Labour has a public sector reform agenda. Or does it?

Ed Miliband has said the state needs to change. He also needs to say how.

A familiar charge against Labour is that the party is in denial about the need to make cuts to public services. This isn’t quite true. The economic argument Ed Miliband and Ed Balls have advanced certainly attacks the government for premature, ill-targeted and aggressive cuts that stifle growth. (It is safe to say the “too far, too fast” line has had an adequate public airing.) There is also constituency on the left that sees budget austerity as wholly unnecessary – a pretext for indulging an old Conservative appetite for shrinking the state. But the official party line is to accept that spending under a Labour government would be tight. Miliband has been explicit in saying a return to pre-crisis levels of investment in public services is not an option. Balls has promised a “zero-based” spending review, which, in theory at least, puts everything on the table for possible cuts.

The problem is that not enough voters think Labour’s heart is in fiscal discipline, partly because there is very little indication of what the opposition sees the state doing now that it imagines not being done at taxpayers’ expense in the future or, failing that, how it might be done differently so money can be saved. Meanwhile, there are plenty of coalition measures being opposed. If there is a credibility gap it won’t be closed by more theoretical commitments to control spending but in the generation of imaginative ideas for getting more for less. No one questions Labour's love of public services. The doubt is whether it has ideas for expressing that love in ways other than central government spending.

Slowly, a reform agenda is emerging. I’ve blogged before about the shadow health team’s plans for “whole person care” and the merger of NHS and social care budgets. This is perhaps the furthest advanced policy area where Labour front benchers are talking openly about long-term financial constraints. They don’t have much choice. Demographic trends mean that health budgets will be squeezed regardless of the timetable a Chancellor adopts for reining in the deficit.

Liz Kendall, shadow social care minister, gave a speech yesterday setting out in some depth Labour’s approach to the question of how society should care for an ageing population and, crucially, how it might better afford to do so. It is worth a read not just because it contains actual policy but because it sets the issue in a wider context of how state services need to evolve more generally if they are to retain the confidence of people who rely on them. Kendall’s argument is that ultimately users of services will expect to have more control and will expect state provision to be more flexible and responsive to their needs. Those demands can be met, in part, by devolution of budgets but they also require a new way of thinking about what state provision looks and feels like. In a revealing pasage in the speech, Kendall notes:

Making the big changes people want, and our public finances demand, will require fundamental reforms to public services and the role of the state. The old top-down approach - where the state does things to or for people - won’t work. This isn’t just because the kinds of increases in public spending that Labour secured when we were last in Government simply won’t be possible for the foreseeable future. It’s because public services must change if they’re going to retain support in the long run. Every week in my constituency surgery people tell me how frustrated and even angry they are about one public service or another: how they’ve been badly treated, fobbed off and passed between different departments, as if their views and concerns don’t matter. A One Nation approach to public services understands that an over bureaucratic state, as well as unrestrained markets, prevents people from leading the lives they want to live.

A similar argument was made by Ivan Lewis, shadow International Development Secretary, writing about the need to reform the state in the New Statesman last week. He wrote that:

By the end of our period in government, Labour’s failure to talk about family and community left the impression that we saw Britain’s future only through the prism of state and market. One Nation Labour believes our future success depends on our capacity to harness the best of an active state, aspirational individuals, strong families and community networks supported by a vibrant private sector.

...

New private sector provision would be supported where state provision has repeatedly failed or is unable to meet needs and where partnerships between public and private can improve outcomes. But this has to be within a framework of public accountability and high ethical standards. It is one tool in the locker, not the answer in all times and places.

In the NHS and education, the Tories have focused on giving power to the providers of services. One Nation Labour will give more influence and control to patients and parents. In my view choice is neither a panacea nor a realistic option in many circumstances. But it is crucial to give people a personalised - not a “conveyor belt” - service, with greater control for individuals and families over decisions about their lives together with a greater stake in collective community provision.

This may all sound a bit wonkish and abstract but in the context of Labour’s gradual advance towards a position on public sector reform it is significant. (Both interventions would have to be approved by the leader’s office so can be said to have Ed Miliband’s permission – even, perhaps, his blessing.) The problem and the reason new ideas sometimes come across as encrypted or camouflaged in jargon is that not everyone in the party is persuaded that this is the kind of language Labour should be using, or even the kind of conversation the party should be having.

