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 »

Patients and doctors are on the move. Where might the power to really improve the NHS lie?

Filed Under (Health Improvement, National Voices, Reform of the NHS, Secretary of State) by Paul on 30-04-2010

My post yesterday claimed that the two letters I reproduced in that post, the first published on March 26th from the patients’ organisation (national voices), and the second on April 28th from many of the Presidents of the Royal Colleges, could be more important for the future of the NHS than the result of the general election. Understandably this relative comparison of what is important has been of some interest to people and probably needs defending.

It needs defending especially since the person who wrote it has been steeped in a tradition of electoral politics for over 50 years and played an active role in my first election day at the age of 11 in 1959. Even in the last few weeks I have spent larger chunks of every day than I should using the excellent BBC 2010 election site which allows you to carry out a three way swingometer and predict the number of seats that each Party will get with different percentages of the vote.

So it’s not that party politics and its outcomes are not fascinating and important to me but most of the likely outcomes of next Thursday do not leave me feeling that there will be radical change from a pioneering Secretary of State for Health.

This leaves us looking elsewhere for the change and leadership that the NHS needs.

Why is that?

First as my three posts on the manifestos show, in the big picture of change the three manifestos agree on the main direction for the NHS. More patients’ rights; more patient choice and information; fairer and stronger competition between providers; everyone becoming a Foundation trust. It’s true there are some important differences but by and large it doesn’t matter that much who wins. The policies will be different but not game changingly so.

Second it’s difficult to see the polls providing a single party with a resounding mandate for implementing strong change in the NHS. Even if any of the three Parties were to scrape an overall majority, it won’t be a big one where a reforming Secretary of State will sweep all before her or him.

Third the issue that will dominate any of the Secretary of State’s life will be the money and not a new policy direction. I know all political parties have said they will protect the NHS and I believe them that NHS money will not decline. But in reality holding the budget still when demand goes up is going to demand a new economics from a Secretary of State not a new policy direction. So it seems quite likely that whoever gets the most seats in the House of Commons, Her Majesties Treasury will win the election.

After they win they will be looking closely at all policies to see if they assist in the main national project of getting charge of public expenditure.

Therefore if a Conservative were to become Secretary of State, and they suggested to the Treasury that the best way we could save money was to create 500 new commissioning organisations called GPs with hard budgets I think the Treasury would not see this as a way of controlling expenditure. But of losing control.

Similarly, if a Liberal Democrat is Secretary of State for Health and they want to put their policy of elected health boards into place I cant see the Treasury – having spent 20 years wresting financial control away from local government, cheerfully giving local elected boards £100 billion.

The policy change will be weak because politics will be weak. And economics and the money will be the strongest – irrespective of the nature of the political party that gets into power.

And this is where these letters from patients and doctors are most important. The Treasury will know that the only way to significantly improve the health care outputs of the NHS from the same level of resources will be to close down those parts of the system that add very little or no value. The two letters make a strong case out for where this is.

Of course it’s not ’the hospital sector’ as a whole, but it is the sector that is not as good at its job as the best. Its hospital services that could be provided, and  with greater value for money, outside of hospitals.

Over the next few years the best hospitals in this sector with thrive and grow. The others will not.

But as these letters argue doctors and patients do not want to waste money on institutions and services that can be clinically provided with better value for money elsewhere.

Commissioners are likely to be the main drivers for improving value for money. If they want to improve efficiency these two letters give them a mandate to carry that out.

If a Secretary of State wants to get in the way of that – good luck to her or him. They might find themselves in a squeeze between the Treasury on one side and doctors and patients on the other.

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