People already vote preferentially

The arguments advanced by both the Yes and No campaigns in the AV referendum concentrate on the perceived benefits of both systems currently under scrutiny, but neither of them consider the evidence of what people actually do when they have the opportunity of expressing different choices on the same ballot paper.

In a minority of Councils there are all-out elections every four years. This is the case in London, and last year on the same day as the General Election the 32 London boroughs held elections, usually for three councillors in each of their wards. Electors are told they can vote with crosses for up to three candidates that are listed alphabetically by surname.

Most of the parties nominated three candidates in each ward and encouraged their supporters to use all three of their votes for their listed candidates. No party campaigned on the principle that voters can and should vote for candidates from different parties on the same ballot paper. However, although no party made this suggestion, thousands of voters across London made the decision to split their votes for candidates for two or even three parties.

In my own ward of West Hampstead in the London Borough of Camden voters had to make a single choice for their preferred MP, but on the same day and within seconds of completing their ballot in the parliamentary election, many voted for a "pick and mix" slate of Council candidates. In West Hampstead our Liberal Democrat campaign managed to secure 1,316 supporters who voted for the three Lib Dem candidates. But the counting of the Council election voting papers then went into the more complex procedure of counting the split ballots, where voters had decided to vote for a combination of candidates (or only one or two) which did not match the party slates.

On the split ballots I received an additional 745 votes which placed me at the top of the poll with 2,061. But that means around 36% of those who voted for me also voted for a candidate from another party. And don't forget this was at a time when every party was saying "only vote for us". No one was advocating splitting votes. No one mentioned this in conversations on doorsteps or in campaign leaflets. This was the electors making their own sophisticated judgements about the mix of parties they preferred.

I think this demonstrates there is a clear appetite for voters to choose to vote preferentially for candidates from different parties. Just think what would happen when candidates in an AV election had to reach out to attract "2nd preference" votes from other parties' supporters.

The appetite for preferential voting is already there and it's about time the politicians learned a lesson from the voters.

Why the Secretary of State has damaged our health

(The following article has been submitted for publication in Liberator magazine)

The Liberal Democrats Spring Conference in Sheffield was much enlivened by a first class debate on a motion entitled “Updating the NHS: Personal and Local”. The Liberal Democrat Health Minister Paul Burstow was forced to accept two amendments to avoid the humiliation of losing a vote by an overwhelming margin. Both amendments in their different ways aimed to increase the accountability of local institutions and were in line with the party’s manifesto commitment to democratise local PCT’s.

Strengthening the role of scrutiny by local Councils had been a message heard loud and clear by our Health Minister in official submissions from local authorities to the earlier White Paper and from individual councillors (like myself) at the Liverpool conference. Paul has listened to this point and the Bill now does provide greater scope for scrutiny as a separate function from that envisaged by Health and Wellbeing Boards within Councils. The motion at conference stressed this by welcoming the proposals to enable local authorities to effectively scrutinise “any provider of any taxpayer funded health services”. So far, so good.

The amendments at conference wanted to strengthen all this further by making sure that democratically elected individuals were involved in every stage, not just in scrutiny, but through “councillor-led” Health and Well Being Boards and with places on GP Commissioning Consortia too.

The debate in Sheffield also highlighted a widely shared hostility to the concept of “any willing provider”, which is possibly the most controversial concept in the Bill. There is a great concern that private operators will cherry-pick the routine operations to make money out of high volume work, leaving complex and serious conditions to be catered for in the public sector.

The last Labour Government had already promoted this private sector entryism into the health market by guaranteeing fees to private operators that were above the standard tariffs agreed for NHS hospitals. The conference was relieved when this was criticised by Paul Burstow but one has to remember that the fixed tariff system only covers around 30% of current procedures, so there is still room for the profiteers from the private sector to make money in any newly created health market.

Openness and transparency was another theme highlighted by the amendment sponsored by the Social Liberal Forum. This called for meetings of GP Consortia to be open to the public. But one has to remember in calling for changes of this sort that we have secretive GP practices now. Each practice acts as a separately traded business with no openness with regard to its business operations. While General Practice accounts need to be registered with their local PCT they are private and confidential and no one really knows how much the partners are paying themselves, and how much they are re-investing in their practice facilities, except the PCT which is not at liberty to reveal all. (There may be some principled GPs in the country who are willing to reveal their accounts but it is not the norm in my part of London.)

