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.

Read my statement in full »

Liberating the NHS from political interference (or not)

Filed Under (Conservative party, Health Policy) by Paul on 31-01-2011

This is a tale of how hospital services were closed once on clinical advice, reopened through political intervention, closed again because of clinical advice, and yet may be reopened again because of political intervention.

In the immediate post election euphoria of May 2010 the Secretary of State stood in front of several hospitals where there were services that he either reopened or prevented from closing. He was usually filmed alongside beaming new MPs who were thanking him for realising their election promises to keep their services open. Read the rest of this entry »

The winding future path for the Health and Social Care Bill

Filed Under (Reform of the NHS) by Paul on 27-01-2011

The Bill was published last Wednesday in a flurry of front and opinion page interest. Suddenly we were all working in an area that mattered to the politics of the country. . People had heard of the reforms that we all know would have an impact on our world and were discussing it and what it might mean. As I said last week the Government were struggling to move the narrative that the media had latched on to – unnecessary, risky, a bit odd – off of centre stage and replace it with their own– essential, revolutionary, GPs are a safe pair of hands. Read the rest of this entry »

What does a modern NHS need?

Filed Under (Reform of the NHS) by Paul on 24-01-2011

Number 1 It needs to be a system with strong incentives that keep moving it forward to ensure it incorporates the dynamism of health care and medical technology. It must pull innovation into its every part.

Read the rest of this entry »

There are alternatives to the Status Quo for the NHS – but they must be articulated

Filed Under (Health Policy, Reform of the NHS) by Paul on 21-01-2011

This final post of the week does two things. It emphasises the first post about the importance of there being a variety of different ways of reforming the NHS and not just the Government’s proposals, and it learns from the politics of the NHS throughout the week to underline the case.

One of the lessons we have learnt from the week is that, as the Daily Telegraph said on Tuesday, the Government have recognised that the current Secretary of State for Health has many strengths but persuading the country that he has a coherent and intelligible reason for his reforms is not amongst them. He will need others, most notably the Prime Minister, to do that for him. And that has been the main lesson of the week. The PM has decided that he will take on the explanation of these reforms.

Given the hesitancy and anxiety amongst the Conservative press this has not been an easy task. Most people end the week as they started it, with no clear understanding of why the Government are carrying out the biggest changes in the NHS since 1948. Indeed part of the problem is that sometimes when the Government want to be seen as bold and radical they say this is a bold and radical reform. And sometimes when they recognise that there is controversy they say this is merely an extension of recent reforms. They cannot have it both ways and will fail to get their message across because they appear to want just that.

In a difficult week the Prime Minister has had one success.

Many people do seem to accept his overall framing of the argument as being about a simple “either or” choice. You are either in favour of the status quo or you are in favour of his reforms.

Of course, as I said on Monday, intellectually this is obviously not the case. There are many ways to reform the NHS. As promised I will try and explain what they are over the next few months and would want to end up with a coherent approach but one that is different from the Government.

But this week the PM succeeded in saying that you either support standing still or you come with me on the journey of change.

He specifically challenged the leader of the Opposition in PM’s questions – was he in favour of reform? – and having received no answer hopes  to paint the Labour Party into the conservative anti-change corner.

There are elements of the Labour party who yearn to be in that corner. When it comes to the politics of public services, there are those in the Labour Party who are deeply conservative and will not see a hair on the head of public services dishevelled by reform. The opposition front bench may feel that this is the safe place to go. As the PM pointed out. It will be a place supported by all the trades unions – including the BMA – so it looks like a good safe place to be.

So the Labour Party could accept David Cameron’s frame and say that if there are only two games in town – change or the status quo or support the NHS as it is – we will rally round the “against change” argument.

This would be a very large political mistake for several reasons.

Firstly if you start in 2011 in the teeth of an enormous political debate about the NHS to frame yourself as simply the defender of the status quo then, given the importance of the current debate, this position of defending the status quo will stick. Take that position in 2011 and you will have to support that position in 2015.

