Mr Lansley’s tough assignment: the update

May 28, 2009 by
Filed under: Public policy, The RSA 

As promised: my update on the speech this morning. We had a packed audience for Andrew Lansley and a very good question and answer session.

I have characterised the basic New Labour model for public service improvement as a combination of pressures from the centre (funding, strategy, regulation), from the side (contestability, freedom for providers) and from the bottom up (patient choice and voice).

In essence Andrew’s position is that we should have less pressure coming from the top and more from the side and bottom, and that we need, overall, to trust professionals in a context of open information and patient choice. I suggested in my questions that this was an evolutionary rather than revolutionary approach. Andrew didn’t disagree although he insisted that his approach was ‘radical’. (Question to note: why does no politician wants to admit to not being radical?)

There was an interesting discussion about targets which led to two quite tough questions for Tory policy. Andrew emphasised a move from ‘process targets’ to outcomes for the NHS and implied that the overarching health outcomes for a Conservative Government would focus on public health issues like obesity, smoking and alcohol abuse. This begs two questions:

1) How do you stop outcome targets turning into process targets when they are implemented? So, you might say that patient satisfaction should be the key objective (as Andrew did and as the Government itself has committed to), but if you then find that patient satisfaction is a function of certain measurable aspects of the service (for example the time a GP spends with a patient) the temptation is to make this the proxy target. After all long waits – which some would argue was not the most important problem facing a health system – became the priority because they were what the public said they cared about most.

2) If the Government moves from NHS related to public health targets it is in essence shifting from things over which it can exercise direct influence to those which are much more complex and difficult to influence. Whether the public, or media, will accept such an accountability framework is an open question.

RSA website users will shortly be able to listen side by side to Alan Johnson and Andrew Lansley – who have both spoken here in the last few weeks – and form their own judgement.

You can watch my brief interview with Andrew after the event here.

Matthew Taylor interview with Andrew Lansley

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3 Comments on Mr Lansley’s tough assignment: the update

  1. Mark on Thu, 28th May 2009 4:09 pm

    2. This is absolutely right. It’s also worth noting that if the Conservatives win the next election, their preferred outcome targets don’t really measure the Conservative government’s performance on the NHS until at least their second term. Take, for example, the Tory goal of getting five-year cancer survival rates in excess of the EU average by 2015. There is a time-lag involved in collecting and analysing this data, so cancer survival rates published in 2015 will tell you about five-year cancer survival up to 2013. This will tell you about the survival rates for people who were diagnosed with cancer five years previously – in 2008, under a Labour government.

    In 2008 (and now), the NHS had targets for cancer treatment which the Conservatives say they will abolish, including the target that you should wait no more than two weeks from GP referral to see a specialist if you have suspected cancer, and the target that you should wait no more than one month for treatment following diagnosis. Obviously the reasons for cancer survival are many and complex, but perhaps the most important factor is early diagnosis and treatment, and these targets focus on that crucial part of the patient pathway.

    If the Tories do reach their target in 2015, this will reflect well on the current Labour government’s cancer strategy, and will tell us almost nothing about the Conservative government’s policies – except, arguably, that they were wrong to abolish Labour’s cancer targets.

  2. Health-Check for a Responsible Britain « The 2020 Public Services Trust Blog on Fri, 29th May 2009 1:43 pm

    3. [...] to do away with top-down ‘tick box’ targets, and towards broad public health outcomes.  But as Matthew Taylor notes, one danger is that broad outcomes can simply become umbrellas for ‘proxy targets’.  And [...]

  3. M on Sun, 31st May 2009 9:19 pm

    4. It was disappointing that the time for questions from the audience was severely limited due to the “banter” on the stage – labour vs conservative, which was NOT what I had come to London to hear. Many of us had valid questions which were not addressed. There was nothing in the title that suggested that labour (Mr Taylor) was going to challenge Andrew Lansley, in fact, I understood that Mr Taylor represented the RSA, not the labour party.
    I wanted to ask Mr Lansley about polyclinics and to add to the voice of the gentleman who was concerned about health inequality in addiction and mental health. This question was not well answered.

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