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The last few weeks must have convinced anyone who still needed convincing that the Health Secretary remains politically and publicly accountable for the NHS. However, the situation has changed since the Health and Social Care Act 2012 and there are now other leaders with different roles who can also speak publicly.
Simon Stevens, the Chief Executive of NHS England, led the production of the excellent strategy document The NHS Five Year Forward View. It was agreed by the leaders of the other five national bodies – Public Health England, Health Education England, Monitor, the Care Quality Commission and the NHS Trust Development Authority.
Dame Sally Davies, the Chief Medical Officer, plays a prominent role in all health-related issues. Duncan Selbie, Chief Executive of Public Health England, is heard in the media leading action on diabetes. Meanwhile Professor Keith Willett, in his role as NHS England’s Director of Acute Care, speaks with all the authority of a deeply experienced trauma surgeon and clinical manger about the problems in A&E. He is an excellent example of the developing role of clinician manager in the NHS. I could continue – there are now many voices.
The theory was that the Health Secretary would determine the strategy which NHS England and the others would deliver. In reality he mostly speaks about the immediate issues of the NHS, and it is the Chief Executive and others who are mostly shaping strategy. In this case the practice may well be better than the original theory. The people who actually understand the day-to-day reality of health deliver services better than any politician can and are best placed to develop strategy while the Secretary of State has the proper role of shaping political priorities, challenging the professionals, legitimising the strategy and taking political responsibility for funding.
Success in the next few years – whichever parties are in power – will depend in part on these leaders working together to create a coherent long-term vision for the entire health system and providing the leadership needed to bring it about. However, they can’t do it by themselves.
The founding of the NHS in 1948 was a great national coming together – albeit reluctant in some parts – of the public, voluntary and private sectors around the common purpose of providing health services for everyone. Its success despite all the vicissitudes of the last 60 years is shown in continuing public support and the fact that it emerged as the top performer in a recent international review of the health systems of developed countries. This result may have surprised many people, but it is a reminder of just how hard it is to deliver health services to a nation. There is no right solution, but some approaches are better than others and all need improvement.
However, improving health services will not by itself improve a nation’s health. Excellent diabetes services, for example, are only a partial solution; we also have to reduce the numbers of people becoming diabetic. Health professionals and politicians, however good, cannot do this by themselves.
An equally bold initiative is therefore needed today to bring together the expertise and resources of all the parts of society which have an impact on health to improve health for all and develop a health-creating society. Everyone has a role to play here. Town planners and architects can design buildings and cities that enhance health; schools and universities can promote health literacy; businesses can develop healthy products and help their employees be healthy. Citizens and civil society can drive change alongside health services and local and national government.
The World Health Organisation has memorably written that “modern societies actively market unhealthy lifestyles”. The time is right to reverse this and begin to develop a health-creating society whose constituent parts all market healthy lifestyles.
Much of what is needed is already happening in parts of the country but there is not a concerted and unified approach which draws on the resources and energy of all sectors, as happened in 1948. In my view, the next government needs to make an early commitment – preferably in the Queen’s Speech – to developing a health-creating society. It needs to establish a new cross-sectorial and non-political Compact for Health in which everyone has a role to play, and bring together people from all sectors into a grand coalition for health in order to deliver it.
Lord Crisp is a Crossbench peer and was Permanent Secretary at the Department of Health and NHS Chief Executive from 2000 to 2006
Words: Paul Waugh and Daniel Bond
Photos: Paul Heartfield
Liz Kendall is in fighting mood, and it’s no wonder. Fresh from her morning run along the banks of the Thames, she reveals the music of choice on her iPod: old-school, hardcore hip hop.
“I mostly listen to rap,” she explains. “I do listen to some Eminem, I listen to Dr Dre – my favourite – and loads of Jay-Z, but from the good old days of The Black Album. I listen to a bit of Public Enemy. It’s brilliant – particularly if I’m about to speak in the Chamber.”
Lean and keen, but with an added steel that belies her youth, the Shadow Health Minister likes to punch way above her weight on everything from the NHS and childcare to Trident and the future of the Labour party. And while hitting the streets is her favourite way to start the day, she’s also relishing the pavement-pounding of the general election, both in her Leicester West constituency and around the rest of the country.
As she explains her mission to reform public services, ‘Fight the Power’ sounds more like a personal political credo than a mere running rhythm. “There are real challenges for the main parties in trying to show people we are actually the insurgents,” she says, referring to surveys showing the Greens are now polling strongly among under-24s. “I feel insurgent. I don’t feel part of the status quo, I want to change things. I want to change what’s happening at home [in Leicester], I want to change things here [in Westminster], I want to change the economy and our public services. I feel insurgent. And that is what you need, young people want more of that, and a bit more honesty, that you can’t snap your fingers and change things overnight, but that you are hungry for change.”
And one area of public policy Kendall believes is desperately in need of some radical change – and a bit of power to the people – is health and social care. She recently visited Northamptonshire to see first-hand the success of the area’s pilot scheme in personal health budgets in mental health services, and describes the experience as “one of the two best days of my life since becoming an MP” (the other, she adds, was the day Islington’s Labour council introduced the London living wage for home care workers).
Kendall says she will never forget the stories of the people she met whose lives had been transformed by the scheme, particularly the cases of a woman called Mary, who had attempted suicide on dozens of occasions before she used her personal budget to purchase a more intensive course of talking therapies, and Alex, a military veteran who struggled with mental health issues following a stroke. “He became very depressed afterwards, for all sorts of reasons,” Kendall explains, visibly moved. “He found driving and remembering routes, for example to his GP, very difficult. He stopped going out and stayed at home, and felt his life was getting worse and worse. And then he got a personal budget for mental health and he bought a sat nav! He started going to his outpatient appointments. Then he decided he was going to go to a stroke support group, and that made him feel better. Then he started picking up other people and taking them there so they could help one another.
