#ldconf, the NHS Bill, and Where The Leadership Stands Now

This weekend has certainly been interesting. For the record, I’m relatively pleased with the outcome of the votes at conference on the NHS bill this weekend. It is one of a whole range of possibilities about what might have happened, and we don’t fully know what the fallout will be yet. No, technically, we have not given any particularly clear instruction to our parliamentarians on how to vote. And yes, technically, the amended form of “The Shirley Williams Motion” (ahem) says almost nothing of any consequence. But since conference has never been in the business of telling our parliamentarians how to vote, that’s probably OK. The act of deleting the clause which asked our parliamentarians to vote for the bill at 3rd reading seems to have sent the right message to the media.

Did Conference Achieve the Right Outcome?

In any case, what the best outcome for conference would have been is a rather complex question. It’s complex because there are a number of objectives which in an ideal world would all be achieved:

1. Kill the Health and Social Care (HSC) Bill.

2. …but leave open the possibility of implementing some of the uncontroversial elements of the plans, like joining up the delivery of health care, social care and public health.

3. Preserve the coalition government, and the goodwill of our coalition partners within it (tricky to reconcile with point 1!).

4. Preserve the sovereignty, democracy and credibility of conference as a policy-making body.

How best to achieve a balance between these objectives, and which ones are more important, is not a straightforward question. For instance, had we passed the motion calling for the withdrawal of the bill, only to find that it made not the slightest difference to the progress of the bill, conference (and by extension the party) would have been utterly emasculated. Had we passed the withdrawal motion and subsequently seen the withdrawal of the bill, I’d be pretty happy, but I would be concerned that the Tories would be on the lookout for some piece of Lib Dem-favoured policy which they could hole below the waterline in retaliation. As it is, we’ve stopped short of passing a (possibly unenforceable) motion calling on our peers and MPs to vote against the bill, but made it fairly clear, in the balance of speeches this morning and in the result of the vote, that we are really not comfortable with this bill and would rather it died. If the bill subsequently does die, the Tories can’t lay the blame squarely at our feet, but we have nevertheless contributed to the momentum of the anti-bill forces. Somehow I don’t think we’ve heard the last of this row yet. So, whilst I was willing to support the Withdrawal motion in the Emergency Motions Ballot, I don’t think it is by any means straightforwardly obvious that what happened today will not have better outcomes than that would have had.

The above may sound rather slippery, or seem to display a warped sense of priorities. How can I put the party and the stability of the government alongside protecting the NHS? I must be some kind of traitor, no? Well, if I believed much of the hyperbole about the effects of this bill, then yes, I’d agree, the reasoning I’ve laid out above would be disgraceful. But I have to say that although I don’t support the HSC Bill and want it dropped, I really don’t buy the idea that it’s going to lead to the end of a comprehensive, free NHS in the way that some of the anti-bill folks have been suggesting. Whilst good impartial information on this issue is scarce, from what I’ve been able to make out this is not a reasonable expectation to have of the effects of the bill. Nor do I think it will result in the wholesale privatisation of the NHS. I just don’t happen to think it’s a good enough revision of the model for running the NHS to justify the disruption which the re-organisation will cause.

 

What Is Actually Wrong With The HSC Bill?

I believe the use of private providers within the NHS can be destabilising to the viablity of NHS services, and that it has led to an ever more fragmented service for the last 10 years or more. I do not like the one-size-fits-all way that the “choice” – or competition, as it is more honestly known – agenda has been clumsily grafted onto the NHS, but we should not pretend that this bill introduces that agenda, or that without this bill that agenda would not continue to drive much of the way the NHS is run. What this bill does do, so far as I can see, is transfer who is doing the commissioning from PCTs to CCGs, and remove some brakes on Foundation Trusts’ involvement in the private sector. I’m not saying that isn’t problematic*, but at root the stuff I most dislike about the Lansley vision for the NHS is not actually new. Marketisation and competition has been the dominant idea behind NHS reform throughout Labour’s time in office. If those of us who are deeply uncomfortable with it don’t like it, we need a coherent vision of our own. Meanwhile, I am satisfied that my party’s representatives in the Lords have secured some valuable safeguards, such that in some ways this might be an improvement on the 2006 Act which Labour left us.

