A word game that just isn’t funny anymore

I’m sure that many of you will have played the business word game. The one where you give a presentation or speech and are tasked by your colleagues to include an incongruous word into the mix. Failure to meet the challenge usually means that the first round is on you next time you’re at the bar. When I was an account manager with a major health provider there was a wide scope for potentially ridiculous words to weave into the conversation – I seem to remember that ‘chronicity’ was a firm favourite and one of our customer service managers somehow managed to include ‘wheelbarrow’ into a placatory call to a disgruntled customer.

I’m sure that David Cameron is far too busy for silly games but I can’t help thinking that some wordplay is underfoot within the Coalition.

‘No-one knows more about the NHS than Andrew Lansley’ said Andrew Mitchell, Secretary of State for International Development, looking very uncomfortable when questioned by Andrew Marr about the Health Bill on the BBC today.

‘No-one knows more about the NHS than Andrew Lansley’ said William Hague, Foreign Secretary, looking very uncomfortable when questioned by Andrew Marr about the Health Bill on the BBC a week ago

‘No-one knows more about the NHS than Andrew Lansley’ said the Prime Minister as reported in the Guardian newspaper last year.

If this is a word game – they’re not very good at it. For a start, the phrase or word is supposed to believable within the context in which it’s used. If this is the only argument the government can muster in reply to Health Bill opponents then they clearly are running out of arguments. If ‘no-one’ knows more about the NHS than Andrew Lansley then let’s give ‘no-one’ the job of UK Secretary of State for Health. Clearly Lansley’s ‘in-depth knowledge’ hasn’t stretched to understanding how to engage the support of most of the people he needs on side to make his reforms work.

Or is this a cunning ploy to personalise the Bill in Lansley’s name? Has the cabinet been instructed to pin the Bill indelibly to the hapless Health Secretary’s mast so that when it all goes horribly wrong he will be the only scapegoat? I wonder.

But back to word games – chronicity means …’of long duration, lasting for a long period of time or marked by frequent occurrence, subject to a habit or pattern of behaviour for a long time’.

Perhaps the choice of word for our silly game a few years ago was strangely prophetic….

Tobacco - the enemy within..

Let me start with a story…

There was once a village where the local people faced a grave problem. Every morning – exhausted and weary villagers were to be found drowning in the fast flowing river that ran through their village. The local community set up an elaborate and expensive alert and rescue system which enabled every drowning man and woman to be dragged out of the water, resuscitated and saved.

For years the village community struggled on, but they were poor because all their resources went into the daily lifesaving process. Then one day, a wandering minstrel happened by, and suggested that rather than saving the villagers – wouldn’t it be a good idea to find out why they were in the river in the first place?

I could continue the story with giants, goodies and baddies and elaborate plots but suffice to say, as soon as the locals realised what was causing their comrades to be in the water in the first place, they fixed it and the rescue and repair system was no longer needed.

My recollection of this well-known fable was prompted by a startling report published in the British Journal of Cancer announcing that 40% yes – 40% of cancers diagnosed in the UK each year are caused by avoidable life choices such as smoking, unhealthy eating and excess alcohol. Tobacco continues to be the most significant cause, accounting for a risk factor of 23% in men and 15% in women. I would like to optimistically assume that these figures would drop as public knowledge and understanding increases but there are no indications that this will be the case.

At a time when we are desperately seeking not only cures for cancer but also trying to reconfigure our health services to ensure that we can afford to treat an increasingly unhealthy population surely we should be doing more to stop people developing illnesses in in the first place?

The smoking debate is long running and emotive. There have been accusations of ‘nanny state’, ‘destroying human rights’, ‘restricting personal choice’ and the  pro-smoking lobby even disputes the extent of the dangers of tobacco. In medicine there is a measure known as the Therapeutic Index – which is the ratio between the toxic dose of a drug and the therapeutic dose (i.e. a dose that works). This is a useful measure of the safety of a drug and if the therapeutic dose is the same as the toxic dose then it is likely this drug will never get a licence. Even the rarest of side effects may stop the development of a drug in some cases and yet a massively toxic substance is freely available, with only an age regulation associated with it’s distribution and consumption.

In the UK you can be fined for not wearing a safety belt and even imprisoned for holding your mobile phone while driving (quite rightly). Children are no longer allowed to play with conkers in school without safety goggles. The same children at just 16 years of age can smoke a small piece of paper wrapped around a lethal substance responsible for 100,000 deaths annually and possibly twice as many people suffering life limiting disease. As soon as they are 18, they can buy this lethal substance in packs of 10 or 20 throughout the UK. Even that piece of legislation is crazy – you can smoke at 16 but can’t buy cigarettes until you are 18. I’m sure that makes a big difference to teenage smokers – not.

