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 »

Winding down

Filed Under (Uncategorized) by Paul on 20-03-2013

I have now been writing this blog for four years. And whilst, over the last few decades, I have always enjoyed writing articles, pamphlets, and even the occasional book, writing a blog is different.

First it has an immediacy which the other more traditional forms of writing don’t have. An article for the HSJ comes out, at best, a fortnight after you have written it. A pamphlet might be published 10 months after it was begun, and writing a book always feels like a lifetime. So the immediacy of writing a blog was very different and I had to learn how to do that.

Most of my posts have been written at 6 in the morning, or on a train journey on the day before publication. Tweeters will know that I have not engaged with their minute by minute level of immediacy. I have used Twitter mainly to advertise the blog.  The reason I haven’t tweeted more is that I have been afraid that if I did my life might disappear in a welter of tweets.

So I have become sufficiently modern to manage day to day commentary, but minute by minute still feels beyond my capabilities.

The second thing I’ve learned about writing a blog is that you have to write it in such a way as to allow and encourage the reader to complete it with their own ideas and emotions. Most of the ways in which we learn to write teach us to complete our contributions by tying them up with a great big bow to show they are finished. A method that leaves no room at all for argument.

I have come to believe that whilst this approach may make a good article for the BMJ  it makes a lousy blog.

The point of each post in the blog has been to progress my own argument but also to provide room for disagreement – and to raise questions and encourage debate. Above all there should be room in the post for people to think their own thoughts and to agree, or disagree, in their own ways.

Learning to write in this way has been a lot of fun, and very different.

A lot has happened in these past 4 years.

I started the blog when there were still 13 months to go for Gordon Brown’s government and during 2009/10 the numbers reading it moved slowly upwards to about 1000. Then the election campaign in 2010 moved them up to about 3000 a week. Over the summer of 2010, as Andrew Lansley’s White Paper was published, they did not go up so much.

It was only when readers realised that the Coalition Government were really going to carry out their reforms that more people wanted to make sense of what they meant. By the time of the famous pause readership had increased to 5000.

The reason for this growth had almost certainly, less to do with my great insight, and was more likely a consequence of people having no idea what on earth was going on.

Then there was the occasion when John Rentoul, in the Independent on Sunday, reprinted my post setting out the words that Lansley and Cameron should have used to apologise for the chaos of the reforms and the ‘pause’.

Through the period of the pause numbers rose again, and as the reformed reforms entered the House of Lords more than 10,000 readers a week were visiting the blog.

As the row about the Bill grew and it finally became an Act the blog readership peaked at 20,000 hits a week and it has stayed around that figure – slipping a little last summer – until recent weeks.

I am advised, by those in the know, that when you reach a certain size there are machines that roam around the blogosphere looking for new material. You, dear readers, will know how many of you are machines.

But now I am now going to wind down the blog. It’s been fun but it’s also been hard work – and I want to reduce that work.

At the height of the politics of reform I was writing four posts a week and in most weeks there have been three. Over its four years of life that’s equated to about 600 posts which probably means I have written around half a million words. They are all there on the web.

This does not mean I am never going to write another post. There will be times when I just won’t be able to help myself. But from the end of March I will not be writing two or three times a week.

Thanks for reading it. Thanks for all the comments and, above all, thanks to all those who have taken the time and trouble to talk to me about the content.

Whilst this is not ‘goodbye’ it does mean that I won’t be popping round to see you quite so often!

Spending on health alone will account for 22.5 per cent of the total increase in spending between 2011-12 and 2014-15

Filed Under (Budget, Economics) by Paul on 18-03-2013

(Not just a crash diet. Reform publication 12 March 2013)

The Budget comes up this week and for this and the next few budgets the best news for any domestic public spending department will be for the health service. As today’s blog headline suggests, health will have grabbed nearly a quarter of all the increase in spending over that time period. Read the rest of this entry »

Reflections on the Nuffield Summit

Filed Under (Economics, Narrative of reform, Reform of the NHS) by Paul on 13-03-2013

The first day of last week’s Nuffield Health summit concentrated on the linked issues of quality and finance. We are going to have to improve the former whilst having less of the latter. I will return to this issue.

Throughout my time at the Summit I couldn’t shake off the nagging idea that, here we are in the spring of 2013 – and right now would have been a great time to launch a Government NHS reform programme. Read the rest of this entry »

How will Liberal Democrats reconcile their policy of keeping Britain in Europe with their policy of not using competition to improve the use of NHS resources?

Filed Under (Clinical Commissioning Groups, Coalition Government, Competition, Liberal Democrat Party) by Paul on 11-03-2013

We have learnt that Coalition Governments get into a rhythm. Every year now, in early March, there is an attempt by the Coalition to change some or other policy just before the spring Liberal Democrat Party Conference so that party members can feel that they are having an impact on the Government. Read the rest of this entry »

Architectural problems with the new NHS reforms (number 64).

Filed Under (Clinical Commissioning Groups, National Commissioning Board, Reform of the NHS) by Paul on 06-03-2013

The new NHS reform architecture contains within it a number of problems that have always been predictable. As I have suggested on many occasions previously this is in part a consequence of the very many different and opposing minds that have been shaping the reforms as they have been developed. The famous pause in April 2011 led to a considerable strengthening of the centre at the expense of CCGs in the localities. Since then the reforms have always been a combination of greater decentralisation, combined with greater centralisation.  Once that process began relationships between the NCB and the CCGs were always going to be difficult. Read the rest of this entry »

The Eastleigh by election, protest votes, and the NHS.

Filed Under (Election campaign, NHS Party) by Paul on 04-03-2013

By-elections always tend to have many more losers than the one winner and last Thursday’s Eastleigh by-election was no exception. There was even a potentially important lesson for the NHS action party which had its first by-election outing, and that’s the main topic I want to write about today.

But first I want to talk a little about one of the biggest losers at Eastleigh – an organisation that was not even standing. The Daily Mail spent the 10 days leading up to the by-election trying its best to get the Eastleigh electorate not to vote for the Liberal Democrats. They ran a media campaign against Lord Rennard in a very clever way – assisted by the failure of the Liberal Democrat leadership to grasp the issue. Read the rest of this entry »