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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Losing even more control of your health policy. Lessons 6 or 7 from the Coalition Government.

Filed Under (Health and Social Care Bill, Health Policy) by Paul on 16-05-2011

A few weeks ago the Chair of the Select Committee, Stephen Dorrell MP, said that the Government had lost control of its health policy. Since that date there has been almost daily evidence of just how far that loss of control has gone, and we are seeing very different groups of people, with very different interests, wrestling for the control of NHS policy that the Government has given up.

This was always going to be the case once a Government that had been arguing for a very fast pace of reform suddenly decided that rather than continuing at breakneck speed they should stand still.

On Saturday Dr Steve Field, who seems to be standing in for the Secretary of State for the month of May whilst he goes off to have a think, gave an interview to the Guardian.

“The senior doctor called in by David Cameron to review the government’s health reforms has dismissed them as unworkable and “destabilising” in provisional conclusions that could fatally undermine the plans.

Prof Steve Field, chairman of the NHS Future Forum – set up last month to undertake the coalition’s “listening exercise” – flatly rejects the health secretary’s plan to compel hospitals to compete for patients and income, which he says could “destroy key services”. The proposal, contained in Andrew Lansley’s health and social care bill, has led key medical organisations to warn that it will lead to the breakup of the NHS and betray the service’s founding principles.”

Headlines and conclusions are always interesting. Given that hospitals have been competing for patients since patient choice was introduced in 2002 it’s interesting to consider how what has already been happening has destroyed key services.

Then on Sunday the Guardian’s sister paper the Observer carried a story saying,

“A senior adviser to David Cameron says the NHS could be improved by charging patients and will be transformed into a “state insurance provider, not a state deliverer” of care.

Mark Britnell, who was appointed to a “kitchen cabinet” advising the prime minister on reforming the NHS, told a conference of executives from the private sector that future reforms would show “no mercy” to the NHS and offer a “big opportunity” to the for-profit sector.”

I always felt it was a bit odd to appoint one group of people to advise the Secretary of State (The Futures Forum) and a different group of people to advise the Prime Minister (The Kitchen Cabinet) on the NHS. This always seemed to be a recipe for producing a cacophony of different voices saying opposing things.

When I read these different stories, my first thought was that no one could really be so stupid as to set up different groups that would so obviously say different things.

But then it occurred to me that was perhaps was the Government’s intention.

All of us, especially me, have assumed that no Government would ever want to lose control of its health policy, because to do so would represent such a failure of leadership that it would look and feel very bad. I think perhaps I was just remembering how very bad I would have felt if I had been involved in such a complete loss of control of NHS policy.

But what if the only alternative you have to losing control is to plough on with a disastrous policy? Isn’t it really rather neat under those circumstances to completely lose control?

Just allow a cacophony of dissent to build and then, after a little while, come in and say, “This all sounds pretty bad, and riven by disagreement – let’s start all over again.”

That way people see not a Government carrying out a U turn, but one moving forward from arguments between different people with different opinions and coming out with a few very small changes to the existing status quo.

So perhaps I have been wrong all along and losing control of a policy is a lot better than being in control of a disaster?



5 Responses to “Losing even more control of your health policy. Lessons 6 or 7 from the Coalition Government.”

  1. Paul

    In my view, Cameron is demonstrating leadership and continues to send the message that the NHS has to change, which is encouraging.
    The two groups will have different views but there will also be areas of agreement. The question is there enough agreement to take the policies forward. I think there will be.
    I see this as a seminal opportunity to change the NHS – and its needed not only for the NHS but for UK plc. I do believe things can be better all round as a consequence but the NHS will be a very different one to that we know today.


  2. […] health analyst who was in a previous life Blair’s health guru, writes a perceptive piece unpacking the propaganda in the NHS debate. He pointed out that a few weeks ago Stephen Dorrell MP, […]

  3. […] health analyst who was in a previous life Blair’s health guru, writes a perceptive piece unpacking the propaganda in the NHS debate. He pointed out that a few weeks ago Stephen Dorrell MP, […]

  4. This is similar to Uwe Reinhardt’s theory about the Clinton reforms. They gave it a many famous for creating mind numbing complexity and bureaucracy and I thin, not very impressive social skills. The conspiracy theory is they didn’t want to reform just frighten the insurers enought to contain costs. On that basis the non-reforms were a huge success

  5. […] widely-respected health researcher who was in a prior life Blair’s health guru, writes a keen piece unpacking a promotion in a NHS debate. He forked out that a few weeks ago Stephen Dorrell MP, […]

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