Vincent Cable: Spending cuts: The Lib Dem approach
1) Trust. Staff would be more motivated and and productive if they had more freedom to exercise professional judgement and were less constrained by targets, paperwork and micro-management. How would you restore professional autonomy and remotivate public services staff?
One key step to getting the NHS and education working better is to motivate those who work there. Top-down, command-and-control management has done great damage. Staff have much to contribute but are currently treated as a cost rather than as a resource. We believe in turning every hospital into an employee-owned trust so that every member of staff has a say in how it's run. In education, the government needs to extend the freedom academies have to all schools in the state system. Teachers would no longer be directed how to teach, and innovation and creativity would be encouraged. The Department for Children, Schools and Families could be massively downsized, cutting out the micro-meddling and endless top-down and costly initiatives. This would allow more money to be devolved to schools, strip out political interference and restore confidence in standards.
2) Staff and pay. There are too many unproductive jobs, too far from the frontline. There are too many managers, and top salaries are too high. Where would you make staffing cuts, will you cap executive pay, and what role in any shake up would there be for alternative providers, such as the private, social enterprise and voluntary sectors?
Bureaucratic overheads are too large and there is an insidious fat-cat culture. We would scrap central NHS targets and unnecessary quangos, and reduce the admin burden on trusts. We would halve the size of the Department of Health. We would abolish strategic health authorities. Health quangos cost more than £1.3bn a year, employ more than 25,000 people and pay 25 executives more than the prime minister. These quangos should not be exempt from the financial reality facing the rest of society.
Redundancies and pay cuts should occur primarily among senior staff, protecting frontline staff and services. There must be a role for alternative providers. I welcome a bigger role for social entrepreneurs, as is now happening in, for example, community care.
3) Sure Start principles. There's too much spending on "picking up the pieces" services or knee-jerk policy responses to media headlines. How would you rebalance investment to encourage long-term preventative services like Sure Start or prisoner rehabilitation schemes, and in which policy areas?
Our education system too often perpetuates inequality by leaving children from disadvantaged backgrounds behind, and the government's endless gimmicks and initiatives often don't kick in until it's too late for intervention to work. Infant class sizes should be cut so that young children get the extra attention they need. Our plans to invest £2.5bn in a pupil premium would guarantee schools that took disadvantaged children the extra cash they need to give these pupils the additional support they need. Schools would be able to offer catch-up classes, more one-to-one tuition and additional weekend and summer classes. The key is to ensure that children who are struggling from an early age do not fall further behind, but are supported so that they can access the opportunities available to others and get the very best from life.
4) People power. Listen to those who use services. Too much spending reflects the needs of providers, not users. How would you ensure user "voice" is incorporated into commissioning, design and provision of services? How far would you hand spending power to users, such as through individual budgets?
People are better able to determine the priorities of the NHS locally – not Whitehall and unelected officials. Primary care trusts (PCTs) would be renamed local health boards, and the majority of board members would be elected. There is scope to extend individual budgets into certain areas of healthcare – to deliver more personal care at a lower cost – and this is already happening with disability. The potential is considerable. This concept turns the traditional model of public services on its head. But it could be transformational, delivering better health and wellbeing and closing the inequality gap between those who have choice, because they can afford to buy the right services with their own money, and those who have had to rely on too often poorly performing public services.
5) Scrap grandiose schemes. The billions spent on national databases, like those for children, and huge IT systems are better spent on frontline services. In a funding squeeze hospital and school building schemes should be scaled down. Do you agree?
We are already committed to scrapping big databases like ContactPoint, the ID card scheme and the so-called "super-database". The NHS IT system has been a costly failure, running massively over cost and failing to provide clinicians with what they need. We would abolish Connecting for Health, the Choose and Book system would revert to being what it was originally designed for – an electronic appointment-booking system - and we'd abandon the National Care Records Service. Future NHS IT systems should be built from the bottom up – locally commissioned to national standards.