Health Matters | Paul Corrigan's blog

Over the last few months the feedback to this blog has made me think about some different themes to post about and how to post them.

The publication of the White Paper on Health on July 12^th made me realise that, given the size of that topic, it was simply not possible to cover the whole issue in a single post. So over the next few days I made a series of posts covering different aspects of the White Paper and ‘stayed with it’  over the following fortnight.

This seemed a move away from the immediacy of blogging, but it gave me as a writer and you as the reader the opportunity to develop a serial approach to a big issue.

Later on a fellow blogger had the very clever idea of boxing these posts into a single unit which in terms of TV programme might have been called a “boxed set”.

At the same time the readership of the blog increased significantly, and a number of people gave me some interesting feedback about the uses they were putting the posts to.

One of the issues this made me think about was how my experience of the detail of the political process might help readers understand what different aspects of policy mean for people in the NHS. Having been involved in developing the argument within White Papers means I have an idea about how the words in a policy document articulate with the wider politics.

Over the autumn the political process developing NHS reforms will continue.

A Health Bill will be published. Whilst the detailed wording of every Bill is a matter for lawyers and law makers, the publication of the Bill will demonstrate in greater detail what the Government intends to do with NHS reform. The publication of the Bill will be worth another series of posts to communicate to those interested in NHS reform how the detail of the Bill will impact upon them.

Over the months after the publication of the Bill, it will be debated in Parliament. The issues in the Bill are likely to touch upon some very important issues which parliamentarians will want to debate.

• What role will Parliament play in holding the Secretary of State to account?
• What role will Parliament play in holding the National Commissioning Board to account for the expenditure of over one hundred billion pounds raised by Parliament?
• How will patients play a role in holding the Board to account?
• Will GP commissioning consortia be nationalised by this Bill and moved into state organisations?
• How will commissioning drive improvement in quality and value for money

These and other issues will be contentious and there will be strong debates about the legislation. My blog will cover these issues as they are raised and will look at the impact on the debate about the reform of the NHS.

As the Bill goes through both houses some amendments may be successfully introduced by other parties. But there will certainly be a raft of amendments introduced by the Government. Often it is only in debate in the Houses of Parliament that the Government comes to understand what a piece of legislation is going to achieve.

Under those circumstances the amendments made by the Government will have a dramatic impact upon what the Bill will achieve and how it will impact upon the NHS.

Alongside these themes I will continue to blog on the day to day issues of health service policy and practice.

Given the interest in policy development in the NHS and given the turmoil about the level of resources in all other public services it is easy to forget that over the next few years – and in some cases the next few weeks – there is going to be a series of problems with resources for the NHS which will become increasingly public. Whilst the public presentation of these problems will all be about deficits of one kind or another, their causes will spring from very different policy interventions. It’s important to try and tease out what they are as and when they happen. Read the rest of this entry »

At all times in the development of the NHS this is an important issue. The NHS depends on all its staff for it to work at all – let alone well. So for it to produce any outcomes at all it depends upon the active involvement of hundreds of thousands of staff at all sorts of grades. Read the rest of this entry »

Conservative policy documents for several years leading up to the election had pledged to “remove politics from the day-to-day running of the NHS” and to “end political micro-management”

This language was repeated in the Manifesto and has been repeated since then in both speeches and in the White Paper itself. Read the rest of this entry »

During August a lot of people are on holiday so I am going to post a weekly blog on a background issue to the current politics of the NHS before getting back to the detail of the current policy and implementation shifts in September.

The four will be

1. Her Majesty’s Treasury why does it consistently resist NHS reforms that are based upon improving productivity through organisational incentives?
2. Keeping politics out of the NHS .The Coalition government’s stated intention and how and why it is returning to ever more detailed political management.
3. The BMA and the other NHS unions
4. NHS resources over the next few years. Pressure points and deficits to come.

Read the rest of this entry »

Over time this part of the reform programme will become less and less visible. Patients should not have to care about the way in which the NHS moves; they should be interested in its outcomes for them and the fact that they can rely on safe free speedy modern services when they need them.

But as the reforms are developed, as they are bedded in, this aspect of the reform programme is probably more important than the others. It signifies the big shift in power from the NHS HQ which at the moment resides in the Department of Health and is run by a Permanent Secretary who is the CEO of the NHS, to an organisation that is completely different – the economic regulator. Read the rest of this entry »

One of the most striking phrases in the White Paper comes on page 36

“Our ambition is to create the largest and most vibrant social enterprise sector in the world”

I am always excited by ambition in a Government White Paper. Read the rest of this entry »

or meet the new regional office of the National Commissioning Board – just like the old SHA.

The current Secretary of State for Health has called his White Paper “revolutionary”.

Because I know a thing or two about the theory and practice of revolutions, I was always careful not to call any of New Labour’s NHS reforms revolutionary. They were not revolutions they were just that – reforms. Read the rest of this entry »

Since the publication of the White Paper I have outlined some of the problems that come from each of the main architectural themes of the White Paper reforms and hopefully some possible solutions

1. What is the responsibility of the National in the English NHS?
2. Who is commissioning health care and how are they doing it?
3. Who is providing health care and how are they organised?
4. What are the transactional relationships between commissioners and suppliers and how are they organised?

2 Who is commissioning health care and how are they doing it?

This is the issue at the heart of the Government reforms and this is the policy implementation that unless it remains unchanged will destroy their impact. Read the rest of this entry »

If there is one group that should have received the White Paper with unalloyed pleasure it is the private sector health care companies who are trying to sell their services into the NHS. Read the rest of this entry »