Targets. They hurt, but (sometimes) they work

A u-turn on NHS waiting times shows the Conservatives have realised how hard it is getting things do

The Guardian reports today that the government has been forced to re-instate something resembling the old target for waiting times. Labour imposed a limit of 18 weeks as the maximum amount a patient should have to wait for an operation. The target was scrapped by Health Secretary Andrew Lansley since it represented an "arbitrary", "top down" bureaucratic approach. This, it was imagined, would be unnecessary because reforms would deliver a newly efficient, ultra-responsive market in health care in which patients' needs would be accommodated by the profusion of competing providers. Clearly, things aren't quite working out that way and a modified version of the 18-week limit will be back in place in the New Year.

The Conservatives in opposition were routinely scathing about targets, which, they argued, skewed outcomes by creating perverse incentives. Plainly this was true some of the time. A target of holding down waiting times in accident and emergency wards, for example, sometimes resulted in patients simply being sent away. And there is no doubt that New Labour came to rely too much on targets across Whitehall as a way to force the civil service to deliver what had been pledged by ministers, which was demoralising for the departments and skewed priorities.

But the reason Labour used targets so freely was because there weren't many other ways to make civil servants focus relentlessly on the government's priorities. They worked.

Many Conservatives in opposition persuaded themselves that Labour simply liked being bossy and controlling because that is what statist lefties do. I remember a conversation with a shadow minister (now a minister) before the election who told me with pride how he had deliberately not written any performance measures into a policy green paper because the Tory way was to create incentives and trust people, not to regulate them with targets. And what if the incentives aren't taken up? I asked. "We'll come up with better incentives."

In the early days of the coalition, a number of senior civil servants reported being told by incoming Tory ministers that the kind of measurements and targets that had previously been used to check performance in the system were no longer required because "that's not how we do things." It was an ideological shibboleth.

18 months into government, ministers are now finding - as was predictable - that without targets and specific performance measures, policies and pledges get lost in the system. Crudely speaking, unless someone is leaning down hard from above asking hard questions about why targets aren't met, nothing seems to happen. The appalling word that Downing Street under Tony Blair used to use for this stuff was "deliverology" - the art (or science, depending on your point of view) of actually getting things done in government.

It is becoming increasingly clear that David Cameron, with his predilection for presidential floating above the fray, has neglected this area. Steve Hilton, his policy chief, is constantly exercised by it but he tends to think the problem lies in all forms of bureaucracy and civil servants not being dynamic, professional or generally enough like private sector entrepreneurs feverishly making change happen like a bunch of Berkeley graduates building a start-up social enterprise in a San Francisco garage. Maybe it would be nice if Whitehall mandarins were a bit more like that. But it isn't going to happen soon. So for the time being, it looks like it has to be targets.

Of course, this government isn't entirely hostile to the idea of setting arbitrary benchmarks for performance. It is committed to bringing annual net migration down to below 100,000. When the public get really cross about something, out come the targets. That tells us something about the u-turn on operation waiting times. Clearly ministers are very nervous about the growing backlash against changes in the NHS.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

Show Hide image

Owen Smith interview: “I’m pretty red”

The Labour leadership challenger is struggling to win over a left suspicious of his past. 

The south Wales valleys embody the history of the labour movement: its victories, its defeats, its heroes, its villains. It was this resonant location that Owen Smith chose for his speech on the morning of 22 August. Labour Party members had that day begun voting on whether the 46-year-old Pontypridd MP should replace Jeremy Corbyn as their leader.

“Our history, our party was literally hewed from the hillsides around where we sit today,” Smith told a small audience at the Ely Valley Miners Welfare Club in Tonyrefail, a short distance from his home. The Welshman cited the Taff Vale judgment of 1901, which ruled that trade unions could be sued for losses caused by industrial action. It was this decision that spurred on the establishment of a Labour Party in parliament to repeal the law (as it would do in 1906 in alliance with the Liberal government).

Smith spoke later of marching with miners from the Maerdy Colliery as a 14-year-old, on the day they returned to work at the end of the 1984-85 strike. “I saw that they were utterly unbowed,” he recalled. “But they were ultimately defeated.”

Such moments, he concluded, proved the need for Labour to win power and to maintain “a powerful voice in parliament” – something he believes Jeremy Corbyn is incapable of providing. On 28 June, less than a year after Corbyn’s landslide victory, 172 MPs (81 per cent of the Parliamentary Labour Party) endorsed a no-confidence motion in him. Sixty-five shadow ministers, including Smith (who was then the shadow work and pensions secretary), resigned from the front bench.

