Blog 2023 Malcolm Blair-Robinson

The toughest job in the Government at the moment is that of Andrew Lansley. He is paying a very heavy, but perhaps deserved, price for lack of candour during the General Election and screwing up on the communications for his important reforms to the NHS. The price he is paying is that the Tories are spooked, Cameron is running scared  and the Lib Dems are in headlong flight. Yet this is the moment when he must stand firm.

There can be concessions about the detail of who sits on the commissioning authorities, but the fundamental pillar must remain. It is that the health management of patients has to come under the control of GPs. Your own doctor knows what you need and where to get it. He fixes for you to see the specialists and receive the treatment. He is always at the centre and never leaves your side. 

At present the interests of patients are managed by shambolic and incompetent bureaucracies, calling themselves Primary Care Trusts, run by self serving and often overpaid career opportunists, obsessed by targets, procedures and practices, not to mention bonuses, whose ignorance of the real needs of patients and the natural flow of medical care, is almost total. This ghastly structure costs vast money and many lives. It must be shut down. For good.

The reason why the majority of GPs have signed up to the new deal is that they know it is much better. The era of medicine which allowed each supplicant, sorry patient, ten minutes before either a prescription or a referral is over. To bury it, Lansley needs the support of the GPs, which he has, but if the rest all run away, let them. Because once the box of this shambles of PCTs is open and it is now, no amount of threats, defections and resignations can close it.

The interim report of the ICB is welcome. The government can now consult and consider. In the autumn the Full Reprt will appear. The government will then decide what to do. Its record for sticking to its guns is beginning to look patchy. Osborne is weak on the banks while strong on the deficit. The Lib Dems are somewhat the reverse. It will be their turn to drive the coalition to do what is needed, just as the Tories pushed them on the deficit. Vince has long been a banking hawk.  For him the autumn could be golden.

Of course everything should have been decided by now and  be on its way to implementation. A sovereign debt crisis may well be brewing, not because the central banks will not cough up, but because the affected populations either will not agree to, or not enact, the terms of the loans. The resultant defaults will bust  more banks. To stop another meltdown, which could include taxpayers refusing another bank bail out by sacking governments which proposed it, ring fencing, or call it what you will, is urgent.

Essentially this must mean that depositors’ cash is used for conventional lending only and is in firewalled segments of the banks, guaranteed by taxpayers as an essential utility of the economy. Investment banking and proprietary trading must be separate. Shareholders, depositors and employees of these operations must bear all the losses of a failure, unrescued by taxpayers. Nothing  more is needed. Nothing less will do.