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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.

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A new strong position emerges: Against the Bill and in favour of NHS reform

Filed Under (Alan Milburn, Health and Social Care Bill, Third Way) by Paul on 10-02-2012

This has been an extraordinary week for the politics of NHS reform.

Yesterday I quoted a Press Association release from Tuesday which had the classic example of a No 10 spokesperson briefing against a Cabinet Minister  (Andrew Lansley should be taken out and shot). Whilst the language was a little strong the idea of Number 10 briefing against a Cabinet Minister goes back more than 50 years.

The fact that within a few hours the Prime Minister gave the Secretary of State his full support is par for the game.

In terms of the support of his own Government Andrew Lansley ends the week more secure than he started it.

Given the extreme language used by most commentators to describe the incompetence of the Secretary of State’s abilities in  explaining the Bill, the strong support from the Prime Minister is remarkable. If the Secretary of State cannot explain the Bill before it becomes law he is not going to have an easy job explaining the patchwork quilt of compromise confusion and complexity (Alan Milburn) that the Bill will be if it becomes law.

Wednesday also saw some interesting examples of a new political position emerging.

A clear argument is emerging among those who oppose the Bill and who also strongly support the need for NHS reform. Leaders in both the Times and the Independent made this case.

The article by Alan Milburn in the Times was the most trenchant, combining very strong language in favour of reform with equally strong language favour of defeating the current Bill.

This position will strengthen. And one of the reasons it will do so is because of the near universal opposition to the Bill by medical profession’s organisations.

Here an interesting politics emerges. The profession has been trying to obtain unanimity against the Bill. It seems to believe that if every part of the medical profession is against the Bill it cannot be passed.

However both the Times and the Independent are suspicious of  opposition to the Bill precisely because it appears to contain all the medical professions.

Both leaders ask the question – what’s in it for the professions to be against reform. Their very unanimity argues that case.

The Times calls the medical profession ‘the most conservative profession in the country’. And the Independent called into question whether opposition to the Bill is merely a reflection of the personal vested interests of doctors.

In the long term the development of this political position is important.

This position recognises two things.

First – that an unreformed NHS will not survive. The money will not be there.

Second – that the Government reforms are not the answer to the problems that need reform.

In the long term this is the most difficult position for the Government to tackle. For as long as they can say the NHS needs reform and this is the only reform in town they believe that they can gather sufficient support around them.

This will never be a majority of the public. They lost the opportunity to gain that majority when they failed to explain their rationale for the changes a year ago. But some people are suspicious of the unanimity against the Bill and will be left with a suspicion about why this is happening.

The Prime Minister’s problem is that his Bill will not reform the NHS sufficiently for it to develop much better health outcomes for the same level of resource.

Opponents of reform will only ever be able to secure a uniform position by standing against reform. That reactionary position will also become untenable.

This week we saw a fledging ‘third way’ on NHS reform emerge (and where have I heard that phrase before?) and begin to gather some pace in the argument.

From here on this position can only get stronger as BOTH the government’s NHS reforms and their conservative opponents weaken.


One Response to “A new strong position emerges: Against the Bill and in favour of NHS reform”

  1. Reform of the NHS in England is inescapable. The current Bill is a sow’s ear of legalese. No amount of tweaking is going to turn it into a silk purse of convincing narrative for change. It has to go and be replaced by something that is comprehensible and that people in the health service and the public of course can all support. Stephen Dorrell and the Health Committee said clearly that the NHS is distracted with reconfiguration and structure. It was ever thus.

    As Peter Carter of the RCN observed recently, the turbulence of abandoning the Bill now will be bad, but that is preferable to the worse turbulence to come – at local implementation level – if it is rammed through. He is right. The public has no idea of what could happen if government persists in pushing this legislation through.

    What people who work in the NHS should be focused on – at every level – is making the systemic changes to deliver better quality and more effective services to the right people in the right place at the right time. That is what “QIPP” (quality, innovation, productivity and prevention) is about. It’s no joke. If we don’t achieve these sorts of changes, through engagement with patients, carers and communities, as well as clinicians, then no new structure is going to be affordable or effective.

    The Future Forum’s two reports – all recommendations accepted with alacrity by the Government – constitute pretty much all that needs saying about what sort of NHS England needs. It is one built on an understanding of needs and engagement with users and carers, the public, clinicians and managers. Keeping things as they are now is not “Plan B” but simply a recipe for disappointment and probably also for bankruptcy.

    There is a strong narrative for change that is simply not being heard clearly over the party political noise. If we do not act on that soon, there is a danger of straying into the wilderness so far that we cannot find our way back to reality.

    Andrew Craig
    Wandsworth PCT Professional Executive Committee Lay Member, 2002-2011

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