The TaxPayers' Alliance - Better Government

Business leaders wish ministers would last more than five minutes

From the Financial Times:

“This is the fifth minister in this role in less than three years. The constant changing of faces and portfolios has been unhelpful to building a long-term dialogue, so it is important that we now see a period of stability,” said Lucy Findlay, head of enterprise at the CBI.

Exactly the same question should be asked about how a minister is supposed to form a working relationship with their Civil Servants and other stakeholders, understand their jobs and impose their authority on a government department in such a short stretch of time.  Five ministers in three years is pretty bad but the problem of short-term ministers is endemic across the Government.  The Better Government position paper (PDF) describes how, since the war, the average time that a minister has stayed in a post has been under two years.

Health service productivity continuing to fall

The picture emerging from today's report (PDF) on health service productivity, by the Office for National Statistics, is  stark:

"From 2001 to 2005, productivity fell, as high growth in health care was lower than even higher growth in inputs. Even with the available adjustments for quality change in output, productivity fell by 2.0 per cent a year, on average, between 2001 and 2005. Without quality adjustment for output, productivity over the same period would have fallen by 2.5 per cent a year on average"

That's a pretty substantial fall.

The quality improvements are a little questionable.  They consist of things like falls in waiting lists - very vulnerable to manipulation - instead of actual improvements in health outcomes.  If we're going to focus on output productivity instead of improvements in health outcomes the straight 'quantity' measure is more instructive.  It tells you about the direct return - in terms of consultations with doctors and drugs bought, for example - we're getting for our money.  If those activities have become more useful that is an important, but separate, issue.

If you want a measure of actual outcomes then you should look to our report (PDF) Wasting Lives: A statistical analysis of NHS performance in European context since 1981 which studies mortality amenable to healthcare.

Those 2.5 per cent falls in output might seem marginal but they become very significant over time.  The crucial table is this one, part of Figure 2:

What that shows is that productivity value has fallen from 100 to 89.8 over the period.  This means that we're getting 10 per cent less today from every pound we spend on the NHS than we were in 1995. 

Given how much we're spending that fall in productivity implies a massive waste of money and the failure to get the improvements in output we might have hoped for had productivity performance been better implies a massive waste in lives.  The step change in healthcare performance we were told we would get for our money hasn't arrived - neither has the end of mixed-sex wards, another promise.  The Government's healthcare policy has failed.

"Fundamental principle of the NHS" proves its lethality

This is a really tragic case. Colette Mills has not lost her case in the legal fight to be able to buy the drug Avastin - that could have doubled the chance of her breast cancer not spreading - without the NHS cutting off support for the rest of her treatment. However, during the four month trial the cancer has spread and it would now be too late for the drug to do much good.

The Department of Health are sticking to their guns and insisting that top-up payments would violate a "fundamental principle of the NHS, now supported by all the main political parties, that treatment should be free at the point of need". This is a disgracefully weak reason to let someone die. They can't go on pretending that this is a binary choice between free treatment and copayment. In Colette Mills' case it was a choice between copayment and no treatment at all. If the NHS cannot provide a drug, if the free treatment option is not on the cards, then denying her the chance to better her chances is not principled but brutal.

Beyond that, as research (PDF) for Doctors for Reform pointed out, the principle the Department of Health appeal to is already violated throughout the NHS.

I can't make this case as well as Mills herself:

"Mills, a 58-year-old former nurse, said: “I am just absolutely gutted. I just cannot believe people make these decisions about other people’s lives.

“It wasn’t going to cost them. I was going to pay for it. How can they say this policy is far more important than somebody’s life?"

Troops leave poorly managed Armed Forces

Over the last year the poor quality of housing provided for those in the forces, and the snails pace of improvements, has been an ongoing scandal.  There are persistent worries about equipment shortages - over the weekend we heard that only one third of the helicopters vital to operations in Iraq and Afghanistan are operational.  The Commons Defence Committee has reported, today, that particular pressure is being put on soldiers are not being given sufficient time at home - the Times says:

"Under Harmony Guidelines no one in the Army should spend more than 415 days away from home in any 30-month period. But as at March 31, 2007, 13.4 per cent of personnel had exceeded the guidelines."

