Civitas Blog

Rudi Giuliani has caused just a bit of a political storm this week for citing poor UK cancer survival rates in an attempt to rile Hilary Clinton's 'socialised' healthcare proposals. So now we have hot-shots on both 'sides' of the US political debate bandying around the merits of the NHS, after the glowing reviews it received in Michael Moore's questionable polemic, SICKO. I'm not going to get into the argument either way here, but just to point out one particular irony: Alan Johnson has the nerve to tell the Times: “The British NHS should not become a political football in American presidential politics". If only New Labour could practice what he preaches in the domestic context.

Will the latest - and most powerful - blow finally force the government to review its primary school strategies?

A report on standards for Cambridge University’s Primary Review published today, finds conclusively that although there have been improvements in primary maths and science, there have not in literacy – since the 1950s.

A largely unreported news item from Italy has perfectly highlighted the differing attitudes to EU legislation between the member states.

The horrific rape and murder of a woman, allegedly committed by a Romanian immigrant, has shocked the Italian public and brought underlying tensions about immigration out into the open. The Italian government has responded to the crime by approving a measure which would allow police chiefs to expel EU citizens who they believe pose a threat to public safety.

A report released last Friday by Civitas, looking at trends in avoidable mortality, found real improvements had been made in England and Wales; avoidable mortality from cancer fell by 15.0% and from circulatory disease by 34.0% between 1999 and 2005. But while this compares quite favourably with improvements made in many European countries, real cause for concern does remain:

• The decline in avoidable deaths from cancer has been less step since 1999, at odds with trends since 1979; which must surely question the effectiveness of NHS Cancer Plan with all the extra money that has come with it.

• Avoidable mortality rates from circulatory disease remain far above most European countries of comparable development. Assuming the best performing country, France, made no improvements in the coming years, and the NHS continued to improve at the same rate as between 1999-2004, it would still take until about 2019 for us to catch up.

The full report may be viewed here.

Let’s get one thing straight. Hospital reconfiguration is necessary. There are too many district general hospitals (DGHs) in England. All the evidence suggests that acute care, such as A&E, cardiology, neurosurgery, liver transplantation, some cancer surgery and major vascular surgery, is more safely provided in larger hospitals where doctors have the right skills, experience and equipment to treat the sickest patients.*

But that does not mean the Department of Health should go about it by just unilaterally cutting payments – or, more specifically, not offering ‘top-up’ premiums – for specialist procedures to some DGHs they’ve decided should no longer be carrying them out, as has been revealed today by the HSJ.

The Times Education Supplement (TES) today reports a battle between teachers and management at a City Academy in Middlesborough. Teachers are taking industrial action against the Unity City Academy senior management team, following a demand that each teacher hands in a lesson plan for each lesson.

There is one man across the English Channel who Gordon Brown must wish would shut up, writes Cem Suleyman.

The man I’m talking about is Valery Giscard d’Estaing (VGE), former President of the French Fifth Republic (1974-81).

VGE was President of the Convention on the Future of Europe, which drafted the original, and failed, EU Constitutional Treaty. Ever since the Constitutional Treaty was torpedoed by the non / nee votes in France and the Netherlands, VGE has made it his mission to make the people of Europe realise the error of their ways and eventually adopt the Constitutional Treaty in full. In the case of France’s non VGE has said “The French did not vote for or against this text, they avoided the text. This mistake must not happen again”. As you can see I’m not discussing the most humble of men!

Last Friday, the Charity Commission announced the creation of a new Faith and Social Cohesion Unit to lead its work with faith-based charities.

In the first instance, it announced, the new unit will focus on Muslim charities and communities. Directing its work will be a newly created Project Board the members of which, we were told, will include representatives from MINAB, the Mosques and Imams Advisory Board.

Continued on the Centre for Social Cohesion blog.

Apparently David Miliband was felt today by the ‘hand of history’, when delivering a speech to the College of Europe in Bruges. You would have thought that hand belonged to Baroness Thatcher given her famous speech of September 1988 at that location, when she laid out the fundamentals of British euroscepticism.

Instead it seems it was Miliband’s “personal history”, of a family history embroiled in continental strife, which directed his proclamation that the EU should not become a superpower but a global “role model” (yet more school boy language from the Foreign Secretary, who only recently childishly described the world as “rather a scary place”). This is skewed on a number of levels but more importantly acts as an opportunity to raise the points made by Thatcher in 1988 and their continued relevance to Britain’s place in Europe today.

Echoing the calls of a Civitas publication, The Corruption of the Curriculum, the chairman of the Independent Association of Prep Schools, Michael Spinney, has launched an offensive against the teaching of “fashionable causes” enshrined in the National Curriculum: ‘Increasingly, we live in an era where teaching and learning are sacrificed in favour of fashionable causes, often with disastrous effects upon standards of learning.’