Yet though Smith enjoys the overwhelming backing of the PLP, few believe he will prevail among members. He achieved only 53 constituency nominations, against the leader’s 285. On social media, where internal party contests are increasingly decided, Smith’s reach is minuscule compared to that of Corbyn (who has 795,000 Facebook fans to his 14,000).

The day before Smith spoke in south Wales, he won the endorsement of Sadiq Khan, the Mayor of London and Labour’s most senior elected politician. He was subsequently also backed by the Scottish Labour leader, Kezia Dugdale. Neil Kinnock and Ed Miliband have trumpeted his cause. Yet Smith-supporting MPs fear that such declarations count for little. “It’s like the Remain campaign and the Archbishop of Canterbury,” one told me, suggesting that Labour members, like Leave voters, ”weren’t listening” to such grandees.

Corbyn’s allies and foes alike are already preparing for the aftermath of the leader’s anticipated victory. The former warn that rebel MPs put themselves at risk of deselection by members. In response, some have threatened privately to form a parliamentary breakaway group and bid for the status of the official opposition.

Smith, unsurprisingly, insists that he can win. “I think the CLP [Constituency Labour Party] nominations don’t truly reflect the views in CLPs,” he told me when we spoke after his 20-minute address. The challenger, dressed in his favoured combination of dark suit and open-necked white shirt, welcomed the black coffee proffered by his aide. “They reflect the fact that some of the people who are new members and are supportive of Jeremy were very organised . . .

“Anybody who knows the Labour Party knows that selections are very often won by the sleepers: the people who don’t go to CLP meetings and don’t necessarily shout from the rooftops.” Smith’s hopes rest on those who share Oscar Wilde’s view: “The problem with socialism is that it takes up too many spare evenings.”

Cartoon: George Leigh

Smith first publicly revealed his leadership ambitions in an interview with me back in January. “It would be an incredible honour and privilege,” he said. I wrote then of a widespread view among Labour MPs that the next leader “will at least need to be from the party’s soft left to be acceptable to the party membership”. When the rebellion against Corbyn came, it was this consideration that proved decisive. Smith was embraced as a Miliband-esque socialist and a parliamentary “clean skin”, untainted by the New Labour years, having been elected in 2010. By contrast, his initial rival, Angela Eagle, had been an MP since 1992 and voted for the Iraq War.

However, Smith proved to have a more ambiguous past than some of his backers anticipated. Corbyn’s supporters swiftly unearthed a series of interviews from 2006 in which their opponent made a notably centrist pitch. Smith, then a by-election candidate in Blaenau Gwent, south Wales, defended Tony Blair (suggesting that they differed only over the Iraq War), supported private-sector involvement in the National Health Service and praised city academies. “I’m not someone, frankly, who gets terribly wound up about some of the ideological nuances,” he told Wales Online.

Since then, he has struggled to reconcile these positions with his increasingly left-wing programme: opposing private provision in the NHS, returning academy schools to local authority control, banning zero-hours contracts and imposing a wealth tax of 1 per cent.

“To be honest, my opponents have extrapolated rather a lot in an attempt to brand me as a ‘Blairite wolf in sheep’s clothing’,” Smith told me. “Well, I’m nothing of the sort, I’ve always been a democratic socialist and I always will be. My views haven’t really changed at all, I’m someone who has been on the left of the party.

“My dad [the Welsh historian Dai Smith] is someone who’s been on the left of the Labour movement all his life. I’m someone who’s been surrounded by people who’ve been on the left of the Labour movement all their lives. It should come as no surprise that I’ve come out of that background and I’m pretty red. Because I am.”

Yet a former shadow cabinet colleague told me that Smith did not stand out as “a radical” in meetings: “The only time that I remember him becoming really animated was over further tax-raising powers for Scotland and the implications for Wales.”

What Smith believes in most, some say, is himself. The shadow chancellor, John McDonnell, described him as “one of the most ambitious career politicians I’ve met”. Others have dismissed him as a “Big Pharma lobbyist” because of his past as head of policy and government relations for Pfizer.

“I’m not ashamed that I had a life outside politics before I became an MP,” Smith told me. “Yes, I worked for Pfizer and I also worked as a BBC journalist and as an adviser to the last Labour government on the peace process in Northern Ireland.

“People don’t want career politicians – they want men and women who have had experience of working in business and in the different sectors that make up our economy. Critics may use it against me, but my time in business has helped me understand what’s wrong with it and how we can make it work better.”

Corbyn’s supporters, however, allege that Smith’s left-wing pledges would not withstand contact with centrist colleagues. The degree to which the challenger has rebutted this charge shows that he recognises its potency.

He has offered to make Corbyn party president or chair if he wins, to allow Corbyn to act as “a guardian of Labour’s values”. In his speech, Smith vowed to increase member influence by making conference votes binding on the leadership.

