Tag Archives: health

Know your place

I’m a bit of a shy republican, but today gave me a glowing reminder of why any sane person should be one (sorry Dad).

On the same day the Queen “generously” agreed to “rededicate” herself to the UK, Downing Street let it be known that the Cabinet spent their time “banging the table” to celebrate the passing of the Health and Social Care Bill.

It is no accident that this little snippet of information was leaked today. The triumphalism is palpable, as is the very explicit attempt to indelibly tie the Lib Dems to the reforms. So too is the signal it is intended to send.

This quintessentially public school act is very clearly meant to send the opponents of the bill a very clear, class-ridden message: “know your fucking place”. It is no coincidence it has been declared on the same day as all the pageantry going on with the Queen’s visit to Parliament.

This is all about class warfare. And, given the country’s response to the royal wedding last year, it will doubtlessly be extremely effective. Until we somehow manage to extricate ourselves from this mindset, the country will always be extremely vulnerable to such propaganda; however much we might consciously find such behaviour repugnant.

Know your fucking place, serf. And if you don’t like it, what are you fucking going to do?

UPDATE: What the Liberal Democrat position on homeopathy IS

Since I previously wrote about what it was, and then wasn’t, I feel it is encumbant on me to include here what the official line on homeopathy now is:

A recent report by the House of Commons Science and Technology Committee examined the provision of homeopathy through the NHS and called for funding by the NHS to be stopped. The Committee did recognise that many users derive benefit from its use and did not argue that such treatments should be banned.

The Liberal Democrats believe that, as a basic principle, individuals should have maximum freedom about how they choose to get treated, so long as the therapy is safe. When it comes to NHS provision, we support a review by NICE into the cost effectiveness of Complementary and Alternative (CAMs) therapies, including homeopathy; as well as expanding the work of NICE to look at the cost-effectiveness of existing conventional treatments.

We know that many complementary therapies are popular with the public. The NHS budget is limited and we want to make sure that NHS funding is focused on treatments which are efficacious and cost-effective. NICE reviews of all existing treatments would give us the best possible basis for future decisions over funding.

That sounds much more sensible and measured. On top of that, I am now getting (unconfirmed) reports that the Scinos will not be at Lib Dem conference after all. Looks like the party may have had an outbreak of common sense.

Or maybe not.

Andrew Hickey on drugs: half right

I’ve signally failed to blog about what has become known as Alan Johnson’s Nutt Sack. The appalling way in which this government is sliding into irrelevance – and how Her Majesty’s Opposition is always only too ready to act as an echo chamber on matters when this government is truly, spectacularly wrong, is both profoundly depressing and barely qualifies as news.

I was interested to read Andrew Hickey’s take on the affair over the weekend. On one level he is certainly right: the degree by which drugs should be prescribed or not should not be lead by science but by the harm principle. It should be up to the individual concerned to decide for themselves if they want to take a narcotic and possible harm themselves in the process – that isn’t any of the state’s business to get involved.

…at least up to a point. Where I perhaps part company with Andrew (I haven’t read all his comments I must confess) is that I think science plays a very crucial role in deciding where you draw the line between an individual making a personal choice and an addict blindly reaching out for the next fix. Just as Mill conceded that an individual should not have the “freedom” to sell themselves into slavery so we must accept that someone physically dependent on a drug is not exerting self-control. To what degree an addict is capable of making rational decisions is very much a matter for scientists to resolve.

The bottom line is, science can’t give you value-free policy and ideology-led, evidence-free policy is equally pernicious. What you need are values and principles underpinning the science. Thus a liberal drugs policy would indeed start from the harm principle but it would rely on scientists to flesh out a lot of the practicalities. Yes, a truly liberal policy would probably result in most drugs being legalised but that in itself would lead to all sorts of questions. What should the legal limit for driving under the influence of cocaine be for instance? Would you go so far as to legalise crack? Do you impose a tax to pay for the externalities and if so, how do you calculate it? What should government policy be on advertising and public health information campaigns. There are plenty of things for scientists to investigate.

In his slightly sarcastic defence of Alan Johnson, Andrew is very wrong in this respect: Nutt was offering scientific advice within the confines of the government’s own legal framework. Within those restrictions he was offering perfectly sound advice and pointing out its inherent contradictions. Johnson hasn’t been simply applying his own principles but besmirching the very principles which the government has for years claimed underpins the existing classification system.

