My immediate response to the report that has been produced by the Future Forum is that if only the Government could learn from the care that has gone into its narrative for change, they would find themselves in a very different position.
How is it that this group of people could construct a narrative for substantial NHS reform when the Government itself couldn’t?
Why is it that a ‘bunch of amateurs’ has proved able to develop much better politics than the leading politicians in the Government?
I had a stab at answering this question last Monday (June 6th) when I suggested that since all four chairs of the listening groups live in the real world of public service leadership, they have, every day, to construct arguments to get anything done.
This Government seem to have come into power believing that for them this was not the case. They believed that power was ascribed to them by winning the election. The day before the election they had no power. The day afterwards they had it all. This was why, until April 2011, they never really felt the need to have a reason for reforming the NHS. They had the power and they could therefore simply get on with it and tell us what to do.
They have learnt, through the experience of political defeat over their NHS reform programme, that power in an open democratic society is distributed. They may have believed that Government could simply say to Parliament that they should not place a nurse on every GP Commissioning Consortium Board. But over the last 6 months they have learnt that it is the nurses that have the power in this issue – and the Government does not.
So if the Government had any sense they wouldn’t just look at the policy contained in the Future Forum report, they would look at the argument – the narrative for change.
The four listening group leaders, in their day jobs, all want to make things happen. To achieve that they have to have arguments with stakeholders, and win them, every day. This is how power is distributed in our society. Authority is not ascribed to someone because they have an 18th century view of the world, because they have 312 seats in Parliament or because they own Berkshire, power is achieved by leaders because they win arguments for change every day.
Read the report. Look at how the arguments for change build from common sense into the wider argument. Consider how these arguments resonate for change. If the Government had any sense it would learn to argue this way.
But if the Government had any sense they would not be in a position where they have to outsource the narrative for their reform programme 10 months into its creation.
So what worries me is that they may think, having been through this weird 10 week pause, that they now have their mandate for reform and that all they have to do now is roll it out. They have made their compromise with the forces of the status quo and now they can get on with it without any more political fallout. Which is wrong for two reasons.
The first is that defenders of the status quo, having been thrown much of what they wanted, will now smell weakness and want more. Will want everything.
The BMA do not like the reality of competition because it upsets their belief that they have the right to try to run the NHS in their own image. The status quo that they want to keep goes back to at least 2000, not just to 2010. They want to move from a policy of competition being promoted to one where it is banned.
In the summer of 2011 they have the Government on the run and they recognise that a weak Government will not stop their demands.
- Since the Government have not given them everything, there is always more to demand
- Since the Government is weak, there is always more to expect.
And they are only part of the coalition for the status quo.
The Government are wrong if they think they have had their fight with reaction. It is only just starting.
That is why the Government needs a powerful post-pause narrative for change even more than they needed one pre-pause. From now on, and every week, they need the public on their side for NHS reform. Even more than before the pause they need to get out and make the argument for how their reforms will improve value for money and patient’s experience in the NHS.
For the Coalition Government the struggle for their NHS reforms has only just begun.