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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Gossip is growing about possible future NHS reform.

Filed Under (Conservative party, Health Policy, Private Sector, Reform of the NHS) by Paul on 27-06-2011

In the last week, two different people have independently told me of conversations they have had with Tory MPs concerning the direction of Conservative politics for the NHS in a few years time.

The story begins with the politics of the NHS becoming increasingly difficult for the Tories. Whilst they have put the reforms to bed, the next few years are going to see increasing political strife about ‘cuts’ in the NHS.  These will be firmly linked in the public mind with the role of the Conservative Government. In reality they will have been caused by an unreformed NHS failing to improve its productivity or value for money.

Faced with increased demand for health care – rising much faster than resources – an unreformed NHS will start to limit the services it provides. Maximum waiting times will be increasing. By mid 2013 the Secretary of State for Health will have to go to the Chancellor and ask for another £5billion to pay off the inefficient hospital fund.

This is a great deal of money. More than is spent on all of the teaching in all of England’s Universities. The Chancellor, having decided against reform in 2011, will have to pay the price of making that decision by sacrificing some of the tax cuts he was planning for 2014.

Most of the Parliamentary Tory Party will be enraged. They will remember that it was the NHS itself that stopped the reforms of 2011 and they will continue to blame it for its own problems.

In this scenario the 2015 election will be fought with the Conservatives being about 15% behind on the issue of who will run the NHS. They will therefore try and fight on every other issue. Let’s pretend the Labour opposition is being run by a group who don’t do politics very well – so that even a lead of that size on NHS policy is not enough stop the Conservatives from winning a majority at the election.

This will deliver a Conservative Government that has won without being the party of the NHS. It is then – so the story goes – that the Conservative Party decides that enough is enough. The thinking goes like this –

“We have given the NHS more and more money and it has failed to deliver, except to cause us problems. Last time we tried to reform it – within its principles – the NHS stopped us.  Between now and the 2020 election we have got to do something really radical and change the whole basis of the service. There will be opposition, but there was when we tried to reform it within its principles.

Let’s change strategy and reform the NHS with co-payments. After all, even if we are 20 points behind on the NHS at the next election we can stand on everything else.”

So the Tory party turns on the NHS and changes it fundamentally with co-payment

As I said two very different people have mentioned this to me this week – and asked me what I think.

The great thing about politics is that it’s not just a bundle of interests and structures, but there are real leaders and real people involved.

So I could imagine most of this story happening. I think the Tory Party will be very angry with the NHS for most of the next five years. They will feel that they have sacrificed all sorts of policies to protect it, and that all they have seen in return are requests for  more and more money and less and less reform. They will turn on it and the Daily Telegraph will be full of stories about its hopelessness.

But the real historical question is how Cameron will behave. In 2011 he demonstrated how afraid he is of a reform battle with the NHS within its principles. Would he really have the political nerve to carry out this political scenario in 2015?

It’s true there will be a big row, but the Conservative Prime Minster will face down the reformists in his party rather than do anything about the problems of the NHS. He made this point himself several times over the last winter. He argued that if you don’t carry out reform in your first term, then you don’t do it.

Clearly he did not do any of this in his first term. What will happen to the NHS on his watch is that it will crumble ever faster every day, but it won’t be reformed nor will it be abolished.

The lack of a political will to improve is matched by a lack of political will to reform. All that’s left is an NHS getting smaller and smaller, while private medicine increases with every crumble.

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