Not that the current pantomimic phase of the government's progress makes it much of a surprise, but its familiar mixture of arrogance, free-market ideology and apparent stupidity has struck again. We now learn that thanks to Andrew Lansley, the English NHS is poised to fall in with George Osborne's plan for "market-facing" regional public sector pay, so that future nurses, orderlies and paramedics may well be faced with a simple enough choice: to be paid half-decently in England's wealthier parts, or earn a relative pittance anywhere else.

By way of taking this plan to widen the north/south divide deep into the realm of the indefensible, it looks like there will be one exception: "high-calibre leaders and staff responsible for transforming delivery", which is official-speak for some of the NHS's most handsomely paid staff, involved in implementing Lansley's ill-starred reforms. Should they have to work in Sunderland or Selby, it seems, their standard pay levels – along, perhaps, with the option of a pied-à-terre closer to London – will remain in place.

And so to a couple of very big questions that have jumped into the media over the last 10 days, partly thanks to a cover story in the Spectator titled Planet London and focused on "the great divide between the capital and the country". How much longer can Britain go on with our economy, politics and culture – and now, if we're not careful, our public services – in such an unbalanced state? And if what passes for public life increasingly seems to amount to a collection of cloistered elites loathed by the population at large, might all this have something to do with it?

The phenomenon has not been analysed nearly enough, but one of the most poisonous legacies of the Blair years is the syndrome whereby the three parties' big figures have tended to come from a roped-off metropolitan milieu. They talk endlessly about "modernisation" and pride themselves on an arrogant disdain not just for their parties' traditions and grassroots but, by implication, large swaths of the country. The Blairites pretty much invented all this, and the idea that Gordon Brown was any different was surely smashed by the infamous Gillian Duffy incident. The Cameron project – whatever that is – is based on very similar instincts: quietly sneering at the Thatcherite heartlands, from a couple of London postcodes. And if Nick Clegg actually has any coherent politics, where would you imagine they originate: in his party's regional redoubts, or the same charmed London circles as his Tory colleagues?

The tendency has been to see a thread that runs between all three main parties in terms of the left-right axis and such elevated ideas as "triangulation", but it also embodies the politics of place. This, in short, is what happens when London groupthink settles on an immovable mixture of economic and social liberalism, and maligns everywhere else as being hopelessly behind the times.

Such is the key source of the current golden period of Scottish nationalism. If power and wealth were more equitably distributed within England, and London was not quite so full of itself, would the SNP's claims of Scotland still being in thrall to a distant, unaccountable elite ring as true?

Note also the voices of a very underrated English revolt. Not that anyone in London seems to have much noticed, but in recent opinion polls, the UK Independence party has been doing rather well, either overtaking the Lib Dems or drawing level with them, and scoring as high as 11%. Nigel Farage is a brilliant frontman for his party's politics: swashbuckling, bluff and, like Alex Salmond, aware enough of his own theatricality to give his public face an appealingly knowing aspect. He is also the embodiment of an almost absurdly anti-metropolitan standpoint, leading a party of British Poujadistes. Europe is what ostensibly gets them out of bed, but their politics of refusal is focused just as much on the London-based political class.

Last week, one-time New Labour stalwart Andrew Adonis revived a suggestion he first made in 2007: moving the House of Lords out of the capital, so as to make a modest start of chipping away at London's monolithic dominance. "London is New York, Washington and LA rolled into one," he said, "which is unhealthy for our national politics." He's right, but we should be thinking much bigger. The case for properly reviving local government (Adonis's beloved elected mayors are a London-conceived distraction) is now unanswerable. Moreover, the national state should shift anything and everything it can well beyond the capital, and reverse the logic of the Lansley/Osborne manoeuvre – incentivising moving out of London, rather than penalising it.

Increasingly, I like the idea of a federal UK, with the devolved government of England based in Manchester or Birmingham, and London secure in the fact that as well as the residual institutions of the British nation state, the City, tourism, most of the media and the so-called "creative industries" would ensure that it carried on doing fine. And the chances? As usual, all this is largely in the hands of people who seem to think civilisation stops at the M25 – so even when it comes to the most tentative move in the right direction, we can presumably whistle for it.

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