I know I shouldn’t go on about this.
This quote – about “constancy of purpose” – jumped out at me from last year’s Government Executive Summary document on the NHS. Words can of course mean all sorts of things but it’s difficult to recall a period of NHS reform which has had such inconstancy and such little purpose ……
“We will maintain constancy of purpose. This White Paperis the long-term plan for the NHS in this Parliamentary term and beyond. We will give the NHS a coherent, stable, enduring framework for quality and service improvement. The debate on health should no longer be about structures and processes, but about priorities and progress in health improvement for all.” 1
So much about this paragraph has proved to be wrong.
- There was no constancy.
- The White Paper was not a long term plan.
- It did not give the NHS a coherent stable enduring framework
- The debate on health has been all about structures and processes.
It’s the birthday of the White Paper and I have been picking at the scab this last week because a client has commissioned me to explain to them what is happening to NHS reform policy now – and what has happened over the past year.
Of course people living outside of the NHS bubble assume this is easy. Government comes into power, formulates policy and then implements it. If you want to understand what is going on, all you have to do is follow that line of activity to see what the Government intends to do with its reforms.
So my client thought this was an easy thing to ask of me. In fact you have to start by explaining that there have been two reform programmes and, given that there is a tension between them, there is now a third which is an outcome of the interaction between these two.
- The first is a reform of the NHS, July- April 2010-11.
- The second is the reform of the reforms, June 2011 onwards.
- And now there is the outcome from the interaction of these two.
Both of these have an overarching rationale and both have detail. Therefore to explain what has happened you need to understand not only the two periods of reform but also how, in the end, these are going to interact.
The next problem in explaining all this to people is that they have to understand that all of this is part of a Bill currently going through Parliament that will change even more as it goes through the Lords. Some of the amendments there will come from the Government outlining the legislative framework for the failure regime and some of it will come from cross benchers and opposition peers.
This latter group will feel that since the Government have changed their own legislation so much, it is surely the duty of a revising chamber to revise it even further.
Therefore what will emerge from Parliament in the new year of 2012 is anybody’s guess.
So if you are the Board of a FT thinking about the environment in which your organisation will be working, you will not feel very confident about the constancy of that environment.
If you are a leading GP considering commissioning you won’t see a clear pathway between now and the future where you will be able to strategically commission what you feel is right. An organisation called a “clinical senate” (that nobody knows about) is not only going to have a say in what you commission but it will have a say in the authorisation process that grants you the right to commission at all.
If you are a third Sector Company thinking of investing in the NHS what on earth do you make of a Government that is pledged to outlaw any Government policy which self–consciously aims at increasing your share of provision for NHS patients?
Constancy of purpose……
1 Coalition Government Executive Summary “Liberating the NHS” – July 2010