There is one important line in Ed Miliband’s Hugo Young lecture which shows the Labour leader is trying to come to terms with some of the difficult questions that he knows he must answer before 2015. Labour knows that it will have to close hospitals to improve services. But it also doesn’t really want to say that, because it makes people angry.
So tonight’s speech, which you can read in full below, includes an announcement that Labour would not close hospitals without involving local people in the decision. Miliband said:
‘I am not going to make promises I can’t keep particularly on this issue. No service can stand still. But if we truly believe in pushing power down to people, we have to accept that we can’t at the same time defend a system where decisions this important are taken in a high-handed, Whitehall knows best way. Indeed, the problem with the current approach is that it creates a dynamic of decisions taken behind closed doors, lacking legitimacy, with little public debate about the real reasons a change is being proposed.
‘Clinicians, managers and patients across the NHS know the system we have isn’t working. We need to find far better ways of hearing the patient voice. So a Labour government will ensure that patients are involved right at the outset: understanding why change might be needed, what the options are and making sure everyone round the table knows what patients care about.’
What this means is that a Clinical Commissioning Group cannot propose to change local services without patient representatives being at the table. And then an independent body, such as a local Health and Wellbeing board, rather than the hospital trust making the change, must consult the local community. But it doesn’t mean local people can block a hospital closure, just that they are offered a proper consultation on the matter.
Ed Miliband’s Hugo Young Lecture – full text
It is a huge pleasure to be here with you tonight.
And to be giving the Hugo Young Lecture.
Hugo Young was a figure of great decency and integrity.
He wrote beautifully and insightfully and gave journalism a good name.
As Alan Rusbridger wrote after his death, “Hugo never forgot why he was there: not to make friends or amiably to chew the political cud, but to report and to explain.”
Of the many things that made Hugo Young famous, was the phrase “one of us”.
It was the title he gave to his renowned biography of Margaret Thatcher.
As Hugo began the book:
“Is he one of us? The question became one of the emblematic themes of the Thatcher years.”
“Posed by Mrs Thatcher it defined the test which politicians and other public officials vying for her favour were required to pass.”
Now, I cite this not because I think we should take it as a model for government.
Nor for appointing civil servants.
But in the use of the phrase, Hugo Young was making an important point.
The very fact that Lady Thatcher was able to ask that question meant that she was absolutely clear what she stood for.
Prime Ministers are elected on a manifesto and make policy on that basis.
But in my view whether they achieve lasting change depends not just on specific policies but whether they can define the purpose and mission of their government.
With thousands of decisions taken in government every day, unless there is that sense of purpose, ministers and the people who support them will simply go their own way.
And the whole will be far less than the sum of the parts.
This is particularly true when it comes to the incredibly complex task of running the state and public services.
Over twenty Whitehall departments, more than a hundred local authorities, thousands of hospitals and schools.
Millions of choices are made each year in these organizations.
Even the most hands-on Prime Minister cannot determine those choices—nor should they want to.
But a Prime Minister and a government can establish a culture for the way public services ought to work.
And the reality is that it doesn’t need civil servants to be ‘one of us’ to respond.
All of my experience is that public servants want a sense of the culture of public service the government wishes to see.
Because this sense of purpose acts as a guide for them.
My aim tonight is to say what that mission would be if I was Prime Minister.
My case is that the time demands a new culture in our public services.
Not old-style, top-down central control, with users as passive recipients of services.
Nor a market-based individualism which says we can simply transplant the principles of the private sector lock, stock and barrel into the public sector.
The time in which we live and the challenges we face demand that we should always be seeking instead to put more power in the hands of patients, parents and all the users of services.
Unaccountable concentrations of power wherever we find them don’t serve the public interest and need to be held to account.
But this is about much more than the individual acting simply as a consumer.
It is about voice as well as choice.
Individuals working together with each other and with those professionals who serve them.
This commitment to people powered public services will be at the heart of the next Labour government and tonight I want to set out why it matters, and what it means in practice.
This vision for public services is rooted in one of the key principles that drive my politics.
The principle of equality.
In his poem, The Prairie Grass Dividing, Walt Whitman talks about what makes for a successful democracy and says it is about a country where people can “look carelessly in the faces of Presidents and Governors, as to say, Who are you?”
