Reflections on Government Health Policy

Within my role at Interim Partners Private Healthcare practice, it is always interesting to meet people who have contributed to the Government’s Health Strategy – and to get an insight from the experiences of leaders who have previously worked at the heart of decision-making.

I recently met with Paul David Corrigan CBE. He was director of strategy and commissioning of the NHS London Strategic Health Authority, and formerly senior health policy adviser to Tony Blair. He talked about his career with me and shared his reflections on the impact of his achievements.

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What was the toughest policy-related challenge you faced?

The problem with implementing policy from the office of the Secretary of State (SoS) for Health in the NHS was the belief that the NHS was a ‘command and control’ organisation. The assumption was the centre (SoS) could tell the whole organisation what to do. However, it was never a command and control organisation. It was (and is) a command organisation with little control.

Therefore, the SoS had to find ways of developing accountability in different parts of the NHS. Foundation Trusts (FTs) were one of these where we tried to create greater local accountability. We felt it was important that provider trusts which could pass the test of competence and were given more autonomy over their activities. I think for those organisations that became FTs, this did increase their individual accountability.

The problem is that as each institution within the NHS improves its accountability, the overall system is no longer seen as ‘in control’. In the last few years the centre has tried to wrestle back ‘control’ of Foundation Trusts and treat them the same way as other trusts, because it wants to ‘tell them what to do’. There are one million consultations in the NHS every 36 hours. It’s just not possible for the centre to tell the full set of institutions what to do.

Which of the achievements in your career do you think most benefitted patients in the UK?

From 2001 to 2007, the key priority for us was reducing long waiting times for all forms of treatment. We were very conscious of how much this issue mattered to the public. Over time, maximum waiting times fell from over 18 months to 9 months, to 6 months and then 18 weeks. This took a lot of large scale policy changes as well as attention to detail.

Survival rates from heart disease and cancer also improved over this time, as did inequalities of life expectancy in some of the poorer-performing local authorities.

What do you think are the fundamental differences between the offering from NHS and private providers? 

It’s important to note that some services are only provided by the NHS and act as a safety net for all private health care. So, for some aspects of care there is no differentiation.

If you look back to 2001, the main ‘selling point’ of private medicine was not having to wait for treatment. When NHS waiting times subsequently fell, this sell was less powerful. So, the differentiation was more around being able to choose your doctor/hospital. The NHS then started making the offer of patient choice, which meant for some time private medicine was having greater difficulty in differentiating itself.

Since the credit crunch, the impact of ‘austerity’ on NHS capacity and capability means private medicine can once again highlight waiting times and choice as genuine selling points.

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