This is the question I asked Nick Clegg after his Hugo Young Lecture when he argued that the Coalition government was setting out a "new progressive" direction in contrast to Labour's conservative clinging to "old progressive" policies. It is slightly polished, I summarise his reply and give my response.
Nick, I welcome your call to place “power in the hands of citizens” and your saying you are for democracy, as the Coalition in your words, “rewrites the rules of British politics”. But is it democracy you are introducing? Take two big reforms whose real nature was not set out in the Coalition Agreement: the NHS and Universities. With higher education the issue is not just the increase in student loans, they should indeed make a contribution after they graduate. It is the scale of the rise and above all its combination with what is in effect the near complete withdrawal of state funding. Together this reduces higher education to a pure market place. With the NHS the Secretary of State Andrew Lansley has said he wants over half the NHS’s services to come from independent providers, such as US health care providers, almost immediately, making the NHS a market place. Surely, it is not democracy you are introducing, it is marketisation.
In his reply Nick Clegg graciously said how much he respected my contribution to progressive politics. But he seemed puzzled by my suggestion. With student fees, the Coalition's plan lowered the benchmark at which many would have to pay and he didn’t see how it marketised higher education. On the health service, as an MP, when he had his constituents complaining he had to go along to see the head of his Sheffield primary care trust (PCT) and beg him for help. He was a good man but he was only one man. And he was answerable only to the strategic health authority, which was answerable to a quango, and only then to an elected person, the Secretary of State. This was completely remote, undemocratic and responsibility would be pushed down to the doctors who knew their patients.
On education my response is that I don’t think Clegg understands what is happening, or if he does he is a completely dishonourable cynic. He is obsessed with the issue of what the students are liable for, as well he might be for this is where he made his pledge. My point is that the very steep increase in fees and loans is combined with a withdrawal of state funding as well. I know one major London department that has lost the whole of its grant. Henceforth it has to fund itself entirely from its student income. It must therefore compete for student applications. It will be forced to drop specialist areas, that may well be the seed corn of the future, if this means employing staff who don’t attract lots of students, whatever the staff's judgment about the international future of their field. This is the marketisation of higher education, turning what is taught into a commodity and forcing out the eccentric, the different, the original and the traditional but unpopular, all of which a university should strive to preserve for society because this is an essential part of what a university must try to be: a place of universal learning.
Second, still on universities, while withdrawing direct state funding, the government is recycling it through students in the form of large loans, which the banks will charge interest on but which the government will guarantee. Leaving aside the increase in government debt this will entail (ah ha), this ensures that private capital gets a slice of what remains a state sponsored policy. This is the second way in which higher education funding is being marketised. My point is not that graduates should not pay a contribution (I’d prefer a graduate tax, but then, of course, the banks can’t charge interest). It is that the larger values of society and scholarship are also being amputated and they are a vital part of what defines us as a society. As we lose these limbs, the Coalition is in effect, whether Nick understands it or not, seeking to ensure that the market colonises our minds and, finally, our sense of what is possible.
Third, on the NHS, of course Nick Clegg is right that the internal power structures of the NHS are profoundly undemocratic. But especially when it faces real cuts in the form of capped growth, the NHS itself should be democratised (See Neal Lawson's Compass pamphlet (pdf)). PCT’s should be made answerable to doctors, nurses, patients and health care auxiliaries. Then Clegg’s constituents will have somewhere to go that makes sense to them and makes the PCT’s accountable. As it is, they are being abolished to open up the country’s largest employer to “any willing provider”; according to an invaluable account in December’s Prospect (£) by Sam Knight. Currently private providers carry out 3 per cent of NHS procedures but Lansley wants this to rise to “a majority of NHS services by 2014”. This is an astounding target and could prove a devastating coup. Obliged to compete with for-profit competitors under EU corporation rules favouring lower initial bids doctors may have little choice but to turn to commercial conglomerates as their ‘willing provider’. According to the head of the UK’s largest private provider to the NHS, the South African controlled General Health Care, the endgame (an ominous word) is our National Health Service moving away from “being an organisation to being a system”.
The Coalition’s programme for constitutional reforms has not made the front page of the New York Times. But Lansley’s NHS proposals did so promptly on 24 July 2010, when Sarah Lyall reported, “Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers”. Just think of that $100 billion plus: yum, yum. Last year, General Health Care reported profits before tax of over 26 per cent, but still a mere £220 million. When its boss says the reforms will turn the NHS from being an organisation to being a “system” that is a euphemism for market place.
The Coalition's higher education reforms promise lots of guaranteed loans for bankers while scholars are forced to decide what they teach and research on the basis of surveys. The NHS, the jewel of the welfare state, is being broken open to sparkle for private providers. This isn’t democracy. It isn’t a new way of being progressive. It is the deep marketisation of our society, carried out at breakneck speed. Prove me wrong, Nick.
PS: Later, I continued on from this with an attempt to "De-Code" Clegg's politics.
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