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 »

12 months ahead of the general election campaign how should we understand the politics of NHS pay?

Filed Under (Election campaign, Health Policy, Jeremy Hunt) by Paul on 17-03-2014

Last Thursday the Secretary of State made an important announcement about NHS pay which was met with a lot of anger from NHS staff and their organisations. What is interesting is not just the announcement per se but the way that the Secretary of State chose to publicise it.

Those who felt that the way in which it was announced was deliberately designed to cause a row are almost certainly right.

Given that everyone in the NHS was either getting an increment or, if they were at the top of the scale with no more increments, getting a 1% pay rise this could have been delivered with a fanfare along the lines of “Good news everyone’s pay is going up!”.  We could have had a few paragraphs promoting that message and then something about how it’s not as much as he would have liked because of the financial crisis.

But no, that is not what was said. Instead an acutely PR conscious Secretary of State decided that a good story about everyone getting a pay rise should be turned into the bad story that a consolidated pay rise of 1% would be impossible because it was unaffordable. He headlined the curbs rather than the pay rise,

“The Pay Review Body proposals suggest a pay rise that would risk reductions in front line staff that could lead to unsafe patient care” .

This will save £200 million a year. (Remember that figure)

So why spin a story saying this is bad news when it could be spun as good news?

Because we are but 12 months away from the start of the next general election campaign. A campaign that will, so far as the government is concerned, be fought on the economic competence of the Labour Party.

So what has NHS staff pay got to do with that?

If the Labour Party say that they will implement the pay review body recommendations, it will cost £200 million. They might seek to justify this in two ways that could play into the government’s plan to attack their economic competence.

First a naïve Labour front bencher might say that this is a punitive attack upon nurses and that after all it will only cost £200 million out of an NHS budget of £110 billion. A rounding error and not a big sum of money.

How might a government spokesperson respond to someone falling into trap number 1?

“Only an economically incompetent Labour Party would say that £200 million is a small sum of money. Any responsible political party would recognise that this represents the pay of an extra 4000 nurses, not a rounding error. This shows how once again the Labour Party cannot be trusted with your money.”

A second naïve approach would be for a Labour front bencher to say they would find the £200 million from inside the NHS.

How might our spokesperson respond to that?

“The Labour Party thinks it can simply conjure money out of thin air. It can’t. NHS money is being spent on patient care. What we need to know from the Labour Party is where it will cut NHS services to find this money? Until it does we believe this could be your local hospital.”    

This Government will be looking for lots of small examples of how the economic arguments of the Labour Party don’t add up.

The politics of NHS pay is just another one.

Over the next year most announcements will need to be viewed through the lens of the election campaign in order to be understood.

But let’s return to the £200 million that Jeremy Hunt says is essential for front line services.

On the same day as the pay announcement another was made with far less fanfare. This was that government departments would make a much greater contribution to pensions for staff and that money would not be spent by the Treasury.

Next Wednesday, when George Osborne announces his budget, much will be made of a £1 billion infrastructure fund that the Treasury will pledge to spend on small infrastructure projects.

This £1 billion has been obtained by taking money from departments to pay for pensions that in the past were paid by the Treasury.

So Jeremy Hunt has agreed to give the Treasury £125 million a year that will now come out of his budget from 2015/6 onwards.

Surely, just as with the £200 million not being spent on pay rises, this £125 million can only be found by cutting front line services?

Odd that we’ve heard nothing about any cuts that might be needed to plug this £125 million gap.

Given the current Secretary of State isn’t playing the role outlined for his job in the reformed structure, which NHS structure is he trying to run?

Filed Under (Coalition Government, Foundation Trusts, Health and Social Care Act, Health Policy, Jeremy Hunt, Secretary of State) by Paul on 05-03-2014

The last 10 months have made it clearer and clearer that Jeremy Hunt, as Secretary of State for Health, can only do the job the way he wants to by completely ignoring the reforms of the NHS brought in by his Government.

We have one of the most activist Secretaries of State for Health of recent years  operating within a legal system – that he helped to create – which grants him very few of the powers that he feels he needs to carry out the role.

