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.

Will entrepreneurs be allowed to play any sort of role in developing the NHS?

Filed Under (Health Policy, Private Sector, Reform of the NHS) by Paul on 27-01-2012

On Tuesday evening I heard an inspiring speaker talk about the role he and his company are playing in the development of efficient hospitals in India. This was the third such talk I have heard over the last 6 months or so – all from Indian entrepreneurs who are driving down the cost of health care and thereby bringing it to many more people than under current provision. Read the rest of this entry »

The progressive argument in favour of lifting the private patient income cap for Foundation Trusts.

Filed Under (Foundation Trusts, Health Policy, Private Sector, Public Health, Reform of the NHS) by Paul on 10-01-2012

As I commented last week, I have given up waiting for the Government to make a coherent case for its reforms. So when, in late December, the Times published the story that a new amendment had been laid in the Bill to increase the level of the private patient income cap for Foundation Trusts, I did not expect too much from the Government by way of an explanation about why this was an important and necessary aspect of the whole NHS reform programme.

I was not disappointed. Read the rest of this entry »

More lessons from the Hinchingbrooke takeover

Filed Under (Hospitals, Private Health Care, Private Sector) by Paul on 15-11-2011

Yesterday I drew some political lessons from the Hinchingbrooke takeover. Today I want to draw some lessons from the procedure that has taken so very long to come to a conclusion.

I think it’s pretty certain that over the next few years there will be a variety of different takeovers and mergers of NHS hospitals. When these have been carried out in the past they have been mainly attempts to reduce costs by forcing several organisations to merge. Most of these would not have been mergers or takeovers in any other industry or service. In the NHS mergers have usually brought together 3 failing hospitals to create a single, large, failing hospital. 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 »

Some more thoughts on the Secretary of State’s attack upon New Labour and PFI

Filed Under (PFI, Private Sector, Reform of the NHS, Secretary of State) by Paul on 01-11-2011

(In yesterday’s post I made the point that I felt that the Secretary of State had shifted his position and now wanted to act to stop the bad results of the variation of practice with the NHS. This met with a number of responses from readers. Some of the early Twitter comments felt I was being incurably optimistic that the Secretary of State would really begin to tackle variation of practice by radically changing hospital organisation. It’s strange to be in the position of defending a very damaged Secretary of State, but I feel he has come to this position not through choice, but because he has had to.

18 months into the job he becomes responsible for the NHS and everything that happens to it. That means that the results of the CQC inspection that was published the week before stops being ‘the fault of the Labour Government’ and becomes the fault of this Government. Given that he has now agreed a set of changes to his Bill which demonstrate that he is firmly responsible for the NHS, it’s about now in the Parliament when, so far as the public are concerned, he becomes clearly responsible.

Therefore when any credible body now criticises the NHS he will need to say what he is going to do and given that he will have to say what he is going to do, someone will start to hold him to account for it.

This will also happen to the Government in other areas of policy and economics. For as long as possible they will say that it’s the previous lot’s fault, but sooner or later the public will think that too much time has passed since the election and that argument will no longer work. This responsibility has come earlier in health than in other policy areas because the last 15 months have been such a noisy political mess over NHS reform. The public clearly know that so far as the NHS is concerned there is a new Government – because there has been so much noise and such a mess.

So my belief that the Secretary of State has changed his position on tackling variation in the NHS does not come from a naive position that he has suddenly changed his mind about his responsibility for improving bad practice. No, I believe he has started to take this seriously because the public and the voters have recognised that after 18 months in the job he is in charge. From here on in. It is his responsibility).

Today I want to comment on another part of his speech that will obviously become a theme. On 27 September I mentioned the fact that when the Secretary of State named 20 trusts that were potentially clinically and financially unstable because of PFI deals he managed – in one speech – to make the leadership of trusts come out in support of their PFI deals. Read the rest of this entry »

Profits; profits and health care; profits and the NHS

Filed Under (Private Sector, Reform of the NHS) by Paul on 05-08-2011

The relationship between profit, the NHS and health care is an important one. It would have been a very useful part of the Government’s narrative if there had been a real public debate about how profit and the NHS might intersect as a part of their reforms. But, as we know, they failed to engage with that narrative at all and now, given the Government has expended all of its leadership political capital on pausing the reforms, we will get no leadership from them in that debate.

It’s a debate in which the Conservative-led Government is embarrassed to engage. Read the rest of this entry »

The politics of profit in English health services

Filed Under (BMA, GPs, Private Health Care, Private Sector) by Paul on 02-08-2011

Last week I posted about a piece of research that examined public thinking about the issue of private sector health companies using staff trained within the NHS at public expense. The majority believed that doctors who made money in private practice should make some contribution to the public purse from their earnings if their training had been paid for by the public. Read the rest of this entry »

Private sector health care and payment for training

Filed Under (GPs, Private Sector, Resources) by Paul on 27-07-2011

Education and training in the NHS use a great deal of our public resources. This investment plays not only a very significant role in developing the NHS, but also plays a much wider role in developing our society. The fact that tens of thousands of teenagers in every generation work hard to get into clinical education demonstrates the central role that the NHS plays in people’s lives. Read the rest of this entry »

Gossip is growing about possible future NHS reform.

Filed Under (Conservative party, Health Policy, Private Sector, Reform of the NHS) by Paul on 27-06-2011

In the last week, two different people have independently told me of conversations they have had with Tory MPs concerning the direction of Conservative politics for the NHS in a few years time.

The story begins with the politics of the NHS becoming increasingly difficult for the Tories. Whilst they have put the reforms to bed, the next few years are going to see increasing political strife about ‘cuts’ in the NHS.  These will be firmly linked in the public mind with the role of the Conservative Government. In reality they will have been caused by an unreformed NHS failing to improve its productivity or value for money. Read the rest of this entry »