Transparency offers a chink of light in a dark week for reform

The national director for heart disease has been boiling away for some time. His Department of Health bosses have had to “keep tearing up his resignation letters” for months, an insider said.

Sir Roger’s rejection of health secretary Andrew Lansley’s plans are the most telling yet. Why? Because they come from a highly respected clinician who has spent over a decade in government service. The professor is no medical politician shouting from the sidelines – he has got his hands dirty in the business of reform and delivered impressive results. He has overseen a transformation in the outcomes for those suffering from heart disease. He is also the man behind the seminal 2007 stroke strategy.

The thrust of his criticism is widely shared. The government has laid waste to large parts of the NHS – some of which had delivered – in favour of an untried alternative. Sir Roger bemoans the loss of “corporate memory” and describes accusations that the NHS was overmanaged as “complete baloney”.

“We need stability, not more change,” he says, a call that is echoed in the NHS Confederation’s survey of NHS chief executives. Asked what was the greatest barrier, other than “financial constraints”, to delivering savings plans, 49 per cent chose “delivering reforms and savings simultaneously”. 23 per cent identified “lack of certainty over reforms” as the main hurdle.

Writing exclusively in HSJ this week, the health secretary downplays structural reform and the turmoil it is causing. He even offers an olive branch to managers, saying: “The future of the NHS requires not just retaining the best management and leadership, but providing them with ongoing development”.

Eyes firmly fixed on the horizon, Mr Lansley writes: “I want to see a system where every service offered by the NHS fits together like a jigsaw”. To secure this holy grail of reform, the health secretary looks to the NHS Commissioning Board “to lead by example”.

It is clear from the draft plans leaked this week that the board will be a mighty organisation with many levers at its disposal. hsj.co.uk users have already critiqued the proposed matrix management structure as creating the potential for competing priorities, while various clinical and patient groups are alarmed by its potential dominance.

Mr Lansley’s reaction to worries about a surfeit of power being held by the board, or indeed clinical commissioning groups, is to declare there “must be a wider culture of openness, adopted fully from top to bottom”.

Here – at least and at last – government appears to be moving forward with both radical and logical intent.

We await details of exactly what the new “duty of candour” will mean and how many loopholes will be left in the obligation to hold board meetings in public. But in the meantime, it appears the Cabinet Office is driving forward the transparency agenda and sweeping up the NHS along with it.

The government’s commitment to roll out GP scorecards and publicly publish clinical audit data will bring forth the normal concerns about accuracy of data and the ability of the public to understand the information. We are still in the infancy of giving the public the tools they need to navigate the NHS and to hold it to account, via intermediaries in many cases, so safeguards will be needed.

But, in an era when cuts and reforms threaten service quality and when people like Professor Boyle give up in disgust – the transparency drive and the possibility of better tracking the performance of public services is a welcome chink of light.

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