There are, crudely speaking, two kinds of obstruction. The first is among those on the left, chiefly in the trade union movement, who see any discussion of private sector participation, choice or markets as an attack on the integrity of a well-resourced public sector and, by extension, a resurgence of “Blairism.” The increasing deployment of that word as a term of abuse has a suffocating effect, stifling any impulse to consider ways to innovate and demand efficiency in the way government works. The second obstacle is more subtle. It is the concern that advertising Labour’s commitment to reform public services with a more-for-less agenda confuses the message of opposition to what the coalition is doing. In essence, this is the enduring argument that Labour’s commitment to public services is a “dividing line” from the Tories who can be presented as wanting to slash, burn and privatise everything the public holds dear. According to this view, conceding that there is a long-term funding challenge, accepting that services were failing to live up to expectations even under the last government and naming ways to improve them risks abetting the coalition when it claims that its own policies represent a clearing up of Labour’s mess.

The trouble with that approach is that is presumes voters haven’t noticed that the public sector needs modernisation and that they are entirely happy with the kind of service that is delivered by monolithic institutions administered centrally and funded top-down by the Treasury. It also presumes that when voters despair of David Cameron and George Osborne they will rebound naturally into Labour’s arms and cease to believe that a cause of their current pain is profligate spending under the old regime. Three years into this parliament, with two years remaining before a general election, there isn’t much evidence that is the case. Labour needs to be in the business of reassuring people that it respects the fact that the money they spend comes from somewhere and that every sinew is being strained to get the best value from it in terms of quality and efficiency.

Ed Miliband appears gradually to be coming round to this view. When I spoke to him a few weeks ago, he spoke about the challenge of addressing public concerns about an “unresponsive state”. He cited the influence of Jon Cruddas, who leads Labour’s policy review and who has written and spoken in the past about the weakness of a position that relies on defending a faceless bureaucratic state model. But Miliband is happiest talking about the way poeple have lost faith in parts of the private sector – in the banks, privatised utilities, energy and train companies - who they feel are ripping them off. He is at ease urging a more humane and moral brand of capitalism. While he recognises that there is also a need to restore public trust in organs of the state, I sense he is far less enthusiastic about that side of the equation and so less consistently engaged in what might be involved. That will have to change. There is only so much that can be achieved by allowing out-riding shadow ministers to float public sector reform ideas in occasional op eds and speeches. At some point, if this is to become a serious plank of party policy, the leader has to put the full authority of his office behind it. If Labour really believes in reforming the state, if it thinks that innovation in the public sector is one route to a better society and a balanced budget, Ed Miliband has to start saying so.

Ed Miliband and Ed Balls at the Labour conference in Manchester last year. Photograph: Getty Images.

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

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Low fat, full fat: why the diet industry keeps changing its mind

A new report illustrates just how disillusioned the diet industry has become, at the expense of everyone else.

Another year, another wave of dietary fads. Most seem to surface in the summer, when new nutritional advice claims to provide the panacea to everyone’s health woes: “Eat clean get lean!” “The simple secret of intermittent fasting!” “The paleo way is the only way!” “Six weeks to a super you!”

However, despite the barrage of diet books, the expansion of nutrition research and the growth of education about healthy living, global obesity has more than doubled since 1980.

It may be that this is due to the conflicting information constantly issued from the diet industry. “Eat lots of protein – it’ll speed up your metabolism!” “Too much protein will damage your kidneys – reduce your protein intake!” “Superfoods are a vital source of antioxidants!” “Superfoods aren’t so super at all!” “Don’t snack it will make you pile on the pounds!” “You should snack – it’ll stop you from binge eating!” It’s no wonder people aren’t sure what to eat.

The UK launched its first dietary guidelines in 1994, which have since been continuously revised to form the guide now known as “The Eatwell Plate”. The dietary guidelines recommend plentiful carbohydrates “such as rice, bread, pasta and potatoes”, at least five portions of fruits and vegetables, some protein, some milk, some dairy and minimal saturated fat.

However, a recent report serves to highlight the confusion consumers face when it comes to food: it claims that the official advice on low-fat diets is outright wrong, even damaging.

