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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If the Government had any sense ….

Filed Under (Coalition Government, Health and Social Care Bill, Narrative of reform, Reform of the NHS) by Paul on 14-06-2011

My immediate response to the report that has been produced by the Future Forum is that if only the Government could learn from the care that has gone into its narrative for change, they would find themselves in a very different position.

How is it that this group of people could construct a narrative for substantial NHS reform when the Government itself couldn’t?

Why is it that a ‘bunch of amateurs’ has proved able to develop much better politics than the leading politicians in the Government?

I had a stab at answering this question last Monday (June 6th) when I suggested that since all four chairs of the listening groups live in the real world of public service leadership, they have, every day, to construct arguments to get anything done.

This Government seem to have come into power believing that for them this was not the case. They believed that power was ascribed to them by winning the election. The day before the election they had no power. The day afterwards they had it all. This was why, until April 2011, they never really felt the need to have a reason for reforming the NHS. They had the power and they could therefore simply get on with it and tell us what to do.

They have learnt, through the experience of political defeat over their NHS reform programme, that power in an open democratic society is distributed. They may have believed that Government could simply say to Parliament that they should not place a nurse on every GP Commissioning Consortium Board. But over the last 6 months they have learnt that it is the nurses that have the power in this issue – and the Government does not.

So if the Government had any sense they wouldn’t just look at the policy contained in the Future Forum report, they would look at the argument – the narrative for change.

The four listening group leaders, in their day jobs, all want to make things happen. To achieve that they have to have arguments with stakeholders, and win them, every day.  This is how power is distributed in our society. Authority is not ascribed to someone because they have an 18th century view of the world, because they have 312 seats in Parliament or because they own Berkshire, power is achieved by leaders because they win arguments for change every day.

Read the report. Look at how the arguments for change build from common sense into the wider argument. Consider how these arguments resonate for change. If the Government had any sense it would learn to argue this way.

But if the Government had any sense they would not be in a position where they have to outsource the narrative for their reform programme 10 months into its creation.

So what worries me is that they may think, having been through this weird 10 week pause, that they now have their mandate for reform and that all they have to do now is roll it out. They have made their compromise with the forces of the status quo and now they can get on with it without any more political fallout.  Which is wrong for two reasons.

The first is that defenders of the status quo, having been thrown much of what they wanted, will now smell weakness and want more. Will want everything.

The BMA do not like the reality of competition because it upsets their belief that they have the right to try to run the NHS in their own image. The status quo that they want to keep goes back to at least 2000, not just to 2010. They want to move from a policy of competition being promoted to one where it is banned.

In the summer of 2011 they have the Government on the run and they recognise that a weak Government will not stop their demands.

  • Since the Government have not given them everything, there is always more to demand
  • Since the Government is weak, there is always more to expect.

And they are only part of the coalition for the status quo.

The Government are wrong if they think they have had their fight with reaction. It is only just starting.

That is why the Government needs a powerful post-pause narrative for change even more than they needed one pre-pause. From now on, and every week, they need the public on their side for NHS reform. Even more than before the pause they need to get out and make the argument for how their reforms will improve value for money and patient’s experience in the NHS.

For the Coalition Government the struggle for their NHS reforms has only just begun.

Comments:

4 Responses to “If the Government had any sense ….”


  1. “The status quo that they want to keep goes back to at least 2000, not just to 2010”

    Maybe a lot longer back?


  2. Paul, The PM is at last listening to your advice. This from the PM’s latest speech at Guy’s.

    Q: Sky News asks what lessons have you learnt from this policy? The reporter says that commissioning is going to be more unwieldly than what we have at the moment in the form of PCTS

    A: PM says democracy is government by persuasion. Have to explain what you are doing. Sometimes have to stand back and do more. Have to do better to take people with us.

    There we are. He always seems to be speaking at a London teaching hospital. Shouldn’t he be getting out more?


  3. Paul,
    The status quo is a New Labour designed market based system that you were a key architect of. The BMA campaigned against New Labour’s market based reforms and so your suggestion that the BMA supports the status quo has no credibility whatsoever.

    The BMA would be keen to go back prior to the purchaser provider split (1991), with adequate public funding of the NHS without the ridiculous costs of the market.
    The pro-marketeers like yourself want to go back to pre-1948.

    As for policy making, the BMA has been excluded since the introduction of the PP split (the market). It is no co-incidence that we have seen multiple redisorganisations of the NHS in a desperate attempt to counter the problems of market failure in the NHS.
    Professional advice from highly experienced frontline staff has been replaced by the management consultancy industy and the pro-market think tanks, whose boards are awash with vested interests from the private sector.

    The NHS is in a mess because is has become the Neoliberal Health Service.


  4. […] fact, as I wrote at the time, the one thing that the BMA can spot from a long way off is weakness in a Government opponent. The […]

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