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 »

The Budget, the Big Society and the NHS

Filed Under (Budget, Coalition Government, Health Policy, NHS Providers, Third Sector) by Paul on 11-04-2012

Whilst the content of my posts rarely stray far from the NHS there are occasions when other page 1 news on strays into the NHS.

This one starts with a process which was the hallmark of the NHS, the Government trying to implement one policy by going against its own policy in another area. Read the rest of this entry »

We know the Prime Minister was in favour of unnecessary changes to the NHS – but is he in favour of the necessary changes?

Filed Under (Conservative party, Hospitals, Prime Minister, Reform of the NHS) by Paul on 04-04-2012

The Health and Social Care Bill has become an Act. This was only possible because the Prime Minister supported changes from the moment he put his name to the White Paper, through to the moment he changed his mind in April 2010, and all the way to the end of the process. It all adds up to the simple political truth that Prime Ministers get the legislation that they want through Parliament.

I suspect that if he were asked what the Bill was for he could give the ‘top line’ answer – that it gives more power to doctors and nurses. But if, over a kitchen supper, you asked him to explain how Monitor would both set prices and performance manage existing FTs, I suspect he couldn’t really give you an answer.

That wouldn’t matter so much if someone else could give an answer, but never mind – for the moment the Bill is an Act.  We know that he was in favour of something that didn’t really matter.

But what I am not clear on is where the Prime Minister stands on change in the NHS that really does matter.

Across the country there is a growing recognition that most hospitals are going to have to change the way that they deliver services, and how they are organised. The best ones are going to have to take over the worst, and as a consequence nearly all of them are going to have to change.

For example, last Friday the London Evening Standard published a page full of likely changes that will be necessary in west London over the next year or two. It involved closing A&Es and many other departments. Some local politicians were shocked at the level of these changes, but what was even more significant was an editorial supporting the changes.

This is going on all over the country.

Long term readers of my blog will remember that when the Coalition Government was formed I said that I suspected that what had been one of the major tensions within modern conservatism would play a role in the development of NHS policy. Since 1979 modern conservatism has believed both in the power of markets to improve efficiency and outcomes, and the importance of conserving institutions.

Of course these two drivers are in tension. In the Conservative-led Government of 1979-1997 markets ran through British society bringing substantial change. Whilst not many Conservatives noticed the closure of the steel and mining industries in their towns and villages, they did notice the closure of the local offices of banks, post offices and shops. All of these closures were the result of market decisions for efficiency that were at the core of the Government’s drive to change society.

Then these same Conservatives would launch campaigns against the closure of these local facilities, because not only do they believe in markets – but yes they believe in conserving as their name suggests. In the 1980s and 90s most of these campaigns, launched against the impact of their own policies, failed. Their market ‘side’ beat their conservative ‘side’.

How does this relate to the Prime Minister and his current policy toward the NHS?

At various stages in the last 18 months the Prime Minister has argued strongly that the NHS needs to change radically and that bits of markets might help bring this about. He will probably see clinically-led commissioning as something that will drive greater efficiency in the health service than the previous PCTs. He recognises that the NHS needs new drivers for efficiency.

But I wonder if he understands how that efficiency is going to hit the way the local district general hospital operates? After all as we saw in the 1980s and 90s driving efficiencies into organisations brings about changes and in many parts of the country those efficiencies meant that services were changed forever.

The consequence of greater efficiency in the NHS will be radical changes to the District General Hospital (DGH).

I think this may mean that the first half of this Parliament will see the Government arguing for greater efficiency in the NHS and the second half will see them defending the DGH against it.

But if he doesn’t make these efficiency savings, the Prime Minister will have to find more billions for the NHS to fund the inefficiency that his conservatism demands.

Over there, over there, can they all be really hopeless in health care over there?

Filed Under (Health Improvement, Reform of the NHS, USA) by Paul on 03-04-2012

Last week I spent some time in Boston as a member of a British Consulate delegation. We were there to discuss health systems with various people carrying out health care innovation in the USA.

I fell to thinking about how readers of this blog would react to that last sentence. To some it will be a red white and blue rag to a bull.

During the last year I must have been in a dozen meetings about NHS reform where most of those present would hiss at the possibility of ever learning anything from the US. Within our NHS reform debate there are groups of people who say that it would be morally wrong to learn anything at all from the US about health care – because they have such a bad system.

I’m afraid I don’t find this a very mature reaction.

In truth, in the last year I have found much of the ‘little Englander’ and ‘little NHS’ emotion which necessitates rejecting the possibility of  learning anything from the biggest economy in the world a bit sick making.

The US health system is an expensive, broken system where nearly all the incentives are moving this non-system in the wrong direction. It would be mad for any country in the world to learn anything systemic from that. The interesting thing is that every single person I have met in my three visits to the US to discuss health care over the last 4 years agrees with that. They feel that their system is an expensive generator of inefficiency and inequality, and all spend a lot of time trying to do something about it rather than accept it as a national ‘given’.

So within a very bad system there are hundreds of thousands of doctors and nurses doing very good things – and there are hundreds, if not thousands, of organisations that are developing interesting and important innovations in care.

For those that understand more about religion than I do there seems to be a sort of ‘original sin’ argument here. If you – or any of your ideas – are connected with the US health care system – then by associating with this ‘original sin’ you are irredeemably lost.

As I say, I think that sort of thinking is immature. More so it treats the NHS as if it were a fragile flower (do you remember David Cameron’s analogy of May 2011 – that it is like carrying a precious glass vase across a slippery floor?). I didn’t believe that then and I still don’t. I think it is a very, very strong institution and because of that can learn from different countries with very different traditions.

So over the next few months I will be challenging this simple anti Americanism by sharing through the blog aspects of US innovation that I think the NHS can learn from. Ideas and practices that can provide better services for patients within the principle of equal access for all, paid for out of general taxation, free at the point of delivery.

Last week the Health Secretary’s communication skills infected the wider Cabinet

Filed Under (Coalition Government, Secretary of State) by Paul on 02-04-2012

I very rarely blog about non-health issues but the petrol crisis created by ministers last week made me think about how Andrew Lansley’s communication skills seem to have become part of the way in which other cabinet members now  talk to the public. Read the rest of this entry »