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 »

Given the current Secretary of State isn’t playing the role outlined for his job in the reformed structure, which NHS structure is he trying to run?

Filed Under (Coalition Government, Foundation Trusts, Health and Social Care Act, Health Policy, Jeremy Hunt, Secretary of State) by Paul on 05-03-2014

The last 10 months have made it clearer and clearer that Jeremy Hunt, as Secretary of State for Health, can only do the job the way he wants to by completely ignoring the reforms of the NHS brought in by his Government.

We have one of the most activist Secretaries of State for Health of recent years  operating within a legal system – that he helped to create – which grants him very few of the powers that he feels he needs to carry out the role.

There are hundreds of Conservative party quotes attacking targets that I could use but I’ll just take one, from their 2008 document, Renewal.

“The problem is Labour’s strategy of trying to manage the NHS through top down centralised targets. These targets focus primarily on processes and administration such as stipulating the time it should take for patients to be processed through their treatment, or for administrative procedures to be completed, rather than the actual results of patient care”

Phoning up chief execs of NHS Foundation Trusts to quiz them about their A and E performance ignores several bits of the legislation that he helped to get through parliament.

He will of course remember, as he phones the CEO of an Foundation Trust, how para 1.5 of the White Paper “Liberating the NHS” (that he agreed in Cabinet in July 2010) said

“We will legislate to establish more autonomous NHS institutions with greater freedoms, clear duties and transparency in their responsibilities to patients. We will use our powers in order to devolve them”.

I am sure the CEO of the FT will feel, as he is being called by Jeremy Hunt, that he is part of a more autonomous institution…

First let’s get one issue out of the way. There are those that say that Jeremy Hunt’s job as Secretary of State for Health is made much more difficult by the fact that he has to work within a structure created by NHS reforms that reflect the ideas of his predecessor Andrew Lansley – and that he in fact had nothing to do with the structure and the law that he now chooses to ignore.

The argument goes that Andrew Lansley had a very idiosyncratic view of how the NHS should be organised and that given just how individual that was it’s hardly surprising that Jeremy Hunt needs to do something different.

This argument depends upon Andrew Lansley having acted purely as an individual who one day simply implemented his very individual plan.

But it wasn’t like that. That’s not what happened. Andrew Lansley was a member of a Cabinet that discussed his plans on several occasions – and on each occasion the Cabinet decided to go ahead with these plans.

Andrew Lansley was a Member of Parliament who belonged to the party that formed the greater part of the Government. Jeremy Hunt is a Member of Parliament who belongs to the same political party. He voted for the Health and Social Care Act on very many occasions. He signalled his agreement with Andrew Lansley’s plans by voting for them on all those occasions.

So it may be that these reforms were odd, but they were actively supported on many occasions by the Coalition Cabinet (member Jeremy Hunt) and the Conservative Party in Parliament (member Jeremy Hunt).

And my obvious point is that Jeremy Hunt was an active part of the processes that enthusiastically agreed the plans for a new NHS structure that he now ignores.

In Cabinet in July 2010 there would have been a discussion of the White Paper that specifically argued for a much smaller role for the Secretary of State in running the health service.

In Cabinet in December 2010 there would have been a discussion of the biggest Health Bill in history where clause after clause outlined how a new architecture of independent organisations would take power away from the Secretary of State.

In 2011, given the trouble that the Bill was in, there would have been several other Cabinet discussions about the Bill. In each of these the Cabinet collectively (member Jeremy Hunt) decided to go ahead with the reforms.

Jeremy Hunt was an active member of this Cabinet. He was a part of these discussions which collectively agreed to push them forward.

These reforms – which the current Secretary of State now finds it difficult to live within – were agreed personally by him over a long period of time.

They are just as much Jeremy Hunt’s reforms as they are David Cameron’s and Andrew Lansley’s.

Jeremy Hunt’s problem is that the reforms he voted for and passed into legislation created a system which now gives him insufficient power to carry out his work in the way that he feels he needs to.

You might think that the daily spectacle of a Conservative Secretary of State trying to wield powers that he personally contributed to removing from his office, would be a matter for some derision and scorn from Her Majesty’s Opposition.

There are hundreds of quotations about not making top down decisions which could be thrown across the chamber at Jeremy Hunt and contrasted with the need to intervene he seems to feel every day.

