Tag: NHS reform

How many poll taxes fit into an area the size of Wales?

There are many shorthand measures used by newspapers to indicate size: Wales for geographical area, Wembley for crowds, swimming pools for volume, Nelson’s column for height, double-decker buses for dinosaurs (a rather specialised subset).  There seems to also be one newspaper measure for showing just how big a problem a politician has got himself into: the Poll Tax.

For Blair, ID cards, university top up fees and inevitably Iraq all got the “Is this Blair’s Poll Tax?” treatment.

Gordon Brown had fewer Poll Tax moments – perhaps he just had less time to stumble into them, although Polly Toynbee was worried that it might be the Tube.

For David Cameron, overwhelmingly it’s NHS reform, although Socialist Worker wants it to be tuition fees,   Labour Uncut feels it could be the housing crisis  and the TUC is warning about the whole package of cuts.

How young do you have to be before the Poll Tax ceases to be meaningful as something which happened during your political lifetime and becomes something that has to be set into context – in the same way that I had to have  Suez explained when it was the standard measure for British humiliations in world affairs (I grew up in the 1970s, there were LOTS of those).

The Poll Tax riot was in 1990.  Thousands of people who voted in the general election  weren’t born when it kicked off.  Does it mean anything to them or is it time for the hacks to stop being lazy?

Update:  Just checked, following today’s Big Society-debacle headlines.  No-one has actually called the BS David Cameron’s Poll Tax – yet.  The WSJ has already described the Big Soc as “the silliest idea to have come out of the party since the Poll Tax” so it’s probably only a matter of time.

Come on down for Opportunity Costs!

I’d missed the news that Michael Gove  banned the use of the phrase Every Child Matters at the Dept for Education until this week.   This is what you get if you try to find the old ECM site online.

For the record, ECM was set up after the Laming enquiry into the death of Victoria Climbie.  It tried to integrate children’s services, closing the gaps between services previously offered in isolation by schools,  social services and the NHS.  It included the expansion of Sure Start and major changes to the way that local authority services were provided.  It was, depending on your political tastes, either a hugely bureaucratic, over-engineered response to a problem which needed a simpler approach; or an ambitious attempt to address systemic problems in services which  left  young people at risk.  I applauded the intentions of ECM even as it drove me temporarily insane.

I worked on the comms  strategy at the beginning of the programme, addressing audiences in every branch of the public sector,  trying to change the way thousands of people worked.  Our approach was to try to work in partnership with the people who delivered services.  It made sense to us to have the people who were going to make the policy work in practice help shape it – the “if you want to go fast, travel alone; if you want to go far, travel in a group” philosophy.

The pace of progress at the start drove me nuts.  My old boss likened the endless trail of seminars and discussion documents and presentations to bushtucker trials, in which we had to eat our diet of toasted kangaroo balls and cockroach biscuits in order to win the opportunity to come back and do it all again next week.  Eventually, despondent at the rate of progress, I moved on to other things.  It’s taken me  years to realise that my expectation of a faster pace to such massive change was unrealistic.

All those hours of work,  the cost of making change happen so that services would be better in the long run, are now being written off – and I doubt figure  in the government’s balance sheet of the savings they are claiming from slimmed-down public services.

A GP taking part in PM‘s debate about health service reforms made the same point to Andrew Lansley this week, asking whether the costs of redundancies, retraining  and waste due to the scrapping of systems figured in his costs for NHS reform :  “I’ve been around for a long time and I’ve seen many reorganisations, and one of the problems is that there doesn’t seem to be any publication of the true costs of these reorganisations, which often take a couple of years to take effect…”    Lansley argued, as ministers always do, that this time the reform was for keeps, so the costs would be cancelled out in the long run.  I wonder.

I also wonder about the government’s approach to working with partners.  They give the impression of wanting to go very fast indeed and opting to do it solo.  The last post highlighted the apparent state of relations between DCLG and local government.  DoH seems to be working in the face of opposition from its key stakeholders too (though I’m not inside the Department so don’t know what conversations are taking place.)  As the Observer’s secret civil servant pointed out in today’s paper, this may have far-reaching consequences:

“Doctors have raised the tempo of the debate and, unlike teachers or policemen, they can comfortably play politics as public deference to medical professionals is strong. Government advisers are not alarmed. The coalition can win this fight. It will pass its health bill in the House of Commons and should get it through the Lords. The new health system will get built but the real risk is what happens then. If doctors are alienated and angry and patients worried and confused, the system won’t work. … Ultimately, this mess may even lose the coalition the next election”