Independent research backs competition in the NHS

Following the passing of the Health and Social Care Bill the Economic and Social Research Council (ESRC) have released their findings relating to competition in the NHS. As an independent research body there should be some weight to their opinions and it is generally positive in relation to competition within the NHS for the following reasons:

  • Hospitals located in areas where patients had more choice had greater improvements in clinical quality and greater reductions in lengths of stay post policy than hospitals located in less competitive areas. Additionally, the hospitals in competitive markets increased their quality without increasing total operating costs or shedding staff.
  • While around half the acute hospitals in England were involved in a merger between 1997 and 2003, recent studies have shown that these did not make improvements with one possible reason being that mergers reduce the potential for competition in a local market.
  • Another study of management in the NHS shows that better management is associated with better outcomes in NHS hospitals and that management tends to be better where hospitals compete with each other.

So while there has been a lot of debate about the future of the NHS and in the extreme the end of the NHS, perhaps we should bear this research in mind as the ESRC conclude:

there is no evidence from recent studies of the UK that allowing patients more choice and exposing poorly performing hospitals to the threat of their patients choosing another provider is going to lead to the whole-scale destruction of the NHS and large equity issues. On the contrary, the evidence we have suggests that it has the power to improve outcomes for patients.

What Clegg can learn from the Business world about staying on top

Nick Clegg makes the Liberal Democrats' Leader...

Nick Clegg

What is Nick Clegg good at? He had certain attributes which were suited to getting to the top of the political pile. Cameron has some of these attributes and Gordon Brown didn’t really have them. But when it comes to staying on top, the necessary attributes can be very different and Cameron has shown he has them and people like him and perhaps Clegg doesn’t have them.

When looking at the attributes that are needed for staying on top there has been a lot of research done in the business world and a new book will be looking at some of these. While all leaders need confidence and conviction, both of which Clegg has a lot of, these do not continue to carry you once at the top. So if there are any lessons for political leaders what would they be for Nick Clegg?

Humility: An important attribute for leaders once they have reached the goal of being in office as confidence is required to command respect, but humility is the necessary counter-balance to earn it. Humility in a leader has been shown in business many times – for a seminal piece of work see here. How would you rate Clegg on a humility scale? If humility is modesty, lacking pretence, not believing that you are superior to others then I am not sure he comes across that well and perhaps he would benefit from this attribute.

Intellectual Curiosity: Often leaders start by asking questions and then find themselves on side of the ordinary person but as leaders mature they then begin to answer them taking them away from where they wanted to be. Perhaps this is happening in the Lib Dem leadership as they seek to offer answers to a concerned membership.

Optimism: Clegg was originally seen as a very optimistic leader and many people liked him for it. He continues to say he is an optimist but leaders are expected to dissent, find the holes in logic, and predict pitfalls. After a while this attitude can become difficult to shift and we have seen Clegg doing some aggressive attacking of Labour and their policies as this is part of his job. The problem is that it doesn’t make him seem very optimistic and nor does it attract Labour voters.

Vulnerability: Power, strength, and confidence are attributes that leaders are expected to project to voters. But vulnerability humanises leaders, creating a “pull” of people towards you. People who ask for help often find others rallying behind them, fueled by a feeling of being needed and collectively working towards success. Clegg doesn’t so much attract people to help him out as turn people away right now so perhaps a little vulnerability from him would help?

Authenticity: Politicians are all too often over-positioned and under-authenticated. You can lose the authenticity in yourself and in the true purpose behind your party. Worse, you can start believing the spin around you and then people can see what you are saying is not their experience and then they are not listening anymore.

Openness: Tony Blair said that openness is the key to success in politics and despite what we might think of him, he was a successful politician in terms of winning elections. Welcoming things that might not fit the traditional mould may be an important part of staying on top.

While there are many reasons why people view Clegg as they currently do, we have a choice, to campaign for a new leader or to support the one we have. Perhaps if Clegg were to display some of these attributes then there may be an improvement for people to want to support him?

An email conversation with Tim Farron

Following a recent post Tim Farron replied via Twitter and I had a brief twitter exchange in which he asked me to email him my ideas so here was what I sent:

Hi Tim,

Thanks for asking me to email you, it is a privilege. My ideas are my own and you may or may not find them useful but I hope they offer you something. These are difficult times for the party and I know you and everyone is trying as hard as possible.

These ideas are based around one theme, which I think is important in a Coalition: how does this act demonstrate that we believe in our core values.

