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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Coming to this blog this autumn!!!!

Filed Under (Health Policy, White Paper) by Paul on 01-09-2010

Over the last few months the feedback to this blog has made me think about some different themes to post about and how to post them.

The publication of the White Paper on Health on July 12th made me realise that, given the size of that topic, it was simply not possible to cover the whole issue in a single post. So over the next few days I made a series of posts covering different aspects of the White Paper and ‘stayed with it’  over the following fortnight.

This seemed a move away from the immediacy of blogging, but it gave me as a writer and you as the reader the opportunity to develop a serial approach to a big issue.

Later on a fellow blogger had the very clever idea of boxing these posts into a single unit which in terms of TV programme might have been called a “boxed set”.

At the same time the readership of the blog increased significantly, and a number of people gave me some interesting feedback about the uses they were putting the posts to.

One of the issues this made me think about was how my experience of the detail of the political process might help readers understand what different aspects of policy mean for people in the NHS. Having been involved in developing the argument within White Papers means I have an idea about how the words in a policy document articulate with the wider politics.

Over the autumn the political process developing NHS reforms will continue.

A Health Bill will be published. Whilst the detailed wording of every Bill is a matter for lawyers and law makers, the publication of the Bill will demonstrate in greater detail what the Government intends to do with NHS reform. The publication of the Bill will be worth another series of posts to communicate to those interested in NHS reform how the detail of the Bill will impact upon them.

Over the months after the publication of the Bill, it will be debated in Parliament. The issues in the Bill are likely to touch upon some very important issues which parliamentarians will want to debate.

  • What role will Parliament play in holding the Secretary of State to account?
  • What role will Parliament play in holding the National Commissioning Board to account for the expenditure of over one hundred billion pounds raised by Parliament?
  • How will patients play a role in holding the Board to account?
  • Will GP commissioning consortia be nationalised by this Bill and moved into state organisations?
  • How will commissioning drive improvement in quality and value for money

These and other issues will be contentious and there will be strong debates about the legislation. My blog will cover these issues as they are raised and will look at the impact on the debate about the reform of the NHS.

As the Bill goes through both houses some amendments may be successfully introduced by other parties. But there will certainly be a raft of amendments introduced by the Government. Often it is only in debate in the Houses of Parliament that the Government comes to understand what a piece of legislation is going to achieve.

Under those circumstances the amendments made by the Government will have a dramatic impact upon what the Bill will achieve and how it will impact upon the NHS.

Alongside these themes I will continue to blog on the day to day issues of health service policy and practice.


6 Responses to “Coming to this blog this autumn!!!!”

  1. Your thoughts on why the government is doing what it’s doing would be interesting. I’m still scratching my head to discern the motivations underlying the White Paper.

    Is there anything beyond simply saving money or being seen to do something different for the sake of being seen to do something different?

  2. Hey, PC

    Always read the blog, top stuff and keep it coming.

    One thing that is stretching my imagination is the obsession with management costs. To any analyst of business the current percentage of NHS Cash spent in this area is relatively small.

    Last week DH publish figures showing referrals by GPs up 6% admissions up 8.3% in Q1.

    Acute services contract has levers to control this. So question – why PCTs not puling those levers? Effect on NHS overspend this year will be marked.

    Surely DH is monitoring.

    So – question – how is DH monitoring the reasons for the overactivity and how will any ‘management’ under resourcing issues be identified and then resolved?

    Sorry that’s three questions, but the drift is there.

    Keep up the blog – inspirational

    (Apols if any typos’s – can’t seem to scroll up to check)



  3. Richard. I think there are two motivations behind the white paper.
    First, a genuine belief that more markets and more competition will be better for the NHS.
    Second, a dislike of ‘NHS bosses’ that are state managers running the NHS and an attempt to put GP commissoning in charge. (The latter is undermined as I have pointed out by re-creating new state organsiations which will have to work like the old ones)

  4. Kevin,

    Three questions in one is doing more for less increasing productivity etc.

    The obsession with management costs is caused by politics. The politics says that managament costs are bad and front line costs are OK. (Managers bad, doctors and nurses good) But the the vast bulk of the money is actually spent on, with, and by the front line. And the problem with the two areas of spend that you highlight – GP referrals and hospital admissions – is that these have been under managed not over managed. The idea behind GP commisisoning is that when GPs manage the system it will be in their interests to manage these costs down. But it will be them as managers that will succeed or not in that task.

    Why don’t PCTs do something about this now in the summer of 2010? Some do and are – but the only way in which this can be done is by the PCT working with their GPs to manage these referrals down.

    If, in the summer of 2010, the GPs were to get the impression from the Government White Paper that they will be ‘liberated’ from management then they will feel able to do what they want. So being a PCT in the summer of 2010 trying to bear down on GPs referral activity is politically a very difficult thing to achieve as the weight of the discussion has been moved against them.

    Given that in the end the budget for 2010/11 is finite I think we will see a lot of flailing around cutting management costs for the next few months and then some rising panic at the size of the referral budget that will need to be managed by someone.

  5. Paul I disagree with your comment that the obsession with management costs is caused by politics.I believe it is due to bad CEO decisions.During 2006 our CEO left to take up a key role at the DOH, at the last meeting of the board the CEO announced a tempory consultancy appointment had been made to cover some of the work load,as a lay person I went home and checked via google who this person was and how successful he had been in his previous position, only to find numerious articles about a £475000 payout after a vote of no confidence by senior medical staff who felt patient care was suffering.The £475,000 taken in context probably represents a lifetime earnings of most patients who pass through the trusts doors.Possible blurring with morality,but still of concern to me ,is the question of the judgement used by the CEO.Why make a controversial appointment?did he think no one would make a connection?was the best man choosen for the job? unlikley.Was he cheap?debatable.We are probaley left with available.Not the best reason for such an appointment in a clinical area (Cancer)It is hoped that these new changes being implemented don’t produce similar results.I think know these are the reasons for obsession with management costs from the public’s perspective

  6. I’m interested in the debate about management costs not least because Andrew Lansley’s arbitrary target risks undermining the goals for the whole white paper.

    I have actually tried to find comparisons from other organisations to see if benchmarks can be found for how much management is required to spend NHS money well. How much, for example, do charities spend to decide which projects to fund? The answer seems to be a lot more than the target for NHS commissioners and, most likely, significantly more than PCTs used to spend. (for more detail see today’s times )

    But I’ve also been thinking about why the debate about management seems to get trapped into “all managers are useless bureaucrats”. As Mary Hoult says in the previous comment this is partially the result of what people have seen managers do. But one of the principal causes of managers being bureaucrats who envisage their job as telling other what to do and demanding adherence to Stalinist protocols is the way the government has chosen to run the NHS in the past. Central planning and central political control tends to produce those bad managers. Good managers, who see their job as designing the systems and environment that make it easier for the front line staff to deliver care, are not that important in a centrally planned system which tends to drive out the innovation and creativity that good managers need and replace them with adherence to central diktats.

    So we have the paradox that the government are using a centrally imposed diktat about the spend on management to correct a problem caused by previous central command and control behaviour. And the result may be a system which is has too little management to be organised well and can’t be controlled centrally either.

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