Paul Burstow and Nick Clegg might well feel emboldened by the clear messages from conference to seek major changes to the Bill, bearing in mind this top down reorganisation was specifically ruled out by the Coalition Agreement, but I fear the real damage to our health service has already been done by another decision of the Secretary of State which I presume had Paul Burstow’s blessing.

My local PCT in Camden was ordered by Andrew Lansley to make 54% cuts in management costs this year. That meant that by the end of the financial year about to close as I write this, 54% of the staff were to be made redundant. There would be some natural wastage and some voluntary redundancies of course. But anyone reading this with any experience of local government efficiency savings, where 10% cuts in staff in one go are just about manageable, could only describe cutting out half your staff in one go as anything but “slash and burn” on an epic scale.

There are several risks involved in doing this. Some staff with commissioning experience might jump ship and start working for the “any willing providers”, helping them to find the corners to cut. Others might be so disheartened by yet another health reorganisation that they seek employment in another field entirely or retire to look after their gardens, their expertise lost forever.

The remaining staff are required to soldier on with the specific task of helping the GP Commissioners take on their responsibilities while at the same time looking forward to losing their own jobs by 2013, which is hardly a great incentive to go the extra mile.

Health if anything is a people business. For successful commissioning we need to have the right people with the right skills carrying out the right tasks to secure good and improving health outcomes, while achieving good value for the taxpayer.

This will not be achieved in my view by a bunch of well-meaning GPs with little training, without a team of experienced commissioning staff who know and understand the intricacies of health contracts. What cannot be guaranteed by this imposed revolution from the centre is that we will end up with commissioning teams that secure both improving health outcomes for patients and good value for the taxpayer because the transfer of the right people in an orderly fashion from the PCTs to the GP consortia is not guaranteed.

It does not matter if the final Bill passed by Parliament establishes that the award of contracts will be on quality rather than cost, because if the contract specification is not written correctly the snags will emerge after the contracts are in place. Anyone with local government experience will know that out-sourcing contracts for services like refuse collection and recycling, or housing maintenance, are fraught with dangers. The so-called “best value contractor” will often be commissioned but when the operation appears not to be working the contractor nearly always has an excuse along the lines of - “what you have now requested is not in the contract but we can now do it for you, but it will cost you extra...”

Having councillors added to commissioning boards might bring some worldly wisdom to these decisions, but it is whether commissioners secure the expertise of those who can write watertight contracts which will determine whether this whole experiment will succeed or fail, and with half the available staff already lost from PCTs I think the die is already cast.

Another area which is fraught with difficulty is the way in which specialist and low volume treatments will be commissioned in the future. In recent years in London the treatment of cardiac arrests, major trauma and strokes have been significantly improved through commissioning on a regional basis. For example one of the great success stories now emerging demonstrates that creating eight Hyper-Acute Stroke Units in the capital has radically improved survival rates. The proposals were developed by Healthcare for London, an off-shoot of the strategic health authority which was answerable to the joint committee of PCTs in London and scrutinised by a pan-London Joint Health Overview and Scrutiny Committee (JHOSC) on which I served as Camden’s representative.

How will proposals for improving specialist acute services be developed in the future? It may be that the NHS Commissioning Board might create local outposts to lead on these developments, but where will the boundaries lie with GP Commissioning Consortia? And how will these developments be scrutinised? Local authorities are increasingly stretched for resources to undertake their scrutiny duties as they are now. If the Government is serious about strengthening scrutiny, and to create quality pathways for acute services, then there is more work to be done and more resources are needed.

I suppose the summary of what I am saying is that if the conference decisions lead to real improvements to the Bill then that is to be welcomed. But, as the saying goes, “if I wanted to get there I wouldn’t have started from here”. Sacking half of the PCT staff before embarking on this change to the commissioning arrangements was clearly the wrong step in the wrong direction at the wrong time.

We might be able to muddle through. The NHS has made great improvements in the past, often despite the meddling of Secretaries of State and not because of them, but does the service have the capacity to do this one more time?

And do we as Liberals in Government for the first time in 70 years want our first term legacy to be a reasonably managed muddle?

Stop the World I want to get off..

