Thursday, October 19, 2006

Against postcode lotteries and for localised decision-making and warm ice cream

Everyone* knows that it would be a Good Thing if access to services, particularly in the NHS, did not depend on whereabouts in the country you live.

Everyone** knows that it would be a Good Thing if instead of the government trying to run everything centrally, decisions were taken at a much more local level.

The problem is that when you try to combine these two principles, you end up with a warm ice cream.

Any devolution of power from the centre necessarily involves the creation of "postcode lotteries". An attempt to proceed in the manner of Lib Dem conference or a Compass pamphlet, through assertion that localism is Good and postcode lotteries are Bad, without any idea about priorities, or how to resolve conflicts between these principles, is no help when it comes to the actual business of governing.

For all that they are accused of not having any policies, the Tories have made it clear that if they win power then they will redirect funding for the NHS from the poorer areas of Britain to the richer ones, and have been spinning this as an attack on funding decisions being taken politically at the moment. This will, of course, widen still further the gap in life expectancies and health between rich and poor.

There are some things which locally run services do well. In particular, they provide the opportunity to try out new, innovative ideas, whether provided by the public, voluntary or private sector. But the number of people who want high quality public services is much higher than the number of people who care whether the decisions are taken locally or nationally. It isn't politically fashionable to say so, but to reduce inequality and be on the side of the majority about public services, we need a strong and growing central state, redistributing funding from wealthy areas to poor, rolling out good ideas and providing constantly improving services.

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