The Telegraph has a fantastic article about rubbish in Bali today.

I know – not exactly something you are desperately keen to read over breakfast, but necessary: this recycling plant in Bali takes in 140 lorryloads of waste a week, and only properly throws away 10. This is exactly the kind of thing we need to do more of.

I’ve had my questions over parts of the Conservatives’ plans for local government (why mandate weekly bin collection? Or, while a good thing in itself,  I don’t really understand how freezing council tax centrally for two years is very localist…) but they are really minor quibbles. What I want to see more of is things like George Osborne’s freeing up of councils to reward people who recycle rather than punish those who don’t – because carrots work better than sticks.

I probably recycle about three bags for every two rubbish bags I throw out. I want to recycle more; my council doesn’t do most plastics, for example, and I would really like them to take food waste separately. I also want supermarkets to reduce their packaging, and I want them to take back their excess without argument – I do feel a bit of a loon unwrapping things at the checkout sometimes. And you should hear the shock when I buy vegetables without a plastic bag…

Even if you don’t subscribe to man-made climate change as a theory, we do all want to reduce the cost of our consumption and maintain a clean environment. Schemes like the one in Bali work because they were local initiatives to solve a problem; it has resulted in jobs and in cleaner surroundings. Of course there are problems translating it directly to the UK. But that doesn’t mean we shouldn’t try.

Last Wednesday saw the publication of the inquiry into the failures at Mid Staffordshire hospital where over 400 patients needlessly died.   The inquiry was ordered by the Secretary of State in response to the public outcry.  The recommendations are, of course, worthy and have been well received by both patient and professional groups alike.  But as there is still appetite for a further inquiry – relatives, families and the Conservatives are calling for a full public inquiry – what was the legal basis for the first?

Mid Staffordshire is a Foundation Trust Hospital.  Foundation Trust Hospitals were created specifically to be independent of the NHS, and of the Secretary of State. The creation of Foundation Trusts was one of the most bitterly contested NHS reforms introduced by Tony Blair. At the time they were opposed by Conservatives and many within the Labour party, now both political parties want to make every hospital a Foundation Trust.  But Foundation Trusts are different; they are accountable to their local communities, not to the Secretary of State.  So while the urge for politicians to interfere in these matters is intense, their powers are necessarily limited.

The policy of creating Foundation Trusts was designed to create a new set of structural relationships within the NHS.  The development of the new structure was, amongst other things, an attempt to create a new culture.  But the old culture of tight central control – the one that NHS managers and civil servants feel safest in – still remains dominant within the Department of Health,and within the minds of Government Ministers as well.

As we pointed out last week, the fundamental failings at Mid Staffordshire were those of the system of hospital oversight and scrutiny, not the policy of Foundation Trusts.  On the whole, Foundation Trust hospitals are much more highly performing than those remaining under tight central control.  So how do we create a culture where the NHS can adopt more of the changes that allowed Foundation Trusts to flourish?   Well, what if the architects of Foundation Trusts were to reveal all in a new Policy Exchange pamphlet later this week…

Henry Featherstone is Head of the Health Unit at Policy Exchange. “Future of Foundations: Towards a new culture in the NHS” will be out this week.

The Department for Health did not have a good week last week.  It started with hospitals being accused of putting patients’ lives at risk, for failing to comply with safety alerts issued by the National Patient Safety Agency.  And it has ended with the DH accepting that it must agree a way of measuring and reporting hospital death rates, after Policy Exchange released a series of official documents, obtained under the Freedom of Information Act, which criticised the NHS for a ‘pervasive culture of fear’ and obsession with targets rather than a focus on patient safety

The documents, submitted to the DH by three internationally respected healthcare organisations, detail a litany of failures in oversight mechanism.  The first report said there was a ‘pervasive culture of fear in the NHS and certain elements of the Department for Health’ and regulation was ‘light-handed’.  It highlighted the flaws in the system of allowing hospitals to declare whether they were compliant with national standards – as two thirds of the assessments made by regulators did not agree with the declarations.

The second report found that the health service did not have a clear idea of what good quality health care meant so resorted to the default position that “quality means meeting the targets”.  This report too stated  “The NHS has developed a widespread culture more of fear and compliance, than of learning, innovation and enthusiastic participation in improvement”, and that “Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experiences of care”.  The final document criticised the Department of Health for being more interested in costs than clinical quality and that assessments of health care seemed to be motivated by political rather than health concerns.

As we’ve pointed out, it is astounding that there is no system of performance improvement in the NHS.  But suppose there was. If we could, say, spot increased mortality at any hospital on a monthly basis we could prevent temporary problems turning into scandals – and so avoid the tragedies like the ones at Tunbridge Wells, Mid-Staffordshire and Basildon & Thurrock.