Ultimately, modern science poses a lot of uncomfortable questions about to what extent we can be said to exert free will. We need to engage with that debate not merely wrap ourselves in Victorian philosophy and hope it will go away.

Andy Burnham’s unhealthy flag wrapping claptrap

I’ve written a response to Andy Burnham’s astounding Guardian article on the NHS on the SLF website:

Given the choice between “national”, “health” and “service” the word that Burnham considers most key to the Labour approach is the former. Ignore “health”, never mind “service” – who needs a bandage when you can wrap yourself in a flag?

Read the full article here, but frankly, Richard Grayson’s article from Reinventing the State on the NHS is more interesting.

While we’re at it, here’s an article from Chris Huhne from 2004 about why the party rejected the social insurance model for healthcare (pdf), courtesy of the Beveridge Group.

When rightwhingers demand nuance, count the spoons…

The Right isn’t particularly famed for its sense of nuance. The shenanigans going on in the US over healthcare rather suggest that and even the touchy-feely Cameroons are not exactly strangers to Mister Brickbat. Yet when lefties employ the same tactics (as is the nature of politics), they suddenly lurch up on their hindlegs and demand to be treated like sensitive, intelligent human beings. It won’t wash.

The current source of the UK Right’s distress is this #welovetheNHS twitter thing. Now, to most people participating in the meme, this was little more than a way of standing up and being counted and reacting against the nonsense happening in the US. That nonsense has been made all the worse by people like Dan Hannan spreading outright malicious falsehoods about how the healthcare system actually works. At one point Hannan even claims that our system is inefficient compared to the US system, despite the fact that it costs twice as much as our one and has measurably worse outcomes.

The effort has been a sucess. Yesterday, and to a lesser extent today, was informally declared LoveNHS Day by thousands of people. You had a choice: piss or get off the pot. It isn’t really something worth intellectualising; it wasn’t even orchestrated – merely a phenomenon. But boy have they been having a go.

None of the points being made are of particular merit. Apparently we are meant to be awestruck by the recognition that the NHS fails a lot of the time. Strangely, this is a point being made repeatedly by many of the #welovetheNHS crowd.

The Rightwingers who complain that they neither want the current US healthcare system or the NHS in its current form have a golden opportunity here. They could be telling us what they do want and why it would be better than either of the alternatives. This seems particularly appropriate because the Obama proposals seem to be more along the lines of mainland Europe than the UK. Lib Dem “Orange Bookers” (in this case the term is appropriate because David Laws’ chapter on health in the Orange Book was indeed about health insurance) could be singing its praises, or at least adding constructive criticism. Instead, they seem to be stuck in bleating mode about how dreadfully unsophisticated the argument is. The conclusion one draws is that either their own ideas aren’t actually much more sophisticated than “the NHS is a bit shit really” or their views are somewhat closer to the likes of Dan Hannan than they feel comfortable admitting. Indeed it is interesting how few friends Hannan seems to have. No-one appears to be rushing to his defence, and yet his views are surely representative of a significan minority. He did get elected by Conservative members in the South East at the top of their list after all.

I’ve got to be honest and admit that the lack of intellectual debate here is beginning to bore me too. The nature of these things is however that as time goes on, the debate will inevitably move on. Remember the expenses scandal? After that, we had a very creative debate about how to fix politics. A debate, it should be noted, that the usual forces of conservativism have been doing their damndest to stop ever since.

Having firmly established that the NHS is an institution the country supports, we really do now badly need a debate on why it isn’t better. We might have a better healthcare system than the US, but other countries are delivering more effective systems for the same cost. But you will excuse me if I spend just one more evening enjoying the discomfort of people whose ideas I’m pretty confident would leave us, and especially the poor, much worse off.

UPDATE: Sunder Katwala is also calling for a debate.

UPDATE 2: I take it all back Progressive/Liberal Vision Progressive Vision, of which Liberal Vision is a wholly owned subsidiary, and Liberal Vision’s Director of Development have launched a campaign in defence of the Dan Hannan position. Its supporters include Liberal Vision’s Director. Charlotte Gore of Liberal Vision is keen to emphasise that this is not a Liberal Vision project, but Sara Scarlett is being permitted to use the Liberal Vision Facebook group to promote it:

In conjunction with Nurses for Reform, Progressive Vision has launched the #no2NHS campaign.

http://www.facebook.com/group.php?gid=116255352868&ref=ts

Show your opposition to socialised healthcare by joining the #no2NHS campaign and invite all your friends! Our target is to make #no2NHS the No.1 trending topic on twitter and make the case against the NHS.

