John Rentoul: The Coalition doesn't need to reinvent the Blairite wheel

Lansley may argue that by putting power in the hands of GPs he is empowering their patients, but the people he is really empowering are GPs
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The Independent Online

You cannot fault the Coalition for its ambition. The end of welfare as we know it. Radical decentralisation of schools. A free market in university education. And the handing over of the National Health Service to GPs. All at a time of the biggest squeeze on public spending since 1976. The huge question is: will it work?

What is likely is that some of it will and some of it will be a heroic failure. David Cameron and Nick Clegg seem to have little idea which reforms will succeed, and so they have decided to try to do anything and everything in the scatter-gun hope that some of it will stick and at least they will be able to take credit for that. It is a foolish approach when we do have a lot of evidence now about what works and what doesn't in the field of public service reform.

Only this week a study showed that exam scores rose faster in schools that took part in Teach First, the scheme for recruiting top graduates into challenging schools. We know now that the school reforms started under Tony Blair and driven forward by Andrew Adonis, who carried on as education minister for a while under Gordon Brown, are working. We know, too, that academies work. They have, on average, higher standards than the difficult schools they replaced. The evidence was so compelling that even Brown could not ignore it. So it is encouraging that Michael Gove has pushed ahead with them with renewed vigour.

The pattern was the same for welfare reform. Late on in his time as Prime Minister, Blair saw that there were real problems with the way sickness benefit and housing benefit operated in particular to discourage people from working. James Purnell tried to push ahead with those reforms under Brown, who shied away, leaving Iain Duncan Smith to drive on with determination.

Higher tuition fees are the intensification of the Blair reforms of student finance – reforms that have transformed university finances for the better over the past decade while allowing ever greater numbers of students to reach degree level. Again, Brown hesitated over the next stage, commissioning John Browne to write a report that is being implemented with the zeal of the converted by the Coalition.

In each case, we know that the Blair reforms were working and, while there may be problems with what the Coalition is proposing, they are mostly the faults of over-enthusiasm. Gove has been carried away with the idea of "free schools", which seem to put too much emphasis on parents spending a lot of time in meetings rather than on changing incentives generally to encourage greater diversity in the provision of schools, especially smaller ones. Last week he announced direct funding per pupil of schools – right in principle but likely to be a huge distraction in practice by creating winners and losers, when the principles of money following the pupil and of direct funding of schools have already been well established.

At least he is trying. The great mystery at the heart of the Coalition's reform programme goes by the name of Andrew Lansley. He is Secretary of State for Health, but most people have never heard of him. Before that, he was the Conservative spokesman on health for six years. He shadowed the department that he now runs for almost as long as John Major was Prime Minister. He did the job so well that Cameron guaranteed that he would hold the post in government if the Conservatives won. So you might have thought that he would be well-prepared and know what he wanted to do the moment he started work. What he actually did, after a baffling delay, was to announce a huge and unexpected change to the way the entire NHS works. He decided to abolish primary care trusts and put their budgets in the hands of GPs. Now, it may be that he has a cunning plan, and that his only failure is one of communications strategy. But if he has a clever plan it is an exceptionally well-kept secret.

Once again, we know "what works". It is the Blair reforms. Brown tried to tone down some of the more market-sounding language because a lot of people don't like it, but he didn't really slow the momentum. Some recent academic research has produced dramatic, and under-reported, findings. A paper this summer by Martin Gaynor, Rodrigo Moreno-Serra and Carol Propper of Bristol University and Imperial College assessed the change in 2006 to give patients the right to choose their hospital: "The effect of competition is to save lives without raising costs. Patients discharged from hospitals located in markets where competition was more feasible were less likely to die, had shorter length of stay and were treated at the same cost." This was no one-off. A similar study by Zack Cooper and others at the LSE published in January came to the same stark conclusion that patients were more likely to die where there was a monopoly provider of NHS services.

So, has Lansley tried to accelerate the spread of choice in the health service? Well, he may argue that by putting power in the hands of GPs he is empowering their patients, but the people he is really empowering are GPs. In the rest of the health service, he has abolished "targets" and replaced them with "quality standards". And he has told doctors how much he respects their professional judgements, which might be all very well as part of a strategy of winning the hearts and minds of providers while secretly sharpening their incentives to greater effectiveness, but it is the secret bit that will make the difference in the end.

There is a danger that the Coalition will learn the wrong lesson from Blair, who berated himself for not making enough progress on public service reform in his first term. But it was not a lack of energy that was the problem, it was a lack of understanding. Throwing everything at reform and hoping that something will work is a pointless waste. Coalition ministers do not need to reinvent the Blairite wheel. It is already there. Ready to start rolling again after three years of braking.



John Rentoul is chief political commentator for 'The Independent on Sunday'

twitter.com/johnrentoul

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