Can National Health Sense Be Dawning?


A trio of former health ministers has called, on 6th January, for a cross-party commission to be set up to review the future of the NHS and social care in England. An epiphany indeed. Alan Milburn (Labour), Stephen Dorrell (Conservative), and Norman Lamb (Lib Dem) should be congratulated.  The NHS has never been a strong card for the Tories and they should be particularly delighted to take this opportunity to remove the rod from their back. This call could be the first step to taking politics out of the NHS and should be welcomed.  Once again we have the prospect of a junior doctor strike brought about by ministerial meddling.  Yes the BMA is intransigent but the lesson of history is that there are no bad soldiers, only bad generals.  Politicians, who know nothing about management, should get out of trying to micro-manage the biggest employer in Europe.

This has nothing to do with privatization: as discussed before, the public corporation should resource internally its core functions and whatever it can do efficiently and economically and outsource the rest.  It should not run blast furnaces to make steel for its own surgical instruments.

Three more strategic changes need to be made and the cross-party review should consider which should take priority: the links with social care, removing bureaucracy and dividing the NHS into right-sized units.  Taking the last first, it is absurd that the NHS Scotland and NHS Wales should both be considered “right-sized” in terms of taxpayer value when one is 60% larger than the other.  Either one is too big or the other is too small.  And Northern Ireland?

And it is still more absurd that NHS England, covering a population 10 times the size of Scotland’s as to be a uniform, standardized organization providing the same uniform standardized service everywhere.  In this logic, Truro is identical with Newcastle but Newcastle is totally different from Edinburgh.

The NHS is too big and needs to be divided into managerially feasible units achieving their own goals in their own ways.

Much of the NHS bureaucracy has been created over the last 70 years in response to ministerial meddling.  Remove the latter and we could have the first ever purge of the time wasters.  A neighbour provided a neat vignette the other day.  “Have you ever wondered,” he said “why it is impossible to find a parking space in the King’s Lynn hospital car park during the week but the car park is empty at weekends?  The number of patients and their visitors are much the same and medical staff not that much reduced.  The bureaucrats have all gone home.”  We should send most of them home permanently.

Finally, as also discussed before, the NHS should focus on “cure” and with “care” managed separately.  They have quite different objectives and need different skills albeit the transition between the two should be seamless.  Keeping those who should be in care in far more expensive NHS hospital beds is bad for everyone.  We need a National Cure Service working closely with a National Care Service.

Well, that didn’t take long did it?  Let’s hope the cross-party review can report and its recommendations implemented before this bright new year concludes.