The NHS: the coalition “will end up doing a U-turn” on waiting lists
New Labour spent its first two years dismantling choice and competition—and the next two terms putting them back in. The Conservatives are spending much of their first two years getting rid of targets and Whitehall control. They will end up doing a U-turn and going back to targets—or be unlikely to get another term.
In opposition you spend most of your time with GPs. And teachers. And local authority directors. You go to their conferences. The easiest way to get a cheer is to promise to get rid of meddling by someone, normally politicians or bureaucrats.
David Cameron cleverly turned this fact of life into a rhetoric for opposition. The Big Society gained much of its thrust from attacking Whitehall’s targets and diktats. (By the way, Labour should be wary of saying the Big Society is a failure: it gave the Tories something to say whenever they were accused of being crypto-Thatcherites.) The catch is that you can campaign on the Big Society, but you can’t govern with it. In government, your job is to run the state. Ministers can’t avoid responsibility for results—as health secretary Andrew Lansley has found. It may not be his job to order flu vaccines, but if they run out, it’s certainly his problem.
By the end, the Labour government had lost the will not just to live but to take decisions. No one could accuse this government of that; it’s got reforms coming out of its collective ears. But that has left a contradiction: it has raised expectations of the state while giving away the levers to influence it.
This won’t last. As soon as it abolished the maximum 18-week waiting time for NHS treatments, waiting lists rose. What is Vince Cable going to say to his constituents when they complain? “Yes, I know, but look at the number of targets we’ve abolished?”
As with most of this government’s mistakes, they come from a misreading of Blair and Brown. The Conservatives liked to present Brown as the statist and Blair as the reformer. As the heirs to Blair, they would continue reform, but end centralised control.
But it was Blair who was the real statist. Like this government, he came in promising change. He started with an interventionist approach to markets—from the minimum wage to strengthening competition policy. But after the first term, he became much more reluctant to interfere in markets. So he had to achieve his promises through the state. People (often in the Labour party) would say he was anti-state because he was pro-reform. But the opposite is true—he was desperate to reform the state because he depended so much on it. He did it through targets, orders from Whitehall, the strategy unit, or taking control himself (as he did during the fuel and mad cow crises). He even had his delivery unit influencing when train conductors should blow their whistles.
There were problems with Labour’s statecraft. Early on, new Labour spread targets on public services like a child sprinkles hundreds and thousands on a cake. But then it hit on the right recipe: a judicious mixture of selected targets, individual guarantees, choice for consumers and therefore freedom for providers.
Brown wasn’t a statist. He was a spender. His best achievements were about how to raise or spend money (overseas aid, tax credits, NHS funding). He showed little interest in statecraft. Brown was pro-spending and anti-reform: exactly the box in which Cameron wishes to lock the Labour leader Ed Miliband.
It may not be fair that Labour is seen as responsible for the deficit, but it is a fact of life, and in opposition it is hard to shed those political facts. The Conservatives were tarred by their last period in government right up until last May—I would say it was largely John Major’s fault that they didn’t get a majority.
When you’re in opposition, there are two ways of changing how people see you. The first is to get into power. Tricky. The second is to take the opposite position to the one for which you are known. In Australia, Kevin Rudd shed the Labour party’s reputation for spending by declaring himself a “fiscal conservative.” Brown did the same with “prudence.” Cameron went sledging with huskies to suggest that he was a different kind of Tory.
Ed Miliband’s trope is that Labour is not a spending party because not all its policies involve more spending. He should go further—and say that, for the moment, none of his policies involve more spending. That would kill the Conservatives’ attack that Labour is a spendaholic. Once Labour has rebuilt its reputation for prudence, it can make some spending commitments in the run-up to the next election, once people start listening again.
But most of all, such a move would redefine the political battleground. Instead of the debate being reform versus spending, it would become good versus bad reform. And with the Conservatives having given up some of the best ways of reforming the state, that would be fertile territory indeed for Labour.