Since the turn of the year, I cannot believe how busy I have been. January is usually a slowly paced month, planning for school meetings that normally become congested in March. But I had a rude awakening on 4th January, the first day of the spring term with a succession of phone calls and e-mails announcing the suspension of my friend Alan King as the headteacher of Furness Primary School.

This set off a flurry of activity for the Governing Body with three special meetings in quick succession and a protracted correspondence with Brent's Director of Education. Not only was the headteacher suspended (and at the time of writing still is), but the Director decided to apply to the Secretary of State to dismiss the Governing Body as well. I had already decided that if that happened, I would not offer myself to clerk the Interim Executive Board that would succeed the Governing Body, and so it is with some regret that I now believe I have ended my association with the school after being its clerk for 22 years.

It is a great pity. I do not believe the current investigation into the headteacher's management of the school will uncover anything of any great seriousness and I reckon the Governing Body's performance was no worse than many others in this area. Alan King always had a great line in conspiracy theories, which always appeared to become more outlandish as the rounds of drinks quickened at his local. And so after knowing him for over 20 years I usually took a lot of what he said with a pinch of salt. This time perhaps his theory was right all along.

Anyway that is what kept me busy in January, and the ever complex health agenda also provided a lot of extra work in the opening months of the year. I confess I also took my usual winter break in February to my favourite hotel in Lanzarote and managed to read five hefty novels of varying seriousness while I was there. But one downside this year was the impact of now owning an iPhone on which I can now screen my e-mails. A holiday is not quite the same when you are still in contact, on an hourly basis, with work and colleagues back home.

Since being back, I have returned to a frenzy of work with the more usual high number of governing body meetings taking place. The Council's budget-setting process created a flurry of activity within the Liberal Democrat Group, so much so that I was checking a suggested budget amendment at midnight while standing at baggage reclaim in Gatwick after returning home.

Is the world speeding up? It certainly feels like it. Many people tell me they think the years get faster as you approach retirement. But why do we have this frantic obsession with activity that keeps us moving like manic hampsters on spinning wheels?

Why indeed do I have massive feelings of guilt when I sit idly for 20 minutes? I have always juggled a number of plates in the air, keeping my schools business, Council work, and social life on track through careful diary planning, but what I have never done is build in "lazy time".

Should I now begin the slippery slope towards deliberate downsizing? Not in the sense of moving down the property ladder, because anything smaller than my flat would be a bedsit, but downsizing the number of things I intend to do and plan for in the diary? But could I ever get used to a diary page with blank spaces in it? And what exactly is being lazy? Is that the first step towards staring vacantly into space, and falling asleep in the afternoons? My grandparents used to do this, leading to low sniggering from the rest of the family, but now my parents do too.

How soon will it be my turn?

The Minister listened!!

I have been a particularly ebullient critic of the Coalition Government's White Paper on Health in the last few months. (see earlier blog entries.)

Today the Government published its formal response document to the consultation process. I was involved directly, taking part in a Consultative session with Paul Burstow at the Liberal Democrats annual conference in Liverpool and in a private session with him later on, and I also helped to frame the official consultation response by Camden Council.

In the published response today Camden get a specific mention -

"Some respondents, for example Camden Council, wanted the Government to “require local authorities and health commissioners to pool resources”. Although we do not think this is practicable, we understand the sentiment. As Solihull Care Trust suggested, “local authorities will struggle to co-ordinate commissioning without a commitment from partners to joint/pooled budgets”. However, we agree with Suffolk and Great Yarmouth LPC when they say that “integrated working depends on the quality of local working relationships and although the Department can outline areas where integrated working is required this should not be too restrictive to prevent local innovation to occur”. This is backed up by the Lesbian and Gay Foundation’s suggestion that “lead commissioning and other flexibilities should be explicitly promoted and supported by the Department for the delivery of high quality community based specialist services”. Staff at Norfolk PCT echoed the views of many NHS respondents when they welcomed “the opportunity to increase dialogue between services and join services together for the good of patients”. The Bill will therefore place a duty on GP consortia and local authorities, through the health and wellbeing board, in drawing up the joint strategy, to consider how to make best use of the flexibilities they have at their disposal, such as pooled budgets. To reinforce this duty, the Department has also decided that the NHS Commissioning Board should be placed under a duty to promote the use of flexibilities by consortia. These duties do not require flexibilities to be used, but they signal the importance of maximising the use of the tools available.

