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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 politics of the NHS, and the last three days….

Filed Under (Conservative party, Health Policy, Reform of the NHS) by Paul on 19-01-2011

The Health Reform Bill is being published on the afternoon of January 19th and before getting into the slog of what will be a solid 10 months of issues about the detail of the Bill and its passage through Parliament, I thought it might be useful to post some thoughts on what has happened in a very full three days of politics. More will unfold in the next few days but so much has happened in the last three – let’s take stock.

The first thing to underline is that the Government has decided to go ahead with its reforms and the current Secretary of State has the Prime Ministers full backing. This is really important because if, at any time and for any reason from here on in, there is a radical change of direction then the Prime Minister will have to eat some words and the current Secretary of State will not only have to eat some tens of thousands of words but will have to bite the bullet and resign.

Second it is clear that not only is there a lot of opposition to these reforms, but there is much less support than might be expected from those that mainly support the Conservative Party.

To understand the Conservative Party I find it is always useful to turn to the Daily Telegraph. I do this because I want to see what the traditional heart of the Conservative Party think about the NHS reforms. If, as looks likely, the going gets rough in the next couple of years as the politics of the NHS heats up, then the support of the Telegraph is going to be pretty important. Yesterday’s editorial (18/01/2011) is instructive:

This hardly squares with the Tories’ pre-election promise that there would be no “top down reorganisation of the NHS”, although ministers argue that the changes are evolutionary and build on those initiated by previous governments. Are they necessary? The statistics suggest Mr Cameron is right to say that doing nothing is not an option. During a decade in which health spending has doubled in real terms, NHS productivity has actually fallen by three per cent. Meanwhile, clinical outcomes have deteriorated, with cancer and heart-attack victims more likely to die here than in most other countries in Europe. At the same time, as Stephen Dorrell points out on this page, the squeeze on public spending means that the NHS is being required to achieve the most demanding efficiency savings.

Are the changes a gamble? Undoubtedly. The new legislation has been delayed for weeks while Oliver Letwin, the Coalition’s policy guardian, combed it for booby traps. There is no doubt it will cause enormous dislocation, which explains the hostility of doctors’ and nurses’ professional bodies and the public sector unions. But it will also offer a once-in-a-generation opportunity to create a more efficient and responsive NHS, which is why so many GPs are keen to embrace a regime that will give them and their patients greater control over, and choice of, health provision.

A number of things here. One of the things that would worry me politically is that the Daily Telegraph is claiming that NHS “clinical outcomes have deteriorated”. Which clinical outcomes? The NHS has improved nearly every clinical outcome over the last 10 years. It’s true that it could do better, but for the Telegraph to claim it is getting worse, is a slip that shows how far the heart of the Conservative Party is from the NHS.  If I were David Cameron it would worry me – a lot. The big politics of the NHS is for the Conservatives to claim that they really love it. For one of their papers to so casually get something wrong in order to slag it off would worry me a lot.

This editorial hedges its bets on reforms. It agrees with the BMA that the reforms are a gamble. They seem to think that it’s OK to gamble with the NHS, but if in the next months or years the gamble does not pay out, then the Telegraph will be able to say that they always said it was a gamble.

If this is the best support that the Government can get for its reforms at the start of the process, the politics of the next year or two is going to get very interesting.

The third issue that arises from the politics of the last few days is that spending the time and effort developing a narrative for the reforms in the days before the Bill came out is very, very late. As I commented on September 14th 2010 – if the Government does not have a narrative for why it is doing this, then other narratives will be told. And this is what  is happening.

The dominant story about these reforms is that they are, as the Telegraph says, a “gamble”. This is a very bad word for the Government to have in any story concerning the Health Service  The second word in the narrative is that it is “unnecessary” as a total reform. The same outcomes could have been developed without the top down reorganisation. Thirdly they will cause “dislocation” – again a word that is pretty frightening in the context of the NHS.

Of course the Government could, over the next few months, develop a different narrative but it will have to do so by shifting the current narrative off of its place at centre stage.

Which brings me to the fourth issue – one of the politics of change. Stephen Dorrell’s select committee pointed out how the White Paper came as a big surprise to the NHS and the country. The rhetoric of July – this is revolutionary and the problems are caused by NHS bosses – has caused real problems ever since. We know that members of the Cabinet – Vince Cable in particular- refer to the Government – of which he is part – as “Maoist”, in that they want to change everything, and very quickly, but this is a perception they have brought upon themselves.

It’s a bit late in January to say that they are building on the reforms of past Government. Especially when they explicitly said that this needed to be “revolutionary”.

In July they could have said that they were developing an existing process. New Labour did this and now we will build on it.. But no, the political rhetoric was that what new Labour did was nothing, so we must now begin – and with speed.

That means the Prime Minister’s attempt to now say that this is all in the image of Tony Blair cannot work. In July he and his Government wanted to be out on their own as reformers.

And that is therefore where they now are – on their own.

Which brings me to the fifth issue – speed. On Monday David Cameron distanced himself from Tony Blair by saying that he wants to go faster. He has argued that going slowly is a bad idea. But in order to be better than Blair, he has had to make a virtue of the very speed that doctors in the NHS are so worried about. He is tying his distinctive politics to speed that is seen as ‘especially risky’

Then, if at any time in the next couple of years he slows down, he has demonstrated that his distinctive politics of reform won’t work.

The Government has a majority. It will start the process of putting this Bill through Parliament with confidence in that majority. But what I don’t see within that majority is a passionate belief in what they are being asked to vote for.

In the last few days the Prime Minister has publicly wrapped himself around the NHS reforms in order to secure that majority. If the politics of the NHS gets very rough in the next few months he may regret that decision.

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  1. […] fact (again in the words of the Telegraph, just prior to the Bill's publication) "the new legislation has been delayed for […]

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