“He said he didn’t want to go on living before he got that budget. But it transformed his life, and it’s that kind of change we need. Because how can a clinical commissioning group – let alone a national government – know in detail what every single individual really needs for them? It’s about putting power and control back into people’s hands.”
While she admits the scheme “would not work for everybody in every circumstance...and if you really believe in giving people choice and control then it includes the choice not to have that”, she says if the right help and support is offered, the programme could be a success in other areas of healthcare too.
“We’d like to go much further in that. Ultimately if you believe that there shouldn’t be a divide between physical health, mental health and social care services in budgets at the council and NHS level, why wouldn’t you be putting them together at the personal level? The people who know best how to join up their service and support are patients, because they don’t see their needs through the prism of separate silos. The people who know best how to shift the focus of care towards prevention are patients, because they’re the ones who suffer if they don’t get services early on. And the people who know best how to root out inefficiency and waste are the people who use services, because they’re the ones who have to spend time talking to people time and time again, which isn’t good for them and is a waste of resources.”
Across the health service, from diabetes to social care for the elderly, Kendall says it’s increasingly clear that a focus on prevention and patient-led care packages is not only key to improving outcomes, but also to reducing costs and easing the financial pressures on the NHS. With the future of the health service proving a key election issue, Kendall argues that there is a natural temptation for politicians and the media to focus on headline-grabbing figures for extra funding – “is it £2.5bn, is it £8bn?” – rather than the more knotty issue of reform. “Everybody always jumps to the extra money,” she says, “but actually we very rarely focus on the long, difficult but vital issues. My personal mission is to make sure that we never take our eyes of those reforms. Because it’s not just about the money, it’s about different outcomes.”
The left in particular, she says, has a responsibility to show that “social justice” and fairness in public services can be delivered at a time “when there is less money around”. “There’s nothing socially progressive about wasting money on services which aren’t achieving outcomes for people. As Bill Clinton said, it’s down to the people who believe in the power of the state to improve people’s lives; the onus is on us more than anyone to be pro-reform, because it is the people without power, wealth and opportunity who suffer when public services fail.”
The political row over the NHS has become increasingly fraught in recent weeks, with Ed Miliband making the A&E crisis the centrepiece of his attacks on David Cameron at PMQs. But the Labour leader has himself faced criticism over allegations he told senior BBC figures that he planned to ‘weaponise’ the health service. Asked if she has personally heard anyone in the party use the damaging phrase, Kendall emphatically insists she has “never, ever” come across it “from any person I’ve had a conversation with in the Labour party or the labour movement”.
In fact, she accuses Cameron himself of seeking to “play the political card on the NHS when it suits him”, whether over the record of the Labour administration in Wales or the Mid Staffs scandal. “I think one of the most disappointing things about Cameron, and Jeremy Hunt, is the NHS is all about politics for them,” she says. “But actually what you need is a man with the plan, and the men – and woman – with the plan are Ed Miliband, Andy Burnham and myself.”
Next Tuesday, Labour will outline its 10-year vision for the future of health and care, a plan Kendall says represents the clearest analysis of the problems facing the NHS in a generation. “If you think about the three previous prime ministers and their health policy, whether it’s Tony Blair, Gordon Brown or David Cameron, they had nowhere near as clear analysis of the problems and the solutions as we now have,” she says. “Successive governments have continually reorganised the backroom structures of the NHS, and it’s rarely if ever achieved the savings or the outcomes people want. We have learnt about what works and what doesn’t work in driving change.”
On private sector involvement in the NHS, she insists there “will remain a role” for private and voluntary firms “where they can add extra capacity to the NHS or challenge to the system”. “I’ve always believed what matters is what works,” she adds, citing the positive contribution independent sector treatment centres (ISTCs) have made in reducing waiting times. “I remember when I worked in the Department of Health a very senior clinician saying ‘you’ve got one of these ISTCs down the road now so I’m going to have to talk to some of my GP colleagues about getting my waits down and stop doing so much private practice’. So it did bring challenge to the system. It was the NHS – and the increased investment we put in the NHS – that delivered the vast majority of the reductions in the waits. But some challenge in the system was crucial to that.”
But she warns against a tendency to see the issue of NHS reform as simply about more private sector involvement. “I think people do worry that there is a kind of ‘reform’ which is to just ‘put it out to the private sector’, when actually what you want is to reshape services locally and, I would argue, nationally too,” she says. “Salami-slicing cuts and simply putting things out to tender isn’t what I call real reform. That isn’t to say that there isn’t an important role for the independent and private sectors. But real reform is more difficult than that.”
Kendall is certainly nothing if not a moderniser. Her career reads like the perfect CV for a health minister: a former special adviser to Patricia Hewitt, King’s Fund researcher, policy wonk at the IPPR and erstwhile director of the Maternity Alliance charity for new parents. She knows health, childcare and social care policy intimately.
She stresses how the NHS has to learn from new technology to cut costs, while delivering better consumer satisfaction and more joined up care.
“It is a disgrace how little we have used technology to transform people’s experience. This [she points to her iPhone] is part of my life now and that is how people increasingly expect to interact with the NHS.” But she’s not just in favour of more medical consultations by Skype or phone.
“Some people think ‘oh it’s just some pushy middle class people wanting to get things from their doctor when and where they want. I don’t think there’s anything wrong with making sure that our NHS needs to meet the needs and demands of middle class people or anybody else. But actually technology is about something much more powerful than that. It’s about allowing people to manage their condition.”
