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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David Cameron stops “Leaving it to Lansley”

Filed Under (Coalition Government, Health Policy, Reform of the NHS, Secretary of State) by Paul on 17-01-2011

…and explains what he thinks NHS reforms are all about. (Meanwhile the BMA says that his NHS reforms are “extremely risky” and “potentially dangerous”)

The Prime Minster has made it clear that he sees himself as the “Chair” of the Government and not its CEO. So he has said he will not interfere and will not, for example, have health policy expertise inside No 10. As far as he’s concerned that is all a matter for his Cabinet.

That is why his speech on Public Service Reform is at least a change of tack. We won’t know whether this is a change of strategy until we see his next actions. For example, if he were to appoint a Number 10 health policy adviser, then I think we could say this is a change in approach. But we will have to wait and see…

From today (17/01) it has become clear that – rather like the Chair of a football club – he has had to express confidence in his Cabinet Ministers in carrying out their reform programmes. This confidence is expressed not just in the current Secretary of State for Health but in his colleague the Secretary of State for Education.

The speech – as befits the Chair and not the Chief Executive of the Government – does not go into detail of the reforms but asks, and answers, four main questions (It’s on the Number 10 web site for those who want to read the whole speech).

First, how can we modernise public services when there is so little money?

Second, why do we believe there is a real prospect of our succeeding in modernising public services when so many others have not?

Third, won’t there be losers from the changes we make?

And fourth, do you have to make all these changes so fast, so soon?

These are the questions that are being asked of his Government and especially of the proposed NHS reforms.

In health the Chair of the Health Select Committee (and he has a report coming out tomorrow) has raised the issue about the need to save money as being rather more important than a structural reorganisation.

On the second question there is scepticism within the NHS that the Conservative Party has the skill and understanding to reform the NHS.

On the third question there is recognition that the competition and market policy that he is speeding up must have an adequate failure regime and that there will be hospital closures.

And on the fourth everyone is saying that to NHS reforms are being rushed.

So these were the correct questions to be asked and answered. And time will tell whether his answers to the questions are to the satisfaction of those who oppose his reforms.

His answer to the first question is that actually even after all the cuts the % of GDP spent on public services will be, at 41%, the same as in 2006. So there won’t be a lack of money. But he does go with a much more radical answer than was in the December 13th Government responses to the consultation on the White Paper. That is that the only way that money will be saved is through reform of the NHS, and that waiting to save the money before reform won’t work.

In the middle of his speech he does what I predicted in my blog earlier today – he says that you are either in favour of his reforms – or you are in favour of the status quo. This is not at all the case. You can be against the status quo and in favour of different reforms. You can – as the Royal College of GPs has said today – be in favour of a radical reform of PCTs without abolishing them. So the reality is that there are many ways to reform that are not those of the Government.

His answer to the third issue is a little more obscure. He doesn’t say that there won’t be losers but he does say that the fear of their being losers does lead to a problem of how you generate success. In fact within the NHS, as a result of the reforms, there will of course be losers.

But it is the last issue, the issue of speed, where he is at his most illuminating. The Government have decided that they have to change things at speed in their first term. The lesson they derive from Tony Blair is that he did not go fast enough. (They don’t seem to ask why?). So they are determined to go faster than Tony Blair. And it is that that brings them into conflict with so many people in the NHS.

On the same day as this speech was made the BMA said that they felt the reforms were “extremely risky” and “potentially dangerous”. These are very strong words and I don’t think the answer by the current Prime Minister – that he wants to be speedier than his predecessor – is going to answer the BMA’s anxieties here.

The speed issue will run through the whole of the next year’s politics of reform. I believe that the public will start to become worried about having the words ‘extremely risky’ anywhere near their NHS.

David Cameron’s speech makes it clear that he supports his Secretary of State for Health’s approach and timetable for NHS reform. The Government is now firmly behind it.

The problem will be that the BMA’s phrase “extremely risky” will be remembered in the public mind as an outcome of January 17th 2011 for a long time after David Cameron’s speech has been forgotten.

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