Health Matters | Paul Corrigan's blog

(It’s the 50^th anniversary of Private Eye – and one of the many brilliant examples of satirical journalism that it has published over the years was “XXX – the man they couldn’t gag”. As with many of their spoofs this was taken from the example of a tabloid journalist who would brag about publishing regardless of any pressure they were put under. Of course within the Private Eye story the journalist could be bought by a decent lunch and would drop his stories under any pretext.

Well blogging – as one of the newer forms of electronic journalism – has shorter traditions than print but I am sure there are blogs that are proud of the fact that they would publish the truth irrespective of whatever slings and arrows might be deployed to stop them. I suspect that there may even be some blogs that have at their masthead “XXX – the woman (or man) they could not gag”.

Well last week I found out how easy it is for a blog to be gagged. It doesn’t take a high court writ, or a Minister of Defence D notice, or even – for that matter – the heavy mob turning up from the DH. No, all that it takes to gag me is a corrupt hard disk. Last Sunday I woke up to a very sick computer and the rest of the week saw someone trying to ‘scrape’ the old hard disk onto a new one. So for last week “Health Matters” was a bit poorly and proved that in these days of individuals and new technology, it’s very easy to gag a blog!).

Readers will know that my day job involves working with a wide range of different health care organisations – all of them providing services to NHS patients. That means that at the moment I spend my time with people whose whole experience of their work is impacted by the NHS reform programme.

Several times a week I stand up in front of health and health care organisations and try to explain what NHS reforms might mean for them. With this set of reforms I have now been doing this since early September 2010. In that time I have probably worked with about 150 different groups of health care people. Most of my day job is not about taking a position on the reforms, but to try and help people make sense of what is going on.

Again regular blog readers will know that the main problem for anyone trying to do this is the Government’s failure to do this itself. Most people hope that people like me can make sense of what is going on because they have not had the experience of the Government letting them know why all this is happening. There may be a variety of reasons for this – but the result is that most NHS audiences really don’t know why all this stuff is happening to them.

And therefore they don’t know what to do.

Of course once the reform programme ran into trouble in the spring and the reforms were themselves reformed this task of explaining what is going on has got harder and harder. But it really doesn’t help people to say that the Government is in the same position as a referee who has just made six or seven odd decisions in a football match. On such occasions the referee might have the experience of 50,000 people chanting – “You don’t know what you’re doing”. In truth, at the moment the Government doesn’t know what it’s doing, but knowing that doesn’t help people. In fact it makes it a lot worse.

So in recent weeks many of my talks have been given under the title NHS reform (today) – because the reform programme will be different by the end of the week.

But despite so much uncertainty, people quite rightly want to know – given all of these different amendments to reforms of the original reforms – what will actually happen and what should they do?

Because everyone in the NHS knows that even if the Bill had stalled in the House of Lords, some sort of change is actually happening – and in a year’s time there will be even more reforms. So give or take the membership of clinical senates and the governance arrangements for the system regulator Monitor – why is all this stuff happening?

So I thought I would share the way I am explaining the aspects of reform.

You have to start this with a strong belief that whatever the Government wanted to do in July 2010 about the ‘liberation of the NHS from the centre’, this one directional approach to NHS reform has not panned out that way. In fact the Government is now trying to both decentralise and centralise the NHS. And the best way of making sense of all this change is to recognise that both things are happening at once.

Of course you can have fun and games saying that the Government ‘should make its mind up’ whether it is centralising or decentralising, but the fact is that it is trying to do both.

This means that what I am doing currently is explaining that while some of the Government’s reforms are making the NHS powerfully more central, others are making it more decentralised. It doesn’t matter that they don’t know what they are doing. What matters, and what the NHS needs to know, is that they are doing it and how to work with it.

Of course people are a bit angry. Why don’t the Government make up their mind? But while it may be politically interesting to note that the Government is doing conflicting things, what is important is that both these things are actually happening and will happen to the NHS.

One way of making sense of this is to see the Government reforms as both being centrifugal and centripetal. On the one hand they drag power toward the centre and on the other spin it out to the localities.

The NHS is going to have to learn to be both a national and a local organisation. Over the rest of this week I will explain how this will happen and what the leadership of the NHS should do about it.