Thursday, February 3, 2011

Good MPs have nothing to fear from NHS Reforms

Benedict Brogan has posted a piece to his blog reminding us of one parliament Labour MP David Lock. Mr Lock, Brogan reminds us, was elected in the Labour landslide of 1997 and after supporting changes to Accident and Emergency services at his local hospital in Kidderminster found that he lost the next election to a local GP stood who won 60% of the vote.

Brogan suggests that many Tory MPs who have been around since the heady days of ‘97 are eyeing the Health reforms with concern and worrying that they’ll be in his words “Kidderminstered”.

Personally I think that’s rubbish. The only MPs who have anything to fear from any controversial proposal are those that are lazy and no good at the job of being a modern MP. Oh and those that are more interested in protecting their jobs by opportunism than doing what is right.

For a start the situation isn’t the same. Mr Lock was defeated by a GP, seeing as we’re putting GPs in charge of the health budgets and it will be their decision whether to use a hospital or not, I’d like to see one stand on a platform of this hospital closed because you put the likes of me in charge. If anything Lock’s experience proves why we are right to put GPs in charge of commissioning, the public believes that they know what they are doing (despite the attempted lobbying of the press of NHS managers and unions to the contrary) and trusts GPs more than it trusts either politicians or faceless NHS managers.

Also this argument that Brogan puts forward that price competition will definitely squeeze out smaller hospitals simply isn’t true. If they’re well run and concentrate on specific areas then local hospitals won’t be squeezed out. As an example locally we have a super hospital in Coventry (UHCW) which is under an enormous PFI contract, and a smaller hospital at Warwick, then there are tiny local hospitals like the Ellen Badger in Shipston. UHCW has been squeezing the PCT for every penny it’s got to cover its costs, whilst Warwick offers A&E and general surgery as well as concentrating on some specific areas and is seen as one of the best in certain areas such as ophthalmology and cancer treatment. If anything I’d put my money on Warwick offering better prices than UCHW as it doesn’t have the same ridiculous overheads. In fact as most mega hospitals were built under PFI, if anything, price competition will risk the under utilisation of larger hospitals not smaller ones. Whilst at the smallest local level GP consortium are desperate to take over the running of smaller local hospitals like the Ellen Badger as they feel they can manage them more effectively and understand their place in the community.

Then there’s the issue with lazy MPs and their attitude to issues in their constituencies. If there’s a perception that something is going wrong in your constituency then it’s your job as the MP to find out about, react to it, and try to influence people to resolve it. This could be either way, if the public are misinformed or confused about government policy and the reasons behind it, then it’s your job to help inform them and change their mind, if the organisation in question (in this case the GPs) seem to be making the wrong decision then within the realms of letting them get on with their jobs, it’s your job to make sure they know. If you wait until an election time to go and try to convince them your party’s views are right then you’re toast.

Unfortunately I think too few MPs see this as their job. MPs of the old school, who have been around for a long time seem significantly less likely to have a constituency office to keep them in touch with what’s going on back where they were elected, and less likely to deal with local issues. I’m also constantly shocked by how few staff older MPs have. I constantly meet MPs who have been around for ages who have one member of staff. By comparison we have 3 and take in work experience students as well, but despite this barely keep on top of our member’s workload and particularly their correspondence from constituents. To only need one member of staff, your constituents have clearly given up trying to communicate with you and know it’s just not worth it. Now if there’s something controversial in your constituency, how likely do you think they’ll be to re-elect you on the basis of all the other good work you’ve done for them?

Then there are those MPs who are more worried about getting re-elected, or thanks to the boundary changes re-selected, than working for the good of their constituents or their country and so target their efforts at easy win opportunism rather than helping to explain government policy to the electorate. HS2 is a good example of that, it’s not going anywhere near my constituency, but I’ll oppose it because I’m getting letters on it and it might help my re-election or selection chances. The forestry consultation is an even worse examples with MPs playing both sides. Yesterday I watched Conservative MPs carefully craft lines in their speeches to fire “warning shots” at the government about a consultation that hasn’t even completed yet, that will play well in the local papers, whilst their overall speech and their final vote supported the government’s position.

So back to my point on NHS reforms, personally I think good MPs should have nothing to worry about, if they explain the reforms properly, the reasoning behind them and if they monitor what’s going on in their constituency and react to it then it shouldn’t be a problem. However if they’re lazy and more interested in looking out for themselves than their constituent and the country then they’re in trouble.

As an aside Brogan’s piece highlights the exact problem with the Comms of the NHS reforms, it’s become way too much of a process story. Every time it’s mentioned you get the process background i.e Lansley had a free reign for being quiet in the campaign, the PM wasn’t sure about his reforms, Oliver Letwin had to look at it, medical practioners aren’t sure, now MPs aren’t sure, instead of it being stories about the substance of the proposals.

It’s said that Coulson had become obsessed with the communication strategy of these reforms just before his departure, hence getting the communications maestro of the PM involved, and it’s no doubt at the top of the list for his replacement Craig Oliver. For what it’s worth my opinion is that we need to start talking about the largesse of PCTs again and the layers of management and staff within them to win the public over to the need for reform.

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