Lordly musings

The listening train is moving on. This time stopping to listen to a group of Lords who have an interest in health and will play a key role in debating the Bill. An informed and useful event; helping clarify some of my own thinking.
Time is now pressing. I'm talking to my " choice and competition"panel colleagues on Friday and we have a Forum meeting on the 11th. By the 11 th I want to test emerging ideas and potential solutions. My Report ( and I have made clear to the civil servants supporting us that I am mainly writing it myself: I'm keeping control of the commanding heights of the vocabulary ; I've seen all those Yes Minister episodes! ) will need to be ready by penultimate week of May for delivery to PM by end of the month .

There has been a little too much emphasis on "Listen" as though it were a consultation or that we have blank sheets of paper or blank minds ; and not enough on "reflect and improve ". That means the sooner we start debating what changes are needed in the Bill the better.

I'm also reflecting on my own experiences of getting close and personal with the Department of Health! When this is over I intend to write about that. And I shall have some lovely tales to tell. Good and bad that is!

But on one thing I'm clear: reform is needed. Choice ( and I'm not just talking shopping) is very limited in our NHS. It must be widened.

Customers are not valued or encouraged in a way that has become normal in other parts of the public service. Citizens are recategorised as patients and patronised.

When 75% of the total budget goes on long term conditions that provides a big clue to where change is needed. How does the NHS tackle long term conditions? Badly.

Despite the big clue on " follow the money" the DH and NHS family more generally are consumed by what goes on in hospitals. Acute care is top of the pecking order. Time for change there.

I make these points at a Kings Fund breakfast this morning. I was told by the minders back at the ranch to just stand there and say " we listened". As I thought this was both disingenuous and disrespectful of the audience I was a little more forthcoming.

One thing was clear; competition has a role to play as a means of securing better health outcomes and to encourage the building of integrated health and social care provision across sectors. But it is a means to an end, not an end itself .