Warmest regards,
Sara

Director of Developement
Liberal Vision

Bad Faith Awards: it’s like being asked to choose between my children!

How on Earth is anyone supposed to be able to pick a winner amongst this set on bozos shortlisted in the New Humanist’s Bad Faith Awards?

It makes you realise quite what a year it has been on the culture wars front. Personally, on reflection, I’ve gone for the governors of St Monica’s School, Prestwich for the simple reason that their decision to deny their pupils access to the cervical cancer vaccination is so transparently mysogynist and so physically harmful that it deserves a lot more attention than it has been getting.

But New Humanist really ought to consider using a different voting system. As it stands, the high profile nominees are leading by miles while the others simply aren’t getting the exposure they deserve. Do we really need Sarah Palin to win? The good people of the USA have already found her wanting. What does it achieve letting her win, or for that matter someone like Ann Coulter who is just begging for the publicity? And wouldn’t it be better using a system which would better establish the consensus candidate?

Frankly, they should be doing a death match (or, to be more pretentious, the Condorcet method). Fundamentally, it is a shame humanists aren’t using a system which encourages deliberation rather than simple knee-jerk reaction. That’s for the other lot.

The NHS: my tax money at work

I managed to fill in a registration form for my local surgery today, on my second attempt. To be clear, I didn’t actually register – that is a formal appointment next Wednesday. But they did at least let me fill in the registration form, which I have to do before I can have the registration, once I had gone all the way home to pick up some proof of address.

It all seems horribly familiar. I last attempted to register for a GP at my old address four years ago. Tried several local surgeries – all were “full up”. Even my landlord’s tip of emphasising that I lived in the leafy Finchley Garden Village* didn’t pay off. Things came to a particular head when I managed to contract the mumps from a dirty intern (thanks a bunch evil media) and no-one would see me. In a state of delirium I ended up walking to the nearby hospital and getting completely lost. I really didn’t think we lived in a country where it was so easy to get into such a state even after going to the authorities for help, but we do.

Back to the present, once I had provided my proof of address and established that my partner was already registered there, the actual form filling went along quite smoothly. The fact that beyond a cursory glance they took no interest in my proof, and that this rule was neither mentioned to me on the phone or on their website, suggests this isn’t a national policy, but a filtering mechanism. It wasn’t a way of determining who I was, but a trial of willpower.

Why is this? I can’t help but suspect it is related to the experience of one of my work colleagues. Of Turkish descent, but born and bred in Sussex, he registered for his GP on the same day as his fiance. Her form went through instantly. His, complete with his name full of Eastern promise, somehow managed to get stuck in limbo for three months and only got processed once he started making some not-too-veiled threats to them down the phone.

What I want to know is, to what extent are my and my colleague’s experiences related to a policy – unofficial or otherwise – to crack down on health tourism? This is the only semi-rational explanation I can come up with. But how well thought out is this policy? From where I’m sitting it is a policy that is doomed to fail. If you are determined to register, you will get on (and if you’ve come all the way from another country, you will be pretty determined). If on the other hand you aren’t really that bothered, you stay adrift. I’m only registering now, partly because of the endless nagging from pretty much my whole family (it’s a conspiracy!) and the fact that my asthma has come back with a vengeance after being in abeyance for the best part of six years.

In the case of the asthma, if I had managed to register four years ago, I’d have always had a beclazone and salbutamol inhaler on hand. If truth be told, it would almost certainly not have got as bad as it is now. Result? Assuming I do manage to get registered, I will probably end up taking more time than I would have done otherwise. And yes, I know, I should have seen this coming. I should look after myself more in general. But life gets in the way, and pretty much my entire experience of the NHS when I was a kid was having my mother told off by my dreadful then-GP for wasting his time (if he’d been a little more helpful, I somehow suspect my allergies would have been diagnosed before my twenties) and a dietician whose wonderful advice began and ended with eating more digestive biscuits. The clear message I got from the NHS when I was growing up was that I was broadly on my own and to only come to them in the case of a real emergency. So that tends to be what I do.

The NHS does a great job at looking after extremely sick people, treating injuries and in crisis situations, but in my experience it is absolutely appalling at preventative health. Is it really that difficult to provide everyone with the basics such as a registration system that can cope with people moving house every now and again? I do believe in universal healthcare, free at the point of need, but I do wish they didn’t seem to go so out of their way to test my patience.