This is all a result of poor management of the armed forces.  Proper planning should have made it clear that the armed forces were going to be under particular pressure with big commitments in Afghanistan and Iraq as well as smaller operations elsewhere.  There are 72,890 Civil Servants in the Ministry of Defence (XLS) who, between them, should be able to deliver a more efficient use of what is a substantial budget and a Government that, when committing soldiers to war, should ensure that they have the resources in place to do so.  Their failure will create long-term problems for the armed forces as experienced soldiers leave, again from the Times report on the Defence Committee study:

"MoD figures show that last year 4.3 per cent of officers and 5.8 per cent of other ranks in the Army left early. The latter figure is nearly 1 per cent higher than normal."

An interview with Ruth Lea

Answering our questions this time is Ruth Lea. Ruth is the Director of Global Vision, the campaign for an outward-looking UK in an outward-looking Europe, working for a fundamentally renegotiated relationship with the EU.  She is also a Governor of the London School of Economics, and formerly Director of the Centre for Policy Studies.

If you were in charge of any ministry which one would it be and why?

I am torn between the Treasury and the Foreign and Commonwealth Office. The Treasury appeals because it is simply the most important domestic department from which power can be exerted over all domestic policy – as Gordon Brown demonstrated when he was Chancellor of the Exchequer. From the Treasury I would, amongst other ambitions, plan a revolution in the delivery of education and health care services. They would remain taxpayer funded but the state would wither away as provider. The NHS would become, for example, the funder and the regulator of state-supported healthcare – but not the provider. I would attempt to implement the policies I have been advocating for several years and on which I have written a good deal – especially when I was in the IoD.

The FCO, on the other hand, deals with our policy towards the EU. And no more important policy is there for the future of this country. Global Vision, of which I am Director, advocates a new, modern look at our relationship with the EU – one that is more suited to the rapidly changing circumstances of the 21st century. Of course, we must remain on good and close terms with the EU, but we need flexibility and a freedom to manoeuvre which is increasingly being blocked by our full membership of the EU. We should renegotiate a new relationship based on trade and cooperation, whilst opting out of economic and political union. We find from our polling that this type of relationship is the people’s option of choice.

So the department of my choice has to be the FCO.

What are the three most successful policies you can think of in the post-war era?

Firstly, there is little doubt that the supply-side policies of the Thatcher Government – trade union reform, tax reform and privatization – were the most successful economically. These micro reforms did indeed revolutionise the British economy. All too sadly, much of the good work undertaken in the 1980s has been reversed since 1997. Secondly, transferring interest rate setting to the Bank of England was a bold move and one that was long overdue. Let us hope that the Bank can maintain its independence.

Finally, the divesting of Empire, though painful for many British people at the time, was done with dignity and honour on the whole. The Commonwealth, as the Empire’s legacy, is potentially a tremendous resource for Britain and our Commonwealth partners – if only we chose to develop the relationship. This would be another job for me if I were in charge of the FCO!

What are the three worst policy mistakes you can think of in the post-war era?

There is, arguably, a great deal more competition for this one. Indeed where does one start?

But they would surely include the development of the welfare state, including the nationalisation of healthcare, and associated welfare dependency since the late 1940s. Though idealized at the time and indeed barely questioned until the 1980s, these developments did much to undermine the self-reliance which is at the core of dynamic countries and dynamic economies. Of course, there must be safety nets for people who need them, but the state’s blanket coverage stifles non-state provision and, ironically, all too frequently fails the really needy.    

The next policy failure relates to the initial terms of our membership of the EEC. Such was Edward Heath’s enthusiasm for membership that he negotiated a poor deal for Britain. His dishonesty concerning the EEC’s true objectives was hardly the act of a true statesman. 

