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.

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12 months ahead of the general election campaign how should we understand the politics of NHS pay?

Filed Under (Election campaign, Health Policy, Jeremy Hunt) by Paul on 17-03-2014

Last Thursday the Secretary of State made an important announcement about NHS pay which was met with a lot of anger from NHS staff and their organisations. What is interesting is not just the announcement per se but the way that the Secretary of State chose to publicise it.

Those who felt that the way in which it was announced was deliberately designed to cause a row are almost certainly right.

Given that everyone in the NHS was either getting an increment or, if they were at the top of the scale with no more increments, getting a 1% pay rise this could have been delivered with a fanfare along the lines of “Good news everyone’s pay is going up!”.  We could have had a few paragraphs promoting that message and then something about how it’s not as much as he would have liked because of the financial crisis.

But no, that is not what was said. Instead an acutely PR conscious Secretary of State decided that a good story about everyone getting a pay rise should be turned into the bad story that a consolidated pay rise of 1% would be impossible because it was unaffordable. He headlined the curbs rather than the pay rise,

“The Pay Review Body proposals suggest a pay rise that would risk reductions in front line staff that could lead to unsafe patient care” .

This will save £200 million a year. (Remember that figure)

So why spin a story saying this is bad news when it could be spun as good news?

Because we are but 12 months away from the start of the next general election campaign. A campaign that will, so far as the government is concerned, be fought on the economic competence of the Labour Party.

So what has NHS staff pay got to do with that?

If the Labour Party say that they will implement the pay review body recommendations, it will cost £200 million. They might seek to justify this in two ways that could play into the government’s plan to attack their economic competence.

First a naïve Labour front bencher might say that this is a punitive attack upon nurses and that after all it will only cost £200 million out of an NHS budget of £110 billion. A rounding error and not a big sum of money.

How might a government spokesperson respond to someone falling into trap number 1?

“Only an economically incompetent Labour Party would say that £200 million is a small sum of money. Any responsible political party would recognise that this represents the pay of an extra 4000 nurses, not a rounding error. This shows how once again the Labour Party cannot be trusted with your money.”

A second naïve approach would be for a Labour front bencher to say they would find the £200 million from inside the NHS.

How might our spokesperson respond to that?

“The Labour Party thinks it can simply conjure money out of thin air. It can’t. NHS money is being spent on patient care. What we need to know from the Labour Party is where it will cut NHS services to find this money? Until it does we believe this could be your local hospital.”    

This Government will be looking for lots of small examples of how the economic arguments of the Labour Party don’t add up.

The politics of NHS pay is just another one.

Over the next year most announcements will need to be viewed through the lens of the election campaign in order to be understood.

But let’s return to the £200 million that Jeremy Hunt says is essential for front line services.

On the same day as the pay announcement another was made with far less fanfare. This was that government departments would make a much greater contribution to pensions for staff and that money would not be spent by the Treasury.

Next Wednesday, when George Osborne announces his budget, much will be made of a £1 billion infrastructure fund that the Treasury will pledge to spend on small infrastructure projects.

This £1 billion has been obtained by taking money from departments to pay for pensions that in the past were paid by the Treasury.

So Jeremy Hunt has agreed to give the Treasury £125 million a year that will now come out of his budget from 2015/6 onwards.

Surely, just as with the £200 million not being spent on pay rises, this £125 million can only be found by cutting front line services?

Odd that we’ve heard nothing about any cuts that might be needed to plug this £125 million gap.

So what is this Government’s policy on the NHS?

Filed Under (Conservative party, Election campaign, Health Policy, Lynton Crosby) by Paul on 06-03-2014

I have counted three very different and opposing policies that the Government have for the NHS. Interestingly none of them represents a split between the political parties of the coalition and all of them have Conservative actors leading them.

The first, as I outlined in yesterday’s post, is Jeremy Hunt’s policy for the Secretary of State to intervene in running the NHS several times a week often using powers abolished by the Health and Social Care Act 2012. His personal NHS policy of trying to run the service as if the Health and Social Care Act 2012 hadn’t happened is backed up by other parts of the Government.

In January the Deputy Prime Minister, in arguing for more attention to be given to mental health policy, came up with the good idea of having maximum waiting times for mental health treatment. He quite rightly reflected on the experience that maximum waiting times had had a significant impact on access for physical health, and wanted the same improvement for mental health patients.

The problem for Nick Clegg is that he signed up to the July 2010 White Paper which stated that the Government should not prescribe such targets from the top. In the summer of 2010 Andrew Lansley had indeed abolished them. (And if you ever wonder why the Government has such difficulties with the 4 hour A and E target it might just be a consequence of this abolition).

The first answer to the question of what is Government policy on the NHS is therefore that they are a powerfully interventionist Government delving into the detail of NHS practice. (Notwithstanding having passed introduced a law that opposes this policy).

Incidentally I have been told third hand that the Prime Minister’s intent for his 2015 manifesto will be to proclaim that “his NHS targets are better than Labour’s targets”. (This despite having abolished top down targets some time ago)

The second – very much quieter – NHS policy is to implement the Health and Social Care Act and the consequent reforms that they pushed through in 2012. This policy stops treating the NHS as a single organisation run from the top, but instead recognises that it is a system of very different organisations that work together to create an overall system called the NHS. NHS England, Monitor and the NHS Trust Development Agency are all separate independent quangos that fit into an overall architecture. Commissioning at a local and national level will drive change and improvement.