* Which is basically a ridiculously cute little road with its own war memorial, village green, Lion, The Witch and The Wardobe-esque streetlight** and property prices in the millions. Needless to say I was renting!

** Since the Pevensie children are supposed to come from Finchley, I’ve often wondered if this was somehow an inspiration for the Narnia books, but have no way of knowing.

Why class still matters

There have been a series of articles in the Guardian over the past week that have made it clear that class is still a very real issue and demands a Liberal Democrat response.

First, John Harris wrote about the impact of right to buy on Tuesday. Then, Felicity Lawrence wrote about the politics behind Jamie Oliver’s new Ministry of Food. Finally, today Jon Henley wrote about smoking, and how people on low incomes remain resistant to attempts to persuade people to kick the habit. It strikes me all these issues are linked.

Taking John Harris first, I don’t share this romantic vision of sprawling 1960s era housing estates draining the coffers of local government (“when I were a lad, this were all sprawling council estate”), but I well recognise the problems of landlordism (*ahem*). What is interesting about Harris’ article is his description of how the positive side of right to buy that was very clear in the mid-90s – where, as he said, you could tell which houses where privately owned and which were council run simply by looking at which ones had the hanging baskets or had been painted relatively recently – has given way to a culture of buy to rent. The nice homes have been sold, their occupants have moved either abroad or to the country, and their homes are being filled with economic migrants. Local people aren’t getting a look in and with no new council houses being built they have extremely limited options. As we have seen in Dagenham, this is fertile ground on which the BNP can build their lies and half-truths.

In student areas, such as Headingley in Leeds where I used to work and Fallowfield in Manchester where I lived as a student, the result has not been ethnic ghettos (although there are plenty of those in Leeds and Manchester) but student ghettos. What these areas have in common is that the toxic mix of right-to-buy and buy-to-let has atomised – or more accurately stratified – local communities. Our cities have curdled like milk, with the rich clumping together in gated communities. Council housing won’t solve that problem by itself (indeed it pre-existed council housing, albeit not to this extreme), because the problem with that is rooted in our exaggerated land values which we allow people to speculate on not because of who owns the property.

Buying back properties owned solely for investment purposes and building on land with inflated values is a very expensive way of levelling the playing field, but with no senior politician prepared to look seriously at taxing land values (nice to see Polly Toynbee on board with that particular issue), it may be the only thing we can do. Meanwhile the cost of housing will continue to price our own workforce out of a job and favour economic migrants willing to spend a couple of years sleeping on floors in the UK in order to better their families’ lot. You can’t blame them, but there is little to be gained from expanding our own underclass.

Jamie Oliver’s programme dealt with fundamentally the same problem but from a different angle. Instead of housing, his concern is – not surprisingly – food. Oliver has an agenda to get Britain eating more healthily. In 2005 he set out to transform school dinners successfully (although it should be pointed out that Lib-Lab controlled Scotland was way ahead of him), although this in turn lead to a backlash. That backlash lead him to ringleader Julie Critchlow and the town she lives in – Rotherham.

In order to get Rotherham eating more healthily, Oliver’s plan is simple – teach eight “can’t cook, won’t cook” local residents the basics of cooking but on the strict understanding that they will undertake to pass the recipes they learn on to two of their friends, who are then to pass the recipes on to another two and so on, until the whole of Rotherham is cooking. If that sounds like a nice idea in theory that doesn’t have a cat in hell’s chance of succeeding, on the basis of the first programme you are correct. By the end of the first episode (I’m blogging instead of watching part two), even the most enthusiastic of his eight trainees are flagging.

Oliver’s mistake is hardly unique. It is the problem common to anyone who is convinced that policy makers need only concern themselves with equality of opportunity and “meritocracy” as opposed to outcomes. The theory goes that if you give people the right training and opportunities, they will run with it – unless they are lazy and feckless and not worth bothering with. At several points in the programme, you can see Oliver wrestle with that idea. To his credit, he is prepared to try to understand, but watching him listen to explain why, at the end of a long day at work, they lack the energy to leap in the kitchen and rustle up a meal, you can see it really grates against his whole outlook on life. Thatcher has a lot to answer for.

As is the nature of such “reality” television programmes, they have cherry-picked some pretty extreme examples of individuals who can’t cook, including an unemployed mother of two who feeds her kids kebabs on the floor every evening and has never so much as boiled an egg in her life despite having a fitted kitchen. What is clear though is that the problem is more than simply educational; as Oliver acknowledges but perhaps does not internalise, the problem is actually cultural and deeply ingrained. That won’t be solved by a few cooking lessons.

