Tuesday, September 27, 2011
Could there be any common ground on the Health Bill?
When the eminently reasonable Stephen Dorrell spoke at the #healthdebate at Labours conference I was glad that he was given well deserved applause. He was doing something that far more politicians should do; Venturing into enemy territory, speaking directly to people and searching for common ground.
He made the point that we often hear from Conservative speakers that the Health Bill continues policies that were already in place. Until last week I might have dismissed this, but as I have listened to the witnesses from the Department of Health at the #midstaffsinquiry I think he may well have a point.
The Mid Staffs Inquiry has been an astonishing experience; A rare opportunity to see and begin to understand the complexity of the NHS; A chance for all the different organisations that make up this vital part of our countries life to re-evaluate what they are, what they do, and how they relate to the other parts of the system. It has also laid out for us where things went wrong in what the chairman is now tentatively describing as a whole system failure, and pointed to the changes we may need to make.
I do not think there will ever be a clear cut agreement about what actually went wrong at Stafford, though the Inquiry will remove many of the false certainties, but Stafford can show us the way forward for the NHS.
The inquiry has been an exercise in trying to find the truth, and that is not at all easy. What we hear as the general public is always filtered. The press and the media give us fragments of stories, and fragments of what politicians say. The politicians use the media to try to sell the policies that they are attempting to drive through the wheels of government.
The press do what the press do. They present issues in terms of debate and conflict; This side, that side; Dramatic changes in direction. The battles that turn it all into soap opera; matters of personality, people we love, people we hate.
Listening to the Ex ministers and to the Department of Health spokesmen I see that this is not the way it is. Ministers are there to represent us. In some cases, as with Andrew Lansley, and Michael Gove, they have arrived in position with their own set of passionately held dreams – a vision of the future they wish to create. When they get there, they always find that power is not all it is cracked up to be. Having a vision is one thing, turning it into reality is another.
The DoH as everyone who has listened to the evidence at the Midstaffs Inquiry has heard is packed with people who really do know their subject matter inside out. They understand the sheer difficulty of bringing about change in something as complex and interconnected as the NHS. They will bring to the minister’s sketchy vision the depth of knowledge that can make parts of it work, and they work with tact and diplomacy to modify or remove those parts that are potentially damaging. It is the Civil Servants job to keep the spirit of their service alive from one minister to another and one government to another. They are there to help us.
It is in this complex dance between elected politicians and appointed civil servants that legislation is brought together, and as the tools for public consultation become stronger the public and potentially the press can play an increasingly strong part in helping legislation take shape.
As a grass roots Labour party member my dislike of the Lansley plans was strong; Strong enough to get me marching for the first time in 30 years. But now, having listened to both Andy Burnham and the civil servants I can see that there is much within the Lansley plans which are as he has claimed – a continuation.
· The quality agenda is being driven in part by the embryonic new information systems which developed under the last government and are now reaching maturity. It is also driven in part by professional concerns about how best to improve standards. This would have happened anyway.
· The decentralising of responsibility and the integration of primary and secondary health care with social care is necessary to deal with the challenges of the future and was happening under Labour anyway.
· The impetus to help or force hospitals into governing both quality and finance better is necessary and would have happened anyway.
· The emphasis on the patient voice is in part what Midstaffs has added into the equation. All parties theoretically agree that a stronger patient voice is needed but there is no agreement about how this can be effectively done. I suspect we will spend the next decade trying to work this out.
There is substantial common ground. There is no need for many of the changes to be presented as radical or new. They are simply stages on a journey. There is no good reason why all parties cannot drop the rhetoric and co-operate on the areas I have outlined.
There is a stumbling block is this – The major structural changes, and increased competition which Andrew Lansley sees as essential , look from the viewpoint of the Midstaffs inquiry room to be both unnecessary and harmful.
There are two main theories on what happened at Midstaffs:
· The orthodox version, espoused by the press, is that this was a major disaster which nobody saw because of faulty regulatory systems and the failure of communication between a series of organisations that had just undergone major structural re-organisations and were therefore in turmoil.
· The alternative version, which I share with many of those closest to the hospital and many of the regulators, is that there has been a significant distortion of the facts. See http://pressreform.blogspot.com/2011/04/what-forms-our-perception-of-stafford.html , and that the problems at Stafford are both less serious and much more widespread than we have been told. These problems that do exist reflect the key challenges that Andrew Lansley has correctly identified for the NHS; Challenges that are set to increase over the next three decades. Those people who are close to my way of thinking on Midstaffs believe the turmoil caused by the series of structural re-organisations left the regulators in a weak position to deal adequately with the major moral panic that arose.
The one thing which unites most of the people watching from the public room at the Midstaffs Inquiry is that Stafford cannot and should not be taken as a justification for the changes Andrew Lansley wants to make. The Inquiry will not prove the case for structural change, and it may well prove why structural change is the wrong answer. Whatever it was that happened in Midstaffs is much more likely to happen at times of structural change and financial pressure. We are creating the perfect breeding ground for future scandals right now.
If I had the opportunity to talk to Stephen Dorrell and Andrew Lansley this is what I would ask them to do. Put the Health bill on hold. Do the bare minimum to stabilise the system and to stop the haemorrhage of talent that has already taken so many people from the system. Allow people to see the Midstaffs report and learn from it; Consult widely; Trust the Clinicians and the patients and set them free to devise the structures they require to do the job; Seek the common ground that does exist, and continue to build on this. Then come back with a better and more consensual bill.
Posted by Diana Smith at 21:16