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 »

Warning! Beware of invitations to come and help the Government.

Filed Under (Culture of the NHS, Narrative of reform, Patient Choice) by Paul on 20-05-2011

Over the last few weeks a few people have been surprised to receive an invitation to breakfast – or a meeting – in an embossed envelope. The embossed mark over the flap looks important and, when they open it, most of them will have been surprised and even a little bit thrilled to find it was an invitation to meet with the Prime Minister to talk about the NHS.

For nearly everyone this is an exciting moment – it’s flattering, and a great opportunity. Surely there can be no down side to an invitation from the most important person in the country?

Generally this has been true – until this week.

Now you may want to think more than twice about accepting such an invitation since the person issuing it might just change his mind about you so quickly that you find yourself under attack in Prime Minister’s Question Time.

That’s what happened to Mark Britnell this week.

I am sure the Prime Minister is not a rude man. I am sure that when he invites people to help him, his manners and breeding would never normally allow him to turn upon his invitee and attack him. .

So the fact that he did just that this week can only be explained by depth of the panic he has got himself into about his NHS reforms.

Since April 4th, when the Government decided to pause and have a bit of a think about its NHS reforms, the PM has met with a wide range of different people. Some of them have received invitations to be a part of the Futures Forum. A smaller group were asked to come and meet him for breakfast on May 4th.

The HSJ had a list of some of the people who were invited to this breakfast meeting – one of them being Mark Britnell. Mark worked for 20 years in the NHS before taking up a position as Chairman of KPMG’s Global Health Practice.

One of the declared aims of the Prime Minister is to improve the success of the NHS when compared with the rest of the world, so having someone with deep experience of the NHS – who now has international experience of health services – looked like a good idea.

Then at the weekend the Observer carried a story about Mark Britnell speaking at a US conference, recommending that the private sector play a bigger role in the NHS.

Last October this would have been an unexceptional argument. After all in July the Prime Minister had signed the foreword of the White Paper that stated in its executive summary,

“Patients will have choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment.

We aim to create the largest social enterprise sector in the world. Monitor will become an economic regulator, to promote effective and efficient providers of health and care, to promote competition, regulate prices and safeguard the continuity of services.

This is a challenging and far-reaching set of reforms, which will drive cultural changes in the NHS. “

Over the winter I delivered dozens of talks about the Government NHS programme and  said, on most occasions, that the Government wanted a greater role for the private sector. I said that because I believed that the Prime Minister had said that he would provide patients with a choice of any provider, and do that through creating the largest social enterprise sector in the world with an economic regulator who would to promote competition and drive cultural change in the NHS.


It does not surprise me that Mark Britnell did the same because (wrongly as it turns out) he thought the Prime Minister knew what his policy on NHS reform was too.


We could not have been more wrong.

By the time the Government reached May 2011 it was battling with a public narrative that says they are privatising the NHS, and this has sent them into a panic.

So in May 2011 a man who was invited by the PM to come and give him advice, and who has been arguing for greater role for the private sector in the NHS, presents something of a problem.

So at this week’s PMQs what the Prime Minister needed to do was to present a political argument in support of having such an adviser…

Did he do that? Did he say that his judgement of a few weeks ago was that he wanted to hear from diverse voices and thought it might be useful to hear from someone with both NHS and world experience?

Does he even acknowledge his own invitation of a few weeks earlier?

No, he decides instead to attack the person whose advice he has sought.

So on Wednesday, when asked by a Labour MP why he was seeking advice from the very Mark Britnell who believes in the private sector, he replied,

“ I am very grateful to the hon. Gentleman for allowing me to clear this up. When I read about Mr Britnell being my adviser, I was slightly puzzled, because I have never heard of this person in my life, and he is not my adviser. However, I did a little research, and it turned out that he was an adviser to the previous Government. [Hon. Members: “More!”] Oh, don’t worry, there is plenty more. He helped to develop Labour’s NHS plan in 2000, which increased the role of the private sector, he was appointed by Labour as chief executive of one of the 10 strategic health authorities set up by Labour, and when the Leader of the Opposition was in the Cabinet, Mark Britnell was director general for NHS commissioning. Although I do not know him, therefore, I suspect that Labour Members know him rather well.”

