Lords reform: time for a fresh approach to an old problem

Craig Prescott 10.17am

Some people think a referendum is necessary, others don’t. Both sides are correct but they miss the fundamental issue.

Nick Clegg has argued that reform should not be dependent on a referendum because all three main parties support reform, and further, they committed themselves to reform at the last general election.

David Cameron, while still open to the idea of a referendum, also believes there are many arguments against holding one.

Both positions are untenable as far as the draft Bill is concerned, or the recommendations proposed by the majority of the Joint Committee for the Bill.

As all three main parties were in favour if reform at the last election, voters were presented with Hobson’s choice and couldn’t express their views either way on the issue. Furthermore, the Labour party included a commitment to a referendum in their 2010 manifesto.

Significant constitutional change should be as inclusive as possible, whereby the agenda is not wholly dominated by a section of the political class. This is why in many written constitutions around the world you would not now be reading this article, as it would be legally required for such proposals to go before an electorate in a referendum (the Australian Constitution is such an example).

Furthermore, it would be odd if a referendum was required to change the method of composition for the Lower House (the AV referendum) but not for a more radical alteration of the Upper House.

On a more principled level, it seems strange to attempt to introduce democracy to the House of Lords in an undemocratic way by refusing to hold a referendum. In this respect, the view of a majority of the Joint Draft Bill Committee in strongly suggesting a referendum is to be commended.

However, those who argue against a referendum are also correct. It all depends on what one means by ‘reform’. At the risk of criticising the Bill committee in the way you might criticise a lemon for not being an orange, they have not considered other proposals for reforming the House of Lords.

Incremental reform, for instance, would not require a referendum. This is the line taken in the Alternative Report, published independently by a minority of the membership of the Bill committee. This report proposes to harness the momentum for reform to propose legislation that could readily be included in the forthcoming Queen’s Speech. It should remove the remaining hereditary peers, permit peers to take permanent leaves of absence, introduce a minimal attendance requirement, and allow for the retirement of peers. Such legislation would be more politically acceptable to all members of all parties. It contains nothing controversial and could be a basis for more long-term reform.

Which according to the Alternative Report should be the responsibility of a Constitutional Convention. This is a common process elsewhere in the world, such as in Australia and certain federal states in the USA. The convention would consider the issue fully and in a broader manner than the current Bill committee has been able to do. Its membership would comprise constitutional experts, current Westminster politicians and representatives of devolved assemblies, local government, businesses and faith groups. It must operate apart from the political cycle. Ultimately, the convention’s proposals would be put to the electorate in a referendum, for the reasons offered above.

The fundamental issue missed by participants in the present debate about a referendum is that it is no longer sufficient for the ordinary political process to dominate the debate. It has dominated for a century, over two Royal Commissions, innumerable policy papers, inconclusive parliamentary debates and votes and, today, a draft Bill with a split committee and two diverging reports.

It is time for a fresh approach to an old problem.

Craig Prescott teaches Constitutional & Administrative Law at the University of Manchester.

Follow Craig on Twitter @craigprescott

Come on chaps, Dr Vince is taking us all for a ride!

Nik Darlington 10.28am

Within moments it dawned on me. Vince Cable’s letter to David Cameron and Nick Clegg is not meant to be taken seriously. The minister with the Dickensian fizzgog has penned a satire of Swiftian proportions.

Because His Vinceship, as Secretary of State for Business, Innovation and Skills and President of the Board of Trade, possesses “overall responsibility for the [business] department strategy and all policies, [and] overall responsibility for BIS budget, particularly focus on business and banking issues”. He is also, rather grandly, the “lead Cabinet Minister for reducing regulatory burdens across Government”.

The letter unearths his unease about the lack of a “connected approach across government”, “a compelling vision…and a clear and confident message”.

Reading it, I was slapping my thigh, tears of mirth streaming in heavy torrents down my face.

It is like a history teacher writing to the school’s board of governors complaining the children’s history exams results aren’t up to scratch.

Or to make a more direct comparison, because I cannot dream to match Dr Cable for subtle irony, it is like Andrew Lansley lambasting colleagues for struggling with the NHS reforms.

