NHS reforms: Health Tsar resigns

Sir Roger Boyle, the Department of Health's heart tsar, has resigned this week, as it becomes clear that the revised Health and Social Care Bill retains - albeit in carefully chosen language -  many of its most controversial elements. This follows on from the BMA's rejection of the revised Bill.

Jacqueline Davis, co chair of the NHS Consultants' Association, has written an article over at the Guardian's Comment is Free expressing concerns that the supposed 'u-turn' by Lansley was not quite as dramatic as many seem to believe.

The government, meanwhile, continues to peddle misleading information regarding the NHS, clearly in the hope that a revised timetable will enable the reforms to go ahead as originally planned with minimal public opposition, although perhaps not as fast as they would have wanted. Many of the criticisms of the original Bill, supposedly addressed and satisfied after the 'listening exercise' are worth revisiting over the coming months.

BSkyB takeover: 24 hours to respond

It is worth drawing attention to the official Notice of Consultation on the proposed takeover of BSkyB by News Corporation.

It remains unclear whether the government is minded to reconsider their decision to approve the acquisition. Those who think they should - particularly on grounds of media plurality - can respond here.

The NHS: smaller isn't always better

Central to the Cameron project are two key concepts: first, that the state should no longer be the default provider of public services and, second, that the fewer large, hierarchical public sector organisations there are, the better. Better still that the invisible hand of the market determines priorities than central planning.

The NHS reforms, of course, were an attempt to do just that: GPs, clinicians and hospitals are to become ever more autonomous. Previous posts on this blog have discussed the problem this poses for accountability that this approach would bring.

Calum Paton, professor of health policy at Keele University, has penned an article that addresses this issue, amongst others. In it, he makes the very valid point that the very same government that condemns public sector hierarchies ignores the fact that in business the approach is wholly uncontroversial:

"The hardest-nosed businessmen have no problem with accountability upwards within integrated organisations. Ironically, every time the Department of Health or the media calls in a Gerry Robinson or some other troubleshooter, the absence of a clear hierarchy based on accountability is the main diagnosis – not the absence of an elegant quasi-market".

The Mail reaches new depths...

Even by the standards of the Daily Mail, today's story on the tragic death of a girl takes the biscuit. Before the weight of complaints forces them to change the text, here is a screen grab:

A good day to bury news

One of the least surprising political decisions of the year has come to pass, as Jeremy Hunt today provisionally approved News Corporations bid for full control of BSkyB.

The great fear of other media companies - from the BBC to BT to the Telegraph Media Group - is that this will give Murdoch's company the ability to bundle online newspaper subscriptions into Sky packages and thus fatally undermine his competitor, at the same time as securing more power from which he can undermine public service broadcasters such as the BBC and Channel 4. The decision was described as Britain's Berlusconi moment.

That the decision has been passed demonstrates yet again that this government preaches localism, Big Society and the importance of competition when it relates to the public sector, but will conveniently forget all these tenets when it comes to their powerful corporate allies.

Is it a co-incidence that the government chose today of all days to make the announcement? Well, that's up to you to decide...

Universities - an easy target for a Tory revolution

At the end of 2010, the Tories looked set to steam ahead with a market-led revolution in public services, albeit one they failed to mention in their 2010 manifesto.

From health care, to education, to local services and right up to the heart of Whitehall, the government - in the name of deficit reduction - looked set to sweep away the whole concept of 'public' services, and in their place bring a multiplicity of private and voluntary organisations.

But they over-reached themselves. Although reforms roll on in education - albeit at a slower pace and in a different manner than they would have hoped - in other areas reforms have stalled or stopped.

First came the forest sell-off u-turn. This was actually a defining moment - when Cameron would have been realised that if an 'easy target' such as this raised such emotion and opposition, then his NHS and public services plans would be in trouble.

And yet he continued - as recently as February he was pushing his plans to effectively end the presumption that the state should be the preferred provider of public services - and he backed Andrew Lansley's NHS plans until it was clear that opposition was too strong.

Both of these culminated in u-turns of sorts. The Public Services White Paper is almost half a year late, and appears to be a shadow of what was originally conceived. Meanwhile, even after a humiliating u-turn, what remains of the Health and Social Care Bill is witnessing continued opposition.

But there is one area where the government have clearly got their way - and it is a case study of how easy it is for a right-wing party to achieve its goals when a sector is divided and fails to command widespread sympathy with the general public.

The privatisation of higher education

The HE White Paper, released yesterday, is in essence a bit of a mess. It's an attempt to try to tackle the frankly hysterically ill-conceived funding changes that the government has introduced in the most hapless fashion. In simple terms, families will have to take on more debt to pay for universities that are less secure and - the icing on the cake -  the cost to the Exchequer (through the student loans system) will be higher under the new regime than the last.

So more debt for individuals and more debt for the government.

But the HE White Paper is a mess for another good reason. It is - rather like Lansley's original Health and Social Care Bill - an attempt to turn into practical policy a hugely ideological plan: namely privatisation and deregulation, at all costs. Furthermore, it's an attempt to put into a practical policy a plan to achieve this without explicitly stating so.

So - new private providers of HE, fewer barriers to overseas companies entering the market, a shift from public funding for education to private tuition fees and even proposed changes to the term 'university' and what it means and entails.

But why havs this succeeded whereas Andrew Lansley plans appears to have been thwarted? Well,quite simply for two main reasons:

Divide and rule

First, the HE sector is divided. There is the Russell Group - the research-intensive institutions - for many of whom higher tuition fees are welcome. It will give them the ability, or so the argument goes, to compete with other global research-led institutions, particularly in the United States. Amongst this group include a select number of institutions who profess little or no interest as to whether they educate any UK students, or offer benefits to their local communities.

Then, at the other end of the spectrum, there is the post-1992 group of institutions, who have been the recipients of most of the growth in students from lower socio-economic groups. They stand to lose badly from any system that may dissuade such students from attending universities. They are also the recipients of the ire of the certain breed of Tory politician that act like walking Daily Mail editorials - of which, alas, there are a great deal.

In between these two groups are a wide variety of institutions, with their own missions and agendas. And it is precisely this diversity in institution type - and agendas - that has given the Tory Party the perfect opportunity to divide and rule.

An unpopular cause

It is these reactionary views -  which permeate society - that provide the second reason for the Tory triumph in this area. The last government may have succeeded in expanding the opportunities for hundreds of thousands more to go to university, but failed to counter-balance the cliched views of universities (promoted relentlessly by the mainstream media) that they aren't that important - not like schools and hospitals.

These views are well-versed: universities are full of feckless, work shy-students studying on 'Mickey Mouse' courses; the last government encouraged too many people from the lower rungs of society to go into higher education when they should have been fixing dodgy plumbing, or repairing cars; and, for a section of the political right, universities are a bastion of liberal-left ideology, full of future bureaucrats promoting health and safety or environmental legislation, or academics teaching about multiculturalism, or lecturers promoting left-wing economics.

It is this lack of broad public support - one that that NHS continues to enjoy - that made the HE sector a prime target for a genuine revolution, and one that has apparently rolled over so easily. So, from Michael Gove's plans to take teacher training out of university hands (and thus, he hopes, to release the teaching profession from their left-wing, liberal mind-set) to this new White Paper, the dismantling and privatisation of an internationally-renowned sector begins.

BMA rejects revised Health and Social Care Bill

So, after what Cameron may have thought was a done deal, the amended Health and Social Care Bill is in trouble again, with the British Medial Association's annual conference calling for its withdrawal.

How the Liberal Democrats - their members, not leadership - respond will be crucial.