Is Andrew Lansley 'screaming inside'?
A commissioning consortium in the west country declares it “does not believe in the purchaser-provider split”, the Foundation Trust Network warns of “serious financial stress” and the membership of the British Medical Association warms up to declare outright opposition to the Health Bill.
Despite all this, according to one senior policy figure fresh from a meeting with the health secretary, Andrew Lansley is apparently displaying “an almost preternatural calm”. One can only assume he is screaming inside.
Last week’s Nuffield Trust summit offered the chance to discover how the health sector’s policy makers and influencers judged the progress of the reforms. Almost as one, they were scratching their heads over how plans with which they agreed in principle had attracted such virulent criticism. Health committee chair Stephen Dorrell spoke for many when he said the cack-handed management of the reforms had allowed opponents to “dig up old arguments” that had been consigned to the dustbin of health policy history before he became health secretary in the mid-1990s.
He also warned that the government had less than 18 months to deliver some good news from the NHS to avoid undermining its chances at the next general election.
A thickening strand running through the reform’s difficulties is the health secretary’s inability to get his preferred candidates into positions of power.
He wanted KPMG’s Mark Britnell as chief executive of the NHS Commissioning Board, he ended up with Sir David Nicholson. Both are men of talent and experience, but anyone who knows them will tell you their approaches are chalk and cheese.
Mr Lansley had hoped former Monitor executive chair Bill Moyes would return to take up the reins of the new economic regulator. Instead he apparently found himself powerless when the appointment board recommended Monitor chief executive David Bennett.
Now, Mr Lansley’s attempt to develop a consensus around the health reforms by inviting another former health secretary, Alan Milburn, to apply to be chair of the NHS Commissioning Board has been rebuffed. Mr Milburn is a political communicator par excellence and it is significant that his greatest criticism of the reforms is not their substance, but the way in which they are being sold.
All of which makes it even more surprising that the health secretary - 10 months after the election - has failed to confirm David Kerr as his adviser.
Professor Kerr is no superman, but he does have two things these reforms desperately need: clinical credibility and a track record of successfully developing and communicating significant changes in healthcare.
One of the world’s leading cancer doctors, he was closely associated with many of the New Labour health reforms, famously writing to MPs arguing the clinical case for foundation trusts just before the crucial commons vote which narrowly passed the proposals. He showed his versatility by heading north of the border in 2005 and producing a report on the future of Scotland’s health services - a report that significantly won cross party political backing and the support of the British Medical Association. Four years later he took a leave of absence from his position as head of clinical pharmacology at Oxford University and headed for the Middle East to advise Qatar’s government on its health service plans.
In February last year Mr Lansley pulled off a major coup in persuading Professor Kerr to support his vision for the NHS and act as his adviser. The then shadow health secretary said: “David’s expertise and knowledge will be crucial in helping us to create an NHS which has patients at its centre.”
Professor Kerr returned to Oxford and waited for the call. He’s still there, still waiting.
Mr Lansley and his reforms are not over-endowed with credible and heavyweight advocates. Whatever the barriers to Professor Kerr’s appointment as an adviser, the health secretary needs to remove them now.
Have your say
You must sign in to make a comment.
Share
Readers' comments (13)
Patrick Newman | 9-Mar-2011 1:05 pm
It is extraordinary that the Health Secretary who has had the health brief since 2002/3 has produced reforms that most of those who have commented have shown that they are not well thought through, to put it mildly. It is equally strange that the Leader of the Tory Party, now PM, does not seem to have understood the extent and implications of the reforms and more crucially the rather obvious political dangers. For those like me who think the coalition will fall this year because they display serious dysfunctionality these reforms will play a significant part.
Unsuitable or offensive?
Anonymous | 9-Mar-2011 1:33 pm
Yes these reforms follow on in some way from Labour's. However, then the end point wasn't definite, they were a trial in some way, not an edict. Now all other options are out and the vision is clear... but sadly the detail hasn't had chance to catch up so we're trying to learn what should be a couple of years of lessons in a few months. No surprise there's some concern then, is it?!
Unsuitable or offensive?
Anonymous | 9-Mar-2011 2:21 pm
At the heart of why these reforms are dangerous is the lack of planning stability it gives providers, in whatever sector they operate in. This inherently will lead to a lack of appetite for all but the foolhardy.
I don't think many would argue that some reform is not needed, which makes the planted question to Simon Burns yesteday a tad ridiculous, but there's a large body of people who fundamentally disagree with the current packaging and leaving out a large parts of health expertise going forwards.
I'd be happy to see an open market in those areas where competition is best suited (primary care, light barriers to entry, high volume patient loads) and a closed market in high-speciality/asset based specialites. Lumping all services toghether will only lead to uncertainty, failure and poor value for money for the tax payer.