Of course, politicians today quite often have that experience.
But not quite in the spirit Walt Whitman meant.
He is expressing the belief that each person however powerful or powerless, matters as much as one another.
An ethical view about the equal worth of every citizen.
This is the foundation of my commitment to equality too.
Whoever you are, wherever you come from, you are of equal worth.
It is the standard I seek to hold myself to as a person.
It means seeking to walk in the shoes of others, not looking over their shoulder to someone more powerful.
And that defines my politics too.
Because from that flows a belief in equal opportunity.
How else can we fulfil our commitment to the equal worth of every citizen?
And from it also flows a belief that large inequalities of income and wealth scar our society and prevent the common life I believe in for our country.
As Benjamin Disraeli wrote in Sybil in 1845 the danger is of “two nations, between whom there is no intercourse and sympathy; who are as ignorant of each other’s habits, thoughts and feelings as if they were dwellers in different zones or inhabitants of different planets”.
Those words were true then and feel as true today.
For decades, inequality was off the political agenda.
But nationally and internationally, this is changing.
Many people across every walk of life in Britain – politics, charity and business – now openly say they believe that inequality is deeply damaging.
Internationally too, political and civic leaders are talking about inequality in a way that they haven’t for generations.
At the end of last month, President Obama put it right at the heart of his agenda for government.
A few months before that the Democratic candidate for Mayor of New York, Bill de Blasio, was elected with precisely the same message.
We now have a Pope who says the same.
And that’s because people the world over are beginning to recognise some fundamental facts again.
That it offends people’s basic sense of fairness when the gaps between those at the top and everyone else just keep getting bigger regardless of contribution.
That it holds our economies back when the wages of the majority are squeezed and it weakens our societies when the gaps between the rungs on the ladder of opportunity get wider and wider.
And that our nations are less likely to succeed when they lack that vital sense of common life, as they always must when the very richest live in one world and everyone else a very different one.
I believe that these insights are at the heart of a new wave of progressive politics.
And will be for years to come.
Indeed, not just left of centre politics.
Intelligent Conservatives from David Skelton outside Westminster to Jesse Norman inside recognise the importance of inequality as well.
I believe that the public want to know we get it; we understand the depths of the cost of living crisis they face.
And we can’t go on with countries where the gap between those at the top and everyone else just gets bigger and bigger.
Tackling inequality is the new centre ground of politics.
In the last few years, I have been setting out what that means for Britain.
Of course it is about a progressive tax and benefits system.
But the lesson of the New Labour years is that you can’t tackle inequality without changing our economy, from promoting a living wage, transforming vocational education, to reforming executive pay, to helping create good jobs with decent wages.
I believe that inequality matters in our politics too.
We need to hear the voices of people from all walks of life not just the rich and powerful.
Building a real movement is the best hope of keeping the political conversation grounded in the reality of people’s lives, which so often doesn’t happen at Westminster.
Rooting the Labour Party in every community and every workplace in the country are what my party reforms are about.
Having explained what my beliefs mean for the economy and for politics, today I want to explain what they mean for the state and, in particular, for the way public services work.
For the left and for Labour, public services have always played an essential role in the fight against inequality and poverty.
An essay written in the late 1940s by T. H. Marshall called “Citizenship and Social Class” explained the idea of how public services could act against inequality.
Just as in the 18th and 19th century, civil and political rights had guaranteed a degree of equality, so too social rights would in the 20th.
A free national health service.
Decent state education.
Pillars of the welfare state and a bulwark against inequality.
For much of the 20th century, politics became a battle about who was best placed to protect and expand this legacy.
For Labour the lesson of all this was a simple one: win power and use the levers of the state to fight against injustice.
That belief endures today.
And understandably so.
But we should never think it does enough on its own to achieve equality.
Because this traditional description of the task of Labour leaves out something fundamental.
I care about inequality of income and opportunity.
But I care about something else as well.
Inequalities of power.
Everyone – not just those at the top – should have the chance to shape their own lives.
I meet as many people frustrated by the unresponsive state as the untamed market: the housing case not dealt with, the special educational needs situation unresolved, the problems on the estate unaddressed.
