One of the defining factors of the early years of the Coalition Government has been the scope and pace of public service reform. David Cameron was apparently determined to avoid what he considers to be the wasted early years of the Blair administration, where large areas of public services were tinkered with, but little more. There seems little danger that the same accusation will be levelled at the current Prime Minister.
Health and education, in particular, are the frontlines of public service reform, with Andrew Lansley and Michael Gove seeking to introduce far reaching change. Yet there is a stark contrast in the perceptions of the political success (or otherwise) of the reforms and their architects. This blog is not about the rights or wrongs of reform in either health or education – readers will have their own views. It is about the extent to which the changes represent a radical break from the past and the effectiveness of the way in which they have been communicated.
It is now accepted as an absolute truth by large sections of the political commentariat that the education reforms have been well communicated whereas the health reforms have been a political disaster, despite both sets of reforms being equally radical. Michael Gove, after a shaky first few months (remember the Building Schools for the Future lists fiasco), is now hailed as a future Prime Minister. Very much the darling of the Conservative-leaning media, he is hailed as a radical reformer and a populist communicator who has shifted the debate on education, forcing Labour to move towards his position.
Perceptions of Andrew Lansley are – well – somewhat different. His reforms are seen by some on his own side as being a political liability, with apparently even Cabinet colleagues arguing they should be put out of their misery. In an episode of particularly tasteless political briefing, someone in Number 10 is even reputed to have commented that the Health Secretary “should be taken out and shot.”
There is no doubt that Michael Gove – a former journalist – is more at ease with the media than Lansley, but is it fair to compare the nature or scope of their reforms? Is the communications task in selling the reforms in any way comparable? There are three reasons why the education reforms are not as radical (for better or worse) – and therefore not as politically risky – as their counterparts in health
1. Free schools are not allowed to make a profit. Any qualified providers of health services are
There is a strong, emotive, political case that money raised from the taxpayer to treat our sick or educate our children should not end up in the hands of shareholders, although there is also a case that the profit motive can be used to drive up quality and efficiency. Before I receive a lot of angry tweets, I am not arguing whether the profit motive in public service is a good or a bad thing, I am simply stating a fact: Andrew Lansley has to make the politically difficult case for allowing profit from public service whereas Michael Gove does not. The former’s task is much more difficult than the latter’s.
2. Schools are not allowed to fail. Healthcare providers are
Michael Gove and Andrew Lansley make the case, respectively, that parents and patients should be able to choose provider and that supporting this choice is critical to improving outcomes. Irrespective of the pros and the cons of these approaches, their logic dictates that popular providers will flourish while unpopular providers will fail. This is a market. However, there is a critical difference between health and education. Health has a failure regime whereas education policy does not.
Market entry without market failure is a recipe for rising costs, which suggests that education will have to face this issue sooner or later, but – for the moment – Michael Gove has sidestepped having to make the theoretical case for allowing schools to close whereas Andrew Lansley has had to confront this emotive issue for hospitals. Again, one approach is more politically challenging than the other.
3. The state has a direct role in education provision. In health, it does not
The purchaser-provider split is a faultline that continues to underpin much of the controversy in health reform, remaining hotly disputed 25 years after it was first introduced. Andrew Lansley has tried to take this approach to its logical conclusion – that if the Government does the purchasing of services, then the providers that deliver them should be operationally independent. This has opened up a can of worms, including rewriting Section One of the NHS Act (the closest thing in health policy to scripture), forcing every NHS organisation to become an autonomous foundation trust and establishing a sector regulator to ensure that purchasers and providers are split (and stay split).
Michael Gove’s policies do not go this far. Free schools and academies may be operationally independent, but local authority purchased and provided schools remain. The result of all this is that Michael Gove does not have to make the case that the state should not directly provide education, whereas Andrew Lansley does have to argue that it should not provide healthcare. One approach is politically more difficult than the other.
Commentators on the right speak admiringly about the ideological purity of public service reforms in education, while lamenting that the health reforms have been ‘neutered.’ This is not correct. Gove’s admirers will rightly argue that he has deftly side-stepped these three political mine fields, whereas Andrew Lansley has jumped in with both feet, but the result of this is that the Government’s health reforms (even post-pause and –nearly – post-Lords) are more radical in scope than its education reforms.
Michael Gove has had an easier job, as he has not had to confront the ideological totems that Lansley has. His policies may make for better politics, but that is because they are less radical – for better or for worse – in what they seek to achieve.