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 »

Eighteen months in Lansley gets it right (at last)

Filed Under (Hospitals, Labour Party, Reform of the NHS, Secretary of State) by Paul on 31-10-2011

Last week, 18 months into his tenure as Secretary of State, Andrew Lansley made a speech at Reform where he unfortunately confirmed that he was going to bail out inefficient hospitals. I will return to that later in the week. Read the rest of this entry »

Centrifugal forces and the role of the Clinical Commissioning Groups

Filed Under (Clinical Commissioning Groups, Reform of the NHS, Secretary of State) by Paul on 28-10-2011

(One of the great experiences of writing this blog is that it is read by doctors. Recently I discovered that one of the great things about doctors is that they know Latin. At the beginning of this week in developing this argument about centrifugal and centripetal forces I got my ‘fugal’ and my ‘petal’ mixed up. A number of doctors very kindly responded saying that ‘petal’ related in Latin to ‘the centre’ and therefore centripetal forces were dragging things to the centre and conversely centrifugal forces dragged thing to the periphery.

So thanks for letting me know! And my apologies to those who have been confused in trying to understand not only NHS reform, but also the creation of the universe – which as all of you will know came after the big bang and involves some large centrifugal forces that are pushing matter every million years or so further and further away (centrifugally) from where the bang took place).

[I am of the generation that thrilled to Peter Cook (and Dudley Moore). In “Beyond the Fringe” there was a great sketch where Pete was convinced that the only reason he did not become a High Court judge is because he never had ‘the Latin’. I feel it must be the same for me and becoming a doctor] Read the rest of this entry »

The necessary role of the centre. How it can create better care through argument and not instruction.

Filed Under (Reform of the NHS) by Paul on 26-10-2011

(There were a number of interesting tweets and comments about yesterdays post on the necessity for a strong centre in the NHS. Many of them argued that there is a false dichotomy between the ‘either’ of centralisation and the ‘or’ of decentralisation. They pointed out that large organisations need both. They need attention paid to a strong centre and to strong outward facing local service delivery.

Having established that they also need to pay attention to how these two forces – pulling as they do in different directions – can pull an organisation apart. Therefore it’s vital to know all the time not only that you are doing both –centralising and decentralising – but to pay very careful attention to how you are doing it.

So to cut to the chase of this string of posts, it is absolutely certain that NHS reform needs both centralising and decentralising at the same time. The problem with the current reforms is that they started with a clear one-dimensional approach to reform – liberating the NHS. Then they were forced into a strong centralisation with the NCB and a strengthened Secretary of State role – but they don’t really know nor can they really say that they are doing both.

Which means that they are unlikely to get the interaction between these two forces right. Centralisation will clash with decentralisation and pull things apart)

Today I said I would talk about how the NCB will have to centralise some aspects of power – whatever the Bill appears to say – and one of the really interesting responses to yesterday’s post helps me with this. I was sent a dissertation about the NHS Cancer Plan. Read the rest of this entry »

Centripetal reforms have to be part of reforming the NHS. So what do they look like?

Filed Under (Reform of the NHS, Secretary of State) by Paul on 25-10-2011

(Note: There was a comment yesterday from The Jobbing Doctor that I would like to share with everyone. The Jobbing Doctor seemed to think that I was masquerading as being impartial. I apologise if I have ever given that impression. I am partial. I have an argument and I have a position. What I try and do is explain that position, and how that position makes sense of what is going on in the NHS.

He also quite rightly pointed out that I was involved at the heart of Government between the years 2001-2007 when I advised two Secretaries of State and the then Prime Minister. My experience of carrying out those roles deeply informs the position that I have and I am very happy to take responsibility for my part in those reforms.

Without having played that part and without standing up for it, I would have very little to say).

Yesterday’s Guardian had one of those revelation/leak stories that are always fun. Read the rest of this entry »

Centralising and decentralising the NHS simultaneously. How to work with that?

Filed Under (Reform of the NHS) by Paul on 24-10-2011

(It’s the 50th anniversary of Private Eye – and one of the many brilliant examples of satirical journalism that it has published over the years was “XXX – the man they couldn’t gag”. As with many of their spoofs this was taken from the example of a tabloid journalist who would brag about publishing regardless of any pressure they were put under. Of course within the Private Eye story the journalist could be bought by a decent lunch and would drop his stories under any pretext.

Well blogging – as one of the newer forms of electronic journalism – has shorter traditions than print but I am sure there are blogs that are proud of the fact that they would publish the truth irrespective of whatever slings and arrows might be deployed to stop them. I suspect that there may even be some blogs that have at their masthead “XXX – the woman (or man) they could not gag”.

Well last week I found out how easy it is for a blog to be gagged. It doesn’t take a high court writ, or a Minister of Defence D notice, or even – for that matter – the heavy mob turning up from the DH. No, all that it takes to gag me is a corrupt hard disk. Last Sunday I woke up to a very sick computer and the rest of the week saw someone trying to ‘scrape’ the old hard disk onto a new one. So for last week “Health Matters” was a bit poorly and proved that in these days of individuals and new technology, it’s very easy to gag a blog!).

Readers will know that my day job involves working with a wide range of different health care organisations – all of them providing services to NHS patients. That means that at the moment I spend my time with people whose whole experience of their work is impacted by the NHS reform programme. Read the rest of this entry »

Two recent reports confirm growing evidence that many NHS hospitals will need to be rapidly converted.

Filed Under (Foundation Trusts, Kings Fund, National Audit Office) by Paul on 14-10-2011

The Kings Fund (today) and the National Audit Office (yesterday) have both published reports underlining the fact that a growing number of NHS hospitals are in trouble. Read the rest of this entry »

The Health and Social Care Bill gets a second reading

Filed Under (Health and Social Care Bill, Reform of the NHS) by Paul on 13-10-2011

I had some interesting discussions with people following Tuesday’s post which had argued that the Government would be in a much better medium term political position if it lost the Bill. One or two really felt that I was offering the only explanation for the Government’s ineptitude in arguing for the Bill. They seriously thought the Government were being deliberately hopeless in arguing for the Bill in the hope that they would lose. Read the rest of this entry »

The Health and Social Care Bill limps back to the Lords…

Filed Under (Health and Social Care Bill, Secretary of State) by Paul on 11-10-2011

A key point to remember is that this Bill, despite all the carnage that it has been through, is still only at the halfway stage of its journey through the Houses of Parliament – and the second half is likely to be harder than the first. Read the rest of this entry »

Let’s face it. This world financial catastrophe will have an impact on the NHS as well.

Filed Under (Health and Social Care Bill, Reform of the NHS) by Paul on 10-10-2011

This may seem obvious but it’s a point I want to underline. Every day, when working with the NHS, I am experiencing an odd dissonance between the internal changes that we are discussing (as if they are absolutely enormous) and the reality of the front page stories about the world economy – which are really absolutely enormous. Read the rest of this entry »

Talking of controlling Foundation Trusts, just who is in charge of Government policy?

Filed Under (Foundation Trusts, Health Policy, Reform of the NHS, Secretary of State) by Paul on 06-10-2011

To conclude this trilogy of posts on the likelihood of a Government retreat on the autonomy of Foundation Trusts, I want to examine lasts weeks’ assertion of a new Government policy by David Nicholson. Read the rest of this entry »