Do you remember the good old days when Think-Tanks actually thought about things.
Mused over the issues of the day. Ruminate about what might happen. Applied their big-brain-boxes to what was coming over the hill.
These days we’re lucky if they even look around the corner.
They press releases ‘their reaction’ to HMG’s press releases and make statements of the bleedin’ obvious.
There was a time when the likes of the King’s Fund, Nuffield Trust, IPPR, Policy Exchange, and others had a serious influence on NHS and wider public service reform.
Their research shaped White Papers, spending reviews and even election manifestos. Today, their traction and impact seems much weaker.
The political landscape has become far more polarised since Brexit. Governments are less interested in independent, evidence-led policy work and more focused on loyalty, media soundbites and culture wars.
Ministers and advisers increasingly distrust institutions. They see traditional think tanks as establishment or liberal.
To be fair there is far less thinking-time. Governments now operate in hyper-short cycles. Driven by media headlines, 24-hour news and immediate public opinion across social media.
Real think-tank work can take months, developing serious research and recommendations. Their brain-box cycle is too slow and by the time it’s published, it’s out of date.
No.10, Treasury and DH+ have their SpAds. Policy wonks prefer in-house control over change, rather than relying on external ideas.
Insecurity means they don’t welcome external inspection. Hence the mess the DH+ is in, relying on old lags for ideas.
There’s always been a risk that think-tanks publish worthy, heavily-researched, but ultimately unreadable papers…
… heavy on theory, light on actionable policy…
… at a time when politicians need sharp, headline-grabbing ideas… ‘gimme a 5-point plan’… not 80-page reports of complexity.
The emergence of instant polling has shifted the balance away from ‘tanks’ to the kitchen-table. Polling firms are now the idea generators, based on the thoughts of the voters and taxpayers, that stump-up for it all.
And… there is the money.
Some think tanks chase corporate sponsorships or DH+ grants, nudging them towards less challenging research, to keep funders happy. They can’t afford the scale of research programmes they once did.
The political market for careful, independent policy advice has shrunk.
The thinking cycle has shortened, politicians want to be told they are right and in order to keep a foot in the tent, they no longer challenge the status-quo.
If Chris Ham, the elegant, ex-boss of the King’s Fund or Nigel (Big Brain) Edwards for the Nuff’s were still around…
… I’d bet they’d find a way to tell Streeting it’s a very silly idea to, all at once; turn the NHS upside down, sack people, ignore staff sickness, the plight of social care and still expect waiting lists to come down.
They’d find an elegant, rapier euphemism for ‘bonkers’.
Which brings me to the latest opus from the Health Foundation called The ‘Did the NHS experience record pressures this winter?’
The answer to their question is ‘no’ but the NHS is still in a mess. What does that tell us?
The report, with some great graphs, meanders around;
…‘faced substantial pressures’, ‘record attendances’, ‘increased waiting times’, ‘high demand for ambulances and more life-threatening calls’, ‘emergency admissions…. all below pre covid levels’… blah, blah.
There must be something systemic wrong, mustn’t there?
There are more staff, winter was planned for back in June, virtual beds get one mention.
To be fair the report is balanced and nuanced but their principal conclusion is just wrong…
‘… the question is not how we better prepare for winter but rather how we improve baseline capacity.’
No, no, no… The Health Foundation does not understand the capacity paradox.
More beds and people to look after people in the beds and you’ll soon fill-up the beds.
More domiciliary care to help discharge and you’ll soon run out of care packages.
More care homes, you’ll fill them.
The thinkers at the Health Foundation better put their thinking-caps back on on…
… right now there are close on a million vulnerable (mostly) elderly people who no longer get social care support. Councils have raised their eligibility criteria because they don’t have the money or the people to provide it.
The thinkers must tell Streeting to fix social care. Cut the admissions. Otherwise we’ll fill up the capacity and never cope with the discharges, or…
… next winter won’t bear thinking about.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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