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Overhauling the public services is proving slower and harder than the government once hoped
HEALTH-CARE reform’s potential as raw material for rappers has hitherto mostly gone unnoticed. Now the government’s plans for the National Health Service have been satirised in a ditty entitled “The NHS is not for sale”; it registered over 150,000 YouTube hits within a week. Nearly a year after the coalition came to power, offering the most sweeping public-service reform agenda since Margaret Thatcher, grind—and ridicule—have beset it. Ministers look tired; U-turns, refinements and clarifications are frequent.
The official line is that reforms to schools, the NHS and other institutions are proceeding as intended. David Cameron is sticking to his plans to devolve more power to those directly delivering the services, cut out bureaucratic middle men and enhance competition. But scratch a bit deeper, and worries about the impact and pace of the changes are evident. “We haven’t succeeded in explaining how our approach saves money and delivers better services,” admits a senior minister.
Andrew Lansley’s bid to devolve the commissioning of hospital care, and responsibility for much of England’s health budget, to GPs has proved the most contentious policy. Under the health secretary’s scheme, GPs will be obliged to form new commissioning consortia; they will also have more freedom to choose private health-care providers over state ones.
Mr Lansley points out that his changes are going more smoothly than hostile interest groups suggest: 177 consortia, covering 70% of England’s population, have already been set up (the deadline for transferring to the new arrangements is April 2013). But the timescale is alarmingly variable. One senior government figure thinks this and other public-sector reforms will take “between five and 15 years” to bear fruit nationally. That might be asking a bit too much of public patience.
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Meanwhile the education secretary Michael Gove’s once-prominent focus on new Swedish-style “free schools”—to be funded by the state but run by charities, parents and others—has been wavering. Although he denies a shift, chains of academies—state schools turned over to autonomous providers—are now being heralded as the driving force of schools reform. Mr Gove is sounding keener on American-style Charter schools than on the Swedish model, in part because the Charter programme has a clearer record of helping to transform education for the poor.
And a bitter row is under way over how far the rise in tuition fees to ??9,000 ($14,500) for some universities should be dependent on them admitting more students from poor and ethnic-minority backgrounds. Supported by Vince Cable, the Liberal Democrat business secretary who is responsible for higher education, the Office for Fair Access, a regulator, wants a portion of the higher fees to be diverted to outreach efforts. It threatens to impose a cap for those universities who don’t oblige. Frustration in the universities is matched by outrage among Tories, who are afraid of damaging standards and biasing the system against middle-class applicants.
Serious reform is always painful: Mrs Thatcher was widely loathed in her radical second term; Tony Blair complained about the “scars on my back” from his fights with public-sector workers. As then, today’s plans pitch fears about the cost and alleged chaos of upheaval against hypothetical arguments for change. But the government’s year-long adventure in reform suggests some other patterns.
First, expectations matter. Before last year’s election the Tories reassured voters that there would be no “top-down reorganisation of the NHS”. Mr Lansley’s plans might have caused less of a rumpus with more explicit warning. The civil service matters too: Number 10 complains that it is being insufficiently zealous in implementing the government’s agenda. Officials counter that the problem is the volume of new measures, and varying competence in departments, rather than intransigence.
Just as importantly, the coalition has learned that the messy happenstance of everyday government can be disruptive and demoralising. A climb-down on the proposed sell-off of forests was followed by a concession over the abolition of the Education Maintenance Allowance, a subsidy intended to keep 16-19-year-olds in learning, after a threatened legal challenge. Number 10 recently intervened to demand a reversal of plans to cut school-sports funding. None of these was a major reversal; but they have rattled MPs, who wonder whether to stick their necks out to defend bigger schemes that might be cancelled or amended.
Finally, the exigencies of coalition have been a burden. A plan to reform housing benefit, vaunted by the Tories in opposition, has been dropped from the government’s welfare-reform bill after rows with the Lib Dems about whether it would penalise low-earners. (The broader plan to introduce a single “universal credit” to replace multiple allowances for those out of work has created its own new network of unintended complexities and forthcoming climb-downs.) The emphasis on fairness in the Tories’ coalition agreement with the Lib Dems helps to explain the reorientation of Mr Gove’s ideas.
So far, the architecture of the coalition has held up well. Mr Cameron and Nick Clegg, the Lib Dem deputy prime minister, share a vision of a public sector enlivened by greater competition and less dependent on a dwindling pot of state funding. They do, however, need to make a bolder case for why they are fighting on quite so many fronts—and to tell the public when it can expect to feel the benefit of the slimmer, fitter Leviathan it has been promised.