Creeping technocracy in the NHS

Yesterday’s Sunday Telegraph had a story about how ‘doctors’ believed old people shouldn’t necessarily be treated on the NHS. On closer examination, only two thirds of them seemed to have agreed – and to the highly ambiguous proposition “not treated when it would not benefit them for long”.

Everyone could probably agree to aspects of that: we should not “strive officiously to keep alive” – at least if we want people to die peacefully and in some control about when and where they do so. Even so, it's a worrying trend that even doctors are beginning to support the outrageous status quo, and even maybe extend it. It’s hard even now to get proper treatment on the NHS when you’re over 70 for strokes or depression.

Any extension of this would be a creeping, inhuman piece of functionalism. It goes along with the horrific way the medical profession is beginning to talk about 'harvesting' human organs. What is it about the medical profession that it swallows the government's mores and attitudes so completely?

I've been wondering whether it is something to do with the way that New Labour has managed our public services that they have been encouraging this kind of inhumanity among the professionals who work there. Are they so desperate to balance the books that they are prepared to accept this slow withdrawal of care from anyone the state deems unproductive?

Either way, it is an attitude that seems to fit with the giant, technocratic and decreasingly ineffective institutions - schools and hospitals and others too - that New Labour has created over the last decade. Or does it?

Trapped inside a metaphor for New Labour

I’ve just been to the newly refurbished London Transport Museum in Covent Garden, with the family in tow. The elderly buses and trains were rather wonderful (the ones in the museum, I mean), the exhibition was brilliant, but – it made me think, presumably thanks to Heritage Lottery, about the miserable straitjacket that New Labour wants us to live in.

Because this was a museum without a map. Where we were expected to follow the arrows, take the lift to the top – it wouldn’t stop anywhere else – and follow the designated route slavishly downwards.

We were, in fact, issued with a map without any information at all about which exhibits were where. Once inside, there was nobody to tell us where to go.

Now, you might say: haven’t they worked it all out to give us the optimal experience? But that really is New Labour speaking – as if nobody could have any specific knowledge and have just come for that (the design? The tapestries for the innovative seats on the Underground?). As if nobody might prefer to go round a different way (too inconvenient).

The shop was, of course, fully staffed. Rather like our airports have become mere adjuncts to massive retailing operations, I fear our museums are going the same way.

So I learned a great deal about the history of London transport, but rather more about Blair, Brown and Livingstone’s utilitarian Britain.

Lib Dem localism vs. Tory localism

I arrived late at the one-day conference and missed the big speech (and the drinkable tea). Having heard what Nick Clegg said about public services, I’ve been checking out the blogs this evening and – rather to my surprise, actually – they seem to be as enthusiastic as I am.

Of course, there are difficult details that will have to be hammered out about the Free Schools policy – letting local people set up local schools, under local authority oversight – but it is still for me a transformative moment. It is, at last, a genuinely Liberal policy on public services, and (I might add) badly needed in my own area in north Croydon, where children are corralled into too few places in mainly indifferent schools managed by a cash-strapped, unimaginative Tory borough.

There have been blogs in the last few hours pointing to the experience of Summerhill and – more relevant this – the Hartland Small School. We might also learn from the Danish small schools movement. Taken together, this is exactly the stuff we need to put flesh on the otherwise empty phrase ‘people’s politics’.

But we have been late arriving: Michael Gove has already spelled out related ideas for the Tories, which leaves us with a problem – how do we distinguish Lib Dem localism from Tory localism, without falling back so boringly on claiming they don’t mean it? This is what I would suggest:

1. Cameron localism is the apotheosis of the quango state: his new schools are not knitted into other networks of local schools, but run by a Whitehall department, as the academies are now. This is not localism; it’s centralisation.

2. Embed what we are saying about localism in a much more fundamental critique of public services. Why don’t they work? Why are Beveridge’s Five Giants still alive and well? Partly because of centralisation, partly because frontline staff and customers have been so side-lined – but partly also because only human-scale services, based on relationships between professional and client, create sustainable change. Yet Cameron is advocating Gershon style cuts to exactly these aspects.

3. Link public service centralisation to economic centralisation: the narrowing of choice to a few giant corporate supermarkets, waste contractors, etc. And do so in such a way that at least one of Cameron’s factions finds it impossible to follow us into radical anti-trust legislation.

History, thrift and nuclear energy

Say what you like about New Labour, under either Blair or Brown, and you come back to two extreme truths about them: they are extreme modernists and obsessive utilitarians. Their blind spot, therefore, is history. They don’t believe in it or understand it. Hence Iraq, and goodness knows how many other misjudgements which a simply knowledge of history would have avoided.

This also applies to recent history. They don’t remember what went wrong with nuclear energy last time, don’t even think it’s important to know, don’t see that it’s relevant. My feeling is that, despite their announcement, only one or two new nuclear power stations will actually be built, and for the same reason as before:

· The vast expense: nuclear energy is not economic if you include decommissioning, security and insurance (nuclear power stations are not commercially insurable, for obvious reasons).

· Public concern about the vats of high level nuclear waste, hanging around waiting for some kind of viable storage solution.

· The terrorist threat, to the plutonium, the waste and the power stations themselves.

In the end, just like last time, the Treasury will pull the plug – but we will have wasted tens of billions and maybe another decade to invest in efficient decentralised energy systems.

But it does provide a political opportunity for the Lib Dems to revive the traditional Liberal campaign for thrift. Look at the waste, after all: nuclear energy (£15 billion), ID cards, NHS computer fantasies, Iraq, bailing out Northern Rock. Isn't there some kind of theme emerging here?