Should we really be surprised that NHS reform has been botched?

I am not in the habit of saying, "I told you so", especially as there have been so many occasions when I didn't. However, I did take a look at Conservative health policy a year ago and noted the sea of contradictions that existed then. And, as far as I can tell, not much has changed.

This explains an awful lot, and is a precursor for future potential difficulties. You see, the Conservatives don't really get localism or at least, they don't really understand its implications. With localism, you get difference, not consistency, and you place your trust in local people. And that in turn means that they will make the choices that suit them. What is good for Barnsley may not work so well for Bury St Edmunds, and vice versa.

In an environment where politics is often about playing off one group against another, the dangers are obvious. If government devolves power to a community, and that community makes a choice that an opposition party doesn't like, who gets the blame? You can hardly blame the community, so you blame the government. The government, under fire from the media, starts to think about regulating for minimum standards. The more minimum standards are set, the less scope there is for the community to make choices, and before you know it, the benefits of localism are lost, and you've created another bureaucratic structure that is now purposeless.

The notion of localism underpins the 'Big Society' concept, but the desire to shrink the size of government is in stark contradiction to those Conservative strands of thinking that are paternalistic in nature or suspicious of empowering people that aren't like them. That isn't to say that all Conservatives are paternalistic, or that they distrust ordinary people per se, it's just that being socially conservative presents them collectively with a number of philosophical dilemmas.

The problem of creating a free market in healthcare overlooks a societal presumption that the NHS is the health provider of last resort. If the private sector cannot, or will not, provide a particular treatment, the public assume that the NHS will. This is not the basis of a free market. It must also be assumed that, in a free market, there will be a degree of surplus capacity, and in a sector where the element of choice is not so clear cut, who pays for that surplus capacity? Indeed, why should the private sector be expected to create it? No, far better to have the certainty of long-term contracts, which effectively limit the options of 'customers' (I'm sorry, I really hate the word, but 'patient' doesn't quite cut it).

Andrew Lansley's NHS reforms smack of a 'back of an envelope' calculation, and every retreat and every compromise simply demonstrates just how poorly thought out the original concept was. If the Coalition partners are going to emerge from the current cycle of budget cuts with any credibility intact, each of them is going to have to display a much more transparent and coherent approach to the changes that our economy and our country needs.

And whilst I still believe that the Liberal Democrats policies coming out of Government are fairly robust, the same cannot be said of the Conservatives...

Three strikes and you're out?

A constant reminder that we are in coalition with the Conservatives is the ability of the Coalition to combine sensible reform with some hysterical, sub-Daily Vile headline-grabbing irrelevancy.

And, in the proposals for welfare reform published today, we see that trend repeated. The proposal for a 'Universal Benefit' is an eminently sensible one, reducing bureaucracy, eliminating duplication and good for the environment (all those trees saved!). And yet the headline is 'three strikes and you're out', the frankly absurd notion that benefits will be withdrawn from those who persistently refuse job opportunities.

Really? Has this been thought through any further than "That'll get a good headline tomorrow!"? I fear not. Because yes, nobody wants to encourage the determinedly feckless and workshy, and yes, as a liberal, I believe that escaping dependancy is part of building self-esteem, contributing to your community and eliminating poverty. But what about the wider implications of removing people's income?

For example, are we really going to put people onto the streets, families with children perhaps? Even knowing that we would need to take those children into care, an option which results in the worst life chances for them? Or is driving these people to crime in order to survive part of the strategy?

Alright, I exaggerate a bit, but you get the idea. In reality, I do not believe that the British people want to create the kind of underclass that the American social welfare net (or lack thereof) has spawned. And what that means is that this isn't a policy, it's a sop.