Filed Under (Uncategorized) by Paul on 07-03-2012
On February 29th I gave a talk to the BBC College of Journalists. This was one of a regular series of meetings where people that have some expertise in a policy area come to talk with a range of different BBC journalists about ‘the story’ and how it is developing.
As of March 2012 there are four different aspects to the NHS story and it is perhaps inevitable that most stories have a relationship with all of them.
1 The party politics of NHS reform with the Bill still in Parliament.
Most commentators now agree that the Government’s biggest failure in relation to its NHS reforms has been its inability to provide a compelling narrative to explain why it is reforming the NHS and why its reforms are the solution to the problem.
For journalists whose job it is to provide an explanation in 250 words of what these reforms are all about, this is an enormous problem. Journalists see it as their professional skill to simplify complex issues for the public.
This is just not possible with this reform programme because its complexity is compounded by the political journey the bill has been on: today’s bill is the product of a series of political lurches and U-turns. The original white paper of July 2010 was styled as a revolutionary liberation of the NHS from central control. It aimed to move power out from the centre and into the doctors’ consulting rooms. It felt – and was – very radical.
But, as the bill was published and began its journey through the Commons, the Government failed to establish a narrative as to its purpose and what it was going to achieve. There was growing opposition from inside the NHS, and by the beginning of April last year many people believed that the NHS was being privatised.
The lesson to be drawn from this is that if a Government fails to establish a narrative for a reform the public will think that they must be doing this for some reason they are not telling us. For this bill that was the privatisation of the NHS. As a result, the Government has had to spend time arguing what the reform is not about rather than what it is.
In April 2011 the Government called for a ‘pause’ in the process and outsourced its policy making to a group of random people it called ‘The Future Forum’. Over the two months of the ‘pause’ this recommended quite a lot of centralisation that was to overlay the bill’s original decentralised structure.
As the Bill continues through Parliament further amendments have been made by the Government (now over 1000) so that the Bill now faces in several different directions at once.
This is why it is not easy for journalists – or anyone else – to explain what it is about. Between now and the passing of the Bill there will be more amendments. Government business managers no longer care what is in the Bill – they just want to be rid of the political pain.
The fact that the Bill will have taken 15+ months to go through Parliament has given opposition to it time to grow and harden. By March 2012 nearly every major medical body has come out against the Bill and their positions are becoming ever more entrenched.
2 The growing imbalance between the increasing demand for health care – with no increase in resource
More people are living longer than ever before. Every year there are many more people living to be over 85, and if you live to be that long you are very likely to get a number of long term conditions affecting your heart, lungs, joints, blood pressure and depression. Overall this is helping to increase demand for health care by about 4% a year. Over 10 years that amounts to an increase in demand for NHS services of at least 50%. Yet over the next 10 years we will be lucky if the resources available for NHS care remain about the same.
In any service this magnitude of imbalance between demand and supply will create a crisis. The economics of the NHS – which for 60 years has been built on continued growth in resource – will now have to confront a very different economic dynamic. Now, and into the foreseeable future, the NHS will have to generate significant increases in health care outcomes for the same amount of resource.
There are many ways in which this could be achieved, but most of them will involve moving care from its most expensive setting – the hospital – to its least expensive setting – the home.
That’s why for the next couple of decades the story of improving outcomes will be set against that of constant and often painful change in the way services are delivered.
Unless the government can establish a narrative about these necessary changes there will be constant stories about cuts and change with hundreds of political stories emerging across the country.
Each story will be different but nearly all of them will be a part of the wider narrative about having to reshape our health services to meet much greater demand.
3 The implementation of the Government’s NHS reform programme
Given the long term political fuss about the politics of reform there will be a lot of interest in how these reforms are implemented. There will be many national and local news stories about, for example, how local GPs will implement these reforms. In some places this will be a ‘good news’ story and in others, where the local GPs don’t want to do it, it will be a bad news story. Many of the reforms are already being implemented, so these stories will start this summer.
Opponents of the Bill will be wanting to point out the emergence of problems that they predicted, and will also be generating stories about what works and does not. Local and national stories about implementation dates will drive the news.
4 News stories appear daily from an organisation that has 1 million consultations every 36 hours and touches one of the most significant life experiences that everyone shares – their health
There will always be news stories from the NHS, and they will always be of enormous human interest. Some of them will be about good things; for example new drugs and their impact upon people’s lives. Then there will be bad stories about things that go wrong for individuals and groups of individuals.
The reality of most NHS stories is that they reflect elements of more than one of these categories. Because of the depth of interest in the current political story we are currently in an odd period where every story is linked with the political problems of the Bill. This will continue for some time.
The Labour Party will want to wrap every story about the NHS around the message that these are consequences of Government reforms. Given the economic pressures we are under there will be those that see the consequences of those pressures as ‘cuts’ – so this will be a significant part of the news agenda for the next few years.
(This piece also appears in a slightly shorter version on the BBC’s College of Journalism Blog)