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.

Read my statement in full »

If you want a revolution don’t get the senior staff of the status quo to organise it for you, or “Meet the new boss – same as the old boss”.

Filed Under (GP Commissioning, Health Policy, Primary Care Trusts, Reform of the NHS, Secretary of State) by Paul on 27-07-2010

or meet the new regional office of the National Commissioning Board – just like the old SHA.

The current Secretary of State for Health has called his White Paper “revolutionary”.

Because I know a thing or two about the theory and practice of revolutions, I was always careful not to call any of New Labour’s NHS reforms revolutionary. They were not revolutions they were just that – reforms.

I think the current Secretary of State really does see reforms such as GP led commissioning as “revolutionary”. But if he knew his history of revolutions he would see how even the brightest of reforms get slowed down and turned inside out when you ask the current regime to implement them.

The mistake that reformists make is to make a big revolutionary claim for what they are doing and then to ask the current regime to carry them out. What comes out is much the same as the present.

The rock group the Who put this much better than either Lenin or Mao when they wrote a great song in the early 1970s called, “Won’t Get Fooled Again” The closing lines are,

“Meet the new boss, same as the old boss”

It is this déjà vu (or perhap déjà entendu?) experience that is about to hit the nascent GP led Commissioning organisations across England.

I have been waiting to see what developmental resource the current NHS HQ will put into trying to help GPs develop commissioning consortia. And I think we now have the answer.

SHAs are being asked by NHS HQ to carry out a remarkable piece of reverse engineering. NHS HQ and the SHAs are looking at the details of the White Paper and their thinking goes something like this,

  1. The National Commissioning Board will have  statutory duty to ‘ensure the development of GP commissioning consortia (White Paper page 32) and they will be able to “assign practices to consortia if necessary” (page 29)
  2. It will be for the NHS Commissioning Board to decide what, if any, presence it needs in different parts of the country.(page 33)
  3. Given that someone from within the current machinery has to have the responsibility for developing GP commissioning consortia,  let’s assume they are part of the current SHA
  4. Let’s assume they will become shadow regional parts of the National Commissioning Boards in the autumn
  5. Each SHA currently has a Director of Commissioning, so let’s assume that they become the National Commissioning Board regional officer who is currently responsible for developing GP commissioning
  6. And then in the future once the legislation is passed they will be responsible for the allocation practices to commissioning consortia.

Using this line of reasoning you have 10 people in post at the moment that can go around talking to GPs in the autumn of 2010 as if in April 2012 they will be performance managing them.

You can then, in the autumn of 2010, gather round these proto-regional officers of the National Commissioning Board staff that will be carrying out these functions who will then be the staff who will carry out the day to day performance management of GP commissioning consortia. These staff will be the current staff of PCTs.

This means by the autumn of 2010 you will have empowered the same SHA and PCT staff you have at the moment. They are currently carrying out one role as NHS bosses to become a part of a new organisation carrying out a brand new role of liberating the NHS..

It’s seamless. You can’t see the join.

This is not the way to make something new happen. And this is of course what is being planned. The old tries to grab hold of the new by any means available.

I need to declare a big personal interest here. I used to be the London SHA Director of Commissioning and for 18 months used to have a monthly meeting with the other 9 SHA Directors of Commissioning.

These are good and clever people who have been at the forefront of thinking through and implementing reform. There were times in the last 3 years when they and a few staff in the DH were the people who were thinking through the next stages of the reform programme.

BUT (and this is a ‘but’ about me when I was working in the NHS as much as it is about them). Some of us – including me – had never actually commissioned a contract for health care and – more importantly for this task – virtually none of them had experience of starting and developing small businesses.

Over the last year I have been spending a lot of time with GPs discussing these issues and they do not think, talk or act like members of large state organizations. They are small business people. If you want to work with them on their development, you need to work with what and who they are and not treat them as if they are part of large scale NHS organisations.

Board Directors of SHA are about as far away from the experience of running a small business as you can get and still be living in the same country. If you give them this task they will do it with great skill – with reference to the experiences and skills that they have to hand – and not the ones that are needed.

