Health Matters | Paul Corrigan's blog

Last Wednesday the Secretary of State introduced his radical new idea of a draft mandate between himself and the NCB to the House of Commons. This mandate has 22 objectives which, in return for giving them the money, he wants the NHS to achieve in the next few years.

What was interesting about his statement is that he didn’t get to the mandate until page three.

In the first page of the statement, in his annual report, he outlined the successes that the NHS had achieved in the last year.

He was proud of these successes and from that we can deduce the sorts of things that are important to him – and will remain important to him.

He started by saying that, “Waiting times are low and stable – below the level at the election – and with the number of people waiting over a year (4317) at its lowest ever level.”

Readers will remember that one of the few consistent themes that ran through the current Secretary of State’s pre-election speeches, the Conservative Manifesto, the Coalition Agreement, and the White Paper of July 2010 was that this new government were going to abolish ‘politically motivated’ targets.

One of the most ‘politically motivated’ targets was the reduction of maximum waiting times. Year after year the current Secretary of State said these were a bad thing that he would end.

And yet… here we are 26 months into his tenure and the very first thing he commends to the House of Commons is the success that his Government has had in hitting a target with which he fundamentally disagrees should have been set at all.

His problem now is that he is in Government. His boss the Prime Minister has discovered that the reason these are ‘politically motivated’ targets is because they contain issues that really matter to the public. In a democratic government the public create politics which impinges upon its Government. What David Cameron knows is that if you ignore that politics it will have its impact in the politics of the ballot box.

In the summer of 2011 he let his Secretary of State know that he had to take on board the politics of this ‘politically motivated’ target. Which, since then, he has done.

But Andrew Lansley’s (and the NHS) problem is that the reform plan that he has drawn up predates his acceptance of the importance of waiting time targets.

Which means that from here on in he, and the NHS, will be running two systems of performance management.

On the one hand his new system will have the management I outlined yesterday. The Secretary of State’s mandate will drive the NCB towards outcomes. The NCB will drive providers and the CCGs towards these outcomes – and the CCGs will drive local health and health care providers towards these outcomes.

There will be a whole network of performance indicators between the DH, the NCB the CCG, and providers that will make this work.

Andrew Lansley will look at his new system with pride.

But he will also be running the old system. His annual report next year, and in 2014, will have to say how many people are waiting longer than a year. He will have to report on all the standards for waiting times for diagnostics etc., etc.

He will have to say – in the year before the ‘politically motivated’ General Election in 2015 – that he has hit the ‘politically motivated’ waiting time targets with which he disagrees.

So he will have to go on driving the NHS to meet these targets too.

What we have here is the real politics of the NHS meeting the plans Andrew Lansley developed in his attic – and they both win.

That means that the NHS will have two performance management systems.

One that reflects the Secretary of State’s new reformed system…

…and one that reflects the waiting time reality that the public wants.

A government that came into power promising less top down interference in the NHS will end up having two top down systems of interference.