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 »

The White Paper – Some issues (2)

Filed Under (Conservative party, Public Health, Reform of the NHS, Secretary of State, Uncategorized, White Paper) by Paul on 20-07-2010

What is the responsibility of the National in the English NHS? (Part Two)

The White Paper aims at very major changes to the responsibility of the National in the English NHS. Let’s go through these one by one:

  1. A National Commissioning Board will be created.
  2. The Secretary of State will no longer be responsible for the day-to-day running of the NHS but will lay out a ‘short formal’ mandate for the NHS Commissioning Board. This will hold the Board to account.
  3. BUT the Secretary of State keeps political control of the outcomes of all reconfigurations that political local government refers to him.
  4. The Health Bill will put NICE on a firmer statutory footing securing its independence and core functions.
  5. The Department will publish an information strategy.
  6. The Department will create a set of tariffs (although later on this becomes the role of Monitor).
  7. A National Public Health Service will be created and a public health white paper will be published this autumn.

Today I’m blogging about points 3-7

3     BUT the Secretary of State keeps political control of the outcomes of all reconfigurations that political local government refers to him.

The Conservative Party, and in particular the current Secretary of State, has made it one of the main aims of their policy to remove politics from the ‘day-to-day’ or ‘micro’ management of the NHS. The White Paper continues this claim. The arrangements around the creation of a National Commissioning Board do appear to carry out this goal.

But as I commented several times before the election the fact that the Secretary of State would retain control over which hospitals were and were not reconfigured, demonstrates that the Conservatives are not allowing the NHS to run itself. They want to liberate the NHS but not so that it can close inefficient or unsafe hospitals. That is to be left in the hands of local political campaigns; local politicians on the council and the politician called the Secretary of State.

Since the election I have pointed out the abiding contradiction in the modern Conservative Party between those who believe in the revolutionary power of the market to cleanse and bring about necessary change  – and those that want to Conserve institutions from change. This Secretary of State represents both. He claims his White Paper is revolutionary – liberating the power of GPs from politicians – but he also wants politicians to be able to resist that power when it comes to changing the nature of local hospitals.

Conservative MPs wrongly think that it has been the fault of ‘NHS bosses’ that there are attempts to improve and change their hospitals. Amongst other causes this has led to the onslaught from the new Government against PCTs and SHAs. But I am afraid that this is just another example of how much they do not understand the NHS. If anything NHS bosses have been failing to change hospitals fast enough. Tory MPs confuse the messenger of change with the cause.

On 12th July, in the Financial Times, one of the leading GPs in Cumbria Dr Peter Weaving said of the power of local GPs in Cumbria,  “This hasn’t been all sweetness and light. There is less money going to the acute Hospital Trust. We have closed about 100 beds at the Carlisle Hospital Trust, but that is not enough. We will have to close another 100.”

The Conservative Secretary of State quite rightly sees Cumbria GPs as leading the way in terms of GP-led commissioning. In terms of reconfiguring the North Cumbria Trust the outcomes of their commissioning intent are clear.

There is a new Tory MP in Carlisle. It will be interesting to see just how quickly they get in to ask the Secretary of State to stop the GPs that he is empowering from carrying out what they want to do to improve the health of their patients..       

4     The Health Bill will put NICE on a firmer statutory footing securing its independence and core functions

NICE rarely hits the policy headlines. Instead it hits the Daily Mail headlines – about once a week when they find that a particular drug is not cost effective for the NHS. Understandably the patients concerned feel let down and hurt and campaign against NICE. Given there are no campaigns to thank NICE for the money that they save by this decision they only ever get bad day-to-day press.

This means that before any election  those who really dislike NICE – the pharmaceutical companies who NICE  makes the rationing decisions about –feel they can really make a case out to the opposition about its failings. Oppositions don’t have to worry about the busting of NHS budgets that would happen if NICE was done away with.

The Conservatives were four square behind NICE until the election campaign started. In January they changed their position and promised that they would ‘stop politicians hiding behind the independence of NICE’ but did not say how politicians would intrude into these decisions about the economic rationing of drugs.

But once in power the last thing the Secretary of State wants is to come out from behind the independence of NICE to make these decisions. Instead the Conservatives are recognising what any Government that does not have unlimited money has to do. They need to stand behind NICE and its independence.

