Health Matters | Paul Corrigan's blog

I have now been writing this blog for four years. And whilst, over the last few decades, I have always enjoyed writing articles, pamphlets, and even the occasional book, writing a blog is different.

First it has an immediacy which the other more traditional forms of writing don’t have. An article for the HSJ comes out, at best, a fortnight after you have written it. A pamphlet might be published 10 months after it was begun, and writing a book always feels like a lifetime. So the immediacy of writing a blog was very different and I had to learn how to do that.

Most of my posts have been written at 6 in the morning, or on a train journey on the day before publication. Tweeters will know that I have not engaged with their minute by minute level of immediacy. I have used Twitter mainly to advertise the blog.  The reason I haven’t tweeted more is that I have been afraid that if I did my life might disappear in a welter of tweets.

So I have become sufficiently modern to manage day to day commentary, but minute by minute still feels beyond my capabilities.

The second thing I’ve learned about writing a blog is that you have to write it in such a way as to allow and encourage the reader to complete it with their own ideas and emotions. Most of the ways in which we learn to write teach us to complete our contributions by tying them up with a great big bow to show they are finished. A method that leaves no room at all for argument.

I have come to believe that whilst this approach may make a good article for the BMJ – it makes a lousy blog.

The point of each post in the blog has been to progress my own argument but also to provide room for disagreement – and to raise questions and encourage debate. Above all there should be room in the post for people to think their own thoughts and to agree, or disagree, in their own ways.

Learning to write in this way has been a lot of fun, and very different.

A lot has happened in these past 4 years.

I started the blog when there were still 13 months to go for Gordon Brown’s government and during 2009/10 the numbers reading it moved slowly upwards to about 1000. Then the election campaign in 2010 moved them up to about 3000 a week. Over the summer of 2010, as Andrew Lansley’s White Paper was published, they did not go up so much.

It was only when readers realised that the Coalition Government were really going to carry out their reforms that more people wanted to make sense of what they meant. By the time of the famous ‘pause’ readership had increased to 5000.

The reason for this growth had almost certainly, less to do with my great insight, and was more likely a consequence of people having no idea what on earth was going on.

Then there was the occasion when John Rentoul, in the Independent on Sunday, reprinted my post setting out the words that Lansley and Cameron should have used to apologise for the chaos of the reforms and the ‘pause’.

Through the period of the pause numbers rose again, and as the reformed reforms entered the House of Lords more than 10,000 readers a week were visiting the blog.

As the row about the Bill grew and it finally became an Act the blog readership peaked at 20,000 hits a week and it has stayed around that figure – slipping a little last summer – until recent weeks.

I am advised, by those in the know, that when you reach a certain size there are machines that roam around the blogosphere looking for new material. You, dear readers, will know how many of you are machines.

But now I am now going to wind down the blog. It’s been fun but it’s also been hard work – and I want to reduce that work.

At the height of the politics of reform I was writing four posts a week and in most weeks there have been three. Over its four years of life that’s equated to about 600 posts – which probably means I have written around half a million words. They are all there on the web.

This does not mean I am never going to write another post. There will be times when I just won’t be able to help myself. But from the end of March I will not be writing two or three times a week.

Thanks for reading it. Thanks for all the comments and, above all, thanks to all those who have taken the time and trouble to talk to me about the content.

There will be a couple more posts next week, and whilst this is not ‘goodbye’ it does mean that I won’t be popping round to see you quite so often…

(Not just a crash diet. Reform publication 12 March 2013)

The Budget comes up this week and for this and the next few budgets the best news for any domestic public spending department will be for the health service. As today’s blog headline suggests, health will have grabbed nearly a quarter of all the increase in spending over that time period. Read the rest of this entry »

The first day of last week’s Nuffield Health summit concentrated on the linked issues of quality and finance. We are going to have to improve the former whilst having less of the latter. I will return to this issue.

Throughout my time at the Summit I couldn’t shake off the nagging idea that, here we are in the spring of 2013 – and right now would have been a great time to launch a Government NHS reform programme. Read the rest of this entry »

We have learnt that Coalition Governments get into a rhythm. Every year now, in early March, there is an attempt by the Coalition to change some or other policy just before the spring Liberal Democrat Party Conference so that party members can feel that they are having an impact on the Government. Read the rest of this entry »

The new NHS reform architecture contains within it a number of problems that have always been predictable. As I have suggested on many occasions previously this is in part a consequence of the very many different and opposing minds that have been shaping the reforms as they have been developed. The famous pause in April 2011 led to a considerable strengthening of the centre at the expense of CCGs in the localities. Since then the reforms have always been a combination of greater decentralisation, combined with greater centralisation.  Once that process began relationships between the NCB and the CCGs were always going to be difficult. Read the rest of this entry »

By-elections always tend to have many more losers than the one winner and last Thursday’s Eastleigh by-election was no exception. There was even a potentially important lesson for the NHS action party which had its first by-election outing, and that’s the main topic I want to write about today.

But first I want to talk a little about one of the biggest losers at Eastleigh – an organisation that was not even standing. The Daily Mail spent the 10 days leading up to the by-election trying its best to get the Eastleigh electorate not to vote for the Liberal Democrats. They ran a media campaign against Lord Rennard in a very clever way – assisted by the failure of the Liberal Democrat leadership to grasp the issue. Read the rest of this entry »

We are just over a month away from the implementation of the new NHS reform architecture on April 1st. So I thought it might be timely to speculate a bit on what is likely to happen. Since some of the biggest changes concern the nature of commissioning it might be worthwhile starting there.  

Read the rest of this entry »

In the last few weeks I have been fortunate enough to have been involved in a simulation about how the new NHS architecture will work rolling forward. I don’t know if you have ever been a part of a simulation but they gained traction in the early 1990s when the famous Rubber Windmill (pioneered by Alasdair Liddell) took place. This rolled forward the new architecture of the time and gave people playing the simulation the opportunity to see not only how the architecture would work but much more importantly what they would actually do in this new world. Read the rest of this entry »

Part 2: The failure to create a failure regime

One of the long term mistakes has been the failure of policy to clearly develop, publish and use a failure regime for the nation’s hospitals. Whatever else we learn from Mid Staffs, we must recognise that a considerable number of local people felt that this hospital was failing them. Yet I am still not clear if, several years later, Mid Staffs is labelled a falling hospital or not.

That fact it has failed is clear. Whether anyone has had to nerve to categorise it in this way is less clear.

This has been a policy area that has been fraught with political failure. Several governments, including the one for which I worked, have failed the public by failing to develop, publish and use a regime that clearly and consistently uses the label ‘failure’ to describe a hospital.

In 2000 the NHS plan made it clear, not only that there should be a simple red amber and green rating system for the nation’s hospitals, but that there should also be a regime which clearly labelled a hospital as ‘failing’ and had a policy to deal with that.

But in fact the development and application of this policy over more than a decade has been weak.

Compare this to education – where the first school was labelled as failing 20 years ago.

Let’s look at where we are today.  South London Healthcare Trust had the administrators sent in because it had failed economically. But the point made by the Public Accounts Committee was that we don’t know the criteria that determined that administrators should be sent into this hospital – and not to any of the others that can only pay their staff because money is stolen from the rest of the NHS to subsidise them.

In quality and safety terms we don’t really know what the failure regime looks like.

Two weeks ago this led the Prime Minister, in his statement in reply to Francis, to ask Monitor to develop what he described as a ‘unified’ failure regime.

We all know why there has been a decade-long failure to construct a failure regime. It is a collective failure of nerve by the political class (including me in my time in Government).

Most of the public believe that all NHS hospitals provide a similar standard of service. As far as they are concerned the NHS brand is a badge which guarantees both quality and their safety.

ALL of us in the system have long known this is not true.

But it took a catastrophe like Mid Staffs to acknowledge this.

It’s true that some Government policy helped patients at Mid Staffs. In the past they would have had to keep going to the hospital because they had no choice. Developing the policy which gave patients the choice to go to a different hospital was hugely controversial. It took row after row with the various aspects of the NHS to say that the public had the right to choose where to go.

This is one area where I don’t have to apologise because we faced down that opposition and implemented a policy of choice.

What did this mean for people at Mid Staffs?

On February 10^th BBC news carried an interesting report on a Freedom of Information request. This had been published on the BBC Stoke and Staffordshire web site.  This showed that the current CEO of Stafford hospital had found that the number of patients who had chosen to go there through the ‘choose and book’ system had fallen from 15740 in 2007/8 to 6513 in 2012/13.

This is a really significant statistic. Because people could choose two third chose not to go.

It is the case that many outside the NHS may find it very odd that as many people as 6513 are choosing to go to a hospital which has been so systematically labelled as bad.

This is the first time I have seen a set of figures which so powerfully demonstrate the choice of the public not to go to a certain hospital. 2 people out of 3 are choosing not to go to Mid Staffs compared to 5 years earlier.

These choices are costing the hospital £3.7 million a year and will be one of the reasons why Monitor has had to look carefully at whether the hospital has a future.

The policy of choice enshrined in the NHS constitution gave people the right not to go to a certain hospital, but because we did not have the nerve to develop and implement a failure policy, we left it all up to the individual.

I am pleased that we gave people choice. But I am ashamed that we didn’t clearly say that failure was failure and decisively act upon it wherever and wherever it took place.

2 “The Government is wrong to carry out an unnecessary top down reorganisation.” 

A few weeks ago Andy Burnham made an important speech launching a major consultation on Labour’s Health Policy. What he described as “the biggest consultation on health and social care policy by the Labour Party for 20 years” is obviously an important event. My Monday posts are discussing his policy proposals in a particular way. Read the rest of this entry »