Mid Staffs: Whither 38 Degrees?

Nik Darlington 3.16pm

In September 2011, I cavilled about the “rise of the clickocracy”, that multi-headed hydra of modern political ‘engagement’. The internet has spawned several campaigning movements, 38 Degrees being pre-eminent, who exist to put the democratic process within reach of a mere click. Click, click, clickety click - and the job is done. Your voice is heard.

The well-funded 38 Degrees made its name by opposing the Coalition’s healthcare reforms. There were just “24 hours to save the NHS”, we were told. Millions of emails made their way to MPs’ inboxes. All, of course, to no avail, but the point was made, not least by that moronic Mirror headstone.

The Health & Social Care Act has of course not killed the NHS. Yet the revelations within the Francis Report threaten to kill public trust in an institution that Nigel Lawson called “the closest thing the English have to a religion”.

Paul Abbott, sometimes of this parish, has a good little piece over at ConHome today, asking what campaigners such as 38 Degrees think about the grotesque conditions at Mid Staffordshire and allegedly sundry other hospitals around the country.

"Now that the Mid Staffs report has been published and debated in Parliament, it makes difficult and upsetting reading - wherever you fall on the political spectrum. Thousands died. The truth was covered up. Problems were endemic and not just because of a few rogue individuals. But, where is the 38 Degrees campaign for NHS reform? Where is the e-petition on their website, saying, “24 hours to save the NHS”? In the past, they have moved quickly to jump on a topical news agenda. So why not now, on their central issue of defending the National Health Service?

38 Degrees will have no credibility on NHS reform in the future, if they don’t step up to the plate now. I’ve met the CEO of 38 Degrees - David Babbs - a few times, and like him. He’s a nice guy, and seems sincere in his intentions. He has told me more than once that he’s not a front for the Labour Party, and I believe him.

But why the silence on Mid Staffs, David? What’s going on?”

Now we shouldn’t expect the likes of 38 Degrees to take a stance on everything (heaven help us all if they did). Though it would be interesting to know what an organisation so vehemently against structural tinkering thinks about endemic cultural and managerial misanthropy.

As Paul suggests, where is the deluge of emails under the subject of “adopt the Francis Report recommendations in full”, or similar?

Typically, big and successful public campaigns rely on catchy, straightforward messages. The nuanced and complex truth cannot compete. Under such conditions do governments often flounder; and organisations like 38 Degrees, conversely, thrive.

Except the entire debate about Andrew Lansley’s NHS Bill was mired in nuance and complexity. 38 Degrees took on the Government with a simple (sometimes just absurd) message, but it still required people to grasp with elaborate change.

The Mid Staffs scandal is, in comparison, really rather straightforward (if frightfully hard to fix overnight). It is simply made for someone like 38 Degrees to take advantage of and put to the people and their clicking mice. Isn’t it?

Reshuffle round-up: inside gossip and double-edged swords

Nik Darlington 4.41pm

The dust has settled on David Cameron’s first Cabinet reshuffle. The press pack has largely plumped for Jeremy Hunt’s appointment as Health Secretary and Justine Greening’s ejection from Transport as the main stories. The former is deemed suitably rehabilitated since Leveson to restore public faith in the Government’s NHS policies; while the latter is off to DfID, ostensibly to clear the path for a third runway at Heathrow.

At least that is the view of the Mayor of London, Boris Johnson, and it is hard to disagree. Above all, it makes her appointment only a year ago look inept and extant policymaking ad hoc and desperate.

The junior ministerial changes look set to begin, with the Lib Dems’ Nick Harvey making way at the MoD, it seems as a trade ito get David Laws back into the Cabinet. As far as I am aware, Mr Harvey acquitted himself well as armed forces minister, but the return of Mr Laws is a long-awaited boost to the Coalition.

Meanwhile, Nick Herbert has apparently quit as police minister, which begs the question, which job wouldn’t he accept? It seems Damien Green will take his place, an appointment I thoroughly welcome. The changes among the lower ranks look set to continue into the evening.