Throughout the 1980s, another soft-left Welshman, Neil Kinnock, struggled to assert authority as the hard left retained control of vital bodies. Smith’s proposals risk replicating this conflict. But he told me that he would respect Labour’s conference even if it endorsed stances such as Trident abolition (Smith joined CND as a teenager but later renounced unilateralism). “I do think in order to reassure members that, under my leadership, we would listen hard to them and act in accordance with their views, conference does need to become sovereign once more,” he said.

Tony Benn’s dream of internal democracy appeared to be within reach. I asked Smith whether he would support other reforms such as a reduced MP nomination threshold for leadership candidates (Corbyn allies have proposed a cut from 15 per cent to 5 per cent). “All of these things can be debated,” he told me. “I’m not sure it should be 5 per cent: I need to look at it when we get closer to it. But I am convinced that the left needs to be able to put up candidates in this contest, I’ve always felt that.”

Smith’s assertion is contradicted by a colleague who described him as having been “furious”, “apoplectic” when Corbyn made the ballot last year (he supported Andy Burnham’s campaign).

                                                                                                                                                         ***

Smith is less equiovcal over the mandatory reselection of MPs. “That would be a really retrograde step for the party,” he told me. “It would be an uncomradely way for us to do business.” He is critical of the Corbyn-aligned group Momentum, some of whose members are spearheading deselection efforts. “I fear an attitude within Momentum that they are a separate organisation and they shouldn’t be,” he told me. “It’s hard to argue that they’re loyal and supportive if they’re organising a bloomin’ great really in the same town at the same time in competition to the Labour Party” (the group will hold its own four-day conference alongside Labour’s in Liverpool).

Some of those close to Corbyn, such as John McDonnell, have unhesitatingly described themselves as Marxists (in 2006, the shadow chancellor named Marx, Lenin and Trotsky as his “most significant” intellectual influences). I asked Smith whether he believed Labour could encompass such views. “Yes, I think we’ve always been a broad church and there have always been people who’ve come from that tradition,” he replied. “There are two broad traditions: the extra-parliamentary tradition, that has always seen parliament as a compromise and parliamentary socialism as a compromise, from [the trade unionist and theorist] Noah Ablett here in south Wales with The Miners’ Next Step through to Ed Miliband’s dad [Ralph, a Marxist historian] ... and the mainstream social democratic tradition that I came from.”

He added: “We’ve had this battle in the Labour Party over the ages, haven’t we? Except now I think it’s more serious because there is a very real danger, with Labour at such a low ebb and politics fragmented more broadly, and so many more parties and so many options for people and such a lesser tribal attachment to the Labour Party, that we can’t afford those fractures.

"If we splinter, there’s lot of other places for people to put their vote.”

                                                                                                                                                        ***

Though they will not say so publicly, some of Smith’s supporters believe Labour would remain unelectable under his leadership. A former shadow cabinet minister told me that he was offering a “warmed-up Ed Milibandism, which was rejected by the voters”. Smith naturally contests this analysis. “I don’t think that we lost the last election because we were too left-wing,” he said. “The proof is that the Tories have engaged in all sorts of these policies ... Theresa May’s opening speech upon becoming leader was to talk about social injustice, economic insecurity, lack of security in the workplace. Labour values, Labour words in a Tory mouth, evidence that the broad story we’re telling about Britain is right.”

Smith said that, unlike Corbyn, he would resign if he became leader and lost a confidence vote by MPs. “Yes - I would [resign]. We are a party that believes in parliamentary democracy and, as such, it is only right that the leader commands the support of his or her colleagues in the Commons.”

Should Corbyn win the contest, as expected, Smith will not return to the shadow cabinet but act as “a loyal backbencher”.  He pledges to resist any breakaway: “I'm Labour, I've always been Labour and I will never stop being Labour," he said. 

Speaking of his fear that Corbyn would seek to remain leader even if the party lost the next general election, he said: “I’m deeply worried about it. I think he’s determined to hang on come hell or high water. And what does that say about him? ... I think he is more concerned with his version of the Labour Party being sustained and being victorious than he is with the Labour Party being victorious in elections. I think he is actually prepared to sacrifice unity and victory - two great words that have traditionally been emblazoned on Labour banners through the ages - in order to secure control of the party.”

The trouble for Owen Smith is that, for all his combative talk and appeal to the left, he is trapped between his past pragmatism and his present radicalism. 

Tony Benn, Corbyn’s late mentor, divided politicians into “signposts” and “weathercocks”: those who shape opinion and those who are shaped by it. He would have branded Smith a “weathercock”. Even if he wins, Smith risks being remembered not as a politician who resolved his party’s contradictions, but as one who embodied them.

George Eaton is political editor of the New Statesman.

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser