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 »

‘Commissioners not providers – should decide what they want to be provided; they need to take into account what can be provided… but in the end it is the commissioners whose decision must prevail.’ Francis recommendation 129

Filed Under (Clinical Commissioning Groups, Contracts) by Paul on 27-02-2013

We are just over a month away from the implementation of the new NHS reform architecture on April 1st. So I thought it might be timely to speculate a bit on what is likely to happen. Since some of the biggest changes concern the nature of commissioning it might be worthwhile starting there.

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Let’s not shed any real tears for the passing of Strategic Health Authorities

Filed Under (Failure regime, National Commissioning Board, Strategic Health Authorities) by Paul on 25-02-2013

In the last few weeks I have been fortunate enough to have been involved in a simulation about how the new NHS architecture will work rolling forward. I don’t know if you have ever been a part of a simulation but they gained traction in the early 1990s when the famous Rubber Windmill (pioneered by Alasdair Liddell) took place. This rolled forward the new architecture of the time and gave people playing the simulation the opportunity to see not only how the architecture would work but much more importantly what they would actually do in this new world. Read the rest of this entry »

Mid Staffs: What I might have done better to improve the policy and culture of the NHS.

Filed Under (Failure regime, Francis Report) by Paul on 20-02-2013

Part 2: The failure to create a failure regime

One of the long term mistakes has been the failure of policy to clearly develop, publish and use a failure regime for the nation’s hospitals. Whatever else we learn from Mid Staffs, we must recognise that a considerable number of local people felt that this hospital was failing them. Yet I am still not clear if, several years later, Mid Staffs is labelled a falling hospital or not.

That fact it has failed is clear. Whether anyone has had to nerve to categorise it in this way is less clear.

This has been a policy area that has been fraught with political failure. Several governments, including the one for which I worked, have failed the public by failing to develop, publish and use a regime that clearly and consistently uses the label ‘failure’ to describe a hospital.

In 2000 the NHS plan made it clear, not only that there should be a simple red amber and green rating system for the nation’s hospitals, but that there should also be a regime which clearly labelled a hospital as ‘failing’ and had a policy to deal with that.

But in fact the development and application of this policy over more than a decade has been weak.

Compare this to education – where the first school was labelled as failing 20 years ago.

Let’s look at where we are today.  South London Healthcare Trust had the administrators sent in because it had failed economically. But the point made by the Public Accounts Committee was that we don’t know the criteria that determined that administrators should be sent into this hospital – and not to any of the others that can only pay their staff because money is stolen from the rest of the NHS to subsidise them.

In quality and safety terms we don’t really know what the failure regime looks like.

Two weeks ago this led the Prime Minister, in his statement in reply to Francis, to ask Monitor to develop what he described as a ‘unified’ failure regime.

We all know why there has been a decade-long failure to construct a failure regime. It is a collective failure of nerve by the political class (including me in my time in Government).

Most of the public believe that all NHS hospitals provide a similar standard of service. As far as they are concerned the NHS brand is a badge which guarantees both quality and their safety.

ALL of us in the system have long known this is not true.

But it took a catastrophe like Mid Staffs to acknowledge this.

It’s true that some Government policy helped patients at Mid Staffs. In the past they would have had to keep going to the hospital because they had no choice. Developing the policy which gave patients the choice to go to a different hospital was hugely controversial. It took row after row with the various aspects of the NHS to say that the public had the right to choose where to go.

This is one area where I don’t have to apologise because we faced down that opposition and implemented a policy of choice.

What did this mean for people at Mid Staffs?

On February 10th BBC news carried an interesting report on a Freedom of Information request. This had been published on the BBC Stoke and Staffordshire web site.  This showed that the current CEO of Stafford hospital had found that the number of patients who had chosen to go there through the ‘choose and book’ system had fallen from 15740 in 2007/8 to 6513 in 2012/13.

This is a really significant statistic. Because people could choose two third chose not to go.

It is the case that many outside the NHS may find it very odd that as many people as 6513 are choosing to go to a hospital which has been so systematically labelled as bad.