So back to the Cabinet. I wrote about Ken Clarke this morning, and shall only reiterate that he remains a figure of vital importance to this Government and to the Prime Minister. A veritable, jolly ‘minister for the Today programme’, he is, as a friend suggested earlier, perhaps becoming something of a Willie Whitelaw to Mr Cameron.

Andrew Mitchell’s appointment as Chief Whip is a double edged sword in two ways. In itself, it feels like a good decision - until one considers how well Mr Mitchell ran DfID and how vulnerable that department (and its enviously coveted budget) might become in the hands of a disappointed Justine Greening.

Furthermore, Mr Mitchell is on no accounts universally loved. He has numerous friends and fans, of course, but the fears about his disciplinarian manner are already being well-aired. Matthew Parris said on the BBC this morning that the new Chief Whip will “either stop a rebellion or start a rebellion”.

Earlier today, one Tory backbencher mentioned Sir George Young - removed as Leader of the House in order to accommodate the demoted Andrew Lansley - as a superior candidate for 12 Downing Street. “Imagine having to go in to see Sir George and him calmly to tell you how ‘disappointed’ he was - you would feel awful.”

Elsewhere, the long-serving Oliver Heald is an apparently popular choice as Solicitor General, replacing the similarly popular Edward Garnier, who took his sacking with enough good grace to appear cheerfully on the telly immediately afterwards. With Ken moved, it is also awfully good to see that Dominic Grieve keeps his job as Attorney General.

Which brings me on to the Ministry of Justice, which now has a non-lawyer as Secretary of State (the Guardian has also picked up on this). Chris Grayling has done a very good job at DWP, not least in dismissing the claptrap spouted about the work experience programme, but his appointment is being lauded in several quarters for the wrong reasons. The likes of the Sun, the Daily Mail and ConservativeHome will surely be delighted. I hope Mr Grayling goes some way to disappointing them and continuing with the important reforms of the past couple of years.

The only other news of note is what hasn’t happened. Tim Montgomerie didn’t get his wish of Michael Gove as Conservative Party Chairman (that bauble goes to Grant Shapps), which thankfully means he can continue his exceptional work as Education Secretary. Iain Duncan Smith remains at DWP, overseeing the crucial implementation of his welfare reforms. And, of course, George Osborne is still Chancellor - but then only the truly cuckoo believe anything different.

I doubt there will be many promotions for the class of 2010, though I suspect we’ll see some worthy roles for their 2005 predecessors. The speculation shall, I’m sure, continue all the same.

Follow Nik on Twitter @NikDarlington

No Cabinet minister deserves to stay in post more than Theresa May

Giles Marshall 10.24am

John Reid, now Lord Reid, used to be Tony Blair’s ‘man for all seasons’. Regularly shuffled around key ministerial posts, the ebullient Scot was Mr Blair’s blunt, aggressive point man.

Yet even Reid was aghast on arrival to the Home Office, memorably describing it as “not fit for purpose”.

Great office of state it might be, but this ministry has long been seen as the graveyard of greater and lesser political careers. Of those lesser, it buried one of Gordon Brown’s more bizarre appointees and the first woman to hold the office, Jacqui Smith.

However another woman, Theresa May, could now be gradually revising a role that is supposed to lead to failure and frustration.

One of David Cameron’s strengths as Prime Minister has been his willingness to maintain a stable Cabinet team. For all the angst this can cause lower down the political greasy pole, the undoubted benefit is seen in a maturing grip on their departments by a number of reform-minded ministers. Amid the mire of local elections, polls and poor Budgets, it is easy to forget just how radical this Government actually is.

Education and health are prominent briefs where reform - of the effective, root and branch sort - genuinely is taking hold, thanks largely to their Secretaries of State, Michael Gove and Andrew Lansley.

But it is Theresa May who has been the quiet toughie, and is beginning to show her true quality, tenaciously pressing for reforms on many levels at the catastrophic Home Office.

Granted, it does not always feel like that. The Abu Hamza extradition case looked badly handled; it was followed by one of the frostiest receptions ever afforded a Home Secretary at the Police Federation conference.

