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 »

Question: When is an amendment to the Health and Social Care Bill both insignificant and important at the same time?

Filed Under (Coalition Government, Conservative party, Health and Social Care Bill, Liberal Democrat Party) by Paul on 29-02-2012

Answer: When it’s being viewed by the two different Coalition political parties.

Monday saw the Government Health and Social Care Bill lurch further down the path of degeneration into farce.

Sunday saw publicity centred around another set of amendments to the competition aspects of the Bill. Placed by Liberal Democrat peers.

On Monday morning at 11, at the press briefing that takes place twice a day, the Prime Minister’s official spokesperson said two contradictory things. First he said that the Bill had been amended a lot so far, and that it was now in a fit state to be passed then he said that he was relaxed about these amendments because they were not significant. This is the Prime Minister playing down the amendments and  the possibility of defeat. Read the rest of this entry »

Generally this is what it looks like when a Government loses control of a major policy area

Filed Under (Health and Social Care Bill, Health Policy, Reform of the NHS) by Paul on 28-02-2012

Long term readers will remember that near the beginning of April last year the Chair of the Health Select Committee commented that the Government had ‘lost control of its health policy’

For two months the Government outsourced the formulation of their health policy to the Future Forum and then accepted all of the recommendations from the random group of people that made it up. Read the rest of this entry »

Question: How did a Government committed to social enterprise manage to close down those parts that were meant to build third sector capacity?

Filed Under (Health and Social Care Bill, Reform of the NHS, Third Sector) by Paul on 27-02-2012

Answer: Because it lost control of NHS reform.

Today – or if they don’t get to it on Wednesday – the House of Lords will stage a further debate about stopping the development of the third sector in the NHS.

Long term blog readers will remember that their Lordships debated this issue in November 2011 and that I commented on the issue at the time. In that post I asked if the Department of Health would become the only Government department forbidden by law to develop the capacity of the third sector.

This part of the mess  that is the Government’s NHS reform policy stems from their ‘U’-turn last June. Then, in order to persuade the BMA that they were not in favour of greater private sector involvement in the NHS; they said that they would pass legislation,

“…to outlaw any policy to increase the market share of any particular sector of provider”

and amended the Bill to that effect.

This does not reflect the policy of any other Department of State. So, for example, the Department for Education or Department of Communities and Local Government can argue that the third sector should be providing more services – for example for young people or environmental services.

But this will be illegal for the National Commissioning Board and the NHS.

And the passing of this law will have an even bigger impact.

We know that NHS bodies are always anxious to avoid breaking the law. This makes it likely that the NHS Commissioning Board – and the NHS in general – will interpret the Health and Social Care Bill as meaning that capacity building – and other policies which support the development of social enterprises and voluntary and community organisations -would become illegal. As a result, it could make it harder for charities and community groups to provide the services and support that many (particularly those who are vulnerable and hard to reach) rely upon.

Which means that the NHS will not only be the only part of Government that cannot have a policy to develop a higher proportion of services through the third sector, but they may also be unable to spend taxpayer’s money on improving the capacity of the third sector to provide health services for NHS patients.

Let’s remember that when this Government published its White Paper in July 2010 it said that it wanted to create in the NHS, “the largest social enterprise sector in the world.”

The gap between their intentions of July 2010 and the practice of February 2012 is now enormous.

They have reached this state of affairs by trying to change the law to appease the BMA’s anxiety about introducing more competition into the NHS.

It didn’t change the mind of the BMA – it just created a mess.

This is what happens when a Government loses control of its policy on NHS reform.

“I am sorry if what I set out to do has not communicated itself.” (Andrew Lansley talking to the RCN – last April)

Filed Under (Health and Social Care Bill, Narrative of reform, Secretary of State) by Paul on 23-02-2012

Last week I posted on several occasions about the problems being caused by the Government’s failure to develop an adequate narrative to fully explain the NHS Reforms. I observed that this omission had now been noted by a wide range of different commentators both inside and outside of the NHS. Read the rest of this entry »

On my being a part of the Government’s attempt at making the case for their Health and Social Care Bill.

Filed Under (Coalition Government, Health and Social Care Bill, Hospitals, Narrative of reform, Reform of the NHS) by Paul on 22-02-2012

As I mentioned yesterday the Government has been using scatter-gun tactics in its attempt to argue its case for NHS reform. For some time they have been trawling through a wide range of sources to try and find support for the necessity for their reforms.

The trick they are trying to pull off is to claim that by being in favour of reform (as many are) you are in favour of their reforms (which few are). Read the rest of this entry »

Confident or anxious narratives produce very different political outcomes for Government.

Filed Under (Health and Social Care Bill, Narrative of reform, Reform of the NHS) by Paul on 21-02-2012

Yesterday the Government found itself under attack for having a meeting to discuss the implementation of the Health and Social Care Bill. The central theme of these attacks concerned those who had been invited and those who had not.

At some moment during the last week it must have seemed like a good idea to have a meeting to discuss the implementation of the Health and Social Care Bill – that excluded both the BMA and the RCN – but it would have been a moment of weakness and not strength. Read the rest of this entry »

If competition is already in the NHS – why do we need Part 3 of the Bill?

Filed Under (Competition, Health and Social Care Bill) by Paul on 20-02-2012

I hope readers of the blog will appreciate the even-handed approach I am taking in my analysis of the bill. Last week, after a number of posts outlining mistakes in the Government’s narrative for reform, I ended with an explanation of what I think is wrong with the narrative of many of the reforms’ opponents. Read the rest of this entry »

Yet another problem for the Government – caused by developing NHS reforms through a Bill.

Filed Under (Competition, Health and Social Care Bill, Narrative of reform, Reform of the NHS) by Paul on 17-02-2012

Another new set of arguments were launched against the Bill last week which tap into another vein of opposition.

It’s really interesting that when there is no narrative for reform to dominate the argument, a whole host of very different ones can and do emerge. Arguments against the Government’s NHS reforms have already been set out and now variant forms of those arguments are appearing – resulting in the reforms now being assailed from not only all sides – but also from above and below. Read the rest of this entry »

“First our Bill gives power to doctors and nurses” – but does it Mr Cameron? Does it?

Filed Under (Clinical Commissioning Groups, GPs, Health and Social Care Bill, Narrative of reform) by Paul on 16-02-2012

Yesterday I remarked on the distance between the Prime Minister’s narrative for the Health and Social Care Bill and the content of the actual Bill itself. I said that whilst it is essential for the Government to try and develop a narrative that can describe the Bill, the crucial thing is for the narrative to encompass the real content of the Bill – and not a fantasy. Read the rest of this entry »

The difficulty with the PM’s Health and Social Care Bill narrative is that it really needs to have some relationship with the reality that it is describing.

Filed Under (Conservative party, Health and Social Care Bill, Narrative of reform) by Paul on 15-02-2012

The Prime Minister is a good communicator. He spent several years in opposition trying to ’detoxify’ the public image of the Conservative Party; and he carried out this process with particular attention to the NHS. Read the rest of this entry »