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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Why is good news so bad?

Filed Under (Health Policy, Reform of the NHS) by Paul on 29-03-2011

There is a lot of evidence that last autumn the British public enjoyed their highest ever level of satisfaction with the services of the NHS. Why is this good news so bad for the Government?

In November the US Commonwealth Fund published its findings on how different health care systems are performing and on November 24th I concluded my post in this way,

“This is the biggest problem for the Government in all the data – the UK public were asked that if they looked at the health system as a whole, do they think it needs minor changes in the system; fundamental changes; or do you think it should be rebuilt completely.

3% in the UK think the system needs to be rebuilt completely (the lowest in the world). 34% think there needs to be fundamental changes, and 62% think that only minor changes are needed. The UK public think their health care system needs changing less than any of the other countries surveyed.

If I were a Government about to embark on the biggest change in the health care system since the war this would give me pause for thought.

Of course in itself this won’t change what the current Secretary of State is proposing. But if it might mean that the narrative around his reforms moves from revolutionary to merely a few small changes.

At the moment the public don’t think their system needs big changes.”

Leaving aside the fact that within a month the Government had dropped the explanation that their reforms were “revolutionary” to in favour of emphasising how “evolutionary” they were, the opinion of the public that the NHS did not need changing was a pretty important problem for the Government.

A month later I posted a comment on the results of the British Social Attitudes survey reporting how the UK population felt about their health service,

“We are told quite frequently that this Government is proud of the NHS. The publication of the British Social Attitudes (BSA) survey on 13 December should therefore see its chest bursting with pride and congratulatory press releases churning out of the machine.

The BSA found that the proportion of people satisfied with the NHS had gone up from 34% in 1997 to a record high of 64% when the latest polling was carried out in 2009.

In 1997 50% were either “quite” or “very” dissatisfied with the NHS – now it is 19%.

Even amongst Conservative voters the satisfaction increased to 61% in 2009.

As the report says:

‘Increased satisfaction partly reflects the fact that people recognise and value the improvements that have taken place within the NHS, particularly in relationship to waiting times’

This looks like a real and significant shift in what millions of people think about the NHS and may well signal a step change in their opinion.”

In two months – and from two different sources – a higher proportion of the British public rated their NHS between good and very good. It is probable that this level of satisfaction was higher than at any point in the history of the NHS.

At the same time as these surveys were published the Government were receiving the report from MORI which included more information on public satisfaction. This report showed such high public satisfaction that it has taken 3 months to be published.

The report found that 72% of people were satisfied with the NHS – up from 63% when the poll was last taken in 2007. It said,

“Satisfaction with the running of the NHS remains high at 72%.. suggesting that there has been a decisive positive shift in the public perception of the NHS”

The fact that the Government is burying good news about the NHS shows what a weird position it has got itself into.

To sum up, in the autumn of 2010 between two thirds and three quarters of the public were either satisfied or very satisfied with the way the NHS is run. And there has been either a step change or a positive shift in this level of satisfaction.

For most organisations this would be a cause for a pat on the back and a smile before getting back to work, but if you are one of the dozen or so people who believe the NHS needs reorganising, this is obviously a complete disaster.

Because if the public really are satisfied then getting their backing for the upheaval of change is difficult. Between 2001/5 the public were deeply dissatisfied with waiting times and wanted change to improve them.  If they had joined the BMA and others as complacent about the NHS, change would have been very hard.

The problem for the Government is NOT the results of surveys – these can be delayed, ignored or buried; the problem is that in the autumn of last year the mass of the public were satisfied and they were in a very different place from where a Government intent upon revolutionary change needed them to be.

Lets compare this with another area of Government policy – the reduction of the deficit.

For a good 18 months before the election every Conservative politician said that the economy was in a disastrous state and we could not go on the way in which we were. The public were frightened about the level of public debt and many made a judgement in the election that radical deficit reduction needed to take place. Since the election, at every opportunity, the Government have said that without radical deficit reduction there will be a disaster for the economy and for the public.

A very great deal of time and effort has been put in by the Government in persuading the public that something very serious is wrong.

This doesn’t necessarily mean that there is dancing in the streets when the local Sure Start centre is closed, but there is a recognition that nasty medicine needs to be taken because the economy is in a very bad way.

Now I know I go on about narratives, but this is one where the Government have spent the time and effort making a case out for change. Their story is clear and is made every day, the economy is in a mess and it will take hard actions to get us out of it.

Compare that with the problem they have about change in the NHS. Here they introduced their policy of radical change without spending any time at all saying that the NHS was in a disastrous mess and needed difficult measures to improve it.

It’s as if they had come into power saying nothing about the economy and within a few weeks started sacking dinner ladies and scrapping aircraft that would have flown off empty aircraft carriers. If they had carried out that radical change without having made a case for change, they would have probably been out on their ear.

But that is what they are doing with the NHS.

The public had a settled view that things were slowly getting better and were really rather good. Without explaining why the Government have now decided to disagree with the public.

It’s true, I am sure, that if you took an opinion poll of what the public felt about the NHS now, their satisfaction will have dropped since last autumn. But those who are now less satisfied will say that this is because the Government is turning the NHS upside down.  The loss of satisfaction will come from the very measures that are meant to improve the NHS (with which the public were satisfied).

As we enter the 12th month of this Government, its explanation about NHS reform is at odds with the public’s feeling about it. They have the sequence of the explanations of their action wrong. With the NHS they tried change first and explanation why afterwards – and it’s not working.

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