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Editor's blog Friday 8 July 2011: Chaos of NHS reform is all my fault - NHS Confederation Conference 2011 review

It"s my fault, apparently. This system-wide, top-down reorganisation, bringing redundancies, confusion, the pausing of a Bill after its second reading - is all down to me.

Andrew Lansley said so in his speech to the NHS Confederation Conference, so it must be true.

Comrade Sir David also told the conference that "commentators and bloggers were telling the NHS it couldn't deliver", so I'm obviously guilty as charged of demotivating the NHS as well.

Shit. Sorry about that, the NHS. I'll buy you a pint.


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It was a surreal NHS Confederation conference in many ways. The atmosphere was subdued, if not shell-shocked.

Opening with a solid speech from Mike Farrar and a presentation from the brilliant Camila Batmanghelidjh of Kids Company, the highlight of day one was a session on choice and competition under GP-led commissioning. Chaired by Sharon Lamb, a useful lawyer from Capsticks, it cantered through the straw men polarities of competition as The Devil or as God.

(This conversation, by the way, is getting boring. Competition is best understood as a garden fork. It's a useful tool when you want to do certain specific jobs, but if you used nothing else, you'd have a bloody awful-looking garden. You also need to remember that it's dangerous in untrained hands, and police advise that it can easily be used to break in through windows by burglars.

You also wouldn't eat your dinner using it.

There we go, people: competition is a garden fork. It is not God or The Devil. That's another long-running health policy argument resolved. See, the NHS? I do have some uses.)

So there we were, going through the motions when Assura CEO Bart Johnson showed a video of some people from lower socio-economic groups talking about deficiencies in NHS services. At the end of the video clip, Johnson asked those present "did you spot the character from Little Britain?"

To the room's credit, nobody laughed.

A veil of decorum will be draped over Wednesday evening's shenanigans; suffice only to say that while competition may not be The Devil, aromatic white wine most certainly is.

Thursday was launched with the release of Health Policy Insight's spoof Lansley conference speech. Little did I know that his real speech would rival it for hilarity, albeit unintentionally. You can find a version of Our Saviour And Liberator's conference speech, with translations and explanations, here.

Thursday also saw the joint most useful and interesting session of the conference: the Mid-Staffs turnaround team group's presentation. It was one of the few sessions when you heard the word "patients" used a lot.

Lansley's speech was described by a colleague with a long frame of reference as the worst they had ever seen by a Secretary Of State. It was nothing less than a disgrace.

Grumpily given, Lansley's characteristic querulousness came to the fore when he was asked by the able conference chair Sarah Montague about Roger Boyle's moment of truth.

Lansley had a chance to engage with the people whose discretionary effort will make the vital difference to his reform strategies, and he screwed it up completely.

There was consensus among all delegates to whom I spoke that the right speech would have gone 'look, I'm very passionate about the NHS, and I really believe we need reform, and so do many of you. And maybe I was trying to go too fast and I got some things wrong, and I'm sorry about that. I owe you an apology. We've responded to your concerns; we acknowledge that they were valid; and I am committed to going forward on this working with you to deliver a better heath service'.

All of the questions after his speech were about manager-bashing, unsurprisingly.

Friday dawned with a pleasant chat with the arriving Stephen Dorrell, who asked how the Secretary Of State's speech had gone down. He seemed taken aback - if unsurprised - by news of the speech and its frosty reception.

The post-pause panel session with Dorrell, Lord Hunt and Baroness Shirley Williams was, in Nigel Edwards' neat line, "that's what politicians are supposed to sound like" - a line which won a  spontaneous round of applause. Dorrell reiterated the need for four years of 4% efficiency gain in reform, Hunt breezily outlined the probable lines of attack for the House of Lords ambush; and Shirley Williams confirmed that the Bill is not a "done deal" between the Coalition parties, and the Lib Dem peers will be proposing further changes.

The second highlight of the conference was Nigel Edwards' brilliant and witty presentation on 'what I've learned', which you can view online here. The room was eating out of his masterfully-played hand. Bravo, maestro.

Comrade Sir David Nicholson closed the conference by reading a "come back to us" extract from Confed chair Keith Pearson's "bodice-ripper" as an analogy of the divorce between the FT Network and the Confederation.

Comrade Sir David is going to grip the NHS to let it go. No, he couldn't explain how it will work. When I asked for an example of this letting-go, he said GP practice-based commissioning (which largely failed) and foundation trusts (which new research from York's Centre For Health Economics has found that FTs' increased costs cannot necessarily be set against expectations of enhanced performance).

So there we have it: gripping to let go will be modelled on stuff that we know hasn't really worked.


Nicholson carried on like a man trying to convince himself he really believes in the reforms. He ended up again quoting reams of the legally unenforceable NHS Constitution, as he has done in previous years.

It felt like a health policy Groundhog Day.