Health Policy InsightEditorial Tuesday 19 June 2012: Words of Worth outline Tory frustration over reform
Health policy adviser to Number 10 Downing Street Sean Worth gave this extremely revealing exit interview to The Guardian.
There are some key lines to give insight into Conservative thinking in Number 10.
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Worth, a central figure in the Health And Social Care Act of Andrew Lansley (saviour, liberator) and until the 2010 election head of the Conservative policy unit before the election, tells The Guardian's Patrick Wintour three main things.
1. The strategy of tariffs and increasing diversity of provision remains core to Tory policy thinking
According to Worth, the thee Cs of choice, competition and commissioning remain the way to go: "The Andrew Lansley model, regardless of how it went down politically, is really very good. Give people a choice, allow other people to come in and provide for services. To ensure there is not a free market free-for-all, you have two kinds of regulators - an economic regulator to stop anti-competitive behaviour and allows a role for charities, and a standards regulator such as Ofsted.
"That is the general model and that would work well across the piece – as would a system of tariffs to pay for services. At a policy level intellectually that is the right model, and the one that we should be pushing out ... I don't think we will have a positive reform narrative if it is all about outsourcing firms gobbling up as much as they possibly can, or else you end up in the same territory as the last government, where you make the budgets smaller and you give it a private company to do it. It needs a lot more positive than that".
The advent of social enterprises, says Worth, "is not happening on the scale we need. Politically we say we want social enterprises and charities doing public services but actually they often cannot because they do not have balance sheets.
"So you end up with the work programme model, where the charities do the soft stuff and the businesses do the bean counting. It is better if you use the skills of both sectors in a genuine outfit that is competing for its contracts on its own terms".
Worth remains a true believer in public sector comparison websites: "when you come into government you realise that these markets do not just emerge. You need to do stuff to make it happen and there are things we need to do to encourage this or else we are going to have sit around for 20 years waiting for free and competitive, markets waiting for comparison sites and smartphone apps to emerge. I don't think we have got that long to wait".
Phew. This strand of markets-and-competition thinking is quite distant from the rhetoric that emerged around integration of care.
To say nothing of the opportunity costs of a plural market, when money is extremely tight.
Meanwhile, the commitment to social enterprise has been, shall we say, variable.
2. Opposition to the Health Bill was a trades unions thing
It was the unions wot spun it, to paraphrase the famous Sun headline. Worth opines that "the biggest wake-up call for me is how to operate vis-a-vis the trade unions, and by the unions I mean the people in the media called teachers' and doctors' leaders. They are not doctors or teachers; they are trade unions.
"You realise they have way, way more money than you, way more than your entire political party. They have got campaigns running all round the country and really skilful propaganda. We were got caught on the hop by it. There are parallels with power of the US oil and tobacco lobbies – they have much more money than the politicians, and they have politicians on the payroll.
"Internally people got confused by the big noise and row from this opposition with popular opposition to what we are doing. They are very different, even if they look the same, and I don't think we got a handle on that and we still have not".
Ahem. To describe the medical trades unions' propaganda as "really skilful" errs on the far side of generosity. Opinions was slow to realise what the Bill was about (probably due to the desire to give the Coalition a fair wind), and slower to mobilise.
The appalling mess that was made of the efforts to communicate the case for Mr Lansley's liberation will not be swept under the carpet by this effort to re-write history.
(There is also the small matter of how the Bill split the Liberal Democrats (who are apparently known as 'The Inbetweeners' in the new series of The Thick Of It).
Worth obviously also hasn't looked at recent polling on public trust in the Tories over the NHS.
3. Time is against the Government on the delivery of reforms
Worth is clear that "at the next election there is a danger there will have been all this spending restraint and there is not great deal of reform narrative – that will be a pretty easy platform for the other side to attack us on.
"It should be much bigger political priority, given we are heading towards 2015 and by then we will split from our coalition partners and they will be able to do their own thing. We need a story to say it was worth it and to give a reason to believe in what we have to done.
"What we need by 2015 is … a whole series of politically attractive results from the policies we have implemented to counteract the fact that Labour says: 'You cut too far, too fast and look at the state of everything'.Reform is the best antidote to that, but you need results and you need it quickly and you need a lot of resources behind it, and you do need to push it through a little more from the centre than so far".
He is, to put it mildly, not wrong. The double-dip recession has removed the easy 'oversee recovery and cut taxes in our last budget' narrative. Recent polling has found that Labour's Ed Balls is currently preferred by voters to Gideon George Osborne.
And it's the economy, stupid.
Oh, and more centrally pushed reform in health?
Mmm. It appears that not even the Conservatives' central policy advisers read their legislation.