Ask Not What Your Hospital Can Do For You...

The Vicar of Downing Street is proposing a "new contract between the state and the citizen setting out what individuals must do in return for quality services from hospitals, schools and the police". His public service commission has been requested to ponder "whether it is possible to move from an implicit one-way contract based on outputs, to one based on explicit mutually agreed outcomes", and whether we should aim for "a more explicit statement of the contract that covers both the service offered by the public sector ... and what is expected from citizens (beyond paying taxes and obeying the law)." Even with all those new criminal offences on the statute books, obeying the law is still not enough. Examples of Tony's new social contract include "an expectation that a local health authority will only offer a hip replacement if the patient undertakes to keep their weight down"; presumably, if the patient fails in this undertaking, the hospital will have the right to institute sanctions - withdrawing pain medication, perhaps, or even taking back their hip. "The police might also promise to achieve a specific response time in a local area, so long as an agreement is struck on the local law and disorder priorities"; and if the police do not respond in the agreed time, no doubt the citizenry will be given extensive powers of investigation and punishment to ensure that "local law and disorder priorities" are better prioritised next time. "Parents might also be asked to sign individually tailored contracts with a school setting out what the parents must do at home to advance their child's publicly-funded education", which raises the intriguing question of how the schools will be empowered to enforce their will in the home, not to mention what kind of conditions the faith schools may seek to impose. Tony hopes that this new push towards the end of private life will "examine how to form a smaller and strategic state" because, in case we hadn't noticed, "in his period of office he felt it necessary too often to push from the centre". That would be the administrative centre, not the political. With tax-funded institutions imposing their wishes at local level on the law-abiding citizens who pay for them, we may hope that such Herculean efforts will not again be necessary, leaving Tony's successor to bask in the glory of the Legacy.