The Government plans to bet the whole of the NHS on the belief that GPs can deliver a business model that can buy £60 billion of NHS health and improve value for money for the NHS as they do so. Given the size of this spend in this industry it is to be hoped that GPs understand how to operate in a business this size. Read the rest of this entry »
One of the oddest experiences for any Secretary of State for Health is the reception that they get from the BMA. Of course you’d expect the BMA to protect its member’s interests by negotiating hard for terms and conditions. That is after all what all trades unions are meant to do. But the much odder experience for a Secretary of State is how the BMA starts to act when you develop a policy which their members have asked for. Read the rest of this entry »
An interesting insight from Alastair McLennan (editor of the HSJ) in his editorial on 16th September about the sharp difference in rhetoric between David Nicholson and Andrew Lansley in describing the nature of the tasks facing the NHS leadership over the next few years.
It has been possible to verify this distance in the regional meetings that the current Secretary of State has been holding. The SHA CEO (or NHS boss or pen-pusher according to the current Secretary of State) is as far away from the SoS in language and position as you can get and still be in the same town. They are talking to the same staff, ostensibly about the same thing, but with totally different meanings and emotions.
Alastair goes on to talk darkly about an NHS internal resistance movement boiling over. But I think that misses the cultural point about the way in which the NHS resists change. It never needs to boil – or even get a little tepid. All it needs to do is remain frozen in the attitudes and behaviours that it has been working in up to now. And through its very frozenness it stops change. Rather than “boiling up” resistance this is much more like the classic old army way of stopping activity. My dad talked about this from his time in the forces in WW2 – it’s what the sergeant major called “dumb insolence”. You don’t rebel, you just stand very still.
In some ways it is not at all surprising that there should be some rejection, since the current Secretary of State has made it crystal clear that he want a paradigm shift on how the NHS is run. It looks likely that not many of the very senior NHS staff will make that transition into the new paradigm. The announcement of the 30 transition leads from all the SHAs may be an attempt to provide some security for those that will have to lead the transition. But if these will be genuinely transitional they do not guarantee employment at this level on the other side of the bridge.
I can, for example, see the new National Commissioning Board wanting to appoint their own people to do the jobs that a brand new organisation needs. I would not expect the NCB to believe that you make the new by rolling forward the old. This is not to say that some of these people will not be employed. Those with experience of managing good commissioning will be vital to the future of the NCB.
But I think there is something more important than even the conflict of rhetoric that has emerged between these two approaches and that is the conflict about how change will be created. Crudely there are two different ways of making a very new future. The first is to build on the present and reach out across the gap to the future. And the second is to grab the future and pull it into the present by shaping the present into the future now.
There are two very different messages coming out about whether GPs should be encouraged to take over commissioning in some areas from April 2011. There are a few areas where GPs are up for this, where they want to get some real experience as soon as possible. PCTs in those areas would be wise to facilitate that new approach given they are the future. So we could expect 10-15 PCT sized areas from next April with GP commissioning really getting under way.
But the counter position from those that favour the existing system is that we need to get everything right (getting the design right) before we actually do anything. This means that the future is designed whilst the past is still in charge and when the past is ready and it has designed the future it will flick a switch and all over the country the future will start.
And funnily enough under those circumstances the future will look a lot like the present.
Filed Under (Charities, Creating public value, Reform of the NHS) by Paul on 16-09-2010
Thursday 16 September marks an event that will, in the long term, become one of the most important in the NHS. This is not a White Paper or a speech by the NHS Chief Executive but I think, in the next few years, it will change the terms of trade that make the NHS tick. Read the rest of this entry »
Over the last week I have run four different sessions about the development of GP Commissioning Consortia.; one to a PCT Board, one to the senior managers of a PCT; one to a local authority and the fourth to a regional group of PCT staff whose job it is to develop and make markets.
This was an interesting set of experiences since, whilst they were different audiences, there were some similarities in the experience. Read the rest of this entry »
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 12th 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. Read the rest of this entry »