The Health Bill
For reasons unrelated to health care , there has just been a general election and David Cameron has been returned with an outright Conservative majority of 20 seats – much fewer than the polls predicted. The Health Bill had been recently passed but it received savage maulings in the Lords and in the press.
In general the NHS is not a happy place. There are continuing rumbles of discontent from the professions and the unions, big service changes are beginning to occur with many services moving tocommunitysettingsandtherebyreducingthesustainabilityoflocalhospitals. Recently10%of multi-speciality acute hospitals were pronounced ‘unsustainable’ by the National Commissioning Board. The need for a 20% reduction in health spend has been largely accepted by the public but they are very disquieted by the move to GP commissioning, the lack of patient choice, the cost of social care and the effects of service reconfiguration.
The PM has decided to abandon what has become known as the ‘Lansley experiment’ and restore the public’s faith in the English health system. He has said that he wants the values of the NHS – universal access and services free at the point of delivery – to shine through. He also wants the service to be integrated across health and social care and across community and secondary care boundaries.
Because the Government has to save such a large amount of money he is willing to contemplate radical changes to the system. Cameron also knows through private polling that the public are so fatigued by what has been happening in health that they are willing to accept – even welcome – change, as long as access and quality are maintained, there are no unmanaged cuts in service and that they do not have to pay higher taxes.
In a move designed to demonstrate that he sees the future of the NHS as more than just a party political football, the Prime Minster has appointed Alan Milburn as his Secretary of State for the NHS for two years so that he can carry through the changes. Alan had a similar job under New Labour when he introduced competitive markets, patient choice and independent foundation trusts. He has a reputation for independence of mind and for being politically tough and capable.
The Prime Minister has told him privately “The old NHS is over – it’s history. There is no way we can patch it together now. We need a new start for the NHS – an exciting and innovative approach that will get the health system out of the mess it is in, renew public and professional confidence and deliver the savings’.
Drawing on your own experience and research of health system dynamics in the UK or elsewhere and using your understanding of strategic management, planning and implementation, what radical and innovative strategic advice on the potential structure and dynamics of a new health system would you give Alan?
Notes:
1. Read the case very, very carefully. It is full of clues. Remember that you are advising a Minister not writing a general essay for University!
2. You will need to describe the context in which this is happening and the position of the principle stakeholders. What you learnt from the classroom discussions might be augmented by research. We will look for evidence of a structured approach to your search. There is a great deal of material available but because it is a current issue, do not expect to find too much in referenced journals.
3. If you treat the NHS as if it were a single organization you will be able to use recognised strategy tools to assess the situation and serve as the basis of your recommendations. We will be looking for links between your analysis and your recommendations.
4. Remember that strategic management is about implementation so not just making strategic decisions. Understanding the power and interests of stakeholders – you will need to advise on how your strategy might best be introduced.
Minimum length: 3,000 words excluding appendices
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Improving Decisions about Health, Wealth, and Happiness
1)Richard Thaler and Cass Sunstein. Nudge: Improving Decisions about Health, Wealth, and Happiness. Yale University Press, 2009
OR
2) Dan Ariely. Predictably Irrational: The Hidden Forces that Shape Our Decisions. HarperCollins, 2010.
OR
3) Daniel Kahnehamn. Thinking, Fast and Slow. Macmillan, 2011
Answer the below questions from any of the books mentioned above-
?What is the specific research question the paper seeks to address?
?What is the real-life relevance of the research question? (I.e. why is knowing the answer to the research question important? This is sometimes called the ?why should we care?? question.)
?How does the study fit (or not fit) with related studies that preceded it? (I.e. how did this study move the literature forward?)
?Provide a clear description of the research methodology.
?Provide a clear description of the findings, and how those findings relate to the research question.
?What extensions or applications would be interesting to study in light of the findings of this paper?
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