Thirdly, it’s neck and neck between the dumbing down of education and the botched 1974 local government reforms which undermined local allegiances and sense of belonging (this should never be underestimated). And I’m sure there are a hundred others. The current obsession with “Global Warming” will surely throw up many horrors in years to come.      

Who do you think has been Britain’s most successful post-war minister and why?

Without doubt it has to be Margaret Thatcher for her stewardship of the economic revolution (see question 2).

Who do you think has been Britain’s least successful post-war minister and why?

More competition here…indeed I find it difficult to decide between Edward Heath and Tony Blair.

I’ve already referred to Edward Heath’s handling of the EEC membership negotiations and, of course, the 1974 local government reforms were during his premiership. But there was a general sense of downward drift, including the Three Day Week, during his premiership. To be fair the drift continued, indeed intensified, under Wilson and Callaghan in the late 1970s. 

Tony Blair is more difficult to assess because his premiership is so much more recent. But, at this stage, I would sum his 10 years in two phrases: “wasted opportunities”, and what golden opportunities there were, and “spin intended to bemuse and, allegedly, deceive”. In other words, failure, dishonestly done.       

What do you think of moves by Gordon Brown and David Cameron to bring more outsiders into government?

I have no objections to Gordon Brown or David Cameron bringing in outsiders – though Gordon Brown surely rues some of Lord Jones’s, wholly predictable, outbursts. It all depends on who the outsiders are and how the “insiders” react to them.   

If you were Prime Minister who would you bring in from outside parliament to help you and why?

It would depend on what I considered to be (a) the big issues of the day and (b) what other talent was available to me - either through the political process or in the Civil Service. 

Do you think it is important that ministers have experience in the subject area they are appointed to?

It is useful but not absolutely essential – provided they are well-advised and are sufficiently experienced in high-level decision making (in whatever their chosen field) so they can use the advice well.

What lessons do you think Britain can learn from other countries about the structure of government?

There are many ways of approaching this question and I shall interpret it very widely – perhaps going beyond the strict remit of the question.

But firstly could I say that Britain’s system of Parliamentary Democracy, allied with a first-past-the-post electoral system, can work well and far better, in my view, than German-style coalitions (for example). Whilst, too, there are many criticisms of overly-powerful Executives in Britain, I prefer this to a situation where the Executive is not powerful enough to push through necessary changes.

But I do believe that British political power is too centralized and distant from the regions (botched Devolution apart) and the people. The increasing indifference to and falling participation in party political activities is worrying – I suspect the indifference is exacerbated by the increasing powers transferred to Brussels.

The Federal systems of the US and Germany would bear study and, in particular, the Swiss approach to direct democracy should certainly be analysed. The Swiss system is especially appealing. 
   
What lessons do you think Britain can learn from other countries about how to deliver public services?

There is a wealth of evidence available from overseas for voucher-style “choice driven per capita funded” educational systems (the Netherlands, the US etc), which I have advocated for several years. As I suggested in my answer to question 1, I would support a similar system for healthcare. My 2 major papers on education and health discussing these issues are, I understand, still available on the IoD website!   

If you were setting up a system of government from scratch would you choose the British model or that of another country?

The British model (see question 9).

The Law of Unintended Consequences

Economist Alex Tabarrok writes, for the Marginal Revolution blog, to describe just what the law of unintended consequences entails:

"The law of unintended consequences is what happens when a simple system tries to regulate a complex system.   The political system is simple, it operates with limited information (rational ignorance), short time horizons, low feedback, and poor and misaligned incentives.  Society in contrast is a complex, evolving, high-feedback, incentive-driven system.  When a simple system tries to regulate a complex system you often get unintended consequences."

There are plenty of examples in his post - and throughout the British public services.  Understanding the law of unintended consequences is central to understanding why so many policies fail.  Our politicians need to understand it and, as Tabarrok suggests, be humble.