So what is the problem? The problem is, in other ways, it’s worse than the 2006 act, and in any case the reorganisation of the NHS is simply massively unhelpful at a time when the NHS is already under budgetary pressure. The problem is that the apparent safeguards about conflicts of interest for CCGs (and any private companies which they might look to enlist in support of their commissioning work) over the services they commission have barely scratched the surface. The problem is that setting tariffs which reflect the “clinical complexity” of work does not prevent “cherry-picking”, it merely quantifies it. The problem is that there are simply too many doubts about this bill, and too many people in the medical professions themselves who oppose it. It is not a very good idea, and it will not improve the NHS, in my estimation. There are just too many pitfalls.

But let’s be honest. It is not going to result in everyone having to get private medical insurance. It is not going to mean that the NHS is privatised. It is not a “US style” health system. And the people who are shrieking hysterically that it is all of these things are doing their case no favours. And since I don’t buy the apocalyptic visions of what will happen if the bill passes, I am prepared to entertain the possibility that it will pass, and I don’t think that every single other one of the objectives I listed above is worth sacrificing because we might – might – be able to stop it.

*”Problematic” might be the understatement of the year if it turns out that this shift does, in fact, lay the commissioning process open to all sorts of legal challenge by the private sector when they don’t like the outcome of a tendering process. This is one area in which I genuinely have no idea who is right, both because I have read contradictory advice from different respectable sources, but also because the HSC Bill is such a moving target, with many ammendments still only existing in potentia as undertakings by the government.

The State of the Party and of the Leadership

So, what of the way that the leadership behaved in this whole matter? Well, I think it’s pretty undeniable that the tactics of using Shirley Williams in the way they did displayed some serious desperation. The stony silences during the Q&A session with Cleggy during the questions about the NHS were telling, as was the fact that during his speech today he didn’t feel confident in trying to make us clap anything about the HSC bill stronger than thanking Shirley for her work on it. It is unfortunate that at a time when the shine was always going to be coming off Nick, as the party started to grow tired of the more unpalatable elements of coalition, he is having to use up extra capital with members (and make no mistake, that’s what he’s doing, burning through it at quite a rate at the moment) to sell something to us which wasn’t even in the coalition agreement, and which actually directly contradicts it (“no top-down reorganisations…” may be over-familiar by now, but it’s still worth remembering: this is a direct breach of the coalition agreement).

To see Clegg at conference nowadays, it’s pretty clear that he’s an increasingly remote figure in the party. That’s not to say he can’t recover, but I’m sure someone with the emotional intelligence that Nick has cannot have failed to notice that he is not trading from a position of strength at conference these days.

So what can the leadership do about the growing gulf with the wider membership of the party? Well, in the immediate terms of the HSC Bill, not much, other than hope that the Tories find the guts to kill a bill that many of them are clearly uneasy about, and which has been an unmitigated disaster for them in terms of re-toxifying their brand on the NHS. But in terms of preventing this from happening again, I think it’s worth considering how they can bring the party along with them on issues which fall outside of the coalition agreement. Let’s ignore for a moment that the HSC Bill contradicts the agreement, what if it was just a “matter arising” which is not adressed by the agreement? Currently the procedure, we are told, is that it goes to the “Coalition Committee”. For some issues, that’s fine. But I would argue that on an issue as large as reforming the NHS, they really should have moved to get conference on side before pressing ahead with the reforms, in the same way they did with the coalition agreement itself. This would, of course, have strengthened their hand in rejecting excessive Tory demands, on the grounds that they couldn’t get them past conference.

One could argue that the leadership tried to do just this with the original Burstow motion at conference last spring. However, that doesn’t quite hold water. Burstow’s motion being selected instead of the anti-bill motion it was competing with made it virtually impossible for conference to reject the bill outright. Since we’re not allowed to move wrecking ammendments at conference, as soon as Burstow’s motion was on the agenda we could do nothing stronger than reject his motion outright. That’s fine, but it wouldn’t have stopped anything, since doing so doesn’t say anything definitive – defeating a motion is the absence of a policy, not a decisive policy against. The likely outcome would have been that the government plowed on regardless. In the event, the people who were concerned about the bill went for a more constructive approach, moving an ammendment which listed the things they disliked about the HSC Bill (then White Paper). This attempt to be constructive has since been thrown back in their face; the fact that they didn’t delete the first sentence of Burstow’s motion (“conference welcomes much of [the white paper]”) has since been used to suggest that they were actually endorsing the Lansley plan, with a few quibbles. Yes, seriously.

