A friend writes to me; and when I ask if can publish it anonymously, says "yes, why not?".
The NHS: well, the Futures Forum report is submitted on Tuesday and the rumour is that Cameron and Clegg will make announcements very soon thereafter. Cameron's speech earlier this week was clearly, in my view, giving some ground. Competition only when it can be justified, emphasis on integration, other clinicians to be involved in commissioning, variable timetable for GP commissioning consortia to make the grade, A&E and 18 weeks targets effectively restored (and this should be milked by Labour as tantamount to acknowledgement of the huge achievement of eliminating waiting times). But - how will this be reflected in next week's announcement and then in legislative changes?
It's pretty clear from what I pick up that Cameron regrets having got into this mess - yet again, the Tories are not trusted with the NHS - and hasn't that been a political fault line for them time and again - his attempt to rehabilitate the Tories NHS position has now failed spectacularly - the question here is whether the electorate will remember. It's also clear that most of what they want to do simply does not need a 350 page bill - indeed, most of it could be achieved with little change to primary legislation.
Meanwhile, the financial/efficiency challenge gets tougher and tougher. It's not that there are no efficiency opportunities - there are, and they add up to many £ billions. But delivering them requires fundamental change, much of which needs to be led nationally (for example: changing GP contracts to make them accountable for the financial consequences of their clinical decisions, thereby creating the leverage to eliminate completely unwarranted variations in long term condition management, prescribing and referrals; facing up to the reality that greater centralisation of specialist services will be safer and more efficient - and hence accepting that this means some local hospitals will cease to have 24/7 A&E, full on paediatrics etc etc).
There is a real sense of fiddling while Rome burns - every ounce of our energy should be devoted to protecting patient safety, improving quality, securing efficiency - and yet we spend loads of time on so called "transition". But - a current saying is that too much tooth paste is out of the tube, and simply calling a halt a least some of the changes the Tories have launched is not feasible. But we could consolidate, and then focus on the real issues.
An interesting and potentially very important week or so ahead for the NHS.
Well, we'll all just have to clean our teeth with what's been squirted out so thoughtlessly to save any waste and then go out and buy a new tube of toothpaste. This one will be (easily) funded by a Robin Hood Tax on the banks and it will be universally available at point of need based on a design that, given all professional groups and the overwhelming majority of patients agree on the shape and contents, apparently only the Tory squeezers oppose. The middle of the toothpaste tube squash has been in the planning for 25 years since the reign of the gap-toothed hag and was worked on by the Fox/Werritty secret army before they discovered richer pickings in the death industry (aka defence); I prefer the gleaming, strengthening, glowing result from Solidarity: The Decency Tooth Paste.
Posted by: Kevin Donovan | 18/10/2011 at 11:12