As Nick Clegg says ‘I am asking, day in day out, Liberal Democrat[s] to vote on things that they wouldn’t do in a month of Sundays if it was a Liberal Democrat government’ so I wonder how we can demonstrate these values considering we are having to do things we don’t want to do. I go back to what worked for us before, which was to have someone who said something different to the Tories and Labour but made sense.

We spend a lot of time defending things now and I don’t think it has been working for us – the best way to kill a relationship is to become defensive. So we need to get that voice back and if it can’t be someone in Government then it needs to be someone else in the party. Your position could be perfect for that role but it means wading into the big debates – to demonstrate our core values that are being undermined while in Government. Even better would be to have a number of senior people who have approval to provide this voice together. We have worked best in Government when we have been publicly fighting to get what we think is best and speaking with more than one voice i.e. demonstrating our values (e.g. NHS, tax threshold) and worst when we have fought behind closed doors (e.g. tuition fees).

Next I think we need to get back to values: Danny Alexander said in ‘Why Vote Lib Dem’ we are a party who believes in collaboration. So how has this government demonstrated collaboration? Where we have done this, how has this been communicated? and where it has not been possible, how have we explained this to the public? Things I think we could do:

Support the Charter for Compassion: A grassroots movement bringing together charities, NGOs, religious groups and more which can make compassionate cities like Seattle and many others around the world see:

Demonstrate collaborative governance: Call for a 21st Century Town Hall meeting from AmericaSpeaks to address issues such as the NHS and other reforms. How would this change perception of the party if we called all significant players together for 1 day which resulted in a policy/amended Bill etc. AmericaSpeaks have done this for the reconstruction of New Orleans, Ground Zero and for the US national budget (not in an official capacity though see: see: I think we should have a policy of collaborative Governance as a stated aim – what better way to demonstrate we believe in collaboration and devolution of power? it would certainly trump the Big Society!

Another value of the party we could show more clearly is our anti-establishment one, as Nick Clegg said we needed to show when he was vying for the leadership position. I know there are a lot of things we have done in this area but there are other things we could do:

Come out against bonuses altogether: Research has shown time and time again that they do not work. Why don’t we listen to the evidence? Who doesn’t want us to move to a system that works better? Not that I suggest the UK goes it alone in banning bonuses but calling for the debate which will demonstrate our anti-establishment value Isn’t this essentially the type of move Clegg did with his recent speech on the economy? Why not spell out some distinctive policy aspirations which show what we believe in? some here:

Call for reform of Civil Service: We need a significant change in the way the civil service is run. You only need to ask a public sector worker of the effects of policy which doesn’t match things on the ground. This is reflected in a lot of the things they do.

In terms of what we can do to improve how we work with the Tories I see things very simply: I asked people to help out with this and this was the updated version which shows how we could focus work with the Tories in a more beneficial way and this was the result

I know I have probably gone overboard with links but my project looks at what works and then amplifies it as well as looking at what isn’t working and then stopping it. These are some ideas but the overarching theme is about demonstrating values, which is not coming across to the members/public as well as it could. There are many other ideas and things I think we should do but it is getting late. I hope this makes sense. I am happy to elaborate if you want to know more.

Keep up the good work and best wishes



Hi Matthew,

Sorry for the delay in getting back to you.

Thanks very much indeed for these ideas. I’m not 100% sure I agree with all of them but I do think they are extremely interesting and worth investigating and so I’ve forwarded them to Nick Clegg’s office and hope they’ll get more attention there.

It’s great to have this kind of input from grassroots members, and it’s an inspiration to the rest of us.

Thanks again.

Best wishes,


A solution to the perception of the Lib Dems as a new nasty party: Time to get back to basics

It wasn’t long ago that Clegg claimed that we needed to own everything this government did. We couldn’t be in it and not own all the decisions because we wouldn’t get the credit for the things that worked but we would get blamed for the things which didn’t anyway. While this was a long time ago this hasn’t changed with Clegg asking Lib Dem ministers, MPs and Lords to vote for Coalition policies no matter how they fit with Lib Dem values. We are still owning everything and it is damaging the party.

You might say that we have differentiation now, which is true, but this seems to me to be Lib Dem politicians explaining how we are different to the public, but still owning all decisions the government makes. So we have tuition fees the Welfare Reform Bill, Health and Social Care Bill amongst others and we have owned the all while complaining about them in public. I understand why Clegg believed this was a necessary strategy but I wasn’t convinced. I even less convinced now and believe it is time to do something different.

Firstly, owning everything in government is clearly not working. In fact we could say that it is the opposite of working. We are owning decisions and Bills which no one in the party agrees with. This is a major reason why people are leaving or disillusioned with the party.

