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 »

It’s the economy, stupid

Filed Under (Expenditure, Health Policy, Resources) by Paul on 29-06-2012

This phrase was first used on posters and “buttons” in all of the offices where Bill Clinton’s staff worked during the 1992 election campaign. It was a reminder to them all that whatever they talked about internally during the campaign the issue that worried the American people was the economy – and that given the importance of talking to the electorate about the things that worry them it’s stupid not to recognise that. Read the rest of this entry »

PFI, failing hospitals and the question of who else was going to pay for the new hospitals that we need.

Filed Under (Hospitals, PFI) by Paul on 28-06-2012

Yesterday was the fifth anniversary of Tony Blair’s departure from Number 10 and  last night I had a small party at my place for some of us who worked for him, so it’s perhaps fitting that today’s post defends one of his health policies.

On Tuesday as South London Hospitals NHS trust was moving towards administration a number of radio journalists asked me to go on the media and talk about it. Unfortunately I didn’t have time on Tuesday but in conversations with the BBC it was clear that the Government was blaming the PFI at the hospital for the financial problems. Read the rest of this entry »

What happened to the South London NHS trust yesterday – and why was it so important?

Filed Under (Expenditure, Localities, Resources) by Paul on 27-06-2012

First I should say that I have some historical interest here. I was an executive director in the London SHA when this trust was created by the merger of three existing trusts. The trusts that were merged were not viable. But the trust that the merger created has also turned out not to be viable and I think we should have been more aware of this at the time. When the NHS did not really know what to do it merged problem hospitals into a single institution. (As you will see from my comments below, this is something the NHS still does all the time). Read the rest of this entry »

The National Commissioning Board is going to be potentially a very interesting organisation – with necessary conflict at its heart.

Filed Under (National Commissioning Board) by Paul on 26-06-2012

As I reminded readers last Thursday, about a year ago I commented that one of the problems with the NHS was caused by a belief that it could answer all of the questions posed to it from within its own resources. I pointed out that the belief that the answer was ‘in the room’ was one strongly held in the NHS. The evidence suggests however that, whilst it may be true that a lot of the answer is in the room, some very important parts of any answer MUST come from outside.

Last Wednesday four new non-executive director appointments to the NCB were announced to join the existing Chair, the Chair of the Audit Commission and the excellent Ciarán Devane (CEO of Macmillans) who are already non-executive members.

These new appointments all have extensive experience of the worlds of law and finance, and, in the shape of Lord Victor Adebowale, the provision of innovative health and social care services from the third sector. (To declare my own experience up front, I have worked with Victor for about 15 years on a variety of different boards from think tanks to a touring theatre company. He, alongside Ciarán Devane, will be a strong addition to the voices that need to be heard on the side of NHS patients in the NCB).

If I understood anything of what Andrew Lansley meant by his catchphrase ‘liberating the NHS’, I would think he would be very pleased with the way in which the non-executive members of the NCB are shaping up. They look like people from the outside who might want to bring about cultural change.

ALL of these non execs have interesting experiences that are external to the NHS.

But when you look at the senior executive staff of the NCB a very different picture emerges. With two (and a bit) exceptions scrolling down the list of staff the idea you can’t prevent from forming in your mind is that if Andrew Lansley meant anything by ‘liberating the NHS’ he probably had these people and their experiences in mind.

I have commented on this blog before about an experience I had in the summer of 2006. During that summer the new SHAs appointed 10 new CEOs. I went to speak to them the day after they were appointed and did some homework ahead of this discussion. I added up all the numbers in the press releases about their appointments and collectively all 10 of them had 173 years experience inside the NHS and 1 outside it. Individually these people were all experienced managers, but taken together these numbers demonstrate an almost total belief in a single culture as being the answer to everything.

It’s not that we don’t need NHS experience – but we need other experiences too.

So what does that mean for the new NCB?

The appointments of the non-executives have been made with a strong recognition of the need to bring outside experience to the National Commissioning Board.

The appointments of the senior staff in the NCB on the other hand show far too little understanding of the need for external experience.

So to sum up, if we look at the NCB to try and understand how far it is going  to be part of a new or an old NHS we will be puzzled. We see the ‘new’ being strongly advocated in the form of its non-executive directors struggling to ‘liberate the NHS’ from the old – in the shape of senior directors in the same body.

The struggle for the new or old NHS will now take place on a daily basis within the NCB Board.

This can only be a good thing.

“If you have tears prepare to shed them now”. The next set of problems for the BMA.

Filed Under (BMA) by Paul on 25-06-2012

When it examines the outcomes of its industrial action last week what lessons does the BMA learn and how does it decide what to do next?

As I commented on Friday it is difficult to understand how they might decide whether or not the industrial action was successful. They will have local reports telling them how well their membership engaged with the action. There will have been a few resignations but I suspect that, by and large, the membership will have taken action as recommended. (It is after all a bit easier to take inaction than to take action). Read the rest of this entry »

A short note on the coming problems for the BMA……

Filed Under (BMA) by Paul on 22-06-2012

Yesterday’s industrial action by the BMA showed how difficult it is going to be for the doctors’ union to develop a popular narrative to explain it.

As the day developed it was clear that the vast bulk of media opinion was not just opposed to their going on strike but became more furious about the nature of the issue for which they were striking when they understood it better. Read the rest of this entry »

To the Confed Conference in Manchester…

Filed Under (Health Policy, Nicholson Challenge, Reform of the NHS, Self Management, Speaking) by Paul on 21-06-2012

The NHS Confederation Conference is the most high profile annual healthcare event in the UK. Every year, Chief Executives, Chairs and senior leadership teams from the most influential health care organisations attend the event. The Confed also attracts Government officials, Ministers and the national media. Potential private sector providers turn up to make contacts and it’s always a location for networking.

Read the rest of this entry »

Now the government faces both ways on civil service reform.

Filed Under (Public service reform) by Paul on 20-06-2012

Readers will remember that last week I posted twice on how the government were letting it be known that the civil service had let badly them down because they – the civil service – had not stopped the government from carrying out the government’s policy. Read the rest of this entry »

Just as the government seeks good news about public opinion of the NHS comes bad news. How did this happen?

Filed Under (Health Policy, Narrative of reform, Secretary of State) by Paul on 18-06-2012

There were several interesting elements in last week’s results in the British Social Attitudes Survey about what the public think of the NHS. Read the rest of this entry »

Much more money needs to be spent on social care for the elderly -so how can we develop the politics to make the case??

Filed Under (Expenditure, Health Policy) by Paul on 14-06-2012

Recently I went to an interesting seminar that was looking specifically at how to develop the case for extra public spending on social care for the elderly.

The seminar was held under Chatham House rules (you are allowed to report what was said but not who said it) which meant that people with a variety of different relationships to decision-making could say not only what they really thought but also what they really thought was going to happen. Read the rest of this entry »