What’s the difference between transform and reform?
One is not a synonym for the other.
Transform; change or alter something significantly… involving a complete or substantial shift in form, nature, or character… a fundamental change in the way something is structured, organised, or perceived.
Reform; making changes to improve or amend a system, process, institution, or practice… modifying or refining an existing structure or approach without completely discarding it.
The upshot, in a word, or two; transform… a significant and often radical change in form, nature, or character. Reform… making improvements or modifications to an existing system, process, or practice.
Why bother?
Well, clarity of thought is something I’d come to expect from former Prime Minister, Tony Blair.
I know he is filed under Marmite. Well, I like Marmite and him.
Aside from the ‘illegal war’ that he is forever tagged with, he did something that moved him to the top of my list of politicians that I admire.
You will know it’s a short list.
I admired a decision he took and more important, saw through, in the face of huge opposition, from vested interests. He took a lot of flak but did it because it was the right thing to do.
He introduced laws to ban smoking in the work place. A very clever piece of legislation that didn’t stop people smoking. They just couldn’t do it at work.
That meant, as bus drivers are ‘at work’ passengers couldn’t smoke. Waiters are ‘at work’, ergo, diners couldn’t puff a Havana with their Courvoisier .
Nurses ‘at work’ put an end to argy-bargy over smoking in hosptials.
Office workers soon gave up huddling in doorways, sheltering from the wind and rain, having a fag… very clever.
The results:
improved air quality;
a catalyst to quit;
a dramatic decline in smoking;
neutral impact on the economy… some places saw a short-term decline in revenue and others attracted more non-smoking customers;
and a shift in attitudes toward smoking.
The tobacco industry mounted a ferocious attack and demanded the right to keep killing people if that’s what people wanted.
Blair stuck to his guns.
Since, I have followed and admired the work of his Foundation.
Hence it was with eager anticipation I read his latest;
Fit for the Future: A Modern and Sustainable NHS Providing Accessible and Personalised Care for All.
Oh dear… if the report were a car it would be a DeLorean. As the Duchess used to say; ‘All fur coat and no drawers’.
It proves you can roll a cowpat in glitter, but it’s still a cowpat.
Blair muddles transform with reform.
Espouses a two-tier system, co-payments and all the rest and still enthuses over equity of access... you can't have both Tony.
Gushes about a digital future with the NHS App… it’s already underway, Tony.
Rhapsodises the use of Cloud technology… the NHS is doing it Tony.
Is lyrical in support of access to the healthcare market for private providers… Tony, the NHS has more contracts with the private sector now, than before Covid and patients can chose a private contractor.
And, harks back, fondly to his 2000 NHS Plan and Alan Milburn, his health secretary’s ‘market’ concept. Demanding more choice, competition and carving out discrete operations like cataracts and hips for contractors… which, I recall, added costs to the system and did nothing for quality.
There is a ray of hope that Blair hasn’t entirely lost it;
‘… [the] Genomic Medicine Service should be taken out of the backwoods of the NHS… turned into a full-fledged part of the system, with the aim of providing whole-genome sequencing for… [everyone]…’
I don’t know where the Genome Gang live or what they do but it sounds like a good idea.
Blair’s bright boys and girls fall into the trap all the think tanks fall into…
... they either don’t think, or worse… they overthink.
If they thought about why the NHS is in a mess, they’d think about...
... the damage that austerity policies do to public services.
How governments without a workforce plan or a cohesive industrial relations policy...
... destroy moral and workflow.
Seduced by technology they over think it..
... when the less glamorous option of getting the basics right; fast login, interoperability and data analysis is all that’s needed.
They talk about artificial intelligence when some basic human thinking about how to treat people, develop them and make the workplace challenging, stimulating and dare I say joyful…
... are transformations and reforms beyond their understanding.
Sorry Tony.
Have the best weekend you can.
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PS; This Monday evening, London, come and join me in conversation with NHSE Chair, Richard Meddings - ticket are free. Bring questions!
