Editor's blog Monday 21 February 2011: PM Cameron tries to sell reform a different way

For the first time, the Coalition Government appears to be under significant external pressure on NHS policy.

They may come to regret their efforts in 'explain NHS reform' week.

Prior to that, beyond the small but perfectly-formed world that we know and love as policyland, few people understood or indeed greatly cared about the financial flows or management of the NHS.

Today, PM David Cameron is spending more of his political capital with this opinion piece for the Telegraph promising private sector providers are to have a right to bid for public sector contracts.

Comments are in bold

How we will release the grip of state control
A new White Paper will decentralise public services and replace targets with common sense.

Ah, 'common sense': the great oxymoron of those whose arguments stand little scrutiny. I have no idea why you want to do this so far.

A week ago, I made clear that while the urgent priority of this Government is clearing up the mess Labour made of our economy, my mission in politics is to repair the breakdown in our society: the family breakdown and community breakdown that has done so much damage to people's lives – not to mention the costs that our deep social problems load on to the state.

Yes, I distinctly remember Labour engineering the global collapse of banks due to collateralised debt obligations of sub-prime US mortgage securities passing contagion through the international financial system - that is exactly what happened. (If that argument gets any less rational, I'll expect to start hearing about The Protocols Of The Elders Of Zion.)

I have no idea how you define a 'broken' society; nor indeed more pertinently what broke it. I have no idea why you want to do this so far.

The idea at the heart of this – the Big Society – is about rebuilding responsibility and giving people more control over their lives. But that doesn't just apply in areas like volunteering. It's as relevant when it comes to public services and the decentralisation of power. Indeed, I would argue that our plans to devolve power from Whitehall, and to modernise public services, are more significant aspects of our Big Society agenda than the work we're doing to boost social action.

Once more with feeling: what's the difference between the Big Society and the Big Issue? Some people buy the Big Issue.

The utter indifference of most people to the Big Society concept as presented, combined with platoons of experts in social action pointing out that cuts to local government funding are having the effect of neutering the Big Society in this field, ought to give you a clue that linking Big Society and public services could well be political anthrax.

We will soon publish a White Paper setting out our approach to public service reform. It will put in place principles that will signal the decisive end of the old-fashioned, top-down, take-what-you're-given model of public services. And it is a vital part of our mission to dismantle Big Government and build the Big Society in its place.

That last phrase is very telling - "dismantle Big Government and build the Big Society in its place". We have no evidence that the Big Society works. Enthusiasm for it is scarcely contagious.

So the motivation is ideology, rather than using evidence to design better delivery of value for taxpayer money. Good that we have clarity on that.

This change is long overdue. We all know the damage caused by centrally controlled public services.

No we don't. You have asserted it; not proved it. Central control created the NHS - which is your political priority, apparently. Lytton Strachey did say that 'the sign of a first-class mind is the ability to hold two contradicting ideas at the same time' - but he was using irony.

As a backbench MP, I campaigned vigorously against the arbitrary closure of special schools, which deprived so many parents of the choice they wanted. During the election, I lost count of the number of parents who complained to me about their inability to find a decent state school for their child.

That is vastly conflating two different issues: arbitary closures (which nobody would justify), and poor quality in state schools (which is generally agreed to be most strongly associated with areas' socio-economic status and pupil mix). Both very real issues; no evidence of Big Society and decentralisation being the answer to either.

And though I was always so grateful for the tremendous care my eldest son received, I never understood why local authorities had more control over the budget for his care than Samantha and I did.

Are you unaware of the piloting of personal budgets in social care? And the intention of the last Government (in their moments out from wrecking the global banking system) to pilot the same in areas of health?

In the past decade, stories about bureaucracy over-ruling common sense, targets and regulations over-ruling professional discretion, and the producers of public services over-ruling the people who use (and pay for) them – became the norm, not the exception. This might have been worth it had it led to dramatic improvements, but the evidence shows otherwise. Whether it's cancer survival rates, school results or crime, for too long we've been slipping against comparable countries.

In NHS outcomes, it's worth noting that the Kings Fund's iridescent chief economist Professor John Appleby pointed out in the BMJ that your arguments on this are very weak For cancer, check out the figures in the Wanless Reports about the NHS underspending backlog in the 1980s and 1990s, relative to comparable European countries.

That's why we need a complete change,

What, because of cherrypicked misleading evidence, assertion and dogma? Marvellous.

and that's what our White Paper will bring. The grip of state control will be released and power will be placed in people's hands. Professionals will see their discretion restored.

Have you ever met any doctors? These are not people who have lacked professional discretion. Ask NHS managers.

There will be more freedom, more choice and more local control.

And more variation, postcode lotteries and less democratic accountability (certainly in the 'liberated' NHS).

Ours is a vision of open public services – and we will make it happen by advancing some key principles.

The most important is the principle of diversity.

Diversity isn't a principle; it's an abstract noun. This is more 'heir to Blair'ism - there was a man who waged war on an abstract noun - terror. Not, perhaps, the most auspicious of strategies.

We will create a new presumption – backed up by new rights for public service users and a new system of independent adjudication – that public services should be open to a range of providers competing to offer a better service.

Openness to a range of providers is not new in health. Labour introduced it in 2006, rolling it out in 2008. Labour also introduced rights for users in the 2008 NHS Constitution.

Of course there are some areas – such as national security or the judiciary – where this wouldn't make sense. But everywhere else should be open to diversity; open to everyone who gets and values the importance of our public service ethos. This is a transformation

Not in health it isn't.

: instead of having to justify why it makes sense to introduce competition in some public services – as we are now doing with schools and in the NHS – the state will have to justify why it should ever operate a monopoly.

It doesn't operate a monopoly. GPs are competing private businesses; they just tend not to compete - which might be a sign of something. In acute provision, there hasn't been a monopoly in health since Labour's 2003 creation of foundation trusts, which you opposed.

This is vital to give meaning to another key principle: choice.

See above: abstract nouns are not principles. Choice, like diversity, is a means; not an end. Principles are ends.

Wherever possible we will increase it, whether it's patients having the freedom to choose which hospital they get treated in

You're giving people something they already have? How radical!

or parents having a genuine choice over their child's school.

And to give our principle of choice real bite, we will also create a new presumption that services should be delivered at the lowest possible level. Working from this presumption, we will devolve power even further. For example, we will give more people the right to take control of the budget for the service they receive. In this new world of decentralised, open public services it will be up to government to show why a public service cannot be delivered at a lower level than it is currently; to show why things should be centralised, not the other way round.

Sigh. Have a look at the primary PCI reconfiguration in London - the story of which your Health Secretary misrepresents. Or at the London stroke reconfiguration, or paediatric cardiac surgery.

Of course, the state will still have a crucial role to play: ensuring fair funding, ensuring fair competition

That is surely the role of regulators?

, and ensuring that everyone – regardless of wealth – gets fair access. But these important responsibilities for central government must never become an automatic excuse for returning to central control. That's why our Open Public Services White Paper is so important. The principles it sets out will make it impossible for government to return to the bad old days of the standard state monopoly.

Which in health, does not exist.

This is not about destabilising the public services that people rely on

Ahem ...

; it is about ensuring they are as good as they can be. These are practical reforms

You haven't come close to proving that, in this article or elsewhere

, driven by a clear rationale that the best way to raise quality and value for money is to allow different providers to offer services in an open and accountable way.

You haven't come close to proving that, in this article or elsewhere

Our public services desperately need an injection of openness, creativity and innovation.

You haven't come close to proving that, in this article or elsewhere

These reforms will bring that – and that is why I am determined to see them through.

Dear oh dear.