Nonetheless, consider this. First, Mrs May acted upon the collective wisdom of the Home Office’s lawyers when pursuing Hamza’s extradition. And whatever ire she felt for it, she calmly took responsibility for the decision, refusing to pass blame, and doggedly continued to pursue the result that most Britons wanted to see. It was a textbook case of ministerial responsibility that has become so sadly rare in recent years.

Second, in facing down the Police Federation, Mrs May was taking on one of the most powerful vested interests in Britain, believing correctly that policing has to change. The Police Federation is a union in all but name and acts in the way that all public services unions act. They seek to preserve inefficient working methods for the good of the lowest calibre of members, rather than seeking to create a bridge between professional delivery and public expectation. The country’s police forces remain highly regarded, but not uniformly so. I joked to one non-political friend that Theresa May had better hope she didn’t suffer a burglary or suchlike, as she might not be able to rely on police support. “Just like the rest of us then,” my friend replied, not entirely cynically.

Theresa May continues to challenge Home Office shibboleths in her demands for changes to judgements on deportation made against foreign criminals living in Britain. The weight of the human legal establishment is set to come down on her, but does anyone seriously doubt either the necessity for such changes, or their popularity?

Theresa May proved that she is a politician with iron in her soul when she challenged the Conservative party, as its chairman, not to relish its role as the ‘nasty party’. She spends her time mastering her brief rather than pursuing it for personal PR - and sometimes this can rebound on her. However, she is a formidable and capable operator, unafraid of challenging vested interests in pursuit of reform.

For all his dislike of unnecessary changes to his Cabinet, Mr Cameron shall soon find himself having to organise a reshuffle. Let us hope it is limited. Whoever is shuffled, the Prime Minister should keep his maturing reformers in place. And no one seems to be earning the right to carry on more than the dogged, flak-carrying Home Secretary.

Follow Giles on Twitter @gilesmarshall

Ignorance about the Health Bill shows how few people read election manifestos these days

Nik Darlington 7.50am

Of course, none of this was in any of the parties’ general election manifestos.

I paraphrase, but is one of the most irritating claims in this berserk public debate about NHS reforms, right up there with “NHS privatisation” and “two weeks to save the NHS” (or, as Mr Burnham said way back in October 2011, “72 hours”).

The error, committed regularly by members of the public (egged on by sections of the media who should know better), can be corrected by doing something as simple as reading the relevant entries on health in the parties’ manifestos. The people in the photograph above clearly haven’t.

The Conservative party manifesto said:

"We have a reform plan to make the changes the NHS needs. We will decentralise power, so that patients have a real choice. We will make doctors and nurses accountable to patients, not to endless layers of bureaucracy and management…"

"…we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers…"

"We will strengthen the power of GPs as patients’ expert guides through the health system by: (i) giving them the power to hold patients’ budgets and commission care on their behalf; (ii) linking their pay to the quality of their results; (iii) putting them in charge of commissioning local health services."

And remembering the Health Bill is largely Conservative policy driven by a Conservative Health Secretary, read the Liberal Democrat manifesto, which contained pledges to “scrap Strategic Health Authorities”and “to make care flexible, designed to suit what patients need, not what managers want”. This should be achieved by “sharply reducing centralised targets and bureaucracy” and “putting front-line staff in charge of their ward or unit budgets”, as well as “empowering local communities to improve health services through elected local health boards, which will take over the role of Primary Care Trust boards in commissioning care for local people”.

Rather than the coalition parties’ manifestos not containing any inkling of the health reforms, it is almost surprising quite how much they actually did contain. And even more surprising is how similar the Lib Dems’ diagnoses and solutions were to the Conservatives’.

Even the Labour party’s manifesto contained the line: “We will support an active role for the independent sector working alongside the NHS in the provision of care, particularly where they bring innovation”.

One of the three main parties has reneged on election promises. It certainly isn’t the Conservative party, and for the most part (despite recent parliamentary amendments) it isn’t the Liberal Democrats.

PMQs review: As a debate it was dreadful, but as a spectacle it was riotous

Jack Blackburn 1.39pm

There they were, their entourages in tow, ready for the latest bout in this series of fights organised by the NHS and Andrew Lansley. In the blue corner, the reigning champion, Dave “Flashman” Cameron. In the red corner, his spindly challenger, Edward “Not to be confused with David” Miliband.