Secondly, there doesn’t seem to be any decision this government has made which will benefit the Lib Dems that we wouldn’t have owned anyway. What we are proud of in government are the policies which we have promoted for years. What we are ashamed of are the policies we have fought for years to only now support them on their way to the statue book.

Thirdly, what we had to offer when we came into government was our party, the values and the policies which stemmed from them and this should have been enough. Our views are not always mainstream but what we had was good enough. There is no benefit in owning anything extra and no one is giving us credit for doing so.

We might have seen Clegg calling the Health and Social Care Bill a Tory bill this conference so perhaps this is his admission that we do actually have to start differentiating what is what in government from now on. If we had called it a Tory Bill from the start perhaps our politicians would have been more sceptical earlier in the process? Perhaps we need to start calling other Bills Tory Bills. Everyone knows this is the case so let’s call a spade a spade.

We should own Lib Dem Bills rather than us having to argue that some ideas are ours. Watch how the Tories will ‘own’ the green agenda, the raising of the income tax threshold or the pensions rise. Watch how they will benefit from having us in Coalition with them. Differentiation needs to be wider than saying we are not Tories, it needs to show we are not Tories.

If Clegg wants to start changing public opinion about him and the party then he needs to start being more of a pain in the backside in government. Call a bad idea a bad idea and say we won’t support it. Call a Tory idea a Tory idea, even if it is a popular one. Our values are our values, even when they are not popular. Be proud of what is a real Lib Dem achievement and people might start listening again.

SFP on BBC Radio Derby: Police strip searching children in school without parental consent

With the news that the police in Derby strip searched 10 15 year olds in school without parental consent left BBC Radio Derby looking for people to comment (2 were found with drugs, 8 were not). They called me for my comment due to my experience in working with children/young people and you can hear the show here (2 hours 35 mins into the show). Unfortunately I didn’t have much time to give but I gave what I could. Lets just say I don’t think strip searching children in school is a good idea and here is some research which explores the area.

For all the members who have left or are considering leaving – are they prey to the Fundamental Attribution Error?

There has been some concern and excitement (depending on your political persuasion) of the news of Lib Dem members leaving such as James Graham (2007 best blog)  (you can see why he left here)  or Graham Winyard as reported in The Guardian (and see the excitement from Guardian readers about this here). When I checked with the party last the stats were that we are down 17% of members from May 2010 (but they were at pains to say that if you were to compare this to other dates before the General Election campaign we have increased members). There are many others who have stopped being involved for the time being and are considering leaving so perhaps we need to look at what is going on because maybe it is more complicated than people think.

A fairly well evidenced phenomenon is called the fundamental attribution error which you have probably observed many times yourself. A simple example I found on Wikipedia is the following:

if Alice saw Bob trip over a rock and fall, Alice might consider Bob to be clumsy or careless (dispositional). If Alice tripped over the same rock herself, she would be more likely to blame the placement of the rock (situational).

The fundamental attribution error describes the tendency to over-value dispositional or personality-based explanations for the observed behaviors of others while under-valuing situational explanations for those behaviors. Have you ever heard someone try to justify why they not have done something they should have – this will usually be for some reason other than themselves. But when the same person explains why someone else has not done what they should have they may explain this in terms of it being something to do with the person.

For people who are not in the Lib  Dems this is a phenomenon we can observe all over the place. Just have a look at the Daily Mail which often attributes the problems with the Lib Dems with the party, the personalities or members (here is one about members and here is one about Clegg being a baby).

At times Lib Dem members can fall prey to attributing everything to the situation and therefore being immune to legitimate criticism. While this may make us feel better it is equally a mistake as it does not allow for a growth mindset which is necessary to keep the party alive. The trick is to be aware that this happens and then to take action.

If most people behave the same way when put in the same situation, then the situation is more likely to be the cause of the behavior. So if we look at the experience of smaller parties in Coalitions we see a fairly consistent picture:

coalitions are always disastrous for the smaller party. It gets swallowed up, blamed for the failures and only rarely credited with the successes, and then not nearly enough.

So Coalitions produce a national collective fundamental attribution error which we can all get swept up in. We can start to attribute the problems with the government or the decisions being made to the smaller party and this will make people want to leave. This is indeed what has happened with people who are leaving questioning not just the decisions of the government but the values of the party or the personalities of the people at the top.

