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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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There are alternatives to the Status Quo for the NHS – but they must be articulated

Filed Under (Health Policy, Reform of the NHS) by Paul on 21-01-2011

This final post of the week does two things. It emphasises the first post about the importance of there being a variety of different ways of reforming the NHS and not just the Government’s proposals, and it learns from the politics of the NHS throughout the week to underline the case.

One of the lessons we have learnt from the week is that, as the Daily Telegraph said on Tuesday, the Government have recognised that the current Secretary of State for Health has many strengths but persuading the country that he has a coherent and intelligible reason for his reforms is not amongst them. He will need others, most notably the Prime Minister, to do that for him. And that has been the main lesson of the week. The PM has decided that he will take on the explanation of these reforms.

Given the hesitancy and anxiety amongst the Conservative press this has not been an easy task. Most people end the week as they started it, with no clear understanding of why the Government are carrying out the biggest changes in the NHS since 1948. Indeed part of the problem is that sometimes when the Government want to be seen as bold and radical they say this is a bold and radical reform. And sometimes when they recognise that there is controversy they say this is merely an extension of recent reforms. They cannot have it both ways and will fail to get their message across because they appear to want just that.

In a difficult week the Prime Minister has had one success.

Many people do seem to accept his overall framing of the argument as being about a simple “either or” choice. You are either in favour of the status quo or you are in favour of his reforms.

Of course, as I said on Monday, intellectually this is obviously not the case. There are many ways to reform the NHS. As promised I will try and explain what they are over the next few months and would want to end up with a coherent approach but one that is different from the Government.

But this week the PM succeeded in saying that you either support standing still or you come with me on the journey of change.

He specifically challenged the leader of the Opposition in PM’s questions – was he in favour of reform? – and having received no answer hopes  to paint the Labour Party into the conservative anti-change corner.

There are elements of the Labour party who yearn to be in that corner. When it comes to the politics of public services, there are those in the Labour Party who are deeply conservative and will not see a hair on the head of public services dishevelled by reform. The opposition front bench may feel that this is the safe place to go. As the PM pointed out. It will be a place supported by all the trades unions – including the BMA – so it looks like a good safe place to be.

So the Labour Party could accept David Cameron’s frame and say that if there are only two games in town – change or the status quo or support the NHS as it is – we will rally round the “against change” argument.

This would be a very large political mistake for several reasons.

Firstly if you start in 2011 in the teeth of an enormous political debate about the NHS to frame yourself as simply the defender of the status quo then, given the importance of the current debate, this position of defending the status quo will stick. Take that position in 2011 and you will have to support that position in 2015.

That would mean the 2015 election will be fought probably between a chastened coalition whose plans have worked somewhere and not worked in other places defending a record of bodged change against a Labour Party in favour of the status quo. All of those people who want a sensible reform of the NHS will not be represented. Most opinion leaders know that the NHS cannot stay the same, but don’t agree with the current Government reforms. So the Labour Party would throw away those people as a part of its coalition.

Thirdly, in which year was the status quo that you want to support? Some of the Labour Party are sure that is about 1999, before Tony Blair’s reforms. Some will say 1948.  Some will pragmatically say 2010 when Labour lost power. 2010 would be a tricky date as there was a whole host of reforms planned by that Government that were still coming in. So what we will have is conservative forces coalescing around a date when there had been enough change and no more. But which date?

Fourthly, what happens if you win an election in 2015 with a promise of no change? Unless Ed Balls started printing a lot of money, there will not be 8% increases in resources for the NHS. The demand for health care will be going up faster than resources and the new Government will have to supply health care in the old way when change stopped. The NHS would not be able to afford this and an unreformed NHS will run out of money. Waiting times will increase rapidly and rationing will be imposed.

The PM is correct that the status quo is not an option for the NHS.

He is just wrong about his reforms being the only other option.


4 Responses to “There are alternatives to the Status Quo for the NHS – but they must be articulated”

  1. The GP perspective (I went to a commissioning meeting yesterday with about 60 GPs to discuss 30% cuts to mental health services) there are alternatives. Firstly increased clinical involvement is welcome, but it needs to be multi disciplinary, involving specialists as well as generalists. Second the purchaser provider split os costly and obstructive -the financial incentives obscure clinical decision making, thirdly clinical services do need to move out of hospitals to save money, improve access and safety, but this must be done in ways that does not force the financial collapse of the remaining hospital services

  2. How does the English NHS compare with the Welsh and Scottish versions which rolled back Blair’s timid reimplementation of the reforms he cancelled in 97 and then had to reimplement ( with different names of course ).

    Isn’t the problem that the Labour party is the client of the public sector Unions whose aim is to preserve the privileges and jobs of their members, not to deliver better health care and save lives by the necessary improvement in productivity ?

  3. These reforms undermine many core elements of the NHS: for example, eliminating national standards and performance management, encouraging a provider failure regime, creating a conflict of interest between commissioning and primary care provider roles, and trying to end national political accountability. Coupled with a real terms reduction in NHS spending, defending the status quo and articulating concern about fragmentation and worsening service standards, is quite appropriate.

    Labour has been in opposition for just 8 months, much of which has consisted of a leadership campaign. To suggest it should have developed a fresh NHS policy position is not credible, to my mind.

    The last government published a 5 year NHS strategy, From Good to Great, in 2009, and began a challenging efficiency programme. These need updating, perhaps radically, to reflect changing circumstances – but not immediately, while we have a fight to save the NHS from a patchwork privatisation, and with an election some years away.

  4. Dear Trevor

    Thanks for your comment.

    I did not mean to give the impression that the Labour Party needed a complete policy on the NHS in January 2011. You are right they don’t. It is important that oppositions take the time to work out their policies over a decent period especially when they have been in power for 13 years. The Labour Party policy review will be hearing evidence until June this year and then I trust that the Labour Party will spend some time developing that policy.

    What I was trying to warn of was the possibility of getting boxed in by the way in which they oppose the current Government Health and Social Care Act. If they accept David Cameron’s frame of “you are either in favour of my reform or you are in favour of the status quo” then by saying they are in favour of the status quo, then they would find they had made some policy choices through their opposition to the Bill.

    What would be good at the moment would be for the Labour Party to say “Given the financial situation and given the dynamism of medicine, no one should be in favour of the status quo for the NHS. The NHS and its reform is much too important to be left to the current Government. We will be developing with the stakeholders our own programme of reform. And we will do that by opposing this Bill.”

    That would demonstrate their refusal to be put into David Cameron’s frame, would recognise the necssity of reform and give them a process, whilst the Bill was being debated, of developing that policy.

    But on the other hand there is a position to be in favour of the status quo. I happen to think that would be wrong for the future of the NHS and wrong for the Labour Party


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