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 »

Does the NHS really have to create a new business model?

Filed Under (Clinical Commissioning Groups, Health Policy, NHS England, NHS Providers, Nicholson Challenge) by Paul on 12-03-2014

One of the remarkable experiences of my last year has been to witness near universal agreement that the NHS needs to change fundamentally. Nearly all of the various bits of the NHS agree with this.

Most of their speeches and papers usually agree that the need for fundamental change exists in terms of both quality and finance.

If you look at speeches from…

  • The Secretary of State
  • The Chief Executive of NHS England
  • The Chief Executive of Monitor and
  • The Chief Executive of the NHS Trust Development Agency

…they continually say that there needs to be change which touches on the fundamental.

Many talk about the next 2 years being the defining moment for the NHS with a warning that a failure to change dramatically will put the institution in peril.

So much so universal.

I am sure these four individuals (one Jeremy and three Davids) really believe in the necessity of large changes, and given that they all run big organisations with, between them, thousands of staff responsible for parts of the NHS, one might expect that their organisations would all be beavering away at the forefront of radical change.

You might expect that if you met a civil servant from the DH, or an employee of NHS England, Monitor, or the TDA they would all be raising questions about how, in order to save the NHS, you were developing your new business model. Given that the leaders of these large organisations are preaching very radical change, then you might expect their staff to be an active part of a massive engine of change.

But you would be wrong.

Whilst the leaders talk about the need for radical change, their staff enforce the old business model that their leaders say is finished.

This can be a bit bewildering for, say, a CCG. They will read NHS England’s call to action and may well start to develop some commissioning intentions and activity that will radically challenge the existing providers of healthcare to change their business model.

They will then discover that their Local Area Team, as a part of NHS England, will sharply question why they are doing something that will ‘destabilise local providers’. A wise CCG will then quote David Nicholson’s letter as a defence of such radical plans back at the NHS England employee.

Usually, and without hesitation, said employee will tell the CCG to pay no heed to that because all that matters is that the health economy breaks even financially – and that if you ask your failing local District General Hospital to do something different, they will financially fall over.

So stop it.

The leadership of Monitor and the NHS TDA both recognise that, for many of the NHS’ acute and mental health trusts for which they are responsible, the current business model is running out of time (and money). There is even encouragement for Trusts Boards to think about radically different business models and models of care.

But woe betide any board, in thinking through those new business models of care, that might opt to forgo any of the finances that come from within the existing model of care. If that happens Monitor and TDA staff will very quickly threaten them with lower ratings if they fail to squeeze every financial drop out of the existing business model.

So these important organisations have a policy of radical change in the NHS…

…and a practice of not allowing that radical change to happen.

On many Trust and CCGs boards there are one or two senior staff who think about going through the difficult process of radical change. But the difference between policy and practice within the major organisations running the NHS makes arguing for the necessary change within the NHS very hard indeed. Those against change argue that the practice of the main performance managers in fact penalises change by enforcing the status quo.

If the necessary changes in the NHS care model don’t happen this will in part be the fault of the very organisations whose leadership appear to be arguing for them.

Practice beats policy every time.

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 »

Andy Burnham (as he moves from being uncomfortable in Government to being comfortable in opposition) and Circle’s takeover of Hinchingbrooke.

Filed Under (Hospitals, NHS Providers, Private Health Care, Private Sector, Secretary of State) by Paul on 14-11-2011

Last Thursday I blogged about a report which examined different approaches to losing weight, and received some interesting comments which I will talk about later in the week.

But by chance this post was published on the day that the agreement between the Government and Circle at Hinchingbrooke was finally signed and some people want to know my thoughts about this. Read the rest of this entry »

Does the answer to the problem of creating integrated care lie entirely within the NHS?

Filed Under (Health Policy, NHS Providers, Patient Choice, Private Sector, Reform of the NHS) by Paul on 16-06-2011

Tagged Under :

Regular readers will have noticed that the relationship between integration and competition is an topic upon which I have posted a couple of times in the last few weeks. In my view all the commentators pointing out the importance of creating integrated care services for the NHS are correct. Read the rest of this entry »

The Development of Private Sector Offers to NHS Patients

Filed Under (Health and Social Care Bill, NHS Providers, Private Sector) by Paul on 23-05-2011

Since this issue has been so much in the news, and since those who are defending the NHS against intrusions from the private sector are all over the media at the moment, I thought I would return to a post I wrote when the White Paper came out last July. Read the rest of this entry »

The White Paper – Liberating the NHS and the independent sector

Filed Under (Creating public value, Health Policy, NHS Providers, Reform of the NHS, Third Sector, White Paper) by Paul on 23-07-2010

If there is one group that should have received the White Paper with unalloyed pleasure it is the private sector health care companies who are trying to sell their services into the NHS. Read the rest of this entry »

Saving for the NHS by building a new business model for the health care of people with Long Term Conditions

Filed Under (NHS Providers, Public Health, Reform of the NHS, Third Sector) by Paul on 06-07-2010

The NHS, alongside all other health care systems in developed countries will soon run out of money. All of these systems have become used to increases in resources that have more than kept pace with the increased demand for health care caused by an aging population and increased public expectations.
Read the rest of this entry »

Coalitions are one thing but there are strong contradictions within the Conservative Party itself and they will tear their NHS policy apart within 2 years

Filed Under (Conservative party, Creating public value, Health Policy, NHS Providers, Reform of the NHS) by Paul on 20-05-2010

Regular readers of the blog will have come across the way in which I have explored the difference between policy and politics in the Conservative stance on NHS change over recent months and in the first few days of the new Government. Policy argues for a fundamental change brought about by the development of markets within the NHS. More incentives must be given to GPs as commissioners to drive change throughout the system. There must be a policy of “any willing provider” and the NHS must get used to empowered patients with much better information flowing around the system.
Read the rest of this entry »

More on the next steps on competition law and the NHS

Filed Under (Health Policy, NHS Providers, Primary Care Trusts, Secretary of State) by Paul on 22-04-2010

I am sure that blog readers are riveted by the politics of the NHS in the election, but to just remove yourself for a moment from that excitement, the real world of policy implementation doesn’t stop just because of the election.

Most of you will know that there is a set of rules called purdah where the Government is not allowed during the election to do anything that could give it political advantage.

But that doesn’t mean that all normal business stops.
Read the rest of this entry »

The end of the line for a personal change of policy

Filed Under (NHS Providers, Secretary of State) by Paul on 29-03-2010

Blog readers will have been following the twists and turns of the Secretary of State’s attempt to change the policy of the NHS to enforce his personal preference for the NHS as preferred provider.

Last week Society Guardian reported the end of the line as follows:

The health secretary, Andy Burnham, has lost his political battle to protect the NHS against competition from the private and voluntary sector. He had declared his intention to make the NHS a “preferred provider” of health services: some primary care trusts took this to mean independent healthcare firms and social enterprises should be excluded from bidding for contracts. Burnham’s ambition was seen by some as a sop to Labour’s trade union funders, and an attempt to re-establish the party’s anti-NHS privatisation credentials. Complaints were made to the NHS competition commission, and there were reports of disputes in cabinet over the issue. Today, the NHS published its revised guidance, which appears to blow Burnham’s ambitions out of the water. Stephen Bubb, chief executive of Acevo, which represents charities that provide public services, said:

Read the rest of this entry »