“Never Again” a pamphlet by Nick Timmins – published by the Kings Fund and the Institute for Government
Filed Under (Health Policy, Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 12-07-2012
Once you’ve read today’s post download the pamphlet that is published today by Nick Timmins “Never Again – the Story of the Health and Social Care Act.” I know we worry about the future of the planet, but I suspect you will want to sit and read this a couple of times, so my tip is to print off all 140 pages.
It’s worth it.
Nick Timmins understands the wider politics and policy of health care reform in England better than anyone else. Since he left the Financial Times in February he has been engaged in carrying out the research for this book. I mention the fact he was a journalist because it has a profound and beneficial impact upon the usefulness of this book.
It has become a truism that the Secretary of State did not have a narrative to explain his NHS reforms. Over the two year period that he pushed them through Parliament, he seemed to feel that explanation was in some way beneath him.
“Asked whose fault it was that people did not understand Lansley says, “What’s not to understand”? He adds that “To be honest it is an idle pursuit to imagine that you could ever get to a place where the great bulk of people understand how the internal workings of the NHS work. They never did. And never have done. And there is a degree of why would you want to?” (p141 – Never Again)
So there you are as Secretary of State radically reforming one of the main institutions in our society. His response to being told he should communicate how and why he is doing it is to say that people should not bother their heads with it, that it’s correct not to explain it to them!
He also has this rather odd idea that policy speaks for itself.
As he famously said to the RCN Conference in spring 2011,
“I am sorry if what I was setting out to do has not communicated itself. “
So any story about the Secretary of State’s NHS reforms is a story about a set of political reforms with no narrative of explanation.
What is so good about Nick Timmins’ book is that it has a clear narrative (about a set of reforms that were a narrative-free zone). The good thing about journalists is that they are used to writing articles with their name on it. They are used to people saying that their style had shone through.
So here, in what was a very confused and confusing set of very important occurrences, Nick has written a story (in 5 Acts with several scenes in each Act) where he is clearly in charge of the story. This means that there are bits of the story with which different people will disagree – as their interpretation will be different at different moments – but because there is an overall narrative you can see which bits they are. Rather than having a welter of different explanations, there is one.
The phrase around which the book is written – “Never Again” – has two meanings and Nick says that history will let us know which is correct.
The first is probably felt by most of the NHS and is contained within the phrase “For God’s sake this must never happen again”. This suggests that a car crash of reform which started with 6 months of no explanation to the public or the NHS, with no attempt mobilise support from either for the reforms, and no attempt to bend at all in the face of opposition – was an inevitable failure. Followed by a two month pause and amendments to the Bill as it moves at similar speed in a very different direction through the House of Lords – where the Bill is completely changed.
“Never again” is an NHS view of the facts – that this must never happen again.
But the other view of the phrase “Never Again” is that it is the Secretary of State’s view that he created his reforms and his legislation to ensure that the reformed NHS could never be ‘unreformed’. He wanted to change the system completely through legislation – so that it could never be changed again. (I find this rather a difficult concept – since all you need for legislation to change anything is a Parliamentary majority). But it is clear from Nick’s interviews that the Secretary of State’s aim was to put his reforms beyond the reach of further reform. He wanted to make sure that there would never again be another NHS reform.
But there was another reason for the legislation. A Conservative backbench MP said,
“He wanted to do a ‘Butler’. He wanted the ‘Lansley Bil’l, as Butler had had the Education Act” (p 121)
It’s a bit shocking to believe that all of that political capital and argument that raged around the Bill simply reflected the vanity of the Secretary of State.
But in the midst of the chaos of calling for the pause Lansley said in the debate – on 3rd April 2012.
“I could have done most of this without legislation”.
This probably is the oddest insight. There we all were transfixed by an Act – bigger than any other Health Act ever – that had had over 2000 amendments to it and yet, so far as its author was concerned, wasn’t necessary.
Read the book it’s great fun. Even if the reality isn’t.
The Government now seems to expect a Secretary of State who has failed to explain NHS reforms to now fail to explain a set of social care reforms.
With any luck an urgent reshuffle will save social care from that fate.