That would mean the 2015 election will be fought probably between a chastened coalition whose plans have worked somewhere and not worked in other places defending a record of bodged change against a Labour Party in favour of the status quo. All of those people who want a sensible reform of the NHS will not be represented. Most opinion leaders know that the NHS cannot stay the same, but don’t agree with the current Government reforms. So the Labour Party would throw away those people as a part of its coalition.

Thirdly, in which year was the status quo that you want to support? Some of the Labour Party are sure that is about 1999, before Tony Blair’s reforms. Some will say 1948.  Some will pragmatically say 2010 when Labour lost power. 2010 would be a tricky date as there was a whole host of reforms planned by that Government that were still coming in. So what we will have is conservative forces coalescing around a date when there had been enough change and no more. But which date?

Fourthly, what happens if you win an election in 2015 with a promise of no change? Unless Ed Balls started printing a lot of money, there will not be 8% increases in resources for the NHS. The demand for health care will be going up faster than resources and the new Government will have to supply health care in the old way when change stopped. The NHS would not be able to afford this and an unreformed NHS will run out of money. Waiting times will increase rapidly and rationing will be imposed.

The PM is correct that the status quo is not an option for the NHS.

He is just wrong about his reforms being the only other option.

According to the Government GPs aren’t up to buying flu vaccines, but they are up to buying everything else!

Filed Under (GP Commissioning, Health Policy, Reform of the NHS) by Paul on 20-01-2011

I might have missed something overnight, but I expected to wake up this morning to hear the Government extolling the capacity of GPs to commission the nation’s health care. It is after all their policy. Read the rest of this entry »

The politics of the NHS, and the last three days….

Filed Under (Conservative party, Health Policy, Reform of the NHS) by Paul on 19-01-2011

The Health Reform Bill is being published on the afternoon of January 19th and before getting into the slog of what will be a solid 10 months of issues about the detail of the Bill and its passage through Parliament, I thought it might be useful to post some thoughts on what has happened in a very full three days of politics. More will unfold in the next few days but so much has happened in the last three – let’s take stock. Read the rest of this entry »

David Cameron stops “Leaving it to Lansley”

Filed Under (Coalition Government, Health Policy, Reform of the NHS, Secretary of State) by Paul on 17-01-2011

…and explains what he thinks NHS reforms are all about. (Meanwhile the BMA says that his NHS reforms are “extremely risky” and “potentially dangerous”)

The Prime Minster has made it clear that he sees himself as the “Chair” of the Government and not its CEO. So he has said he will not interfere and will not, for example, have health policy expertise inside No 10. As far as he’s concerned that is all a matter for his Cabinet. Read the rest of this entry »

Well, are you in favour of reform or not?

Filed Under (Health Policy, Reform of the NHS, Secretary of State, White Paper) by Paul on 17-01-2011

This week the Government will publish its Health Bill to reform the NHS. It will be the biggest health bill ever and will take up both a lot of Parliamentary time and, over the year, most of the discussion about health care politics will centre on it. Of course that is at it should be. They are the Government and they are bringing in the changes that the current Secretary of State has referred to as ‘revolutionary’. Read the rest of this entry »

Learning from other health care systems in reform – Finland

Filed Under (Finland, Health Policy, Public Health) by Paul on 13-01-2011

This week I have spent 3 days in Finland talking to clinicians, civil servants and managers about reforming their health services. I was invited to talk to two very different gatherings about some of the lessons from my experience of the last decade of reform in England. Of course the really interesting issues that come out of explaining your own nation’s experience is how much you have to learn about another one. Every time you make a point about some aspect of reform in England – for that point to stick – you have to make the idea work in a very different set of circumstances and ones that you need to carefully relate to your own. Read the rest of this entry »

Political straws in the wind and the NHS

Filed Under (Big Society, Coalition Government, Reform of the NHS) by Paul on 12-01-2011

Thinking back to when I was a political special adviser in the Department of Health (2001-2005) there were several times when I and my colleagues was surprised by sudden surges of political interest in NHS stories. Some of that interest seemed to come from the media itself but also, underneath and around that, there were powerful emotions that the public had about the NHS which suddenly seemed to surge forward unexpectedly from outside of the media themselves. Read the rest of this entry »