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Charm Offensive: Andrew Lansley Interview

Charm Offensive: Andrew Lansley Interview

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Andrew Lansley’s job is safe – for now. The Health Secretary still has to win over a lot of recalcitrant GPs. He talks to Victoria Vaughan about his strategies to engage and reassure the health community.

Andrew Lansley looks tanned and relaxed. Life is good. He’s just got back to his constituency from a lovely family holiday in Suffolk. His controversial Health Bill finally received royal assent last month. And while the Health Secretary’s long-term political ambitions still depend on the successful implementation of his health service reform plan, for now his position is relatively safe.

It’s quite a transformation from the brusque, exhausted creature GP Business met last Spring. Even before he published the Bill in January 2011, he’d long been under severe, sustained pressure for his proposals to improve the health service. With the benefit of hindsight, it’s likely Lansley would have done a lot of things differently. But he’ll only admit to one regret: his team could have presented the reforms much more effectively to general practitioners.

“I think there was a big issue about the lack of engagement at a practical level in the service in the first six months,” he admits. “What became obvious in February [last year] was that, firstly, lots of people had not really read any of this [Bill] and that, secondly, even if they had read it they had not really understood it or engaged with it.”

To help bring GPs on board, the government launched a so-called ‘listening exercise’. This consultation process “got us to a good place in terms of identifying where the key issues were and enabling us to make some amendments that dealt with that,” says Lansley. But he’s candid that: “in truth, a lot of those amendments were practical things in order to give further reassurance. They did not really fundamentally change the principles at all.”

The implication that GPs just needed “reassurance” is not entirely convincing. What about all the GP associations and clinical commissioning group (CCG) leaders that repeatedly slammed the Bill right until the last moment? Lansley blames ‘the media’ for blowing any negative comments out of all proportion. “There was, for example, a front page story about one clinical commissioning group that said we are not happy with the Bill. And almost the same day 75 clinical commissioning group leaders could write to The Times and it is not a story. Well, of course… what the media want is they want to report the row.”

But this isn’t born out by the evidence. Dissent is becoming increasingly widespread: a BBC poll of 814 GPs at the start of April found that 12% thought clinical CCGs would lead to a “noticeable” improvement for patients, a fall from 23% when a similar poll was carried out in September 2010.

“Why would they express confidence when everybody is telling them it is going to be a problem?” Lansely retorts. “Their own organisations, the BMA and The Royal College, are telling them it is all going to be terrible. It is not, and actually the BMA and The Royal College of General Practitioners have themselves been supporters of clinical commissioning. What we have to do is to get beyond the rows to the place where we all work together in the same direction because the principle of clinical commissioning support organisations; it has done for primary care trusts (PCTs) in the past, probably in a more competitive framework in the future than they did in the past. The private sector had, I think, in the year before the elections, something like £250 million worth of contracts with PCTs, most of which, frankly, were in order to enable them to tick all the boxes on world class commissioning. Well, I do not want to be in that place; if they are providing services it is because they are providing exceptional value.”

By way of example Lansley cites analysts Experian, who have been doing population-based data analysis in Nottingham. “Why would the NHS want to invent something new when you have got a data management company that... is able to manipulate far more data, far more effectively. You would not want to recreate all of that, would you? So, there is a role for the private sector but they are going to have to prove that they can really add extra value.”

Ultimately the success of the reforms comes down to GPs stepping up, taking the reigns of CCGs and making the decisions on service redesign to save NHS money and improve care for patients. A fine principle, but the constant complaint from GPs is that they want to be clinicians not managers.

“Let us say there are 220 CCGs – I am looking for clinical leadership in those groups. But by no stretch would I expect that every GP is going to be required to do anything in those CCGs, and most CCGs in my experience, probably one in ten of the GPs in any given area, are actively engaged in this process.”

Lansley believes that many GPs have long been involved in clinical commissioning - they just don’t call it that.
“The other week I was sitting around a table with GPs and consultants and nurses who were planning dermatology services – well, you might be a GP who has a special interest in dermatology so you go to that and you say, ‘Right, we are designing what the commissioning pathway, what the referral pathway for dermatology going to make a big difference.”

This ‘modernisation’ is not simply about CCGs, says Lansley. It will also focus on public health “big time.”
“It is going to be about things like the reform of social care. It is going to be about bringing local authorities in the NHS much closer together so we integrate care and health services more effectively. Things like the three million lives telehealth systems, it will be things like the 111 Urgent Care system.”

“Maybe I should be concentrating on the public health side and much less on trying to think any new thoughts about the NHS. I am open about that. I am very clear, part of my objective is to get beyond the reform processes that we had to bring in place, get comprehensive reform for the NHS so that it does not have to go through a set of further changes for, hopefully, a long time in the future. So we get to what is a stable and a sustainable structure for the NHS in the future.”

For more from this interview read our Q&A part 1 and Q&A part 2 from Andrew Lansley.

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