Filed Under (Health Policy, Primary Care Trusts, World Class Commissioning) by Paul on 17-11-2009
Something very strange is happening to current Ministers of Health in the run up to the election and at the end of this Parliament.
At periods of time such as these Ministers are usually trying to demonstrate both their surefootedness and their ability to make things happen in the NHS. They try to use Government to impress upon the electorate that they are powerful people who can make things happen. It’s not a bad tactic.
But the current team seem to have hit upon a new way of operating. They seem to pick issues that demonstrate how enfeebled they are. They publicly say that they want something to happen whilst, I assume, knowing that in fact it cannot be achieved. Taking on battles that they cannot win looks increasingly odd to the electorate.
There probably is an electoral strategy here but I am at a loss to see how it will work. Do people vote for politicians that cannot make things happen? Are they impressed by politicians who take on things that can’t be made to come about?
Since September 17th the Secretary of State has attempted to develop his personal preference for a particular type of health care provider to be the preference of every NHS commissioner in country. To achieve this he will have to change guidance and rules so that it puts him and the rules on the other side of competition law. I am sure m’learned friends have been advised on how, when and where they might take him to court. Having the Secretary of State the dock in the run up to an election is an odd strategy, but, as I say, this is obviously a new way of doing things.
Now Minister of State Mike O’Brien has hit upon a new way of showing how weak he is. He has said that the current economic situation must not be used as an excuse for cuts in services. He sits alongside – and I mean literally, just a few rooms away – the Chief Executive of the NHS who has told the NHS that all bets are off. Every SHA, presumably with ministerial knowledge, has told every PCT to develop its commissioning strategy plans for the next few years with a series of downside scenarios which involve considerable loss of money. Their Commissioning Strategy Plans will be submitted for December 18th.
On September 16th the Department of Health – presumable the same DH in which the Minister resides – published its plans for World Class Commissioning Assurance for this year. Every PCT will be expected to demonstrate how it will balance the books in the next few years – even in scenarios where there is a loss of resource. In fact every PCT will be judged by its World Class Commissioning Panel on how it carries out this task. If they fail to do this they will be marked down. If they make plans for a realistic economic future they will suffer the wrath of the Minister of State.
Which course do you think they will take? Will they ignore the Chief Executive of the NHS? Will the Boards of PCTs decide that they want to get poor marks for WCC assurance? Or will they risk the wrath of the Minister of State?
Difficult one. But I think I know what they will choose.
And what has the Minister of State said he will do to those PCTs that follow the advice of the Chief Executive of the NHS? He has said that he will ‘name and shame’ them.
Some people find this shocking. That a Minister will publicly attack a PCT for doing what it knows to be the right thing. But I don’t think that. I am reminded of a scene in a film which shows one of the greatest examples of solidarity as one person is picked out for punishment from the crowd.
It’s a reworking of the penultimate scene in that great film Spartacus. The Roman General (here played by Mike O’Brien) says to the rebels (played by PCT Chief Execs) “which one of you is Spartacus? He who has decided to set a budget that is in line with what everyone in the world says is going to happen? “
A slow but rising chorus from all the PCT CEOs declare “I’m Spartacus” as they all claim the right to be named and shamed for doing what is best for their localities.
Quite moving for the NHS.
It’s going to be an interesting winter.
A historical note in the defence of King Canute. I have resisted making the analogy with King Canute as the latest revisionist interpretation is that he has been wrongly accused of stupidity by history. He has always been portrayed as the King who wanted to show how powerful he was. To achieve this all powerful image he is alleged to have sat on his throne in front of the tide, and ordered it to retreat. However he failed and for evermore has become a kind of “Patron King” of enfeebled leaders who overreach themselves by trying to command forces more powerful than themselves.