In the same vein as the book of a similar title, the last week has been characterised by Government Ministers (at least those willing to say publicly they support the Bill) trying to justify the Bills behaviour. The SoS is even writing letters to the (estranged?) trade rag the Health Service Journal. At least it's happened before the massacre, unlike the retrospective reflections that forms the basis of the book.
There is an old adage - no-one wants to be told they've got ugly kids. Certainly that was the case shortly after the birth of the White Paper. Who wouldn't agree with devolving decision making to people who do the work, removing unnecessary bureaucracy and focussing on delivering better outcomes? Early concerns were dismissed, much in the same way as one dismisses normal children's behaviour. Nothing to worry about - "just teething" or "got a bit of a cold", or "very tired", or "it'll be alright when we come back from our break..." But what were seemingly innocuous events at the time have, for many, become a major concern. So much so that not only are some saying "your kid is ugly", but that it has no redeeming features whatsoever.
Events over the weekend are just another example of how much confusion reigns. First, ConservativeHome claim that at least 3 Cabinet Ministers want the Bill to be dropped, other political bloggers and commentators queried why Tim Montgomerie could only find 3, the Daily Mail claimed, in a nutshell, that the DoH was being run by McKinsey's with much of government policy written by them and now a report in the Lancet casts doubt on the claims that NHS productivity has fallen over the last 10 years. On the back of report after report by independent bodies claiming the NHS to be one of the most effective and cost effective healthcare systems in the world, it is no surprise that Coalition MPs seem to have a hard time explaining the purpose of the Bill. It can't help that Baroness Williams now seems to have added her clout suggesting that Part 3 of the Bill is dropped. All this culminating in intense pressure on the SoS and questions about how long he will be in the job and a mixed narrative about the changes themselves (as explained by Paul Corrigan here).
And therein lies the rub. Supporters and detractors of the Bill are now engaged in a rational debate. But not only is the debate confused because there remains no clear underlying narrative (is it competition, is it collaboration; is it radical, is it evolutionary), it is also the wrong way to solve the problem. Opinion based argument is no substitute for empirical understanding. Currently the debate around the Bill can be characterised by the difference between searching for evidence to justify a position versus searching for evidence to establish a position.
This isn't about the SoS or the Bill, or the Coalition as much as it is about the thinking that goes behind much of the design and management of work. The Bill itself is even called the Health and Social Care Bill, emphasising an already unnecessary divide. Lansley has come out fighting, underlining his commitment to choice and competition as the way of driving up standards. But this is policy based evidence at its finest. And that's the trouble with evidence. By the time it reaches Ministers ears it has been transformed into opinion. That makes it easier to ignore.
This isn't about the SoS or the Bill, or the Coalition as much as it is about the thinking that goes behind much of the design and management of work. The Bill itself is even called the Health and Social Care Bill, emphasising an already unnecessary divide. Lansley has come out fighting, underlining his commitment to choice and competition as the way of driving up standards. But this is policy based evidence at its finest. And that's the trouble with evidence. By the time it reaches Ministers ears it has been transformed into opinion. That makes it easier to ignore.
Applying the Vanguard Method has taught me the importance of moving from opinion to knowledge through experimentation as the most powerful way to think about the design and management of work. With that knowledge one can begin to understand that social care provision is commissioning and competition based already - the very system the SoS wants the NHS to move to. One can also start to understand that it is not providing people with the support to solve their problems that they need because the system views people as commodities, units of activity, transactions and episodes. And that, empirically, is both more costly and doesn't work.
What we design should be a consequence of knowledge, not an inevitability of policy. There is a better way. And our experiments are proving this - listen about it here. What's missing is method and taking the time to deploy this method to get this knowledge rather than continuing to implement the latest initiative. If we can change this then maybe the next genre might be the "feel good" movie
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