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Aligning the different faces of system reform

Health policy debate
27 February 2006

A common complaint about the government’s health policy agenda is that it is difficult to align its different faces. As with the other sides of system reform, the ambitions in the recent white paper have been welcomed but serious questions about them remain. Professor Angela Coulter, seasoned observer and passionate patient advocate said it ‘is full of aspiration but contains a dearth of practical ideas’ [Go to note 1]

The chief executive of St George’s in Tooting, Peter Homa likens his position to ‘sweltering in a policy jacuzzi’. ‘There are a lot of policies, which if implemented in a sequential, managed way would be a very powerful machine. But on the front line it is extremely difficult to come up with a coherent narrative of how these fit together. And we’re going through this huge structural change at the same time as the biggest financial challenge the NHS has seen for years’ [Go to note 2]

Manchester-based academic, Kieran Walshe wrote in the Health Services Journal that ‘it would be comforting to assume it all makes sense to someone – perhaps the DoH strategy unit or political advisers. But it’s more likely that most of them would admit privately that the NHS and the DoH are in a bit of a mess, which someone is going to have to sort out before it starts to hit the government’s re-election prospects’ [Go to note 3]

So how will this difficult situation be resolved? How will local doctors, nurses, managers and ministers make sense of system?

The following sections report recent debate and discussion in relation to six dynamics that are key to how policy will be shaped on the ground:
1) how, and if, the shifting political context comes to settle;
2) whether change be centrally driven or locally led;
3) whether the NHS overcome the fundamental financial challenges it faces;
4) whether processes to ‘reconfigure’ services in health economies can be established that hold the trust of professionals, politicians and the public;
5) the extent to which regulation can construct of rules for competition that are balanced with incentives for collaboration;
6) the extent to which there is professional engagement with the change process and the space available for the emergence of clinical leadership and innovation.