Health Matters | Paul Corrigan's blog

The first thing to say is that wherever the organisational line is drawn for public health it is wrong. I think – as does most of public health – that if it is separated from the main commissioning and delivery mechanisms of the NHS then it misses out on one of the major methods of health improvement. But equally if it is separated at all from the other organisations of Government then it misses out on the a close relationship with the social and economic policies that impact upon what public health sees as the social determinants of health.

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A year ago a lot of the earlier posts in this blog concerned the powerful and closed nature of NHS culture and I realise that I have been remiss in not returning to this in the current context of the new Government’s reform programme.
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…is not encouraging. They meet in Liverpool being confronted by a radical new Secretary of State who wants to make radical changes to the way in which the NHS organises itself. The Confed collectively, and many of the individuals within it, who run the nation’s NHS organisations, believe that they have most of the knowledge needed to maintain and improve the NHS. They therefore confront most external change agents – and a new Secretary of State is an external change agent – with a sort of sophisticated world-weariness.
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The economic regulator; providing a helping hand to the hidden hand and replacing the ineffectual worrier.

My previous posts on the new architecture of the NHS proposed by the new Secretary of State have concentrated on what the new architecture for commissioning and provision looks like. This will describe how the relationship between provision and commissioning will be organised.
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Provision for NHS patients used to mean nearly all NHS provision. This will change.

For 60 years this was organised in two distinct ways. The 1948 NHS settlement agreed that GP services would be organised through private sector small businesses called GP practices. For the most part GP services have remained organised through small private sector businesses and it is only recently that the BMA has found the introduction of private enterprise into the NHS an ideological problem.
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Over the next few days I will post a series of blogs on how I see the new architecture of the NHS proposed by the Secretary of State working. These will be updated after the health white paper in July but this is my best guess.
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One of the more interesting interactions for the new Secretary of State for Health will be with the BMA. As with any opposition the Conservatives and the Liberal Democrats had spent time and effort courting the BMA. This is always an easy experience since almost by definition in their role as the doctors’ trade union, they don’t get on with the Government. The Government, in the case of the NHS and the Secretary of State for Health, are ‘the bosses’ and therefore over a few years the BMA fall out with them. So it’s easy for an opposition to get on with them. They agree – and this is after all an opposition party’s core task – that the Government is “up to no good” and the opposition, if elected, will of course be different.
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