We have to learn from history. We have learned that vast monolithic structures rarely deliver good results: in health, education or business. Choice, diversity and competition are good things – they help keep people on their toes. Soviet Russia taught us that monochrome state-controlled service delivery is highly inefficient. British Leyland taught us that state-owned businesses rarely succeed – just think back to all of those broken down cars on the hard shoulders of our motorways in the 1970's!

Yet there clearly has to be a balance between a national system and a complete free for all. Some would argue that our healthcare landscape is currently too fragmented. Hospital trusts, independent GP practices, separate community healthcare companies, Clinical Commissioning Groups, Local Authority social care departments, NHS England, all notionally overseen by the Department of Health – the field is cluttered and disjointed.

This fragmentation came about because the previous large scale organisations were not delivering and certainly could not meet the challenging demands of today's ageing population. An injection of rationalisation into the system and greater coherence would be welcomed, without the upheaval of another structural reform.

I am cautious about much more disintegration in the education field also. I strongly support the movement towards academies. I have seen all too often quality school leadership held back by pointless meddling from the local education authority. But it is possible to go too far and create a shambles that is too diverse. I support free schools – for example the one at Sparkwell is very successful and popular – but I am not sure of the contribution made in Plymouth by specialist art and technology schools. A step too far perhaps. 

Neither am I sure about the government's recent announcement to allow another wave of grammar schools. I would not want to see us heading back to a system whereby one set of exams at age 11 determines your future. Selection is great for the ones who pass, but what about the many children who do not?  The grammar school system in Plymouth works well because it sits alongside an excellent bank of comprehensive schools. I would not want to see the quality of non-selective schools undermined by a new raft of selection. I will study the details of our policy carefully before deciding whether I can support it.

Moderation in all things is a worthy maxim. Getting the balance right in the structure of service delivery is a very difficult but important objective.  


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posted by Gary @ 13:16