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 »

An Olympian break

Filed Under (Uncategorized) by Paul on 27-07-2012

Today, July 27th , sees the start of the London Olympics.

The NHS was founded in July 1948 and later that summer, London hosted the first post-war Olympics. Being only a few months old at the time I don’t remember anything about those events, but here I am in London, 64 years later, celebrating both again.

I understand that the opening ceremony will devote some time to making the connection between 1948, the NHS and the London Olympics.

As a Londoner I find all this very exciting will be suspending the blog for the duration of the Olympics – and will then take a holiday.

Normal service will be resumed on September 3rd.

Enjoy the games!

Having rewritten everything else about the NHS the Coalition Government has now rewritten the meaning of the word ‘independent’.

Filed Under (Conservative party, Health Policy, Hospitals, Independent Reconfiguration Panel) by Paul on 26-07-2012

On July 2nd the new chair of the Independent Reconfiguration Panel took up their post. Lord Ribeiro, who was between 2005 and 2008 President of the Royal College of Surgeons, is, as a top doctor, an obvious appointment. If you want someone to do something ‘independent’ then it’s obviously totally within the meaning of that word to go to a top doctor.

But look again. This is the same Lord Ribeiro who became a member of the House of Lords in December 2010 and has, since then, taken the Conservative Whip. Whether he was one before he took up his seat in the Lords on 21 December 2010, he has, since that date, been a publicly committed Conservative.

But, you might say, are not these doctors who sit in the Lords an independent bunch? Don’t they vote with their conscience and not with a Party? Isn’t he an independent first, and a Conservative second?

Luckily an organisation called “The Public Whip” keeps a record of the balance between Lord Ribiero’s independent votes against the Government and his adherence to the Conservative Whip. They have computed that there have been 157 whipped votes since he took up his seat.

The noble independent Lord has only once voted against the Conservative whip. Or to put it another way he has demonstrated his independence over party loyalty on 0.6% of the occasions when he could have done so.

Let’s not forget that during this period of time a contentious Health and Social Care Bill has gone through the House of Lords. During this period there were many pressures on doctors to vote against the Government whip in favour of a different approach to NHS reform.

But again, perhaps like many members of the House of Lords, he has been a part time politician. Perhaps these voting record figures are those of a reluctant politician who only occasionally turns up?

Another organisation called “” computes the number of times that Lord Ribiero has voted with his political affiliation as a % of all of the occasions upon which he was eligible to vote. They calculate this figure at 73.02% – being the percentage of occasions on which he elected to vote with the Conservative whip. They comment that “This is well above average amongst Lords”

We have the evidence that the new chair of the Independent Reconfiguration Panel has been an active Conservative.

Does this matter?

It does. For two reasons.

First you will remember that the Coalition Government has wanted to take politics out of the NHS. “We want to free NHS staff from political micro-management” said the coalition agreement in May 2010. Over and over again the Government have said that the aim of their reforms has been to remove politics from the NHS. It is therefore, at the very least, strange to appoint a person with a clear track record of party political belief to a part of the NHS that has been, up until now, independent and free from political micro-management.

So the small point is that – as in a number of areas – the Government are doing the very opposite of what they said they would do. Rather than removing politics from the NHS, this is a clear example of the way in which they are putting people with a track record of active Conservative party politics into positions of power within the NHS.

The second issue is the specific work of the Independent Reconfiguration Panel within the NHS.  Hospital reconfiguration is a profoundly political issue. At both local and national levels there are campaigns against hospital reconfiguration.

The current Secretary of State was engaged in these campaigns in the run up to the last election. Within days of his coming to power he made reconfiguration even more party political by making statements in front of hospitals – opening up parts of them. These were all in Conservative constituencies and were all opening parts of hospitals where clinicians had supported their closure.

Over the next few years everyone agrees that the pace of hospital reconfiguration must quicken. The NHS will need a larger number of radical changes to develop sustainable and safer hospital services.

For the NHS to thrive the reconfiguration process will have to be seen to work well and work cleanly.

By appointing someone with a public record of Conservative affiliation the Secretary of State has made that process much harder.

