New depths of confusion.
On May 16th 2011 (I add the year because it would have been a great idea for him to have made the first half of this speech in 2010, at the beginning of this process, rather than in 2011 towards the end of it) the Government’s NHS reforms hit new depths of uncertainty.
The first half of the Prime Minister’s speech on May 16th outlines, for the first time, (along with the now usual protestations of “love” and a Gollum-like over use of the word “precious”) the strong need for change in the NHS. At last, after a year which began in July by racing down the road to radical, speedy reform, slowed considerably to “evolution” by December and ground to a halt in April, the Prime Minister finally decided to tell us why he felt all this reform of the NHS was essential.
It would have been a different story if he and his colleagues had spent last summer going round the country explaining that it if we were going to have an NHS free at the point of delivery and paid for out of universal taxation then it was essential that the NHS was reformed. But last summer was all about speed, not explanation.
When I was in my late teens a writer called William Burroughs was in vogue. Burroughs decided that the most interesting way to write a narrative was to cut up the story into different sections and reassemble them in a new and challenging order.
The Prime Minister appears to have adopted a similar approach to his narrative for NHS Reform.
Most people would have taken a more orthodox approach and started with the case for change. They would then have had a period of listening to what the NHS and the public thought about their proposals for change, and then published those proposals. In “homage” to Burroughs the Prime Minister has adopted a more creative approach and put these steps in the opposite order.
He thought it would be different to start with the breakneck speed of revolutionary change. Then pause to listen to what people think about it, and only then make the case for change.
Well this approach certainly got our attention. And whilst Burroughs was always a bit too unorthodox for my taste I am always interested in new ways of expression.
So let’s go along with yesterday’s case for change.
He is right. Doing nothing will put the NHS in great danger. It is difficult to see how it will survive this decade unreformed. The extra demand caused by long term conditions will not be met by extra resources, so to save the basic principles of the NHS, very big reform of the way in which it works is essential.
And so having made the case for change, it was interesting to examine yesterday’s speech to see how the changes the Prime Minister is putting forward measure up to the scale and the pace of change that he says is necessary to save the NHS.
But the rest of the speech didn’t say HOW he was going to save the NHS through reform.
Continuing his unorthodox approach to narrative, the rest of his speech told us what he was not going to do.
Yesterday’s narrative was that it is vital to reform the NHS to save it for future generations, and that what he has decided to do to carry out this reform is not to use the private sector.
The internal narrative of his speech yesterday was another foray into what we might call the “Grand Old Duke of York Strategy” for story-telling.
You march people up to the top of the hill by saying that it is essential to reform the NHS, and then you march then down again by saying that you will not use the private sector to carry out that reform.
A few months ago the PM felt he not only had a set of reforms for the NHS, but a strategy for reforming public services as a whole. Yesterday he seemed to decide that his strategy for public service reform – by opening up provision to new and diverse providers is wrong.
Yesterday morning I sensed that there would be yet more twists and turns in the nature of the reform narrative, and yesterday’s speech showed I was right.
It proved to be too much to expect that at the same moment he was at last getting round to telling us why it was vital to reform the NHS, he would give us a glimpse of how and why the reforms that he is proposing could help make the change that his analysis says is essential.
Instead, as he has done consistently throughout the last year, he spurned any analysis based on some logical relationship between problem and solution, by delivering a chopped up narrative that leaves me asking still how what he is proposing will solve the problems he outlines…