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Mr Lansley's tough assignment: the update

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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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