Alan Milburn might not thank me for the comparison, but his recent rhetoric about the mutual and local character of foundation hospitals echoes George Lansbury. Lansbury, whose biography coincided with Labour party history for the first four decades of the last century, revelled in what we’d now call the communitarian nature of his socialism. It welled up from his attachment to London’s East End. He became a councillor and a Poor Law guardian in order to help his fellow citizens in Poplar realise a better future together.
But his activism and Alan Milburn’s proposals are based on a contradiction. Lansbury went to prison for failing to levy enough in local tax to pay for Poplar’s welfare spending. He wanted more assistance from central government. In other words, realising his commitment required central government to bail out
a poor part of London.
Similarly, foundation hospitals may turn out to be dynamic and innovative, as envisaged by the health secretary, but they will continue to depend on the flow of funds to them from the Department of Health – a flow based, at least in part, on the socio-economic characteristics of the areas they serve. A good hospital in a poor area is no paradox, but its success will rest in some measure on differential allocations of money.
The history of Labour in the 20th century shows that social progress depends on a strong central government able to tax and spend on the basis of (national) schemes to identify need. Localism, old and new, cannot be relied upon because resources – human as well as material and economic
– are badly distributed. Some areas are better off. Economic history leaves some places derelict. They need help – of a kind that only central government, and the tax it raises, can supply.
My anxiety about the ‘new localism’ is that it sometimes uses neo-conservative language, implying the problem is (central) government. In doing so it may inadvertently whittle away the trust and confidence needed for progressive taxation, to be shared progressively on the basis of deprivation or regeneration potential.
During the recent spat over school funding, new localists have derided the centre. What can Department for Education and Skills officials know of a secondary in Salford or a primary in Pinner? The answer is that they can and must know enough to be able to direct sufficient resources to those schools, based on pupils’ backgrounds, their household income, their home language and so on. Self-evidently, school management has to be the business of the head and governors. But what or rather how much they manage is very much the business of progressive central government.
New localists, I am afraid, tend to accentuate the positive. If all local authorities were like Lewisham and all hospitals like Aintree the case for letting go would be stronger (though it wouldn’t answer my point about distributive mechanisms).
But the logic of localism is that for every excellent local authority there are a number of poor performers, let alone many coasters. The three-star hospital trusts are matched, and exceeded, by the no-stars. Who is to kick-start the drive for improvement if not the centre, with its inspectors and threats to substitute better management?
Is the drive for equality in public service provision inherently centralising? The answer has to be yes. Does that involve some sacrifice of local managerial energy? The answer has to be, possibly: but that will be counter-balanced by the centre’s capacity to stimulate areas and local organisations that would otherwise relapse into torpor.