NICE is one of the truly world class organisations in the NHS. Other health services either just use its recommendations or are trying to copy the whole institution.

The Government recognises that without NICE the NHS goes bust.  Given the policy in the White Paper, the only danger point for NICE will be when the new legislation is going through the Commons and the Lords when there will be some important drafting amendments that will try to hamper its workThe author, and all of NICEs many other friends, will be watching and will blog and highlight this as and when it happens.

5      The Department will publish an information strategy

This looks boring – the Department publishing another strategy – but the Government cannot afford for this to actually be boring. The whole White Paper depends upon the development of active informed health consumers, and one of the main ways of reaching them would be to develop much better and much richer information for the public.

The web site “NHS Choices” seems to contain more numbers than any census and is just about as worthy. It is full of information, and more important information gets added every day. But it is a classic public sector web site. There is nothing personal to Paul Corrigan on this web site.

When I go onto Amazon  – where I have been buying books for over a decade – they have bothered to learn from every interaction I have had with them. They don’t just try to interest me in books they try to interest me in books that almost certainly I will want to read. They do so by personalising their messages to me on the back of all of the information I have given them over the years. They create – in the language of the web – a personal portal. I can break out of that. I can say that I am really interested in management books and they will help me with that. But every July they suggest thrillers to me that are based around Mediterranean cities. In 2010 Amazon know more about the books that I want to read than I do.

The NHS does not. It presents all its information to me as if I should be interested in it all. This is the difference between Web 2.0 – Amazon, and Web 1.0 – the NHS. It should be possible to hook all this information into our lives in such a way as to make us informed consumers.

If the Government reforms are to work the White Paper needs very active informed consumers of the NHS to drive improvement and change. It believes that any market needs customers to drive it hard. Up until now customers have made only limited use of choice in the NHS but the Government say that this is because it has been packaged wrongly with insufficient power. It is patients that the White Paper wants to liberate.

Within the NHS there is very heavy scepticism about the possibilities of this happening. But in part that scepticism comes from decades of infantilising the public and patients. If doctor knows best, the patients don’t.

I really hope this works and it has been a matter of packaging the information and the rights to choose better. If it doesn’t the providers and the professionals will be the ones that have been liberated and will run the NHS in their own and not the patient’s interests.         

6     The Department will create a set of tariffs ( although later on this becomes the role of Monitor)

This is both important and a bit confusing. Later on in the White Paper (and in a little time in this blog), it makes an important innovation in creating an Economic Regulator around Monitor. They will set prices and regulate the system around competition.

But the White Paper also has the Department of Health setting a wide range of prices that have been a matter for discussion in the NHS for some time.

The old NHS is, at best, ambivalent about tariffs and at worst simply against them. They feel that such things as prices ‘destabilise’ the old NHS – and of course they are right. When an institution has to ‘earn’ the resources it gets rather than just receive the money, then it has a very different attitude to the world outside its walls. But if it’s not good at earning money then it’s true that having to please the customer is destablising. And that is what has happened with a lot of NHS secondary care. In the last few years it has become a lot clearer who has been at the better institution than others. They are getting more patients and earning more money. The others are earning less.

So the DH has not been speedy in introducing new tariffs. The fact that they are put in charge of the next round of tariffs is a victory for the HQ of the NHS in the drafting of the White Paper. The fact that later on in the White Paper this is clearly a matter for the Economic Regulator is a victory of the Secretary of State. Who wins in the end will be one of the signals about who is in charge of reform..     

7     A national Public Health Service will be created and a public health white paper will be published this autumn

There will be a White Paper in the autumn about public health. This will be important both organisationally and politically. In opposition the Conservative Party made much of its belief that public health should be of prime importance for the Department of Health – perhaps even changing its name. And how they frame the debate about public health will be important.

I must say that I expect that the public health profession will again be disappointed. They will be, strangely, looking to a Conservative Government to emphasise how Government works to tackle the determinants of health and I suspect they will find that a Conservative Government says primarily that this is a matter for individuals.

The Secretary of State has already said that he does not want to ‘lecture’ people about improving their health so I can’t see him really pilling into his Cabinet colleagues about rising unemployment and inequality determining bad health.

But let’s wait for the White Paper.

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