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 »

Suggestions from the USA’s equivalent family doctor commissioners

Filed Under (GP Commissioning, Health and Social Care Bill, Reform of the NHS, US opinion) by Paul on 29-06-2011

There was a time during the last few months when those who were defending the NHS status quo turned the US into a pariah. I heard very sensible people say in public meetings “I won’t take any lessons from the USA about health care because their system is so bad’. This became a sort of “know nothing” rejection of an entire nation – and all of its knowledge. NOTHING from the USA was any good because their overall system was so bad. Read the rest of this entry »

MORI poll shows Labour lead on health policy

Filed Under (Coalition Government, Health Policy, Labour Party) by Paul on 28-06-2011

Yesterday I was hypothesising about how Number 10 would be thinking about the politics of the NHS in its overall political strategy for the next election. I suggested that given the failure of the last year it will now not be able to do as well in comparison with the Labour opposition on the issue of the NHS as it did at the last election. If it were wise it would try and discount the extent to which it could neutralise the NHS as an issue and get used to the fact that at the next election it would be 15 points behind the Labour Party in answer to the question, “Which Party has the best policy on the NHS?”. Read the rest of this entry »

Gossip is growing about possible future NHS reform.

Filed Under (Conservative party, Health Policy, Private Sector, Reform of the NHS) by Paul on 27-06-2011

In the last week, two different people have independently told me of conversations they have had with Tory MPs concerning the direction of Conservative politics for the NHS in a few years time.

The story begins with the politics of the NHS becoming increasingly difficult for the Tories. Whilst they have put the reforms to bed, the next few years are going to see increasing political strife about ‘cuts’ in the NHS.  These will be firmly linked in the public mind with the role of the Conservative Government. In reality they will have been caused by an unreformed NHS failing to improve its productivity or value for money. Read the rest of this entry »

What to do if you want to push on with NHS reforms – Some thoughts for national GP leads.

Filed Under (GP Commissioning, Reform of the NHS) by Paul on 24-06-2011

The national GP organisations such as the NHS Alliance and the National Association of Primary Care have, over the last couple of months made some strategic errors that now cannot be fully recouped.

(The Royal College of GPs is in a different category. As a professional membership organisation representing GPs it would always be conflicted about these reforms, as the two very different views of its previous and current president exemplify) Read the rest of this entry »

What to do if you want to push on with NHS Reform. Progressive practice in reactionary times.

Filed Under (Culture of the NHS, GP Commissioning, Reform of the NHS) by Paul on 22-06-2011

Given that I don’t know what the Government plans to do about moving forward NHS reform (and, as it seems, neither do they) I thought it might be interesting to write a couple of posts on how a government might continue with reforms – despite the fact that it looks like this one doesn’t..

Interestingly I suspect that this is something that the current Secretary of State for Health may also want to do – even if his Prime Minister no longer wants any more reform. I also think that a sizeable number of NHS staff recognise that an unreformed NHS may not survive the decade and will also want to press ahead with reform – even if the Prime Minister doesn’t. Read the rest of this entry »

The next election campaign started last Tuesday – with the NHS reform U turn

Filed Under (Conservative party, Election campaign, Reform of the NHS, Right wing ideology) by Paul on 20-06-2011

The dust is settling on the Government’s U turn on NHS reforms (referred to by my old boss Alan Milburn as the biggest car crash in NHS policy history). As the view becomes a little clearer it’s possible to see what was there before the winds blew dust in our faces. Read the rest of this entry »

Does the answer to the problem of creating integrated care lie entirely within the NHS?

Filed Under (Health Policy, NHS Providers, Patient Choice, Private Sector, Reform of the NHS) by Paul on 16-06-2011

Tagged Under :

Regular readers will have noticed that the relationship between integration and competition is an topic upon which I have posted a couple of times in the last few weeks. In my view all the commentators pointing out the importance of creating integrated care services for the NHS are correct. Read the rest of this entry »

So what does it all add up to?

