Who is winning the Coalition? Us or the Lib Dems?

By Mark Wallace
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Now that both parties are fighting to take credit for the coalition's achievements, rather than seeking to blame each other for its impact, it seems an opportune moment to ask: who is winning the Coalition? Do the Lib Dems or the Conservatives enjoy more success in Government?

Let's tot it up, match by match, across thirteen key policy areas:

Home Office

With PCCs introduced, an immigration cap in place, the concept of regional immigration limits rejected, spending cuts to the police but crime falling regardless and even the now-famous "Go Home" vans, the Home Office is a round victory for the Conservatives. The Lib Dems will be happy about the scrapping of ID cards, but it's worth remembering that this was Tory policy at the election, too.

Blues 2 - 0 Yellows

Local Government

Both parties described themselves as localist in the run-up to 2010, but the plan the Government have implemented is almost entirely Eric Pickles'.  Spending transparency, guaranteed referenda for council tax increases over 5 per cent and relaxed planning regulations all point to a Conservative win.

Blues 2 - 0 Yellows

Justice

It's a little hard to say how the different parties have fared in the Justice department. The failure to fulfil the Tory pledge for automatic jail sentences for carrying a knife illegally and the fact the Human Rights Act still has not been replaced by a British Bill of Rights are certainly points against the Conservatives, but they were respectively scored by Ken Clarke and a Commission set up by the Prime Minister, so count as own goals. Since he took over as Justice Secretary, Chris Grayling has been pushing ahead more productively with cuts to legal aid, reform of the courts system and a new, more accountable prison regime. The Lib Dems have had barely a look-in, but the own goals go on their tally - we can expect a better rematch later in the Parliament.

Blues 3 - 2 Yellows

Constitutional Reform

The Lib Dems had a good sequence of play early on - for a while it looked like they might romp home. They certainly secured the referendum on AV which they had demanded, but then the electorate overwhelmingly rejected the plan. Lords reform briefly came onto the agenda, before being torpedoed by Tory backbench opposition. In revenge, Clegg sank the boundary reform the Conservatives desperately need to iron out structural bias in the election system. Both sides lose out - a no-score draw.

Blues 0 - 0 Yellows

Education 

It's fair to say Michael Gove has emerged victorious on almost every measure in Education. The academies scheme has been dramatically extended, Free Schools are springing up and new, more rigorous exams are in place. The flagship Lib Dem policy of the Pupil Premium has been implemented, but their promise to aboilish tuition fees has been entirely reversed.

Blues 5 - 1 Yellows

Transport

Both parties supported High Speed 2 in 2010, and despite heavy fire from all sides it remains Government policy. The Lib Dem policy of introducing road pricing has been rejected, and replaced by reductions and freezes in fuel prices, driven by Rob Halfon. Clegg and Cameron both promised that Heathrow would not be expanded, and they've got their way - with Lib Dem support for the policy helping to overwhelm any Tory suggestions it be revoked.

Blues 2 - 1 Yellows 

Defence

The decision to hold a Strategic Defence Review rather partially removed this department from the realm of pure party politics early on in the parliament. However, the Lib Dems regularly boast that they have managed to delay any decision to replace Trident until at least 2015, while the Conservatives have successfully slimmed down the MoD's size and balanced its budget for the first time in years. A score draw.

Blues 1 - 1 Yellows

Energy and Environment

Chris Huhne, and later Ed Davey, have dominated these policy fields from DECC until Owen Paterson gave DEFRA more Tory bite in the last year. The Green Deal is in place (and splashing money everywhere), wind farms are still going ahead despite the Tories wishing to implement a moratorium and the Green Investment Bank has got the go-ahead. Shale gas has now been given the green light, but only after lengthy delays thanks to Lib Dem opposition. 

Blues 1 - Yellows 5

Tax and Spend

Both parties agreed on the need for austerity after the Brown years, but we should note that the Lib Dem manifesto proposed £15 billion of spending cuts, delayed until 2011-12. Austerity has been larger than that, and began immediately. While Clegg and Alexander's presence in the Quad has certainly reduced the fiscal tightening somewhat, Government policy looks closer to Osborne's position than theirs.

On tax, it's a different story. The 50p rate is gone, but it is now 45p rather than the 40p many Tories would have preferred. The income tax threshold is rising to £10,000, following a Lib Dem manifesto pledge - though it's not a policy many Conservatives are uncomfortable about. It's fair to say Osborne's enthusiasm for tax cuts (for example on Inheritance Tax) has been sizeably hindered by his coalition partners.

