This week, I’ve been listening carefully to the way the government talks about their proposals for reforms and cuts.
What’s striking is how David Cameron tries to define the political territory, and force the opposition into a corner.
First he defines the issue as a challenge for more equal, fairer outcomes.
So for NHS reforms he stresses health inequalities and standards of cancer outcomes versus Europe. On EMA it is increasing Social Mobility and focussing limited resources on those who need it most.
Next, his reforms are implicitly stated to be the only way to achieve these outcomes .
Finally, if you oppose the reforms, he argues you effectively oppose the objectives.
The Prime Minister’s instinct is always to will progressive ends with conservative means.
As he said in PMQs yesterday:
“we have health inequalities in our country that are as bad as those in Victorian times. Let us be frank: we have those after a decade of increased money going into the NHS … That is the reason for carrying out these reforms. If we just stay where we are, as seems now to be the policy of the Labour party, we will lag behind on cancer… his constituents will die younger than mine because we do not have a fair system. Let us reform it and sort it out.”
It’s a model followed by his more ideologically attuned Cabinet members. Here is Michael Gove’s peroration from yesterday’s EMA debate:
“There is a basic choice today: vote with the Opposition, and therefore vote for reaction, complacency and deficit denial; or vote with the Government, and therefore vote for progressive policies, an education policy that will really change things and an opportunity, at last, to kick-start social mobility in this country.”
It’s not an unreasonable style of debating. It puts an onus on the opposition to explain why Labour opposes the change.
The conservative means are always firmly in place in the government’s agenda.
Sadly, the progressive ends are more honoured in the rhetoric than in the policy. It’s often very hard to see how David Cameron’s reforms will meet the ends he publicly states are important.
So on health, the PM talked at PMQs about the problem being one of health inequality and cancer care outcomes.
Yet his proposal is to encourage variance in treatment depending on the commissioning choice of the GP. So one GP might find budgets under pressure, and choose not to prioritise some services. It is easy to see how this could become a vehicle to drive health inequality, not reduce it.
I’m not trying to argue here that David Cameron and his government are a bunch of heartless swines who want to encourage health inequalities*. I’m arguing that to oppose them effectively, it’s essential to break the link between the means and the ends.
It’s scary how quickly the political debate skips over this link.
Reform A is intended to produce Result B. Oppose Reform A, and you oppose Result B. Why would anyone want to oppose result B, unless they were trapped by vested interests or out of touch with reality? Those anti-reform A swines, going out there to stop decent folk getting result B!
(To be honest, I suspect Cameron learned this trick from Tony Blair. I just think that Tony Blair’s reform A usually did lead to result B)
All of which makes it really important for the opposition to break the link between progressive rhetorical ends and actual conservative means. (Also, if we struggle to do that, we have slightly bigger questions to ask ourselves, No?)
Without doing that, you become trapped by the Tory narrative. You need to have something that says “We all want result B. But this doesn’t get us there”.
So, for example, on NHS reforms. You start off with waiting lists, as Ed did on Wednesday. Then you move on to postcode lotteries. Then you ask how much is being spent on consultants like KPMG, Then you move onto mechanisms to prevent hospitals that seve the neediest communities going bust, or GPs in the toughest areas running out of money.
If some GP commissioners are only as good as PCTs in budget management, this will happen. Remember the problems under Patricia Hewitt? That’s why the NHS commissioning board is being given powers to hand a struggling GP consortium to a private company. I reckon that’s something people will find startling.**
(By the way, can I once more recommend reading Paul Corrigan on health – his post today is excellent on why Government policy on the flu vaccine shows the problems with their overall GP commissioning policy)
On EMA, the same applies. The reason Cameron and Gove supported EMA in opposition was because it was a policy to support social mobility.
They say they still support social mobility, but it’s too expensive to do it this way. Instead, they want to launch a more targeted approach with a fraction of the budget. They just won’t tell us how the new approach will improve social mobility.
So the question for Labour isn’t “Why abolish EMA?”, it’s “you want more social mobility? So how will replacing EMA with a small “Discretionary learner scheme” achieve that?”.
That takes you into asking whether, for example, everyone who received free school meals at School, is in care, has special educational needs, is a parent, was a NEET, or is from a known deprived area and is taking a key vocational or University track course would be guaranteed EMA levels of support at college.
Given the small (Fifty million increase) budget for the new fund, and the fact it will go to colleges to administer, I doubt the government could give a very good answer to any of these questions.
Another approach would be to point out that the IFS research that discusses the cost of EMA is actually a discussion about social mobility. The IFS says that the cost of EMA is off-set by the savings.
This means that the increase in social mobility EMA delivers saves the government money.
Further, The IFS research suggest that those who receive EMA not only stay longer in school, they get better grades. 5 extra A level points, and it is the most able at age 11 who benefit most from EMA***
That means that in the long run, people who get EMA are more likely to get into university, or get better jobs. If that support is to be widely reduced, then social mobility will suffer.
So cutting EMA becomes not an argument about dead weight costs, but an argument about investing in social mobility, which the government claims to take most seriously.
Once you have established the case against the reforms delivering what the Prime Minister claims they will, I think Labour has a much stronger foundation to oppose the reforms and the cuts.
This also provides Labour with a much better jumping off point to address the question of what it would do. First, we would listen to the experts who were worried about the outcomes. Second, we would make our decisions on that basis.
Just as importantly, opposition to the cuts cannot then be couched as opposition to what the reform is apparently intended to deliver.
In other words, to oppose conservative means, we should expose claims about progressive ends.
*It’s worth noting that there are ways around these problems. You could shift funding into areas where health outcomes are worst, so GPs there face little budget pressure. You could invest heavily in public health strategies that would help reduce the variability in the first place (though these would inevitably have to be nationally directed “prongs”, pushing past all he local control gubbins). I’m sure the government will end up implementing something along both these lines, going back to the point Paul makes about the flu vaccine.
**Also, when David Cameron talks about the need to improve cancer outcomes, we should point out that he has not actually said how cancer care is to be reformed. It’s not yet clear precisely which Cancer treatments will be commissioned by GP consortiums, which by groups of GP consortiums and which by the new NHS commissioning board. This is important, as it would be lunatic to end up with a “Cancer lottery” where your ability to get treatment was based on who happened to be commissioning it.
*** reading this report makes clear that EMA is not a perfect tool for lifting social mobility. (Nothing is). Though it is pretty good.
“Tables 4a and 4b confirm that the impacts of the EMA on attainment were concentrated among pupils from the most deprived backgrounds. Females from the most deprived backgrounds, for example, were found to be 2.4 percentage points more likely to meet the Level 3 threshold by age 19, with a corresponding improvement in A Level tariffs of around 8.1 percent on the base. For males from deprived backgrounds the impacts are generally smaller, but there are still significant gains at Level 3 by age 18”
(by backgrounds the mean community, not family income. It’s done by postcode)
However, the most deprived boys (those from the bottom fifth deprivation, or on FSM) only have impacts at the very lowest levels of achievement, while girls from the same background do well at higher levels too. If the report authors are right, it would suggest that we need, earlier, heavier intervention to ensure boys from most deprived backgrounds are in a position to benefit. That’s an argument for better school education for low income boys, followed by EMA, not an argument for abolishing EMA.