And the views of Southampton City Council were identical to ours on the need for "compliance" of GP Consortia to follow the Joint Strategic Needs Assessment (or JSNA). The relevant sections in the response paper today are these -

"In the reformed system, the process and product of the joint strategic needs assessment takes on much greater importance. The health and wellbeing board will have a role in helping meet the need - expressed by the NHS Confederation and others - for GP consortia to have “access to public health expertise so that they can take a population health viewpoint, in particular access to epidemiological advice and insight into parts of the population that are either unregistered or invisible to general practice”, through for example the Director of Public Health being a member of the board. As Southampton City Council has suggested, the focus on the JSNA will help “ensure that GP consortia take commissioning decisions based on the overall needs of the population in future rather than the needs of their current set of patients”.

5.20 The Government fully agrees with the view of the Association of Directors of Adult Social Services that “all commissioning should be driven by the JSNA or shared assessments across local authority boundaries, whether these are GP commissioning, council commissioning or joint commissioning”. Many respondents, for example the Association of Directors of Public Health, Nottingham City Council, Oldham PCT, and Peterborough City Council, felt that the value of the JSNA could be enhanced by clearer expectations about its use within commissioning plans. The point is well made. At present JSNA obligations extend only to its production, not its application. To remedy this lacuna, the Government is therefore introducing in the Bill a new legal obligation on NHS and local authority commissioners to have regard to the JSNA in exercising their relevant commissioning functions.

Added to this was a commitment to strengthen the distinctive role of Scrutiny Committees, including the ability to scrutinise the decisions of GP Commissioners.

So we made some progress. And it's good to note that the Coalition actually listened to the responses and adjusted their approach accordingly.

JOHN BRYANT

Let's stage a World Premiership instead!

The huge disappointment of England not being chosen as the 2018 host for the World Cup has led on to some angry criticism of FIFA and it's internal workings. Corruption of officials appears to have been fully uncovered by the Sunday Times and BBC's Panorama programme.

However the argument that investigative journalism should be restrained out of patriotic interest is in itself suspect. If we had won the nomination through a corrupt process, then how could we then be proud of the outcome? England offering a friendly against Thailand in exchange for a vote is as corrupt in my book as a brown envelope stuffed with cash to a FIFA representative.

The exhaustive ballot process is also inefficient and suspect. I noticed that in the vote for the 2022 tournament Qatar actually lost a vote between two stages. Use of the Alternative Vote would stop all attempts of later stage tactical voting, as the losing country's votes would automatically transfer to later pre-registered preferences.

Given the total lack of confidence many nations (at least of a democratic variety) now have in FIFA, it is time for English football to replicate its own previous rebellion when the leading clubs rebelled against the Football League and set up their own tournament.

Surely it is time the English FA formed a World Premiership tournament to take place in England during one summer when the Olympics and World Cup will not be taking place - perhaps in 2013? We already have the stadiums and training facilities to stage a tournament. It could be by invitation only to the world's top 16 footballing nations, taking account of the most recent regional tournaments such as the African Cup of Nations, Euro 2012 and the South American and Asian equivalents.

For some countries it might prove to be a useful trial run for the Brazil World Cup in 2014, but it might find its own momentum as a genuine alternative to FIFA's suspect package. After all we had significant splintering of the world titles in boxing some years ago and so the precedent is set for staging an alternative to the "official" tournament.

If FIFA threaten to exclude the top nations who choose to take part in the World Premiership then the top nations should walk. The TV companies know where the money will be and they will choose to show the best football they can to their subscribers.

So does anyone in the English FA have the guts to lead on this?

Who is ready for a public meeting?

It was curious to note that although we had around 80 residents who turned up on a cold night for the Area Forum in West Hampstead on Monday hardly anyone had been attracted to come by reading about the event on Twitter or Facebook. While most of our citizens are using e-mail these days there still seems to be a generation gap between those who are attracted to attend a traditional public meeting to keep up to date with current affairs, and those who aren't. The latter appear to be under-45, and are ready to post their opinions on social networking sites, but won't push through the doors of a community hall of an evening.

