THE MATHS !)

        A wide ranging curriculum over the subjects History, Geography, English Literature and others. We should also return to a Judeo/Christian ethos as the basis behind ALL schools (It is after all the culture on which this country is based before the rot of PC set in) and was so back in the days where our education system was second to none. With a set school uniform !

    • eddyh
      Posted September 7, 2010 at 6:18 pm | Permalink

      Hear Hear!

  6. Richard1
    Posted September 6, 2010 at 12:07 pm | Permalink

    The fundamental principle should be: where the consumer/taxpayer has choice and there is competition between providers there is likely to be a good service, and when there isn't the service is likely to be poor. Its as true in health and education as in other fields. We should measure any changes in either of these fields by the extent to which they give the people who use them more choice, and introduce competition into provision.

    • Andrew
      Posted September 7, 2010 at 12:05 am | Permalink

      The free market principle surely works best when consumer choice is exercised as often as possible, and in small "quanta." No one would for example reasonably dispute that a grocery retailer who does not give value for money should either improve quickly , or go bust..

      With health care it is rather different , –why should a consumer (i.e. a patient) who exercises an albeit unwise or ill -informed choice, infrequently, — be nevertheless "punished" by diminished quality of life, — or worse ?

      • Morningstar
        Posted September 10, 2010 at 12:03 pm | Permalink

        Comes down to education ! So it NEEDS sorting out in a big way !

  7. @jboulton101
    Posted September 6, 2010 at 12:28 pm | Permalink

    Perhaps this radicalism comes from the health budget being ring fenced. Not having to find savings must cut down on the workload quite a bit; that would allow Mr Lansley and his staff the time to push though radical changes, as well as ensuring that funds are in place for these radical measures to succeed.

    • @spirallingfwds
      Posted September 6, 2010 at 5:04 pm | Permalink

      the health budget may be ringfenced but it actually has more pressure on it in terms of finance than some depts that are being cut. Health inflation is rocketing as new (and expensive) treatments proliferate and as the population ages. Health services are now able to extend the life of many but the extra years they generate are those when people are in most need of medication. The other significant problem in health is that despite all the extra finance targeted at the most deprived areas of the country health inequalities have grown. Money alone isn't making the poorest and least healthy any healthier and so a new approach has to be tried.

    • HampsteadOwl
      Posted September 8, 2010 at 12:51 pm | Permalink

      It's not true to say that the NHS doesn't have to find savings. The figure put on it by the NHS chief executive, and endorsed by both the previous and current government, is £20 billion over the next four years. This is to allow the health service to keep up with demand, technological advance etc from essentially a standstill budget.

      This to my mind is the biggest problem with Lansley's reform plan, radical or otherwise. It doesn't address this savings gap – and the new GP commissioning arrangements could easily generate enough new bureaucracy to mop up anything that is saved from scrapping PCTs and health authorities.

  8. Iain Gill
    Posted September 6, 2010 at 12:57 pm | Permalink

    On the schools front do the following

    1. Get a list of the 100 biggest public housing estates, council houses and housing association, then get a list of the schools serving those catchment areas, then instigate immediate emergency measures – treat it like a military operation. These schools are appalling there is no excuse for it. Appoint a general to run the show like we did for foot and mouth, this is surely a major national emergency. Nothing else will change the game quickly enough.

    2. Same for the big inner city schools.

    3. Allow decent teachers who are prepared to work for a period in a poor school to do it on rotation. So they can do it for X months/years and be guaranteed a swap back to a more middle of the road school. Don't allow them to stay in the worst schools for years and get burnt out. Rotate teachers like the police rotate officers, some time on the worst estates then get swapped back to a more routine job, so that overall they don't get worn out, and allows best practise to flow around the system.

