I don’t generally blow my own trumpet but if you look at my post of September 14 2010 I think it contained the first comment anywhere pointing out that the Government did not have a narrative to explain why its NHS reforms were necessary. Since the Government did not have a reason for its reforms how could it explain how they would deal with what was wrong? Over the following 20 months it was open season on their inability to communicate either what was wrong, or how their reforms were going to put it right.
Occasionally the Government said that the nation’s cancer and coronary heart survival rates were not, when compared to other European countries, what they should be. But if this was the problem it was never really explained, for example, why giving the National Commissioning Board the power to commission GP services was going to improve heart attack survival rates in Lancashire.
In September this year most commentators felt that Andrew Lansley left office because he couldn’t construct any narrative about the reforms at all.
The Government now has its reforms and we are, at this late stage, beginning to see a post hoc explanation of why they were brought in.
The narrative now goes along the lines of, “Whatever bad happened under the unreformed system, will not happen under clinical commissioning groups”.
Last week, in a statement about the attacks on patients with learning difficulties at Winterbourne, we heard what I suspect will be the first of very many such explanations of how the reforms will help to stop such outrages from happening.
In the Lords Lord Howe made it clear that one of the main problems at Winterbourne was that the commissioning of services wasn’t what it should be. He is right. But he went on to develop what I think will be the first of a series of hostages to fortune. He said,
“In general terms it is our perception that commissioning has been too remote from the patients that it is intended to serve …Clinical commissioning is intended to push local decision making much closer to patients and local communities with the aim of ensuring that local people are able to hold commissioners to account more effectively for what they achieve.”
It is difficult to disagree with this. But moving commissioning from 152 PCTs to 220 CCGs is hardly a radical shift in the localisation of accountability.
Claiming that clinical commissioning will improve the outcomes of patients with complex needs, such as those at Winterbourne, the Government now face a bigger problem. Having had no reasons for their reforms up to now, from here on in they are in danger of overclaiming what their reforms will achieve.
Over the last 18 months I have worked, as they were developing, with about a dozen CCGs-to-be. For much of that time we have been looking at commissioning intentions and I cannot once remember any of them mentioning the commissioning of services for people with complex needs.
That is not because these commissioners are bad people – but the problem for the CCGs-to-be is that they have an incredible amount to achieve in very little time. Indeed I am on the record as saying that over time some of these CCGs will become really good commissioning organisations.
But will the creation of a national network of CCGs mean that commissioning will be at such a level that there will be no more scandals such as Winterbourne? – No.
The problem for the Government is that this is what they are beginning to claim. There will be two years between the creation of these new commissioning organisations in April 2013 and the election.
During those two years this over claiming for the achievements of the reforms will be put to a very hard test – and funnily enough it will not solve all the problems of the NHS.