Led by the National Obesity Forum and the Public Health Collaboration, the report (not peer-reviewed, it’s worth noting) attacked a host of official health proposals. It claims that “eating fat does not make you fat”, and criticises Eatwell Plate’s small fat allowance. The report also stated that saturated fats have been unfairly demonised, as there is allegedly little evidence to suggest that they cause heart disease. Meanwhile sugar consumption should be dialled down to zero, apparently, and calories shouldn’t be counted, as an abundance of them won’t cause obesity. Also, forget about the exercise - apparently a bad diet can’t be outrun, according to the report.

Professor David Haslam, chairman of the National Obesity Forum, said: “As a clinician, treating patients all day every day, I quickly realised that guidelines from on high, suggesting high-carbohydrate, low-fat diets were the universal panacea, were deeply flawed. Current efforts have failed – the proof being that obesity levels are higher than they have ever been, and show no chance of reducing despite the best efforts of government and scientists.”

Dr Aseem Malhotra, consultant cardiologist and founding member of the Public Health Collaboration reinforced this by saying the guidelines were “perhaps the biggest mistake in modern medical history, resulting in devastating consequences for public health.” Under current dietary guidelines, obesity levels have indeed increased in the UK, with nearly two-thirds of men and women overweight or obese, costing the economy more than £3bn per year.

In the face of such starkly opposed sides - both backed by seemingly reputable experts who claim all their research is based on empirical evidence - what are consumers meant to do?

The vilification of fat

In 1983, it was recommended that overall dietary fat consumption should make up only 30 per cent of total daily energy intake – 10 per cent of which, at most, should come from saturated fat.

The recommendations came from a number of research papers published at the time, which suggested a link between saturated fat intake and increased levels of LDL cholesterol – the cholesterol which has been connected to increased risk of heart disease, stroke and atherosclerosis.

An even simpler reason for the suggestions boiled down to this: fat has more calories per gram than carbohydrates – nine calories per gram versus four, to be exact. This shape to future official guidelines, and gave birth to the low-fat high-carbohydrate mantra. Fat was cemented as public enemy number one.

As a result, the fat eliminated from people’s diets was to be supplemented with an increased intake of carbohydrates. Tipping the scales in favour of carbohydrates were promises of weight loss as a result of higher fibre content, elevated levels of serotonin to aid sleep and boosts in mood from feeling fuller.

But obesity levels continued to soar, and health experts shifted their focus to the next culprit: carbs.

The low-carb era

An analysis by The American Journal of Clinical Nutrition combined the results of 21 studies and found that “saturated fat was not associated with an increased risk of coronary heart disease”. Other studies demonstrated the positive effect on testosterone levels in men from increased saturated fat intake, and have noted increased levels of triglycerides (the stuff that makes you fat) from lower fat diets.

As a result, dieticians developed a deep suspicion of carbs, and sugar in particular, and diets like the Atkins regime became more and more popular.

In part, the report by the National Obesity Forum and Public Health Collaboration uses the research that propped up these low-carb high-fat diets as a means by which to attack the general consensus surrounding healthy eating. Dr Malhotra, who led the latest report, previously worked in a pressure group called Action on Sugar – a group that has tried to get the food industry to reduce the amount of sugar added to food.

The reasoning goes something like this: guidelines encouraging greater carbohydrate consumption are oblivious to the fact that sugars constitute a vast amount of refined carbohydrates. By cranking up the sugar intake we ratchet up the risk of type 2 diabetes; this in turn could spark further health problems including obesity.

The logic seems sound, and yet obesity levels have continued to soar in the face of this research. The notion that all sugar should be avoided also ignores the fact that our brains require a significant amount of glucose for optimal functioning.

Everything in moderation

In the face of an industry that can’t make up its mind about how people should eat, it’s no wonder obesity levels have grown to epidemic proportions. So what can be done?

Professor Susan Jebb, the government’s obesity adviser, believes that the current debate needs to expand beyond the battle between carbohydrates and fat. She said: “We’re eating too many calories – if we want to tackle obesity people do need to eat fewer calories and that means less fat and less sugar.” And she’s right. If decades of research have pointed to anything assertively, it’s that calories count, and paying attention to portion sizes could take us a long way.

Both fat and carbohydrates are necessary for our bodies to function. The solution? Enjoy everything in moderation. Eat fruits without fearing fructose, don’t throw away the egg yolk, get a decent amount of protein and yes, you should have your slice of cake too.