Kendall cites the example of an arthritis club in her constituency that helps sufferers share information on social media. Another scheme helps pensioners with breathing difficulties by letting them take their own oxygen and blood readings at home, relaying them electronically to a nurse.
“I went to the States to look at what they are doing there and it’s very interesting that one of the fastest areas for venture capitalists to be investing their money is health and IT. One half was in medical records, the other half was in health apps. Follow the money.”
She’s as keen on reforms highlighted by NHS chief executive Simon Stevens (a fellow former Blairite special adviser), to get different services working from ‘multi-use’ facilities. “We’ve got to get the best out of all our assets,” Kendall says. “If I look back to my greatest passion in life, which is about giving kids the best start in life: we need to make sure that our health visitors, midwives, Surestart and schools are all joined up. If we want to get parents understanding that the way they interact, talk with and play with their baby can have a huge impact on their later life chances, why couldn’t your first midwife appointment be at your SureStart or your local school? It’s about joining all that up to get the best outcomes for people.”
In public services, as with personal health budgets, “people want a sense of control over their lives”, she says. “Money gets you choices and chances and opportunities, a cushion and networks and contacts, I want to see those available to everybody.”
Another Blairite characteristic that Kendall is unafraid to display is her hawkishness on defence and foreign affairs. Asked if she now regrets voting with the leadership on Syria in 2013, she replies: “No. I don’t, but I think it is really important that we make a strong case for Britain’s role in the world, and that it is in our national interest to do so. Many would wish we could put up the drawbridge and hope the rest of the world goes away. Labour must and will remain firm in our belief that we do have an active role to play in the world along with others.”
So, it is time for the party to move on from its Iraq hangover? “We need a new generation of people to make a case for Britain to play an active role in the world along with our international partners. Politics in the end is always the route to solving some of the big challenges we face – but the ability for our military to act must always remain part of the range of tools that we use. It’s really important, when we see what’s happening with ISIL in Syria and Iraq.”
And to those who say the Syria crisis could have been curbed if the Commons had voted for military action two years ago? “I think Ed was right to say there were a series of important criteria that need to be met. And he’s also right to support the action the Government has taken in Iraq.”
Even Blair’s severest critics accept that his forte was winning general elections. With the 2015 campaign well underway, Kendall is already enjoying the race. Yet with Labour appearing to flatline at 30-32% in the polls, isn’t it true that the message isn’t cutting through on the doorstep?
“When you are able to talk to people face to face rather than through anybody else’s prism it’s always much better,” she says. “But I think it will be incredibly close, it’s all to play for there are still a lot of people still undecided. The challenge and the prize is to set out a credible message of hope that things can be better for you and your family and this area. It’s about credible hope. The party that nails that message I think will be the one that comes through. You can have easy headlines like UKIP or the SNP make, it’s always somebody else’s problem, it’s Europe’s problem or all the problems in Scotland are down to Westminster. Or the Greens who say it’s all this awful globalisation. Easy answers to very tricky problems.
“I think people understand that if we are straight and honest with them we can make a big difference, if we work together. Not simply thinking that somebody else is always to blame. For me this is the big choice.”
And she reveals she’s even had to rehearse her Labour doorstep pitch with her own parents, both of whom take a keen interest in politics. “A lot of my election campaign is spent dealing with texts from my parents,” she says. “With comments on everything from ‘it was a disgrace on PMQs today, what are you going to do about it?’ to ‘nobody’s talking about old people’, ‘what are you doing for my brother?’, ‘what are Labour saying about schools and families and kids?’
But does she get the same reaction as some colleagues when they canvass ‘soft Labour’ supporters: that they can’t vote for Ed Miliband? “I don’t get that, that’s not what I get. I get ‘What are you going to do about it? None of you make any difference.’ That’s what I get. Less so on my own patch…although you still get it.”
And she has a broader point about the need for Labour not to been seen as negative. “You can’t be the moaning man in the pub. Actually the moaning man in the pub often has a real point underneath it all. But mostly you end up not listening,” she says. “People want us to hold the government to account but they want a credible solution. And I think many people understand that on most of the big changes we need to say people will have to play a role themselves, it’s not just something you can just click your fingers from here [Westminster]. We can’t really turbo-charge our economy unless we also change what’s happening in the European economy. We can’t really transform our kids’ life chances unless we work with parents to give their kids a start in life, we can’t improve our health unless we all take on more of a role. That’s where we started as a party.”
As for Blair or even David Miliband possibly appearing again on the campaign trail, Kendall says it’s up to “this generation of Labour MPs and shadow ministers to be leading the campaign”. “People want to feel and see something different. If there’s one thing that Tony rightly taught us all, it is that our values stay the same but the policies that we need change as circumstances change around us. It’s down to Ed and the Shadow Cabinet to lead this now.”
Some in the party say privately that Kendall herself has the passion and brains to make a future Labour leader. Does she rule out the leadership? “If anyone says anything nice about me it’s incredibly flattering,” she says, before adding firmly: “All I care about is winning on 7 May. All I care about is getting Ed into Downing Street, full stop. That’s it.”
In the meantime, Kendall’s morning runs, 5 or 6 times a week, despite freezing cold or driving rain, are her own way of keeping it together amid her hectic schedule. “I run from near Vauxhall Bridge to the Millennium Bridge and St Paul’s – ah, it was lovely this morning – and back round for Westminster. I do the Great Central Way when I’m at home and the big difference is you smell stuff in Leicester. You can smell grass and flowers and damp. You don’t smell anything in London,” she says.
“I love it. I run for myself not as competition against anybody else. Haruki Murakami in What I Talk About When I Talk About Running, he’s the only person who’s ever described it well. You don’t think about all the separate things in your professional life and your personal life and focus on them, they just kind of percolate around in your head and afterwards you feel a bit more sorted. You feel great.”
But even at the tender age of 43, her body is beginning to feel wear and tear, she says. “I’m properly addicted to running, but I have to find something else because I can hear my knees. Yes, I can hear my knees. It’s a disaster. It’s not good.”
How about taking up cycling? “I would worry that I would get road rage,” she laughs, imagining the run-ins with cabbies and bus drivers. “I can’t do that, an MP shouting abuse! And I would, I know I would.”
So for now, she’s sticking to the pavements and footbridges of the capital and Leicester. Few MPs have an interest in both hip-op and hip-ops. But running against the forces of conservatism, in music and in politics, seems to be the activity Elizabeth Louise Kendall likes most of all.
KENDALL ON…PRIVATE HEALTH INSURERS
“I have been spammed by private insurers increasingly over the last year or so. People’s worries are increasing as [treatment] waits go back up.”
KENDALL ON…HOW LABOUR CAN WIN
“It’s about the degree to which we are simple and straightforward with people about the really big challenges and don’t provide false promises but something credible.”
KENDALL ON…THE TORIES’ EUROPE POLICY
“It’s not to work with our partners to reform Europe so that it’s a stronger growing economy that we can export into. It’s to have some sort of individual little repatriation of powers.”
KENDALL ON…TRIDENT RENEWAL
“It’s been agreed by our national policy forum. We have to remain very, very firm on that in a very dangerous world.”
KENDALL ON….CHILD ABUSE INQUIRIES AND WESTMINSTER
“Absolutely no stone should be left unturned…whether it’s any part of the Establishment, that has to be looked into.”
KENDALL ON…HER 2010 TWITTER REPRIMAND
“It’s ridiculous, the [State Opening] is broadcast. I’m all for obeying rules when I think they have a point, but I didn’t really understand that so I wasn’t mortified at all.”
Any treaty with implications for the future of the NHS should be subject to parliamentary approval, argues Clive Efford
The debate about the Transatlantic Trade and Investment Partnership (TTIP) has caused widespread concern among our constituents. They fear that under TTIP our NHS will very quickly change from the one to which they are accustomed to one where the rigours of the market come before the needs of patients.
The Government are giving assurances that they will not allow TTIP to impose market tendering on our NHS. We have had similar assurances from the EU. However, given that negotiations are ongoing and will not be completed until after the general election, we are being asked to take the Government on trust.
The lack of trust is inevitable given the way competition and procurement of NHS services has been opened up to market regulation under the 2012 Health and Social Care Act. If TTIP were to apply to the health service it would be entirely consistent with the approach the Government has taken when imposing its reorganisation of our NHS.
The Government has made a lot of the fact that the proportion of NHS services contracted out to the private sector has gone up by 1% to 6% since the provisions of the 2012 Act came into force. However, this does not allow for existing NHS contracts that will soon come up for re-tendering and will be exposed to private sector competition. There are already examples of where decisions about competition are being made by market regulators over the heads of local managers and clinicians.
Take, for example, Monitor’s investigation into plans to consolidate head and neck cancer surgery in Bristol. They refused to approve the plans of the hospital despite accepting that the changes proposed were likely to be in the interests of patients.
Monitor’s report concluded: “There is likely to be a benefit arising from the timely and effective transfer of specialist consultants required to deliver a model of care that includes a head and neck cancer, ENT [ear, nose and throat] and OMF [oral and maxillofacial] ward; an increased number of clinical nurse specialists; a treatment room available 24 hours a day; and, consultants with different expertise operating in adjacent theatres.” However, it went on to say that the merger “removes important competitive constraints for elective head and neck, ENT, OMF, urology and symptomatic breast care services in the absence of other competitors”.
It is decisions like this under the existing legislation – which was imposed without a democratic mandate – that make people fearful of the implications of any TTIP negotiated under this government. A piece of legislation that imposes this kind of logic on any public service – let alone one as critical as cancer surgery – is not remotely in the interests of the public.
The safeguard we need is to make Parliament sovereign over any future trade agreements that may impose any form of competition on our NHS, as set out in Clause 14 of my National Health Service (Amended Duties and Powers) Bill. This would mean that any future government would have to seek the approval of Parliament before they could agree any treaty that would apply to the NHS.
Currently, trade agreements are negotiated by government and Parliament has virtually no influence on the process. Parliament can put down motions delaying the approval of a treaty in its entirety, but it has no means to scrutinise and change its content (and in the case of TTIP, negotiations are at a European level with the US).
There are many eminent lawyers who differ over whether TTIP will or will not have implications for the contracting of services in the NHS. The decision for us as legislators is whether we take a chance on which set of lawyers is correct. If we choose wrong, then the courts – not Parliament – will decide which procurement and competition obligations will apply to the health service. The uncertainty can only be resolved by ensuring that Parliament has the final say.
Clive Efford is Shadow Minister for Culture, Media and Sport and Labour MP for Eltham
Poor communication has allowed fear, not facts, to drive the debate around TTIP, says Ian Duncan
Like nature, politics abhors a vacuum. In the absence of information it is unsurprising that suspicion and fear have begun to dominate the debate on TTIP. Last week the European Commission paused negotiations on the controversial investor-state dispute settlement (ISDS) clause following a scathing public consultation. The majority of responses – over 52,000 – came from the UK, reflecting a vocal campaign by trade unions and NGOs who believe the NHS and other public services will suffer under the deal.
It took a similar chorus of public outcry for the Commission to publish its negotiating mandate last October – over a year after European governments had started work on it. As noted by John Healey, the Labour chair of the APPG on TTIP and himself a supporter of the deal, the House of Commons has only debated the proposed treaty three times in 18 months.
European governments may be losing the battle of information, but that’s not to say TTIP’s opponents are right. In reality, TTIP as it stands will not harm the health service for one reason – the NHS is not part of TTIP. That much was made clear by Jean-Luc Demarty, the Director General of the European Commission’s Trade Directorate, in a letter he sent to me after I raised the question on behalf of my constituents. Since 1994, when the updated version of the General Agreement on Tariffs and Trade (GATT) was signed, the EU has followed a consistent line of excluding public health systems from free trade agreements.
It has two ways of doing this: firstly, by taking no commitments on public health at all (as in the EU-Korea agreement), or by taking a full ‘reservation’ on public health systems which effectively dispenses the EU from any market access or non-discrimination obligations (as in the EU-Canada agreement). Mr Demarty could not have been clearer: “TTIP does not affect the UK or devolved governments’ sovereignty over how NHS services are provided, whether in Scotland or the rest of the UK.”
The principle that public health systems should be excluded from free trade agreements existed long before 1994. To exemplify how the NHS might be at risk from large multinationals, Len McCluskey wrote to me citing an example where the Slovakian government were being sued by large multinational Achmea for attempting to socialise their private healthcare insurance system. What Mr McCluskey failed to recognise is that the Slovakian government won that case, with the judge stating he had no remit to force governments to run their health systems in a particular way. The trade deal in question dated from 1992.
Opponents of TTIP and of the Conservative party (it is an election year, after all) are quick to point out that parts of NHS are now being delivered by private providers, and that should a future Labour government wish to bring those services back into public hands they may be sued by American multinationals.
TTIP negotiators are quick to counter that assertion, however. By deliberately not applying the ‘ratchet clause’ – therefore allowing the reversal of liberalisation under a trade deal – they believe future governments will be able to bring privatised services back into public hands without the risk of being sued. Similarly, negotiators are determined – through the controversial ISDS clause – to ensure that a change in legislation is not criteria for breaching the agreement.
The irony of the Commission’s decision to halt negotiations on ISDS is that we won’t be able to see that ambition in black and white for some time yet. As a result, I fear that the vacuum will grow and will be filled by yet more suspicion.
The Commission’s ambition is to have a deal put before MEPs by the end of 2015, but I don’t think that’s feasible. While we do know that the NHS will be excluded, questions still remain as to the impact of TTIP on key areas like agriculture and the environment. Before a final deal is reached, governments and the Commission need to learn the lessons of the past 18 months and begin countering assertion with fact. TTIP could be a huge boost to jobs and growth in Europe, and it’s time to start telling people how.
Dr Ian Duncan is a Conservative MEP for Scotland
I suspect that I’m among those who could be accused of betraying feminism by Professor Alison Wolf, the crossbench peer and Cambridge economist who has declared the “sisterhood is dead”.
She has complained of a “complete preoccupation in feminism with the economic self-interest of the top people, whether it’s boards or Parliament”. Modern feminism, she argued at a Demos lecture and in The Times, should be more concerned about the lives of those working long hours in low-paid, unstable shift work, or facing hostile domestic environments.
Of course it should. But I don’t understand how focusing on the number of women in Parliament could possibly be at odds with that. We don’t make the case for more female MPs because we are concerned about the rights of successful, middle-class women like Harriet Harman, Yvette Cooper, Nicky Morgan or Jo Swinson.
The argument isn’t on behalf of these women MPs and their career progression – it is about the voters whose lives they can affect. Having female figures in Parliament changes not just the tone and the content of debates but policy outcomes.
Baroness Wolf said diversity in Parliament was important but it wasn’t about sex, arguing that adding in women who were part of the “metropolitan elite” wouldn’t help. I think gender does matter. Ms Harman’s schooling at the elite St Paul’s Girls School didn’t diminish her feminist credentials, and it isn’t just about individuals – numbers are important too.
Of course there are male MPs who care deeply about some of the issues that most affect the lives of women (we have a male childcare minister). Yet the reality of my time covering Parliament is that every meeting, conference or rally most focused on these areas – from childcare and pregnancy discrimination to female genital mutilation, domestic violence, or forced marriages – has been disproportionately filled with and driven by female MPs.
Baroness Wolf has warned against representing all women, with their many different lives and interests, by the views and voices of a single female summit. I agree this is not a homogenous group, but there are issues and struggles that simply do affect women more, and justify a gendered response.
As for childcare, she argued that making it cheaper helps the educated middle classes in regular, stable jobs. That may be true of some reforms, but not the largest of all – the 15 hours of free nursery care pioneered by the previous Labour government and extended under the Coalition. The head of a large London children’s centre recently told me the policy had dramatically changed the socioeconomic mix of her nursery, bringing in far more children from disadvantaged families.
As for women on boards, it probably does swallow up more than its fair share of policy focus, but it is important. She points to evidence from Norway that shows forcing change in this area has no impact on pay, promotion or even profits. Yet a study by McKinsey found that companies with the highest level of female representation at executive levels had significantly higher average returns on both sales and equity.
And even if the jury is out, surely there is powerful symbolic value in breaking down the male dominance at the top of the food chain? I agree that areas of policymaking like this – and perhaps tax-free childcare or parental leave – do tend towards the needs of better-off women (and so shouldn’t dominate, although they are feminist causes). Yet others have focused on exactly those women who Baroness Wolf believes have been ignored.
For that to continue, we need yet more women in Parliament. So let’s not give up on one of the sisterhood’s important fights.
Anushka Asthana is political correspondent for Sky News
Words: Paul Waugh
Photos: Paul Heartfield
For a woman whose weekend lie-in was ruined by pre-dawn tablet computer action, Nicky Morgan looks remarkably bright-eyed and bushy-tailed.
“Alex woke us up at half past five,” she says, highlighting an exchange of views with her seven-year-old son to which many modern parents will relate. “And as a result he lost gadget time for the rest of the day. He was deeply unimpressed by that. We had a little negotiation about whether ‘gadget time’ meant ‘TV and screen time’ as well.”
Firm discipline, parent power, pragmatism and a willingness to consult key stakeholders: the early-hours Morgan household sounds like a microcosm of the Education Secretary’s political philosophy.
Unashamed of admitting she’s learning on the job, both as a minister and a parent, the 42-year-old Loughborough MP was installed by David Cameron last summer precisely for the fresh approach she’s brought to the post. Not so much the anti-Gove as the not-Gove, her mission has been to provide a more telegenic, voter-friendly face of the Conservatives, while not undermining her predecessor’s reforms. Somewhat like Jeremy Hunt after Andrew Lansley’s departure, Morgan has the twin task of calming troubled waters while consolidating and explaining changes already made.
And with the election campaign effectively already under way, it’s no surprise that the Prime Minister this month selected education as one of his six key themes – and Morgan as one of his key ministers – to sell the party’s message. As an MP in a highly marginal seat, Morgan also brings a heightened awareness of the need to appeal to Labour voters and others pitched firmly in the centre ground.
“In terms of education, I draw a lot on my experience in Loughborough. I am interested in what works,” she explains in her seventh-floor office on Great Smith Street. “There’s always lots of ideologies; you can talk about structures and this, that and the other. But actually I’m interested in ‘what does that mean for the family in Loughborough, or the family in the north, or the family in the south-west?’. Can they get their child into a school that they want to? Do they have confidence in the teaching? And is that school preparing their young person for life in modern Britain? That’s what’s driving me.
“I was interested in education before, but it has been a steep learning curve, there’s lots of education lingo and acronyms to learn. I’m thinking ‘who are we doing this for?’.”
Morgan stresses that she firmly believes in rigour, high standards, and putting power back in the hands of parents and teachers. “My own personal style, the reason I came into politics and joined the party when I was pretty young, was very much about representing people against big government,” she says.
Yet she is clear that now is the time to sell the reforms rather than disrupt the system further. “As an MP with a marginal seat I’m able to bring that to the table and can say how these things are going to play. How do we communicate our messages to people? How do we bring across people who may not be traditional or long-term Conservative supporters but actually we have a message for them? And how we communicate that.
“I think the past six months and the next three is about me explaining to parents outside Whitehall and the Westminster bubble: this is what the reforms mean. A lot of time we talk about academies and free schools, but we should be talking about putting power in the hands of heads and teachers, who we trust, and the reasons why.”
Whereas Gove often appeared to be waging a one-man war with an education establishment that he famously dubbed ‘The Blob’, his successor is keen on bringing people together on common ground.
“I am a One Nation Conservative. I do that in terms of giving our most disadvantaged pupils the best start in life – that’s where education plays its part – but also stretching our most able children. If we believe in a meritocracy, which we do as a Conservative party, you have to give people the tool – which is a great education – in order that they can make their way in life.”
There is that Gove-like impatience with the system, however. “We haven’t got a day to lose. If there’s a school that is struggling, that’s where reforms of this government have been: let’s not waste any time about this,” she says.
“Coming from a business background, one of the things that is most surprising is just how long it takes to make changes in Whitehall. Just occasionally you are able to say ‘change that statutory bit of guidance’ but a lot of time there’s lots of debate, and one of the things about education is everybody has a view on it...because we’ve all been through the education system.”
One man who very much has a view is former DfE Permanent Secretary and Ofsted chief Sir David Bell. Last week, he attacked the damage done to education by five-year election cycles and the dangers of “ministerial whims”. Bell even reserved some praise for Morgan, saying she was “less tone deaf to people who can offer intelligent, constructive proposals and critique”. Though his remarks seemed aimed at her predecessors, has she been guilty too of ‘ministerial whim’?
“The things I’ve done have been on the basis of what people from outside have told me...things like the character building, but also the new careers enterprise companies,” she says.
“David Bell’s speech, I had to chuckle. If you’ve been involved in education, it’s very hard to leave it behind. And I think it’s great to have a debate. The five-year electoral cycle, for anybody outside politics, it is frustrating, whether you’re talking about business people or schools. People have to plan on a longer-term basis.”
She says that at a recent event with the Teaching Schools Council, “they were asking what’s going to happen in May. I just said ‘you just be the best you can be’ and people respect that”.
But while her tone is respectful, Morgan says she disagreed with Sir David on his suggestions of political interference and argues that his call for an independent body to set curricula “doesn’t solve the problem he says he identified”. “I do think that at the end of the day as a Member of Parliament I go out on Saturdays, I stand in Loughborough Market and I talk to people and I think it is right for us to be making decisions: direct accountability. But you also draw on expertise in terms of informing your policy.”
Bell also attacked the lack of an evidence base for the Home Secretary’s “bizarre” idea of deporting foreign students once they’ve graduated. Both No 10 and George Osborne – Morgan’s former boss and a clear admirer of hers – were swift to make clear that the plan would not go ahead. Does Morgan agree there’s no need to change the present arrangements? “I do. I also represent a constituency with a successful university in Loughborough and I know just how important the graduate market is for this country. There’s no doubt immigration is of course a concern. But when my constituents are talking about immigration, I don’t think they are talking about Loughborough University.”