Cameron entered the arena, flanked by his regular posse of Clegg and Hague, the latter offering vocal support, and the former performing an amusing mime act entitled, “Don’t do anything”.

Miliband, however, shook up his team, pushing Ed “Gesticulating” Balls to one side and replacing him with Andy “Eyebrows” Burnham. The scene was set. The atmosphere was expectant. The referee was impotent.

Edward tried to get an attack going with a few jabs, pointing at the ridiculous NHS summit from Monday. But Dave held his defence initially, deciding on a tactic of skipping round Edward, evading his questions.

So Edward tried again, and briefly there was some excitement in the ring as Dave fought back, challenging his opponent to ask a question about the substance of the bill. He said that Labour used to be in favour of choice, competition and GPs being in charge of budgets, but now they’re against it.

This should have been the start of a classic encounter, but a melee broke out around them and the chamber descended into utter chaos. Burnham began shouting with such verbosity that even Balls was impressed by, nay jealous of, such talents.

When Andrew Lansley tried to hand his pugilist some notes, Edward jumped on him like a cat: “The Prime Minister doesn’t want advice from you!” John “Squeaker” Bercow intervened for the 27th time in the session. He had been up and down like a jack-in-the-box, but nobody was paying any attention.

After which, Cameron stood up when it wasn’t even his question. There were howls, whoops, laughs and jeers. It was as like hearing the canned laughter tracks from the BBC’s radiophonic workshop on a diabolical loop.

Cameron called his Labour opponents “rank opportunists”, once again neatly avoiding answering any questions. Edward said that this was going to become Cameron’s “Poll Tax”, once again neatly avoiding making any statements of policy.

As a debate it was dreadful, but as spectacle it was joyous. Edward Miliband was actually quite funny. You’d have to have been there, but he was funny.

In fact, we’ve seen a real improvement from Edward this term. One wonders how he’ll fare on a topic other than the NHS. He can’t keep this up for three years.

Follow Jack on Twitter @BlackburnJA

NHS risk register debate exposes Labour’s mendacity at its worst

Nik Darlington 6.01am

Whatever the public relations disaster that will result, the Government must resist the frenzied clamour for the Department for Health to publish its risk register.

Tomorrow, the Labour party has called an opposition day debate on the issue, so keeping up the pressure on the Government over its healthcare reforms.

And MPs have been deluged with cursory click campaigns from cross constituents who want the register to be released. But judging by the tone, I’m not sure many people truly understand what it is (I’ve brooded on the detractive effects of the ‘clickocracy’ elsewhere). So what is it?

A risk register is a commonplace management tool used to assess operational and organisational risks. I came across them as a management consultant and I have come across them in government. There is nothing particularly esoteric or spooky about them. English Heritage employs a risk register for the nation’s historic sites. Councils use them to assess and monitor certain risks to the local area. Most large enterprises have similar procedures in place to manage risks.

In Whitehall, risk registers set out financial and policy risks, including contingent commercial and contractual risks. These risks, however implausible, can then be mitigated. Risk registers are therefore essential to good government.

But they are not essential public knowledge. Were risk registers routinely made available, it could lead to civil servants concealing the greatest risks, so reducing the quality of advice to ministers and causing less effective risk management. They could also serve to distract and to distort public debate, and disclosure of risks could make them more likely to occur (such as a run on a bank).

To release the Department of Health’s risk register now would set a very dangerous and needless precedent. In a letter to MPs yesterday, Andrew Lansley wrote:

"No government of any persuasion has routinely made risk registers of this type public for the very reason that to do so would undermine open and frank discussion among policy makers for fear that this may be made public before it is fully developed.

This is not an issue that the Department of Health can make in isolation, because it has implications for how the information in risk registers of this type is recorded across government.”

No government of any persuasion has routinely made risk registers of this type public. That includes the last Labour government, several of whose members are today insisting the current Government caves in and publishes.