In political terms it must be the case that following the appointment of the new Chair of the Independent Reconfiguration Panel the Labour Party in the localities and nationally will be looking very closely at all of the decisions that they make.

With this chair every contentious decision becomes more contentious.      .

A very strange way for the Government to remove politics from the day-to-day running of the NHS.

For the NHS the big question is can the number of referrals from GPs to secondary care be reduced?

Filed Under (Clinical Commissioning Groups, GP Commissioning, Health and Social Care Bill, Secretary of State) by Paul on 25-07-2012

…for the Secretary of State it’s, can he claim that his policies have made this happen?

Last week the HSJ revealed an analysis of figures that showed that the recent national downward trend of GP referrals had returned to its historical upward trajectory. In fact the current peak of referrals from GPs is now higher than its previous highest point. This is bad news for the NHS since it shows that current attempts at managing the demand for secondary care do not appear to be working. . Read the rest of this entry »

How competition between hospitals improves quality and integration of services. A report from the Cooperation and Competition Panel.

Filed Under (Competition, Cooperation and Competition Panel, Health and Social Care Bill) by Paul on 24-07-2012

Readers will remember the high noise level of the row that took place about the role of competition in the NHS in the last three months before the Health and Social Care Bill was passed. It was ferocious – with those opposed to competition claiming that one of the main things wrong with it was that there would be an increase in competition. Read the rest of this entry »

Nursing in today’s hospitals is a very different task from nursing 20 years ago

Filed Under (Nursing) by Paul on 23-07-2012

Dr Foster – the informatics company – has an ethics committee which holds a number of discussions. Last week I went to a session on the role of nursing in the modern hospital. These take place under Chatham House rules which means I can say what was said but not who said it. Read the rest of this entry »

Why does the new architecture of the NHS have to pretend so hard to be something else?

Filed Under (Foundation Trusts, National Commissioning Board, NTDA) by Paul on 18-07-2012

Monday saw the NHS Trust Development Authority  (NTDA) appoint its second tier of staff. Leaving aside the fact that it looks now as if the NHS is a completely closed shop – with no external advertising for what are all very important posts being filled over this month or so – there are some very good people being appointed.

As the new architecture emerges from the mist it is clear that the NTDA is really very important. Read the rest of this entry »

Where will Clinical Commissioning Groups get their support from?

Filed Under (Clinical Commissioning Groups, Commissioning Support Services) by Paul on 17-07-2012

Regular readers will be aware of the ongoing tussle between the writ of the Secretary of State and that of David Nicholson, CEO of the National Commissioning Board. Over the last year readers will have recognised that this takes a number of forms, and one that takes place regularly  continues to be the amount of freedom that clinical commissioning groups have and will have to select the support they need in their commissioning role – and from which organisations they can obtain it. Read the rest of this entry »

News from members of the National Commissioning Board

Filed Under (Clinical Commissioning Groups, National Commissioning Board) by Paul on 16-07-2012

Readers will not be surprised to know that I am very mistrustful of the ability of internal NHS culture to reform itself with sufficient speed and depth to enable it to survive, let alone thrive. Nor that it is my belief that many of the appointments to the leadership of the NCB have been from within the most conservative wing of that most conservative culture.  Given how much power the NCB has been given by the Secretary of State over the future of the NHS, this is a big worry. Read the rest of this entry »

“Never Again” a pamphlet by Nick Timmins – published by the Kings Fund and the Institute for Government

Filed Under (Health Policy, Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 12-07-2012

Once you’ve read today’s post download the pamphlet that is published today by Nick Timmins “Never Again – the Story of the Health and Social Care Act.” I know we worry about the future of the planet, but I suspect you will want to sit and read this a couple of times, so my tip is to print off all 140 pages. Read the rest of this entry »

One of the oddities about our Secretary of State is that he is both profoundly apolitical and politically partisan.

Filed Under (Reform of the NHS, Secretary of State) by Paul on 11-07-2012

The publication of last week’s draft mandate for the National Commissioning Board by the Secretary of State demonstrates once again the awkwardness with which he sets about explaining anything about the overall politics of his reforms. So much is old news. But the statement also shows how consistently partisan he is in his approach to working with (and mainly without) the main opposition party. Read the rest of this entry »