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 »

What would the Government do if a majority of GPs walked away from the commissioning offer?

Filed Under (Clinical Commissioning Groups, GP Commissioning, GPs, Health Policy) by Paul on 29-11-2011

Back in April someone who was just about to start working for the Government on NHS reform asked me what the biggest risk was to their success. I said I thought it was clear. The biggest risk would be what would happen if the vast majority of those GPs that had once been enthusiastic about commissioning lost interest and walked away? Read the rest of this entry »

Good news about the NHS is bad news for the Government

Filed Under (Coalition Government, Narrative of reform, Reform of the NHS) by Paul on 28-11-2011

The government finds itself in a really odd position when it comes to good news about the NHS. In the last month two prestigious organisations operating in the field of comparative international work have said that compared with other health systems, the NHS does between ‘pretty well’ and ‘very well’. Read the rest of this entry »

Why doesn’t the Secretary of State have anyone to warn him about doing such stupid things?

Filed Under (Hospitals, Secretary of State) by Paul on 23-11-2011

Now I’m not saying that when I was advising new Labour Ministers on health reform that we didn’t sometimes do the wrong thing. Of course we did. But generally when someone came up with a really crazy idea someone would say “Hang on – let’s just think about that for a bit longer shall we?” A warning bell would go off in somebody’s head – and we would all calm down. Read the rest of this entry »

How 6 years spent attacking politically motivated targets finally missed its mark

Filed Under (Reform of the NHS, Secretary of State, Targets) by Paul on 22-11-2011

I crave a little self indulgence from the reader for the first half of this post since it covers an issue that stayed near the front of my mind every week for six years of my working life.

Last Friday saw several of the broadsheets rehearsing the history of the use of targets in the NHS over the last decade. They were doing so because the current Secretary of State, having spent 7 years railing against politically motivated targets, set his own last Thursday. Read the rest of this entry »

Develop Social Enterprise? Not in the NHS…

Filed Under (Health and Social Care Bill, Social Enterprise) by Paul on 21-11-2011

Q . Which Department if State will soon find itself as the only department forbidden by its own law from arguing for an increase in the size of the social enterprise sector?

A. The Department of Health.

In July 2010 the Government published a white paper which stated their aim to make the NHS the largest set of social enterprises in the world. A few people – including myself – felt this was a little over the top, but new governments often seem to want to go further and faster than their predecessors. So a little licence is allowed. Read the rest of this entry »

More lessons from the Hinchingbrooke takeover

Filed Under (Hospitals, Private Health Care, Private Sector) by Paul on 15-11-2011

Yesterday I drew some political lessons from the Hinchingbrooke takeover. Today I want to draw some lessons from the procedure that has taken so very long to come to a conclusion.

I think it’s pretty certain that over the next few years there will be a variety of different takeovers and mergers of NHS hospitals. When these have been carried out in the past they have been mainly attempts to reduce costs by forcing several organisations to merge. Most of these would not have been mergers or takeovers in any other industry or service. In the NHS mergers have usually brought together 3 failing hospitals to create a single, large, failing hospital. Read the rest of this entry »

Andy Burnham (as he moves from being uncomfortable in Government to being comfortable in opposition) and Circle’s takeover of Hinchingbrooke.

Filed Under (Hospitals, NHS Providers, Private Health Care, Private Sector, Secretary of State) by Paul on 14-11-2011

Last Thursday I blogged about a report which examined different approaches to losing weight, and received some interesting comments which I will talk about later in the week.

But by chance this post was published on the day that the agreement between the Government and Circle at Hinchingbrooke was finally signed and some people want to know my thoughts about this. Read the rest of this entry »

Markets, business and the creation of innovative value for money health care for NHS patients.

Filed Under (Creating public value, Health Improvement, Innovation, Private Health Care) by Paul on 10-11-2011

A small story last Friday exemplified a much bigger issue. The story concerned the results of research from the University of Birmingham on how the effectiveness of different weight loss schemes. Read the rest of this entry »

Medical and resource decisions. Should GPs make them both?

Filed Under (Clinical Commissioning Groups, GP Commissioning, Primary Care Trusts) by Paul on 09-11-2011

(These new forms of media can be very difficult. Blog readers will probably know that I tweet to let people know there is a new post on the blog. But I am not sure whether blog readers follow me on Twitter. I assume that some of you just read the post and are not in the Twittersphere.

Yesterday I posted about the very difficult relationship between the autonomy of GPs in CCGs to make commissioning decisions for their locality, and the National Commissioning Boards central control of those decisions. Following that there was a fascinating flurry of activity about the problem – or not – of GPs making referral decisions about their patients and how those decisions will relate to the financial decisions they will have to make as commissioners.)

This question is not only at the heart of the current Government reforms but is also at the heart of the debate about the vision of professional responsibility within the NHS. Read the rest of this entry »

At last a narrative (if a little naive) for the Secretary of State

Filed Under (Clinical Commissioning Groups, GP Commissioning, Narrative of reform, Secretary of State) by Paul on 08-11-2011

As I mentioned yesterday I spoke last week at the National Association of Primary Care Conference. What was really interesting was listening to the Secretary of State speak just before my panel session began. Read the rest of this entry »