Filed Under (Coalition Government, Health and Social Care Bill, Narrative of reform) by Paul on 15-06-2011

The 11 page Government document published yesterday Government Changes in Response to the Future Forum does contain a considerable set of changes to the Government reform programme. This is a genuine reform of the reforms.

Going through each paragraph, most of them contain significant amendments to last July’s White Paper and will require extensive changes to the Bill. (This is why the Government is correct to ensure that the Bill has to go through the Commons Committee stage again. You can’t politically say that the Bill is being radically changed and at the same time procedurally say that it doesn’t need a completely new Commons Committee stage)

But what I am unclear about is where this leaves the NHS reform programme. The Future Forum was asked to think through a set of reforms to the original reforms. It was not, nor should it be, their responsibility to ensure that the entire package of reformed reforms is coherent.

But that is the problem for the Government.

I think there are three  problems that are likely to emerge.

First, nearly all of the amendments to the original proposals are a softening of those proposals. I can understand politically why this was necessary to get the reforms through not only Parliament but also ‘through’ the NHS. For the last few months however we have been told that the strength of the original programme was necessary to achieve significant improvements in value for money within the NHS. Commissioning for example, was being strengthened by putting GPs in charge…

But using that example, every additional check and balance on GP commissioners will limit the effectiveness of GP Commissioning in creating value for money and bringing about strategic change.

Most commissioners, for example, want to restrict the number of emergency admissions into hospital. Commissioners have wanted to do this for the last 5 years or so but few have managed to achieve it.

Two of yesterday’s new checks on GP commissioning power will limit their capacity to reduce hospital admissions. First, having a hospital doctor on their board will not make it easier to lower the number of hospital admissions. Second, since GP Commissioners now have to have their plans agreed by the local authority Health and Wellbeing Board, the likelihood of moving care away from a politically iconic hospital will diminish.

At the very least this will make it harder to implement the very changes that the Government have identified that the NHS needs.

The second problem with the new reform programme is that there are now two very different authorial voices creating this single reform programme and the Bill. The phrase “authorial voice” is one that novelists use – it lets readers know who is telling the story. If you have a strong authorial voice the story, characters and dialogue all fit together. If you have two different voices, especially if the second has been introduced to criticise the first, it can lead to much greater incoherence.

And that will become clear for the reform programme as it progresses. There are very different ideas here that will clash and murmur against each other.

The third problem is the completely new idea that has become important to the new reform of the reforms – the integrated care programme. The Government are right to single this out since their problem is not a general increase in demand for health care but a very specific increase in the numbers of people with long term conditions. They are right in believing that we need integrated care to provide a new and more “joined up” approach.

Whilst nearly everyone agrees with this view, there are very very different ways of bringing about such integration. There are those who believe that it is this new idea about competition that is preventing the NHS from collaborating in building integrated pathways. Then there are those who believe that without competition the NHS has failed to collaborate to create integrated pathways – and that we need competition to bring it about.

If integration is as important as it seems to be (and it is) then sorting out this difficulty must also be important.

Sunday’s Andrew Marr programme contained the best public discussion I have heard about this issue so far – between Clare Gerada of the Royal College of GPs and Stephen Dorrell, Chair of the Select Committee on Health. I will post about this tomorrow.

First signs of a real shift in power. Watching who is under attack can reveal who really matters.

Filed Under (Coalition Government, Narrative of reform, Reform of the NHS, Third Sector, Uncategorized) by Paul on 14-06-2011

One of the more interesting consequences of the Government’s outsourcing of their NHS reform policy is that those now under attack for wanting change are not the Government but the leaders of the Future Forum.

Today’s Times contains an article arguing for greater choice in the NHS. For me it makes a better common sense argument for choice than anything that the Government has tried to stitch together in the last 12 months. Read the rest of this entry »

If the Government had any sense ….

Filed Under (Coalition Government, Health and Social Care Bill, Narrative of reform, Reform of the NHS) by Paul on 14-06-2011

My immediate response to the report that has been produced by the Future Forum is that if only the Government could learn from the care that has gone into its narrative for change, they would find themselves in a very different position. Read the rest of this entry »