This is the first time I have seen a set of figures which so powerfully demonstrate the choice of the public not to go to a certain hospital. 2 people out of 3 are choosing not to go to Mid Staffs compared to 5 years earlier.

These choices are costing the hospital £3.7 million a year and will be one of the reasons why Monitor has had to look carefully at whether the hospital has a future.

The policy of choice enshrined in the NHS constitution gave people the right not to go to a certain hospital, but because we did not have the nerve to develop and implement a failure policy, we left it all up to the individual.

I am pleased that we gave people choice. But I am ashamed that we didn’t clearly say that failure was failure and decisively act upon it wherever and wherever it took place.

How do Andy Burnham’s proposals stack up against his own attacks on Government policy?

Filed Under (Clinical Commissioning Groups, GPs, Health Policy, Labour Party, Local Government) by Paul on 18-02-2013

2 “The Government is wrong to carry out an unnecessary top down reorganisation.” 

A few weeks ago Andy Burnham made an important speech launching a major consultation on Labour’s Health Policy. What he described as “the biggest consultation on health and social care policy by the Labour Party for 20 years” is obviously an important event. My Monday posts are discussing his policy proposals in a particular way. Read the rest of this entry »

Mid Staffs: What I might have done better to improve the policy and culture of the NHS. Part 1 (Part 2 next week)

Filed Under (Culture of the NHS, Francis Report) by Paul on 13-02-2013

In the last few days several people who have commented about my blog regarding Mid Staffs have said something to the effect of “What about an apology from you for your part?” and of course, given the depth and the breadth of what happened at Mid Staffs, everybody that had a role in the NHS over those years has to look carefully at what they did and did not do.
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How do Andy Burnham’s proposals stack up against his own attacks on Government policy?

Filed Under (Health Policy, Labour Party) by Paul on 11-02-2013

1: “The Government is wrong to be fragmenting the NHS.”

A few weeks ago Andy Burnham made an important speech to launch a major consultation on health policy. What he has described as the biggest consultation on health and social care policy by the Labour Party for 20 years is obviously an important activity. Over the next few months I am sure there will be fierce debate about what should and should not go into the final policy but every Monday for the next few weeks, I’m going to discuss the policy proposals in a particular way. Read the rest of this entry »

The Government’s response to the Francis Report

Filed Under (Francis Report, Prime Minister) by Paul on 07-02-2013

Since he became Prime Minister David Cameron has made three statements to the House of Commons in response to important reports into failures of the state. The first was the report on ‘Bloody Sunday’, the second on the Hillsborough report and the third, yesterday, was the Francis Report.

Of course all three of these reports investigated very different sorts of failures. But importantly all three of them relate to failures by government to listen to what they were being told, again and again, by the public. In all three cases the public, who were telling the truth, saw cover-ups by different parts of the state.

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An important day for the NHS to show it can stick to its principles whilst learning from mistakes.

Filed Under (Francis Report, Uncategorized) by Paul on 06-02-2013

The Francis report is published today. Nowadays even the most sensitive legal documents are heavily leaked – with the Guardian seemingly having a copy on its front page last week. However despite the leaks it’s always best to wait for publication before commenting on the actual content.

I want to make some wider points here. These have occurred to me whilst looking at the press preparing for Francis. It is already clear that a number of newspapers will construct from the findings an analysis that chimes with their fundamental hatred for the basic principles of the NHS.

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The Francis Report, transparency, and what counts as knowledge inside and outside the NHS.

Filed Under (Francis Report, National Voices, Patient involvement) by Paul on 04-02-2013

A few weeks ago Alan Milburn outlined how he saw that one of the main outcomes from the Francis Inquiry into events at Mid-Staffs should be much much greater transparency of information about the NHS for the public outside. In 2013 very few people would disagree with that. But there will be important disagreements about what this means.

Last week Liz Kendall from Labour’s Shadow Health team spoke to a National Voices’ conference about how she felt we needed to extend transparency. One of the points she made was that the public didn’t just need more numbers about what is going on inside the NHS, but that the NHS needs a form of knowledge about what is going on inside that has been partly created by patients and the general public outside. Read the rest of this entry »