Andrew Lansley: an enemy of reform?
HSJ’s increasingly unfashionable, strained and conditional support for Andrew Lansley continuing as health secretary is predicated on two beliefs.
The first is that the broad thrust of reforms over the last 20 years have improved the NHS. Relatively high funding; a focus on commissioning with increased clinical input; an attempt to align financial incentives with desired actions; increasing choice through better information and a wider set of providers and more. (Of course, reality has proved less straightforward and desirable.)
The second belief is that these reforms are best driven by someone who understands the interconnected nature and underlying logic of the changes. Mr Lansley is best qualified from the available candidates, given that Stephen Dorrell is highly unlikely to return to frontbench politics or that the health portfolio will be given to a Liberal Democrat.
But there appears a real danger that Mr Lansley might actually put the reform cause back through his mishandling of the changes.
A Department of Health insider from the time of 2005’s flaky Commissioning a Patient-Led NHS reforms spoke to HSJ about the lessons from the period. First, if the answer to your problem is a reorganisation, you have probably asked the wrong question. Second, do not ask the NHS to do two things at once – especially if one is reorganisation – because it will focus on the new structures. Lastly, it does not matter if you are right if you have not convinced anyone else.
It appears Mr Lansley has taken Commissioning a Patient-Led NHS as his blueprint for national change. Failure to correct that approach could set reform back a decade – a far more toxic legacy than even the damage that the changes are wreaking in the system at present.
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Readers' comments (4)
David Hooper | 14-Apr-2011 7:56 am
It is better that a Health Secretary understands the policy and the rationale underlying it but not to be in charge of it's implementation. The latter requires skills beyond most politicians' abilities. AL seems to want to conflate policy formulation and it's implementation.
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Anonymous | 14-Apr-2011 2:57 pm
It is right that AL takes a patient-led approach. Indeed that was the thrust of his white paper. Trouble is everything since has been structure-led. He needs to refocus on the patient and consumer. Just as important, he needs to be seen to be doing so. From the outside in, it currently looks like nothing more than officials, politicians and clinicians fighting among themselves for money and status.
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mphindisi nqwaku | 15-Apr-2011 11:26 am
I don’t have problems with this proposed GP consortia. How long are we going to witness Drs being supported by governments? Why are professions taken for granted? The fact that someone went on to study nursing doesn’t mean anything in relation to intellect. Government has to start a process of achieving same status for all. I wonder what the public would be saying if these powers were given to nurses? Next time the PM appoints his health secretary he/she aught to be a nurse.
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Anonymous | 18-Apr-2011 8:37 am
AL's reforms are not patient centred. They are market centred. Markets care about profits not about customers. Have you ever tried to contact your mobile phone carrier?
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