And there is already a way to do that.  The Hospital Standardised Mortality Ratio (HSMR) was developed here in the UK.  It accounts for different risk factors so that hospitals undertaking complex operations, or dealing with critical patients, are not painted in a poor light.  It measures the hospital’s actual performance against what is expected – and so can give an early warning to inspectors, regulators, clinicians, and patients.   HSMRs have been around for many years and consequently they have large evidence base which shows that they are reliable and robust.

More and more countries around the world are adopting and publishing HSMRs as part of their hospital performance improvement plan.  Whilst it is welcome that the DH has finally admitted it must do the same, we can’t afford for the Government to drag its feet any longer – the sooner we have a proper means of seeing hospitals’ performance rates, the better.

Natalie Evans is Deputy Director of Policy Exchange.

The murder of army cadet Joseph Lappin suggests that there is something very wrong with the way we tackle anti-social behaviour. Despite having breached sanctions more than 40 times, his attacker was never sent to jail – and was free to kill Joseph, an innocent bystander, outside a Liverpool youth centre in October 2008. Although the particular consequences of the criminal justice system’s failures were exceptional in this instance, our research released this week suggests that the case is worryingly indicative of wider, systemic failings.
 
A State of Disorder, published last week, reveals that between 2002 and 2007, just 14 people were imprisoned for breach of an ASBO. The Government officially claims that more than half of those who breach their ASBO are imprisoned, but they are actually being locked up for other criminal offences at the same time. The figures expose the myth that ASBOs are being used as a stand-alone, preventative tool to protect the public from repeat and serious anti-social behaviour. In reality, any sanction for breaching an ASBO is merely an addendum to an already blossoming criminal career.
 
The scale of anti-social behaviour is such that the ongoing national debate about ASBOs often misses the bigger picture – especially the needs of victims. One of the most prevalent problems for them is persuading local agencies to take anti-social behaviour seriously. As the Home Secretary has admitted, victims of persistent antisocial behaviour find themselves bumped from one agency to another, when all that they want when they report it is simply for the behaviour to stop and for them to be dealt with by the council and/or police in a satisfactory way. But there is, for instance, no measure of victim satisfaction with the action taken by local agencies and no indication of the success rate of cases. Last year, the Government did consider creating a new national indicator – but the measure was inexplicably dropped.
 
 We need radical police reform to ensure that local concerns are taken seriously.  First, we need the police to be more accountable to local communities – through the introduction of directly-elected local police commissioners. Proper local accountability would drive a radical change in policing culture, making sure that community concerns (especially anti-social behaviour) are prioritised. They would also chair the local Crime and Disorder Reduction Partnership, driving multi-agency working and ensuring a coordinated approach is taken.
 
This must go hand in hand with comprehensive steps to free the police from the performance management regime which has prevented them from doing those unseen things – mediating, problem-solving, prevention, protection, setting community standards – that real community policing should be all about. One recent example highlighted in a Government review told the story of a police officer who reduced crime and disorder on one estate by 90% over six months through a problem-solving approach. His only reward was criticism for not meeting personal arrest targets. This kind of performance management must be stripped away if we are ever to make an impact on a problem which blights so many of our most deprived communities.
 
Max Chambers is a Research Fellow in Policy Exchange’s Crime and Justice Unit.

‘This is not Ted Kennedy’s seat. This is the people’s seat.” And with those two sentences, Scott Brown started to overhaul Martha Coakley.

I don’t know enough about the ins and outs of the Massachusetts race which ended so spectacularly this week. But looking at recent UK and US elections and campaigns, something has become increasingly clear: if you’re asking people to vote for you, then you campaign for change and you make that change sound radical.

Of course hopefully then you actually deliver on what you promise.

Oliver Letwin summed up the underlying thinking behind Conservative pledges  at the Conservative Intelligence conference yesterday: decentralisation, accountability and transparency. I would argue that he needed to acknowledge that the first priority is also saving money but to be fair to him he did say that all their policies are designed to cost no more in the short-term, and less in the long-term.

The Economist this week has a great article about why the rise of the size of the state is unpopular. It’s not so much about the cost, but more about the reach that the state has into our lives.  This will be hard to reverse – it’s all very well saying you want the government to do less, but think about all those people who want ’something to be done’ about their pet issue.

But reversed it must be. I have long-argued that the Conservatives want to win power in order to give it away. I’m not sure how seriously anyone takes that as a proposition. Certainly if I talk to people about the Tories’ approach to, for example, the environment or ‘big business’ or any of the other areas where there has been a significant shift in emphasis, they generally assume it’s all about political positioning and that all will return to business as usual if they are elected to government.

What I think is not widely understood is this: that the people who are writing policy in the party are deadly serious about Oliver’s three principles. They are deadly serious in what they say. Yes of course some of it is finely calibrated for political effect – they are politicians after all. But they know that the only way to achieve the fundamental change needed in how our poor battered society, economy and politics operates is to deliver on what they promise.

So they mean what they say. And they must do their utmost to deliver it.