We wouldn’t have email, we wouldn’t have the intertubes (based on RFCs 791 and 793), if a government had approached those problems (e.g. how to transfer mail reliably and efficiently) in the same way as NHS Connecting for Health, or indeed any other government IT project.

I edited that suggestion out of my comment: couldn’t think what the name of such a standard should be. .pdf? XML? Something like that but I don’t speak computer….

the NHS computer system … the most gargantuan monster.

Another example of top-down idiocy. Top-down does not work; all that is needed is a minimum standard (e.g. what goes into an electronic medical record, or what constitutes a medical broadband connection) and let the ‘market’ take care of the rest.

The minimum standard should be the norm – what drives standards up is people voting with their feet/money/vouchers.

Or we can carry on pissing away billions of pounds.

It’s one of our mantras at the Adam Smith Inst. that cutting bits and pieces is indeed difficult. The answer is to cut entire functions of government rather than simply tinker.

For example, we probably need about 30-50 billion’s worth of cuts to get rid of the structural deficit (remember, bing Keynesian doesn’t just mean fiscal stimulus in the bad times, it means fiscal contraction in the good as well), 6-8% or so of total spending. Trying to salami slice that off everything will create so much screaming and wailing that it’s going to be impossible.

So rather go for a few big ticket items. ID cards, the NHS computer system: one we don’t want anyway the second has simply become the most gargantuan monster.

Save 14 billion or so by leaving the EU. Simply get rid of corporate subisdies, abolish the Business department, all the little tinkering with grants for this and that. 10 billion more: abolish regional assemblies, regional development corporations, that entire structure, regional development funds….

We’ve pretty much made the savings we need to and not pissed off all that many people….

But I have been struck by several people – esp on Con sites – seemed to respond yesterday and today by saying IVF is something the NHS should not be doing anyway, or should cut now given spending constraints.

That’s arguable, of course. But, politically, I am not sure I see Mr Cameron trying to put ‘no IVF on the NHS’ past the Daily Mail (who were showing a touching attachment to tax credits for the middle-classes recently too) or indeed past voters more generally. Perhaps you think he should. I am simply predicting that he will not.

It is another example of how “cuts” are easier in the abstract than the proposal of a specific cut…

Why ? No one ever died from not having kids. I would dispute that IVF should be funded by the taxpayer at all.

So the idea of British “national standards” has already gone, hasn’t it?

Terry – “I haven’t got much time for the Irish or the Welsh, and the Scots are worse…”

Bob – “And you never could stand southerners.”

Terry – “To tell you the truth, I don’t much like anyone outside this town. And they’re aren’t many families down our street I can stand.”

Personally, I expect that would differ according to what we are talking about, being seen as a good approach to some services and not others. On the whole, I think that may prove relatively difficult in the area of health provision, where the strength of belief fairness as equitable provision may well trump that (but perhaps less so in areas like preventive services) but probably would be rather more in other areas (eg culture, sport, leisure to take an example which might be towards the other end of the spectrum).

A (Rawls-like) test might be what we could agree can be legitimately varied before we know what variations will be chosen, and whether we agree with those specific choices or not. And a key political test of its sustainability is whether somebody who then misses out on provision because of the variation can see the process fairness/legitimacy in why that has happened. (This isn’t, I think, likely in the case of acute health treatment). The visibility of the devolution of local decision-making, funding, etc is probably crucial here, as Dan suggests.

Something like Tim’s argument @13 is I think part of the motivation for the approach which suggests that variation is a good idea – because of the potential to drive innovation or experimentation – as long as there are some floor standards and guarantees to protect service users from a major failure, so reflecting the trade-off being made. But that could then have limited effect if there is pressure to make the minimum standard the norm, so that there is little or no real scope for variation beyond it.

To extend Dan’s point: markets/localism, call it what you will, can be seen as a process, not a static outcome. Different places try different things and we find out through such experimentation what works best (the aim being to find out what works best for consumers of course, not producers).

Over time (and there are very definitely lags in the system) our knowledge of what works best increases and we would expect to see provision get gradually better as that knowledge spreads.

My basic problem with centralism is that this experimentation leading to innovation does not happen.

I’m thus (and do understand that others might disagree) willing to put up with the postcode lottery now so as to get increasing stadards over time.

Of course, it shouldn’t be seen as an excuse for not delegating power even further down to the individual whenever possible. School vouchers could allow for greater variation of schools even within the same district, and Dutch-style healthcare insurance (with government top-ups for the less well off) could allow for health providers to compete for individual customers more effectively.

The point about postcode lotteries is that is a local variation that comes down from central government. With localism, you still get the same sort of variation, but that variation comes up from the people and, providing there is sufficient support, can easily be changed.

E.g. with localism, if people are unhappy about local NHS IVF provision then they can get that changed through voting. With the current setup, central government dictates NHS IVF provision and there is absolutely nothing local people can do about it.

I do however find the call within the Building Britain’s Future strategy for legally enforceable minimum standards in public services an interesting one. It’s a rights-based approach – which normally I’d be sceptical of because of the dangers of stagnating political culture – but in the context of a potential tory government which would introduce massive and damaging cuts to political services, it’s an attractive idea.

Within that context it could be possible to give providers greater control and also guarantee a certain level of service, guarding against accusations of a postcode lottery.