My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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What the NHS needs now are commissioners that are good economists, not just accountants.

Filed Under (Expenditure, Primary Care Trusts, World Class Commissioning) by Paul on 29-01-2010

Last Monday January 25th every PCT in the country finished its Commissioning Strategy Plan (CSP) for the next three to five years. Over the next month these will be published and somebody should be making sense of this “bottom up” approach to planning the future of the NHS. In a way, since this is the commissioning intent over five years for about £500 BILLION, it is more important than any DH operating plan or white paper. The collective wisdom of these documents should be describing the future of the NHS.

Even more significant is the problem that if the PCTs do not have the capability to bring these plans into reality the NHS will probably have no future.
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Who’s going to be the next Chief Executive of the NHS? The good news is I don’t know.

Filed Under (Culture of the NHS) by Paul on 25-01-2010

Most of my posts are a commentary on the powerful and internal nature of NHS culture.

Most people in senior positions in the NHS have only ever worked in that service and their experience and ideas are nearly all self referential. They compare themselves internally and tend to think that they represent the entire world of possibilities.
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It’s the incentives wot done it……

Filed Under (Incentives, Reform of the NHS, Resources) by Paul on 21-01-2010

A moment’s indulgence for the blog writer from the blog reader.

Wednesday’s publication of the Nuffield report on the four different home countries NHS reform policies left me shouting at the Today programme with much glee. (And that is not a reaction that ‘Today’ often draws out of me.) Not only had they published a research report that went beyond the orthodox finding of on the one hand and the other, but Jennifer Dixon as CEO of the Nuffield was on the radio defending the findings.
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One man’s incentive is another man’s ideology….

Filed Under (Culture of the NHS, Public service reform, Reform of the NHS) by Paul on 19-01-2010

In December 2009 David Nicholson Chief Executive of the NHS gave an interesting interview in the Financial Times in which he said,

“One of the mistakes that the ideologues around reform make is that they think that all you have to do is put the right incentives and penalties into the system and the service will respond”

NHS culture always demonstrates it’s a bit rattled when it calls people it disagrees with ideologues.

What they mean is that we inside this warm and cosy NHS culture work with common sense. Those people outside trying to change us only have a nasty foreign thing called ideology which we don’t need.
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Running a “system” called the NHS – or running the NHS as an “organisation”

Filed Under (Health Service Unions, Primary Care Trusts, Secretary of State) by Paul on 13-01-2010

Leaving aside the knockabout comedy value of a Secretary of State being brought up before a panel whose job it is to look after the rules that his own Government has agreed to……there is an important set of principles about the nature of the NHS that are being tested at the present time.

At the moment the NHS half believes it is a single organisation in which everyone can be told what to do, and half believes that it is a system where people don’t obey a set of management instructions from the top, but work to a set of transparent rules which make it work.
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It’s official! Competition panel to investigate Secretary of State for Health’s decision to impose his personal preference on NHS Commissioners

Filed Under (Creating public value, Primary Care Trusts, Secretary of State) by Paul on 07-01-2010

On December 18th I posted concerning the decision of ACEVO and private sector providers of health services to take a case to the NHS Cooperation and Competition Panel concerning the Secretary of State’s personal preference for NHS providers and his attempt to impose that preference on NHS Commissioners.

Today the unprecedented news came through that the Panel have decided that they can accept the case and are carrying out an investigation.

Whilst I have always argued that the Secretary of State’s intention to impose his own preference on the NHS commissioners was almost certainly breaking competition law, to actually see it happening is a bit startling.
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Little things become big things (especially in an election year)

Filed Under (Charities, Primary Care Trusts, Secretary of State) by Paul on 04-01-2010

It’s not often that minor changes in accountancy rules become big political issues, but over Christmas it became clear that we are to have one of those moments.

The issue will concern those NHS trusts that also have charitable organisations linked to their NHS services in any way. The new accountancy ruling that would come in from April would impose new rules on NHS charities requiring all donations — including those to specialist children and cancer units, local fundraising campaigns, teaching hospitals and local community trusts — to be listed on a hospital’s balance sheet.
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