An obesity smokescreen

The Government has released new plans to pay people to lose weight.  This risks creating an incentive for people to lose control of their weight in the first place and is a bit of a gimmick.  As has been pointed out before this kind of problem can be avoided in a system of competing social insurers.  Incentives for healthy behaviour can be allowed and will be kept at a sensible level by competition to provide affordable, quality insurance to both fat and thin.

The Government are not just grasping at straws in order to confront the obesity epidemic.  They have a vested interest in making that epidemic seem as serious as possible.  The more serious it is perceived to be the more they hope to escape blame for the dire state of our health service.  This is a smokescreen - survival rates for conditions like cancer are substantially lower in Britain than elsewhere - and we need to avoid being taken in.  While obesity is a serious issue politicians should be looking at the performance of the public services they are responsible for instead of trying to pin the blame on lifestyle changes.

The mismanagement of the Northern Rock crisis

Today there is a withering attack on the Government's management of the crisis at Northern Rock in the Times, by Anatole Kaletsky:

"The Northern Rock bailout will demolish or, at best, discredit the entire economic policy framework created in 1997. Since the creation of this framework was his one unquestionable achievement, it seems fair to say that Mr Brown's career as a serious  ended yesterday."

Here at the TaxPayers' Alliance we've been doing a lot of work fighting the taxpayers' corner on this issue in the media.  Politicians are going to be lobbied by shareholders who insist they shouldn't suffer when their company's risky business model, which paid fat profits when it was doing well, runs into trouble.  Companies bidding to take over the bank will try to exploit the Government's political trouble to extract more taxpayer support.  Someone needs to speak for taxpayers who stand to face such a big bill if Northern Rock gets into trouble - insist that their interests are the Government's top priority.

Taxpayers' should be outraged at the new rescue package announced by the chancellor.  It gives up on having the private sector pay back significant amounts of the taxpayers' money immediately and leaves us hoping to claw back our money over a number of years.  This exposes the taxpayer to significant risk.  It is likely to be expensive as we might not get a market rate for the kind of risk we will be running.  For more examination of this issue see this post on the Burning Our Money blog.

We don't know what kind of mechanisms will be in place to ensure that taxpayers get a share of the upside if things go well at Northern Rock, in return for the risk we are taking.  The deal which will set out these mechanisms is still to be decided but there seems little reason to expect the Government can be expected to get us a good deal.

Beyond that, the incentives being created by the new deal for any private sector rescuer are pretty poor.  They are being shielded from the downside risk - if things go wrong it is mostly taxpayer money at stake - and, in return, their share of the upside is being limited - we'll take a chunk of any profits.  That means we have dramatically reduced the incentive for them to make a success of Northern Rock in the years to come.

This issue has been examined ad nauseum but there is an important lesson to be learned about the ability of politicians to manage public services:  This was a big, obvious problem.  The politicians were focussed on it and had every incentive to get it right.  Despite that they've made a complete hash of their management of the crisis at Northern Rock.  Why do we expect them to effectively handle the detailed decisions required every day in order to run high quality public services?

LSE study suggests centralisation in the NHS is lethal

A host of problems are created by centralisation.  A few advantages to decentralisation were summarised in our report, Wasting Lives: A statistical analysis of NHS performance in European context since 1981:

• "It is easier to vary decisions according to local circumstances.
• It is easier to feed local information and the views of individual professionals and patients into the decision.
• People will feel greater ownership of institutions that they are more closely connected to."

The huge costs of failing to vary decisions according to local circumstances are highlighted by a superb new study from the Centre for Economic Performance at the London School of Economics (via Tim Worstall at the Adam Smith Institute Blog).  From the abstract:

"We present evidence that stronger local labor markets significantly worsen hospital outcomes in terms of quality and productivity. A 10% increase in the outside wage is associated with a 4% to 8% increase in AMI death rates. We find that an important part of this effect operates through hospitals in high outside wage areas having to rely more on temporary “agency staff” as they are unable to increase (regulated) wages in order to attract permanent employees. By contrast, we find no systematic role for an effect of outside wages of performance when we run placebo experiments in 42 other service sectors (including nursing homes) where pay is unregulated."

