Wednesday, 26 January 2011

NHS Reforms and 'Excellence in Policy-Making'

A few days after my last blog, government ministers felt the need to give a robust defence of their current plans for reforming the NHS. So I couldn't resist seeing how this contentious and admittedly radical policy matches up against the principles of excellent policy-making that I discussed last time. The question is, leaving aside political philosophy, how well-created is the policy itself?

I'll use the criteria of the DWP Model mentioned last time as a starting point (it's a different Department but the principles should still hold), with my comments against each:
Clear Objectives: OK here. The aim is to ensure that money follows demand hence improving responsiveness, and reduce overall costs in the process. The thinking has to be that reconstructing the system largely from the ground up should produce a much leaner (and hence cheaper) structure than the current one, even if GP consortia become quasi-PCTs with their own accountants and managers.
Outward Looking: Hmmm - unclear. How much stakeholder consultation went in to the development of this policy, and does any other nation have a similar health system?
Good Analysis: I'm sure the calculated savings work out, at least on paper, but less sure about the research that underpins them.
Well-Designed Proposals: A fairly broad criterion, but probably OK here.
Good Plans for Delivery: This is the criterion that comes closest to my point on Empathy - see below.
High-Quality Advice: Despite tight timescales, I'm sure DH can tick the boxes here.
Excellent Communications: They've done their best. It's the message rather than the medium that could be the problem.
Continuous Improvement: Yes in that piloting is going on, even if one suspects that decisions have already been taken.

OK, I'm sure this is unfair in that I've looked at these 'Excellence in Policy-Making' criteria only very briefly and subjectively, but it suggests a reasonable attainment against most of them.

But what about that extra factor of Empathy that I mentioned last time? What about the feelings and reactions of those affected by these proposed changes? Well:

  • GPs generally don't want it. Most GPs entered the profession to work with patients, not because they wanted to manage the NHS.

  • Managers and staff in PCTs and SHAs are largely against it, for obvious reasons.

  • Patients themselves probably don't care. They certainly want excellent service and treatment, but the systems and money that provide these are not 'visible'.

  • The General Public - if they understand it - are probably against anything they see as an attack on the NHS, even if they accept the need to reduce public expenditure.

In summary, a big FAIL here.

So will it work? Can the government drive through a policy that seems unpopular from every perspective? In practice, just because it fails this (modified) 'Policy-Making Excellence' test doesn't mean the government won't try to force it through. But they will need to brave the political unpopularity it will generate, and face the risk that the system will prove unworkable simply because no-one wants it to work.

I'm going to make a prediction: By sometime in 2013, when the current redundancy scheme has already reduced overall staff numbers, we will see the emergence of NHS Reforms Mk.2. These will present a compromise system, somewhere between what we have now and the coalition's current aspirations. Watch this space!


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