How can this madness be stopped or at least reduced? Yes, if the substance was banned it would drive smoking underground but surely the number of smokers would reduce dramatically. Yes tobacco -growing economies would be severely damaged but surely alternative crops could be grown? Yes, the UK government would in the short term lose significant taxation income and face huge pressure from the powerful tobacco companies’ lobby but in the long term, healthcare costs from smoking-related diseases would be massively reduced.

At a time when the Health and Social Care Bill is concentrating on the minutiae of who commissions what, disbanding and reconfiguring the beaurocratic process we continue to allocate massive resources on fishing the villagers out of the river. I can’t help but wish more time and resource was spent on stopping them jumping into the water in the first place.

Is any of the Healthbill protocoligorically correct?

There’s a great line in The Slipper and The Rose, the Hollywood version of Cinderella, where the autocratic King announces ‘Kings don’t cheat – they adapt to circumstances!’

As David Cameron calls an NHS summit today, adapting to circumstances - or changing the rules as you go along - seems to be the modus operendi when it comes to The Health and Social Care Bill. Plans for this summit, called by the Prime Minister ‘to discuss the implementation of the NHS Reforms’ were leaked by the Health Services Journal on Friday and more details emerged via social media over the weekend. Firstly we hear that the Royal College of GPs hasn’t been invited. Then we find out that the British Medical Association (BMA), Royal College of Midwives and Royal College of Nursing are also snubbed. Spookily all these organisations have been vehement in their opposition to the Bill. There’s even a rumour that Larry, the Downing Street cat has been banned from attending this hastily called meeting as his support cannot be guaranteed…

Yet again the coalition PR machine have got it so wrong with the Health Bill. When I first read of the summit – my immediate reaction was positive - maybe Cameron is going to get the key players together not just to talk but to plan a workable way forward? And yet again I, and literally millions like me, have been let down. As the BMA so politely put it ‘It would seem odd if the major bodies representing health professionals were not included’. Considering previous form on this legislation, this is not odd at all. Restructure of the NHS has already started, without mandate. The future forum came and went but still the reforms have been pushed forward.  Consensus of key stakeholders appears to be neither required nor valued.

Downing Street have, in a move smacking of autocracy and not democracy, refused to release the invite list and have quickly re-positioned the summit as ‘part of an ongoing dialogue’ . Simon Burns, health minister continued that this was a meeting with ‘those constructively involved in improving the reforms’

Mmm … ‘ongoing dialogue’ appears to mean ‘think as I think, speak as I speak’.
‘Constructively involved’  translates to ‘those who are empire-building, currying political favour or stand to gain financially, professionally or personally from the reform without consideration of the greater good and the NHS as a whole’

The coalition have defied protocol throughout – which brings me to a song from the Slipper and the Rose, as the head of court questions the king about his tunnel-vision approach to leadership...

‘And when the treasure is tapped of it's treasures
Are the tapestries stripped from the walls?
No, the court carries on with it's pleasures
Inquisitions and banquets and balls

But they must be protocoligorically correct
Good form must never suffer from neglect
The rules and regulations we respect
Must be treated circumspect

Else the kingdom will be wrecked
We've a system to protect
Checked and double checked and protocoligorically correct’

Oh how I long for the NHS to be shaped in a protocoligorically correct way…and where is Prince Charming just when we need him?

Why Miss Piggy is bigger news than Andrew Lansley

As the Health and Social Care Bill struggles its way to the statute book (or maybe not), it has to be noted that this has not been one of the Coalition’s finest hours. The Bill has become a political embarrassment and therefore a PR disaster.

When the fabulous David Beckham fell out with the equally fabulous (but in a very different way) Alex Ferguson, manager of Manchester United football club, Beckham had to go. Why? Because in Ferguson’s words ‘no-one is bigger than the club’. This puts me in mind of some of the issues facing the Health Bill. Andrew Lansley, UK Secretary of State for Health, is making more headlines than the reform itself. In the past week alone we have read:

‘Lansley will have to go, says top Lib Dem as party faces revolt’

‘Tories turn ‘toxic’ as health bill falters and reshuffle approaches’

‘Andrew Lansley right man for NHS Reform – Nick Clegg’

Lansley and the coalition PR machine have got it all so wrong. A good definition of public relations is ‘The art or science of establishing and promoting a favourable relationships with the public’.  Lansley’s ‘public’ includes over 1 million healthcare workers, a multitude of charities, care organisations and clinical practitioners. Not forgetting the powerful clinical bodies, colleges and unions. The lack of convincing and coherent narrative and Lansley’s inability to sway from his fixed, flawed vision are the two greatest contributing factors to this debacle. Another golden rule of PR – adapt to circumstances and sadly, flexibility is definitely not one of Lansley’s fortes.

It is widely accepted that reform is needed and some of the content of the Bill makes sense. But the message has been consistently off the mark.

