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.

A report out today has calculated that the bankers’ bonus tax will raise around £2 billion more than initially thought.

While this begs a number of questions (who got the initial calculations THAT wrong? Why were the banks so focused on short-term gain that they didn’t delay their bonus payments? Why were the banks able to pay such high bonuses if they were really in such trouble? And so on…) the really big question is this: what will the government do with the money?

Will they put it into the general spending pot? Will they use it in a pre-election bribe budget? Or will they do the responsible thing and use it to start paying down our deficit?

This is something to watch for. It’s an indicator of whether the money markets and voters are able to believe Gordon Brown when he talks about making the right choices.

George Osborne and William Hague have been in Afghanistan this week; it’s important that potential Chancellors as well as Foreign Secretaries and Prime Ministers understand the implications of their actions (particularly relevant in light of the revelations Geoff Hoon is expected to make this week about Gordon Brown’s treatment of the armed forces).

The general approach that the Tories would take to Afghanistan’s reconstruction – exploiting the dual expertise of the Territorial Army’s personnel in particular – seems to me to be a sensible way forward. One thing that does worry me a little though is the last section of this article:

“Senior military officers have been calling for a stabilisation brigade, having grown frustrated by what they see as the failure of aid agencies to rebuild the economy in Afghanistan.

“In private, they complain that development officials spend too much time and money on civil society initiatives, rather than investing in local infrastructure and jobs.”

I do not believe this can be an either or question. Of course infrastructure and jobs are the only sustainable way for a country that has been ravaged by sanctions, war and deprivation for decades to return to anything approaching normality. I think we’ve seen in Iraq what happens when, for example, electricity supply is still demonstrably worse for most people five years after they were assured they were being rescued from a tyrant. Or if you were an Afghan, your only potential source of income was the Taleban offering you money, wouldn’t you be tempted?

But as we’ve seen in Northern Ireland this week, functioning institutions and a healthy civil society are the things that pose the real threat to those who wish to spread terror. So it is absolutely imperative that, at the same time as the basics of electricity, water, banking, business and general infrastructure, we continue to focus on supporting the development of national institutions. They have to develop with the grain of the nation concerned – it would clearly be ridiculous to expect any country with no history of any sort of democratic activities to be able to instantly run a fully clean election, for example. But part of what makes institutions function properly in favour of those they are supposed to serve is the very fact of practicing. So – for example – the more elections that are held, the more people understand how they are supposed to work and how the contract between voters and elected representatives works.

In Britain, we are hugely fortunate that most of us, most of the time, are able to rely on the institutions that bind our communities together – things like the NHS, the BBC, or even (dare I say it…) the Houses of Parliament and the monarchy. But we’ve had hundreds of years of practice, and of evolution. None of it was perfect when they were first established. They are constantly evolving in accordance with current requirements and expectations.

Melanie Reid’s brilliant article about the way that snow is bringing out our inner Tories is instructive here – in many (most?) cases, there’s an attitude of ‘we just have to make this work ourselves – and we’ll help other people along the way’. Which is exactly how civil society gets stronger and stronger.

Unusual snow across all of Afghanistan is, to be fair, unlikely. But giving up on helping the Afghans to build their own institutions means that they will be unable to realise their potential to do it themselves.

This article in the Sunday Times about Anthony Seldon, the head of Wellington College, is fascinating. His head of wellbeing, Ian Morris, caused a certain amount of scepticism when he was first appointed, but points out this key insight:

“Traditionally, PHSE [personal, health and social education] has been about telling kids all the bad things to avoid — promiscuity, drugs, etc — instead of trying to get them to think about how they can make their lives better.”

This seems to me to be an absolutely fundamental part of how we need to approach policy-making more generally. Endlessly having people telling you that this is bad, that that is forbidden, that something else is dangerous just wears us down and makes us disengaged.

Encouraging people to try, to make the right choices, to take advantage of the situation they are in, and helping them to do so, is exactly what the Conservatives’ social revolution is all about.

Clearly it is not a given that this will work in every situation, for everyone. But for example, while there’s a lot of over-interpretation of the marriage tax bonus (this article, also in the Sunday Times, tries to invent a revolt – but every single quote from those  supposedly revolting MPs who are named could be said by David Cameron or indeed me), what the Tories want to do is not moralise, or stigmatise, but to support people who make good choices for their own lives, and help those who, for whatever reason, don’t.

I get the impression that a lot of people are deeply cynical about whether the Tories mean what they say on such policies, and whether there is any point in them. But the point of the hugely ambitious Tory social revolution is not to shoehorn everyone into little boxes. It is to free and support people to make the very best that they can of their lives.

So that insight from Ian Morris, of the value of help to make good choices rather than just telling people not to make bad ones, is actually the key Conservative insight into human behaviour, and the fundamental requirement if we really want to change the way our society functions.

And it has the added bonus of lightening the seemingly never-ending doom and gloom to enable that sense of optimism – which is what Tory members voted for when we chose David Cameron as leader.

Does Gordon Brown have the guts to suspend Harriet Harman from her Cabinet positions?  She is about to be taken to court over two driving offences (driving without due care and attention, and driving while using a mobile). She apparently left the scene of her accident proclaiming, “I’m Harriet Harman, you know where to get hold of me.”

In much the same way as Baroness Scotland should have been sacked over breaking her own law, Harriet Harman should be suspended until her case comes to court and if found guilty, she should be sacked too.

Yes this is holding politicians to a higher standard than the rest of us – but they are the people who make the law, and they should be even more careful than the rest of us about obeying it. If they don’t like their laws, perhaps they shouldn’t have introduced them in the first place.

The depressing thing about this, though, is that she probably won’t be suspended, she probably won’t be sacked even if she is found guilty, and Brown will carry on leaking what authority he has left.

I am not a fan of Harriet Harman’s politics (though I do confess a sneaking admiration for her willingness to do feisty battle) but I would think a great deal more of her if she appeared on the news tomorrow and said that as a lawmaker, the suspicion that she broke the law must be dealt with in the most transparent way possible, and she does not believe it to be right that she can legislate for the rest of us while she is under suspicion. If she doesn’t though, it’s unlikely I will be able to think less of her!