What this is saying is that regulation - in the form of centralised pay bargaining - prevents health authorities in areas with higher average wages (and hence, usually a higher cost of living) paying more to get staff.  If health authorities cannot vary pay then the authorities responsible for areas where things like housing are vastly more expensive won't be able to get the staff they need.  They have to rely on agency staff whose pay can be varied.  This strategy has significant downsides in terms of cost and performance.  Its effect on healthcare quality is demonstrated by significantly lower survival rates after heart attacks for authorities in areas with higher average wages.

Lord Warner argued, in an interview with the Evening Standard today, that NHS Chief Executives in London needed better pay in order to attract staff.  He focuses just on one side of the equation, on trying to secure bigger pay package for staff in richer areas.  This isn't likely to deliver better value.  So long as the decisions over pay are still made centrally it will be hard to sell significant variations in wages to unions who need to serve all their members - most of whom won't be in London.  All we are likely to get is another big boost to Chief Executive pay across the board.

Hospitals are rarely poaching managers from the City.  The important thing isn't how salaries in the NHS compare to those in the private sector but how they compare to each other.  If London can't pay more than Birmingham despite London being a much more expensive city to live in then equal pay will mean London struggles to find attract doctors, nurses and managers who can choose to work for other health authorities in poorer areas.  We need decentralisation so that authorities in London can pay more to get the staff and authorities in Birmingham can pay less and get better value.

Pay bargaining at the centre means paying staff in poorer areas more than is necessary and not paying enough to get good staff in richer areas.  Local healthcare providers need to be able to set pay - the largest item in their budget - themselves.

Some rather weak responses to our report on NHS performance

Here at the TaxPayers' Alliance we're used to rather unconvincing government responses to our reports.  Tessa Jowell produced the memorably meaningless argument that it "is a mistake to view 2012 as a cost, rather than an investment" - as if investments don't have costs.  The DFID managed to completely contradict their own press release in a response to our study on hate education in the Palestinian Territories.

Today we've had some equally lackluster responses to our study Wasting Lives: A statistical analysis of NHS performance in European context since 1981.

The King's Fund, quoted in the Guardian, were good enough to acknowledge that our basic methodological approach is valid.  Unfortunately, they then tried to diminish the conclusions of our study by placing them in a completely inappropriate context.

Even if the statistic that total mortality is between 750,000 and 1,000,000 is accurate that isn't the correct number to compare with our estimate of 17,000 deaths from poor NHS performance.  Most deaths occur either from a condition, or at an age, that they should not be considered amenable to healthcare and therefore have a limited part to play in any discussion of the ability of the NHS to save lives.

The proper comparison is with total amenable mortality and that comparison is contained in our study.  As the Times noted "mortality from [amenable] conditions is 26.9 per cent higher in the UK than the average in the four European countries, and 48.6 per cent higher than in France, the best-performing country."  This is a very significant difference.  We only cited the number of lives lost more prominently as we didn't want the human tragedy to be lost in a fog of more esoteric statistics.

If the King's Fund don't think that 17,000 deaths is a high number then why do we concern ourselves with deaths on the road or deaths related to alcohol?  Neither are nearly as lethal as poor NHS performance.

Health Minister Ben Bradshaw responds for the Government with a quote in the Guardian.  First, he said that the gap between EU peers and the UK has been narrowing.  That was clearly acknowledged in our study.  However, it has been narrowing at pretty much exactly the same slow pace since 1981 despite a huge cash injection since 1999.  There are probably several trends underlying that pattern, technological change that erodes established advantages is probably particularly important.  There is a lot of analysis of the trend in our report but, suffice it to say, Bradshaw has to explain how exactly his government has spent so much more, £34 billion, and got exactly the same results.

He follows that with a meaningless ad hominem.  Hopefully Guardian readers will be open minded enough to know that calling someone "rightwing" is a poor substitute for being able to point out how they are wrong.