The same generation gap is sadly affecting the active membership of traditional residents and amenity groups too. I attend a fair number of community meetings as a councillor but I know there is a significant demographic I rarely come across. Within the boundaries of West Hampstead ward we have a higher than average number of people in the 25-34 age group compared to the population as a whole, but these are precisely the people we don't see taking part in community groups.

Many will be transient because of their work, so do not settle in the area, and therefore take less interest in local affairs. Those who put down their roots by buying a property or by having permanent tenancies are those who tend to join in. The only exceptions to my thesis are those who have children of primary school age and get involved in the local schools as Parent Governors or members of Friends Groups. But I suspect these are also the "settlers", and given the trend to have children later in life, many of these will be approaching 40 before they get stuck in to organising the school tombola or joining the Governors' Finance Committee.

I am not sure whether I should be worried or not. We have gone twenty years or so since a younger generation was catching the headlines with direct action with demonstrations and sit-ins. More recently the demonstration against the Iraq war also caught the imagination although this was across all age groups.

The recent unrest about student tuition fees, although in my view largely misplaced (See my earlier blog) at least shows us that when the right cause comes along the young can still get worked up about it. They are the ones who do use the social networking sites to organise their activities, but it tends not to be an invite to a public meeting in a draughty hall...

The NUS has got it wrong

I have not been blogging for a while because a lot of work has got in the way since last month. In that time the tuition fees issue has taken the headlines in a big way.

I am one of those fortunate enough to have enjoyed a free university education in the 1970's and an almost complete maintenance grant. Grants were means tested then according to your parents' income, and coming from a modest background I qualified for the full grant for my first two years.

Since then we have had the introduction of tuition fees, the withdrawal of grants except for a very small number of poor applicants, and the introduction of top-up fees too, each change made by a Labour Government following manifesto pledges against such moves.

So am I arguing that because Labour reneged on manifesto commitments it's all right for the Liberal Democrats too?

Well there is a big difference between the two parties. Each time Labour made a promise they failed to keep they had secured a working majority in the House of Commons at the General Election that preceded their decisions. So they had the power to fulfil their promises but chose not to do so.

In 2010 the Liberal Democrats did not win the election.

They did not secure the power to implement their manifesto in full, which included in case any reader has forgotten, to phase out tuition fees over six years. Not immediately, but over longer than a parliamentary term.

At the election we secured around 23% of the vote and got about 10% of the seats. Both Labour and the Tories support tuition fees, so whether the Liberal Democrats had done a deal with either party, securing a phase out of tuition fees just wasn't going to happen.

The Coalition Agreement secured the option for Liberal Democrat MPs to abstain on any vote to increase fees, and in practice I expect many will vote against the increase. This is the position taken up by our new party president Tim Farron who was my choice for the role.

However our instincts for fairness has led to the party securing a better deal for graduates than the Browne report (commissioned by the last Labour Government) envisaged. The repayment scheme now being proposed makes sure that the third of graduates taking on the lowest paid jobs (such as in Social Care) will actually pay less back than they do now, and those graduates in the top third of jobs on the highest pay (such as those in financial services) will pay back more. It is the closest one can get to a Graduate Tax without calling it such.

So why is the NUS trying to unseat Liberal Democrat MPs?

I don't think they have thought this through. If we have fewer Lib Dems in the next Parliament we are likely to have more Labour and Tory MPs who actually believe in fees and are not interested in making the system fairer. Labour is very publicly split over the concept of a Graduate Tax already, and as they are a party that has twice reneged on tuition fee commitments when in power they cannot be trusted. The Tories are waving the flag of fairness at the moment, because while they are in coalition with us they have to. But give them a working majority and the fairness principle will soon be lost.

So by supporting the NUS campaign to unseat Lib Dem MPs students will be making sure the opportunities for their fellow students from poor backgrounds are diminished further for another generation.

In fact the opposite would be a better way forward. If students actively campaigned for the Liberal Democrats to win more seats we could extend the fairness principle further.

Whether we can ever recreate the conditions that applied when I was a student, when I was the first person from my family to ever go to university, will always be difficult given the higher proportion of students now qualifying for Higher Education, but it's still a campaign worth pursuing.

So I think the NUS needs to reconsider its position. It would be usual for students to blame the older generation for mistakes that impact badly on them, but this time they could be making it worse for themselves....