Goals for each side, but level pegging so far.

Blues 2 - Yellows 2

Welfare Reform

Like Eric Pickles, Iain Duncan Smith went into the 2010 election with a coherent plan and a deep personal dedication to his brief. As a result, he's got his way on the bulk of his proposals. The two parties have collaborated to protect the Universal Credit scheme from Treasury attempts to axe it or scale it back. It says a lot that the Lib Dems' main impact on the DWP has been to veto IDS' offers to make even more savings from his budget.

Blues 2 - Yellows 1

Business and Banks

Vince Cable has long touted his Department as the heartland of Lib Dem opposition to Conservative leadership of the coalition. He's certainly managed to get the Government to adopt his industrial strategy, and blocked the Beecroft reforms to workplace regulation. But he has also had to accept the abolition of the Regional Development Agencies and the Conservative-driven cuts to red tape. The decider is the Government's decision to accept the Lib Dem policy to break up the banks.

Blues 2 - Yellows 3

Health

To say the Health and Social Care Act proved controversial is an understatement. Various of the policies within it are drawn from the Conservative 2010 manifesto, although Lib Dem opposition forced the Government into a "listening period" and resulted in several changes to the legislation. 

Blues 2 - Yellows 1

Europe

This always seemed likely to be the sticking point of the Coalition. Clegg has prevented Cameron from offering an earlier referendum, and the Conservatives have been forced to use a Private Member's Bill to pursue their policy post-2015. However, the Lib Dems so far have been too afraid of public opinion to vote against the Wharton Bill, resorting to wrecking attempts in the Committees. The In/Out referendum is on the way, but Yellow blocking tactics have left the Blues open to attack by UKIP.

Blues 1 - Yellows 2

Scores so far

Here are the overall scores from the first half of the Parliamentary season. Of 13 matches, there have been 7 Blue victories, 3 Yellow wins and 3 draws. 25 goals for the Conservatives and 19 for the Liberal Democrats leaves the goal difference at +6 for the Blue team.

The contest is only going to become more hotly contested - as can be seen by Nick Clegg's attempt to take the credit for Rob Halfon's ideas today - so we will continue to watch every match and report back.

The NHS has a higher death rate than most Western health systems - it requires bravery to set that right

By Mark Wallace
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New analysis by Professor Brian Jarman, the respected expert on comparing the performance of hospitals, has revealed some shocking home truths for our healthcare system.

Jarman's figures - compiled using 2004 data as the more recent numbers are not yet available - suggests that the death rate in English hospitals was 22.5 per cent higher than the average performance in six Western nations, and 45 per cent higher than America.

We're all aware of the Mid Staffs scandal, which Prof Jarman helped to expose, and the suggestions that some other NHS Trusts may have similar problems, but this report suggests our concern should be much broader. I've written before about the need for more fury when the NHS fails patients - that is certainly the case, as large numbers of patients are dying who would not do so if our health service performed even at the average level.

The political environment always makes it hard to talk about the NHS. The Opposition will jump on any perceived criticism, and the polls show voters' strong support for the service. 

But if politicians wanted an easy life, they should have chosen a different job. As a matter quite literally of life and death, this issue is too important to allow Westminster taboos to shut down discussion. Those who truly care about the NHS should also support scrutiny and reform to improve it.

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Hunt is right to take the fight to Labour on healthcare

By Paul Goodman
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The Daily Mirror likes to see itself as a fount of truth about the NHS, so let's look at recent poll results it published about the service. "Asked which of the main parties people trust most on health," the paper reported, "37 per cent picked Labour, compared to 19 per cent for the Tories and just 7 per cent for the Lib Dems".  In other words, Labour's trust ratings are almost double those of the Conservatives, whose own ones are more than double those of the LibDems: in crude terms, over twice as many people trust David Cameron to run the health service as Nick Clegg.  However, only 63 per cent of those questioned name a political party at all: well over two in five voters don't trust any of them.

This is a useful background against which to set the calculations about who is winning and losing the political dogfight about the NHS - and whether the Conservatives should be engaged in it at all.  In a nutshell, Labour have a formidable advantage over the Tories on health, but scarcely more than a third of voters trust Ed Miliband's party on the issue.  It follows that given the low standing of politics and politicians, it is open to reputational damage.  Attacks from Conservative politicians are unlikely to have much effect in this regard.  But they help to highlight and frame a simple point about the Keogh Report: namely, that it describes a system established on Labour and Andy Burnham's watch.