Meanwhile, since conference doesn’t, by convention, discuss the same issue twice in two consecutive conferences, the fact that a motion had been discussed at the spring conference about the white paper meant that conference could not react to the bill as it became draft legislation by moving any motion at all at autumn conference – the attempt to suspend standing orders didn’t get the two thirds majority it needed. By the time this year’s spring conference rolled around it was almost too late to stop the bill, but nonetheless the leadership still clearly feared the embarassment of the withdrawal motion passing enough to go to the desperate lengths of wheeling out Shirley’s name, as I’ve already mentioned. In this light, the leadership’s (and FCC’s) behaviour at successive conferences looks less like an attempt to seek conference’s blessing for the bill in any meaningful way, and more like an attempt to prevent conference from making any decisive and timely call for the bill to be dropped.

The sad thing about this whole process is that it seems to have forgotten what we know about the strengths of our democratic structures. Repeatedly in David Laws’s book about the formation of the coalition, it is mentioned explicitly that the threat of having to get something past the membership strengthened our negotiating position. A strong, independent minded conference is one of the key buffers we have against Tory domination of the coalition. And yet for whatever reason, the leadership of this party seems to have been willing to actively frustrate members’ attempts to intervene in the case of the NHS bill. Ultimately, the result is that a bill which is now an albatross around the government’s neck has been allowed to progress past the point when it could have been quietly sidelined.

What could the leadership do about it? They could stop playing the kind of pathetic procedural games at conference which would make a student union trot blush.

Predictions for 2012

Not that they’re likely to display any dazzling powers of prediction, but…

1. The coalition will survive in tact, despite a few unhelpful interventions from prominent figures in the Lib Dem parliamentary party, and continued howls of frustration from the Tory right.

2. Chris Huhne will survive the fallout from the allegations about speeding in 2003, without having to resign, but will be substantially weakened.

3. Vince Cable will still be a member of the cabinet by the end of the year.

4. Ed Miliband will find that the disloyal mutterings from some of his frontbench colleagues become a serious problem. Ed Balls will not be unconnected to this!

5. Ken Clarke will be retired from the cabinet in a reshuffle that will see David Laws return to government.

6. Barack Obama will beat Ron Paul in the US Presidential Race, in a much closer result than many analysts predict when Paul is nominated.

7. The Euro will finish the year in a much stronger position than it started it.

8. UK economic growth will continue to be sluggish, but will not fall back into recession.

9. A major UK newspaper will close or merge with a rival.

10. The Higgs Boson will officially be declared to be discovered, and, rather boringly, the details will utterly fail to significantly challenge the Standard Model.

See you back here this time next year for the results!

11 for 2011: How Did I Do?

Well, another year has been and gone (any amazing late-breaking developments notwithstanding), so it’s time to look back at my success (or more likely otherwise) in predicting anything that was going to happen this year.

Here, then, are the predictions I made:

The coalition will survive through the year.

Correct. 1 point.

The “Yes” campaign will win the AV referendum.

Incorrect. Nul points.

Whilst the year will start with Michael Gove looking increasingly insecure in his position, it will ultimately be Andrew Lansley whose position is threatened most, after his ambitious and rapid set of NHS reforms inevitably come a cropper somewhere along the line.

Well, ultimately Lansley is still in post, but I think it’s fair to say that the general gist of this is right – at one point during the year, there was quite serious speculation about whether Lansley was secure in his job, because the NHS reforms had somewhat blown up in his face (with a little help from us, naturally). 1 point.

David Laws will return to government.

Not yet, alas, but there’s nothing blocking it any longer, after the Standards and Privileges committee made its ruling back in May, and Laws was given a week’s suspension from the house as a (somewhat heavy handed relative to those of many other less forgiveable expenses abusers) punishment. 0 points.

The decision on Murdoch’s attempt to take complete control of BSkyB will ultimately be to deny him his wish, having first undergone several months more investigation.

