Grant Shapps has always been one of the key supporters of the localist movement. Which is why I’m so surprised to hear him demanding that every NHS trust provide three rounds of IVF.
I understand that he is really complaining about yet another broken government promise. I understand, too, that for most people, going private for IVF simply isn’t an option. And I really do understand that for some people, having children is the most important thing is their lives.
But. But but but. Infertility is not an illness (though it can of course be caused by disease or a chronic condition). Having children is not a right. NHS trusts are supposed to have the independence to spend their budgets on their own local priorities (that was the point, after all, of foundation hospitals). We know that that independence is undermined every time someone yells ‘postcode lottery’, and that politicians are particularly terrified of that charge in relation to health issues.
The real problem here is that the government once again raised people’s hopes and then failed to fulfil them. It’s a microcosm of Labour’s record. Governments need to be honest about what they can and can’t do, and they need to be transparent in giving people the information needed to judge their delivery.
On the plus side of Grant’s report, he has brought together all the information in a clear, usable format – one of the things that is absolutely crucial in returning power to people and communities. However, what I think Grant has failed to recognise is that you can’t have your cake and eat it. You can’t proclaim localism when it suits you and then decry it when you suddenly realise it’s going to affect you adversely.
This is an argument I’ve made again and again about the Conservative localist agenda – they have got to accept that it won’t be perfect, that there will be complaints about postcode lotteries, there will be people elected who can’t do the job…
I’d love to hear – just once will do – a Conservative shadow turn down the chance of a quote being published and saying, ‘That shouldn’t be the job of central government so I’m not going to comment.’
I live in hope.
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Fiona
I agree with your drive for localism. But you can only have localism with genuine accountability. In the case of PCTs the managers who choose whether or not to follow NICE guidelines are accountable to no local people for their decisions. In fact the only person that they are accountable to is the department for health which is the controlling authority – so its quite legitimate in the current set up to treat this as a central government concern.
It would be localism if those managers faced the electorate and justified their decision to say spend more on cancer than on IVF in an area. If local people didn’t like the decision then they could have a mechanism to change the policy. What mechanism do people have to change this policy? No mechanism at all. PCT managers just making their own unaccountable decisions is not localism that’s just another manifestation of the bureaucratic age that we need to get beyond.
Mark Clarke
Mark, you’re absolutely right to say that there is currently little or no accountability. But I think at this stage in the electoral cycle, ‘you’ve broken your promises’ is not really enough. Given that many assume that there will be a Conservative government next year, it’s up to everyone to look at how they campaign against Labour, and to make sure that they are being consistent.
I do understand, as I said, why Grant is making these points. But I think he’s going about it in a way which is unhelpful for the Conservative idea with the most potential.