So it must all be one big jape, scripted for bored hacks to show just what terrific tomfoolery those old buffers in Cabinet get up to. How instead of being worried about the lack of progress with deregulation, or the lack of even the most threadbare of industrial strategies, we really should just smile a bit more. Because you know what, at least we’ve got each other!

Of course, I could be entirely wrong. Cable’s letter could be serious. In which case he shouldn’t be concerning himself with, as he writes, how Britons “earn our living in the future”. He ought to be more concerned about how he earns his own.

Integrating health and social care: “The NHS was better in the old days”

Dr Dan Poulter MP 11.49am

My front-line NHS experience has shown me that under the previous government, there was an increasing and damaging emphasis placed upon nationally imposed, top-down, procedural bureaucracy, as opposed to improving the integration and delivery of key frontline healthcare services.

The result has been a failure to invest properly in healthcare and social services support for the elderly, and a failure to recognise that the healthcare challenges facing inner city areas in terms of disease profile are very different from those facing rural communities.

The single biggest challenge facing the NHS is how to meet both the human and the financial cost of looking after our growing elderly population.

We know that by 2033, it is predicted that a quarter of the UK’s population will be over 65, and on current projections, by 2035, the number of people aged 85 and over is projected to more than double to reach 3.6 million, and to account for nearly 7 per cent of the UK’s population. Most startling of all, the number of working age people for every state pensioner will fall from 3.2 (2008) to 2.8 (2033).

The priority must be to deliver a more integrated healthcare service that is tailored to individual patients’ needs.

In many parts of the NHS, there currently exist distinctly isolationist working practices - often referred to as ‘silo-working’.

There is the primary care silo, the hospital silo and the social services silo. Silo-working has failed patients, and has only served to drive up the cost of patient care. For example, hospitals are rewarded for treating patients for an acute episode of care - ‘payment by results’ - but hospitals are not incentivised to think together with primary care to promote better care in the community, which would avoid inappropriate and expensive hospital admissions.

Properly integrating NHS services means that we must recognise that different healthcare needs exist in different parts of the country, which requires a more tailored and locally-focused approach to the delivery of NHS and adult social services care. For example, the healthcare needs of those in metropolitan areas are often very different to those in rural areas. Lord Darzi’s super clinics may work in Islington but not in rural Suffolk.

In July 2011, the Dilnot Report was published. Among many compelling findings, it concluded that the current social care formula in the UK is simply unsustainable. Additionally, it recommended that a cap of around £35,000 should be placed on individuals paying for their care, that means tested support should continue, and, crucially, better integration of the health and social care sectors. We should welcome these findings as an objective, cross-party analysis of what is required for the future.

The previous Labour government was strong on the rhetoric of healthcare inequality but failed to address adequately the biggest healthcare inequality of all - meeting the care challenges of an ageing population.

The coalition’s NHS reforms are a step in the right direction. NHS budgets and health services will be mostly run from the community by local NHS commissioning boards, and this will help break down the funding divisions that currently exist between primary care and hospital services.

The result should be a greater emphasis on integrated, community based health services rather than acute response based medical services, or in other words healthcare that better supports people at home and prevents the inappropriate admissions that are so distressing to patients and expensive to the NHS.

The Dilnot Report makes clear that the greatest need for joined up healthcare exists in the better integration of NHS services with adult social care, but true harmonisation of healthcare service delivery in both financial and human terms will only be achieved by fully integrating the NHS and adult social care budgets in the way that they once used to be.

My consultants at medical school used to tell me that the NHS was better in the old days. As in so many other things, it looks like they were right.

Dr Dan Poulter is MP for Central Suffolk and North Ipswich and a former NHS hospital doctor specialising primarily in obstetrics, gynaecology and women’s health. He continues to practise medicine as a NHS hospital doctor part-time, and is a member of the Health Select Committee.

This is a shorter version of an article that originally appeared in the TRG’s autumn edition of Reformer, available to download here.

It is pure folly to reduce the number of MPs

Craig Prescott 11.58am

At the last general election, both coalition parties pledged to reduce the size of the House of Commons. The Conservatives offered a 10 per cent reduction (manifesto is oddly no longer available online), while the Lib Dems (link here) wanted to cut the number of MPs by 150. The eventual Coalition Agreement is actually weaker than both parties’ original pledges, as Parliament will only be trimmed by 50 MPs from its current level of 650.

This 600 figure was created by the negotiating teams during those ‘Five Days in May’. That episode revealed one of the worst aspects of our unwritten constitution: essentially, just six chaps in a room determined how many MPs will sit in the main chamber of our national legislature. In most other countries in the world the number of seats in the legislature is defined in a constitution - in the USA, each state is allocated two Senators - and the process of changing this is considerably more laborious than chatting over some tasty biscuits.

There is no underlying rationale for this reduction. For the Liberal Democrats it was part of a grander constitutional scheme, the only part of which that may emerge is House of Lords reform (but even this could be in difficulty).

For the Conservatives, the rationale is one of reducing cost both in line with ‘deficit reduction’ but also as part of the response to the MP’s expenses scandal.

Another justification, considerably more viable, is to equalise the number of constituencies. A fundamental principle is that each vote should count as equally as possible. However, it does not automatically follow from this that the number of MPs had to be reduced. Any party gain is likely to be minimal. Psephologists believe the bias against the Conservatives will be reduced, but only by 3 per cent.

As far as I can tell there has never been any serious consideration as to the optimal sum of MPs. There should have been some thought dedicated to this before committing to a final number, and it may well be the case that considerably more or fewer MPs would be needed.

My view is that Parliament would be better served by more rather than fewer MPs. The reduction of MPs will not be followed by a corresponding reduction in the number of Ministers (the ‘payroll vote’). This is a shame. Much has been made of the quality of the 2010 intake and the fact that MPs are more rebellious in this Parliament than at any point since 1945.

Furthermore, there have been procedural reforms to enhance the role of the backbench MP, in particular the creation of a Backbench Business Committee. Parliament matters again.

But fewer backbench MPs means fewer types of people being represented in Parliament, at a time when people are concerned (whether rightly or wrongly) about a so-called political class with little ‘real-world experience’ outside of Westminster. Reducing the number of MP’s does nothing to alter this perception. While expertise is often an argument against House of Lords reform, expertise is also provided by MPs in the commons. The current chamber comprises of the usual smattering of lawyers and businesspeople, but also doctors, academics and economists and former members of our armed forces.

On certain major issues such as the EU and human rights, it is groups of backbenchers rather than the leaderships of parties that tends more closely to represent the views of the electorate.

The ‘gene pool’ for Ministers is also reduced. This may have been one reason behind Gordon Brown’s ‘Government Of All the Talents’, as by the time he became Prime Minister, he had, to some extent, run out of suitable backbenchers.

Parliamentary committees could also be harmed. This is a growth area in MPs’ workloads, so it is inevitably going to be more difficult for the smaller number of MPs to fulfil their commitments in this area alongside all their other commitments without an increase in resources (which will hinder the overall intention to reduce the cost of politics).

The greatest irony in all of this is that should Scotland separate from the rest of the UK in in the forthcoming referendum (whenever that is held), the cost of politics in Westminster will be reduced at a stroke, and the opportunity to revisit constituencies would have emerged. Boundaries could then be equalised without any of the harmful side effects mentioned above.

We desperately need NHS reform, but does NHS reform need this Bill?

Nik Darlington 3.42pm

Mr Miliband, I want to make this very clear, these remarks do not necessarily represent those of the Tory Reform Group. Much like individuals in the Labour party can have an opinion that may not represent the collective Labour view - such as your ineffectiveness as a party leader - what I write or what anyone else writes on these pages is not, unless explicitly stated, official TRG policy.

Over the past 48 hours, a commonly held misconception has been that criticism of the Health Secretary and the Health & Social Care Bill in its current form equates to a rejection of NHS reforms. The status quo in the NHS cannot continue. As Philip Collins writes in a brilliant op-ed for the Times (£) today:

“The NHS needs to change beyond recognition. The population is ageing. Health inflation runs at 7 per cent per annum. Chronic diseases and the flow from social care have the potential to bankrupt the service. There are too many hospitals and the effective power in the system is still located there. The NHS needs to save £20 billion by 2015 just to stand still. This is, on its own, a demand for a 4 per cent improvement in productivity a year.”