An awkward one, this. Ultimately Murdoch was more or less forced to withdraw the bid as a result of the phone hacking scandal, rather than as a result of deliberations about media plurality directly. Having said that, it seems that campaigners for media plurality have indeed had their hand strengthened by the results of this process. Half a point.

Lib Dem autumn conference will see attacks on the leadership, with councillors who lost their seats in May out for blood.

Well, not so much as you’d notice, really. Despite some none-too-subtle positioning by Mr. Farron, actual slagging off of the leadership was fairly muted at conference, much to the frustration of the media present. In part, this could be credited to Federal Conference Committee, who did much to selflessly draw the anger of conference-goers in their own direction. 0 points.

The economy will not suffer a double dip, although it will start the year sluggishly, and by the end of the year things will be looking up.

Well, the first half of this is certainly true of 2011, though whether the optimistic second half of the prediction could be said to be true is a bit more of a stretch, what with the eurozone crisis still very much unresolved as we head into 2012. Half a point.

Lib Dem leadership will contribute to progress on a legal vehicle at COP 17.

Well, whether the term “legal vehicle” could be said to be equivalent to an “agreed outcome with legal force”, I will leave to better legal minds than me, but I think it’s fair to say that European leadership, and within that Lib Dem leadership in the UK, has contributed to a positive (though sadly not positive enough, yet) outcome at COP 17. 1 point.

Alan Johnson will not be Shadow Chancellor by the end of the year.

True. Not 20 days into 2011, this not-too-surprising prediction came off nicely. 1 point.

The Independent will not be being published in its current form by the end of the year.

Not happened, unless you count a redesign with a spanky new masthead (which I don’t). 0 points.

House of Lords reform will not be scuppered by the House of Lords itself, and by the end of the year it will be fairly certain that elections for the House of Lords will take place within the next 10 years.

Well, the atmosphere of doom around this has somewhat subsided, and it certainly hasn’t been scuppered yet. Having said that, I don’t think I can really give this one – more work still to do! 0 points.

 

So, overall, I make that 5 points out of a possible 11.

Still about as accurate as flipping a coin then!

On The Conference Accreditation Motion #ldconf

Yes, yes, long time no blog. Sorry, no time to dwell on that.

So having sat through the debate this morning and watched with horror over 100 people put their hands up to vote for ammendment 1 (for all papers relating to this post, so you can read the motions and ammendments, go here; the motion is F9 on page 20 of the agenda, and the ammendments are on page 23 of conference extra, both available as pdfs at the above link), I thought I might as well write the speech that I should have put a speakers’ card in to make earlier today.

Basically, my problems with this come under three headings:

1. How is it making us safer?

Let’s assume for the moment that I’m a maniac and I’m looking for opportunities to do something nasty to people inside conference. On my way into conference, four different people check my pass to make sure I match my photo, my bag has been X-rayed and if necessary searched, and I have passed through a metal detector and if necessary frisked. I don’t object to this, I can see the use of it, and I would like to take the opportunity to congratulate FCC on significantly speeding up this process at this conference.

But I’m sorry, I just don’t get how, in addition to these basic physical checks, the fact that the police think that I’m the right sort of chap to be attending conference makes us any safer. Short of strangling someone with my bare hands, I don’t see what damage I could inflict on people inside the barriers even if I wanted to.

2. The argument that “it is still ultimately conference who decide” is flawed.

Andrew Wiseman (who, to his credit, has done more than he could have done to engage with the discontent over this, and is taking a disproportionate amount of flak for a decision that, with the honourable exception of Justine McGuinness, all of FCC should be held accountable for) told us yesterday that two people have been flagged by the police as recommended for being turned away from conference. Of these, one was over-ruled by the “three wise men” who apparently now speak for the party on these matters, and one wasn’t. Andrew told us that he couldn’t give us details, for confidentiality reasons, other than to say that the one who was turned away was a recently joined member, who the police had significant concerns about.

Now, since I don’t have the information, I’m going to have to speculate and make generalisations. But it seems to me that on this limited evidence, we can draw a couple of conclusions: Firstly, if the police try to bar you, you have a pretty good chance of being turned away, compared to if they don’t. And secondly, it seems likely that the most likely people to be turned away are new members, younger people or other new recruits, who don’t happen to have a friend in high places to put in a good word for them.