Under that last Labour government, requests to publish departmental risk registers were refused with similar justification in July 2008, September 2008 and September 2009. That last refusal was ordered by Andrew Burnham when he was Health Secretary. Yet Mr Burnham, now Labour’s shadow health secretary, has vacillated from gamekeeper to poacher - and not for the first time.

On a very rough headcount, there are at least fifty current Labour MPs who held some form of ministerial office during the thirteen years Labour were in power. This includes three former health secretaries: Frank Dobson, Alan Johnson and, there he is again, Andrew Burnham. These dozens of Labour MPs have direct experience of risk registers, what they are and what their publication entails. Some of these MPs, as we know, have previously refused to publish them - for good reason.

What this suggests is that some people in the Labour party have sat down, thought this all through and carried on with their demands to publish regardless of past knowledge and experience. This type of wilful and blatant mendacity goes to the heart of the dark side of New Labour. It is a nasty and insipid habit that has caught hold far too widely, but particularly in the party now in opposition.

People are using the risk register issue as yet another hook on which to hang grievances about the Health & Social Care Bill. Which only goes to show how disconnected this debate has become from reality, because the risks associated with that Bill were already published last year.

The Government is not helping the situation by continuing to fail to state convincingly the case for reform. But this is a Labour opposition treating each day as if the general election is the next. And as the most electorally successful Labour party leader demonstrated, if you live out life like that, you don’t win many elections.

Labour have successfully turned the majority of the public against these health reforms, but at what cost?

This pathetic argument about the Department of Health’s risk register can go one of two ways. Refuse to publish it and the Government is damned. Or publish it to save one’s hide now, but in the long run subvert sane and proper governance.

We should hope the Government is strong enough to choose the first option, and let the righteous opprobrium be damned.

Labour attacked from left and right for its morally corrupt blanket opposition to health reform

Nik Darlington 10.48am

Two important blogs appeared this morning. One is by a Conservative MP, one is by a former Labour party General Secretary. Both are about the NHS and, in their different ways, both identify the same problem: the Labour party’s stance on NHS reform.

Chris Skidmore is one of the most thoughtful of the 2010 Tory intake (he used to be an adviser to David Willetts, of course, where two brains are better than one). His blog for ConservativeHome is not exactly cerebral - it is more factional than phrenic - but it has a clarity of expression and fight that sadly has too often been lacking. Mr Skidmore is also an articulate historian. That he can write well clearly helps.

Burnham and Labour have set their face against an NHS that is centred around the needs of the patient, precisely what the Coalition’s reforms seek to achieve. They have become the party of anti-reform, anti-competition, anti-choice, and above all, anti-patient.

Peter Watt also happens to be one of the more thoughtful people in the Labour party. He regularly stands out as a voice of reason amid the silly squabbling, neither a fully-signed up Blairite nor a dyed-in-the-wool statist. In a blog for Labour Uncut, he attacks the Health & Social Care Bill in its current form - “a largely unnecessary piece of legislation” - which I cannot claim is an unreasonable position to take having questioned it myself.

But like Mr Skidmore, Peter Watt insists that the NHS must change. Reform is desirable and inevitable, which makes the Labour party’s opportunistic opposition to reform untenable.

…more reform is exactly what the NHS needs. The current legislation is clearly ill thought out and is rightly being resisted, but that does not mean that the NHS does not need to change. And if the Labour party really wants to save the NHS, it must aggressively embrace further change, not reject it. Because budgets will continue to be squeezed and efficiencies will still need to be found. At the same time patients will demand greater and greater choices, higher standards of care and service. This simply can’t be achieved without reform, even if money were no issue.

Labour’s shadow health secretary, Andrew Burnham, is censured from the left and from the right for hypocrisy and hysteria. Mr Skidmore writes:

…to listen to Andy Burnham, you would be forgiven for thinking that he was never a keen Blairite reformer of our public services. As Secretary of State for Health, he helped oversee an expansion of new providers in the NHS, particularly Independent Treatment Centres, the same expansion that this government backs, and that he now derides as privatisation. It was Andy Burnham who was happy to back an increase of £10 billion going to the private sector, between 2006-2010.  It was Andy Burnham who fought an election on a manifesto pledge to ”support an active role for the independent sector working alongside the NHS in the provision of care, particularly where they bring innovation.”