The opposition could make him a figure of fun for doing the opposite of what his legislation signed up to.

But they don’t. No one says this is weird because the opposition think that if and when they take over the role of Secretary of State for Health they will also be looking to use as much power as possible to tell people in the NHS what to do. They relish the thought of telling CEOs what they can and cannot do and are rather pleased that they don’t really seem to need legal powers to do that.

Their failure to point this out doesn’t change the rather odd nature of what is going on though.

How will Liberal Democrats reconcile their policy of keeping Britain in Europe with their policy of not using competition to improve the use of NHS resources?

Filed Under (Clinical Commissioning Groups, Coalition Government, Competition, Liberal Democrat Party) by Paul on 11-03-2013

We have learnt that Coalition Governments get into a rhythm. Every year now, in early March, there is an attempt by the Coalition to change some or other policy just before the spring Liberal Democrat Party Conference so that party members can feel that they are having an impact on the Government. Read the rest of this entry »

“We will scrap politically motivated targets…”

Filed Under (Coalition Government, Conservative party, Health Policy, Manifestos, Targets) by Paul on 16-05-2012

(Conservative Manifesto 2010)

It was always going to be interesting to see how the Coalition government would live with this pledge.

Over the last weekend, just prior to its conference, the Royal College of Nurses published a survey of its members reflecting their experience of patient waits in A and E. Their President was on the airwaves saying that the progress that had been made on speedier and better working with A and E patients was being lost as more were being treated on trolleys. Read the rest of this entry »

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 »

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 »

Why is the Government so pleased with itself now that it has passed its Health and Social Care Bill?

Filed Under (Coalition Government, Conservative party, Health and Social Care Bill, Health Policy, Prime Minister) by Paul on 21-03-2012

Since the autumn of last year I have blogged several times about the rather odd truth that the Government really doesn’t seem to care much about the detail of their Health and Social Care Bill. Since June last year they have been agreeing amendments to almost every part of the Bill (and then amendments to these amendments) with a reckless disregard for whether the Bill still makes any sense at all. Read the rest of this entry »

Question: When is an amendment to the Health and Social Care Bill both insignificant and important at the same time?

Filed Under (Coalition Government, Conservative party, Health and Social Care Bill, Liberal Democrat Party) by Paul on 29-02-2012

Answer: When it’s being viewed by the two different Coalition political parties.

Monday saw the Government Health and Social Care Bill lurch further down the path of degeneration into farce.

Sunday saw publicity centred around another set of amendments to the competition aspects of the Bill. Placed by Liberal Democrat peers.

On Monday morning at 11, at the press briefing that takes place twice a day, the Prime Minister’s official spokesperson said two contradictory things. First he said that the Bill had been amended a lot so far, and that it was now in a fit state to be passed then he said that he was relaxed about these amendments because they were not significant. This is the Prime Minister playing down the amendments and  the possibility of defeat. Read the rest of this entry »

On my being a part of the Government’s attempt at making the case for their Health and Social Care Bill.

Filed Under (Coalition Government, Health and Social Care Bill, Hospitals, Narrative of reform, Reform of the NHS) by Paul on 22-02-2012

As I mentioned yesterday the Government has been using scatter-gun tactics in its attempt to argue its case for NHS reform. For some time they have been trawling through a wide range of sources to try and find support for the necessity for their reforms.

The trick they are trying to pull off is to claim that by being in favour of reform (as many are) you are in favour of their reforms (which few are). Read the rest of this entry »

Does all this NHS reform really require legislation?

Filed Under (Coalition Government, Health and Social Care Bill, Narrative of reform, Reform of the NHS) by Paul on 06-02-2012

The problem with the Health and Social Care Bill is that it moves reform backwards.

Over the weekend I had several conversations with journalists questioning whether the Government really needed a Bill to achieve the main themes of the NHS reforms that they want. Read the rest of this entry »

Who will account to Parliament for all the unconstitutional changes that have been made if the Bill falls?

Filed Under (Coalition Government, Health and Social Care Bill) by Paul on 02-02-2012

One of the main arguments currently being used by those in favour of the Health and Social Care Bill getting through its last stages in Parliament is that most of the changes it would bring about have already started to happen. Those arguing for the Bill say that to stop it now would cause greater disruption than if the changes go ahead. Read the rest of this entry »