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 »

More reflections on self management in NHS care

Filed Under (Resources, Self Management) by Paul on 28-07-2011

Over the past year I have been working with a number of organisations to think through how the NHS can achieve much better outcomes by encouraging patients take on much greater self management of their long term conditions. Whilst few people in the NHS would ever say that they are against self management as a form of care, it has failed to become part of the central activity of the NHS and remains on the periphery. Read the rest of this entry »

Private sector health care and payment for training

Filed Under (GPs, Private Sector, Resources) by Paul on 27-07-2011

Education and training in the NHS use a great deal of our public resources. This investment plays not only a very significant role in developing the NHS, but also plays a much wider role in developing our society. The fact that tens of thousands of teenagers in every generation work hard to get into clinical education demonstrates the central role that the NHS plays in people’s lives. Read the rest of this entry »

Abolishing “politically motivated targets”. One year on, when is a target a target?

Filed Under (BMA, Health Improvement, Kings Fund, Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 25-07-2011

One of the constant conversations that the current Secretary of State had with the leadership of doctors’ organisations over the six years of his apprenticeship as shadow secretary of state concerned how much they hated waiting times targets.

From 2001 onwards they had railed ineffectually against a Government that won the 2001 and 2005 elections partially on the promise to reduce maximum waiting times for NHS patients. The capability and capacity of the NHS to reduce maximum waiting times was one of the core public reform narratives that brought about change in the NHS over that period. Read the rest of this entry »

“NHS hospitals will struggle to meet productivity targets” – King’s Fund 15th July 2011.

Filed Under (Health Policy, Kings Fund) by Paul on 20-07-2011

One of the consequences of the loss of public trust as a result of the Government’s NHS policy is that alternative sources of public information to the ‘official statistics’ will become more and more important.

I remember a period of time, about 2003-5, when NHS maximum waiting times were dramatically improving. However the public lost belief in the picture that was being painted by the monthly DH statistics. They felt that despite the fact that the official statistics were making the case that waiting times were improving quickly, they couldn’t explain why individually they had to wait so very long for their operations. (The reason being that at the time the government was reducing maximum waiting times for operations from 2 years to 6 months – and could feel very pleased with itself. While this IS a big improvement it is difficult to weigh the experience of what feels like a very long wait, against the headline which says waiting times are improving if you have to wait 6 months for an operation.) Read the rest of this entry »

Dealing with failure is vital for the NHS to succeed.

Filed Under (Competition, Health Policy, Reform of the NHS) by Paul on 18-07-2011

Last week saw the latest episode in one of the longest running policy development sagas within NHS reform – the failure to create a failure regime for NHS hospitals.

This is a policy that has been much announced since the NHS plan in 2000. However little has been delivered in the 11 years since then. Three separate Governments have failed to create a failure regime. Each of them has recognised how important it would be to have one, yet each of them, as they come close to publishing one, has backed away. Read the rest of this entry »

“We will maintain constancy of purpose..”

Filed Under (Coalition Government, Health and Social Care Bill, Health Policy, White Paper) by Paul on 13-07-2011

I know I shouldn’t go on about this.

This quote – about “constancy of purpose” – jumped out at me from last year’s Government Executive Summary document on the NHS. Words can of course mean all sorts of things but it’s difficult to recall a period of NHS reform which has had such inconstancy and such little purpose …… Read the rest of this entry »

The Politics of Pause – the new contagion afflicting the NHS?

Filed Under (Economic Regulator, Health Policy, Reform of the NHS, Regulation) by Paul on 12-07-2011

Since the April pause ended in June with the launch of the reformed reforms, the Government has been trying to give the impression that it is now moving full steam ahead with its reform programme. But once the leadership of a change programme turns delay into an art form, it becomes inevitable that such an approach will impact upon the whole system. Read the rest of this entry »

To avoid accusations of dithering….

Filed Under (Health Policy, Public service reform, White Paper) by Paul on 11-07-2011

Today sees the publication of the Government’s Open Public Services White Paper. First discussed last autumn it was considered possible it might appear by Christmas 2010, and then spring 2011, but has finally made it on July 11 2011. Read the rest of this entry »

Today NHS England….. tomorrow the world (or is this too far?)

Filed Under (Health Policy, Reform of the NHS) by Paul on 08-07-2011

None of the posts in my blog derive from leaked documents. Many people ask me where I get the material from, and nearly all of it is a combination of information in the public domain and an understanding of how people in power actually operate. So sometimes I can provide a different interpretation from the way in which an official document is published (for example the initial response from the Government to the Future Forum – where the panic fumes off the page), and most of the time there is so much going on in the public domain that it is unnecessary to delve any deeper. Read the rest of this entry »

Centralisation, grip and improving NHS efficiency

Filed Under (Creating public value, Expenditure, Health Policy, Reform of the NHS) by Paul on 06-07-2011

One of the outcomes of the Government’s June 2011 reform of its July 2010 NHS reforms has been the increased centralisation of Government control. As I will explore later in the week, the first set of reforms that was intended – in the heady days of July 2010 – to liberate the NHS and localise decision making is now set to provide much more national centralisation of commissioning than has ever previously existed. Read the rest of this entry »