NHS reform: why it’s good to talk

Speech bubbles

Stereotype has it that many journalists like to head off to the pub on a Friday afternoon. Not the Health Service Journal.  In just the latest in a string of Friday afternoon exclusives which have helped shape the news agenda on NHS reform, the HSJ revealed that Downing Street had called a summit of leading health bodies to discuss the implementation of NHS reform. The HSJ story has been followed up by most of the media over the weekend, providing a new angle on which to speculate about the future of the reforms to health and social care, as well as the future of its architect.

Many of the details of the story were – and remain – hazy.  The agenda for this meeting was not clear, still less the cast list.  Organisations such as the BMA and Royal College of GPs – both vocal opponents of the Health and Social Care Bill – were initially claimed to be attending, only for it to emerge that they had not been invited.  The story was repeatedly updated as the Twittersphere contributed intelligence. 

The exact list of attendees – or indeed the purpose of the meeting – is, however, not the point.  It is clear that the most vehement critics have been deliberately excluded.  This represents a hardening of the Government’s position.  Downing Street is trying to make clear that it wants to do business with those who want to do business, but the time for concessions to those opposed to the very principle of the reforms has passed.  Today’s meeting is a good indication of some of the communications missteps experienced by the Government that exclusion is now being worn as a badge of honour by some organisations.

Yet there is still merit in talking.  The Government and health stakeholders both know that if and when the Bill finally passes (and I still believe it will), they will need to work together.  Assuming most organisations decide against outright and continuing non-cooperation, they will need to find a way to work with the Government in the interests of patients and their members.  With the rhetoric on health reform becoming ever more heated, this may not be easy.

Opponents have dismissed the meeting either as a sign of panic or as ‘window dressing,’ shutting out critics as Number 10 sought to demonstrate clinical support for reform.  Yet this might not be fair.  Today’s Downing Street meeting could be a way of beginning to build bridges between the Government and organisations with significant concerns about reform who are nonetheless not seen as outright opponents.  Both sides – and the NHS – desperately need to forge a productive relationship after the Bill if any of this is to work in the coming years.

Some of the scepticism comes from the fact that this is not the first such effort.  The pause which, after all, was an attempt to reach out to stakeholders, has recently come under attack.  James O’Shaughnessy, a former Downing Street advisor (although not directly involved in health policy) apparently said that the Future Form was simply a tactic to push ahead with the Bill.  This met with fury from both opponents of reform and Professor Steve Field, the head of the Future Forum (who declared he’d never heard of O’Shaughnessy). 

The explanation that the Future Forum was simply a tactic to push on with the Bill suits many.  For critics of reform who are not exactly charmed by the Government’s listening abilities, it demonstrates that little changed, even if many were temporarily beguiled by the post-pause changes.  For the media, it adds fuel to a fire which is already burning pretty brightly.  For political advisors, it shows how clever manoeuvring helped their masters.

I was no fan of the pause.  On the day it was announced I argued that it would prove incapable of reconciling the fundamental differences that existed around issues such as competition.  I also said that the politics of the pause were less beneficial to both sides of the Coalition than its proponents claimed.  I have also maintained that the changes resulting from the listening exercise were more cosmetic than radical.  So the critique of the Future Forum partially suits my own arguments.  Yet I also think in this case it is unfair, and this is important in the context of this weekend’s coverage.

The purpose of the Future Forum was never to rewrite the principles underpinning the Government’s reforms, nor to create an alternative vision.  Instead it was to improve the proposals in areas which had attracted particular controversy.  It had to do its work in parallel with heated, highly political and often inconsistent negotiations within the Coalition.  And it had to do so mindful of the views of a bruised Secretary of State who was not particularly inclined to compromise.

That the Future Forum did not resolve the Government’s political problems with NHS reform, nor address opponents’ concerns about the nature of change, is not surprising.  This was an impossible task and one which was outside its remit.  The political failure of the pause does not mean that the Future Forum itself should be deemed a failure.  Many stakeholders achieved important policy concessions which, although not changing the fundamental nature of NHS reform, do have benefits, both for the people those organisations represent and for the Government in seeking to address concerns about its policy.  The Downing Street meeting is of course very different from the Future Forum.  Amidst all the weekend confusion about its purpose and who is attending a meeting, both the Government and stakeholders might do well to remember that it can actually be beneficial to talk, to each other.