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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The pace quickens…

Filed Under (GP Commissioning, Health Policy, Reform of the NHS, Secretary of State, White Paper) by Paul on 16-11-2010

I had expected that during this period that those of us interested in health service reform would be simply waiting for the Bill to be finished and then published. We would then have a much clearer idea of what the Government intended and a better idea of the political battle lines as it goes through Parliament.

But it is clear that the BBC have decided in the last few days that the NHS reforms are going to be important. The last 2 days have seen reports on the Today programme with today’s report taking nearly 10 minutes to explain what the reforms mean.

When it does this, the BBC shows itself to be a fine public service broadcaster. Taking something that is very difficult and developing it into a 10 minute slot that really does manage to explain the main themes of the reform.

Since September I have probably given about 15 talks about what the reforms will mean for different audiences and I am quite jealous of their ability to so clearly explain this in just 10 minutes!

I don’t think this requires a great deal of commentary as it offers a fair outline of the debate.

But if I were David Cameron or Andrew Lansley I would worry about the BBC preparing for the next couple of years of political debate with quotes from people who say this is ‘fantastically brave’. Famously Yes Minister always helped us decode what senior civil servants said about Ministers and the phrase ‘You are being very brave Minister’ usually means that the civil servants feel that the idea is really risky but since it’s your career and not mine – Good luck with it.

“Fantastically brave” is off the Richter scale of risk.

What is interesting, in listening to the different perspectives, is the insouciance of the advocates of GP commissioning who say that there will be winners and losers in terms of patients between different GPs  – as if there will be no consequences associated with that..

The politics of this situation remain as they have been since the publication of the White Paper. The Government believes that between now and the next election they can shift the accountability for the NHS, in the voter’s eye, away from the Secretary of State to the GPs in their locality.

Whatever else these reforms achieve, in the next 5 years they will not manage that.

At the next election the public will think “We are paying for the NHS out of national taxation. It is a national service and the Secretary of State is responsible for it. If the NHS goes well the current government will get my vote. If it doesn’t I will think about voting for someone who can develop a better NHS”.

In 2014/15 the phrase that Today links to these reforms David Cameron has taken a huge political gamble could be heard over and over again throughout the election campaign.


3 Responses to “The pace quickens…”

  1. Paul,

    I respect your judgement and have always found your blogs interesting and provocative. However I feel latching onto a two word “fantastically brave” sound bite is misrepresentative given the full quote given by Dr Michael Dixon, chair of the NHS Alliance, to the BBC (4m:30s at

    ‘The real question is “who do you want to run the health service?” We’ve tried the bureaucrats in Whitehall and we’ve had targets and all the problems that they have created. The alternative is big business, and this idea of saying to local GP practices and their patients “actually, its over to you”, seems to me a fantastically brave and a fantastically good option, and something that both GPs and patients, would, I think, embrace very wholeheartedly.’

  2. Another interesting blog – many thanks. I’m interested in the issue you raised earlier about how the GPs and the BMA will negotiate before agreeing to take on this new responsibility. As well as the remuneration (never far from their thinking) it will be interesting to see what terms they lay down for structural and policy changes in the NHS. For example, if I was a GP contemplating taking on a hard budget, I would not want to be held to a policy of unlimited patient choice about where to have their operations. I couldn’t get best value for secondary care if my patients can go to Plymouth because their aunty lives there, Edinburgh, because they like going to the Fringe, or Doncaster because Laughing Boy is running in the 3.30 next Tuesday. I’d say that the condition for me taking on the budget would be that I can restrict choice to 3 local acute providers so that I can negotiate best commercial terms with each of them. You can see similar negotiations about other aspects of policy with the common thread being no interference by politicians in local health arrangements. Likely? I think not. Interested in hearing your thoughts. Alan

  3. Dear Alan
    I think the examples they provide are yet further examples of the coming clash between nationally guaranteed rights of a NATIONAL health service – something this Government along with all others will want to claim.
    Alongside the local delivery of those rights with GPs having local knowledge and interests that will cut across those National rights.
    Another example would be the necessity for all GP commissioning decisions to be in line with competition law, but many local GPs will have a strong local knowledge of what services would be best for their patients so why do I have to put this out to tender?

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