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 »

Winding down

Filed Under (Uncategorized) by Paul on 20-03-2013

I have now been writing this blog for four years. And whilst, over the last few decades, I have always enjoyed writing articles, pamphlets, and even the occasional book, writing a blog is different.

First it has an immediacy which the other more traditional forms of writing don’t have. An article for the HSJ comes out, at best, a fortnight after you have written it. A pamphlet might be published 10 months after it was begun, and writing a book always feels like a lifetime. So the immediacy of writing a blog was very different and I had to learn how to do that.

Most of my posts have been written at 6 in the morning, or on a train journey on the day before publication. Tweeters will know that I have not engaged with their minute by minute level of immediacy. I have used Twitter mainly to advertise the blog.  The reason I haven’t tweeted more is that I have been afraid that if I did my life might disappear in a welter of tweets.

So I have become sufficiently modern to manage day to day commentary, but minute by minute still feels beyond my capabilities.

The second thing I’ve learned about writing a blog is that you have to write it in such a way as to allow and encourage the reader to complete it with their own ideas and emotions. Most of the ways in which we learn to write teach us to complete our contributions by tying them up with a great big bow to show they are finished. A method that leaves no room at all for argument.

I have come to believe that whilst this approach may make a good article for the BMJ  it makes a lousy blog.

The point of each post in the blog has been to progress my own argument but also to provide room for disagreement – and to raise questions and encourage debate. Above all there should be room in the post for people to think their own thoughts and to agree, or disagree, in their own ways.

Learning to write in this way has been a lot of fun, and very different.

A lot has happened in these past 4 years.

I started the blog when there were still 13 months to go for Gordon Brown’s government and during 2009/10 the numbers reading it moved slowly upwards to about 1000. Then the election campaign in 2010 moved them up to about 3000 a week. Over the summer of 2010, as Andrew Lansley’s White Paper was published, they did not go up so much.

It was only when readers realised that the Coalition Government were really going to carry out their reforms that more people wanted to make sense of what they meant. By the time of the famous pause readership had increased to 5000.

The reason for this growth had almost certainly, less to do with my great insight, and was more likely a consequence of people having no idea what on earth was going on.

Then there was the occasion when John Rentoul, in the Independent on Sunday, reprinted my post setting out the words that Lansley and Cameron should have used to apologise for the chaos of the reforms and the ‘pause’.

Through the period of the pause numbers rose again, and as the reformed reforms entered the House of Lords more than 10,000 readers a week were visiting the blog.

As the row about the Bill grew and it finally became an Act the blog readership peaked at 20,000 hits a week and it has stayed around that figure – slipping a little last summer – until recent weeks.

I am advised, by those in the know, that when you reach a certain size there are machines that roam around the blogosphere looking for new material. You, dear readers, will know how many of you are machines.

But now I am now going to wind down the blog. It’s been fun but it’s also been hard work – and I want to reduce that work.

At the height of the politics of reform I was writing four posts a week and in most weeks there have been three. Over its four years of life that’s equated to about 600 posts which probably means I have written around half a million words. They are all there on the web.

This does not mean I am never going to write another post. There will be times when I just won’t be able to help myself. But from the end of March I will not be writing two or three times a week.

Thanks for reading it. Thanks for all the comments and, above all, thanks to all those who have taken the time and trouble to talk to me about the content.

Whilst this is not ‘goodbye’ it does mean that I won’t be popping round to see you quite so often!

An important day for the NHS to show it can stick to its principles whilst learning from mistakes.

Filed Under (Francis Report, Uncategorized) by Paul on 06-02-2013

The Francis report is published today. Nowadays even the most sensitive legal documents are heavily leaked – with the Guardian seemingly having a copy on its front page last week. However despite the leaks it’s always best to wait for publication before commenting on the actual content.

I want to make some wider points here. These have occurred to me whilst looking at the press preparing for Francis. It is already clear that a number of newspapers will construct from the findings an analysis that chimes with their fundamental hatred for the basic principles of the NHS.

Read the rest of this entry »

An Olympian break

Filed Under (Uncategorized) by Paul on 27-07-2012

Today, July 27th , sees the start of the London Olympics.

The NHS was founded in July 1948 and later that summer, London hosted the first post-war Olympics. Being only a few months old at the time I don’t remember anything about those events, but here I am in London, 64 years later, celebrating both again.

I understand that the opening ceremony will devote some time to making the connection between 1948, the NHS and the London Olympics.

As a Londoner I find all this very exciting will be suspending the blog for the duration of the Olympics – and will then take a holiday.

Normal service will be resumed on September 3rd.

Enjoy the games!

This year’s mandate will pile added layers of instruction on top of last year’s operating framework for the NHS.

Filed Under (Uncategorized) by Paul on 10-07-2012

Last Wednesday the Secretary of State introduced his radical new idea of a draft mandate between himself and the NCB to the House of Commons. This mandate has 22 objectives which, in return for giving them the money, he wants the NHS to achieve in the next few years. Read the rest of this entry »


Filed Under (Uncategorized) by Paul on 12-06-2012

In the latest issue of Gesundheit!, the Stockholm Network invited myself and others from different arenas of healthcare policy to examine what they think the future holds for healthcare.

The article is available on their website.

Doctors to take industrial action to secure better pensions than most of their patients.

Filed Under (BMA, Uncategorized) by Paul on 31-05-2012

Blog readers will remember the fury of the BMA when the Government continued with their Health and Social Care Act . Month after month – from the autumn of 2010 to the passage of the Bill in March 2012 – the BMA warned that the Bill would endanger the NHS.  Read the rest of this entry »

News and the NHS – the journalist’s challenge in March 2012

Filed Under (Uncategorized) by Paul on 07-03-2012

On February 29th I gave a talk to the BBC College of Journalists. This was one of a regular series of meetings where people that have some expertise in a policy area come to talk with a range of different BBC journalists about ‘the story’ and how it is developing. Read the rest of this entry »

Just when you thought Government NHS reforms couldn’t get any weirder…

Filed Under (Health and Social Care Bill, Reform of the NHS, Secretary of State, Uncategorized) by Paul on 09-02-2012

I am afraid that for today’s blog I can do no better than to completely reprint a Press Association Press release issued at lunchtime on Tuesday February 7th,



Feb 7, 2012 1:17:26 PM Read the rest of this entry »

Blair’s and the current Government’s NHS reforms – is there any continuity?

Filed Under (Coalition Government, Health and Social Care Bill, Health Policy, Tony Blair, Uncategorized) by Paul on 23-01-2012

Last week I posted on the necessity for the Labour opposition to construct a set of medium to long term policies for the NHS which would clearly see them work with it over a period of time that I think of as ‘the long austerity’.

I received a number of comments from people who felt that the reforms in which as special adviser to Alan Milburn, John Reid and Tony Blair I was involved from 2001 – 2007 had laid the ground for the current reforms and that I should take some of the blame for the current Government. Read the rest of this entry »

But if the Bill does pass – what happens next …

Filed Under (Health and Social Care Bill, Uncategorized) by Paul on 16-01-2012

A couple of people said over the weekend that they thought my post on Friday about the passage of the Health and Social Care Bill was a bit of a tease. They wanted me to explain what I thought would actually happen next if the Bill is passed. I think there are three potentially different outcomes – each of which needs a post in itself.

Firstly there is the immediate politics of what happens if the Bill is passed – how do the Government – as victors – behave? How do those that wanted the Bill defeated behave – as losers? Read the rest of this entry »