Not many people in the Government agree with this. A bit of the No 10 Policy Unit, a bit of Norman Lamb, but for the most part they want to forget the whole reform movement in health. It’s OK to talk about the reform of welfare or education, but let’s not mention the 2 years of hard work and disruption that went into the Health and Social Care Act.

There is then a third policy on the NHS that is run by an Australian in Number 10 called Lynton Crosby. ‘Cobber’ Crosby has been put in charge of winning the election. His policy on the NHS is to say nothing about it at all.

Polling tells him that every time the NHS is mentioned it moves up the salience of issues that matter to the public. If this were allowed to continue, and if by the spring of 2015 the NHS were to be say the third most important issue that the public cares about, then the Conservatives will lose votes.

To win the election the Conservatives need voters to be concerned about issues that will win them more votes – and the NHS will not be one of those.

So Mr Crosby sits in number 10 and fumes at the hyperactive Secretary of State intervening in this and that and making speech after speech about what’s wrong with the NHS whilst Jeremy Hunt is really pleased to get headlines for his speeches and interventions.

Mr Crosby considers Jeremy Hunt’s hyperactivity a very strange way of winning votes for a Conservative Government.

So there you are. 3 very different policies for us to watch will wend their way over the next 14 months until the election.

The Eastleigh by election, protest votes, and the NHS.

Filed Under (Election campaign, NHS Party) by Paul on 04-03-2013

By-elections always tend to have many more losers than the one winner and last Thursday’s Eastleigh by-election was no exception. There was even a potentially important lesson for the NHS action party which had its first by-election outing, and that’s the main topic I want to write about today.

But first I want to talk a little about one of the biggest losers at Eastleigh – an organisation that was not even standing. The Daily Mail spent the 10 days leading up to the by-election trying its best to get the Eastleigh electorate not to vote for the Liberal Democrats. They ran a media campaign against Lord Rennard in a very clever way – assisted by the failure of the Liberal Democrat leadership to grasp the issue. Read the rest of this entry »

Would 50+ doctors standing for Parliament at the next election have any impact?

Filed Under (Conservative party, Election campaign, Liberal Democrat Party) by Paul on 20-03-2012

Last Sunday’s story in the Independent concerning at least 50 doctors standing at the next general election against members of Parliament from the Lib Dem leadership and Conservative marginals was an interesting one. Once again – as much of the campaign against the Bill has shown – it demonstrates the gap that exists between the detailed experienced of party politics and the detailed experience of medicine. Read the rest of this entry »

The next election campaign started last Tuesday – with the NHS reform U turn

Filed Under (Conservative party, Election campaign, Reform of the NHS, Right wing ideology) by Paul on 20-06-2011

The dust is settling on the Government’s U turn on NHS reforms (referred to by my old boss Alan Milburn as the biggest car crash in NHS policy history). As the view becomes a little clearer it’s possible to see what was there before the winds blew dust in our faces. Read the rest of this entry »

What are the pressures on the new Secretary of State that might lead to a new direction?

Filed Under (Election campaign, Health Policy, Secretary of State) by Paul on 11-05-2010

After an election a Secretary of State for Health exists in a vortex of three major pressures.

The relative power of each of these three determines outputs.

They are the policy; the politics, and the public finances, and to understand what is going to happen we need to understand the relative power of these three forces. In May 2010 these clearly have different strengths.
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Be careful what you wish for! Now let’s see how the nation gets on without strong politics power

Filed Under (Election campaign) by Paul on 08-05-2010

For once and only once I am going to allow myself a post which does not concern itself with health care practice, policy or politics but does deal with the bigger picture of outcome of the May 6th election. Let’s look at the wider issue of politics and politicians in general.

I have spent most of my life closely working with and within politics. And the people who practice it – politicians- are also my very closest friends. It is the main topic of our conversation on most days. This means it matters to me not just in the abstract but concretely through the real people I love doing real things with their lives.
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Further evidence of post election changes from today’s Times

Filed Under (Conservative party, Election campaign, Health Policy, Labour Party, Liberal Democrat Party) by Paul on 04-05-2010

The Times on May 4th picks up on the big issue of post election NHS politics by highlighting the coming significant changes in hospital services. As with my own posts of last week they recognise the significance of the advice from patients’ groups and doctors to bring about improvement and value for money.
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The Election and the NHS

Filed Under (Conservative party, Election campaign, Health Policy, Labour Party, Liberal Democrat Party) by Paul on 27-04-2010

Whilst the opinion polls  show that the electorate still see the NHS as the second or third issue of importance to them (Behind the economy and in some polls behind immigration), there is really no trace of the politics of the NHS in this election. Given my comments on the Conservative manifesto this is exactly what the Conservative Party would hope from the campaign. At the start of the campaign the Labour Party was trusted with the NHS more that the Conservatives and it would therefore be to the Conservatives advantage if there was not much discussion of the NHS.
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Guardian 19th April

Filed Under (Conservative party, Election campaign, Health Policy, Labour Party, Liberal Democrat Party) by Paul on 19-04-2010

A very interesting analysis of the election campaign and the politics of the NHS in today’s Guardian:

The weekend polls pointed to a sudden shift in the political weather, but the vicissitudes of party conflict are underlain by the everyday concerns of the voters, which move at glacial rather than cloud-like speeds. Foremost among them is the NHS, recently ranked by Ipsos Mori as being second only to the economy in determining how the nation will vote. You would hardly know that from the coverage of the campaign so far. Still less would you guess that the Conservative party is planning to entrench a regime of competition which could shake up British healthcare just as dramatically as the leaders’ debate has shaken up the election.
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