Finally he accuses us of admitting that our figures are "more than three years out of date".  We did no such thing.  The data used in our report is the very latest available mortality data. It describes deaths in 2004 for the simple reason that mortality statistics for more recent years just don't exist yet.  2004 isn't that long ago and is five years after the cash injection whose effects we wanted to study.  Almost all statistical analyses have to look a certain distance into the past thanks to the time taken, by the relevant organisations, to produce the statistics that they analyse.  If Ben Bradshaw isn't willing to accept any study that does so you have to wonder how he understands health policy at all.

Decline in educational standards affecting the economy

The Telegraph reports that an inquiry by Cambridge University has found that a failure to teach children the three Rs - literacy and numeracy - is hurting economic productivity.  They found that there was a significant productivity gap between the UK and France, with 30 per cent higher productivity, and Germany and the US, with 10 per cent higher productivity.  A large measure of this difference is attributed to skills shortages in the UK.  The continuing failure of politically managed public services is undermining our economic competitiveness.

The recommendations in the report are dissapointing.  Instead of looking at how standards can be improved across the education system they prefer to launch another attack on middle class parents looking for a good education for their children.  If we can get more, rather than less, educational freedom then the standards of all schools can be improved - this has been seen in Sweden with its school voucher system that forced poor performing schools to up their game.

MAJOR STUDY ON THE NHS REVEALS OVER 17,000 UNNECESSARY DEATHS A YEAR

Download the full report here (PDF).

• A statistical analysis of World Health Organisation data reveals that the poor performance of the NHS is causing 17,157 deaths per year
• £34 billion of extra spending under Brown has made no difference to UK mortality

Using data from the World Health Organisation and statistical techniques pioneered in the British Medical Journal, the TaxPayers’ Alliance has produced a major report on NHS performance since the 1980s.

Wasting Lives: A statistical analysis of NHS performance in a European context since 1981, analyses data from the WHO to estimate the number of deaths that could plausibly have been averted by the NHS since the 1980s.  The measure used is known as “mortality amenable to healthcare”.  The calculations compare the UK performance to that of Germany, France, the Netherlands and Spain.

• If the UK were to achieve the same level of “mortality amenable to healthcare” as the average of the other European countries studied, there would have been 17,157 fewer deaths in 2004, the most recent year for which data is available. 
• This is equivalent to over five times the total number of deaths in road accidents and over two and a half times the number of deaths related to alcohol in 2004.
• Steady improvements in mortality rates, relative to European peers, have been made at almost exactly the same rate throughout the Thatcher, Major and Blair governments despite huge increases in spending from 1999 to date.  There can no longer be any doubt that the Government’s extra NHS spending has completely failed to deliver results.
• If NHS spending had continued to increase relative to European peers at its pre-1999 rate £34.3 billion – £1,350 per household – less would have been spent between 1999 and 2004.  In 2004 alone, £9.8 billion less would have been spent, 9.7 per cent of total spending in that year.  This extra money has largely been wasted.

Matthew Sinclair, author of the report and a Policy Analyst at the TaxPayers’ Alliance, said:

“Thousands are dying every year thanks to Britain’s health service not delivering the standards people expect and receive in other European countries.  Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality.  This is a colossal waste of lives and money.  We need to learn lessons from European countries with healthcare systems that don’t suffer from political management, monopolistic provision and centralisation.”

Professor Karol Sikora, Medical Director of CancerPartnersUK, steering group member of Doctors for Reform and author of the foreword to the report, said:

“The NHS should not be a religion, with its structure set in tablets of stone.  We face a choice between a modern, consumer driven service for all or a decaying, bureaucratic system which only those with their own resources manage to escape.  Politicians need to read this report carefully and determine the optimal strategy they can put to a well informed public.  Those that capture the best way forward will carry the British voter with them.”

NHS Dentistry; A study in organised neglect

Back in 2000, when 'investment' in the NHS seemed to know no limits, the government felt confident enough to promise all citizens access to an NHS dentist within just two years. A report brought out today though, by the charity Citizens Advice, reveals the impressive extent to which the government has failed to deliver on this promise.

