Blog 2023 Malcolm Blair-Robinson

Useless Jobs.

Lord Tebbit, admired always by this Blog for his personal courage and public candour but rarely for his policy positions, has written an excellent article for the Times today. In an assessment of the road ahead for the coalition he considers the prospect of the unions bringing it down, as they did with the  Heath and Callaghan governments. He makes shrewd comparison with those two frustrated leaders and their much more resolute successor, Margaret Thatcher.

He also points out that the cost of the public sector is not because of the dedicated employees at the sharp end of delivery; refuse, hospital ancillaries and so on, but the middle class, often overpaid, public sector workers doing utterly useless jobs. He says they should be the first for the chop. I entirely agree. It is a harsh doctrine, especially if it is your job that goes, but spending has got to come down to the level of revenue. Many of those affected will be Tory voters. Some will recognise the party is over, but others will feel aggrieved. 

Nevertheless the coalition as a sum and in its parts, must remain resolute. It must also do everything possible to create the opportunities, freedom and finance to enable British industrial strength to be rebuilt. The destruction of our industrial base with its employment and wealth creating capacity, replacing it with a so called services economy is where Thatcherism went wrong. In his quiet reflective moments Lord Tebbit will know that.  The coalition must work also to ensure that this current upheaval does not leave an unwelcome problem for future generations to resolve.

Health Reforms

The centrepiece of the government’s White Paper on Health is that GPs (I prefer the title Personal Doctor) will be in control together with the patient, of their diagnosis and treatment path, for the first time since the NHS was formed. This is the critical point. It is not about funding or who controls funds. Huge delays now occur to both diagnosis and treatment (especially for less well known or test sensitive conditions) because patients are shuffled from hither to thither without anybody being responsible for the overall progress or outcome.

In conditions such as cancer, diabetes or heart disease, which are common and for which there are well rehearsed and resourced procedures, the inefficiency of the current system is masked, as is also the case in an accident or health emergency. Outside these and similar boxes there is a muddle; sometimes sufferers make do for years without a correct diagnosis or, therefore, effective treatment. Putting GPs in charge, as opposed to keeping them informed, will not only change process and outcomes, but will, if done properly, be much more patient focused. It will be better for the doctor and better for the patient.

The idea that timely and efficient healthcare could be organised by ‘commisioning trusts’  responsible for determining the scope of care, in which patients and doctors were no more than customers or providers, has always seemed to me to be based on a misunderstanding of the nature of medicine itself.

The path ahead will not be smooth or without mishaps, but it does go in the right direction.