Thursday, 19 January 2012

What a difference a year makes – not.

A year ago, 19th January 2011 I posted a blog entitled NHS Reform – The Titanic has now hit its iceberg. I commented that as the Health and Social Care Bill was published that day, I had a growing sense of foreboding.

Exactly one year on have my concerns eased? Of course they haven’t.

A few months later I published a blog entitled The List. This included 29 organisations and influential individuals who had spoken out against the Bill. Despite 12 months of lobbying, pausing and listening, and, let’s be frank, a degree of bullying by Andrew Lansley, UK Secretary of State for Health, I’m not aware that anyone on that list has changed their minds.

Today, on the anniversary of the Bill another two major organisations have come off the fence. The Royal College of Nursing and the Royal College of Midwives have announced that they feel continuing to work with the government to implement the reforms is no longer the best way forward. In a powerful statement Peter Carter, general secretary of the RCN, which represents 410,000 nurses, midwives, support workers and students, said: "The RCN has been on record as saying that withdrawing the bill would create confusion and turmoil, however, on the ground, we believe that the turmoil of proceeding with these reforms is now greater than the turmoil of stopping them’

Like everyone else with an investment in the NHS (approximately 60 million of us) I accept that the NHS needs improvement. In fact – 18 months ago I worked with an organisation called just that - NHS Improvement. It was one of the most satisfying and rewarding times of my life. My daughter also came on board to work on a project and we used to bore the rest of the family with our passionate recounting of working with committed and talented clinicians and managers, overcoming cultural and institutional barriers to achieve real progress. The improvements the team implemented impacted directly on patients’ survival and quality of care. Reform was going on in pockets throughout the UK. That is what the Bill should have built on.

But instead of watering the green shoots of new growth, the pin has been taken out of a grenade and the explosion from within is wreaking its damage through the core of our state funded system.

Influential organisations are demonstrating continued and unremitting opposition to the Bill. NHS workers seem to be unreasonable in their expectations of job for life and unsustainable pension contributions. Maybe this perceived intransigence is down to their genuine concern for the patients in their care and the discomfort of a stressful and confusing working environment.  The public/private healthcare sector divide is also widening as it was announced a few weeks ago that 49% of NHS hospital incomes could be gained from private patients.

As predicted – the Health and Social Care Bill is a divisive vehicle – busy going nowhere and dismantling previously good working relationships along the way. Confidence in Andrew Lansley is at an all time low. Bad news stories about the NHS are now the norm rather than the exception. It has not been a good year. Lansley has had 12 months to win the hearts and minds of over 1 million NHS workers. He has failed spectacularly and key relationships are now significantly worse than they were when the Bill was published.

Back to the shipping metaphor. We have all been shocked by the horrific spectacle of the Costa Concordia cruise liner grounded on the rocks off the coast of an Italian island. The captain has confessed that he steered the liner along the wrong path, with devastating results. Worse than that – once he realised his mistake, the actions to protect the massive vessel and the precious lives on board were grossly inadequate.

If only they had had a different captain steering that path...


Chairman Chegwin said...

It hasn't been a good year, that's true. The Bill and policy processes have been really difficult - and remain difficult. This is largely the consequence of us still not having an Act - or a functioning Board.

Even if the Parliamentary process is completed before the end of the current session (which is likely with LD support - just), we will then have to tackle the practical problems that are most immediately significant for the NHS - i.e. around implementation.

The likelihood is that the Bill will be passed only one year before the most significant aspects come into effect on 1 April 2013. This is an extremely rapid implementation timetable for a Bill of such complexity and scope and we all need to think through whether it is possible. With in excess of 100 implementing SIs to get through Parliament, many of which will be subject to affirmative procedure in Parliament, one wonders.

From where I'm sat, the NEXT 12 months or so are going to be very very difficult....

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