It seems likely that the people whose flagging will be over-ruled will be people of whom the three wise men can say “oh, that’s just Bill, he’s been coming for donkeys’ years, he’s harmless”. Which is fine, as far as it goes. The problem is, what happens to new members who are flagged. Nobody will vouch for them, since nobody knows them yet. We will create a closed shop, where the only people who can come to conference are longstanding Lib Dems, and nice folk with no questionable things in their records. As was eloquently argued this morning, conference will be all the poorer for the loss of those voices.

3. Some of the arguments being made in favour of accreditation are pretty weak.

Since we know that the same bind on FCC to follow police advice in order to secure their insurance was presumably in place during Sheffield (where, incidentally, the crowds outside the security zone were a damn sight more rowdy than they are in Brum), it is reasonable to assume that in Sheffield, the police didn’t insist on accreditation, even if they might have thought it was a good idea. So there are, presumably, conference venues where we could go where we wouldn’t be subject to this “requirement” from the police. To suggest, therefore, that critics of accreditation would rather have no conference at all is a contemptible piece of sophistry.

So was the argument I heard from one member of FCC today that the nature of some of the people outside the security barriers should be seen as a reason to want accreditation. Either this is supposed to imply that soon everyone who comes within a mile of conference should have to be vetted, or this is merely highlighting the limitations on the effectiveness of this kind of measure anyway. The saddest part of this is that some of the people arguing the FCC line didn’t even look much like they were convincing themselves.

Ultimately, then, I find it hard to conclude that the vetting system is anything other than a piece of security theatre, and a damaging one at that.

And don’t even get me started on the patronising bollocks from a couple of people today who denied the very existence of anyone who had stayed away from conference because they didn’t want to submit to the process. Those people deserved all the angry heckles they got today.

Thoughts from Lib Dem Conference #ldconf

This year’s Lib Dem spring conference was an interesting affair. Here’s a few thoughts about it:

1. The narrative of the party leadership.

The tone of much of what the party’s coalition frontbench is saying is not massively changed, but there has been an evolution if not a revolution. As was widely called for and predicted 6 months ago, the penny seems to be starting to drop about the need to start to “badge” (to borrow Tim Farron’s phrase) more of our policy achievements in government as Lib Dem wins, whilst avoiding the potential pitfalls of exposing the push and pull at the heart of the government too much. In particular, the approach of Nick’s leader’s speech was subtly shifting in this direction, and where previously it was notable that he barely said anything disapproving about the Conservative party 6 months ago, today we saw him, if not laying into the Tory party, at least feeling able to start to express explicit differences.

The main shift by the party leadership, though, was in tone rather than content. More than once, we were urged to “keep your heads up”, not to apologise for being in government. I think this must be right, at least to some extent. 90% of communication is nothing to do with the actual content of what we say, after all. Rather, it is to do with the way we say it. Too often, “we didn’t win the election”, “it was the best we could do in the circumstances” etc. sound like cringing apologies for our part in government. They may be factually correct, but if it sounds like we’re trying to convince ourselves because we’re a bit down about the difficulties of government, it’s not likely to win many people over. What was noticeable about this change of tone is that it was ubiquitous across the spectrum of the party’s leading lights, not just from the cabinet ministers.

2. The battle for the ongoing identity of the party – a rise in social / economic liberal factionalism?

One consequence of coalition, it seems, is going to be the dredging up of old dividing lines within the party, as people try to win the battle for the “direction” of the party in the future. The drive for this seems to spring from suspicion of the party leadership, which I suspect is inevitable in the circumstances of a coalition. Much of our faith in Nick at the moment rests on what we as members believe he is doing within government behind closed doors. People don’t know what to make of Nick’s attempts to find intellectual common ground with the Tories. Some worry that in fact, Nick wants to shift the party to the economic liberal end of the spectrum, and he secretly agrees with some of the Tory policies we would like him to oppose. Others, meanwhile, accept that Nick respects the existing balance of opinion within the party, and is not trying to move us anywhere, merely to paint the party for the moment in a light which makes sense of the coalition.