Let’s consider the article on Tuesday by Craig Barrett, whose strident criticisms were misshapen by Ed Miliband at PMQs in order to claim that even Tories don’t trust Tories on the NHS. I’ll admit it was a brilliant and uncomfortable line, but without the protection of parliamentary privilege his assertion that the TRG had “come out against the reforms” would have come close to slander.

As I told the BBC yesterday, Craig’s article was misrepresented by Ed Miliband. Yes, Craig questioned the rationale for the Bill and its presentation; yes, he attacked the Bill’s progenitor, Andrew Lansley.

But Craig also said:

“The NHS must be continually analysed and rationalised to ensure that it is fit for purpose in the modern world.”

Whatever his opinion about the Bill and the Health Secretary, Craig’s belief that we must reform the NHS is a belief we all share in the TRG. I have written in support of Andrew Lansley and in support of reforming the NHS on these pages before (a link to that article also appears in Craig’s post).

But NHS reforms cannot be thought of in isolation to present circumstances. For instance, Stephen Dorrell, the former health secretary and current chairman of the Health Select Committee (and TRG patron), has a valid point when he says that it will be difficult to reconcile reform with the considerable efficiencies and productivity gains the NHS must achieve in the immediate future (cf. Philip Collins above).

Electoral considerations may play a part in how some Conservatives look at this controversial NHS Bill. But the future of the NHS - as Craig wrote, “one of the great glories of post-war Britain” - oughtn’t be reduced to the base winning of votes.

It must be about what is right for the NHS, and the guiding aims of increasing competition, devolving decision making and adapting a 1940s monolith for the twenty-first century are altogether right for the NHS.

These reforms are very much the right reforms. They are what Mr Lansley set out to achieve. They are what he still wants to achieve, and he should be given the support to do so. I don’t believe he should resign and I don’t believe this is the time for the Prime Minister to sack his Health Secretary. That would look weak and desperate. It would also undermine the very real case for reform.

But since the opponents of reform have been permitted to shout loudest and longest, this Bill has been marmalised beyond recognition. The Labour party have acted reprehensibly, let me make that very clear. But the whole issue has become far too toxic. It pains me to say this, but that is why I believe it needs serious reappraisal.

That doesn’t mean I do not support reform, or that I am more concerned about what the voters will think in 2015.

On the contrary, it is the strongest evidence that I do support practical and meaningful reform of the health service. Because in this presently spiteful and distrustful environment, I just can’t see how that is going to happen.

Follow Nik on Twitter @NikDarlington

A Shared Resolve

Rt Hon Danny Alexander MP 10.55am

This Coalition Government is delivering on its founding purpose – returning this country to a path of prosperity that is sustainable for the long term. Both the Liberal Democrats and the Conservatives should be proud of the decision we made to put the national interest before party politics. It wasn’t easy, but it was the right thing to do.

With massive market turbulence across Europe the backdrop to the election, both parties knew that economic stability could not be achieved without political stability too.

This historic decision and our shared resolve to tackle the deficit have resulted in interest rates staying low – keeping families in their home and workers in their jobs. Getting ahead of the curve on dealing with the deficit means that despite having a deficit larger than Portugal, UK government-backed bonds still attract interest rates that are as low as Germany’s. We have established financial discipline, motivated not by ideology, but because it is a vital precondition for effective government.

But recovering from the catastrophic legacy left by Labour cannot simply be achieved by tackling the deficit. Not only was the way of life they promised unaffordable, it relied disproportionately on the square mile of the city of London and an unsustainable house price bubble. Gordon Brown vowed to end boom and bust, but in the end presided over both.

We must ensure the lessons of Labour’s failure are learnt for good. Which means rebalancing the economy as well as tackling the deficit, and being straight with people about how long this will take, how hard it will be and what we will do to get it right.

Laying strong foundations for prosperity requires an economic strategy that invests in the future to deliver growth that is sustainable, balanced, competitive and fair. This strategy must seek to unlock our economy’s potential in every sector of the economy and in every part of the UK.

As a government that means prioritising infrastructure investment, as we already have in the Spending Review. The projects getting the go ahead have been assessed and selected on the basis of the economic benefit they will bring. As a result, we are spending more on transport infrastructure over these four years than Labour managed in their last four, which will help support businesses and growth across the entire country.