Back to the drawing board La-La (or hopefully your successor) and this time, try canvassing opinion while you're there and come back with a properly thought through set of proposals.
Unsuitable or offensive?
Anonymous | 9-Mar-2011 3:16 pm
This is one of the most inetersting and perceptive pieces I've read on the politics of influence behind the reforms. The failure by Lansley to get key players on board is a massive weakness of the reform plan. Probably not fatal to the reforms, but it may be a facctor in the 'on the hoof' rewrites and cobbling together we're seeing at the moment.
One has to question whether he was challenged rigorously enough beforehand; large elements of the plans have a very weak evidence base and don't stand detailed scrutiny. Now they are in the cold light of day, thsat much is very clear. Assertions are not evidence, and it can be argued there are far too may of the former masquerading as the latter in SoS's (and his supporter's) arguments.
So you have to ask; what was the quality and balance of his advice ? Policy has to hang together with an intellectual and practical coherence, and that comes from testing and a sound base. In every policy or planning post I've held, it's been hammered home to me that you should test ideas to destruction at an early stage; be ruthless, be probing, listen to and address all the counter-arguments. Was this there ?
Unsuitable or offensive?
Anonymous | 9-Mar-2011 3:17 pm
And was the intellectual and thinking net to develop and test the polic cast widely enough ?
Unsuitable or offensive?
Anonymous | 9-Mar-2011 3:58 pm
My personal view is that this is Andrew Lansley's personal policy (soap box??), not one which has been heavily scrutinised or has wide-scale evidence or is fully understood within government. Consequently advice may not have been sought or listened to, and stakeholder engagement is conspicuous by its absence.
Unsuitable or offensive?
Anonymous | 9-Mar-2011 4:04 pm
I don't think A L "is screaming inside" -- if he was, he would have the same gut feeling that everyone else has -- that things are not going right!
Unsuitable or offensive?
phil kenmore | 9-Mar-2011 6:25 pm
The issue is the absence of thought about an implemention plan that should have gone alongside the thinking about the Policy framework itself. Andrew Lansley is now playing catch up on this but the ever-expanding complexity of real implmentation at the same time as a massive efficiencies agenda is just too much for the system to cope with. A perfect storm may be approaching?Alastair is right - the SoS needs some more serious advisors in place to pull this around.
Unsuitable or offensive?
Anonymous | 10-Mar-2011 12:05 pm
Phil
Absolutely right; there's a need for some serious, credible advisors to support implementation. And these need to include people who aren't afraid to say "X may work, but Y definitely won't. You need to rethink".
This means that the people he needs aren't just cheerleaders for the reforms; they need to be practical, aware people who can be honest about the strengths and weaknesses. Polarised debate and political sloganeering won't deliver in hard terms.
Unsuitable or offensive?
Anonymous | 10-Mar-2011 2:21 pm
I can't help thinking that criticisms of the reforms for causing instability is like criticising bears for their personal hygiene or the Pope for his dogmatism. Michael White put his finger on it with his reference to Danny Kruger and Creative Destruction.
This agenda is about change (indeed change for changes sake) it is not about stability. It is about allowing new, innovative (and profitable) players to thrive in the chaos. A few state owned hospitals failing and being replaced by "new market entrant" would be a success for the policy and not a failure
As for the broader strategy, this is only part one. Out of this creative destruction will emerge a demand for the right of people to "top up" their NHS provision and therefore to use insurance funding alongside the NHS provision. Anybody expecting the Lib Dem leadership to stand against this privitisation of funding should listen to a podcast of the recent Radio 4 Analysis programme on the Lib Dem Orange Book.
Unsuitable or offensive?
Anonymous | 10-Mar-2011 7:55 pm
AL has always been critical of the DH and NHS "leadership". Anyone who has much to do with it would agree. But then to put that same team in charge of the "reforms" he and his party will be judged by.... well, it takes some beating
Unsuitable or offensive?
Anonymous | 12-Mar-2011 9:37 pm
I'll say it again in football fan parlance "You don't know what you're doing"
Unsuitable or offensive?
Anonymous | 16-Mar-2011 3:23 pm
To Anonymous 2.21 - did you enjoy Russia and did you like the old style planned economies. I hope you continue to prosper in the private sector as you know F**K ALL abot health provision or the NHS. Enough of your narrow views,
The present policies have not been thought through. If L has not thought them through what was he doing in all those years in the willderness?
I suppose when all your "chums" are from the same social circ le and keep patting your back you will never learn.
Like the Government these changes will fail in the short term never mind the long term.
Unsuitable or offensive?