An open letter to Labour's new shadow education and health secretaries
Labour has too often looked as if it is simply the defender of the status quo and vested interests.
Dear Stephen and Andy,
Since the general election, Labour has played a largely reactive role on public service reform, as the Coalition has made most of the political running. To some extent this is understandable: Labour is no longer in charge of the reform agenda and needs time to rethink what it got right and where it went wrong during its 13 years in government.
However, Labour's first year in Opposition has also been characterised by a further weakening of its intellectual and political leadership on public services. From the late 1990s to the mid-2000s Labour led the debate on improving the NHS and raising educational standards. Since then, it has largely run out of ideological steam and political energy. Your task - as the new lead Shadow Ministers for Education and Health - is to recapture the spirit, political ambition and intellectual creativity of the best Labour reformism on public services.
Whilst you will surely want to oppose misconceived Coalition reforms, you cannot be left having little to say on the future shape of the nation's public services. Lacking in alternative proposals for reform Labour has too often ended up looking like it is simply the defender of the status quo and professional vested interests.
Reform will be critical to improving services simply because there will be little if any new money to spend after 2015: even after the structural deficit has been reduced, long term demographic trends will continue to put huge pressure on the public finances. The Office for Budget Responsibility estimates that Britain will need to spend around 5 per cent more of our GDP every year just on meeting the costs of caring for an ageing population by 2060. This will heavily constrain spending in other areas and means that if Labour wants to invest in new priorities, such as childcare and early years' education, it will have to find ways of making mainstream services like the NHS, schooling and the police much more efficient and effective.
You also need to think through what the public service landscape will look like in 2015. It will be impossible in practical terms, as well as undesirable, simply to reverse everything the Coalition has done.
Overall Labour should position itself clearly as on the side of the citizen, a champion for parents, patients and victims of crime, willing to use a judicious mix of government pressure and bottom up user empowerment to drive improvements in services. The party should also be more sensitive than it was in government to the need to design public services that create spaces for us to come together as citizens and work collaboratively to achieve mutual ends.
With that in mind, you should consider the following ideas in your respective portfolios.
Michael Gove is determined that by 2015, the majority of secondary schools will be academies and there will be hundreds of new free schools. Once free schools have been established they are likely to be popular with parents and it is inconceivable that a future Labour government would abolish them. Likewise, Labour created the academy school model and these have greatly improved educational attainment in disadvantaged areas. A future Labour government would want to build on that model, while retaining the school autonomy that is at its heart.
However, Michael Gove is obsessed with numbers and categories of schools rather than thinking through clearly the balance between school freedoms and the need for local and national coordination and accountability. Hundreds of schools are now funded and commissioned directly by the Secretary of State. It is truly Napoleonic. Currently if an academy were to underperform Michael Gove would personally have to intervene. This is a crazy way of holding schools to account; we urgently need a new model of local accountability for schools.
You should therefore support the creation of powerful new Schools Commissioners at the local level, starting in the big cities where they would be appointed by the new city mayors. School Commissioners should not be involved in managing schools, but instead act as local champions for standards, with control over admissions and other local coordination functions, and the power to replace a school's management where it is failing to improve standards.
Despite recent budget cuts, the Pupil Premium offers a transparent way of ensuring that more funding goes to disadvantaged children. You should insist that all of this money is spent on the disadvantaged children for whom it is intended. Every child eligible for free schools meals should have a Pupil Premium Entitlement, which would guarantee that the pupil premium will be spent on one- to-one tuition or enrichment activities for those children that need them. Parents could even be given the ability to spend the money on extra private tuition outside the school - something currently only available to wealthier families.
If we want to ensure that schools focus on helping children from disadvantaged backgrounds we need to reform school league tables. Currently they incentivise schools to focus on children on the C/D borderline because that is what determines their league table position. Michael Gove's new E- Bacc, which is an accountability tool rather than a curriculum reform, means they will now focus on those children who are likely to do well in traditional academic subjects. This should be replaced by a School Report Card, as exists in New York City, which gives each school a single score but one based on a wider range of measures of performance, including the attainment of poorer children.
All of the international evidence demonstrates that improving the quality of teaching is crucial to improving standards in our schools. The government has recognised this but has focused excessively on teachers' academic qualifications and going back to traditional forms of classroom authority. We need to focus more on rigorously assessing quality at the early stages to remove poor teachers, on-going professional development, peer review and regular re-licensing.
Other areas need greater stability: there has been far too much tinkering with the curriculum and we need a political consensus around the future of 14-19 education, in particular with regard to vocational routes which have been plagued by institutional instability.
Finally, Labour should focus additional investment on introducing a universal and high quality system of under-5's provision. This is a 'win win' in policy terms: all the evidence shows that early years' education is crucial for improving the learning and development of children from disadvantaged families, whilst affordable child care helps women into the labour market, thus raising family incomes, reducing child poverty and expanding the tax base.
The coalition's health reforms are misconceived, driven by an ideological commitment to markets. But Labour needs its own strategy for improving efficiency, innovation and productivity in the NHS, while retaining it as an integrated publicly owned service. The rising costs of treatment and of caring for an ageing population will put huge financial pressure on the NHS over the long term.
Labour should always be prepared to do what works in the interests of patients. The party is right to oppose the ideological imposition of market competition across the health service. But Labour should be pragmatic about using private or third sector providers in areas where they can increase capacity or improve quality and efficiency of provision.
Whereas the government has focused on empowering professionals, in particular GPs, Labour should directly empower patients to create a more personalised and responsive service. More and more people are living for decades with chronic conditions such as diabetes, arthritis and hypertension. These patients should be offered personal budgets so that they have greater control over their own long term care. Medical professionals will be sceptical that people can make the right choices about their own care: Labour faced down similar concerns with direct payments in social care and was right to do so.
You should avoid the chaos of further top down reorganisations of the NHS and therefore retain the basic organisational architecture of clinical commissioning groups and local health and well being boards. However, there is still a Chinese wall between health and social care despite the fact that both are caring for the same population of people. You should set out plans for joint commissioning and planning of health and social care provision at the local level. This also means looking at re-skilling and integrating much more effectively the health and social care workforce.
You should be in favour of providing better quality health and social care in the home and in community settings. The provision of integrated health and social care services is an area ripe for the development of new mutually owned and managed organisations, controlled directly by service users and their families. A lightly regulated social care market dominated by a small number of too-big-to-fail providers is crying out for reform.
In a tight financial context, you will also need to think hard about how to improve productivity in the NHS. This will involve changing ways of working, re-thinking roles and careers, stronger performance management and fostering a culture of continuous professional development.
An approach such as this across both your portfolios will enable you to get back into public service debates. Labour should be committed to sustaining and improving high quality universal services. It should be on the side of the parent and the patient and pragmatic about the means of providing them with the best possible service. Crucially Labour needs to develop a clear strategy about how it would deliver better services without increased spending. That era is behind us. Without being clear about this, Labour will struggle to deliver a sustainable social democratic agenda if it returns to power.