Guest post by Prof Roger Brown (Liverpool Hope University)

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It appears from a recent series of essays on the Coalition Government’s NHS reforms (Davis and Tallis, 2013) that there are many parallels with the higher education reforms.

In both cases the reforms were driven by ideology, by a belief in increasing competition between providers, where the service could not be wholly privatised.

There are close parallels in the means of giving effect to this.  The NHS is being reduced to little more than a fund of taxpayers’ money through which services are purchased from a variety of providers.  In higher education, the state’s role in funding teaching is almost entirely limited to lending money to would-be graduates to support their tuition and living costs.

In both cases, the barriers to entry to new private providers have been significantly reduced, even though such providers are bound to ‘cherry pick’ the services/areas of provision, and to limit professional autonomy in doing so.

This is in effect the intended privatisation of a public service at the hands of private interests: various companies, many US-based in the case of the NHS, Pearsons and various shadowy finance groups in the case of HE.  This has been skilfully and successfully disguised by rhetoric about ‘putting the patient at the heart of the NHS’ and ‘students at the heart of the system’ as well as by consistent denials (in the NHS case) that the aim is privatisation.

There is no manifesto commitment, indeed such statements as there were by both Coalition parties ruled out significant reforms. After the election, the Lib Dems made noises but went along with the Conservatives after obtaining largely symbolic concessions: the National Scholarship Programme in the case of HE, now effectively jacked, various amendments to the Health and Social Care Bill.

To justify the changes, efforts were made to manufacture a crisis by portraying a service/sector that needed fundamental reform.  Yet in both cases the service/sector was an outstanding performer in international terms, especially in terms of value for money, and the main need was not for more competition but for a higher level of investment and state support.  Neither the NHS nor the English university system was ‘broke’ or needed fixing.

The reformers’ case was made easier by the fact that the prestigious public bodies concerned either did not oppose the reforms (the Vice-Chancellors) or did so too late to make a difference (the BMA, the great majority of the medical royal colleges).  Moreover, in both cases, the Government made a successful appeal to professional self-interest (many doctors, the Vice-Chancellors, especially of the more prestigious universities).  At the same time there were rewards for those who supported or went along with the reforms.

With a few honourable exceptions (The Guardian, Channel 4, in the case of the NHS) the mass media, and especially the BBC, failed to report and analyse the reform proposals in a timely fashion and with any degree of rigour.

The Government made much of the fact that key paving decisions had already been made by the Labour Government (Foundation Trusts, variable fees).  Labour opposition to the reforms was therefore to a large extent contaminated, and remains so.

There are also close parallels in the overhang of long term costs for PFI-funded projects and the cost to the taxpayer of the recent HE reforms.  Both have significant indications for the level and the quality of services that can be provided in the future: revenue for NHS services and non-PFI hospitals, funded student places and access.

There is one outstanding issue: who will speak for the service/sector as a whole?  In both cases, the (intended) effect of the reforms is to fragment the pattern of provision.  The Government’s responsibility for the NHS has been deliberately diluted.  Higher education is not in quite the same position but there is no one body that can now speak credibly for the sector.  There is a related issue, regulation.  It is generally accepted that the existing regulatory apparatus for the NHS is too weak to prevent for example another Mid-Staffs.  Higher education has not so far had any comparable difficulties, London Met being perhaps the closest.  But with increased competition and more variable institutional funding, similar problems can be expected before too long (McClaran and Brown, 2013).

References

Davis, J and Tallis, R. (Eds.) (2013) NHS SOS How the NHS was Betrayed – and How We Can Save it.  London: Oneworld Publications

McClaran, A. and Brown, R. (2013) The New Quality Assurance Arrangements.  Oxford Higher Education Policy Institute