“I am from the SHA and I am here to develop you” (and in 2 years time to performance manage you) is not going to lead to new organisational forms carrying out new tasks.

So the current Secretary of State for Health may be having his revolution snatched from under his nose.

If you want to develop GP commissioning consortia why not ask GPs and their organisations to do it?


9 Responses to “If you want a revolution don’t get the senior staff of the status quo to organise it for you, or “Meet the new boss – same as the old boss”.”

  1. What a fabulous snapshot into the world of NHS/DH duplicity and fabrication Mr Corrigan. Fortunately, some of us are old enough to have experienced first hand the antics of various breeds of Mad Hatter burrowing in and around the NHS and DH and so find your blog somewhat comforting in these troubled times. For those that remain staring into the Mirror, transfixed by the promises of a brighter fairer NHS, beware. You are doomed to living in never-never-land.

  2. I agree,this article is spot on.I have in my possession the 1997/2002 Leeds Areas Health Authority very large plan for health in our area of Leeds, 13 years of change appears to have resulted in this new white paper putting back the same people in control of health.No change there then.I must say you’ve got laugh about 7 large scale re organisation to arrive back to the same position as 1997 .

  3. This is interesting! If you wanted to post a longer piece on this web site just outlining how the 13 years of change have led to no change in Leeds it would be useful.



  4. I wonder what your current thinking on commissioning maternity services is? The recent King’s Fund report shows a need for more GP involvement but I don’t think doctors should be commissioning maternity services, in an ideal world I see a commissioning body made up of mothers, (+fathers) midwives, GPs and obstetricians. But above all, predominantly women. This reorganisation would be an ideal opportunity to release the stranglehold the acute sector has on maternity, controlling women and midwives, and would allow more women to have a normal birth. Have you any suggestions as to how we can achieve this? (Looking for your political and management insights please)

  5. This is really interesting. The National Commissioning Board will be in charge of commissioning maternity services and I think you should keep hold of this idea until they get their act together. I will ensure that the idea is around when it needs to be, with attribution to you.

  6. Perhaps maternity should be commissioned at all except for a small number of services for very high risk deliveries, specialist care etc. One option would be a voucher for every pregnant woman combined with competing groups of midwives and/or obstetricians. Hospitals would be required to make facilities available to these groups and provide clinical support. Groups would be required to collaborate in providing cover for C-sections etc.

    One might allow topping up for single rooms, extra ante-natal.

    Most significant obstacles to this – the UK’s dreadful tort based medical negligence system, hospital empires and the fact that we pay specialists so much.

  7. Hi Paul I will try to exlpain the lay person take on all this.
    The Leeds health Authority”FUTURE OF HEALTH SERVICES IN LEEDS consultation document suggested that Ophthamology should be centralised on the LGI site to eliminate inappropriate duplication across sites and prepare for a primary care led NHS.Ophthamology has been centralised at Jimmies so that target was acheived.The consultation document included increased theatre time,staffing levels new outreach clinics which have not materliazed. Year on Year we have seen increased patient access without the promised resources resulting in reduced patient time and greatly delayed follow up appointments.The philosophy and Aims quoted in the original document was to establish an integrated and unified ophthalmic service for the city of Leeds?then we introduced Choose & Book,to confuse matters futher!!!.Not to name names, but the people responsible for a lot of this are key players in this new white paper which makes it look as if we are just losing the last 13 years working for more community services.

  8. Sorry ,I forgot to add I call it the famous five syndrome we all know who they are.

  9. Thanks. I’ve cited you in an editorial in Midwifery Matters due out on Sept 1. I love the idea of not commissioning much – does this mean we leave most normal birth to midwives? Wow. That would save a bob or two and reduce NHS costs. Must get CNST sorted first though. I’ve always thought no fault compensation in maternity the best route forward, after all what difference is there between accident of birth (e.g congenital anomaly) and birth accident (e.g. Erb’s palsy after stuck shoulders)

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