Wednesday, 16 February 2011

NHS "Reform"

I can't now remember the exact dates, but within the past 15 years I spent six years as the Liberal Democrat representative in the local Community Health Council, the body which monitored the local NHS. I started out as an enthusiast, eager to find out how the NHS worked and what its problems were, but soon found that, as soon as I'd begun to get the hang of things, the system changed, new jargon was introduced and I had to start all over again. So "reform" of the NHS is nothing new. The Labour government eventually displayed their indifference to local participation by abolishing the CHC and, as far as I could see, nothing was put in its place.

Given their explicit promise not to impose further "top down" reorganisation of the NHS I cannot understand why the Tories aren't receiving anything like the flack the Liberal Democrats received for breaking our word on tuition fees.

I have no clear view how, if at all, the NHS should be reorganised. What I do know is that, as soon as the reorganisiation of any organisation is on the cards the upwardly mobile participants within in it promptly make the securing of their own position in the new structure, or preferably their promotion within it, their first priority, and the function for which they're paid, in this case healing people, becomes secondary. So however dysfunctional the present system is, it would be better to leave it alone for a while so the staff can concentrate on the job we want them to do.

Two aspects of the proposed reorganisation are extremely worrying.

1. GP's are trained to heal, not to manage. They will either do the job badly or contract out the work to private firms, who will do the job but only for a profit. Either way the NHS suffers.

2. Allowing "any willing provider" to tender for NHS work is not only privatisation, but allows the private providers to "cherry pick" the easy and profitable work and leave the long-term or difficult treatments to the NHS. I believe the private insurance systems such as BUPA already do this.

There are proposals to have the NHS reforms debated at the Liberal Democrat spring conference. I hope his will happen so that those who really know what they're talking about can thoroughly explore the pros and cons. Party managers blocked a debate on student fees at the conference to approve the coalition and the result is the most serious debacle in Liberal Democrat history. Stifling debate in the interests of unity is always likely to be counter-productive. I hope they will not make the same mistake again.


  1. I'm not sure whether most GPs can manage their appointment schedules, never mind a "small business". Of course, these reception and booking processes are in the much-maligned areas of "back office", which, for the most part, seem inseparable from the major functions of GPs, police, whatever.

  2. I agree. The idea that " back office" staff are dispensable without affecting "front line" workers is a very short sighted Tory myth.

    However, we do need to remember Parkinson's Law about the way bureaucracies take on a life of their own and expand.

    The first school in which I taught had one head, one deputy and one senior mistress to run it, plus, I think, one secretary. The rest of the teachers each taught a full timetable. (There was no reduction for probationers, either.)

    The school from which I retired had, for roughly the same number of pupils, one head, three deputies, four heads of year and four deputy heads of year, all with a reduced teaching load.