One area where the DfE is working in tandem with the Home Office is on the Coalition’s wider attempt to combat radicalisation, both in universities and schools. Morgan, who had to make a Commons statement on the Birmingham ‘Trojan horse’ affair, says that “in the light of recent events” in France, the prevention programme is even more important. “One of the other things we are asking of schools is the whole teaching of British values. This applies to all schools, it’s about these core values. We’ve seen what can happen last week when people don’t appear to respect some of those values, things like tolerance and mutual respect,” she says. “It’s very, very important. I know this is being discussed in governing boards up and down the country. Many schools do this without necessarily badging it as such. And others are having to think ‘how do we bring this in?’
“Things like PHSE, citizenship, are all very important in terms of that. But we must have core common values that build us as a country. These British values have been defined in various strategies by the Home Office, and we are asking schools to think about how they promote them. Ofsted will be looking at them when they visit schools.
“It’s about that shared history or heritage, which I think makes us really strong as a country. We have freedom of speech and liberty in this country, we may not have had a revolution in the same way they perhaps had in France but I do think there are things that are precious, and if we don’t guard them and if we don’t appreciate them…Sometimes we think it’s not very British to talk about them, but I think it’s now clear that we do need to talk about them.”
The value of teaching children about sex and relationships has become a hot topic in recent months, with Labour pushing for compulsory lessons. The Ched Evans rape case has highlighted the debate about role models for boys and the importance of teaching them ‘no means no’ at a young age. “It’s appalling,” she says of the case. “I’d like to see a lot more emphasis on it – and I think there is – in relationship education; that’s where things like consent come in as well as unhealthy relationships, knowing when there’s a bit of an issue. I think it’s a really important part of what schools do in terms of preparing young people for life in modern Britain.”
Morgan saw sex education in action on a recent visit to a school in Kris Hopkins’ Keighley constituency, part of the tours she makes of the nation’s schools at least once every Thursday. And it’s seeing schools share their know-how that’s struck her most. “One of the exciting things people miss about our education system, and I certainly didn’t know until I got in [post], is actually the profession really care, and they want to share best practice among themselves,” she says. “The whole peer-to-peer, school-to-school support is so important, really effective and really more credible than the man from Whitehall.”
Pupil premium is the Coalition’s landmark attempt to trust teachers with extra cash, and ex-union leader John Dunford is now the ‘champion’ for the project, spreading best practice around the country. Morgan says many heads are targeting the money on extra English and maths tuition. “I feel really strongly, as a mum of a seven-year-old. I’ve just watched him learn to read over the past 18 months, it’s a completely magical thing. But if you don’t get that, if you are a child in a school where for whatever reason you don’t get that English and that maths, the absolute basics, how can we possibly as a country say we have done the right thing and we have served that child well?”
And with private tutors used increasingly by parents, the Education Secretary believes poorer children can keep up thanks to premium-funded extra tuition. “That’s for pupil premium, that’s [a good use of the money] in terms of investing in that child or a particular group of children.”
Homework also appears to have increased in volume in recent years, a fact that led Times columnist Caitlin Moran to recently call for it to be banned. Moran wrote: “Let’s call homework what it really is. It’s a parent test. It’s a life-vampire. It’s emptied our playgrounds and panicked our children. It puts work into a home. I wish it death. I hope the biggest dog in the world comes and eats it.”
Did the Secretary of State read that, and if so did she laugh? “I did laugh, but I also slightly wanted to strangle her. Because actually I think homework has got to be age-appropriate. I’m sitting here and my husband is the one who does the homework with our son and he has a lot more patience than I do. But I do think homework is good discipline, it’s about learning that. It’s a discipline in doing a little bit of work at home, investing in your own education, but it’s also about parental engagement.”
She points to a project in a primary school in her constituency which has a new scheme to get parents to practice key words and times tables with their child. “I do think as a parent sometimes you want to know what’s going on in the classroom but don’t necessarily know how to ask. I still get nervous talking to teachers and it reminds you of being at school yourself. And seeing what your child is doing is really, really important.”
But isn’t it the case that many parents actually end up doing their child’s art or geography projects instead of their offspring, as polished posters or models attest? Isn’t that a waste of time? “Absolutely. I think it’s about parental supervision and support and engagement. You know it’s not them. I would trust teachers to make sure they were asking for projects that work, that children are going to be doing. They will make it clear to parents that you’re not helping necessarily if you’re doing an awful lot of it.”
Another 21st-century foible of some parents is the heavy diarising of their children’s extra-curricular lives, with cello on a Monday, Mandarin on a Tuesday, jujitsu on a Wednesday, and so on. “We can always find the parent who does that and then there will be parents at the other end of the spectrum too,” Morgan says. “I think extra-curricular things are important. But I do think that, speaking as a mum, when my son says ‘I’m bored’, I say ‘well, just go away and find something to do, you’ve got lots of toys, lots of things there’. And then suddenly I will find that my son is busy, has dragged something out, he’s amusing himself, and I think there is an element of not needing every moment in the day to be filled. I think it’s an important skill to be learned.
“If we say to him ‘just go and do something’, it’s amazing how much the Lego will come out, or Playmobil, whatever it might be, and actually it’s lovely then to see him, he’s busy building things, Hot Wheels tracks.”
Boys tend to be heavy iPad and Xbox users, and having been on the sharp end of that early-morning tablet disruption recently, Morgan takes a close interest. “Because of the growth of tablets and everything else and the fact that children are using them younger – which is in many ways a good thing, they are great learning tools – I think it’s all kinds of new challenges. I guess our parents had ‘TV time’, we had the same kind of issue, but I do think it’s one of those things to grapple with.”