And the causes of the frustrations are often the same in the private and public sector: unaccountable power with the individual left powerless to act against it.
So just as it is One Nation Labour’s cause to tackle unaccountable power in the private sector, so too in the public sector.
Of course, there is a vibrant and important tradition on the left which takes these inequalities seriously.
More than ever we need to rediscover this tradition.
Michael Young is most famously known as the author of the 1945 Labour manifesto which some saw at the blueprint for a centralized state.
But in 1949 he wrote the book Small Man, Big World which argued that the “large institutions of modern society tend to ignore the interests of ordinary people, who suffer collectively as a result.”
In the 1960s, the New Left and their colleagues also argued for a different kind of state.
The American Saul Alinsky wrote: “self-respect arises only out of people who play an active role in solving their own crises and are not helpless, passive, puppet-like recipients of private or public services.”
And at the same time, feminists were pointing out that women were often especially poorly served by the existing structures of the welfare state.
In my thinking, I have been much influenced by a book written by Richard Sennett, called Respect: The Formation of Character in an Age of Inequality.
He grew up on a Chicago housing estate, and he talks about the interaction between the “professionals” of the welfare state and those who lived there.
And he talked in a memorable phrase about the “compassion that wounds” – well-intentioned, properly motivated, but nevertheless disempowering.
Since then, people like Hilary Cottam have been actively creating new ways of providing public services, moving beyond the old model of delivery.
So the issue of power in public services has always been important.
And it is, in fact, even more urgent today.
For a whole set of reasons.
Because the challenges facing public services are just too complex to deliver in an old-fashioned, top down way without the active engagement of the patient, the pupil or the parent: from mental health, to autism, to care for the elderly, to giving kids the best start in the early years.
Because we live in an age where people’s deference to experts is dramatically waning and their expectations are growing ever higher about having their say.
And because the knowledge and insight that users can bring to a service is even more important when there is less money around to cope with all the demands and challenges.
Clearly the next Labour government will face massive fiscal challenges.
Including having to cut spending.
That is why it is all the more necessary to get every pound of value out of services.
And show we can do more with less.
Including by doing things in a new way.
At the same time, while the challenges are greater for public services than ever before, and make the issue of power all the more urgent, there are greater reasons for optimism too.
Contrary to a 1980s view of self-interested individualism, people by instinct want to help each other.
And that means if we care about giving power away, there will be someone to give it to.
Similarly, technology makes things possible, in ways that simply wouldn’t have been possible in the past.
Big Data, sometimes provided by the public themselves, provides entirely new ways of tackling everything from crime to improving the environment.
And today, the internet means that whether you are a parent, a patient, or a carer you don’t need to be left on your own but can link up with others.
Able to form communities of interest even when people are thousands of miles away.
So the challenge of power is both pressing but also more capable of being solved.
Some people, including the present government, conclude from this challenge that the answer is simple.
Addressing inequalities of power just means crudely importing principles of the private sector into the public sector.
Choice, contestability and competition have a role.
Labour showed in government how the private sector could help to provide extra capacity and speed up hip replacements and cataract surgery for the NHS.
And where existing services have consistently under-performed then alternative providers, including private, third sector or mutuals, are important as a way to turn things around.
But to conclude that market principles are a panacea is simply wrong.
The logic of market fundamentalism is that just like we have a choice over which shop we go to or which cafe, so too we should apply the same to public services.
But it is fairly obvious that this logic is flawed.
Making a decision about which cafe to go to, is something which can be made each time you choose to go out.
It is a completely different story with my son’s school.
If I wasn’t happy with the teaching he was receiving, I shouldn’t have to take him out of the school, disrupting the family, moving him away from his friends.
Even having to set up a school myself.
There should be a mechanism to improve the school.
And this is not the only issue.
Even if we did think market principles were the answer, the resource constraints on government will always limit their effectiveness.
When this government sets up Free Schools in places where there are already surplus places supposedly to create more choice, it does so by taking money away from other kids in real need of a school place.
And we have a looming school places crisis as a result.
Even more problematically, the promised choice often isn’t real.
