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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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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

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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.

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