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The roots of the NHS scandal are in a culture that grants human life no absolute value

By Paul Goodman
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Here are the figures.  14 hospital trusts were investigated by the hospital review commissioned by Jeremy Hunt.  Ten require "urgent action".  21 are still failing critically ill patients.  The best part of 3500 people may have died needlessly.  According to the Mail on Sunday, the Health Secretary will make a statement to the Commons on Tuesday.  Hunt has already set out his plans to improve the performance of hospitals - a new "Duty of Candour", the publication of more performance data, clearer responsibility for patient care, new "deep-dive" inspections - and so on.

The Health Secretary has gradually moved, partly under pressure from Conservative backbenchers, to put some of the blame where it belongs - on the consequences of Labour's command and control targets regime.  As the paper points out, Alan Johnson, then the Health Secretary, gave the  Health his "absolute assurance" in 2009, that what was happening in Mid-Staffs was "not indicative of what’s happening in the NHS".  This was untrue, and the Conservative MP Charlotte Leslie wants an inquiry into who knew what, and when.

None the less, party politics and official inquiries only get one so far.  The horrifying treatment of some elderly people in our hospitals and care homes is a symptom of cultural change - one in which there is no longer a presumption that older people should be treated as possessing experience and wisdom, and in which human life itself is no longer seen as possessing absolute value.  "It has saddened me that in the past four months I have heard almost no one use the word “kindness”, writes Camilla Cavendish behind the Sunday Times paywall.

Cavendish was put in charge by the Government with conducting a review into NHS healthcare assistants.  She argues for proper teamwork, shared responsibility, shorter shifts and "weeding out staff who are not caring" (easier said than done).  But it's evident to anyone who reads her piece or who has followed the hospital scandals, that - as the headline on her article puts it -  "What the NHS needs is a degree of kindness. The rest can be taught."  In Britain, that kindness has been rooted in absolute values, formed by the country's Christian tradition.

The country is moving from one in which the churches were the main manifestation of religion to one in which there are many more - and in which the place of religion itself is under question.  But, as Philip Blond suggests on this site today, the faith communities (and specifically the Church of England) have much to contribute in ensuring that public services are stronger and better.  If government was more skilled at utilising the churches - and if some in them didn't see caring as the state's job - older people in our hospitals and institutions would get better care.

How to heal the hospital scandals

By Paul Goodman
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Six out of ten people don't trust the NHS, according to today's Sunday Times (£). So why doesn't David Cameron tear up his commitment to the service, as its critics urge, and commit the Party to ushering in a system based on insurance or payment - like some of those used by other European countries which yield better results?  Half of the answer is that there is no intrinsic problem with a system free at the point of use: indeed, the NHS has its strengths (such as emergency care, despite the A & E waits) as well as its weaknesses (such as some cancer survival rates).  The other half is political rather than medical.  Voters may distrust the institution, but they also distrust the Conservatives - at least, when it comes to reforming it.

An NHS was originally proposed by Henry Willink, Churchill's wartime Minister of Health.  But it is Labour that has taken credit for the service, and churned out black propaganda about Tory intentions towards it from the age of Aneurin Bevan until the present day.  This explains the caution with which both Cameron and Jeremy Hunt originally approached the revelations about events in Mid-Staffs: had they taken place under a Conservative Government, Tony Blair would have tried to hang the corpses of the dead round Ministers' necks.  As the horror of the reports and the culpability of officials began to sink in - not to mention the distorting role of Labour's centrally-commanded targets system - the Health Secretary grew bolder.

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The Morecambe Bay scandal: David Morris sends an open letter to Andy Burnham

By Harry Phibbs
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On Wednesday there was a powerful contribution to Conservative Home from David Morris, the Conservative MP for Morecambe and Lunesdale. He represents constituents whose babies died in Morecambe Bay hospitals due to a lack of care. Their grief has been compounded by anger at the cover up.

Mr Morris was raising a constituency issue that could hardly be more serious. But his point was that it was more than that. Together with other scandals identified there has proved to be "a cover-up culture and tick-box inspection regime."

Those being held to account must include the former Health Secretary Andy Burnham. Mr Morris is determined to pursue the matter. He has written the following open letter to Andy Burnham:

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Where is the fury over the weekend spikes in NHS deaths?

By Mark Wallace
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The horror of the Mid-Staffs scandal will stick in the minds of many for a long time to come. Patients left lying in their own faeces, ill people crying out for water - these images and more were burned into our minds when the disastrous mismanagement of the NHS Trust was finally exposed.

