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Editorial Thursday 20 February 2014: Will Care.Data Lansleyism prefigure reconfiguration conflagration? | Health Policy Insight
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Editorial Thursday 20 February 2014: Will Care.Data Lansleyism prefigure reconfiguration conflagration?

Publish Date/Time: 
02/20/2014 - 15:57

Is it too late to coin the phrase ‘Lansleyism’?

It’s not?

OK, then: the Care.Data fiasco is a near-perfect Lansleyism.

For starters, there’s a pause for six months. That always helps.

More obviously, here comes another technical solution that will revolutionise the NHS, where the communications to the professions and the public was so dramatically poor as to create significant and unanticipated uproar.

I know nostalgia isn’t what it used to be, but this 2010-12 retro is ridiculous.

To declare my position, I’m a fan of the concept of using healthcare data much more, and much more effectively. The Kings Fund’s iridescent chief economist Professor John Appleby made a very good case for not worrying too much about Care.Data in the BMJ; a summary to which I can add little.

I’m struggling to understand how the obvious potential for this issue to blow up was missed by those associated with the project. In the wake of the Snowden revelations about intelligence capacity to eavesdrop on our electronic communications, public anxiety about information security is likely to be higher.

It is also startlingly naïve to underestimate the impact on public confidence in NHS administration after the 2010 promise to “stop the top-down reorganisations of the NHS became the 2012 Act: probably the biggest reform in the service’s history. Certainly so big that a Comrade could see it from space.

This, combined with the Mid-Staffs Effect and the Keogh Review (not to mention the newly-activist ‘please-don’t-abolish-us’ CQC – now with added inspection!) is likely to manifest in a lack of public trust in the system’s leadership.

Public satisfaction with the NHS is one proxy for understanding this: the BSA Social Attitudes survey tracks this over decades, and although the last data saw a small recovery, is still well down from the 70% record high in 2010.

Ipsos MORI’s ‘issues index’ also shows that the NHS remains a matter of significant public concern, as does Lord Ashcroft’s polling.

This is curious to the policy cognoscenti, since the service has been under real pressure and yet has broadly continued to deliver on access time targets. The NHS staff survey is likely to furnish us with its usual fairly clear picture of what the frontline are thinking.

However, in the policy cognoscenti, I think we have a significant part of the explanation why Care.Data’s pitch was so grievously mishandled, right down to not checking whether the explanatory leaflets to every household in England were delivered alongside junk mail, and thus promptly filed in the paper recycling by practically everyone.

I’ve written about this before, but it can’t be repeated often enough that people in NHS policyland, politics and the media are massively, disproportionately more interested in policy, politics and current affairs than the average person.

We are the kind of people who would even consider watching the shout-fest approval-seeking that is Prime Minister’s Questions (let alone BBC Question Time) without someone holding a gun to our heads.

We are therefore weird, and also likely to easily slip into groupthink that, say for example, Big Data is an unalloyed good which nobody in their right mind could oppose. This leads to making far less effort than is needed to make the case for a radical transformation of the kind Care.Data proposes.

The policing principle of a ‘thin blue line’ is the one to remember: there are not sufficient police to enforce law and order – citizens consent to being policed.

There’s a marvellous Snoopy cartoon, where Linus reads out from his book ‘qui tacet consentire videtur’, which he helpfully renders as ‘he who is silent is understood to consent’. Snoopy thinks to himself ‘but what if you never even know what’s going on?’

Well, exactly. It’s also invariably unwise to ignore Murphy's Law that if a thing possibly can go wrong, it will.

Unless the issues of trust and appropriate case-making are adequately addressed over the next six months, Care.Data will create fresh headaches come September. That much is obvious.

Cut our service or close our hospital? We'd be thrilled!
Another thought is required: provider reconfiguration on an unprecedented scale is the current groupthink here in policyland.

Yet we haven’t even begun to have that conversation with the NHS staff.

We certainly haven’t begun it with the public.

And given the patchy history of NHS public consultation as a condom to prevent provider reconfiguration getting pregnant with a judicial review, only donned once the decision has been taken that services will be altered in a certain way, I don’t feel too hopeful.

Communications and engagement are your core business when you’re trying to do major change.

Will that lesson be learned?