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 »

The NHS Confederation makes its case for a year of change in NHS hospitals

Filed Under (Clinical Commissioning Groups, Health Policy, Healthcare delivery, Hospitals, Independent Reconfiguration Panel, National Commissioning Board, Secretary of State) by Paul on 02-01-2013

The Government’s NHS reforms have done little to prevent the main change that will have to take place to ensure that our health service survives and thrives in any meaningful way in the future. That is the major reorganisation of many of the patient services that are at present delivered from NHS hospitals. In the last few days of 2012, the NHS Confederation has been putting the argument for change.   Read the rest of this entry »

Having rewritten everything else about the NHS the Coalition Government has now rewritten the meaning of the word ‘independent’.

Filed Under (Conservative party, Health Policy, Hospitals, Independent Reconfiguration Panel) by Paul on 26-07-2012

On July 2nd the new chair of the Independent Reconfiguration Panel took up their post. Lord Ribeiro, who was between 2005 and 2008 President of the Royal College of Surgeons, is, as a top doctor, an obvious appointment. If you want someone to do something ‘independent’ then it’s obviously totally within the meaning of that word to go to a top doctor.

But look again. This is the same Lord Ribeiro who became a member of the House of Lords in December 2010 and has, since then, taken the Conservative Whip. Whether he was one before he took up his seat in the Lords on 21 December 2010, he has, since that date, been a publicly committed Conservative.

But, you might say, are not these doctors who sit in the Lords an independent bunch? Don’t they vote with their conscience and not with a Party? Isn’t he an independent first, and a Conservative second?

Luckily an organisation called “The Public Whip” keeps a record of the balance between Lord Ribiero’s independent votes against the Government and his adherence to the Conservative Whip. They have computed that there have been 157 whipped votes since he took up his seat.

The noble independent Lord has only once voted against the Conservative whip. Or to put it another way he has demonstrated his independence over party loyalty on 0.6% of the occasions when he could have done so.

Let’s not forget that during this period of time a contentious Health and Social Care Bill has gone through the House of Lords. During this period there were many pressures on doctors to vote against the Government whip in favour of a different approach to NHS reform.

But again, perhaps like many members of the House of Lords, he has been a part time politician. Perhaps these voting record figures are those of a reluctant politician who only occasionally turns up?

Another organisation called “” computes the number of times that Lord Ribiero has voted with his political affiliation as a % of all of the occasions upon which he was eligible to vote. They calculate this figure at 73.02% – being the percentage of occasions on which he elected to vote with the Conservative whip. They comment that “This is well above average amongst Lords”

We have the evidence that the new chair of the Independent Reconfiguration Panel has been an active Conservative.

Does this matter?

It does. For two reasons.

First you will remember that the Coalition Government has wanted to take politics out of the NHS. “We want to free NHS staff from political micro-management” said the coalition agreement in May 2010. Over and over again the Government have said that the aim of their reforms has been to remove politics from the NHS. It is therefore, at the very least, strange to appoint a person with a clear track record of party political belief to a part of the NHS that has been, up until now, independent and free from political micro-management.

So the small point is that – as in a number of areas – the Government are doing the very opposite of what they said they would do. Rather than removing politics from the NHS, this is a clear example of the way in which they are putting people with a track record of active Conservative party politics into positions of power within the NHS.

The second issue is the specific work of the Independent Reconfiguration Panel within the NHS.  Hospital reconfiguration is a profoundly political issue. At both local and national levels there are campaigns against hospital reconfiguration.

The current Secretary of State was engaged in these campaigns in the run up to the last election. Within days of his coming to power he made reconfiguration even more party political by making statements in front of hospitals – opening up parts of them. These were all in Conservative constituencies and were all opening parts of hospitals where clinicians had supported their closure.

Over the next few years everyone agrees that the pace of hospital reconfiguration must quicken. The NHS will need a larger number of radical changes to develop sustainable and safer hospital services.

For the NHS to thrive the reconfiguration process will have to be seen to work well and work cleanly.

By appointing someone with a public record of Conservative affiliation the Secretary of State has made that process much harder.

In political terms it must be the case that following the appointment of the new Chair of the Independent Reconfiguration Panel the Labour Party in the localities and nationally will be looking very closely at all of the decisions that they make.

With this chair every contentious decision becomes more contentious.      .

A very strange way for the Government to remove politics from the day-to-day running of the NHS.