Replacing one large public sector bureaucracy with a large private sector bureaucracy doesn’t necessarily make the system less frustrating.
Once a government contract for the Work Programme is signed or a train franchise is confirmed, people themselves have no choice over which provider to use because the choice has already been made by the government.
And it turns out that the Serco/G4S state can be as flawed as the centralized state.
Finally, while the creative destruction of the private sector is what powers an economy forward overall, there are other principles that drive public service success.
Like co-operation and care.
If you want to know what can go wrong, just take the government’s decision to import the principles of the privatisation of the utilities in the 1980s into the NHS.
It has meant that hospitals that want to co-operate with each other and integrate are prevented from doing so by an army of competition lawyers who say that’s “collusion”.
The Chief Executive of the NHS himself is saying it is now bogged down in a morass of competition law.
Unable to integrate services which is crucial to improving care and controlling costs.
So while David Cameron promised a Big Society, to unleash the forces of the voluntary sector, he has delivered something rather different.
In some cases, the monolithic private sector replacing a monolithic public sector.
In others, a crude application of market principles which simply hasn’t worked.
And in others still, leaving the unsupported voluntary sector to pick up the pieces where the state has abdicated its responsibility.
It’s no wonder he never uses the phrase Big Society any more.
So what are the principles that should guide us in tackling inequalities of power and improving public services?
What kind of culture would a Labour government seek to encourage?
I want to suggest four principles that will guide what we do.
And these are principles that I hope will be welcomed by millions of public servants who work tirelessly, day in day out, often for low wages, to serve the public.
They often feel that we have a culture that stops them doing their best.
Because the system doesn’t allow them to put those they serve at the heart of what they do.
First, we should change the assumption about who owns access to information because information is power.
And if we care about unequal power, we should care about unequal access to information.
From schools to the NHS to local government, there is an extraordinary amount of information about users of public services.
But the working assumption is still that people only get access to it when the professionals say it is OK or when people make a legal request.
Our assumption should be the opposite.
That information on individuals should be owned by and accessible to the individual, not hoarded by the state.
That people get access to the information unless there is a very good reason for them not to.
As the government has already acknowledged, that must include the right to access your own health records, swiftly and effectively.
But we should go beyond that.
Schools collect huge amounts of information on our kids.
The old assumption is that it gets shared with us once or twice a year at a parents’ evening.
But this is a very old fashioned assumption.
As good schools are already showing, there should be continuing access, all year around.
Many good teachers know that its better if parents shouldn’t have to wait for a parents’ evening to understand how their son or daughter is doing, where things are going well and what more they could do.
And new technology makes the sharing of this information much easier.
As at Shireland Collegiate Academy in the West Midlands which provides teachers, pupils and parents real-time information on pupil attainment.
Indeed the Learning Gateway they pioneered is now used by over 100 schools.
And just as with the best private sector companies, we can “track our order”, so too in the public sector we should be able to “track our case”.
Whether it is an application for a parking permit or when you have been a victim of a crime.
Boston, in the United States, pioneered that kind of service a few years ago.
And the Labour council in Birmingham has already created an app for a mobile phone that can do it as well.
We are still in the foothills of what we can achieve for users in the transformation of public services through new technology.
If it can be done by one local council, it should be possible in every government department.
And that’s what we would task the government’s digital service to do.
Guaranteeing for the first time that people get the information they need.
But information is not enough if we are going to tackle the inequalities of power that people face.
My second principle is that no user of public services should be left as an isolated individual, but should be able to link up with others.
The old assumption is that success in public services comes from the professional delivering directly to the single user.
What I have called the “letterbox model”.
Indeed the very term “public service delivery” conjures up this idea of waiting for a service to be delivered by somebody else.
In fact, there is now a wealth of evidence that the quality of people’s social networks with other patients, parents and service users can make a all the difference to the success of the service.
A recent study in the United States found that women suffering with serious illness, with small social networks had a significantly higher risk of mortality than those with large networks.
Support networks made it easier to keep to recommended treatment schedules and, just as important, kept the morale of patients higher.
This is not surprising.
Nothing makes people feel more vulnerable than having to stand on their own.
Confronted with a vast and complex world of services that they can’t make sense of or options they don’t understand.
