Blues and blueprints

The political story of the week has been the continuing travails of Andrew Lansley’s NHS reforms. ConservativeHome’s attack on the reforms is significant in at least a couple of ways that interest us here: firstly because of the message it sends and how it brought to the surface widespread concerns in Conservative circles about the reforms; secondly because of the medium, which is to say the source of the challenge. Both have significant implications for traditional think tanks, in suggesting that the conventional way of doing things needs to change.

First point first. The underlying idea of the NHS reforms (or one of its underlying ideas) – that of devolving power, responsibility and money to the frontline through clinical commissioning – has widespread and long-standing support. It’s the approach to change that has come dreadfully unstuck. We’ve suggested before that the NHS reforms are indicative of a particular way of approach to public service reform and social policy that’s increasingly questionable – the ‘MBA thinking’, top-down, somewhat abstract ‘big idea’ approach that looks lovely at the blueprint stage but turns out to be extremely difficult to implement, with all sorts of unintended costs and consequences. It would be interesting to know who helped to develop and design the original plans; it has all the hallmarks of a certain well-known (or notorious) global management consultancy, but let’s see.

This week also saw Reform launch its second annual Reform Scorecard report. As ever it contains some useful commentary and discussion, although the claim that it represents a “dispassionate analysis” when it includes bald statements such as “Cuts are working” perhaps fails to treat readers as grown-ups. The report emphasises that it’s not just the direction of reform that matters, it’s the management of reform which is also critical – a point which is both obvious and often neglected. But as demonstrated by the NHS reforms (to which Reform says, with unfortunate timing, that the Government should “renew its commitment”), there’s a third dimension which is arguably even more significant, which is the way in which reforms are developed and designed. The architects of the NHS reforms failed to involve practitioners and patients sufficiently in the development stage (until the Government was forced to do so); it’s no wonder then that the reforms now lack the intelligence and the support of either group. The think tank’s breezy argument that the Government should “Reform fast and at scale” would surely only exacerbate the lack of frontline engagement and involvement across more change programmes and replicate many of the problems that the NHS reforms have run into.

Reform (the think tank) has some previous in this regard. Just before the election it published a report called The front line which suggested that cuts would encourage reform (a point happily ‘proven’ by the Scorecard analysis), but without any evidence of having talked to anyone at the frontline or having invited their view on cuts, reform or anything else. According to Andrew Haldenby from Reform: “…police officers themselves are arguing that the cuts are a reason to do things differently and better”, but it’s not who exactly these ‘police officers’ are. It’s a questionable habit shared by many of us in thinktankland to cite only those frontline practitioners when they align with our own ‘dispassionate analysis.’ Here’s another: the ease with which policy wonks emphasise the need to maintain the “momentum of reforms”, when it’s frontline practitioners who have to cope with the fallout when reforms are pushed too far, too fast.

The second issue takes less time to describe but is perhaps just as significant (read worrying) from the perspective of thinktankland. Would ConservativeHome’s challenge have got the same amount of media coverage if it had come from a traditional think tank? Perhaps only if the think tank was aligned closely with a particular politician and so interpreted as a politically-motivated attack, especially if the politician was a Cabinet ‘colleague.’ Otherwise probably not. The media isn’t so interested anymore in what think tanks say about the NHS reforms (the Kings Fund, which isn’t prey to the same addiction to advocacy over analysis as other think tanks, remains the notable exception); instead the media have focused on an much larger and apparently much more influential online community of bloggers and commentators (and as an aside, it’s interesting that newspaper reports referred to Tim Montgomerie’s blog post as an ‘editorial’, reflecting the much older medium’s language and assumptions).

What this week has suggested is that, contrary to the stereotypes, it’s the online forum that’s acted as the considered, insiderish, influential analyst – and the think tank that’s on the outside looking in, adding commentary that feels like it follows rather than leads.


One Comment on “Blues and blueprints”

  1. lemexie says:

    To really test the resolve of the “global management consultancy”, the equity of the firm should be at stake in successful implementation….not just their reputation. This aligns the firm’s aim and the government’s aim on NHS reforms. At the moment they don’t. McK want wealth through profit. Gov want health through savings.


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