Poor Crazy Olive, as Craig Oliver is now known in Downing Street. The new director of communications has not had an easy start. He dressed well on his first day, and his brogues, manbag and cycle helmet sent out the perfect new Tory message. But he has struggled since then.
This week he was turned away at the Downing Street gates when police guards didn’t recognise him. Seconds later, the Prime Minister’s motorcade cruised past on the way to Derby, leaving him to scramble for a taxi.
His deputy has gone on holiday and he didn’t even have time to find the stationery drawer before he was expected to be an instant expert on the Duke of York’s hobbies and the failed SAS operation in the Libyan desert.
The former BBC executive suggested that Prince Andrew had been shown the yellow card — “no one here knows the first thing about football”, one bewildered aide said — only to be contradicted by the Prime Minister . No wonder Mr Oliver tweeted “really, really long day”. The “to do” list is horrendous. He has to be manager, spokesman, troubleshooter, strategist and politician, selling government policies on education, benefits, the police, the Middle East and universities.
Since the summer, David Cameron has realised that he must wrest back control not just from civil servants but ministers. The forestry sell-off debacle has strengthened his resolve. He needs more people in Downing Street, so the guards had better get used to seeing new faces. Mr Oliver is also helping with the restructuring of No 10 and the employment of new special advisers.
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But on top of the former comprehensive schoolboy’s in-tray is an enormous file marked “health”. Mr Cameron has told Mr Oliver to concentrate his efforts on the NHS. The Prime Minister gave his former boss at Conservative Central Office, Andrew Lansley, free rein and the Health Secretary has come up with radical proposals to abolish primary care trusts and to force GPs to take control over the lion’s share of the NHS budget.
But these proposals have been rejected by the British Medical Association, the Royal College of Nursing, physiotherapists, the unions, health charities such as Diabetes UK and the British Heart Foundation, not to mention Shirley Williams and the patients themselves. It’s important to have a few enemies but Mr Lansley has to take some of the country with him as he cuts bureaucracy and waste. Look what happened to David Lock, the Labour MP who supported minor changes to A&E services at Kidderminster hospital a decade ago. A local GP stood against him in 2001 and he lost his seat.
So what can Mr Oliver do? Go to Cumbria. No, really. In the rolling hills lie the answer to all his health problems. Mr Lansley has been unable to express his plans clearly but in Cumbria they are already working. GPs have control of budgets, they have virtually abolished primary care trusts and, crucially, patients receive better service.
The reforms in Cumbria came about because of a huge funding crisis several years ago when the local primary care trust ended up £37 million in the red. It planned to close all nine of Cumbria’s community hospitals to make up the deficit. But then a woman named Sue Page was appointed as chief executive and she decided on a new approach — allowing doctors to get involved in decision-making so that they could keep patients out of the two main hospitals and save money.
Putting GPs in charge of a patient’s progress allowed more treatment at home and less in expensive hospital beds. Slowly GPs took charge of the local hospitals and finances and by next month they will manage 97 per cent of the £800 million primary care budget. Since they took over, there hasn’t been one case of drug-resistant Clostridium difficile in the nine community hospitals and the average stay has dropped from 36 days to 10.
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One GP, Peter Weaving, says: “It’s gold standard service on your doorstep, cheaper and better.” He is convinced that when his colleagues see the benefits, they will understand the changes.
But the crucial difference in Cumbria is that the doctors wanted to join the project, they weren’t forced to. The process may have taken four years but it has been made to work through trial and error; the PCT wasn’t chopped down but was allowed to wither away naturally and still retains a few functions, such as dealing with disputes and epidemics.
So there is a solution. Mr Lansley must allow GPs to volunteer to join the scheme. Let them decide whether to opt in. Mr Oliver doesn’t need to make a U-turn but just to slow down. The coalition agreement promised that there would be no “top-down reorganisation” of the NHS. Reform must come from the grass roots and depends on GPs’ enthusiasm. They should spread the message. It won’t work everywhere but, as in education, one size doesn’t have to fit all. After all, Mr Cameron has always said that health service reforms should be about evolution, rather than revolution.
So there you are, Mr Oliver. One problem solved. Now you have only police, education, the Middle East, benefits, universities and trying to turn a frog back into a prince. Good luck.