The NHS could become the coalition's biggest headache again

Patient care is set to worsen next year, warn NHS finance directors.

The NHS didn't receive a mention in Nick Clegg's speech yesterday, but the state of the service is likely to become one of the government's biggest headaches in 2013. The latest King's Fund survey found that 40% NHS finance directors expect patient care to "worsen over the next few years" and that two-thirds believe there is a "high" or "very high" risk that the service will not achieve efficiency savings of £20bn by 2015.

Although spending is ring-fenced, healthcare inflation is significantly higher than the general rate, so the NHS will be continually forced to do more with less, particularly if, as expected, George Osborne carves out £1.7bn from its budget in order to pay for social care reform.

The political problem for the government is that while it could have blamed the service's problems on the fiscal situation, its inept reforms (for which it had no mandate) mean that it will now take the flak. Patient satisfaction fell from 70% to 58% last year, the largest annual drop since 1983 , a trend that is likely to continue this year. The number of patients who are waiting for more than four hours in A&E, for instance, is at its highest level since 2005. And David Cameron's decision to appoint Jeremy Hunt as Health Secretary provides the media with every incentive it needs to highlight the NHS's failings.

Health Secretary Jeremy Hunt will struggle to prevent a further fall in patient satisfaction. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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The BBC's Question Time shows how narrow our establishment really is

 35 per cent of all panellists in the show's history attended Oxford or Cambridge.

In February the Sutton Trust published a report digging into the backgrounds of professionals across a wide range of industries and the findings pointed to one unambiguous conclusion: in the upper echelons of society, the privileged still dominate, with wildly disproportionate numbers attending private schools and Oxford or Cambridge University.

But how does this actually manifest itself? We have spent some time crunching the data on what we think is an indicative snapshot of the establishment: the BBC’s Question Time.

Each week, David Dimbleby is joined by politicians, journalists and other opinion formers, who together represent the spectrum of opinions it is acceptable to have in public life. Looking at this pool of people is better than analysing something as narrow as, say, Members of Parliament because it encompasses a wider subset of people who make up the ‘establishment’ - politicians, journalists, activists, business leaders and cultural figures too. But is this establishment truly representative? Does the panel truly reflect Britain at large?

The short answer is “no”.

And this is clear simply by looking at the gender split on the panel: Throughout the show’s history only 35 per cent of panellists have been women - though of the shows broadcast in 2015, this rose to a slightly less dire 42 per cent. And when women have appeared on the programme, producers have been drawing from a smaller pool - with women more likely to put in repeat performances. Shirley Williams is the most ubiquitous panellist, having put in 55 appearances on the show.

But the real meat of our digging comes from research into universities.

To find this out, we took the data on appearances on the show since it began in 1979, and matched each panellist with the universities they attended. For the approximately 1500 panellists, we relied on publicly available information, and we were able to find data on around 85 per cent of panellists. Some of the data we used will almost certainly contain errors - but we’re broadly confident that our findings hold up. Even if the following numbers are not precise, they certainly represent the magnitude of the figures involved.

In an echo of the Sutton Trust’s findings, Oxford and Cambridge are massively over-represented. 35 per cent of all panellists since 1979 attended Oxbridge - and if you count it by the number of appearances, as a measure of who is sat around the panel on each show, 42 per cent of the seats in the show’s history have been occupied by Oxbridge graduates (and this doesn’t count Christ Church, Oxford, alumnus David Dimbleby, nor his Oxford predecessors Robin Day or Peter Sissons in the host’s seat).

Graduates of “Post-92” institutions, the so-called “New Universities” make up just 3 per cent of panellists.

93 per cent of every episode of Question Time ever broadcast have included an Oxbridge graduate. And amazingly, this got worse in 2015, where not a single episode was broadcast without Oxbridge representation. Our hypothesis is that any attempts at positive discrimination are cancelled out by the professionalisation of the political classes, as many non-university attendees early in the show’s history were people from a trade union background. One trend over the course of the show is the decline in the number of guests who haven’t been to university at all (and yes, that’s despite Nigel Farage appearing what feels like almost every damn week).

Of the top 20 most recurring panellists, half went to Oxbridge. By comparison, less than 1 per cent of the UK population went to Oxford or Cambridge.

Measuring which institutions get the most graduates onto Question Time also enables us to build a new league table. The best represented institution over the show’s history is women-only Newnham College, Cambridge - with graduates like Diane Abbott, Patricia Hewitt and Mary Beard, 76 of its alumnae have made it on to the Question Time stage.

What’s particularly amazing about this is that Newnham only takes on about 500 students per year. Second in the list is the LSE - with 54 different alumni appearances. And this is despite LSE taking in 10,000 new students every year. The best-represented post-92 institution is Middlesex University, with just 5 panellists over 36 years, despite taking on 23,000 students every year.

This makes for distressing reading - not least because both of us attended post-92 institutions. Was our hard work for nothing? Does Question Time suggest that the gates to the establishment forever remain firmly bolted shut to us?

To be clear, we don’t entirely blame BBC for these findings - nor would we want these figures to be used to make foolish allegations about “BBC bias”. The BBC is more worried about party political representation - and as our findings make clear, the producers of Question Time are clearly drawing from a pool of people who are already overwhelmingly dominated by Oxbridge.

Whether Oxbridge’s dominance is a symptom or a cause is up for debate. Looking at a year-by-year comparison since 1979, what’s most striking is how little has changed. Though we like to believe that society is more progressive now than it was in the dark old days, Oxford and Cambridge still dominate the upper echelons of public life.

More than 1500 panellists have appeared on Question Time over the last 36 years. They were selected due to their role in forming or reflecting the opinions held by the nation on some of the most important issues we have and will face. Is it really right that the less than 1 per cent of the population who attended Oxford or Cambridge Universities should have such a loud voice?

James O’Malley tweets as @Psythor, Blakeley Nixon tweets as @BlakeleyNixon.