Friday, September 29, 2006


For the past couple of days I've been wondering what it is that the rest of the world sees in Mr Brown's NHS reform that I've missed. Those people who don't confidently reply "son of the manse" when asked about Mr Brown instead say "man of substance" and cite his NHS reform plan as evidence of his sagacity. And there am I thinking that it is completely daft.

The policy of giving the Bank of England the power to set interest rates, free from political interference, has been an undoubted success. So now Mr Brown wants to extend that model to the public services, with the NHS most commonly named as the first to be reformed in this way. An independent board will be established to administer the service, with the role of politicians restricted to setting overall goals and strategy. Conservatives are sufficiently enthusiastic about the idea to claim that Mr Brown has stolen it from them. The day will come when the Tories will pretend that they had nothing whatsoever to do with it....

The NHS is not like the Bank of England. The Bank is setting the price of money. The NHS has an output not far off that of Portugal. It handles something like 10 per cent of our national income. It employs thousands and thousands of people. It is a very different animal.

There are two ways of holding such a body to account. The first is through voice - the right to protest to a political representative who depends on your vote. The alternative is exit - the right to take your custom elsewhere, with the seller dependent on your patronage in order to thrive. Mr Brown plans to remove both these forms of accountability. When he describes the new board as independent, you just have to ask: independent of what, exactly? And the answer, it turns out, is independent of you and me.

Sir Peter Lachmann, former president of the Royal College of Pathologists, felt moved to write to this newspaper that Mr Brown's new policy was "probably the best news the NHS has had in the past 30 years". I was not surprised to read this endorsement. The senior management of the service is bound to conclude that the interference of meddling politicians is nothing but a nuisance. They want to run their NHS with our money and without us pesky voters sticking our nose in the whole time.

The Chancellor is arguing that the closure of a local hospital ought to be decided by health service managers without the right of politicians to prevent it. If he isn't saying this, he is saying nothing. But is it really acceptable that such sensitive decisions be made only by a group of unelected people, accountable only to each other and without appeal to the local electorate? The model that Mr Brown intends to apply to the NHS is not really the Bank of England at all. It is, well, the model that the Tories tried to apply to the NHS in the mid-1980s.

In 1985 Norman Fowler, then the Health Secretary, appointed Victor Page as the chief executive of the NHS with the idea of relinquishing political control of administrative matters. It was perhaps with this experience in mind that another former Health Secretary yesterday told me that he thought Mr Brown's plan was "bonkers". Political pressure from voters and the media ensured that it didn't last five minutes. And neither will Mr Brown's plan.

There is an alternative. If Mr Brown truly wants to stop political interference in the day-to-day decisions made by clinical staff and local management there is something he can do. He can replace accountability by voice with accountability by exit. If a local hospital were to close because everyone was using a better service near by it might anger some residents. But no one could claim that the service providers were unaccountable.

The Chancellor has set his face against such a Blairite (actually Tory) solution. But his third way between two forms of accountability is to provide no accountability of all. His NHS board idea was intended to reinforce his image as a man of substance. I think he would have been better off with one of Doddy's wisecracks.

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Compulsory citizenship classes covering subjects such as the law, the electoral system, human rights and economics are unsatisfactory in a quarter of all secondary schools - often because teachers do not know what they are talking about, research suggests. A devastating report from the schools watchdog Ofsted has found that gaps in teachers' subject knowledge and an insecure grasp of what the lessons were supposed to achieve, led to dull or irrelevant classes that were counter-productive. The report called for more training of specialist teachers and gave warning that the subject citizenship often strayed into areas such as immigration or racial, religious and ethnic diversity, "where little knowledge can be a dangerous thing".

In one of the worst classes observed by inspectors, a lesson on the principles of decision-making in society drifted into a discussion of the bodily needs of people stranded on a desert island. A more common failing was for lessons on conflict resolution - which should include discussions of the role of Parliament, the UN, nongovernmental organisations, and pressure groups - to turn into discussions on friendships and relationships. Inspectors were also appalled by the lack of written work, which they attributed not to any failing by the children but to the low expectations of their teachers. "Very good and lively discussion can be followed by dismal written activities," the report said.

Citizenship education has been part of the national curriculum in secondary schools since 2002 and is compulsory for pupils aged 11 to 16, but there have long been concerns that teachers are ill-prepared to teach it. The report found that while a minority of schools teach it well, in most the teaching was found to be merely adequate. Provision in a quarter of schools was inadequate.

Although growing numbers of schools are entering pupils for a short GCSE course, the report concluded that too few schools taught citizenship as a subject in its own right, with many lumping it in with classes in other core subjects, such as history or geography. Some schools merely assumed that the good ethos and behaviour of their pupils meant they were "doing it already". Others were wary of engaging pupils in political discussions.

The findings raise important questions about the purpose of citizenship education, which was introduced amid concerns about political apathy among young people and fears that society faced a "moral crisis". These worries have since been overtaken by public and political concerns about immigration, diversity and multiculturalism, raising questions about what the focus of citizenship lessons should be. Sir Bernard Crick, one of the architects of citizenship teaching in schools, said the subject should educate children in how to be politically literate, using real issues.

The Department for Education said that 1,200 new citizenship teachers were being trained over the next two years. "Citizenship has had a positive impact on the curriculum in the majority of schools and we are confident it will continue to improve as it becomes more embedded," a spokesman said.

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