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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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David Cameron: “I don’t think people know how radical we are going to be”

Filed Under (Conservative party, Public service reform, Right wing ideology) by Paul on 10-03-2010

…except in the NHS where he keeps telling us he won’t be

David Cameron made an interesting speech to the Welsh Conservative Party at the weekend. His political problem is that whilst I am the sort of nerd to find code breaking interesting, most people don’t really know what he means. I know, I am sad, but there’s nothing that is more fun for me that decoding the weird text of a senior politician.

It’s just that most people think he should be saying things they can understand rather than speaking in code.

Every week, he tries to sound very reassuring in one speech, and in the next very radical. Inevitably it comes across as being very confused.

This was the “radical” speech appealing to the radical wing of the Tory Party who want to see him apply the rules of “post bureaucratic business” to the public sector. Yes, I know no one knows what on earth he means by “post bureaucratic business”, but it seems important to him.

So when he says “The next Conservative government will be the first genuinely post-bureaucratic government in the world.” I don’t really know what it means but it does sound really exciting.

As he said in the title to this post “I don’t think people know how radical we are going to be”.

One of the reasons people don’t know how radical he is going to be is because he also keeps saying that he won’t be at all radical.

If he was to apply his wish to be the first post bureaucratic government in the world to the NHS, then it is likely that this will mean a lot of radical change. But it’s difficult to see the full rigours of post bureaucratic government being brought to bear when there is a moratorium on changes to hospitals. 

David Cameron does pose the crucial question for public services – which is also in fact the crucial question for the NHS -  “The question today is this: how do we make things better without just spending money?”.

“This is the question that will define British politics for the years to come. In answering how we can make things better without just spending money, we need to deliver more for less.

Let me make it clear. We are not offering a simple efficiency drive. What we propose is something entirely different – something so bold and radical I would call it a whole new type of government. “

What would this “whole new type of Government” mean for doctors and nurses? Luckily for them it means very little change at all since the major institutions that deliver care will be left unaltered.

He went on to pledge “We’re going to shape government in a way that has never existed before, so we will use our instincts as Conservatives, our understanding of how people and communities really work, and the latest technology to deliver more for less.”

Now either he really means this for other services but not for the NHS, or he secretly doesn’t mean it for anybody, or secretly means it for the NHS. If he secretly means it for the NHS he went on to give us a glimpse of what that might mean.

“We’ll also smash open the state monopoly and open the door to charities and private companies who can play a part in the public sector. And we’ll pay them all by the results they achieve.”

So there we have it. I look forward to the speech in the next two months when he says how he is going to smash open the state monopoly of the NHS and pay the third and independent sector to deliver health care. But somehow their fear of frightening the BMA is going to stop short of saying this.

So there are three ways of reading all this stuff.

  • He doesn’t really mean it. In which case the post election Conservative world will be run by a “top down” Treasury with more power than ever before. Where the post bureaucratic government will see that every pound of public expenditure will be tracked by a team of post bureaucratic civil servants in Downing Street.
  • He does mean it – but not for the NHS. In which case within a year the Daily Telegraph and the Mail will be screaming as to why a state monopoly has been left alone which they and the bulk of the Conservative Party hates, and see as the biggest bureaucracy in the country.
  • He means it for all public services – including the NHS – in which case we will be looking at the largest ward closure programme ever and many new MPs elected on a “save my hospital” campaign will feel very uncomfortable when they visit their constituencies .

Or of course if some of the latest opinion polls are correct we may never know what on earth he means, because if he doesn’t win the election the Tories will finish him off within seconds in a decidedly pre bureaucratic leadership coup..


One Response to “David Cameron: “I don’t think people know how radical we are going to be””

  1. Hi Paul

    There is another possibillity, which is that he simply doesn’t know what he means to do with the NHS.

    So we do have to go by his words. Which to the national Conservative Party conference last Autumn, were “We will never change the idea at the heart of our NHS, that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay.

    “We’ll say to the doctors: those targets you hate, they’re gone. But in return, we’ll do more for patients. Choice about where you get treated. Information about how good different doctors are, how good different hospitals are.
Information about the things that really matter, cancer survival times – the rate of hospital infections – your chances of surviving if you have a stroke.

    “We will give doctors back their professional responsibility. But in exchange they will be subject to patient accountability. That’s why we can look the British people in the eye and say this party is the party of the NHS now, today, tomorrow, always.”

    Their policy proposals do get a bit confused at points: all national targets are going, but there will instead be mandatory ‘results’ on cancer survival and MRSA rates. The difference between a target and a ‘result’ is not immediately clear.

    There also appears to be a belief in the Conservatives that sticking everybody’s health records on a Google-type online system will do away with significant need for NHS bureaucracy. Which I think we would both suspect to be a form of heroic optimism bordering closely on the stupid.

    More choice and competition appear to be the Conservatives’ answer to most health policy questions. Which could well make it hard to close lots of things and yet stay within the financial envelope.

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