  9. Iain Gill
    Posted September 6, 2010 at 12:57 pm | Permalink

    On health

    1. Everything elective whenever possible (i.e. not drug users or mentally ill patients, who should have some impartial mentors help them) should be decisions with the patients. When they are queuing in a dirty room in a large hospital all day for an appointment that was supposed to be at 9.00 am and they get to 6.00 pm before they are actually seen, and this is not the result of a one off emergency – it happens all the time, those patients should simply be able to get in a taxi to another provider – and the money should in a real sense follow the patient so that the new service provider gets more funds and the place they walked out of looses money.

    2. A & E to be run as a nationally coordinated service, like the coastguard.

    3. Patients can go to any GP they like, I'm still waiting to be able to register outside current catchment areas despite it being govt policy that I am supposed to be able to.

  10. Jetman
    Posted September 6, 2010 at 2:18 pm | Permalink

    The problems that the two respective ministers face are slightly different though. Michael Gove has a difficult job because he has to change what has been built up after 40 years of idealogical claptrap in the educational system and where there seems little agreement about what is the best way to teach. The educational establishment favours pupil led learning whereas everybody sensible knows that that drags every child down to the lowest level. As a left wing idealogy it is eminently sound especially when done hand in hand with watering down the stringency of the examination system to hide this fact. As a way of educating our children it is an abject failure.
    In health the problem is much more structural rather than idealogical. Cutting out multiple layers of bureaucracy and handing decision making powers to the closest possible level to the patient has to make sense.

  11. anextoryvoter
    Posted September 6, 2010 at 2:40 pm | Permalink

    Further discussion of what is or is not needed is a complete waste of breathe. There has been endless debate, an enormous amount of hot air has been expended and any number of excellent ideas put forward, but we have gone nowhere yet.
    All we need are politicians willing to stand up and to act on the basis of their belief and their principals, regardless of the effect it may have on their political careers. Men and women of principle (present company excepted) seem to be in very short supply at Westminster, plenty of hot air until the division bells ring. "Never has so little been owed by so many to so few".

    • Morningstar
      Posted September 10, 2010 at 12:27 pm | Permalink

      I would agree – but as we have seen: How many current politicans have 'beliefs and principles' to which they would stick against the cries and clamours of the left ? I think JR is one of those – which is why he is on the outside fringes of todays crowd.

      In order to get elected – the Conservatives have given up any notion of what is 'good governance' in favour of what is politically expedient (or possibly acceptable). What is politically expedient – is rarely what the majority of the (dumbed down and PC'd) electorate want to hear. What IS required is definitely NOT what the people want to hear – though it WOULD turn this country into what they WANT !

      As the saying goes – there is no gain without pain !

  12. Corin Vestey
    Posted September 6, 2010 at 3:02 pm | Permalink

    My apologies for my error strewn posts.

    In particular – Education should have been the lightning rod for Health – not for Heath, though on reflection…

  13. waramess
    Posted September 6, 2010 at 3:25 pm | Permalink

    It is better to journey than to arrive. I suspect we will see quite a lot of journeying from this administration and little arriving.

    Maybe they look for a radical solution that involves no more than tinkering around the edges of the existing system because of the fear that is engendered by the thought of real change.

    The existing state owned system of education and health are seen as monuments that may be tinkered with but cannot be changed and that is like seeing the state owned water boards and gas boards in much the same way.

    Frankly I think that the task is far beyond either Gove or Lansley and so they are to be consigned to either spinning or apologising for introducing a system that does not work.

    I suspect they will both choose the former for as long as possible.

    Better to concentrate on how health and education might be privatised; an act where both individuals may be capable of a measure of success

  14. @FelixLiberty
    Posted September 6, 2010 at 4:49 pm | Permalink

    I happen to think both policies are fairly bland. Let me lay out some radical ones:

    Education – a real voucher system where money can be used in any school public or private and schools can charge whatever fees they like (top ups allowed). Schools would also be able to select on any criteria and the national curriculum would be abolished. The schools owned by the state would be either sold off to private companies, charities, religious institutions or communities to be run by them in the way they choose. This would be a real free market education policy. The state would not run education, own any schools, employ any teacher etc – it would merely provide the funding to ensure everyone got an education. It is an egalitarian policy.

