Being on retreat means being behind the game when it comes to the news. So, I have picked up on the latest NHS shenanigans with a certain incredulity. Given the lesson learned from Tony Blair – that New Labour behaved during its first term in office as if it was still in opposition and didn’t move quickly or radically enough to instigate change – it is understandable that David Cameron wants to get as much done as quickly as possible.
However, he is hampered by three factors: (a) his big ideas (the Big Society, for example) have coincided with massive financial retrenchment… with the former being undermined by the latter; (b) there seems to be little dynamic coherence between the major initiatives launched; and (c) the sheer incompetence of the process for legislation.
Is the NHS fiasco the third or fourth claw-back of confidently announced initiatives? The difference here, however, is the enormity of the changes proposed and the fact that NHS reform represents the flagship policy of the new government. Clawing back the sale of forests is one thing, but announcing a ‘pause’ in the legislative process for NHS reform is of a completely different order.
The arguments can continue about NHS efficiency (provided we remember that efficiency of itself is not the raison d’etre of the NHS) and whether or not care might be delivered more effectively (which is the point of the NHS). The inevitable pros and cons of different ways of organising health care must be weighed up – and it must be recognised that any and every system will have pros and cons – but we must not confuse ends with means.
The worrying thing this time, however, is that opposition to the reform of the NHS is huge and crosses many social and professional boundaries. Some resistance will surely be down to inertia, insecurity, vested interests, fear of change and institutional bloodymindedness. That happens in any institution. But, what is interesting here is that the opposition is informed, unconvinced by the proposals and fearful of potential disarray in the system – not for the sake of the system, but for the sake of the people for whom the system is supposed to exist.
There are two dangers here for the government. First, they rehearse the Thatcherite mantra that it is not the policy that is wrong, but that some poor people out there just haven’t understood it – that once they have understood it, they will obviously have no objection. In this case the policy has been understood and is being questioned in substance by very well-informed people. Patronising opponents won’t work any more.
Secondly, the process appears to be driven by a political dynamic and not one that serves the service itself. That is to say, it might be helpful if a pilot scheme or three were introduced in order to road-test the proposed reforms. A process in which the public was able to see what the outcome might look and feel like is far more likely to win over sceptics than an ideologically driven rush for change. But, we don’t do pilot schemes any longer, do we – in education, health or anywhere else?
I have no problem with proposals for ways of improving the NHS (given the caveat above that improvements always bring with them unanticipated or unintended deficits). I have no problem trying out alternatives. I am open to be persuaded that reforms are necessary and might be helpful. But, I am not happy to see legislation passed on proposals that have not been properly thought through, not tested in the real world (as opposed to on Excel) with real people, not communicated in a way that is respectful and convincing, and possibly shaped to solve a different problem (finance rather than health).
It must have been humiliating for the Health Secretary, Andrew Lansley, to stand in the House of Commons, unsupported by Cabinet colleagues, and announce a ‘pause for listening’ in the legislative process. Yesterday David Cameron had to take personal control of the ‘presentation’ and (bizarrely) state that consultation during the next couple of months will be ‘genuine’.
It’s a mess. And it is just the latest in a line of incompetently handled initiatives in this government’s first year in office. As Blair says in his book A Journey, it is far harder being in government than in opposition. It’s also hard, having listened to the Tories accusing the last government of incompetence, now to see such obvious incompetence in office.
Wouldn’t it be great if the Prime Minister could treat us like adults, apologise for the systemic process and communication failures of his government so far (forests, education, NHS, etc.) and announce a more mature way of doing things. It’s his first year and the economic pool we are paddling in is horrible, so we might even be sympathetic. But, while he pretends that everything is under control, that all the problems are the fault of the previous administration and that all his colleagues are competent for their office, we will continue to be suspicious.
April 7, 2011 at 11:52 am
The More or Less Podcast this week seemed to suggest that the cuts were not as deep as the government likes to suggest. And many countries, e.g. Japan, carries more debt than we do and seem to be doing better. The more jobs are cut, the more people who are unemployed, the less contribution to our (economic) society.
April 7, 2011 at 1:57 pm
I agree with Tony’s comment, and also with you Nick over the fudging and double-think going io ,in the higher reaches of the ConDem govt.
It simply is not B & W/cut n dried, as you point out; reference Mrs Thatcher when she was chucked out by erstwhile mates who saw their own demise staring them in the face.
April 7, 2011 at 2:33 pm
Out of interest, you point to failures in terms of ‘forests, education, and NHS’. What are you thinking of in terms of ‘education’?
April 7, 2011 at 3:00 pm
It would indeed be refreshing for any politician to admit that they or their party has not done anything well.
What is also clear is that the government will continue to persist in policies which are dogma driven rather than to benefit the services or public which they serve.
From my experience as an ex-civil servant, the government doesn’t want to run pilot schemes anymore as they are a pointless exercise. This is as all the ones when I was there were brought in regardless of whether the pilot worked or not.
