Blog 2023 Malcolm Blair-Robinson

Reforming public services is a difficult concept. The nature of public services tends to make them large, complex and difficult to steer. Over time they can be fashioned. Certainly the modern NHS is different to the way it was in the 1950s, but this is more to do with changing nature of medical science and the structure of society, than it is to do with the endless so called reforms. None of these has achieved to the level of its promise. The combined effect of all of the reforms is probably negative and it can be argued that if the original organisation had been allowed to develop organically under the simple umbrella of providing 24/7 universal health-care, whether routine or emergency, it would have worked a model to do this a good deal better than the current outcome.

As things stand now the NHS has become, in many ways, dysfunctional. In a recent post I related to my long delay in seeing a cardic consultant. Today I met a friend who took her husband to the local hospital to see a consultant about a hip replacement. The appointment was for 11.10 am. Note the precise time. Due to delay and confusion, including the consultant busy in the operating theatre, this couple finally got home again, a twenty minute drive from the hospital, at 5.15 pm. Their prize for the day was the husband’s name on the ‘short list’. This means he will wait at least four months.

This is not a service. It is a process. Moreover it is not free. Everybody, even the poorest, are paying through the nose for it. The £100 billion plus a year bill, is a prime reason why we have vat at 20%, income tax which kicks in at too low a level of earnings, and a budget deficit of dangerous proportions. Without the NHS the deficit would be well under control, because the NHS represents two thirds of it.

This is not an argument for closing it down. But it is a clear signal to be considerably more demanding of the outcome it delivers. It is a moment to be on the front foot asking big questions. It is also important to understand why some love the NHS and some are less sure. Had my friend’s husband, let us call him Bill, fallen down his front steps and broken his gammy hip, he would have been rushed to hospital, operated on and given a new one, all within hours and be home within days. Bill would then claim the NHS was marvellous.

This reason for this chaos is that the same outfit does both emergencies and routines, operations and clinics. Had the meddlers kept away for the last fifty years, the organic growth would have led to a community health system based on the GPs covering all health maintenance, servicing and minor repairs, with hospitals reserved for surgery, acute treatments and full time nursing care. Separate emergency departments (or hospitals) would, with dedicated staff and facilities, handle all the admissions to A&E. It is the simple logic of needing two trains, one express and one stopping. It is not possible to achieve both with one train.

Additionally, because the GPs are self employed and the hospital staff are NHS employees, the emphasis over the years has been to shift all but the most basic prescription bashing healthcare, which is dispensed in the allotted ten minutes at GP surgeries, to the hospital clinics, which cannot cope or deliver. This gives us waiting lists of months and years and casualties kept on trolleys for hours.

Andrew Lansley spent years studying the problem and came up with a plan which might, just might, have got to grips with the challenge. His mistake was in the weak communications employed to sell it to NHS staff. There was then inevitable opposition from entrenched self interest, bad medical practice and phony moralising. A political bandwagon began to roll. A panicked Cameron and a rejected Clegg united to call for re-think and change. The outcome looks much less like a bold reform to set things on a better path and much more like a meddle, as in the past, which will deliver, after wasted £billions, no better and maybe worse than we have now. If that happens, the coalition will pay a heavy electoral price.

The government’s record on u-turns is now something of a record. Daily the tally rises. Most of them are on flagship Tory policies. Many of these were ill thought through or their implications mis-read. The Government is fast losing its authority as it falls prey to the strident cries of lobbies and focus groups. Many of these u-turns will have little practical effect. Not so the NHS. This may yet prove to be a disaster.

How the activists of the Tory party must hanker for those far off days, when the Lady Who Was Not For Turning, nailed her colours to the mast of her chosen reforms and then set sail, no matter what, confident that she was right and she would win. She was not always right, of course, and not all her reforms turned out in the end as well as they looked in the beginning. But she always, always, had the courage of her convictions.

It is not clear whether the current leadership of the Tory party lacks courage, or convictions. Some are beginning to fear it is deficient in both.

This entry was posted on Wednesday, June 15th, 2011 at 6:04 pm and is filed under Malcolm Blair Robinson. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.