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.

Reform and Healthcare in Canada

Filed Under (Canada, Healthcare delivery, Public Health, Public service reform) by Paul on 12-11-2012

I spent last week in Canada talking to people engaged in health care reform in the provinces of Ontario and Quebec. Canada has a socialised medicine system with a lot of similarities to the UK system. The very existence of a socialised medicine system is very important to most Canadians.  Many would say that it is their socialised medicine system that differentiates them from the USA. Read the rest of this entry »

The Labour Party is right to talk of reforming the economy and, for the Labour Party, to reform the economy you have to reform the state.

Filed Under (Economics, Labour Party, Public service reform) by Paul on 03-10-2012

Ed Miliband has been right to concentrate on Labour’s plans to reform the economy at the Party Conference. There is growing and longer term evidence that the British economy really is broken. The prospect of our being able to revive it in its present form – so that it can provide prosperity for even the average earner let alone the lower paid – looks bleak. Read the rest of this entry »

Now the government faces both ways on civil service reform.

Filed Under (Public service reform) by Paul on 20-06-2012

Readers will remember that last week I posted twice on how the government were letting it be known that the civil service had let badly them down because they – the civil service – had not stopped the government from carrying out the government’s policy. Read the rest of this entry »

We keep hearing that Cameron will become Goverment’s CEO rather than its Chair – but it keeps not happening.

Filed Under (Health Policy, Prime Minister, Public service reform) by Paul on 15-05-2012

Regular readers will remember that back in April 2011 the Government paused the development of its health policy and outsourced it to a group of people it brought together over a weekend. At about the same time number 10 let it be known that the Prime Minister had made a strategic error when he came into power eleven months earlier, in explaining how he as Prime Minister would lead the organisation of the Government. Read the rest of this entry »

What do you need to do to carry out health service reform?

Filed Under (Health Policy, Narrative of reform, Public service reform, Reform of the NHS) by Paul on 22-09-2011

This week I spoke to a meeting of international CEOs from various countries and different parts of their respective health services. They wanted to know how the reforms were going and what the prospects are for the NHS. Read the rest of this entry »

Public Health – The Government’s reforms of its reforms – the National picture

Filed Under (Accountability, Public Health, Public service reform, Secretary of State) by Paul on 23-08-2011

In July the Government published its response to its initial reforms about public health. Whilst their original reforms had failed to excite as much public interest as their plans for GP commissioning, they did contain some very radical changes to the relationship between the Department of Health and public health.

Rather oddly, at a national level the public health reforms went in the opposite direction to those proposed for the NHS. Whereas the stated aim of the NHS reforms was to remove the Secretary of State’s accountability for the NHS (something that the 2011 reforms of their 2010 reforms changed radically), their original reforms of the Department’s relationship to public health abolished the independence of the Health Protection Agency (HPA) and brought their powers under the direct control of the Secretary of State. Read the rest of this entry »

To avoid accusations of dithering….

Filed Under (Health Policy, Public service reform, White Paper) by Paul on 11-07-2011

Today sees the publication of the Government’s Open Public Services White Paper. First discussed last autumn it was considered possible it might appear by Christmas 2010, and then spring 2011, but has finally made it on July 11 2011. Read the rest of this entry »

Taking the next steps in paying for social care – forwards or backwards?

Filed Under (Health Policy, Public service reform, Social Care) by Paul on 05-07-2011

Governments – all governments – produce hundreds of reports every year. This is partly because they all set up hundreds of reviews that all – at one time or another -have to report their findings. So it’s tempting to see the Dilnot report as just another report from just another review.

This would be a mistake. The reality of an ageing society is now all around us and will create more and more stresses on our social and economic reality. From previous posts on this blog and from the NHS itself we already know that Long Term Conditions will in the future cost the NHS an increasing amount of resource every year primarily because of the ever increasing number of people who live to be older than 85. We know that this increase in demand for health care from much older people is going to force the NHS to radically change the way in which the whole service delivers health care for people with Long Term Conditions. Read the rest of this entry »

When hesitation and retreat becomes a habit, it’s very hard for governments to shift into forward gear again.

Filed Under (Coalition Government, Competition, Public service reform) by Paul on 04-07-2011

Armies and governments can get used to retreating. In becoming expert at doing so they may forget that they are giving ground all the time, and when reviewing their week’s work, think it good – because they retreated well.

When the strategy is to give ground, the tactics are to do it well. Read the rest of this entry »