Ends, means and opposition

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.

16 Responses to “Ends, means and opposition”

  1. The Collective

    The biggest question they have answered on health reforms for me is how it will make it better for a patient. Without that, their narrative is bogged down management speak.

    • hopisen

      That’s why Lansley is such a bad HealthSec for them (presentationally speaking) He wants to show how big his reforms are, only then talk about what they’ll do for patients.

      That takes you to “enormous shake ups” – which is stupid narrative. Cameron smarter, but still seems to think he should sell enormous reform. Maybe they think that going on about the scale of what they’re doing will distract people from the underpants gname elements?

      Gove is smarter on this, but has his own problems, because he keeps doing stupid stuff.

  2. Dominic Minghella

    Excellent article. I was really struck by this skilful misuse of logic too. Many thanks for articulating what’s going on so clearly.

    Your analysis of the corner it backs Labour into is particularly astute.

    I like your reasoning on how to respond, but my sense of this is that piecemeal response, devilling out the detail, is not the answer.

    Labour needs a big narrative, an alternative credo, in which to tent and contextualise detailled opposition. Without that, the party will just get rained on.

  3. Greg Lovell

    I completely agree. What strikes me about the Tory narrative strategy is that it’s verging on a sort of reverse reductio ad absurdum terrritory (bear with me!). They will say “Labour was introducing some private involvement in healthcare, Labour says it cares about outcomes, so much more privatisation must lead to much better outcomes.” It’s a similar thing with cuts (and here is where it’s most dangerous for Labour). Tories say “Labour wanted to make some cuts, Labour are supposed to care about poorer people, therefore more cuts means we care even more.”

    They teather their message to a completely false logical argument and extrapolate as far as they can. It should be a risky approach, because if it was genuinely addressed as reducio ad absurdum, then they would look ridiculous e.g. “By that logic, we should cut the entire deficit now and the country would miraculously have full employment in the private sector”. However, they are successfully treading a logical tightrope which allows them to be seen as reasonable despite both the premise and the implementation of the policy being false.

    As Hopi says, this presents a challenge to Labour and in particular, it’s why the economic argument of “slower cuts” is failing to resonate. If a little bit of something is a good idea, more of it must be better. The nuances are lost completely and Labour looks weak. Labour must start to build its own, alternative narratives from the ground up (I agree with Dominic here). Then, when challenged on why they oppose x and y, they can say “because, quite simply, the entire approach is wrong”. I only wish they’d get on with it.

  4. Robert

    That women with a disabled child to day, Cameron gives his heart felt feelings, whether these are true or not does not matter, when labour gets asked Miliband comes out with a lot of hot air about NHS reforms, he was not asked about NHS reforms he was asked about a mother with a disabled child, but of course this mothers problem were in fact caused by labour.

    In a few years time this child who is severely disabled will be told she is fit to work under New labours WCA .

    God almight what a position to be in, at the next election we will have Tories, Newer labour or the Liberals what a bloody choice a three way choice for Thatcherism.

    • Gilliebc

      You are right Robert about the choice that will face the voters at the next election. There no longer seems to be any choice, unless you count “Hobson’s choice”
      It’s all rather depressing really.
      My plan, if I can call it that, will be to vote for the least worst option, which imo at the moment would be Labour. Even with Ed in charge!

  5. Huw Clayton

    It reminds me very strongly of the strategy Blair took. Blair always said whatever he was doing was to ‘clean up the mess’ left by the Tories (‘2 million extra jobs’ was his equivalent of Brown’s ‘No more boom and bust’ and about as accurate) and because the Tories knew they had royally screwed up in certain areas they simply lacked the intellectual self-confidence to point out that Tony Blair was actually pursuing policies that bore a close resemblance to their own. Somehow, he defined being ‘reactionary’ as being ‘opposed to him.’ It was a brilliant political success and bought him two huge election victories. Cameron’s trying to do the same.

    Will he succeed? I don’t credit him with sufficient public goodwill to manage it in quite the way Blair did – but he will probably make Milliband’s job of LotO over the next few years miserable by trying.

  6. Brian Hughes

    Mr Cameron is very well tuned into the world of red top rage. In that curiously simplistic enclave, doctors are firmly in the good camp and managers in the bad. So any attack based on the observation that GPs may not have the necessary skills to run their complicated local health services, whilst possibly true*, won’t go down well. A better tactic might be to point out how jolly busy they already are healing the sick and that imposing more tasks on them is awfully unfair.