The report found that 'lack of access is the most common reason cited by people in England and Wales for not seeing an NHS dentist since April 2006, along with not needing treatment. It was mentioned by 31% of respondents in England and Wales who have not been to an NHS dentist since April 2006. This is the equivalent of approximately 7.4 million people who have not been to an NHS dentist since April 2006 because of difficulties in finding one. Of these, the equivalent of approximately 4.7 million have sought private treatment instead and the equivalent of approximately 2.7 million have gone without treatment altogether.

Publicly funded dentistry under this government has been woefully neglected. Year on year, the numbers
who use an NHS dentist fall - 266,000 fewer in 2006 than in 2005. At the same time, and no doubt in part responsible for the fall in patients, the cost of seeing an NHS dentist has risen substantially. Under the 2006 dentistry contract drawn up by the government, some dentists were forced to put up prices for a regular check-up from £6 to £16. Many see that contract as the straw that broke the camel's back, encouraging many dentists to move into private practice and pricing publicly funded oral health care beyond the means of those who need it most. As the NHS enters its 60th year, it is a telling state of affairs that one of the planks on which it was built - government funded dentistry - looks set to be one of the first parts of it to slide into obsolescence.

Hospital deep cleaning

Let's get this straight.

People who think that the deep cleaning is a gimmick, at best:

The Lancet medical journal.

The cleaning contractors hired to do the deep clean.

People who think it is a good idea:

Gordon Brown - briefly an academic and then a journalist but, for most of his life, a full-time Labour politician.

Alan Johnson - moved into politics from a job at the postal union.

Sure enough, the deep cleans are going ahead at a cost of £50 million pounds that could be spent on the day-to-day cleaning that the contractors say would be more effective.  Another day in our politically managed public services.

The Better Government Initiative report

Today the Better Government Initiative, a group of establishment figures with no relation to our campaign, have published their report (PDF) today and have noted the problem of inexperienced political management:

"Ministers are increasingly drawn from a specialist political background with little experience of the management and operation of large organisations, but they are in a position of great influence in relation both to their own Departments and to deliverers of public services. They need appropriate training. Such training should also be available to potential Ministers within the governing party and to members of the Opposition and Select Committees."

It is great that they have acknowledged the problem but their conclusion, that training is needed, is a mistake.  There is a reason why big, private sector, firms wouldn't dare to hope than an inexperienced candidate can be prepared for the role of chief executive - an analagous role to that of a minister - with training alone.  Managing large organisations is not a skill that has ever been effectively taught through formal training alone.

Beyond that, even if a Minister knows how to do manage large organisations they will also need to know their subject.  Few have an in-depth knowledge of the area in which they'll be working so can be, at best, informed laymen.  They rarely stay in a department for long so they won't be able to build up that knowledge over time or build up a close working relationship with their staff.

All these weaknesses make it harder for Ministers to attempt the already close to impossible task of managing big government departments - huge, monopolistic conglomerates.  Training will not improve the situation.  Instead, we need politicians to get out of management and hand services over to professionals - held accountable either by the politicians or, in most cases, the competitive market.

Ring-fencing the doctor training budget

The Telegraph reports a suggestion that the training of doctors should be split off from the NHS:

"Billions of pounds for junior doctors' training should be taken out of the NHS and given to a new medical education body, an independent inquiry will conclude.

The inquiry into the junior doctor recruitment crisis will recommend moving at least £2.6 billion to a body called NHS Medical Education for England that would oversee training and fund courses, study leave and a proportion of juniors' salaries."

If healthcare in Britain were delivered by a multitude of competing providers then it might work well to have another set of organisations responsible for assisting in the education of doctors.  You could have a genuine labour market for doctors just as we do for other professions.

However, within the structure of the NHS as it stands separating the educating of doctors from the single organisation responsible for the overwhelming majority of their employment will just weaken the already fragile links between supply and demand for doctors' labour.  Such a measure would exacerbate the all to common problem of an over or under supply of doctors.