I had, in the past, generally accepted the argument that the line between social liberals and economic liberals in the party was overplayed. Sure, there is a spectrum of thought in the party on some issues, but liberalism isn’t primarily about the left/right divide, it defines itself against authoritarianism – it lies on a different axis. I still believe this, but as the party tries to reassert its identity it is perhaps inevitable that it is going to end up pulling away from the centre of gravity of the coalition government.

Thus, we have seen a resurrection of the struggle between liberalism and social democracy within the party, with many within the party, consciously or not, playing up to these terms. The Social Liberal Forum, for instance, and many other members of the party, spent the weekend trying to reassert the values of what they insist (probably correctly) are the mainstream of party opinion. Speeches were heard in the debate on the strategy paper bemoaning the lack of reference to social democratic traditions from the leadership of the party. As if to underline their point, Nick then spoke in his speech of the great intellectual history of the Liberal party, but not so much of the social democratic tradition.

Partly, though, this is because Nick’s mission in his speech was to set out a coherent narrative of who the party is for and what it believes, whilst at the same time maintaining the intellectual coherence of the coalition’s joint programme. The language of the party’s liberal inheritance makes this easier; I personally don’t think Nick is deliberately shunning the other side of the party’s roots – indeed, quoting Shirley Williams in this context rather masterfully downplayed the significance of the divide.

Lastly on this point, it’s probably worth pointing out that, had we been in a parallel universe where we now found ourselves in coalition with Labour, I very much suspect that the economic liberals in the party would very similarly be decrying an over-emphasis on social democracy at about this point in time. I think this kind of ideological rebound is likely to be an inevitable feature of coalition for our party, and I don’t know that there’s much Nick or anyone else can do about it.

3. The NHS amendments and the risks of “going native”.

One problem for our ministers, it seems, is the risk that they may be perceived to be “going native” in their departments. In particular, many of the people with concerns about the Lansley reforms have been getting the impression that Paul Burstow pretty much approves of the policies in the proposed NHS reforms, rather than regretting that they are not in line with many aspects of Lib Dem policy. I rather get the impression that he is much keener on the reforms than Nick Clegg ever was. But of course, I have no idea what Burstow might have privately been saying to Andrew Lansley and his other Tory colleagues in the Department of Health. This, really, is the problem our frontbenchers have. We simply have to take it on trust that they don’t really believe everything they have to say as coalition ministers.

That NHS motion in full #ldconf

Just for the record, I thought I’d post the motion on the NHS which conference actually passed (as amended and with lines rejected in a separate vote removed), since I’m not really sure where it is that one finds this information online. I’ll be writing a proper post about this motion and several other things besides later, once I’ve got my thoughts in order a bit more.

F5 Updating the NHS: Personal and Local

Conference believes that the NHS is an integral part of a liberal society, reflecting the social solidarity of shared access to collective healthcare, and a shared responsibility to use resources effectively to deliver better health.

Conference welcomes our Coalition Government’s commitment to the founding principles of the NHS: available to all, free at the point of use, and based on need, not the ability to pay.

Conference welcomes much of the vision for the NHS set out in the Government’s White Paper, Equity and Excellence: Liberating the NHS, which commits the Government to an NHS that:

i) Is genuinely centred on patients and carers.

ii) Achieves quality and outcomes that are among the best in the world.

iii) Refuses to tolerate unsafe and substandard care.

iv) Puts clinicians in the driving seat and sets hospitals and providers free to innovate, with stronger incentives to adopt best practice.

v) Is more transparent, with clearer accountabilities for quality and results.

vi) Is more efficient and dynamic, with a radically smaller national, regional and local bureaucracy.

vii) Gives citizens a greater say in how the NHS is run.

Conference particularly welcomes the proposals to introduce real democratic legitimacy and local accountability into the NHS for the first time in almost forty years by:

a) Extending the powers of local authorities to enable effective scrutiny of any provider of any taxpayer-funded health services.

b) Giving local authorities the role of leading on improving the strategic coordination of commissioning across the NHS, social care, and related childrens’ and public health services through councillor-led Health and Wellbeing Boards.

c) Creating Health Watch to act as a local consumer champion for patients and to ensure that local patients are heard on a national level.

d) Returning public health duty to local government by ensuring that the majority of public health services will now be commissioned by local authorities from their ring-fenced public health budget.

Conference recognises however that all of the above policies and aspirations can be achieved without adopting the damaging and unjustified market-based approach that is proposed.

