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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Good news about the NHS is bad news for the Government

Filed Under (Coalition Government, Narrative of reform, Reform of the NHS) by Paul on 28-11-2011

The government finds itself in a really odd position when it comes to good news about the NHS. In the last month two prestigious organisations operating in the field of comparative international work have said that compared with other health systems, the NHS does between ‘pretty well’ and ‘very well’.

This is not to say that everything is fantastic, but it is to say that international comparison puts the NHS in quite a good light. So sharing in our national delight what do the Coalition Government have to say about this? Do their chests burst with pride as the NHS they claim to love, compares so well with our neighbours?

Er … no.

Their problem is that if we are doing between ‘well’ and ‘very well’, why does the NHS need to be subjected to the biggest set of reforms since the war?

So when the OECD published its comparative data on November 23rd and said some good things about the NHS, The Secretary of State had to say,

“It clearly shows that although the NHS is doing well in some areas, it is still lagging behind other countries in some keys areas of patient care. Improving patient results is top priority for me. We need to allow the NHS to focus on what really matters to patients – things like survival rates, recovery rates and whether people can live independently and with dignity”

Incidentally the latter point – letting the NHS concentrate on the things that matter – was a clear point in the narrative during the summer of 2010. To stop telling the NHS to concentrate on waiting targets and to allow them to deal with the things that really matter was the narrative of 2010.

But unfortunately for the Secretary of State only a week before this statement was made he had reinstated maximum waiting targets and, in terms of the previous year’s narrative, was very actively ‘directing people away from the things that really matter’.

So he is both a bit confused and a bit confusing.

Of course the data is a mixed bag and of course the NHS must be improved. But it takes a more skilled politician to successfully make this complex point – how to improve a system that is basically working well.

But the problem for the Government is much bigger than that. Whilst the NHS does quite well at some things and not too well at others (and whilst this is likely to be the case for some time – reforms or no reforms), what the public think about the NHS is much clearer.

Of course not all the public think the NHS is great. The Commonwealth Fund – in early November – published a comparison of 14 international health systems (International Profiles of Health Care Systems). They asked 14 different national populations whether they felt their health system need fundamental change or not.

In fact over a third of the public in England think that the NHS either needs to be completely rebuilt or needs fundamental changes. (37%).  That 37% is remarkably close to the 36.1% that voted Conservative at the last election. So it’s a good chunk with which to build a political campaign but probably not enough to win a majority.

However 62% believe that the NHS works well and that are only minor changes needed. Look at the international data:

  Australia Canada France Germany Holland New Zealand Norway Sweden Switzerland UK US
Works well, Minor changesneeded 24 38 42 48 51 37 40 44 36 62 29
Fundamental changes needed – or needs to be completely rebuilt  75 61 58 62 48 62 58 53 52 37 68


These comparisons showing what the public thinks about the need for change are very telling. The people of the UK believe – by more than 10% – that their system works well and only minor changes are needed. In every other country, except for the Netherlands, the majority feel that there needs to be either fundamental change of the system or that it needs to be completely rebuilt.

All the other evidence from the British Social Attitudes Survey supports this, but this data puts that in an international context. Not only do the UK electorate think the NHS needs only minor change, but they have significantly less belief than all the other countries that there needs to be significant reform of their health system.

On most occasions a Government would feel that this is good news. Their stewardship of one of the major institutions of the country is endorsed by the public – the electorate.

But this is a Government which has launched the biggest set of NHS reforms since the war, having failed to check whether the public felt they were necessary.

The Government needs the public to be disaffected with the NHS so that they can claim support for reform.

But – compared to other countries – they simply aren’t.

And that’s how such very good news has become bad.


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