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.

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Coalitions are one thing but there are strong contradictions within the Conservative Party itself and they will tear their NHS policy apart within 2 years

Filed Under (Conservative party, Creating public value, Health Policy, NHS Providers, Reform of the NHS) by Paul on 20-05-2010

Regular readers of the blog will have come across the way in which I have explored the difference between policy and politics in the Conservative stance on NHS change over recent months and in the first few days of the new Government. Policy argues for a fundamental change brought about by the development of markets within the NHS. More incentives must be given to GPs as commissioners to drive change throughout the system. There must be a policy of “any willing provider” and the NHS must get used to empowered patients with much better information flowing around the system.

All this is modern and in keeping with what the Conservative party has been about since 1979. Over the last few months I, and many others, have pointed out that all of this market driven policy – increasing movement and change – runs into the politics of the outcome of all this change. Unsurprisingly this radical change creates – well – change, and in particular to the services provided through NHS hospitals. And when that happens politics trumps policy and nothing closes.

Obviously over a five year period this creates a very unstable situation and the  sweepstake doing the rounds at the moment is betting on the exact date when the NHS goes bankrupt – since it will not have enough money to keep redundant wards open. This contradiction cannot last.

You cannot pile a great deal more movement into the drivers of the system and then hold still one of the main outcomes of all of that change. For example if you correctly follow the policy of “any willing provider” and more non NHS providers come into the system, then by definition there will be less work for NHS hospitals – and you have to do something with that empty capacity. Leave it there doing nothing and it burns up your money.

So I have seen all this as a clash between high-minded policy and low-minded politics. But I am beginning to think there is a bigger contradiction in play.

When, in 2001, I started working for Alan Milburn on the new Labour reform programme for the NHS, it was obvious that the Labour Party was a coalition of a wide range of different strong ideas within it. Foundation Trusts was one of those that drew from the tradition of public service to join in with the tradition of co–operative involvement. The Labour Party was a coalition in just the same way as the Conservative Party is a coalition. And political parties think that because they exist with contradictory ideas inside them, then so can a Government 

So I no longer think that the problem is a Conservative policy that believes in markets and Conservative politics that is frightened of losing votes if they close a hospital. I think it goes beyond that (as indeed do such things in the Labour Party).

It is not an original thing to say but since Mrs Thatcher was PM, the Conservative party has contained a very radical political force that believes passionately that markets make the world. But also, at the same time, it has a very passionate belief in the stability of important institutions that makes the organisation – Conservative. It wants to hold things still. Both of these things give the modern Conservative Party a thrill.  They want to put radical market drivers into everything – and they want some things to stay the same.

In healh under Cameron and Lansley the things that stay the same include hospitals. They feel they are one of the cornerstones of our society and provide meaning to localities and communities and if they were to go then more than a health institution would go with them.

(Yet they also believe passionately in markets that will change everything)

So Andrew Lansley has taken political control of hospital change because he believes that the NHS has been reckless with these vital institutions. He feels, as a good Conservative, that closing a maternity ward or an A and E department is a wanton destruction of a part of the community, and for these reasons will not countenance their closure. So does his boss David Cameron. They think that in wanting to close hospitals  ‘NHS bosses’ have been playing fast and loose with the national heritage and they wont have it.

Both also believe that the NHS needs many more market interventions to increase efficiency and bring about quicker change. They think that the modern world they want to create will work much better with much more movement and change driving the NHS. They think that NHS bosses have been resisting the development of these modern changes.

So I don’t think the main problem is the contradiction between policy and politics – although that is there – I think it’s much deeper than that and lies at the heart of what the Conservative Party has been since 1979.

They want to be really radical change agents and they thrill to those changes brought about by empowered consumers and markets.

They want to hold certain institutions still as they are a part of the rich fabric of our society.

What will become clear – in between 18 months and 2 years time – is that markets create change; changes create successes and failures; and some hospitals will fail and will have to close.

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