2010 proved to be a tumultuous year for the reform of the NHS and whilst I don’t want to summarise the whole year’s blog, there are some moments from last year that really stand out.
First, going back to before the election, I and others ran a campaign against the then Secretary of State’s policy of the NHS being his preferred provider. Who knows what would have happened if an election had not intervened? More and more evidence was emerging that the policy would have been declared to be outside of competition law. It was only the stopping of a particular tender that saved him from being brought before the Competition Panel.
What was important for me, over the 6 months development of that policy, was the recognition that whilst a Secretary of State can say that he or she wants to effect a significant change, there are a now range of detailed reforms in the organisation that make that very hard to achieve without legislation. .
We then had an election in which the politics of the NHS played little part. One of the oddest outcomes of the election was that all three political parties lost.
Gordon Brown’s Labour Party was the biggest loser. Despite an attempt by some around him to hang on they lost many seats. It was clear that the electorate had decided that 13 years of Labour Government had come to an end.
David Cameron’s Conservative Party were also losers because despite looking like a “shoo in” for a large majority he did not get it There are those in the Tory Party who will not forgive him and if he had not become Prime Minister of the Coalition in May 2010 it is pretty likely he would have been replaced as leader ,
Nick Clegg’s Liberal Democrats would have expected half way through the campaign to gain a large number of seats and when they didn’t, the election felt like a loss.
The creation of the Coalition government from this outcome was a political masterstroke. It broke the political rules that I have been used to for the last 50 years. More than anything it is giving David Cameron a platform to radically change the Conservative Party. Something he failed to do when in opposition.
7 months later it always looks as if it is the Liberal Democrats that are under the biggest strain in the coalition. But in fact I believe it is the traditional Tory Party who will probably lose the most from this new politics.
The current Secretary of State came energetically into post and set his own agenda for the “Reform of the NHS”. He has stuck to it with determination throughout 2010 and I am pretty sure that he will in 2011 as well.
I have commented on many occasions that his main narrative to explain the changes is revolutionary or radical. ‘The biggest set of changes to the NHS since 1948’. But usually a little later on, when everything gets a bit sticky, he says that they are continuations of previous policies.
For me each of the elements of his policy look very like a set of continuities. Sometimes moving a bit faster but continuing the direction.
The difference between the Secretary of State and most others is that he wants to execute his plan all at once, and very quickly. His gamble is that doing it all in this way, and at this speed, will work.
The other problem that I noted in September is that, for reasons that are a part of his theory of change, he did not spend the autumn going out and developing a narrative that explains these changes. He believes that if he removes the “oppression” of NHS bosses there will be a series of spontaneous uprisings from within the NHS. This will happen because they have been oppressed in the past.
To provide his own narrative, within which these uprisings happen, would be to demean them.
He is wrong about this and I think his Government now realises this.
Given that I think I know how the narrative needs to explained, this created an interesting autumn for me. Looking through my diary, between September 6th and December 17th , I have given 40 talks to different audiences that explain what the intention of the reforms are, and how the architecture of the reformed NHS would work.
On nearly every occasion someone from the audience has come to me and said “So THAT’S what it’s all about. Why hasn’t the Government been explaining that to us as a whole?” Readers will have to take my word for it that I don’t “do” false modesty, but the reason 40 audiences felt that I was explaining something that they did not know was not because I was doing it brilliantly, but because the Government were not doing it at all.
On many occasions this has led me to question what I am doing. There have been times when I felt that I was doing the Government’s explaining for them because they wouldn’t.
On many occasions over this autumn I have pieced the Government together for people. Strange really. It sometimes felt quite lonely doing the explanatory job.
The end of the year sees the Government backing the reforms and promising a Bill first thing next year, and also promising a better attempt at a narrative.
We will see.
Next post, …Hello NHS reform in 2011!