In response, independent schools are introducing their own curriculum, which focuses on the no-frills basics such as spelling in English, times tables in maths and dates in history.

A priority of the Dutch health care system, just like in the NHS, is to guarantee access to health care services in accordance with principles of solidarity and equality. As a result, health care coverage, just like in the NHS, is universal.

But, unlike the NHS, universal coverage is being achieved not through a predominantly government-run system, but through an insurance market that aims to be patient-focused and competitive. The government regulates the system and provides extra funds for the poor and those with excessive health care risks, but is neither the major provider nor funder of health care. It is patient demand, not central command that drives quality of care. As this Civitas briefing shows, there is much the NHS could learn.

…our fishing industry slips into crisis.

The European Union’s Fisheries Commission places strict quotas on fishing in the North Sea, areas that were previously sovereign British territory. The purpose of this policy is to encourage fish stocks to recover from over fishing that previously took place because of the free for all policy that allowed several European countries to access the same waters. The perverse result is that between 40 and 60 per cent of all fish caught have to be thrown back dead into the sea, leaving us with the worst of all worlds: a growing environmental crisis as fish stocks fail to be replenished and a crippled fishing industry. This policy is no good, either for today’s fisherman or tomorrow’s consumer.

The Conservatives have barely stuck their head above the parapet with their new education green paper but the backlash from the self-appointed champions of the disadvantaged has already begun. Fiona Millar attacks their policies as re-heated Thatcherism.

Admittedly, the Tories have left themselves open to this sort of criticism. Their policies are a bit of mishmash that combine suggestions for greater parent choice and hesitant supply-side reforms with centrally driven directives that threaten teacher autonomy every bit as much as the New Labour regime. These policies include targets to get every child reading by the age of 6 using synthetic phonics and more streaming by ability within schools. The problem, as we have commented before, is that no matter how well designed these ideas are, imposing them centrally often produces perverse consequences. The, originally Conservative implemented, National Curriculum is a case in point: centralisation leads to politicisation and the easy corruption of teaching by whatever ideologies are nested within Whitehall.

Despite Alan Johnson’s protestations in the FT that the newspaper is ‘wrong to suggest the government is reversing the NHS reforms’, few are that inclined to believe him. As Blair’s former health advisor, Julian Le Grand, has said: the government no longer seems to believe in, or at least wants to pay for, the idea of using competition to drive up standards in the NHS, following its decision to slash the second wave of the ISTC programme last week. But then along comes what might possibly more than a glimmer of light at the end of the tunnel.

According to Illinois University professor Lilian Katz, we are getting our children to learn to read too soon. ‘It can be seriously damaging for children who see themselves as inept at reading too early,’ Professor Katz told the Guardian.
But the real burning issue in the UK is that we have not been getting our children to read early – because of poor methodologies.

Last week, this blog wrote strongly in favour of David Nicholson’s hints that it might not be too long before choice might eventually be expanded to allow patients to choose their commissioner or PCT - and not least because it could end the postcode lottery in the NHS. If ever there is a case to support this it is the figures released today by the Conservatives on cancer care expenditure. This proves it really is a lottery, just not a very funny one. Oxfordshire PCT spends £5,182; Nottingham City PCT spends £17,028 and spending by the rest is spread right across the range in between. Clinical need alone cannot account for such wild differences.

Some will say this is the ultimate case for more central direction to ensure ‘equality’, but this would be disastrous – the last seven years have well and truly proved this approach doesn’t work. Enabling patients to vote with their feet by switching PCT if not satisfied with the outcomes of their care would be a much more effective way.

In a follow-up piece in today’s Guardian Unlimited to his important debate on Islam last week with Ayaan Hirsi Ali, Ed Husain laments the woeful ignorance about that religion whch he claims is displayed by her and other ex-Muslims and non-Muslims who condemn it in toto on the strength of what he argues are only certain immoderate versions of it.

continued on the Centre for Social Cohesion blog.

The number of privately educated pupils being accepted into the UK’s top 20 universities is gaining over state educated pupils, despite government policy to encourage universities to widen their intake. The BBC’s somewhat aggressive headline ‘Private pupils grab top courses’ makes it sound almost like their achievement is more down to their superior grappling technique, perhaps practiced during the push and shove of the tuck shop queue!

In an important new report for Civitas, Nick Seddon argues compellingly that it is out of respect for the founding principles of the NHS – to provide universal and comprehensive health care – not to mention better care, that it must embrace fundamental, market-based, reform.

Described in a foreword by Mr Bernard Ribeiro, CBE, President of the Royal College of Surgeons of England, as ‘an excellent analysis’, Seddon picks apart the recent NHS reforms and shows:

Apparently having taken little heed of the intense criticism fired at the initial introduction of a “baby curriculum”, the government has provoked a new riot amongst pre-school education experts.