Conference regrets that some of the proposed reforms have never been Liberal Democrat policy, did not feature in our manifesto or in the agreed Coalition Programme, which instead called for an end to large-scale top-down reorganisations.

Conference therefore calls on Liberal Democrats in Parliament to amend the Health Bill to provide for:

I) More democratically accountable commissioning.

II) A much greater degree of co-terminosity between local authorities and commissioning areas.

III) No decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed GP consortia.

IV) The complete ruling out of any competition based on price to prevent loss-leading corporate providers under-cutting NHS tariffs, and to ensure that healthcare providers ‘compete’ on quality of care.

V) New private providers to be allowed only where there is no risk of ‘cherry-picking’ which would destabilise or undermine the existing NHS service relied upon for emergencies and complex cases, and where the needs of equity, research and training are met.

VI) NHS commissioning being retained as a public function in full compliance with the Human Rights Act and Freedom of Information laws, using the skills and experience of existing NHS staff rather than the sub-contracting of commissioning to private companies.

VII) The continued separation of the commissioning and provision of services to prevent conflicts of interests.

VIII) An NHS, responsive to patients’ needs, based on co-operation rather than competition, and which promotes quality and equity not the market.

Conferences calls on:

1. The Government to uphold the NHS Constitution and publish an audit of how well organisations are living by its letter and spirit.

2. Liberal Democrats in local government to establish local Health and Wellbeing Boards and make progress developing the new collaborative ways of working necessary to provide joined-up services that are personalised and local.

3. The government to seize fully the opportunity to reverse the scandalous lack of accountability of publicly-funded local health services which has grown up under decades of Conservative and Labour governments, by:

a) Ensuring full scrutiny, including the power to require attendance, by elected local authorities of all organisations in the local health economy funded by public money, including Foundation Trusts and any external support for commissioning consortia; ensuring that all such organisations are subject to Freedom of Information requirements.

b) Ensuring Health and Wellbeing Boards (HWBs) are a strong voice for accountable local people in setting the strategic direction for and co-ordinating provision of health and social care services locally by containing substantial representation from elected local councillors; and by requiring GP Commissioning Boards to construct their Annual Plans in conjunction with the HWBs; to monitor their implementation at meetings with the HWBs not less than once each quarter; and to review the implementation of the Annual Plan with the HWBs at the end of the year prior to the construction of the Annual Plan for the forthcoming year.

c) Ensuring commissioning of health services has some degree of accountability by requiring about half of the members of the board of commissioning consortia, alongside GPs, to be local councillors appointed as non-executive directors.

d) Offering additional freedoms only to Foundation Trusts that successfully engage substantial proportions of their local populations as active members.

Why Can’t Britain Do The Daily Show?

I wasn’t in to see 10 O’Clock Live on Thursday, so I’m a bit late in reacting to it, and it’s probably not fair to judge it on the very first episode. But when has that ever stopped anyone?

Well it certainly wasn’t terrible, I guess. I should probably preface this review by saying that I would dearly love the UK to have an answer to The Daily Show in the US, which I think is brilliant. I would be quite happy to see some brave network simply import the format wholesale, so long as they did it right. I accept that not everyone wants to spend their career simply trying to make a carbon copy of someone else’s success, though, so I’m not going to insist that 10 O’Clock Live be that show. It clearly is trying to be something a bit like it, though, and for that I have both a lot of goodwill towards it, and a lot of points where I really wanted it to be better. I will identify some of the areas I think it needs to work on to take on the best aspects of the Daily Show.

Some people, like Mark Lawson, thought it was an issue that the programme had a pretty consistent liberal leaning to it, but I’m not sure that’s such a problem. For one thing, I actually thought David Willetts did pretty well on the tuition fees interview, in what could have been a very hostile environment (how many politicians would relish being interviewed in front of a rowdy studio audience by a well-liked comic?).

In any case, Conservative-leaning satire has always been rather unloveable, largely because it tends to revolve around mocking the weak and the vulnerable. As many people pointed out, the Daily Show has a similarly liberal slant to it, and the Colbert Report, ostensibly a kind of Republican balance to the Daily Show’s leftish sensibility, doesn’t really balance the situation out because it revolves around a bloviating Glenn Beck-alike character as a presenter, which is clearly intended to be appreciated on an ironic level. But I digress.

