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11 April 2016
This is a Parliament of change. The debate on public services has moved on, from a focus on “cuts” in the last Parliament to a deeper dialogue on genuine reform. Here the Prime Minister has played a valuable role with a series of big policy speeches on the need for change, comparable to the major speeches that Tony Blair gave as Prime Minister.
There will also be change in the personnel of politics. Iain Duncan Smith’s departure is a significant one. David Cameron himself has said that he will step down at some point in this Parliament. These moments will be great political theatre but they also mean a lot for policy. Once politicians have established their positions, it is hard for them to change course (or “U turn” as the inevitable headlines would have it). (I wonder if that is one reason why governments lose their political capital over time. It becomes increasingly clear that policy has to change, and Ministers’ entrenched positions look steadily less worthy of support.)
I will devote a short series of weekly blogs therefore to the ideas that David Cameron has stood for, area by area, and how they might change before the end of this Parliament. I will try to look to his own personal contribution rather than the contributions of those in the Governments which he has led.
The first is the NHS. Before the 2015 General Election, it would have been right to say that David Cameron played the politics of the NHS wrong. Marching with junior doctors and declaring his personal affection for the NHS might be fine if the Service did not need to change. Ring-fencing the NHS budget might be OK if the service did not represent the biggest opportunity for value for money in the public sector.
The Prime Minister’s position has however changed. His commitments to reform in the Service has strengthened sharply since the Election, as this blog has commented before. The Spending Review included an important commitment to competitive delivery of NHS care. He has given full support to Jeremy Hunt over the junior doctors’ strike. There is a lot here on which his successor can build.
A remaining question is how to pay for health and social care. The postponement of the Dilnot Review means that this question is hanging. The clear sense is that the Prime Minister does not want housing wealth to pay a greater role in the funding of care. Again, that position might be fine if public spending on health and social care was freely available. The uncertainty over the issue has hindered the insurance industry from developing much-needed new products.
The second is Whitehall. David Cameron has not included a speech on the reform of the Civil Service in his series of policy speeches since the Election. He has not pushed any set of ideas on stronger accountability for civil servants or the reshaping of Whitehall departments.
If we take reports at face value, the Cabinet debated elements of real Civil Service reform in 2012, for example Ministerial appointment of Permanent Secretaries, on the occasion of the Civil Service Reform Plan. Those ideas were not carried through.
Clearly a great deal of positive change has happened under both the Coalition and the Conservative-led Governments. Reform has written before about the internal reforms of the Ministry of Defence and the Department for Education, now being matched by the ideas of Liz Truss at Defra. Ministers can have more support (via so-called “Extended Ministerial Offices”). Departmental Boards have broadened expertise at top of departments and agencies. External appointments such as John Manzoni embody the idea that experienced people can bring their skills to government. Mr Manzoni aims further to professionalise cross-government functions within government, from property to procurement. These are not ideas however associated with Mr Cameron.
After five years as Prime Minister, Tony Blair made a speech saying that he wished he had sought improvements in the Civil Service sooner. David Cameron would do well to follow his example.
Next week, education and welfare.
Andrew Haldenby, Director, Reform