Listening exercise: they’ll hear what they want to hear

Andrew Lansley is facing a bit of a crisis. It turns out that not many people support his plans to reform the NHS. On the plus side, he’s managed to successfully unite MC NxtGenUK and Norman Tebbit. On the down side, he’s lost the support of clinical staff, patients and voters.

Norman Tebbit doesnt like the reforms

Facing this opposition, Cameron (ever the PR-man) announced a listening exercise. An opportunity to “Pause, Listen, Reflect and Improve” apparently. It doesn’t take a genius (or a cynic) to see just how much “listening” Lansley is doing. Faced with overwhelming opposition and a vote of no confidence from nurses, Lansley apologises for not communicating his message well enough. It’s an odd way of ‘listening’, but the best indicator of learning how much ‘listening’ Lansley and

the DoH are doing is to look at the questions they’re asking.

MC NxtGen made his views clear with his Lansley Rap

Open this document. Take a look at what the DoH are asking. The questions are all painfully leading, direct you towards the answer that the DoH wants you to give, and ignore large areas of public concern about the bill.

To give some examples:

“Which are the types of services where choice of provider is most likely to improve quality?”

“What else can be done to make patient choice a reality”

I don’t think it is possible to write more leading questions. Why not ask whether people want choice of provider? Given that 59% of people think they have too much, or enough choice in the NHS, lets not assume that everyone wants more choice. And lets not assume that more patient choice is necessarily beneficial. Lansley doesn’t want to ‘listen’ to that point of view, because it’s the wrong point of view.

“Are we doing enough to make sure the NHS at a local level has the freedom it needs to take locally-based decisions”

There are two possible answers to this question. Either you say the DoH are doing enough, and then they can write a press release saying “Our reforms supporting local decision making are supported by the population”.

The second option is to say that the DoH are not doing enough, and then the poor DoH interns can write a press release saying “The public want us to do more to remove centralised planning in the NHS”. Either way, Lansley is leading you to the answer that he wants to hear.

“What early action is being taken in your area to improve quality of services through clinically-led commissioning? What is working well?”

The DoH isn’t asking what is working badly. That’s not important. They don’t want to ‘listen’ to that. Again, you can see the press-release, half written already: “Doctors tell us that clinically-led commissioning improved services for diabetics in Milton Keynes” And Lansley can safely ignore any answers that criticize clinically led commissioning.

Andrew Lansley is not listening to the concerns of doctors. He’s not listening to the concerns of nurses. He’s not listening to the concerns of managers. He’s not listening to the concerns of his coalition partners. He’s not listening to the concerns of the general public. More importantly, he shows no indication that he wants to listen. I imagine Andrew Lansley sat with his fingers in his ears singing “la la la, I’m right and you’re wrong”. This sham of a “listening” exercise is lazy, poorly designed, and painfully transparent. And in the meantime, the DoH continue to charge ahead with their reform plans with all the subtlety of an oil company in Libya.


About James Chan

I am the Prospective Parliamentary Candidate for The Green Party in the St Helens South and Whiston constituency. I grew up locally, before moving to Leeds in 2004 to study, and now work as an A&E doctor. I currently live in Eccleston, St Helens.
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11 Responses to Listening exercise: they’ll hear what they want to hear

  1. David Rogers says:

    I can best respond with a copy of a letter in Friday’s Guardian:-
    Dear Mr Lansley.
    We get it. We really do. That’s exactly the problem you have, not the one you think you do.

  2. Dr Grumble says:

    I think the answer is to write what you think regardless of the leading questions. Here’s a nice example I have copied across:

    Mrs. Susan England says:

    April 17, 2011 at 1:32 am
    I do not want choice. This bogus “choice” the government is attempting to impose on us is simply an effort by politicians to reward the private companies who have given them money. Unfortunately for the politicians and the private companies, the public know what you’re up to. Price competition is good for supermarkets but devastating when applied to healthcare. I simply don’t see a way to prevent cherry picking from private companies. They are all about profit. They will only want the services that are profitable. This is a truly horrific bill that should be scrapped outright.

  3. Quiet Knoll says:

    Health Policy is too important to be rushed …. unless that is we have absolute faith in the voodoo economics of ersatz markets, “choice” and “competition” or contestability. Then instead of “getting it right first time” we always seem to need one more “once in a lifetime” reform because when the previous effort failed to work we remain convinced that “the status quo is not an option”. We have been set on this convoluted course for nearly 3 decades now. Instead of “Revolution” or “Evolution” we have had 30 years now of “Convolution”

    An NHS motivated by Altruism, Benevolence and Charity has gone and is well on the way to being replaced by one based on Dread, Envy, Fear and Greed.

    The old NHS has put up a brave fight for nearly 3 decades but is so weakened that we we cannot hope to return to the pre 1984 NHS before a grocer’s daughter asked a supermarket boss to reorganise the NHS along “business lines”.

    And yet we have not really given the commercial alternative a try. Perhaps only when the full horror of unrestrained health markets and private insurance have replaced the social insurance model of the past will a British public be able to truly vote in favour of a return to socialised medicine.

    Until then – or perhaps once any major political party admits openly to the folly of previous “once in a lifetime” reforms that aimed to make the NHS “more businesslike” – the old ethos will continue to die a death of a thousand cuts.

    Old fashioned though it may seem perhaps the real answer to arriving at sensible Health Policy would be a “Royal Commission” to invite evidence and really listen to the views of Patients, Public, Professionals and Politicians. To set out the pro’s and cons of different models of health care provision and funding in a report in say 3 years time. Such an approach would be a real and open dialogue aimed at “listening and learning” not a PR exercise to “tell and sell” fixed ideas of closed minds.