The Prime Minister's NHS interventions

The Telegraph has an excellent leader today describing the absurdities of political management in the NHS:

"There is something faintly absurd in the spectacle of Gordon Brown - who is, after all, a politician, not a medical professional - making detailed recommendations for clinical practice in healthcare.

But in Britain, we have become so accustomed to the concept of a politically driven health system that it no longer seems bizarre to hear such proposals as the deep-cleaning of hospital wards and the prescribing of specific screening procedures being made by the Prime Minister, whose judgments must be no more expert than those of an informed layman."

Our centralised and monopolistic health service does not face the imperative to improve standards and deliver good value that hospitals and insurance funds face in countries like the Netherlands - with its more competitive system.  Customers are not able to abandon the poor service delivered by political management unless they can afford to pay twice - through the tax system and a private channel - for their treatment.

Another thing to note about these interventions is that they are being led not by Alan Johnson but by Gordon Brown.  This is a further centralisation that makes the Prime Minister - and the limited number of priorities that any one man can keep track of - a powerful limitation on the set of issues that politicians can reasonably expect to keep a track of.  Central authorities are unable to keep track of everything that needs doing but are still able to dictate priorities thanks to targets and financial control.  It is easy for them, and by extension the entire system, to neglect important work that isn't a political priority, like making sure soldiers' homes are fit for heroes.  Or, put off vital decisions till another day - the late decision to increase nuclear power capacity, for example.

Political management, by ministers with little management experience or subject knowledge, cannot deliver proper standards in public services.  Prime Ministerial management is just about the only way to make things worse.

'Soft' A-Levels rejected by top universities

The Telegraph reports that both Cambridge and the LSE have drawn up a list of subjects that are considered insufficiently academic to form a preparation for candidates to study at their universities.  These include business studies, travel and tourism and media studies.  The universities have confirmed what has been apparent for some time:  these courses are not as rigorous and have been concealing, in the exam results at least, declining educational standards.

Vocational study can be very valuable if it develops useful career skills but there is no sense in claiming that vocational A-Levels, or the Government's new diplomas, represent the same academic challenge posed in traditional subjects.  Trying to pretend that they do may improve the Government's statistics but misleads students and conceals failures in the education system.

Results of TaxPayers' Alliance study of big government projects supported by new research

Near the end of last month the European Services Strategy Unit released a study (PDF) looking at cost overruns in outsourced government IT projects.  They looked at 105 contracts and found:

"The average percentage cost overrun is 30.5%.

57% of contracts experienced cost overruns."

Compare this with the results of our study Beyond the Dome:  Government Projects £23 Billion Over Budget which looked at 305 big government projects of various kinds and found an average overrun of 33.7 per cent and that 57 per cent of projects overran.  The evidence that we are paying a substantial price for endemic overruns becomes stronger by the day.  These overruns are a result of the politicians and civil servants responsible failing to properly specify what is desired from a project before the project begins, underestimating costs to get the project approved and paying over the odds in an attempt to solve the problem.

The Better Government Initiative

The Better Government Initiative, a "grouping of top civil servants, ambassadors and former local government chief executives" with no relation to our own campaign, are set to report today.  The Financial Times describes how they will argue that:

"Gordon Brown's proposals for revamping the way Britain is governed address neither the issue of "sofa government", nor the erosion of both cabinet responsibility and parliament's ability effectively to scrutinise the executive."

These problems are described as contributing to the number of "failed and flawed" initiatives in recent years.  Their report will be released later today but at this stage it looks like they have confined themselves to too narrow a remit to address the root causes of public service failure and the resulting collapse in trust in politics.

The recommendations mentioned so far, parliament setting standards for the preparation of legislation, select committee members and chairmen being paid and select committee appointments being brought under the control of MPs, are pretty minor adjustments.  With administrative chaos and endemic failures in the public services more serious reform to end attempts by ministers without management experience to manage public services from the centre is needed.