April 7, 2011 at 3:05 pm
Andrew, how about EMA, the reading/books scheme and student fees (particularly in respect of setting a maximum and being surprised when every body goes for it)? My point here is not about the content of these various proposals, but the process that is clearly diminishing confidence in competence. No one is well served by a shambles – whatever one thinks of the reforms themselves.
April 7, 2011 at 4:22 pm
If I can be cynical for a moment: I found, working in local government for some years, that pilot projects invariably and distressingly demonstrate why and how something is ‘not going to work’. Ignoring the detailed report showing the way forward, the usual short-sighted reaction was simply to refuse to proceed at all. Decision-makers have to learn not to panic: draw value and insights from the ‘dead’ project and make the idea work another way.
April 7, 2011 at 5:10 pm
It seems to me that we have a government of naive apprentices. The only one’s who seem to speak any sense are Ken Clark and IDS.
It’s time for a government of national unity, without party political agenda’s. Get us out of the mess and then try AV and whatever is fashionable at the next election.
We’ve tried everything else and still come up second-best.
April 7, 2011 at 9:23 pm
I am not feeling very pro-NHS this evening having spent the whole day trying to get help for a mentally ill young woman who needs a very little input to secure priority re-housing.
Everybody, Court, Shelter, Local Authority, Housing Association were ‘ on side’ and positively co-operative but when we tried to report the simple thing that the Mental Health Team needed to do – providing 20 mins worth of outreach work to the patient to organise the claim – they refused to listen on the misconceived basis of “confidentiality” – notwithstanding that we were asking nothing from them but simply reporting what information that they needed to supply to the patient to help the Local Authority do its work swiftly.
Tonight was spent organising the complaint.
A moment of grim humour was when we considered the difference between NHS “carers” and heroin dealers.
The dealers are there for you at 2 in the morning.
It’s a grim thought but does rather explain why some damaged young people escape the pain in a less bureaucratic fashion.
The NHS needs urgent reform when you experience this aspect of the service.
Normally I am much more positive but this kind of nonsense is very dispiriting.
April 7, 2011 at 9:53 pm
You probably will not remember me, I was one of those pathfinders who you had to drive many miles back home when I couldn’t say away from my parents! If I can drag your mind back to St Thomas’s Kendal you may remember me as Nicole Kitchener. Both yourself and Linda were very kind to me and my mum and I sadly never had the opportunity (until now) to thank you. I have of course stumbled onto your blog which I have to say makes for interesting reading, especially as I am now well entrenched in the NHS! So “Thank you”.
April 8, 2011 at 6:48 pm
Martin, the drug dealers understand ‘customer service’ better than some. Tragic, really.
April 8, 2011 at 6:50 pm
Nicole, I remember you very well. I will email you separately.
April 13, 2011 at 12:59 pm
It was not only Thatcherites who argued that “it is not the policy that is wrong, but that some poor people out there just haven’t understood it”. The same mantra was used by some left-wing socialists during the 80′s when the labour party was routinely losing elections.
It is a sign of an appalling arrogance, by some politicians and others, who regard anyone who disagrees with them as unthinking. What price democracy?
April 15, 2011 at 9:22 am
Good point, Kevin_K, but there’s often something else going on. The ‘poor people out there’ might well suspect, and in some cases know, that they are not being told the whole truth. This is usually because those who make the policies fear that the real drivers behind them would, if publicly spelled out, cause outrage. Then they go and complain that people ‘don’t get it.’
Well, yes and no. As a local PR flack I had to find endless ways to keep local residents on-side with regard to unpopular policies such as council commitments to Gypsies and Travellers. You can’t lie; you can’t obfuscate; but you shade things and then complain to youoself that your audience doesn’t understand…
April 16, 2011 at 2:47 pm
Rimboval, I think I understand your point, it called “spin” , or sometimes “dissembling”, or “economical with the truth”. The art of lying without telling lies. Am I to assume that you are or were a spin-doctor?
It is my personal opinion that our politicians are not particularly clever people. They are just well-trained, arrogant, and greedy.
K
April 16, 2011 at 6:07 pm
Yes, Kevin_K, I was a PR person, or spin doctor, but I’m a reformed character now.
To bring the discussion back to Bishop Nick’s original blog, I am concerned that “necessary changes” in the way the NHS is managed are being sold to us, citizens, as essentially benign. But I can’t help thinking that the real underlying policy is one of privatising the NHS little by little, until it ends up in the hands of American companies cherry-picking what they want to cover and brushing away the rest.
When politicians say that GPs will do all the managing now, I can scarce believe my ears. How can they?
The only people who can arrest this slide down a slippery slope are our elected representatives, not all of whom are debased, plus respectable opinion formers (including bishops)and the responsible media. We look to them to cry “Fire!” when it becomes apparent what the Real Policy is, not the phony version which people “don’t understand”.
Do the people really understand? Oh yes, they will, they will..