Another cause of irritation for some parents is the vogue for parents’ evenings during the daytime. Morgan is characteristically reasonable, while making her point on behalf of working mothers and fathers. “I think there should be a happy mix. Teachers themselves are often working parents and so I think they’d have to realise that evening meetings are more convenient for working parents. I think many teachers run an open classroom door. Morning meetings may be better for some parents, it’s easier to arrive an hour later in the office than it is to take half a day off to get there. My son had an open morning, that was terrific.”
Working parents have also had to juggle childcare to deal with teaching union strikes. Now that Patrick McLoughlin has announced that a Tory government would ban action which lacked a lower threshold of support, would that mean fewer strikes for schools? “I do think it’s important. It’s not about people not being able to strike and there will be times when people take that decision. But it is about parents having confidence. When there is a strike and schools shut that is very difficult for parents. I’ve had a number of constituents who were affected back in 2011 telling me: ‘How am I supposed to cope?’ It’s a day off work, or it means childcare. Sometimes some schools have done it so some classes are affected and not others. So that means one might be going to school, another one isn’t. That’s also very tricky. Every time a parent has to take a day off work that’s not planned that has an impact on wherever they are working on staffing patterns and the bottom line.”
So the tighter strike laws will be a vote-winner? “I think it’s one of those things that contributes to the sense that we are on the side of people who are working hard and want to do the right thing for themselves and their families. Good strong schools are a part of that. A good strong economy. Things like the strike action, saying we want schools to be open unless a certain threshold is met, is important.”
Yet with huge numbers of students in her constituency, is that other key coalition policy – tripled tuition fees – turning out to be a vote loser, or is she confident she can sell it? “I am confident. It depends very much on the candidate, how much you’ve engaged with the students. Loughborough University is very much at the heart of the constituency. I spend a lot of time on campus meeting both staff and students. I always meet the student union at the start of every academic year, and I get quite a lot of casework of constituency correspondence from students. And I think it’s very important to represent them.”
So are students coming round to the idea that the current system is better than what went before? “I think so. I think Loughborough have always been quite focused on ‘where do our students end up?’ Loughborough students are hugely employable, partly because of the sport but also because they’ve got great engineering facilities and other courses. Talking to universities, to my Vice Chancellor and others, students do now ask that question: ‘OK, I’m going to invest this money in this university, where is that going to get me?’
“Whether people are completely reconciled to the system, I think for families it’s still quite a big thing, and there’s always a job of work to do to explain what it means for families and their finances. Who knows, I never want to pre-empt how anybody is going to vote, but I am confident. It’s over-simplistic to say that the student vote will swing it and be a deciding factor in a number of constituencies.”
A key educational decision for one particular Loughborough family – her own – is just where to send her son to school once he’s left primary level. Would she like to send him to a state secondary?
“I would very much like to send him, we have got some great secondary schools in Loughborough, state secondaries, academies. And actually I think they are a terrific option. We are a way off having to make any decisions.”
But is it, as some argue, now almost a duty on a secretary of state – and a prime minister – to send their children to state schools? “I don’t know about political duty as such, but I think it sends a clear signal that actually there are great schools. And both Michael Gove obviously and the Prime Minister, whose children are at primary school at the moment, have identified schools that they think are right for themselves and their families.
“I think it is a vote of confidence. But I think it’s one of those really difficult things for politicians’ families, which is at what point is the family public property compared to a Member of Parliament or the minister? And it’s something that we grapple with quite a lot as a family.
“Doing this job with a child in the system, I think it’s good I’m able to say to people ‘look, I have a very personal stake in the system’ but on the other hand you are always sort of thinking it is separate. The Prime Minister will say that actually he has made the right decision, talking about it, for Nancy, going round talking to schools, he’s been very clear about making the right decision for her.”
Which brings us to the right decision for Nicky Morgan. If she is returned in Loughborough at the election, some have said she’s a dark horse in any future race for the leadership. So, would she one day like to lead the Tory party?
“It’s not something I dwell on at all,” she says, laughing. “I’m delighted to have a position. We’ve got a Prime Minister, I’m a huge supporter, I think he’s doing a fantastic job.”
But she adds: “One day it would be lovely to have another female leader of the party and I do think that it was great in Scotland at one point they had female leaders of the parties. My other brief is Minister for Women and Equalities. I do always say more generally, we need more women in politics.
“You know, we’re 50% of the population and we don’t have enough, and whether it’s having senior women, a Home Secretary like Theresa May or female leaders of parties as we’ve seen in Scotland, it is important in terms of raising girls’ aspirations. Not that politics is the only thing to go into, but I think it sends a clear signal that women can get to the top of their chosen profession.”
If David Cameron’s ‘aspiration nation’ message wins out in May, Nicky Morgan could well be a key beneficiary. And that’s a screen test even her son could agree with.
MORGAN ON…TEACHING 'CHARACTER'
“The character-building stuff has really caught schools and teachers’ imagination.”
“I’ve yet to go to a school where a head will say to me ‘becoming an academy was not the right thing’.
MORGAN ON…BEING EDUCATION SECRETARY
“I didn’t expect to be Secretary of State with just over four years after coming into Parliament. But it’s just the most massive opportunity. It’s a challenge for me, it’s been a steep learning curve. And it’s great.”
MORGAN ON…HOMEWORK PRESSURES
“It’s right for the heads to make a decision about what’s appropriate at that particular age.”
MORGAN ON…TRISTRAM HUNT’S FREE SCHOOL ‘YUMMY MUMMIES’
“You should never ever sneer at people’s aspirations or their desire to do the best for themselves and their families.”
MORGAN ON…LABOUR’S THREAT TO PRIVATE SCHOOLS
“It showed a slight out of touchness. Many independent schools are already collaborating very closely with other schools in the local area.”