    Health- unfortunately you cannot have a free market in healthcare while things remain free at the point of use, this distorts incentives and the price mechanism working as they should. However I will concede that making people pay for their healthcare (at least in part) is politically untenable even for a radical policy so instead will suggest supply side reform of the health care provided. Currently nearly all hospitals are owned and run by the NHS, I would begin to privatise them while ensuring the government paid the bills for all healthcare. Patients would be able to visit any hospital they wished and companies would be allowed to build more hospitals or provide any health services to consumers without regulation. Consumers would be free to choose in a real market, but health would remain free at the point of use. If you want to have a real free market in healthcare then I suggest moving to system of health savings accounts combined with insurance against catastrophic risk, based on the Singaporean system.

    What Landsley and Gove are bland by comparison – if your going to have a fight with the unions and the healthcare/education elites you might as well do it for some really wholesale reform.

  15. StevenL
    Posted September 7, 2010 at 1:47 am | Permalink

    On education, put all the hard stuff they used to do in maths in the 1950's O Levels back into the maths GCSE, like long-hand standard deviations etc. Explore further the idea of abolishing grade inflation by 'banding' grades.

    I really haven't got a clue on health, only had to use it a couple of times. As I have suggested before though, make it easier for patients to get small quantities of prescription drugs they might need for acute issues without having to go through the bureaucracy. For example you are 300 miles away from your GP's surgury and becoming ill, you queue at A and E for 4 hours only to get refused and told to register with a GP because they can't get at your medical records.

  16. THE ESSEX GIRLS
    Posted September 7, 2010 at 1:53 am | Permalink

    STATE SCHOOLS. Simple. Model every state school on the precise lines of the best independent schools. Streaming, discipline, uniforms, houses, sports, general ethos. Make pupils proud of their school and identifiable by it. Give Headmasters, housemasters and prefects/monitors authority and scope.
    POLITICAL SLOGAN: ‘An independent-style education free of charge’

    • Morningstar
      Posted September 10, 2010 at 12:31 pm | Permalink

      Oh – and bring back 'fagging' (just joking !)

      I agree with what you say !

  17. RPH
    Posted September 7, 2010 at 3:23 pm | Permalink

    Lansley may be talking reform but is it happening on the ground?

    NHS managers in PCTs are trying to minimse the reforms so that the new 'GP commissioners' will just be rebadged PCTs with the same incompetant staff running them.

    Lansley is already following the Labour policy of running down community health services.

    In a years time, apart from a few title changes it will be as if Labour are still in power.

  18. richard
    Posted September 7, 2010 at 7:28 pm | Permalink

    It is a great shame that the idea of education vouchers has never been given a try.

    This would give far more power to parents in choosing a good local school regardless of their income or catchment addresss.

    Schools that have a queue of customers must be made to expand to meet the demand.
    Perhaps this part needs to begin first to enable voucher holders to have some real choice.

    In my area as there are enough total places to meet numbers of children, the LEA won't allow the better schools to expand even though year after year they are over subscribed.

    Each school knows it will be full every year whether it is good or bad and this cannot be allowed to continue if radical improvement is required.

    • Mark
      Posted September 8, 2010 at 12:32 pm | Permalink

      Surely the more important point is that they don't force the worse schools to shape up or to contract or close?

    • Morningstar
      Posted September 10, 2010 at 12:34 pm | Permalink

      If they gave parents vouchers (to choose their childrens education) – We'd all send our kids to public schools ! That is why they will NEVER be introduced !

  19. Iain Gill
    Posted September 8, 2010 at 10:31 pm | Permalink

    oh yea and id get struck off straight away the docs handing out dyslexia diagnosis to all the middle class kids so the poor little darlings can have longer in their exams and their grades bumped up, its a middle class con trick to get them more marks and their diagnosis soon disappears when they leave education

    there is no dyselxia on the working class and under class estates, is this some medical mystery?

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    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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