So for people who have left or are considering leaving there is a strong possibility that the FAE is playing a part. Labour will exploit this to the max because they will be the biggest benefactors of people thinking there is something wrong with the party and not just that the situation is extremely difficult to operate in. This is not to say that mistakes haven’t been made because they have and I have been critical of many of them. What it is to say is that we need to be much more mindful of the fact that this situation is a much bigger threat than perhaps many have given it credit for, mainly because the result can be that they ignore it resulting in a new nasty party – the Lib Dems.

In Praise of the Daily Telegraph: Finding strengths in the Lib Dems

The Daily Telegraph write This fine Coalition government won’t see out 2013 – what a shame for Britain in which there is some considerable praise for this Government and the Lib Dems which is well worth reading:

Plenty of mistakes have been made since 2010, but this has nevertheless been the best government for a generation, led by men and women for the most part of decency and goodwill. Important steps have been taken towards addressing the financial deficit, while the reforms to welfare and education are essential to the health of Britain as a nation and will soon be irreversible… It is only thanks to the skill and admirable personal forbearance of Mr Clegg and Mr Cameron that the project has lasted as long as it has.

Labour’s new strategy to attract Lib Dem voters and what we should do about it

Tony Blair, Prime Minister of the United Kingd...

Image via Wikipedia

Tony Blair seems to have made a bit of a return to British politics recently to give his opinion on how to steal the Lib Dem vote. He believes that the Lib Dem position is hopeless having run to the left of Labour in three successive elections, only to go into coalition with the Tories in 2010, they will be clobbered next time. He believes that Labour’s task is to ensure those Lib Dem voters who feel betrayed come Labour’s way and stay there.

Blair’s proposed method starts with a repeated insistence that this is nothing but a “Tory government”. Labour should constantly be reminding Lib Dems that they were once against tuition fees and for Europe – yet now sit in a government that has tripled the former and is hostile to the latter. Every day, runs the Blair advice, Labour should be asking Lib Dems: “What on earth are you doing in this government with these Tories?” The aim will be to put asunder the alliance of Liberals and Social Democrats that created the Lib Dems in the first place. (The Guardian)

Apparently Clegg has ordered Lib Dems to repeat the same line in all media appearances – “We’re doing the right thing” – so that we might win respect from voters. The question is whether this is enough to defend our votes and I suspect it is not. Being defensive usually results in people feeling they are not being listened to. Labour’s strategy is to exploit those who are disillusioned with the Lib Dems for being in Coalition with the Tories, and no matter how much you might think this is a ridiculous position to take, this is a reality we have to deal with. Blair is right in the fact that there are many things we can be attacked for so our question is what strategy can we take which will make people feel they are being listened to. Saying we are doing the right thing in the face of people saying we are not is not going to make people feel listened to.

There are a number of things we could do to make people feel listened to and the first is always the messenger. It does not matter what the message is if the messenger is not accepted. We have started to hear calls from inside and outside the party that Clegg is not the messenger and if this is the case then the party has 2 options – to accept this as the truth and that a) it can’t be changed and so get a new leader or b) ask what we can do to change it. As there aren’t many calls to get rid of Clegg right now I assume it is the latter. Which brings us onto the next point to get people to feel listened to which is to start accepting the criticism. Then make assurances of what we would do if Governing on our own (obvious I know but I don’t hear Lib Dem ministers saying this).

Repairing relationships is hard and it takes time to build up trust and trust is built up once people feel you will do what they think you will do. When asked why people don’t know what the Lib Dem message is Blair’s point is the same a Clegg’s – that subsequent leaders have said different things. The difference between Blair and Clegg’s points is that Blair sees it as a bad thing for the Lib Dems while Clegg sees it as a good thing to have moved the Lib Dems in the last few years. I suspect it won’t be a good thing anytime soon, people like to know where they stand and moving positions makes people feel uneasy (I realise that out movement may be more public perception than reality but that is what we are dealing with).

So we are under attack from the Tories and Labour and we need more than defensiveness. Perhaps we should get better at negative campaigning as the rule of thumb for this is that you should never use negative campaign tactics unless you have to because you simply cannot win by presenting positive information about yourself. These are legitimate negative campaigning techniques:

  • Highlighting someone talking one way and voting another
  • Highlighting someone not paying taxes
  • Highlighting someone accepting campaign contributions from special interests
  • Highlighting someone’s voting record as an elected official

In Praise of the Daily Telegraph: Finding strengths in the Lib Dems

The Daily Telegraph write The high cost of coalition: Tory policies are evaporating as the tail wags the dog which is not a very positive piece on the Lib Dems but it does offer this, which is worth highlighting:

On the economy, the most important subject of the lot, the Government does much of its ongoing trading in public. The Lib Dems, smaller and wanting coalition to be permanent, are better at this.


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