Conflict

An article on the HSJ website today is titled: "Conflicting messages from the top hint at growing resistance". It reports that Andrew Lansley and the top civil servant in the NHS, Sir David Nicholson, are providing conflicting messages about the planned changes. On the one hand Commissar Lansley is attacking just about every part of the NHS in his attempt to break it apart into private corporations. On the other hand, Sir David recognises that if any change has to be made it has to be done by the people who work for the NHS and hence he is carefully asking for help. The HSJ article gives the 18 week target as an example:

Mr Lansley trumpeted the end of the 18 week waiting target, Sir David chooses to specifically remind NHS chief executives that it “remains a constitutional right” and commissioners have “a responsibility to ensure that commitment is met”.

This is a clear conflict, especially since Lansley made targets a political issue (even thought he is totally wrong about targets, because patients really do like them since they guarantees them prompt care).

As a civil servant Sir David has to do what his political master tells him to do, but as we well know from Yes, Minister, the Sir Humphrey's of Whitehall usually know best and implement what they know to be best.