Filed Under (Hospitals, Labour Party, Reform of the NHS, Secretary of State) by Paul on 31-10-2011
Last week, 18 months into his tenure as Secretary of State, Andrew Lansley made a speech at Reform where he unfortunately confirmed that he was going to bail out inefficient hospitals. I will return to that later in the week.
But it would be very churlish not to note that in this speech – for the first time – he dropped his obsession with structural reforms and began to address the crisis that is developing in many of the nation’s NHS hospitals. He said,
“We have hospitals that are respected across the world for what they do. But there are others that simply aren’t good enough. At times, it can seem as though there is a conspiracy of silence about poor performance. That doctors and nurses who were not up to the job go unchallenged by their colleagues. That institutions that deliver poor quality care, that keep patients waiting for treatment months on end, or who run up massive debts, are excused, or are bailed out by the government. We allowed a system to develop where, sometimes, failure was rewarded.”
This is an example of the kind of leadership that the NHS needs from its Secretary of State. And it deserves support for its sentiment. What I and others will hope is that policy and practice will now flow from this commitment and not run against it as it has for the last 18 months..
But I would be equally remiss if I didn’t also tackle the party political aspects of the speech.
He is correct in saying that the last Government – including the time during which I was a special adviser – could have done more to tackle variation of performance amongst our hospitals. But for the last 8 years, while he has been shadow and then finally Secretary of State, he has consistently opposed reconfigurations of hospitals that would improve safety and efficiency.
In 2007 the Leader of the Opposition, Mr Cameron, promised a clash with the then Prime Minister Gordon Brown over hospital closures.
“I can promise what I’ve called a bare-knuckle fight with the Government over the future of district general hospitals.
“We believe in them, we want to save them and we want them enhanced, and we will fight the Government all the way.”
And he did.
As I outlined in April and May 2010 before and after the election Andrew Lansley and David Cameron promised more and more bare knuckle fights to stop hospital conversions. Then, after the election, the new Secretary of State toured a range of hospitals opening up services that clinicians had recommended for closure.
He may have a point that the new Labour Government could have and should have done more. But undoing the steps they had taken is hardly a recipe for moving things along faster.
However over the last 18 months he has – one by one – agreed the changes that he rejected in those first few weeks.
Last week’s speech appears to indicate that he will now start to tackle these issues rather than make them worse.
There are many ways in which he could prove that he is really going to tackle variation and inefficiency.
Firstly he could stop SHAs taking money away from efficient parts of the health system to bail out hospitals that will not make the hard decisions necessary to become efficient. This is still happening up and down the country.
Second he could start to use the failure regime that was enacted under the 2009 Health Act. In his speech he quite rightly pointed out that this was never used under the Labour Government. His problem though is that he makes that statement as a critique of the failure of the previous government to use its own legislation.
Having spent 6 years as Shadow Secretary of State he still thinks like one. So he is right to point out that in the last 6 months of the last Government it failed to use the failure regime that it enacted in 2009. But he also needs to note that the present government has failed to use it in the 18 months since it has been in charge. And who has been the Secretary of State for that period? Andrew Lansley.
So I look forward to a newly emboldened Secretary of State moving the first NHS hospital into administration and giving it the opportunity to take the very radical changes that would make it a viable and safer proposition.