What will the Government learn from its chief listeners about developing better NHS reform?
Filed Under (Health and Social Care Bill, Listening Groups, Narrative of reform, Reform of the NHS) by Paul on 06-06-2011
By now the Secretary of State will have received the reports of the four listening groups and will be poring over them for their recommendations concerning the detail of changes to the Health and Social Care Bill.
Having lost control of its health policy on April 4th how, two months later on June 6th, can the Government regain control of it?
I am sure policy experts will be trawling through small aspects of the changes and seeing how they can be made to work. My recipe for this Government to regain control by working with these reports is a different one.
Over the last year this Government has shown itself to be useless at developing a persuasive narrative for its reforms. I think it has made this mistake because it doesn’t really understand the nature of distributed power in a modern society. It made the mistake of interpreting what was, at best, a very weak democratic mandate as having invested it with very strong ownership of power to do what it thought was the right thing.
It assumed that sufficient power came out of its electoral mandate and that it could act accordingly.
Power is much more distributed than that in a developed democratic country in the 21st century. Power is held by a wide and dispersed set of organisations and simply holding a Parliamentary majority (or in the case of the Conservative Party a Parliamentary minority) is not enough.
Last July by publishing the White Paper and failing to construct a narrative that would at least carry some people along with it, the Government failed to recognise that distributed power means that you need to possess an argument.
They have a sort of 18th century view of power with which they seek to reform the 21st century NHS.
Luckily for the Government the four people it put in charge of its listening exercise all live in the 21st century. In their day jobs they are all committed to bringing about various forms of change and, because they understand power, they recognise that the only way in which they are going to succeed in bringing about the changes they desire is through robust, powerful, and continuing argument. There is no point in being right if you don’t have a convincing argument to win the day.
All four of these people are not policy nerds who come up with ideas and expect others to do the hard work of winning the argument. They all understand that if you want anything to happen you will need a very good and winning argument yourself.
They started their work in April 2011 when the Government had comprehensively lost an argument they had never had. At that time forces in favour of the status quo were completely dominant and if any one of the main organisations representing vested interests had claimed that the Bill would mean that the NHS would end up being run by the men from Mars (or from the USA – whichever is the most scary) it would have been treated as a serious threat to the NHS.
This means that the four chairs have had to develop their reports with a very strong “status quo” wind blowing against them. Many of the NHS vested interest groups they were listening too had, at that particular moment, stopped the Government. They were in a mood to stop reform forever. This meant that the four listening groups developed their proposals within an atmosphere very hostile to NHS reform.
Therefore the proposals for reform the chairs will come up with will have been formed against this backdrop. Their proposals will not just be interesting as individual policies, but will contain an overall argument for change that the Government itself has not so far possessed.
So my main injunction to the Government is to learn from these four people how to argue for change. Look at how they frame their arguments in such a way as to organise support and to limit the power of those arguing for the status quo. Because they began their work in the teeth of a rampant and dominant status quo gale, they will have constructed their arguments sentence by paragraph in such a way as to win from a difficult starting position.
If the Government wants to restart its NHS reforms it will have to do so in the face of a dominant set of arguments from the NHS status quo. Learn how to make and win the argument for change from people who have to do it in their practice every day.
