Monday, 6 June 2011

If I was David Cameron's speech writer....

The Daily Telegraph today outlined the five pledges to the NHS that David Cameron will include in a keynote speech tomorrow. In summary they are:

·         Keep waiting lists low
·         Maintain spending
·         Not to privatise
·         Keep care integrated
·         Remain committed to the ‘National’ part of the health service

I’m not a spin doctor, so don’t really understand why you would leak the contents of a speech beforehand as it gives people like me plenty of time to identify weaknesses and must have some effect in reducing the impact of the message.

These pledges do beg some questions.

At least we don’t need to ask ‘why?’ No-one can dispute the need to reduce costs and improve service. There is not one organisation in the land that would not aspire to such a worthy aim (apart from a well-known mobile telephone provider who severely tested my good nature recently and seem to be bent on rubbish service with confusing cost schedules.)

The more important question is ‘How?’

Those of us who are now obsessed with the health reforms, and I suspect, many more besides, are pretty tired of the what and why – we want to know ‘how’.

If I was Cameron’s speech writer for the day this is how my advice would go..

Firstly, Dave, don’t repeat any of the old soundbites that your health secretary, Andrew Lansley has been splurging out. Not good. We know he means well but we need concrete facts and action plans now. I know that I don’t have the answers, but my job is to provide commentary and maybe the odd suggestion so it really is down to you and your advisers to get this right.

I would suggest that you stick to these pledges, with some tweaking, and craft your speech around the following:

‘Sorry’ – Our intentions are good, reform is needed, but we didn’t think it through properly and we acted hastily. We will take guidance from Steven Dorrell’s select committee and the results of the Futures Forum. Yes we have ‘paused, listened, reflected’ and here are our improvements.

‘Why’ – A very brief summary of the challenges facing any state provider or healthcare.

‘What’ The five pledges listed above are good – stick with them, but they need qualifying with …

Keep waiting lists low: Unpopular as they may be in some quarters – targets work, I’ve seen it first hand at many hospitals. In fact ‘targets’ are the same as ‘outcomes’ really. If outcomes are measured and benchmarked against reimbursement they become targets. The other way to keep waiting lists low is through all the other measures in the following pledges. Maybe ‘keep waiting lists low’ should be supported with ‘provide efficient services in primary, secondary and tertiary care, through effective management, ongoing training and robust cost and quality controls’

Maintain spending: My father used an expression – ‘good money after bad’ when someone spend excess funds on repairing something beyond help – like replacing the engine on an old banger when the chassis was falling apart. I think ‘maintain investment, ensuring value for money’ would be more acceptable. This value for money could be achieved through effective commissioning, using existing expertise. (why re-invent the wheel?) Standards should be agreed centrally and applied locally.

Not to privatise: perhaps could be better stated ‘subcontract suitable services based on local need, quality and cost effective delivery’. The private sector can still play a crucial role in supplementing and supporting the NHS.

Keep care integrated: Again – a worthy pledge but care isn’t integrated currently. It isn’t even integrated within individual units let alone across the entire patient pathway (My stepdaughter being given breakfast in hospital this morning only to be visited ten minutes later by an anaesthetist saying she was first on the list today for major orthopaedic surgery. Not having had breakfast she wasn’t) I digress. How about ‘agree integrated pathways to ensure that patients receive the best possible care’. This can achieved by training and communications. In fact let’s add another rider to this pledge ‘improve communications across each patient pathway’

‘Remain committed to the National Part of the Health Service’ Oops, a bit of a soundbite going on there but it is reassuring to hear you say this.

So Dave, here is your crib sheet for your five pledges for the NHS – reworked:

1.  Keep waiting lists low by providing efficient services in primary, secondary and   
    tertiary care through effective management, ongoing training and robust cost
    and quality controls.
2.  Maintain investment, ensuring good value for money
3.  Subcontract suitable services based in local need, quality and cost effective
4. Agree integrated pathways to ensure that patients receive the best possible   
    care and improve communications across each patient pathway.
5. Commit to offer world class healthcare, free at the point of delivery and  
    maintain the best traditions of the NHS while seeking improvement in quality
    and outcomes.


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