A friend of mine was telling me just the other day, what it felt like when his son was diagnosed with autism.
And he was battling the local council for proper support.
He and his wife didn’t know what they were meant to do.
They didn’t know what information to trust, or who to believe.
They felt they were standing alone in the world.
What really would have made the difference was being able to talk to other parents in the same position.
That way they could have made sense of the services that were available.
And asked for different teaching methods.
Eventually after years of struggle they managed to do this, but no thanks to the state.
Just as the presumption should be that the user owns and has access to their information, so the presumption should be that service users have the right to be put in touch with others.
Of course, there are already some amazing organisations in Britain that help people do exactly that.
Voluntary groups, for the ill, and the old, for those with kids in local schools, for those battling to look after relatives.
But too often at the moment, rather than helping people come together, the official services feel they’ve been told by people at the centre that their job is not to help put people in touch.
There is often no requirement on them to do so.
It is not part of their training.
Not a central part of what they are expected to do.
We need to change that.
There are already some examples that do precisely this.
In Newcastle, GPs don’t just prescribe drugs to patients, as a norm, they also put patients with chronic or complex conditions directly in touch with others who have the same concerns.
Whether it is diabetes, cancer or Parkinson’s.
The options flash up on the doctor’s computer screen, in exactly the same way the other treatment options do, and they are passed on to the patient.
So no-one has to deal with a long-term condition by themselves.
With the political will, and a small change to the existing information made available to GPs, we could make that possible in every GP’s surgery across our country.
And that is what a Labour government would do.
It is the right thing to do, keeping people healthier and less likely to end up in hospital.
It also means that people have greater power to hold to account a state that is not being responsive.
Some people will fear this.
I think we should embrace it.
Empowering people against the state where necessary.
And we should make it happen in every service that we can.
But if we are truly to make our public services open to the voices of those they are meant to serve, we need to throw the decision making structures open to people too.
We need to tackle inequalities of power at source.
So my third principle is that every user of a public service has something to contribute and the presumption should be that decisions should be made by users and public servants together, and not public servants on their own.
Of course, this is what so many great public services already do.
Personal budgets have allowed many disabled people to shape the services that matter for them, working hand-in-hand with public service professionals.
On a community level, the co-operative council model in Lambeth also shows us the way.
Its services are shaped and controlled directly by the people who they serve, not just by the council staff.
Despite reductions in budgets, services in Lambeth have been improved by this model.
From parks to youth services.
And we should apply this principle more widely.
Take the most difficult decisions that have to be taken in public services, like the restructuring of services in the NHS.
David Cameron used to go round in Opposition saying he would have a moratorium on all hospital changes, that closures would never happen.
He has monumentally broken that promise, including at hospitals he stood outside with a sign opposing change.
Recently the government attempted to close services at Lewisham and downgrade the A and E.
But they failed because they ignored the voice of patients.
Now, instead of learning the lessons, they want to change the law so they can change services across an entire region, bypassing patient consultation.
I am not going to make promises I can’t keep particularly on this issue.
No service can stand still.
But if we truly believe in pushing power down to people, we have to accept that we can’t at the same time defend a system where decisions this important are taken in a high-handed, Whitehall knows best way.
Indeed, the problem with the current approach is that it creates a dynamic of decisions taken behind closed doors, lacking legitimacy, with little public debate about the real reasons a change is being proposed.
Clinicians, managers and patients across the NHS know the system we have isn’t working.
We need to find far better ways of hearing the patient voice.
So a Labour government will ensure that patients are involved right at the outset: understanding why change might be needed, what the options are and making sure everyone round the table knows what patients care about.
No change could be proposed by a Clinical Commissioning Group without patient representatives being involved in drawing up the plan.
Then when change is proposed, it should be an independent body, such as the Health and Wellbeing Board, that is charged with consulting with the local community.
Not, as happens now, the Hospital Trust or Commissioning Group that is seeking the change.
And we will seek to stop and will, if necessary, reverse the attempts by government, to legislate for the Secretary of State to have the power to change services across whole regions without proper consultation.
This is just one example of how we can involve people in the key decisions that affect their lives.
Not saying change will never happen.
But saying no change will happen without people having their say.
