Prof. Ian Shaw: Reflecting on how not to do policy – current NHS reform

It started going wrong at the LibDem spring conference last year. There was criticism of the Health reforms and Nick Clegg had to back track. In interview Shirley Williams said that neither Clegg nor Cameron (neither renowned for their work ethic) had read the Health Bill before signing it – they had relied on a verbal briefing by Lansley. The Royal colleges and the Unions were beginning to mount a resistance and the famous pause listen and reflect took place.

The Health Select Committee said that the Govt. had `lost control of the policy agenda’.

In April Cameron decided that Lansley needed time to get the professionals `on board’ and policymaking was `outsourced’ to the Future Forum.  Lansley was effectively told to agree to whatever the Future forum came up with. This needed a climb down by Cameron and saw him lose some face, but he expected that it would be worth it when he could deliver the reforms.

This, in part, explains Cameron’s anger this year when he found that, not only had the pause not got the professional `on board’ with the reforms but that there was now significantly more bodies opposed to the reforms than there were before! It was this that led a No.10 spokesperson to say that the Health Secretary `should be taken out and shot’.

The NHS has never been out of the front pages since and Government is having to make policy in the full glare of the public spotlight. Usually a policy issue will burn in the public gaze for a week or month and then get relegated to the political sections of the newspapers and the public slowly forgets . These reforms have been in the front pages for at least a year.  It’s etched in their memory and it will still be in their memory at the next election. Cameron and Lansley has made the NHS toxic for the Conservatives yet again. Now everything that happens in the NHS will be blamed on the reforms and if the Govt try to spend their way out by injecting large amounts of cash into the NHS to make the reforms work – critics will point to how expensive they have been.

Lansley must have felt pleased when he decreed that 45% of Commissioner Management costs would have to be cut, demonstrating his zeal in cutting back bureaucracy. However, with more and more concessions and changes having to be made to the Bill and more risks apparent it seems that the reforms are likely to create more bureaucracy not less. As I write the National Commissioning Board announced that they will be organised into 3 layers – National, Regional and Local (read DH, SHA and PCT) and you can add to that the CCGs as well as the Health and Wellbeing Boards, etc.

Whether this reform is passed or not, Lansley will be reliant on NHS managers and professionals to try and sort out the mess and make the system work.

Posted by Prof. Ian Shaw
University of Nottingham, Professor of Health Policy

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2 Comments

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2 responses to “Prof. Ian Shaw: Reflecting on how not to do policy – current NHS reform

  1. I must confess to have not spent as much time as I would have liked following or unpicking the NHS reforms. The thing which concerns me most, however, is that there have been numerous studies done which show that GPs do not have enough knowledge or understanding of mental health or intellectual disabilities, particularly the latter. The idea of these reforms (as I understand it), is to give GPs more power is that they ‘know their patients, and their patients needs best’. From the research I’ve seen, this couldn’t be any less of the case in these contexts, and I worry about what the impact on specialist LD and/or CMHT services will be. Certainly I don’t see how it will avoid any more than is currently the case the ‘postcode lottery’ in service provision…

    • Well – the next blog report covers GPs and CCGs specifically – to be posted Monday I understand. There are specialist leads for mental health etc in each CCG, but you are right that GPs in general dont see many citizens who are `well’ so LD has to be championed by other means. Also the understanding GPs have of mental illness (within the context of a GP consultation) is evidenced by the need to `outsource’ diagnosis and treatment pathways to Single Point of Access Meetings…

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