My first job in healthcare marketing and PR was to promote a new private hospital in North London. State of the art medical facilities, cooperative working with the NHS and a high standard of care was of absolutely no interest to the local press, who we were very keen to get on side. We knew that a bad news private healthcare story would hit the headlines but any positive press releases were ignored. And then I got a front news story. A lifesaving heart transplant? Ground breaking technology? No. A baby. We sent pictures to the press of the first baby born in the hospital and the adorable little tot and her proud Mum graced the front page of every local rag.

There just haven’t been any good news stories about how this Bill will actually work. Poor Lansley, who according to his colleagues is ‘a decent man’, will ultimately have to take the rap for not only his, but his party’s failings. They really have made a pig’s ear of this.

Which brings me nicely to the title of this blog. Earlier this week I was flicking through the Metro newspaper (a free circulation newspaper with over 3.5 million readers) as always looking for health news stories. A large headline on one of the early pages caught my eye ‘Miss Piggy wants to start a family with Kermit’. About 10 pages later was a much smaller article entitled ‘Andrew Lansley rules out resigning over NHS reforms’

No contest.

NHS Reform – Has the penny finally dropped for Cameron?

The signs are all there when a relationship starts to falter. He doesn’t look you in the eye, won’t sing your praises in public anymore, avoids direct questions about your future together and doesn’t even let you sit next to him at Prime Minister’s question time in parliament….

Andrew Lansley, UK secretary of state for health is certainly feeling the cold – and not because it’s snowing outside. It’s the cold shoulder that will be providing the chill as he is increasingly sidelined while the political argument supporting the Health and Social Care Bill slowly unravels.

There seems to be a significant shift in commentary on the Bill recently, as it faces the next report stage in the House of Lords next week. There have been some cracking debates on TV and in the press as informed stakeholders become increasingly frustrated with the blinkered view of the Coalition health ministry.

On BBC’s Newsnight, the Health Minister Simon Burns was made to sit in silent agony as Jeremy Paxman read out the very long list of professional organisations opposed to the Bill. Burns, who in my opinion always has something of the pantomime about him, had to quash his usual flamboyance as he shifted uncomfortably in his seat, clearly desperately formulating some sort coherent repost to this growing list. The best he could manage is ‘If you talk to the GP’s - the people on the ground doing the commissioning, you will see the support for this Bill’.  He failed to comment on the fact that the Royal College of General Practitioners, who represent 50,000 members are vehemently in opposition. He ignored the question on why the majority of medical bodies rejected the Bill but claimed with great glee that the Royal College of Gynaecologists was in support of the radical NHS reshuffle. (There has to be a joke there but I can’t think of one I can print). Burns repeated the same mantra in other interviews this week as Lansley remains strangely absent. Mr Burns, please, change the record.

So Lansley is heading for the dark recesses of Prime Ministerial rejection, but sending another minister into the fray with equally weak argument and who clearly struggles with supporting this tragic Bill is not a good strategy.

The language surrounding NHS reform is becoming emboldened. A headline in the UK Times yesterday reads ‘Tories turn ‘toxic’ as Health Bill falters and reshuffle approaches’  reporting that the atmosphere within the Tory benches is ‘toxic’ as it dawns on them just how damaging this Bill could be not only to the NHS but to the party. Zoe Williams, the Guardian journalist summed up the situation beautifully on a politics show earlier today saying ‘It’s a car crash’

I wonder if David Cameron realizes now just what a car crash this is. As another journalist, Andrew Pierce commented. ‘This could be Cameron’s Poll Tax’ (referring to the local taxation policy Thatcher introduced which was the beginning of her downfall). But what can he do? Hope, as Pierce suggests, that The Lords will let him off the hook by rejecting the Bill? But the equivalent of a motorway pile up has already started. Despite the lack of legislature to back it up – the existing structure of the NHS is already changing beyond recognition. PCTs and SHAs are dismantled or merged, NHS Trusts are panicking as they scrabble to achieve Foundation status, staff are disengaged, Clinical Commissioning Groups are struggling to rise to their new challenge, the private sector has become totally vilified and patients are confused.

Yes, I think the penny has dropped, but removing Lansley or even stopping the Bill won’t avoid the metaphorical car crash. Fasten your seat belts – it’s going to be a rough ride.

NHS Reform – Is it too late for the public to take notice?

‘You’re scaring me now – can we change the subject please?’  Was this the recounting of a tale of horror – a scary film, gory story? No – it was me having dinner with a friend a year ago. She is a teacher, mother of three, with a semi-retired husband, elderly parents and a blind faith in the sustainability of the NHS to be able to care for them all. Conversation had turned to my blog and I shared my concerns about the Health and Social Care Bill. An intelligent and socially aware individual, she had until that point assumed that a radical reshape of the NHS would automatically produce a better state funded health system – until I shared some of my personal views on this flawed piece of reform.