It isn’t to say his initiative is a wasted exercise (although if he really does want to get millions of people cooking he should probably consider producing a 99p version of his £25 book), just that it can only scratch the surface.

This is reinforced by Jon Henley’s article. Independently, I drew remarkably similar conclusions to Darrell G on Moments of Clarity. We appear to have come up with an anti-smoking policy that has proven to be remarkably effective at stopping you smoking – so long has you happen to be well educated, well housed and on a good income. If you are from a lower socio-economic background all it appears to be doing is eating up a bigger slice of your income and leaving you even more addicted. I was particularly struck by this paragraph:

“One of the things that means, says Jarvis, “is that if you’re a poor smoker you’re going to want to maximise the ‘hit’ you get from each cigarette, because it represents a larger chunk of your income. The amount of nicotine you can get from each cigarette is very elastic; it depends how hard you puff, how deeply you inhale, how much of the cigarette you smoke.” Across all age groups, and even if they smoke the same number of cigarettes, poorer smokers take in markedly more nicotine that wealthier ones. “Smokers in lower socio-economic groups,” says Jarvis, “are addicted to a higher hit. Their nicotine addiction is stronger.

I have to admit, that gave me a “what the fuck are we doing?” moment. Sheesh – maybe John Reid was right. Unlike Jon Henley, I’m less than sanguine about the progress we’ve made in reducing smoking because it seems to have increased inequality. This is skirting dangerously close to Morlock / Eloi territory.

But it is also silly to say that we should never have made smoking a public health issue and settled for a less healthy but more “equal” society. And the theory advanced by some libertarians that any political party that became pro-smoking would instantly become massively popular is pie in the sky as well and not backed up by any evidence. It isn’t that poor people want to smoke; its that they live tough lives that make them prone to dependency. It is the same underlying problem that Jamie Oliver identifies. It’s about quality of life, but fundamentally it is about economics.

Most studies I’ve seen suggest that social mobility is now going in reverse after a half-century of progress. If that is the case, and our society is becoming rigidly stratified once again, then despite the “classless society” platitudes of the 1990s, it is time we started talking about class. In this respect, I pay credit to Nick Clegg for forcing the agenda on the pupil premium. We need more of that sort of approach.

Government plan for cig crackdown is too weak

The government’s plan to make it even more difficult to market and sell cigarettes doesn’t go anything like far enough. Personally I think they need to do something serious, such as ban the word “cigarette” which sounds far too innocuous, even friendly. Surely “paper based tobacco smoke inhalation system” would be a better term? We could start by banning the term cigarette on the packets themselves and then reach out to TV, the press and eventually the internet. Pretty soon we could be issuing fines to people for even saying the word out loud in the street.

Some people might object that this all sounds a bit too draconian, but what about the children? And it’s not like I’m actually talking about banning the things, that would be illiberal.

The Clegg era starts here

Notwithstanding my gripe on Thursday, Nick Clegg has had a very good week. He started by putting the finishing touches to his front bench, made a series of appointments regarding reforming party structures (about which I must get around to blogging about it detail at some point), made a well-judged debut at PMQs and has now made a major speech on public services reform.

This is the speech I didn’t get during the leadership election but nonetheless voted for, so I’m delighted my gamble seems to have paid off. Linda Jack’s point that he spelled out his approach in an SMF seminar in December misses the point: he spent the election campaign downplaying all this stuff when so many of us were urging him to be bold. Making a token speech to the SMF, towards the end of the campaign and with no fanfare is the oratorical equivalent of putting planning proposals, to quote Douglas Adams, “on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of The Leopard‘.”

So much for the past and back to today’s speech. I’m happy with it because it moves us forward, not in some symbolic “break with the past” way that some of the headbangers in the party might like but through clear-headed liberal analysis about what is wrong with public services in the UK and how they work elsewhere. There is a clear continuity with the approach the party has always had and the direction it has been traveling in.

It is a very politically calculated speech, and I mean this in a good way. He’s correct to say that the Orange Book was correct to call for the marrying of social and economic liberalism. What no doubt would have been more boring to say was that notwithstanding the question of how you get the balance right there is virtually no-one in the party who would disagree with that sentiment (a point about which most political commentators seem unaware): he could equally have said the same about the “social liberals'” answer to the Orange Book, Reinventing the State.

