I recently agreed, thanks largely to the charms of the young Ralph Michell of ACEVO, to be part of an ACEVO task force on health and social care. Reluctantly, because there's nothing I enjoy less than three hours of jaw-ache abou which up and coming somebodies in the Blah Blah Commission or DH we simply must get on-side.
So I arrived today, and sat through the first hour wondering what else I could be doing....Then arrived our special guest, Paul Corrigan. Paul used to advise Alan Milburn, then John Reid and Tony himself on health policy. He was here to talk us through three scenarios for health - two in the event of a Tory victory and one for hung Parliament.
What followed was was fascinating. Scenario 1. Decent Tory win - with a reform agenda on health. An emergency budget which spares health but still only gives a small increase. NHS becomes independent though a constitution (take out the politics) and has a regulator. GPs are given serious budgetary power.
This quickly picks off the PCTs as commissioners and starts quickly to impact on hospital admissions as primary care grows, proportionately, in relation to acute, hospital-based treatments. Smaller hospitals start to go bust. Lots of politics. Government holds its nerve. We have bigger regional specialist hospitals, some specialist units, both public and private for common ops that need doing locally, lots of local polyclinics in small places (like Bury St Eds I presume). Far fewer bog-standard hospitals where you hope you don't have to go if you get cancer or need tricky surgery - and want to live to tell the tale.
Under this scenario, the NHS becomes more decentralised, has a diversity of suppliers - including third sector organisations - (leading to more efficiency) and a more sane allocation of resources.
Scenario 2 - Narrow Tory win. Same pressures but this time without a reform agenda. This time a `cash agenda'. Here the Treasury is running the show. Every penny spent is in Treasury line of sight. Ultra-centralist. Reserves from Foundation Hospitals all pulled into centre and sent to prop up Trusts in Tory constituencies about to go under. Thin majority prevents strategic approach. Little in way of reform of NHS to actually drive change from below. Definite short term cash-saver but negligible in terms of long-term saving or reconfiguration of NHS into something that can deliver its own value. Third sector isn't gaining much in this scenario as current problems are `locked in' without a proper reform agenda to move things on.
Scenario 3 - Hung Parliament. Like most people I speak to, this is seen as worst of all worlds. The markets react badly. UK loses triple A, run on pound, bank rates rise and we are effectively, in the hands of the banks. Politically there is a total vacuum as the Government struggles for overall direction. We end up with an austerity budget but no policy on health to go with it.
Huge tumult as society and public goes through febrile period as it becomes clear we lack clear leadership. Everyone is fighting for life and working short-term. Not easy. Third sector is resilient and uses its `asset-base' - the public's trust, its own relationships and creativity - to find a role.
What made this presentation so compelling was Paul's clear sense of how the state works in particular scenarios. I asked at the end how he saw things in five years. His hope is for the main triad of the current `20th century' welfare state - hospitals, prisons and welfare' - and the producer interests that underpin them - to be rendered obselete by alternative generated by civil society.
Nobody, he said, would create the particular response to the problems we have now by inventing today's welfare state. It needs to be superceded and third sector organisations - with their innovation, ability to involve users and create value-adding partnerships - were part of the answer.
If you ever get a chance to hear him speak, go. Paul Corrigan. Superb.