NHS reforms: a lesson in how not to do it

In assuming that Andrew Lansley had it all in hand, David Cameron and Nick Clegg have taken an enorm

"It all seems slightly dramatic to me, but I tend to hope that Lansley knows what he's doing," sums up what friends in the Conservative Party have said to me about the NHS reforms over the past few months.

This remains the danger within any government: to assume someone else is getting on with it and knows what they are doing. I remember a friend in the Labour Party once saying to me, as we debated during the lead-up to the Iraq war, "The thing is, I trust Tony. I assume he knows what he is doing." Well, the rest, as they say, is history.

Within government, within cabinet, everything should be challenged and nothing assumed.

The NHS reforms are turning out to be the perfect example of how not to do it. In assuming that Andrew Lansley had it all in hand, David Cameron and Nick Clegg have taken an enormous risk. Simply sending in their policy lieutenants from No 10 in the early days of drafting was an insufficient response.

It is these bread-and-butter issues – welfare, health, education and crime – that the Prime Minister and the Deputy Prime Minister need to challenge and challenge again until they are satisfied that the policies are right.

If either leader leaves this to others, they will be left with the results, good or bad. Getting the policies right is everything; presentation comes later.

With the Treasury totally tied up with structural deficit reduction, and the Cabinet Office pushing through so many other reforms, the fundamental challenge of these bread-and-butter issues is in severe danger of getting lost.

We are left with the impression that policy is continuing only because it has started, not because it is coherent. We are in danger of driving through a policy that is not a left or right issue, but one that places too much power in the hands of the producers – the GPs – rather than patients themselves.

We now are in a situation where uncertainty means that people will get the impression that the whole reform is a mess.

I remain convinced that we are oversentimental about any discussion regarding the NHS and that the issue is one of behaviour rather than structure. The interview by Claire Rayner's son Jay on the Today programme this morning (starts at 2hrs, 14mins, 25secs) about training people in compassion in the NHS said it all.

Then again, all that said, this is an early lesson for the coalition about the failure to challenge, and assumptions from the very top.

Olly Grender was director of communications for the Liberal Democrats between 1990 and 1995.

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The Prevent strategy needs a rethink, not a rebrand

A bad policy by any other name is still a bad policy.

Yesterday the Home Affairs Select Committee published its report on radicalization in the UK. While the focus of the coverage has been on its claim that social media companies like Facebook, Twitter and YouTube are “consciously failing” to combat the promotion of terrorism and extremism, it also reported on Prevent. The report rightly engages with criticism of Prevent, acknowledging how it has affected the Muslim community and calling for it to become more transparent:

“The concerns about Prevent amongst the communities most affected by it must be addressed. Otherwise it will continue to be viewed with suspicion by many, and by some as “toxic”… The government must be more transparent about what it is doing on the Prevent strategy, including by publicising its engagement activities, and providing updates on outcomes, through an easily accessible online portal.”

While this acknowledgement is good news, it is hard to see how real change will occur. As I have written previously, as Prevent has become more entrenched in British society, it has also become more secretive. For example, in August 2013, I lodged FOI requests to designated Prevent priority areas, asking for the most up-to-date Prevent funding information, including what projects received funding and details of any project engaging specifically with far-right extremism. I lodged almost identical requests between 2008 and 2009, all of which were successful. All but one of the 2013 requests were denied.

This denial is significant. Before the 2011 review, the Prevent strategy distributed money to help local authorities fight violent extremism and in doing so identified priority areas based solely on demographics. Any local authority with a Muslim population of at least five per cent was automatically given Prevent funding. The 2011 review pledged to end this. It further promised to expand Prevent to include far-right extremism and stop its use in community cohesion projects. Through these FOI requests I was trying to find out whether or not the 2011 pledges had been met. But with the blanket denial of information, I was left in the dark.

It is telling that the report’s concerns with Prevent are not new and have in fact been highlighted in several reports by the same Home Affairs Select Committee, as well as numerous reports by NGOs. But nothing has changed. In fact, the only change proposed by the report is to give Prevent a new name: Engage. But the problem was never the name. Prevent relies on the premise that terrorism and extremism are inherently connected with Islam, and until this is changed, it will continue to be at best counter-productive, and at worst, deeply discriminatory.

In his evidence to the committee, David Anderson, the independent ombudsman of terrorism legislation, has called for an independent review of the Prevent strategy. This would be a start. However, more is required. What is needed is a radical new approach to counter-terrorism and counter-extremism, one that targets all forms of extremism and that does not stigmatise or stereotype those affected.

Such an approach has been pioneered in the Danish town of Aarhus. Faced with increased numbers of youngsters leaving Aarhus for Syria, police officers made it clear that those who had travelled to Syria were welcome to come home, where they would receive help with going back to school, finding a place to live and whatever else was necessary for them to find their way back to Danish society.  Known as the ‘Aarhus model’, this approach focuses on inclusion, mentorship and non-criminalisation. It is the opposite of Prevent, which has from its very start framed British Muslims as a particularly deviant suspect community.

We need to change the narrative of counter-terrorism in the UK, but a narrative is not changed by a new title. Just as a rose by any other name would smell as sweet, a bad policy by any other name is still a bad policy. While the Home Affairs Select Committee concern about Prevent is welcomed, real action is needed. This will involve actually engaging with the Muslim community, listening to their concerns and not dismissing them as misunderstandings. It will require serious investigation of the damages caused by new Prevent statutory duty, something which the report does acknowledge as a concern.  Finally, real action on Prevent in particular, but extremism in general, will require developing a wide-ranging counter-extremism strategy that directly engages with far-right extremism. This has been notably absent from today’s report, even though far-right extremism is on the rise. After all, far-right extremists make up half of all counter-radicalization referrals in Yorkshire, and 30 per cent of the caseload in the east Midlands.

It will also require changing the way we think about those who are radicalized. The Aarhus model proves that such a change is possible. Radicalization is indeed a real problem, one imagines it will be even more so considering the country’s flagship counter-radicalization strategy remains problematic and ineffective. In the end, Prevent may be renamed a thousand times, but unless real effort is put in actually changing the strategy, it will remain toxic. 

Dr Maria Norris works at London School of Economics and Political Science. She tweets as @MariaWNorris.