We need to do the same in schools.
Having promised to share power, this government has actually centralised power in Whitehall.
Attempting to run thousands of schools from there.
That doesn’t work.
And as a result some schools have been left to fail.
Just last week we saw the Al-Madinah School in Derby close, because its failings were spotted far too late.
Clearly, we need greater local accountability for our schools.
And in the coming months, David Blunkett will be making recommendations to us about how to do this.
As part of that plan, we must also empower parents.
Parents should not have to wait for some other body to intervene if they have serious concerns about how their school is doing, whether it is a free school, academy or local authority school.
But at the moment they do.
In all schools, there should be a “parent call-in”, where a significant number of parents can come together and call for immediate action on standards.
This power exists in parts of the United States.
And I have tasked David Blunkett with saying how that can happen here too.
The fourth principle is that it is right to devolve power down not just to the user but to the local level.
Because the centralized state cannot diagnose and solve every local problem from Whitehall.
And if we are to succeed in devolving powers to users, it is much harder to do that from central government.
It is right that we elect a national government to set key benchmarks for what people can expect in our public services.
That’s part of tackling inequality.
Like how long we have to wait for an operation in the NHS.
What standards of service the police should provide.
And to ensure that the teachers in our classrooms possess a proper qualification.
But how specific services are delivered within these standards and guarantees cannot simply be dictated from Whitehall.
For the last year, as part of Labour’s Policy Review led by Jon Cruddas, our local innovation taskforce comprising outstanding council leaders from Manchester, Hackney and Stevenage has been looking at how we can deliver more with less.
And Andrew Adonis has been leading work on city regions, and their potential to drive our future prosperity if we devolve budgets and power down.
The conclusions of both these important pieces of work will be published in the coming months.
And as we prepare for a Labour government the on-going Zero-Based Review across all of public spending, being led by Ed Balls and Chris Leslie has these ideas at its core.
This work is clear that by hoarding power and decision-making at the centre, we end up with duplication and waste in public services.
As well as failing to serve people, particularly those with the most complex problems.
That is why the next Labour manifesto will commit to a radical reshaping of services so that local communities can come together and make the decisions that matter to them.
Driving innovation by rethinking services on the basis of the places they serve not the silos people work in.
Social care, crime and justice, and how we engage with the small number of families that receive literally hundreds of interventions from public services.
And so too in the coming months, across the major public services, we will be showing how we can improve genuine local accountability.
In addition to the Blunkett Review in education, the Institute of Public Policy Research’s Condition of Britain project is doing important work here.
John Oldham will also be reporting on how we can fulfil the vision of “whole person” care, better co-ordinating mental health, physical health and social care by devolving power down.
And following the Stevens Review on policing, Yvette Cooper will be coming forward with recommendations on how we can bring decisions on neighbourhood policing closer to local people.
In all of these public services, we are determined to drive power down.
This devolution of power is the right thing to do for the users of public service and is the right way to show that we can do more with less.
When I set out on the journey of becoming Leader of the Opposition nearly three and half years ago, I knew the most important thing was to do the hard thinking about the condition of Britain and what needed to change.
As Hugo Young knew, ideas and hard intellectual thinking are the most under-rated commodities in British politics.
To be a successful Opposition, you need to be able to tell the country what’s wrong and how it can be changed.
And to be a successful government, you need a defining mission.
Hugo Young and I didn’t agree with Lady Thatcher on most things.
But I suspect he would have agreed with her on this: “Politics is more when you have convictions than a matter of multiple manoeuvrings to get you through the problems of the day.”
Over the last few months, whether it is on energy or banking or on 50p tax, Labour has prompted debate and indeed criticism.
I relish that debate and believe strongly that the criticism just comes with the territory.
It is what happens when you make the political running.
I know that we are putting the right issues at the heart of our programme.
And we are standing where the British people stand.
They want a government that will stand up for them against unaccountable power, wherever it is.
They want more control over their own lives.
I am determined that is what the next Labour government will do.
That is the culture of the government I want to lead when it comes to public services.
Tackling inequality in income, opportunity and power.
That will be Labour’s mission in 2015.Tags: Ed Miliband, Hospitals, UK politics