Some sections in it, such as his call to scrap F and G GCSE grades, probably won’t transform society, but they represent a move away from an “everyone shall have prizes” approach to education and towards clearer delineation between pass and fail. This is symbolism, but in a meaningful way.

Possibly the most important passage of the speech can be summed up in a few lines:

I stand for these simple principles:

The state must intervene to allocate money on a fair basis.

The state must intervene to guarantee equality of access in our schools and hospitals.

And the state must oversee core standards and entitlements.

But once those building blocks are in place, the state must back off and allow the genius of grassroots innovation, diversity and experimentation to take off in providing an array of top-class schools and hospitals.

At first it sounds very motherhood and apple pie, but in practice this is a real challenge for political parties of whatever hue to live up to. Clegg singles out Brown’s approach for failing to live up to these core principles, but the same could be said of Cameron, such as his proposal for a “Tsar of all the MRSAs.”

It will be a key test of the Lib Dems in the future to see if they can live up to these principles or are tempted to jump on this interference bandwagon. The biggest challenge is what exactly is meant by “core standards and entitlements”. You could argue that the National Curriculum does that; Labour certainly do. The National Curriculum is a “minimum standard” that has grown and grown over the past two decades, driven by political expediency. One person’s minimum standard is another person’s nanny-state interference. Literacy? Some educationalists argue you shouldn’t even start to formally teach reading until the age of seven. Sex education?

How do you stop minimum safety nets from transforming into straitjackets over time? And who sets those minimum standards: national or local government? My suspicion is that we need to better spell out what checks and balances need to be put in place for such a system to work in practice, but that is for another time.

His model for Free Schools will also need careful crafting. Over the New Year period, Clegg caused some controversy by endorsing the role faith schools have to play as “engines of integration” in The Jewish News. I commented a few months ago about the hypocrisy of Jonathan Sacks making the same point while opposing any measures which would stop faith schools from being able to choose their own pupils. If Clegg wants to ban selection completely, which also means taking on the handful of local authorities which still have grammar schools, he will have to also take on the faith lobby which he has been courting.

Orthodox Judaism isn’t the real issue here anyway. I’m sure the Vardy Foundation will have very little problem with banning selection if what they’re getting in exchange is even greater freedom to teach creationism. I’m sure the Scientologists Applied Scholastics are similarly licking their lips. And these problems are relatively simple in urban areas where there is a great enough population density to mean that parents have a wide choice of schools to choose from; in rural areas the economics works very differently.

It isn’t all one way of course; under this proposal there is nothing in principle to prevent a group of parents setting up their own school and effectively starving the local brainwashing academy of minds (so long as they can find enough support). If it is an open enough system for L. Ron Hubbard’s supporters, it is certainly an open enough system for fans of Richard Dawkins. The challenge for this proposal (which emphatically is not a fatal one) is how we combat liberalism’s greatest enemy: monopolistic power.

The health proposals are less problematic for me. The idea of allowing patients to go private after a waiting time period has expired is a sensible middle way between the Tory’s old policy of voucher system which would simply have undermined the NHS by allowing the wealthiest to take the money and run, and Labour’s target culture.

Overall then, this is an excellent start for the Clegg era. It is the most thoughtful speech given by a party leader since Ashdown departed these shores for Valinor. I think he needs to slightly change his mode of attack on Cameron, with whom he is so frequently compared. He needs to emphasise that while Cameron adopts similar rhetoric, even if he is being sincere he can never deliver while he is at the mercy of a mulish party which only allows him to lead when it feels like it.

The key fight to pick with Cameron, which to Clegg’s credit he seems to have identified as well, is over school selection. The more Clegg challenges Cameron to support a system which emphasises parental choice over school selection, the more the swivel eyed loons in the Tories will go nuts and start banging on about grammar schools. The fact that Cameron has already buckled under the pressure once suggests this will be a fun fight to watch.

The important point is, Clegg’s speech today is one that Cameron could never afford to make. That is what annoyed me so much about the “senior official’s” interview in the Guardian on Thursday. Our strength, ultimately, is our unity. The Tories’ fatal, potentially election losing flaw is their internal division. It makes no sense to talk up disunity within the party when it prevents us from exposing our opponents’.

Finally, this has been a good speech about challenging what he calls “inherited disadvantage”. That’s fine but ultimately if you want to truly tackle social mobility you need to tackle inherited advantage as well. As Clegg has set up a social mobility commission, he can’t afford to leave it too long before starting to address that.