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Good morning. Labour has won the Stretford and Urmston by-election, while the stand-off between the British government and striking nurses continues. Small wonder that Rishi Sunak and other senior ministers are thinking about NHS reform. Some thoughts on that below.
The forward march of Labour?
What sort of result would we have expected in Stretford and Urmston if the opinion polls are about right? The general election model by Britain Predicts expected a Labour win of 69.5 per cent to the Conservatives on 20 per cent, as did Survation’s model back in September.
These are the kind of results that we would expect to see if the current polls (which suggest an overwhelming Labour victory at the next election) are about right.
And that’s almost exactly what we got: the Labour party on 69.6 per cent of the vote, the Conservatives on 15.9 per cent, the Greens way back in third with 4.3 per cent of the vote, the Liberal Democrats on 3.6 per cent and ReformUK, the Farageist party which Conservatives are fretting a lot about, on 3.5 per cent.
So, essentially, another sign that the polls are about right and the Conservative party has big problems.
I wouldn’t read too much into the low turnout (25.8 per cent): it is a safe seat, it is the bleak midwinter, and we would expect turnout to be lower than usual in those circumstances.
Doctor, heal thyself!
Katy Balls has written a well-sourced piece about what Rishi Sunak and his inner circle are thinking for the Times (registration required). The plan? Tackle the Channel crossings and reform the NHS to make it more effective. Here’s what the key players think the issues and lessons are in the NHS:
Jeremy Hunt takes the view that the health service can learn from education where there is more freedom and less high command. In place of top down targets, managers should be given more powers to run their hospitals as they like. Sunak believes Michael Gove’s education reforms offer a blueprint of how modernisation rather than more money offers the answer.
As it happens, Nick Gibb, the schools minister and one of the most consequential ministers of the past 12 years, has done a rare interview with the TES’s Jon Severs.
It’s a great bit of work if you want to understand one of the key thinkers and movers behind one of the biggest things the Conservatives have done in office. But the key extract for today’s purposes is this one, in which Gibb reflects on the fact that while most Tory MPs believe school reform is one of the big achievements of the past 12 years, their grasp on what those reforms actually entailed is less good:
“If you talk to most Tory MPs, they will say that the Gove-Gibb reforms are probably one of the most successful elements of our period in office. But what they don’t know — and this is what I learned when I was out of this recently — is what we did. They couldn’t tell you there is a multiplication check; they probably don’t know there is a phonics check. They certainly couldn’t tell you about the knowledge-rich curriculum. Or even really what the academies programme is.”
I have to say, based on Katy’s column — and Katy generally has an impeccable understanding of what it is that ministers and senior politicians in general are thinking — some of the Tory MPs who don’t really understand what their school reforms entailed are in cabinet.
Far from being about a removal of “central” control, the knowledge-rich curriculum, the multiplication and phonics check, the baseline assessments, the academies programme: these are reforms that increased the amount of central government control.
Equally importantly, the schools reforms of the Gove-Gibb period built upon the reforms of the Blair-Adonis one. One reason why per-pupil spending has fallen during the past 12 years but results have continued to improve is that the most expensive period of any public service reform (the bit when you are having to pay to run both the old unreformed service and the new one) had essentially come to an end fairly early on in David Cameron’s first term.
Given that there isn’t really an equivalent of Blair-Adonis for the Conservatives to follow as far as NHS reform is concerned, “reform” is not really an alternative to “more money for the NHS”.
In general I would be a bit wary of using UK schools reform as a heuristic for how to reform UK healthcare. Ultimately, almost everyone can leave school with the skills they need to succeed, and adult education can, for almost everyone, provide both retraining and a second chance at the education they have missed. The more you get it right early on, the less you have to spend later.
The same is not really true of healthcare spending: ultimately everyone will at some point get sick. Our greater effectiveness at treating cardiovascular illnesses means that most of us will end up costing the healthcare system quite a lot of money in end-of-life care.
There is a UK education reform that does provide a useful thought experiment for UK healthcare reformers, though: university tuition fees! In the UK, tuition fees are in practice just a type of graduate tax. But they are — or at least, they have been in the past — a way to increase income tax on wealthy graduates without the Chancellor of the Exchequer having to deliver a difficult speech to do, and without as many people getting angry when they work out what you have done.
It may be, as graduates become more numerous and therefore more electorally powerful, that tuition fees become every bit as politically fraught and hard to deliver as income tax rises. (I wrote a bit more on all that in my column a few months back.) But so far, tuition fees have been a useful lever for successive governments to pull in order to levy in more cash from graduates without the political headache of a broad tax rise.
There is an obvious lesson here: unlike most other free-at-the-point-of-use healthcare models, there is no insurance component to the NHS model. Sajid Javid has hinted that the UK should be open to that in his first interview since announcing his retirement.
An insurance component does solve one recurrent problem of the NHS. While it historically provides similar results to peer countries for similar amounts of money, all that money needs to be raised directly by the government, which is harder politically than the various stealth tax options that an insurance system gives policymakers.
But anything like what Javid is proposing comes with an upfront political cost, too: because any kind of big switch in the way that universal healthcare is delivered in the UK is going to cause no end of political pain and dislocation for the government of the day.
The Financial Times offers free online subscriptions to students aged 16-19, their teachers and schools around the world, and to colleges of further education in the UK. Register for the schools programme here (you can also request an individual account) and subscribe to the Schools Digest newsletter to receive articles picked by our teacher advisers every Monday here.
Now try this
One of the small regrets for British political journalists is the closure of Pickles, an old-style greasy spoon just a few minutes walk from Whitehall where you could get a cup of builder’s tea and a nice bacon sandwich. It has been replaced by an upmarket brasserie called Old Queen Street Cafe. It’s one of the worst things to happen to central London since Fuzzy’s Grub went into administration.
I am yet to discover a proper replacement for Pickles in the Westminster area, though I have spent some time scrolling through the Caffs, not Cafes Instagram account. I’m always grateful for reader suggestions, so if there is anywhere you’d recommend I take a minister or a civil servant for a proper breakfast it would be gratefully received.
However you spend it, have a wonderful weekend.
Top stories today
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