Confident or anxious narratives produce very different political outcomes for Government.
Filed Under (Health and Social Care Bill, Narrative of reform, Reform of the NHS) by Paul on 21-02-2012
Yesterday the Government found itself under attack for having a meeting to discuss the implementation of the Health and Social Care Bill. The central theme of these attacks concerned those who had been invited and those who had not.
At some moment during the last week it must have seemed like a good idea to have a meeting to discuss the implementation of the Health and Social Care Bill – that excluded both the BMA and the RCN – but it would have been a moment of weakness and not strength.
The big problem for the Government is that it still doesn’t believe in the strength of its own narrative to explain how its reforms will solve the problems. As a result of this anxiety it does not know how to cope with disagreement over the reforms.
If it had, over the last 20 months, established an agreed view of what the problem facing the NHS actually is then there could at least be a discussion about how the solutions they are proposing might help solve it. This would then have formed the basis of discussion that they might have had with others at Number 10 regarding implementation.
If that had happened – imagine what the discussion in Number 10 might have been. Whilst the BMA and the RCN would still have disagreed with the Bill as a solution, the discussion would have centred on the imperative of solving the problem.
This creates a very different dynamic. Because the argument for change has not been made, the strength of the argument against the Bill at the moment is with conservative forces in the NHS – who are simply against change. They don’t have to say very much, because the prevailing opinion remains that things in the NHS are mostly OK.
Recent weeks have seen the Government use a scattergun burst of explanations – there are things that are wrong with the NHS now, or will be at some time in the future. But their approach is both unsure and contradictory. It doesn’t help that the PM said in May that after the reforms the NHS would be much the same as it is now. In which case – if there is nothing very much to change – why change?
For 20 months the Government have failed to persuade the public that there is much wrong with the NHS.
Contrast this with their powerful narrative on the economy, where the majority of the public recognise there is a problem and that its solution will be difficult – not just in the abstract – but for many of them as individuals. They are not wildly enthusiastic about the pain they must suffer, but most believe that it is a necessary part of both their present and their future.
We can only guess at why the Government have failed to do the same with the NHS.
But for the moment, the Government continues to be enfeebled by not having made its case for change, which has led to the exclusion of the BMA and the RCN from a meeting called to discuss the implementation of the Bill being seen as a sign of weakness rather than strength.
Let’s pause for a moment and think about this meeting.
This meeting was called by the Prime Minister – at the heart of Government, at Number 10. This is the Government playing on its home territory. The PM is also a good communicator. If the Government are not confident of winning their argument here they’re not confident anywhere.
All the BMA and the RCN could do is to simply disagree. This wouldn’t be bad behaviour; it would just be an argument.
The conversation would take place between some people in favour of the Bill and some against. It will be chaired by the PM – who is in favour. This provides him with an opportunity to demonstrate how strong the argument for change is and – in the discussion – how his ideas will work to bring about the changes that he believes are necessary.
It’s not likely that the BMA or the RCN would have changed their minds as a result of the discussion, but they might have felt, after the meeting, that the Government have some good strong ideas that they have to take into account.
The most important thing for the Government is that the Bill’s opponents would have been a part of a discussion looking at what will happen after the Bill is passed. This is when the problems really start for the Government and it will need as many organisations to be ‘on side’ as possible.
Including the BMA and RCN in these discussions would have placed them in the position of being part of the post Bill solution.
Excluding them just leaves them as a part of the Government’s problem.
What struck me was the report, amidst a plethora of managers and clinicians, was the extension of an invitation to only one patient representative. Has the government not noticed who is meant to benefit from (small r) reform, and their commitment to it?
Mike is spot on about patients.
The number of meetings and PR opps without them is becoming ridiculous.
No decision about me without……
Interesting point about the paucity of patient input. One of the weaknesses with the Bill (and its preceding White Paper) is that it tend to look no futher than the individual Doctor-patient consultation for the patient voice. The proposals on Healthwatch are lacklustre to say the least. There is little sense of the value and mechanics of strategic public engagement and there’s a desparate need for a coherent narrative on this.
[...] I mentioned yesterday the Government has been using scatter-gun tactics in its attempt to argue its case for NHS [...]