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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The next election campaign started last Tuesday – with the NHS reform U turn

Filed Under (Conservative party, Election campaign, Reform of the NHS, Right wing ideology) by Paul on 20-06-2011

The dust is settling on the Government’s U turn on NHS reforms (referred to by my old boss Alan Milburn as the biggest car crash in NHS policy history). As the view becomes a little clearer it’s possible to see what was there before the winds blew dust in our faces.

I had thought that the important date in the NHS reform story was in early April 2011. That was when the new strategist at No 10, Andrew Cooper, by polling the opinion of the electorate on the NHS proposals saw that the reforms would be a political disaster for his boss the Prime Minister. Cooper is the strategist that helped David Cameron develop his original political position and had seen in 2007/8 that it was necessary to ‘detoxify’ the way in which the electorate understood the relationship between the NHS and the Conservative Party..

By April 2011 Cooper could see that the failure of Andrew Lansley to communicate any rationale for his NHS reforms had created a “political catastrophe”.

Yet apparently the crucial date for ditching the NHS reforms was a month later. The first Thursday in May saw the Conservative Party do very well in both the local elections and the AV referendum. From that moment on the Prime Minister started to believe that the next election was his to lose. From that day he apparently felt that the Conservative Party would have a really good chance of winning a good majority in the May 2015 election without its coalition partners – the Liberal Democrats.

This explains the large number of Government U turns that we are now seeing across a wide range of different Government policies. The NHS policy “reform of the reforms” announced last Tuesday is the greatest of these, but the changes on sentencing policy, not enforcing weekly bin collections, as well as the delay in the Public Services White Paper on NHS reforms – all within a week – are further examples of a radical reshaping of what were the Government’s previously radical policies.

Let’s remember that last summer the Government was luxuriating in seeing itself as Maoist and wanting to change everything by the next election in 2015. It wanted to radically change the relationship between the public and the government and felt that it needed to introduce markets into many more public services, including the NHS.

We were told that one of the outcomes of this radical policy was to be a White Paper on Public Service reform that would be published in December 2010. (This was delayed first to April, then July 2011).

David Cameron continued this radical approach in an article he wrote for the Telegraph in February where he said,

“Instead of having to justify why it makes sense to introduce competition in some public services… The State will now have to justify why it should ever operate as a monopoly.”

This quote offers something of a clue as to why the public had become so confused about what the Government was doing with the NHS. When David Cameron now puzzles over why 59% of the public believe that deep down the Conservatives want to privatise the NHS, he might refer to this piece for an explanation.  If you go around saying “we are in favour of a market approach to public services”, you can’t really blame the public for believing that you have taken a market approach to the NHS.

Third and private sector firms were told to prepare themselves for many more bids for a much wider range of public services.

But after the Conservatives polled very well in the May elections David Cameron felt he could win the next election – still 4 years away- on his own. This meant that during May he listened a great deal more to his pollsters telling him about what the public felt about his policies, and a great deal less to those Ministers who were advocating radical change.

By the end of May the Prime Minister had made up his mind, and a number of Cabinet members who just a year earlier had been told to come up with radical plans were told to make a U turn – and become Conservative.

I have posted several times before about the contradiction within modern Conservatism – between a radicalism that wants to change the way in which public services work by introducing market discipline into public services, and a philosophy which seeks to maintain institutions in the same way as they have been for generations. Conservatives want to conserve. Radical market conservatives want to change everything.

The conservative Conservatives have now won the ear of the Prime Minister and Andrew Lansley has had to compromise his plan and take part in the “biggest car crash in NHS history”.

As the Economist said on June 16th of the Prime Minister,

“Thus a flagship reform has become a messy compromise designed to comfort politicians rather than patients; a change intended to improve efficiency instead threatens to be both chaotic and costly. And Mr Cameron has shown that this commitment to recasting the state as an enabler and a regulator rather than a monopoly provider is flimsy. His opponents, both inside and outside the coalition, have noted his timidity; his supporters have good reason to be disappointed.”

The insight here that we need to explore over the rest of this week is not that the U turn was a change in policy. If a U turn has been made in policy, the problem for the Government is no longer the policy; the problem is the reality of what will happen to the NHS over the next four years. The Economist feels that this policy U turn could be “chaotic and costly” in terms of its reality for the NHS.

We now need to turn our attention to the reality of the impact of all this on the NHS.

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