They had been left to themselves and their employing organisations to make sense of the enormous changes. No one had made any overall sense of the reforms for them.
This meant that whilst they might like or dislike some parts of the detail, each clinician had made their own overall sense of what was going on within their own political and moral world view.
So those that were passionate about the NHS as a public provider, felt that this was all a scheme to privatise the NHS. Nurses felt that the late addition of a nurse to the CCG board was a continuation of the usual tokenism that they had come to expect, and those that were simply pragmatic were getting on with the bits and pieces that made sense.
Another issue is that most clinicians in this group ‘get’ the long-term financial issue. Above all, they, as experts in diabetes, know that there will be a growing imbalance between the increased demand for healthcare and the much smaller increases in resources. They know that they have to increase health care outcomes with the same levels of resource.
They are worried about this but recognise that if this is the world they must face for the next decade then at least it is better that they are heavily involved rather than it being left to abstract management.
The most interesting issue for me was that whilst nearly everyone in the room was employed by a primary or secondary care organisation, they nearly all realised that the answer - the overall answer - could not be found from within their organisation. There was a strong recognition that the successful future diabetes pathway would cross all sorts of organisations.
So the really interesting thing is that this group of clinicians, who were clearly driven by the necessity of creating clinical improvement for people with diabetes within a very tight resource budget, did not feel either before or after the reforms that they were empowered to set up and develop new organisations of provision.
Throughout our discussion, time and again the arguments about working together - that could have been solved by developing a new organisation to deliver across the existing organisations - appeared insurmountable.
It occurred to me that if a fraction of the organisational and political capital expended by the government in its reforms - and the reforms of the reforms - had gone into providing a simple explanation of how we could have organisational fluidity of approach, then we would have secured a lot more of the change that we need.
- Professor Paul Corrigan is a healthcare management consultant and former special adviser to Tony Blair. More at www.paulcorrigan.com