    We might also note that lots of the people made redundant (at considerable cost) in PCTs are likely to be re-employed fairly rapidly by GP consortia or the agencies that will be advising them. Nice for the individuals – they can stick their redundancy cash in the bank – not so good for reducing costs and/or bureaucracy. Or we could point out that increasing the number of contracts between various bits of the health service isn’t a good way of cutting bureaucracy.

    But, because we’re in opposition, nothing we say now will make much difference to what happens and most of it will be forgotten during the 1,567 days between now and the next general election. So perhaps saying little and waiting for things to go horribly wrong might be the least worse response.

    Opposition is tough; having to hope that people will endure pain, lose their sight, die waiting for adequate treatment or suffer other nasty deprivations is not a nice place to be…

    * as a letter writer to the Guardian asked yesterday: why, if GPs have such an aptitude for management, did they waste five years training to treat the sick…

  7. Michael Fitchett

    or, we could make the point that Cameron has never run anything in his life, and simply does not have the ability to do anything more than talk waffle, and has no idea how to get from here to there: he does not know how to translate his fine words into practical government action.

  8. Boz

    By Boz
    Leftie Mafia close ranks over Baby P

    “WHY did Gordon Brown react so violently when asked in the Commons about Baby P’s shocking death?

    Was it a guilty conscience?

    The unforgivable death of Baby P has revealed Labour’s dirty little secret — the arrogance verging on corruption of entrenched Socialism”.

    Not such a secret now, after the hideous catalogue of incompetence leading to what anyone but our modern justice system would regard as murder.

    This avoidable tragedy tells us about the way the Left works when, as in Haringey, it has unbridled power.

    Baby P’s fate was the culmination of a blinkered authoritarianism in which rigid political correctness supersedes human decency.

    Haringey is a bastion of the loony Left.

    Its website boasts: “We are committed to eliminating discrimination on the grounds of age, colour, disability, ethnic origin, gender, HIV status, marital status, nationality, national origin, race, religious belief, responsibility for dependants, sexuality, or unrelated criminal conviction.”

    Great. But they can’t tell when a baby has a broken back and hours to live.

    It swallows £100million a year for a child “protection” programme, and allows TWO of them to die in unimaginable agony.

    Hard-faced “welfare” chief Sharon Shoesmith won’t apologise and it takes two days before anyone in Haringey says sorry.

    Yet when Shoesmith IS finally kicked out, she could win £200,000 in compensation. That’s blood money. It’s disgusting.

    Nobody in today’s blame-free public services walks away without a bung.

    We hire armies of new nursing assistants, classroom assistants and police support officers. to help the professionals.

    Yet we won’t sack any of the 20,000 rubbish teachers identified by Whitehall – or the hundreds of thousands of other idiot State employees doing nothing useful except causing lots of harm.

    Superbugs kill thousands and strike terror into us all, yet no nurse or orderly has been fired for shoddy hygiene. Just fill in the forms and tick the boxes and it’s a job for life.

    Look at Dr Sabah Al Zayyat, still practising after failing to spot Baby P’s ripped fingernails, let alone his bust ribs and broken spine.

    The herd of State employees closes ranks, bound by a Mafia-style code of Omerta.

    Speak out, like Haringey whistleblower Nevres Kemal, and you are sacked and legally gagged.

    Why is such primitive tyranny tolerated?

    Public service unions are Labour’s paymasters. That’s why Gordon Brown has put 800,000 more of their members on the state payroll.

    It’s why they can retire at 60 on inflation-proof pensions, paid for by millions who can’t afford to retire at all.

    It’s why we have hundreds of pointless quangos, costing £70billion a year and run by unaccountable stooges on £200,000 salaries.

    Welcome to Labour’s client state, a multi- billion—pound gravy train driven by buck-passing bureaucrats who aren’t fit to look after a baby”.

    That’s where all our taxpayer money goes !

    This is an edited version of an article by TREVOR KAVANAGH Published on 17th Nov 2008 in the Sun newspaper.

  9. Tim Hardy

    Great detailed analysis and suggestions. I’ve summarised your position in a recent post in four bullet points:

    * The Prime Minister’s instinct is always to will progressive ends with conservative means
    * The conservative means are always firmly in place in the government’s agenda
    * The progressive ends are more honoured in the rhetoric than in the policy
    * Therefore to oppose them effectively, it’s essential to break the link between the means and the ends and expose dishonest claims about progressive ends

    Please correct me if you think I’ve misrepresented it.


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