It doesn’t take a management consultant, healthcare expert or even brain of Britain to work out that the radical restructure of an organisation at the same time as introducing stringent cuts is a tricky assignment. Add into the mix that the organisation has an annual spend in excess of £100 billion, over 1 million staff from a multitude of disciplines, and 60 million potential customers and the project gets a whole heap tougher. Then throw in unrealistic timescales and take away the support of the majority of that 1 million staff and you are on the road to hell.
You don’t need to be Sherlock Holmes to see the link between this scenario and the current state of the NHS as the Health and Social Care Bill continues to de-stable an already unsteady ship.
No surprises either to hear that the report of a cross party commons select committee chaired by former health secretary Stephen Dorrell voices serious concerns about the effect of ongoing debate about reform, saying they were ‘complicating the savings process’ because they were acting as a ‘disruption and distraction’.
Stephen Dorrell and his committee are the voice of reason, stating that the ‘need to achieve efficiency savings in the NHS was paramount, and that the bill must come second’. Dorrell continued ‘The priority is to deliver more efficient care, in order to meet demands placed upon the system - and the implementation of the bill has to fit in around that’.
This point is key. We should be creating savings by developing cost effective, high quality integrated care pathways. Just the goal of 4% savings, year on year, should be sufficient to generate some of the behavioural changes required and alongside this goal, some long term strategies for sustainability of state funded care could be explored.
But back to Andrew Lansley, current UK secretary of state for health. I say ‘current’ because I cannot see how much longer he can dig in, hanging on to his precious Bill, despite all those around him, wiser, more experienced and the majority not politically motivated who believe he is over-complicating an already complex issue.
I listened to a radio interview with Lansley earlier today as he was asked to respond to the growing cacophony of opposition to his reforms. As usual, he continued to tow his own special party line, ignoring his detractors and sticking to his polemic – his ritualistic support of his own brand of reality. He still chooses not to hear the combined chorus of the majority of medical and therapy organisations, charities and independent think tanks. He rejects the findings of the committee in the same way that he ignores any other report failing to support his one man mission.
This Bill has now become a bigger problem than the issues it seeks to repair. It is, as Dorrell quite rightly says, a distraction. Lansley’s commitment to this flawed reform is admirable but misguided.
Lansley is alone in his wilderness – I would rather he came back into the fold and started to respond to the wise people around him. Failing that – Cameron should release him into the wild to roam free – as far away from the NHS as possible.
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6 comments:
Whoever is SofS makes little difference now I feel.
Yes, there might be someone that is better liked, more touch-feely and willing to massage the huge egos that abound in the NHS and professional bodies but the current state of play is simply about pushing Government business through.
Cameron has had to intervene on several occasions in the last year or so and he is known to have a very short attention span, so I'm pretty sure he now just wants it on the statute so that he can forget about it and move on. The question is, has he misjudged the mood of those opposed to the Bill? Is the Bill in more trouble than perhaps he amd Mr Lansley think?
I don't think so. It will no doubt be a rocky ride from here on in but I do believe the Bill will go through in some form or other (though certainly not in the form it was introduced).
The reason that I think it will be passed is - and I've said this many times - that opponents have not constructed a simple narrative or killer argument as to why the proposed legislation is so bad.
It's easy to be caught up in the Twitter and SavetheNHS opposition bubble but that isn't real life. The public at large are not in the main politically motivated and they see and hear arguments that are not fully formed and which they don't understand. Opponents of the Bill haven't connected with the wider public and gained their support in the way that they needed to do. And public trust in politicians and public sector bureaucracy is not what it was. Additionally, for once the NHS isn't top of everybody's list of priorities - the economy and being able to put food on the table is the most important aspect of people's lives at the moment.
Taken together, I do think that there is maybe some public distrust of the reforms but since the detail is impenetrable and no one has been able to explain it adequately, it doesn't add up to outright opposition.
As I say, narrative is everything.....
Thanks Rob. Your comments are welcomed, especially as you have such a sound understanding of the political process which observers like me haven't quite got yet! What a good ppint about the NHS being lower on the general public agenda. Those of us embedded in health forget there's another world out there..
I fear that Lansley HAS become a distraction - he makes great blog fodder and you are so right about narrative. Sadly - it's his narrative that is doing more harm than good.
I think that's the point - the Government has a narrative of sorts (not necessarily one that is understandable!) and certainly they haven't "made the case" as it were, but then neither have opponents of the Bill. And this is the key point for me. Whatever you think of Lansley and the Coalition, Governments are elected and have a mandate to govern. They are entitled to put forward proposals and bring forward legislation. That's how it works. In the case of the NHS reforms this hasn't been spectacularly successful and the Coalition has lost a lot of political capital but they have yet to lose the argument.
One might expect a properly functioning Opposition to do a better job in leading the debate but in the case of the NHS reforms they can't because their fingerprints are all over the central aspects of the reform agenda, dating back to Alan Milburn's time in office.
Blame Lansley all you like but this process started in 2000. The Coalition is just taking it to what some might term its natural conclusion....
Believe it or not - I've always voted Tory! (No surprise there I guess - living in leafy Bucks) but I think that many of the quality initiatives under Labour were very good. I know reform is needed and costs must be curtailed but i still can't get my head round how Lansley's plans will work and it breaks my heart to think of all the time and money wasted so far. As you say - it's down to narrative, but I feel Cameron must do something to break this cycle of confusion and dissent.Poison chalice though - who would want it? Do we need to see and hear more of Nicholson to take the heat of Lansley?
You won't get DN racing to help Lansley out - he absolutely loathes him! No, DN is doing a very good job at grabbing power and building his empire in his own right.
I'm so glad you said that! It was always my impression that this was the case! Probably a big part of the problem..
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