The response, rightly, was fury. Fury at the individuals responsible, and fury at a system which allowed such appalling neglect to take place. Ministers vowed to ensure it could not happen again.

Where, though, is the fury about a very different healthcare scandal reported in today's newspapers?

It turns out, as many have suspected for a long time, that if you have the misfortune to require surgery at or just before the weekend, your chance of dying in our health service rises by as much as 82%. That is a shocking figure which, given the number of operations the NHS carries out, must mean a lot of people have been affected over the years.

The problem is that, unlike Mid-Staffs, this is not a geographically isolated issue, or one clearly pinned down to one system or another. It is apparently due to an endemic structural issue with how our hospitals are run - simply that at the weekend there are fewer staff on duty, so post-surgical care is not as good.

There seems to be no logical reason why the NHS should run its staffing like an office, or a call centre. By definition, caring for the sick is a round the clock job - illnesses and injuries don't clock off at 6pm on a Friday, so why do many of those treating them?

I can appreciate the political difficulty of restructuring NHS working practices away from the traditional week - just look at the fuss GPs kick up over out of hours services. Ultimately, though, this goes to the heart of the NHS' mission: they are there to care for and heal people. Reforms are needed to save patients' lives.

Justifiably, Mid-Staffs grabbed many headlines and caught prominent attention in Parliament, on the front and backbenches. It would be a betrayal if this issue did not get the same treatment - it deserves the very same fury, and the patients at risk deserve better.

How Jeremy Hunt plans to improve the NHS (and boost his own standing)

By Paul Goodman
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The Financial Times this morning reports the conduct of a Cabinet Minister who arrived at his Department in a position of strength. Philip Hammond is digging in over cuts to his budget.  Meanwhile, the Daily Mail reports the plans of another, who came to his Department in a position of weakness.  Jeremy Hunt is planning for prescriptions to be available online.  The latter Minister is more exposed to public wrath than the former. Rightly or wrongly, voters are more concerned about the NHS than defence, and the Conservatives have long been targetted on the health service by their opponents.  Remember Tony Blair claiming in 1997 that Britain had a fortnight to save the NHS?

Tim Montgomerie set out on this site last year how the Health Secretary aims "to be angrier than any voter at NHS failures".  But Hunt's plan to champion the interests of patients is only part of his larger strategy to improve the health service - and, in the process, leave the Department stronger than when he arrived. To understand it, it's essential to grasp that the NHS is experiencing the tightest financial squeeze in its history: its budget may be protected, but the rise is planned to be 0.1% a year until 2015.  Like other western countries, Britain is experiencing a rise in the number and proportion of older people, and is struggling to contain the health costs that follow.

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The new politics of the NHS ring-fence

By Peter Hoskin
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Jeremy Hunt is setting out a “back to basics” approach to care in the NHS today, but he may just want to go back to bed after reading the main editorial in today’s Sun. “The NHS is one of our proudest creations,” it notes half-way through – so far, so positive – but then it continues, “But Cameron’s insistence on ring-fencing its funds creates a climate in which idiocy and incompetence go unchecked.” Ah.

The problems with the NHS ring-fence were clear as soon as it was erected, before the election. There was a mismatch between the Tory Opposition’s insistence that “more” could be achieved for “less,” and their Brown-style argument that only they could be trusted with the health service because only they would shield it from cuts. Sure, they deployed demographic arguments too … but the politics were still inconsistent.

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Dropping plan for minimum alcohol pricing is sensible

By Harry Phibbs
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In The Times on Saturday Matthew Parris offered (£) a DIY guide to pointless political advice. One is to urge politicians to "stay the course" and "not to wobble" - this is when you happen to like their proposal. Another is to warn politicians against a "refusal to listen" or "stubborn dogmatism" - this is when you don't like their proposal.

This is a Government which typically sticks to its policies on the big issues but makes u-turns on smaller matters. The modest "u-turns" on the spare room subsidy seem pretty reasonable to me - as does pressing ahead with the general policy.

We had another u-turn in the news today with the plan for minimum alcohol pricing being ditched. I am pleased. This is the sort of nannying that politicians are often attracted by. I remember talk of banning alcopops a couple of decades ago. It is an unattractive condescending brand of politics. It punishes the innocent along with the guilty. Most young people who drink alcopops don't then go on a rampage. Similarly most of those looking for special offers when they buy booze are doing so because they have to be careful with their money. They are not "pre loaders" but pensioners in council flats.

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