New Labour spent its first two years dismantling choice and competition—and the next two terms putting them back in. The Conservatives are spending much of their first two years getting rid of targets and Whitehall control. They will end up doing a U-turn and going back to targets—or be unlikely to get another term.
In opposition you spend most of your time with GPs. And teachers. And local authority directors. You go to their conferences. The easiest way to get a cheer is to promise to get rid of meddling by someone, normally politicians or bureaucrats.
David Cameron cleverly turned this fact of life into a rhetoric for opposition. The Big Society gained much of its thrust from attacking Whitehall’s targets and diktats. (By the way, Labour should be wary of saying the Big Society is a failure: it gave the Tories something to say whenever they were accused of being crypto-Thatcherites.) The catch is that you can campaign on the Big Society, but you can’t govern with it. In government, your job is to run the state. Ministers can’t avoid responsibility for results—as health secretary Andrew Lansley has found. It may not be his job to order flu vaccines, but if they run out, it’s certainly his problem.
By the end, the Labour government had lost the will not just to live but to take decisions. No one could accuse this government of that; it’s got reforms coming out of its collective ears. But that has left a contradiction: it has raised expectations of the state while giving away the levers to influence it.
This won’t last. As soon as it abolished the maximum 18-week waiting time for NHS treatments, waiting lists rose. What is Vince Cable going to say to his constituents when they complain? “Yes, I know, but look at the number of targets we’ve abolished?”
As with most of this government’s mistakes, they come from a misreading of Blair and Brown. The Conservatives liked to present Brown as the statist and Blair as the reformer. As the heirs to Blair, they would continue reform, but end centralised control.
But it was Blair who was the real statist. Like this government, he came in promising change. He started with an interventionist approach to markets—from the minimum wage to strengthening competition policy. But after the first term, he became much more reluctant to interfere in markets. So he had to achieve his promises through the state. People (often in the Labour party) would say he was anti-state because he was pro-reform. But the opposite is true—he was desperate to reform the state because he depended so much on it. He did it through targets, orders from Whitehall, the strategy unit, or taking control himself (as he did during the fuel and mad cow crises). He even had his delivery unit influencing when train conductors should blow their whistles.
There were problems with Labour’s statecraft. Early on, new Labour spread targets on public services like a child sprinkles hundreds and thousands on a cake. But then it hit on the right recipe: a judicious mixture of selected targets, individual guarantees, choice for consumers and therefore freedom for providers.
Brown wasn’t a statist. He was a spender. His best achievements were about how to raise or spend money (overseas aid, tax credits, NHS funding). He showed little interest in statecraft. Brown was pro-spending and anti-reform: exactly the box in which Cameron wishes to lock the Labour leader Ed Miliband.
It may not be fair that Labour is seen as responsible for the deficit, but it is a fact of life, and in opposition it is hard to shed those political facts. The Conservatives were tarred by their last period in government right up until last May—I would say it was largely John Major’s fault that they didn’t get a majority.
When you’re in opposition, there are two ways of changing how people see you. The first is to get into power. Tricky. The second is to take the opposite position to the one for which you are known. In Australia, Kevin Rudd shed the Labour party’s reputation for spending by declaring himself a “fiscal conservative.” Brown did the same with “prudence.” Cameron went sledging with huskies to suggest that he was a different kind of Tory.
Ed Miliband’s trope is that Labour is not a spending party because not all its policies involve more spending. He should go further—and say that, for the moment, none of his policies involve more spending. That would kill the Conservatives’ attack that Labour is a spendaholic. Once Labour has rebuilt its reputation for prudence, it can make some spending commitments in the run-up to the next election, once people start listening again.
But most of all, such a move would redefine the political battleground. Instead of the debate being reform versus spending, it would become good versus bad reform. And with the Conservatives having given up some of the best ways of reforming the state, that would be fertile territory indeed for Labour.