There are hundreds of Conservative party quotes attacking targets that I could use but I’ll just take one, from their 2008 document, Renewal.

“The problem is Labour’s strategy of trying to manage the NHS through top down centralised targets. These targets focus primarily on processes and administration such as stipulating the time it should take for patients to be processed through their treatment, or for administrative procedures to be completed, rather than the actual results of patient care”

Phoning up chief execs of NHS Foundation Trusts to quiz them about their A and E performance ignores several bits of the legislation that he helped to get through parliament.

He will of course remember, as he phones the CEO of an Foundation Trust, how para 1.5 of the White Paper “Liberating the NHS” (that he agreed in Cabinet in July 2010) said

“We will legislate to establish more autonomous NHS institutions with greater freedoms, clear duties and transparency in their responsibilities to patients. We will use our powers in order to devolve them”.

I am sure the CEO of the FT will feel, as he is being called by Jeremy Hunt, that he is part of a more autonomous institution…

First let’s get one issue out of the way. There are those that say that Jeremy Hunt’s job as Secretary of State for Health is made much more difficult by the fact that he has to work within a structure created by NHS reforms that reflect the ideas of his predecessor Andrew Lansley – and that he in fact had nothing to do with the structure and the law that he now chooses to ignore.

The argument goes that Andrew Lansley had a very idiosyncratic view of how the NHS should be organised and that given just how individual that was it’s hardly surprising that Jeremy Hunt needs to do something different.

This argument depends upon Andrew Lansley having acted purely as an individual who one day simply implemented his very individual plan.

But it wasn’t like that. That’s not what happened. Andrew Lansley was a member of a Cabinet that discussed his plans on several occasions – and on each occasion the Cabinet decided to go ahead with these plans.

Andrew Lansley was a Member of Parliament who belonged to the party that formed the greater part of the Government. Jeremy Hunt is a Member of Parliament who belongs to the same political party. He voted for the Health and Social Care Act on very many occasions. He signalled his agreement with Andrew Lansley’s plans by voting for them on all those occasions.

So it may be that these reforms were odd, but they were actively supported on many occasions by the Coalition Cabinet (member Jeremy Hunt) and the Conservative Party in Parliament (member Jeremy Hunt).

And my obvious point is that Jeremy Hunt was an active part of the processes that enthusiastically agreed the plans for a new NHS structure that he now ignores.

In Cabinet in July 2010 there would have been a discussion of the White Paper that specifically argued for a much smaller role for the Secretary of State in running the health service.

In Cabinet in December 2010 there would have been a discussion of the biggest Health Bill in history where clause after clause outlined how a new architecture of independent organisations would take power away from the Secretary of State.

In 2011, given the trouble that the Bill was in, there would have been several other Cabinet discussions about the Bill. In each of these the Cabinet collectively (member Jeremy Hunt) decided to go ahead with the reforms.

Jeremy Hunt was an active member of this Cabinet. He was a part of these discussions which collectively agreed to push them forward.

These reforms – which the current Secretary of State now finds it difficult to live within – were agreed personally by him over a long period of time.

They are just as much Jeremy Hunt’s reforms as they are David Cameron’s and Andrew Lansley’s.

Jeremy Hunt’s problem is that the reforms he voted for and passed into legislation created a system which now gives him insufficient power to carry out his work in the way that he feels he needs to.

You might think that the daily spectacle of a Conservative Secretary of State trying to wield powers that he personally contributed to removing from his office, would be a matter for some derision and scorn from Her Majesty’s Opposition.

There are hundreds of quotations about not making top down decisions which could be thrown across the chamber at Jeremy Hunt and contrasted with the need to intervene he seems to feel every day.

The opposition could make him a figure of fun for doing the opposite of what his legislation signed up to.

But they don’t. No one says this is weird because the opposition think that if and when they take over the role of Secretary of State for Health they will also be looking to use as much power as possible to tell people in the NHS what to do. They relish the thought of telling CEOs what they can and cannot do and are rather pleased that they don’t really seem to need legal powers to do that.

Their failure to point this out doesn’t change the rather odd nature of what is going on though.