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 »

This year’s mandate will pile added layers of instruction on top of last year’s operating framework for the NHS.

Filed Under (Uncategorized) by Paul on 10-07-2012

Last Wednesday the Secretary of State introduced his radical new idea of a draft mandate between himself and the NCB to the House of Commons. This mandate has 22 objectives which, in return for giving them the money, he wants the NHS to achieve in the next few years. Read the rest of this entry »

Mandating NHS reform: – the new world according to Andrew.

Filed Under (Clinical Commissioning Groups, GP Commissioning, Reform of the NHS, Secretary of State) by Paul on 09-07-2012

This is an exciting week for me! (I know, it’s sad but I live in a small world).  My first three posts this week will reflect on different aspects of the draft mandate for the NHS that the Secretary of State launched last Wednesday, and on Thursday I will review Nick Timmins’ publication on the NHS reform programme Never Again. Read the rest of this entry »

Why Government-induced public fear about the economy creates a smaller economy and more fear.

Filed Under (Economics) by Paul on 06-07-2012

I promised a series of Friday blogs about the nature of the current economic crisis and the policies related to it. Last week I hope I explained how the problems the government has with its policy of containing public expenditure impacts the NHS.  Despite the government having a policy of cutting public expenditure, it became clear last Tuesday week that it had actually risen over the year by nearly 8%. I think that figure may have had a direct impact upon the NHS’ first entrant into the ‘failure regime’. Read the rest of this entry »

When is a ‘GP led commissioning organisation’ GP led – and when is it not?

Filed Under (GP Commissioning, Health and Social Care Bill, Secretary of State) by Paul on 04-07-2012

One of the many choices that Andrew Lansley had to make when he became Secretary of State in 2010 was whether to develop the GP led commissioning of NHS services that he wanted within the current PCT structure or whether to introduce legislation to develop that policy. Famously he decided that he needed the biggest NHS Bill in history to enact his vision. In making this choice he obviously felt that developing existing legislation would not give GPs sufficient power. To really empower GPs as the leaders of the new commissioning framework he felt he needed completely new structures and legislation. Read the rest of this entry »

The intention of having practical clinicians commissioning care for their patients could be undermined by the process of authorising Clinical Commissioning Groups.

Filed Under (Clinical Commissioning Groups, GP Commissioning) by Paul on 03-07-2012

Yesterday I posed the suggestion that one of the main problems for NHS commissioning was the split between the practicality of doing the commissioning and the strategic level of planning. The standards of plans varied between ‘OK’ and ‘very good’ but for some PCTs the use of their powers and capacity of their commissioning to put those plans into effect was very minimal. Commissioning, in a number of places, simply meant handing out the money to the same providers as last year plus or minus a few percentage points. This continuation of past commissioning activity took place even where there was recognition – in the plans – that radical changes to health care were needed in the locality. Read the rest of this entry »

Planning and doing – one of the problematic schisms within NHS culture.

Filed Under (GP Commissioning, Primary Care Trusts) by Paul on 02-07-2012

Health care is essentially a very practical activity. It involves patients paying attention to the detail of looking after themselves and taking the drugs that they have been prescribed. It involves medical professionals carrying out diagnostic tests and working with patients that are experiencing pain and distress. The vast majority of NHS staff and patients experience the NHS as a very important set of practical activities. Read the rest of this entry »