Filed Under (Narrative of reform, Reform of the NHS) by Paul on 01-02-2012
Sometimes events with potentially disastrous outcomes are described as a “car crash waiting to happen”. Over the last year this phrase has often been used about the NHS reforms.
Yesterday’s debate – caused by the letter from the editors of the Nursing Times, the Health Service Journal and the British Medical Journal – provoked the use of this metaphor on many occasions.
When I heard the discussion on Tuesday’s Today programme between Charles Alessi and the BMJ’s Dr Fiona Goodlee, what struck me more than anything else was that presenter John Humphrys kept on saying – to gales of his own laughter – that nobody knew what the changes actually were.
He said repeatedly that while he was used to there being disagreement about what reforms might actually achieve, the experience of having no-one able to persuade him what empirically they were was a new one for him. He thought it really funny that – there they were, on prime time radio, discussing a major set of changes – and no-one could tell him what they actually were!
So he asked the two doctors he had invited to debate the changes.
Charles Alessi said that the reforms will give clinicians the right to decide what should happen in their localities. And it’s true – this was an intention of the Bill.
Fiona Goodlee countered by saying that national organisations gain more power through the reform. And that’s true too – this was an intention of the Bill.
The reason John Humphrys finds this so funny is that the car crash between these opposing intentions is already embodied in the Bill. This is not a matter of intention -but actual fact.
As I mentioned earlier this week, CCGs are being set up in every locality. The NCB is set up to bring power to the centre. More NHS commissioning will take place at a national level than ever before.
So the car crash is taking place already – with the system trying to achieve two contradictory things on everything.
Tomorrow I will explore what this means for public health.
Since September 2010 I have been pointing out that the Government has no narrative for these reforms. The fact is that we are – 16 months later - hearing John Humphrys thinking it’s really funny that no-one can explain to him what the Government is trying to do with the biggest organisation in the country.
I have now discovered what an NHS reform car crash sounds like.
It’s John Humphrys chuckling on the Today programme that – as one of the best informed people in the country – he hasn’t a clue what they are.