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 »

“Unless you bring the consumer into the heart of these changes you won’t get the change.”

Filed Under (Ed Miliband, Health Policy, Patient Choice, Private Sector, Public service reform) by Paul on 10-03-2014

 (Ed Miliband on the Marr programme)

When Ed Miliband said this in January he was talking about the energy industry. One of the major planks of his policy for developing a new economy is to encourage and enable much more active consumers.

Active consumers challenge provider bad practice in two ways.

First they make a fuss about their existing supplier. Increasingly they may join a range of campaigns about how badly they are treated – and social media is making those campaigns more powerful every day.  The political scientists (and Ed Miliband) call this ‘voice’. Increasingly consumers let the world know when they get bad treatment and they say it ever more loudly and in greater numbers. The reputational costs for providers of services that have campaigns run against them can be immense. So providers worry about consumer voice.

Second, where there is competition consumers have the right to take their business somewhere else. Political scientists call this ‘choice’. In the energy industry Ed Miliband makes the important point that exercising choice is difficult. He is committed to making it a lot easier for consumers to move their business. And where there are monopolies he will develop policies to break them up and provide the consumer with more choice.

Whilst voice can raise problems of reputation for businesses, it is the loss of customers through choice that is the direct driver for companies to improve service. If there is no choice the impact of putting consumers at the heart of change is diminished.  Thousands of active consumers combining voice and choice will have an impact on bad providers – or they will lose a lot of business.

The important political point for Ed Miliband here is that given his committtment to stand up for consumers against monopolistic power in the private economy where does he stand on the issue for consumers of public services.?

On February 10 he made a speech addressing the problem for consumers of public services. In this speech he clearly said that he was as committed to tackling the abuses of power of public services as he was of private services. This is a new dimension to the recent post-2010 politics of the Labour Party and of course will have a big impact on the politics of the NHS.

If you are to win votes from voters outside your tribe then good politics is all about developing positions that are a bit different from those that the tribe expected. A traditional Labour position attacks the power of private companies over consumers but has not attacked the power of public organisations over citizens.

So when his Feb 10 speech talks about understanding that that there are people feeling powerless because of state institutions and not only private sector companies, he is making an important and not completely expected point.

The speech went on to talk about enhancing the power of the citizen in developing their voice in gaining more power in public services. There were important promises for parents (and in the future patients) on developing their public voice to have a greater say. In particular a part of the speech that could have a big impact on the NHS was the promise of helping individual patients organise themselves with similar patients. This blog has often spoken about the importance of patient organisations developing a more powerful collective voice for individual patients. This is potentially an important and practical policy.

He was talking about people powered public services.

But when it came to choice he said that this was different for public services because parents don’t choose a school in the same way that they choose a café. That’s true. A café choice is made every day, and a school choice once every few years. That makes them very different choices – but they are still choices.

And parent choice of schools informed by information from Ofsted has had and is having a big impact on driving up standards. Just as for a private company if you don’t listen to the voice of parents about your school then parent choice will have a direct impact on your bottom line. Head teachers who don’t care how parents use their ability to choose schools don’t last long.

To allow consumers in private industry to use the power of choice is a vital way of empowering consumers.

Not to allow citizens who use public services to use the power of choice will limit their empowerment.

If you want to improve public services people need all the power they can get, choice as well as voice.

Something is stirring in the Labour Party…

Filed Under (Andy Burnham, Ed Miliband, Health Policy, Shadow Secretary of State) by Paul on 04-03-2014

…on NHS and social care policy.

Today sees the launch of a report by John Oldham’s Independent Commission for the Labour Party into health and social care policy, and to declare an interest up front, John is a close friend of mine.

Those that know him will recognise that his report “One Person, One Team, One System” is very much his own (and his colleagues on the commission). By which I mean that it is not owned by the Labour Party and some of it will make difficult reading for the Shadow Secretary of State.

That is why it’s interesting that today’s report will be publicly received with a speech by the leader of the opposition Ed Milliband. One of the reasons that he is playing such a big role in receiving the report is because it does not support the line taken by some of his Shadow Secretary of State’s speeches. It therefore provides the Leader of the Opposition with an opportunity to drop some of the things his Shadow Secretary of state has said he wanted to do.

Again, those that know John Oldham will not be surprised that his report is based upon a radical critique of the current delivery of health and social care for NHS patients and social care service users.

The press release begins:

In 2014 the NHS and social care work very hard to deliver a model of care that was created for a different population with different diseases. It mainly provides a wide range of good episodes of care aimed at improving the health of parts of the body but this does not meet the needs of our current ageing population. At the moment 70% of the health and social care budget is spent on older people with long term conditions and much of considerable resource is not well spent.  The crisis for the NHS and social care is that in order to meet the needs of our new ageing population needs to radically change its model of care. It finds it very hard to do this”

In truth none of this is news to any of the leadership in the NHS. But the case for change in John’s report goes a few steps further because it is most strongly voiced by the people themselves. People receiving fragmented care need a radical new approach over the next parliament to rework the health and social care system to meet these new needs.

And one of the things that is most needed to bring about this radical change is for the next Labour Secretary of State NOT to launch a reorganisation of the health service.

We do not need a new Health and Social Care Reform Act.

We do not need to change the local commissioning structure for NHS care by giving it to local government.

We do not need a new reorganisation of NHS structures.

As the press release for the report continues:-

“It is vital that the next Government leads this change and does so without a complete reorganisation of the structures of NHS and social care. The recent reorganisation has left the NHS and social care demoralised and not able to understand the system within which it is meant to be working. A further reorganisation in 2015/2017 would place the whole system in very great peril.   

The next Government must dedicate itself to improving health and social care outcomes for patients and service users defined by them. Government leadership is needed to change how the organisations that provide care actually behave with people It should not spend time passing legislation to change structures.”

How the Labour leader and his Secretary of State for Health respond to this challenge will be an important part of the politics of health over the next few years.