What a difference opposition makes. One of his first actions as shadow secretary was to fly in the face of expert consensus and declare that it was “irresponsible to increase NHS spending in real terms”, turning against the Coalition’s real-terms increases in NHS spending, despite knowing that the NHS is facing the toughest efficiency program in its history.

While Mr Watt, portraying Burnham more captive than co-opted, says:

Andy Burnham may be a supporter of competition and choice, but many of those rallying to the cause certainly aren’t. The Tories inept handling of a largely unnecessary piece of legislation has given them their chance. This is an opportunity to finally put a nail in the coffin of further reform and they are going for it. You can hear it in the rhetoric, the old cries of the NHS being “the best in the world”, of its great efficiency and how we need more cooperation and not more or any competition. All of which are highly debatable, no matter how much you love the NHS. So all in all, the prevailing mood within the Labour party is for less reform not more.

I have made no secret of my discomfort with the Bill, its presentation and its parliamentary management. But healthcare reform is essential.

The Labour party, lone sensible figures like Peter Watt aside, has behaved reprehensibly: a spiteful spasm of collective amnesia and nitwittedness.

Reforms begun under Tony Blair, by Alan Milburn and John Reid, were producing improvements in NHS outcomes. And the stubborn, statist and vested interests within the Labour party hated them for it. They hated them viscerally, for proving that the introduction of some choice, competition and independent provision could work.

The Labour party is, as Peter Watt writes, in its “comfort zone”, at the same time as the NHS, says Chris Skidmore, “faces a perfect storm of an ageing population and a boom in chronic illness and lifestyle-related diseases”. It is a thoroughly miserable, and morally corrupt, state of affairs.

If Simon Hughes says Andrew Lansley should go, his job must be secure

Nik Darlington 10.12am

One my desktop Twitter thing I have separate streams for Conservative, Labour and Liberal Democrat MPs. It can be quite revealing (you always know when the Labour party’s effective social media operation gets into action because its MPs start parroting the same tweets).

Last week, Labour MPs seemed happier than they’ve been for some time, perhaps even before it dawned on them that they’d been given a party leader who fires blanks. From the moment the shadow health secretary set upon Craig’s article on Wednesday morning, my Labour stream was awash with re-tweeting MPs and party hacks. I had a suspicion it might surface at PMQs. When I saw Mr Burnham sat at Edward’s right-hand side instead of the typical toad-in-arms, that suspicion was confirmed.

The Conservative stream was a curiosity. I checked often but over the course of Thursday and Friday I didn’t see a single tweet from a Tory MP in support of the health reforms or the besieged Andrew Lansley. And health minister Simon Burns cut a lonely figure as he did more telly appearances than Alexander the Meerkat.

Over the weekend, however, Cabinet colleagues took to air and screen to pledge their support for the Health Secretary - and rightly so.

Mr Lansley is not one of life’s natural communicators. But he is a brave and decent man. Moreover, having spent several years shadowing and then running the Department for Health, he knows the NHS inside out. I challenge anyone to identify an alternative candidate better qualified to take on such a complicated job at this desperate moment (and a realistic candidate: neither Alan Milburn nor Stephen Dorrell count).

Perhaps Simon Hughes has a better idea. The Lib Dem deputy leader roused himself to declare (£), with impeccable gravity, that the coalition had to “move on from this Bill”. And in consequence, said Mr Hughes, “my political judgement is that in the second half of parliament it would be better [for Mr Lansley] to move on.” How he must have agonised before bestowing us with this missive.

I said what I have to say about the Health Bill in Friday’s article. I shall not repeat it here, except to reiterate that worthwhile reforms have been mangled by poor communication, vested interests and indulgent opposition. What is worth salvaging must be salvaged, and unlike maritime convention, this is a moment when the sinking ship’s captain must survive to pick up the pieces.

The Prime Minister is doing the right, honourable and sensible thing in standing by Mr Lansley. It is one sort of humiliation to have one’s government run by hysterical newspaper headlines. To have it determined by the “political judgement” of the Member for Bermondsey & Old Southwark would be a farce.