I was reminded of this conversation reading Benedict Brogan’s excellent Daily Telegraph blog (@benedictbrogan) today where he comments ‘Mr Cameron is now opposed by the nurses and doctors in a way that the public might begin to notice’

To those of us with any inside knowledge of the NHS and how it works (or doesn’t),  the shortcomings of the Bill have haunted us daily – but the public so far have been oblivious to the realities of this top down restructure. In our press they see horror stories of inadequate care, limited resources and nightmare scenarios for hospital patients. They read of waste, poor standards and treatment rationing. Yes, most of these stories are true, but the situation is unlikely to be improved by these reforms. How can ‘the man in the street’ possibly understand what’s really going on?

Although I try to avoid politics in this blog, this coalition government has shown some weakness in a desire to please everyone. I wonder how long it will be before public opinion starts to sway Westminster on the Health Bill. Unfortunately this is where the opponents to the Bill have made their biggest mistake. The public are not impressed with strikes by NHS workers demanding that their pensions and jobs are protected in a way that those outside the public sector can only dream. Although Andrew Lansley, the UK Secretary of State has failed spectacularly in his narrative to clinicians and NHS administrators, his sound bites have, so far, persuaded the public that giving GPs the lion share of power and budget control is the way forward (even though the Royal College of Physicians do  not support this Bill).

One of the comments on posted by a wise reader of this blog states that the public are too concerned with paying their mortgages and riding the recession to be bothered with the arguments offered by the Bill’s detractors. This is where Lansley has got it right and the Bill’s opponents have missed their chance.  The Coalition is still backing the Bill. It may have a rocky ride through the Lords and the Commons but, again as Brogan writes ‘Cameron has shed too much blood to back down on health reform’.

I hope I’m wrong but I believe it is too late to muster public support.

Lansley will have his way.

Baffled? Moi?

Opposition to the coalition’s NHS Reforms has stepped up a pace again this week. The Royal College of General Practitioners (RCGP) has released a statement calling for the Health and Social Care Bill to be scrapped. Clare Gerada, chairman of the RCGP stated ’We cannot sit back. Instead, we must once again raise our concerns in the hope that the prime minister will halt this damaging, unnecessary and expensive reorganisation which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt.’ The Chartered Society of Physiotherapists joined the fray with ‘the views of patients and professionals had been ignored’

These two professional bodies alone represent 84,000 clinicians. They aren’t talking about pay or pensions – they are concerned with patient care.  Add the British Medical Association, Royal College of Nursing, and Royal College of Midwives and the growing body of evidence that this Bill remains unpopular becomes stronger than ever.

Then consider that the editors from three prestigious journals (British Medical Journal, Health Services Journal and Nursing Times) in an unprecedented joint editorial stated that the reforms were already creating ‘an unholy mess’. They agreed that ‘the resulting upheaval has been unnecessary, poorly conceived, badly communicated and a dangerous distraction at a time when the NHS is required to make unprecedented savings. Worse, it has destabilised and damaged one of this country’s greatest achievements’

This all adds up pretty powerful commentary by respected individuals and organisations. The sort of commentary that surely deserves some reasonable and carefully worded response from the architects of this ‘unholy mess’.

Not so. Health Minister Simon Burns said he found the criticism from GPs 'baffling' and in defence of the Bill his best shot was that the RCGP had previously supported some aspects of the Bill. He went on (or should I say whinged on?)  ‘Now we have this constant criticism and I find it in one way baffling, because it's not representative of what I hear GPs up and down the country saying, now that they're beginning to engage in having the powers to determine the care that needs to be commissioned for their patients.’

Hardly a well-considered response and still no real justification or explanation of how these reforms will actually improve the NHS while achieving a 4% saving year on year.

Burns’s boss, Andrew Lansley, has remained remarkably quiet this week, and it would seem that he still finds it incomprehensible that anyone would dispute the validity of his brainchild, despite over 12 months of dissent, growing more vehement by the day.

I agree with the three editors when they suggest that the Bill will no doubt become law and the way forward is that ‘Parliament should now establish an independently appointed standing commission, to initiate a mature and informed national discussion on the future of our national health system. Let us try to salvage some good from this damaging upheaval and resolve never to repeat it’

But back to being baffled – even though everyone involved with the NHS may have to accept that these reforms are now unstoppable there are still some questions that really warrant a decent answer.

 
Why has David Cameron not intervened to at least improve the quality of ministerial statements around this top down reform?
Why has Lansley been allowed to continue with his intransigent rhetoric surrounding key elements of the Bill?
Why have so many independent, intelligent and experienced voices been ignored?
Why was such a drastic, complex, top down shake-up of the state funded health system planned to coincide with major savings demands?

Baffled? It’s not you, Mr Burns who should be baffled. It’s the rest of us…