More thoughts about the possible development of different party political narratives about NHS reform
Filed Under (Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 17-09-2012
Last week I posted about the different way in which party political narratives about NHS reforms may develop. I expect a very different kind of debate now that the Government may have the ability to communicate some form of message about what it is trying to achieve.
I have also had some interesting discussions with people about my own experience with 2 different Secretaries of State between the years 2001-2005. In 2003, two years into a Parliament, Alan Milburn resigned from the Secretary of State for Health’s job and was replaced by John Reid. I stayed on as special adviser.
At that time the new Labour Government were engaged in what appeared to be highly controversial NHS reforms – including the development of the patient’s choice of hospital and the creation of Foundation Trusts.
This meant the Government were engaged in strong pro-reform arguments with a wide range of NHS and other organisations. I remember the BMA and other trades unions loudly telling us that the creation of independent public sector hospitals, the introduction of independent sector treatment centres and the right of patients to choose, would fragment the NHS – and that that fragmentation would lead to problems for patient care.
So there are some similarities in the nature of the clash of narratives between then and now and the current handover to Jeremy Hunt. Two years into a Parliament, a new Secretary of State taking over the job at a time of great controversy about reform, and dire warnings from trades unions about fragmentation.
Under these circumstances I would expect the new Secretary of State to straightaway stop making the waves that his predecessor created when he tried to explain what he saw as the problems the NHS faces that need such profound reform. For two years the Government has been going around saying that the NHS has a great deal wrong with it, and it is this that has raised public anxiety so much.
The detail of particular reforms that hold such interest for those of us obsessed with NHS reform are of very little interest to the public. But what does worries the public is a front page row about the future of the NHS such as we saw in the first three months of this year. Very few people knew that the nature of the row was about the composition of the organisation that carries out NHS commissioning. Being a change in a piece of administration, it really didn’t matter very much to people.
Let’s be honest, there were at most a few hundred people who were looking at the debate in the House of Lords in March and were worried at whether and how the Bill would be amended to limit Monitor’s power to interpret competition law. That was not what was being discussed around the kitchen tables of England. What was being discussed was, I hope, “will Gran be able to continue her treatment?” and “if one of our children gets ill will we be able to see a doctor without having to pay for it ourselves”.
The row created headlines about the NHS for a couple of months – and that really does worry people. In February I was sought out by two people in different parts of the country who were in the middle of chemotherapy for cancer and both of them asked me whether they would have to pay for the continuation of their treatment in the new financial year. When the “future of the NHS” is on the front page with a question mark behind that phrase, the public get very alarmed indeed.
So the first and most likely thing that a new Secretary of State will do is to take the sting out of this entire row by remorselessly talking the NHS up. Stop talking about reform and structures and changes in organisation. Start talking about patient experience and staff commitment.
In the past 2 years I have blogged a few times about really good news stories for the NHS which the then Secretary of State had to turn into bad news stories. For example, every November a US foundation carries out an international survey of what the public in different countries think about their health services. In both 2010 and in 2011 the NHS did very well. But on both occasions the then Secretary of State had to scrabble around for a bit of bad news to justify his reforms. This is bonkers.
So I would expect that in the new Secretary of State’s forward plan there will be a little star in the first week of November when we can expect a speech saying.
“I want to unreservedly congratulate the staff of the NHS for getting this great international result. I stand with Danny Boyle and want to showcase our NHS as the best in the world…….etc etc .”
The NHS will be talked up and the climbing weekly total of GPs engaged in clinical commissioning groups which was the main cause for joy and press releases of the previous Secretary of State will stop being, as far as the Government is concerned, a part of the public discourse.
If anyone has to claim that the NHS is in trouble it will have to be the opposition. If anyone has to get into the level of detail about how much of the country will not have GP commissioning in 2013 it will be the opposition. It is they who will feel the need to bring up disaster and detail – and if they do they will be politically on the back foot about the NHS.
Of course the opposition could decide not to do this. They, like the Government, could change their narrative. If they don’t, and the Government is successful in changing its, the party politics of the NHS could look very different in 18 months time.