    This could then be used to inform a public debate about the preferred model to adopt. Even in our failing democracy, an informed debate could then take the form of manifesto commitments by political parties at the next General Election or even (more unlikely) a referendum 3 months or so before that General Election.

    British Health Policy has for too long been neither Revolution or Evolution rather it has been Convolution. Instead of continuing on this path perhaps an effective pause is needed to arrive at a Resolution.

    Kill this Bill and truly seek the Public Will on what it wants its Health Policy to be.

  4. The questions are only part of the problem, it appears that some of the infomation that they are putting out to “support the the consultation is dodgy too…

    Ben Goldacre with his usual precise disection of nonsense:

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  6. Rich Hamilton says:

    It is astonishing that the bogus leaflet (whose stats should really be titled “We would have saved 7,000 deaths from cancer if we’d done a proper job when we were last in office” like Labour did after us when it launched a proper cancer strategy the year after our study quoted here finished!) has come out from Cameron’s office, completely bypassing the department of health altogether (loss of confidence in your minister anyone?)

    It was encouraging to see Ben Goldacre’s usual precise demolition job, but also that the leaflet Cameron has produced is being investigated by the Advertising Standards Agency (James Lyons, Daily Mirror)

    Fascinating that an area of government that was supposed to be such a winner for the tories (Cameron’s own story, plus being the only party that guaranteed continued funding rises despite cuts elsewhere) has back fired so spectacularly. It is like one long motorway pile up. Lansley has so alienated everyone that even things that were introduced years ago and have been working well are now becoming controversial.

    Lansley has appointed a chair of his new regulator (monitor) whose first interviews were to talk of ‘dismembering the NHS’ as his objective, and saying ‘it worked in oil and gas, and thats not dissimilar to healthcare”. Not exactly a good recruitment process Mr L. Inflammatory, Ill Informed and Patronising.

    When I joined the NHS I was inspired by a plan for reform that seemed to make sense, and had all the professions behind it. I’ve never seen anyone publish a bill, get it 95% through the commons then decide to see if those implementing it think it’s any good.

    The Pause – as it is known, is a pause for effect. But this error may ultimately cause Cameron to fail to be re-elected. Having messed with the one area that seemingly didnt need the big painful cuts, he has introduced a big painful and controversial reorganisation, precisely when quality and productivity has to be improved. Expect the public to blame DC for all the job losses and financial deficits that are about to hit NHS hospitals.
    The biggest irony is that prior to this debacle, there was an emerging cross party consensus about the essential elements of a working system, and health had been defused as a political issue, with public satisfaction levels at their highest for decades, and in many cases outcomes improving at a faster rate than the other countries the tories are keen to compare us to.

    It wasnt broke, but they had to be seen to be “fixing” it. And now they’ve completely bodged it.

    Will the NHS achieve the efficiencies it needs to, to be affordable in 3 years time? Put it this way, do you think you would do your best work whilst working out your notice period having been put out of a job? There are about 100,000 leaders (managers and trained clinicans) for whom Mr Lansleys clever ideas mean just that. The sword of damocles may fall in a few months or even a couple of years, but they are getting their affairs in order, ready to not be there any more. BONKERS!!!!

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  9. Carl says:

    There is only one reason for Lansley to give £80 billion + to GP’s. For some years public and private companies have been seeking to make a profit from primary care out of public money. This Pulse seminar is what is to be expected of GP’s. The word “medicine”, which is what GP’are supposed to be practicing, is not mentioned:

    GP’s, not generally being business minded, will soon be swallowed by predatory business men whose motivation is purely profit. Private companies will inevitably take control of GP consortiums’ and their commissioning budgets on the basis that they are acting as providers as well as purchasers of healthcare.

    This report on the future of healthcare by The NHS Support Federation, supported by the BMA, the NHS Consultants Association, Unison and the Barry Amiel and Norman Melburn Trust shows the direction in which Lansley is heading:

    “…the whole primary care sector has undergone a massive upheaval due to the presence of the private sector: large numbers of contracts have been sold, others renegotiated, and companies have abandoned contracts as they lack financial viability.

    “Whichever strategy private and publicly traded companies take to try and make a profit out of the NHS, what has happened in just one year shows that the ultimate outcome is unlikely to be a positive one for patients and NHS employees.”

    It is concluded that, “overnight your surgery could be under new management, with no public consultation whatsoever; indeed the PCTs involved will also have had no input in this move either. Already pressures from investors seeking short-term
    profits are shaping the NHS, and it is only a matter of time before financial pressures on the smaller private companies begin to exert an affect and some consolidation takes place or even bankruptcies…”

    It is nothing less than the destruction of the NHS as a public service and the pillaging of public money by private companies to maximise shareholder profit.

  10. N. Barnett says:

    I worked in various private companies over the years, before becoming a public servant. I have never seen such waste of resources, poor planning and profligate rewarding of worthless “managers” and salesmen over people who actually know how to do a job. The public sector knows how to do more with less. Private companies only know how to make the managers look good.
    Q.V. Alan Sugar, well regarded in Government circles, who made his money selling us all Chinese and Taiwanese goods with a label stuck on them. The vast amount of empty space in an Amstrad amplifier of the 1970s, compared to the functional content, still speaks volumes about the approach of British “industries”. If it wasn’t for the wife’s job in th NHS and the lad being in a relatively decent State school, I’d be gone.

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