Most of the British attempts to Do Something A Bit Like The Daily Show have run into a couple of depressingly familiar stumbling blocks. And by the way, there have now been a number of attempts to get a topical, satirical, spoof-news ‘n’ interviews format like this going – see also the laudable The Late Edition (a BBC4 Marcus Brigstocke-led effort), and Channel 4’s previous effort, the abysmal Tonightly and its successor The TNT Show.

Problem 1: They have tended to talk down to the audience. Much has been made of the fact that in the US, viewers of the Daily Show and Colbert Report have been found to be better informed about current affairs than people who primarily get their news from more conventional sources, like the mainstream network news channels. Of course, correlation is not causation, and it might be because the Daily Show has a high student audience, for instance.

It’s probably not just that, though. Often you will see more coverage of what is said in Congress on the Daily Show than you do on other news reports – admittedly cherry picked for stuff which is easily mocked, but still. Interviews with academics and people who have written interesting, and not at all mainstream, books, are also a regular fixture, although admittedly they vie for time against interviews with film stars about their latest movie. The jokes on the Daily Show don’t sound like someone is trying to make a dry subject palateable to an audience which is otherwise too lumpen and incurious to care; the best of the Daily Show assumes that you already do know and understand something about the issue it is addressing, even when discussing geopolitics with former presidents.

Compare and contrast this approach with both Jimmy Carr’s bit on Tunisia-as-holiday-destination, and Lauren Laverne’s sleb-news spoof about Sudan’s vote for independence. 10 O’Clock Live does not come out of this comparison at all well, given that we are a country which would like to imagine it is culturally more sophisticated. I mean, come on, 10 O’Clock Live even opened with a kind of mission statement that they were here to explain the complicated world to us poor, addled simpletons.

Of course, 10 O’Clock Live has a challenge, in that Britain has news programmes from the BBC and Channel 4, whereas the US… doesn’t. That shouldn’t stop them from aspiring to hold that same position, though. Programmes like this don’t really work when they try for a mass audience. They work best when they appeal directly to an audience who are educated, interested, and don’t want to feel like they are being edutained at a level which is one or two levels down from anything they might actually find in the least bit informative.

Problem 2: Often, British shows try to start off being weekly, which just doesn’t really work very well. I think to really establish itself, a network just has to have the balls to really commit, and go straight for a nightly show. Tonightly at least got this bit right – its problem was simply that it suffered horrendously from Problem 1. Anything which wants to be The British Daily Show just has to go big or go home. It needs a big, intelligent writing team, and it needs to churn out good content on a daily basis, like the Daily Show somehow manages to.

In addition to these common problems, 10 O’Clock Live seems to have given itself a bit of a problem of its own. Its mutli-star format seems like a bit of an encumberance, at least in the way they have construed it. If I was to cast a British Daily Show, I can’t think of many people better suited to be Jon Stewart than David Mitchell. Charlie Brooker would certainly feature as a regular correspondant. But I’m not so sure about Jimmy Carr, although he certainly wasn’t a disaster. Lauren Laverne isn’t known as a comic, and felt rather as though she’d been chucked in for gender balance (which is a fair point, but surely the answer is to use one of the many good female comics who’d do well on a show like this) and to play the straight-woman to the other three, which seems a rather thankless task.

I wasn’t sure about their semi-funny, semi-earnest discussions around the table, either. These seemed a bit… neither nowt nor summat.

But still, it’s early days. With a bit of luck some of these crinkles will be ironed out in time. And of course, much of the charm of the Daily Show is in the way it has established long-running characters and features, and found its voice over many years. It wouldn’t quite be fair to expect this of 10 O’Clock Live straight away, when they haven’t had time to establish themselves.

So, my prescription:

1. Nightly, not weekly.
2. Talk up to the audience.
3. Cut down on the number of “hosts”, and redeploy some of them as more confined contributors – Charlie Brooker, much as I love him, is much better scripted than off the cuff, IMO.
4. Bring in more contributors, too. Why not show off some of the great, intelligent comics Britain has? MacIntyre types have plenty of formats that serve them well, but what about the less observational, more thoughtful ones? I would have thought this would be right up any number of people’s streets.