But we also realise that it is not possible just to impose growth from the centre. This government must also help local businesses and communities drive economic growth too. To this end, at the Liberal Democrat conference, I announced the launch of a £500 million Growing Places Fund. This money will go towards helping kick start developments that have been identified locally that are currently stalled by tough market conditions, difficult cash flow and a lack of confidence.

 Of course, our focus on supporting growth isn’t just about spending money – government must break down the barriers that regulation puts in the way too. The Red Tape Challenge is proving effective at identifying unhelpful and expensive regulations, but the government is tackling more controversial barriers too. That is why we must press ahead with our planning reforms. The current system means it can take years for development to get off the ground. A presumption in favour of sustainable development will ensure local protections are in place, but will help deliver much needed local homes and jobs.

Delivering growth also means looking beyond local and national horizons. Trade is vital too. In the 1980s, Britain led the agenda in developing the European Single Market, helping to create hundreds of thousands of new jobs. The Eurozone crisis means it’s now more important than ever that they deepen their integration, and for our own sakes it’s important we support them, to ensure we can continue to progress ensuring all areas of the European economy are open to British Business.

Finally, investment in the future also means investing in people – giving them the best opportunity possible to prosper. Raising the income tax threshold makes work pay better for millions in jobs on low incomes. Investment in apprenticeships and work experience placements is helping young people get started in a tough labour market. And even at the youngest age, the Pupil Premium is helping children from the poorest backgrounds get the best start in life.

We are putting this country on the path to prosperity for the long term, as well as introducing immediate incentives for growth. The years ahead will not be easy, and the economic storms surrounding us are still raging, but this government will not be distracted from its goal – a more prosperous future for us all.

Rt Hon Danny Alexander MP is Chief Secretary to the Treasury. This article first appeared in the most recent publication of Reformer, the journal of the Tory Reform Group.

 Share this article on Twitter

Choose your battles wisely, Edward

Daniel Cowdrill 10.47am

The Tories’ election defeat in 1830 ended some forty years of dominance. What was left of the Tory party in Parliament came to be led by the former Home Secretary, Robert Peel.

Peel’s preferred strategy was, as far as possible, to support Whig measures. He resisted the temptation to enter into opportunistic alliances to inflict embarrassing defeats on the government. Instead, where appropriate, he would support it and allow its nominal supporters to attack instead.

Peel’s aim was to break-down gradually from within the government’s majority. It worked. After significant gains in 1835 and 1837, in 1841 the Conservatives won a majority of 70.

Opposition exercised judiciously is the best choice out of a bare arsenal for opposition leaders. It takes judgement, discipline, and quite often a long spell out of government.

The advantages are numerous. It shows that the Opposition party is a disciplined force and likely to conduct government business in an apropriate manner. It also prevents the Opposition from becoming background noise. By predictably opposing everything you become a fixture in the game rather than a player.

Edward Miliband has made his choice: headlines, rather than credibility. Officially, the Labour party remains implacably opposed to the coalition government’s spending reductions, 80 per cent of which would have taken place were Labour still in office. Mr Miliband continues to attack each ‘cut’ without proposing any of his own.

Another example is David Cameron’s veto at last month’s EU summit. Agree or disagree, the Prime Minister made a decision. Edward Miliband, contrastingly, argued that it was a bad deal for Britain, that the Prime Minister had put party before country. Yet Edward refused to answer whether he would have signed up to the treaty himself.

It is a self perpetuating spiral. The less credible Edward becomes the more he and his colleagues resort to cheap shots and gimmicks. It is not the stuff great opposition parties are made of.

Edward Miliband is also unfortunate. David Cameron looks, sounds and acts like a statesman. And his “big, open and comprehensive offer” to the Liberal Democrats appeared to position him above party politics.

Examine the two leaders’ personal ratings. Mr Cameron has remained consistently the most popular. By the end of 2011 his personal approval was approximately 25 points ahead of Mr Miliband’s, with the gap widening. Even voting intention as we head towards the peak of the public spending cuts is edging in favour of the Conservatives.

After Sir Robert Peel’s death, William Gladstone observed from Peel’s handling of opposition that he had matured into a ‘profound statesman’. People are likely to say the same about David Cameron in years to come, but not the younger Miliband.