I will get to the detail of this attack in a moment. But take note – just in case you receive an invitation to breakfast at Number 10 – the PM may claim that he has never heard of you..

In the core of his answer the PM politicises the civil service. He claims that ‘Labour’ appointed Mark Britnell to be the CEO of the SHA. He links the fact that Ed Milliband was in the cabinet with Mark Britnell’s appointment as a Director General of the Department of Health.

Where is the evidence that these appointments are political? All of these appointments went through the proper procedure. Is he suggesting that all senior NHS and DH appointment are political?

To discover just how scared the Prime Minister is, think a bit more about what is going on.

We have the extraordinary position of a Conservative Prime Minister denying all knowledge of someone who thinks there should be a wider private sector involvement in the NHS – simply for having that belief. In fact he says that this is much more the position of the last Labour Government than his own.

Given that this Prime Minister is prepared to attack someone simply for arguing in favour of greater private sector involvement in the NHS, do not expect him to stand by you under any circumstances. If things get tricky he will dump you.

So when that embossed invitation drops through the letterbox think very carefully about the possible consequences of accepting it.


7 Responses to “Warning! Beware of invitations to come and help the Government.”

  1. I don’t see how Cameron’s comments can be interpreted as an attack on Britnell. Instead it was an attack on Labour for pretending to be outraged by a policy (increased private sector involvement) that they introduced while in office and which the Labour leadership actually also think is the right thing to do to improve standards.

  2. I note you do note quote the question the PM was asked. So I will:”May I ask the Prime Minister why he has not sacked his NHS adviser, Mark Britnell…” I’m not entirely sure how you sack someone from a breakfast meeting but that’s not the issue.
    The issue here is that the Labour Party were trying to suggest that this man has wide influence on government policy and thereby tar the PM with any old quote he may have made in the past. Why not a criticism of the Labour Party for trying to use this chap in such a political and untrue way?
    The idea that the PM has to defend every Tom, Dick or Harry who turns up to a meeting is just comical. Perhaps a replacement saying for “one swallow does not make a summer” should be “one breakfast meeting does not make you a government adviser.”

  3. Why did Britnell allow so many press reports and blogosphere mentions about him being “a senior adviser to the Prime Minister” go uncorrected and unchallenged? A bit of honest self-deprecation might have spared him public humiliation. A call from Paul Bate doesn’t put you in a “kitchen cabinet”.

  4. To say Britnell recommended ‘that the private sector play a bigger role in the NHS’ is disingenuous. What he said – which is why this became a story to attack Cameron with – was, speaking to private healthcare organisations, that the reforms would ‘show no mercy’ to the NHS and offer a ‘big opportunity’ for private sector companies to make money out of muscling in on public healthcare. Given that Cameron wants to show that allowing private sector companies to be involved in providing NHS care will not be about them maximising profits at the expense of the things about the NHS most people value and some people rely on, how do you think he should have responded to this?

  5. Great post Paul.
    Laura – if you do not think Mr Britnell is in favour of greater private sector involvement in the NHS you are misinformed. He was arguing forcefully to selective audiences in favour of full throttle competition as the answer to the NHS productivity challenge even before the 2010 election.

    Cameron is increasingly coming across as a policy lightweight, blown around on the winds of public and media opinion.

  6. Ah, Trevor. I think by winds of public opinion, I think you mean ‘democracy’.

  7. The difference between Labour’s involvement with the private sector and now is that they used the private sector to enhance the NHS not compete with it. What concerns me is what would become of the very inefficiently required parts of the NHS like “Intensive Care Beds” which must have spare capacity to cover for inrushes due to epidemics, disasters etc. (Each bed requires four skilled nurses to man them around the clock), but much of the time they are therefore underused. The NHS can not hold on to these spare capacities and compete with cherry picking private health firms turning us quickly into a USA type system, which would become brilliant for the rich, and become very poor for the rest of us. If Cameron persists with this policy supported by Libdems the NHS is finished, and they will not be forgiven. Especially after stating the NHS is safe in their hands.

Leave a Reply