The editorial of the latest edition of the British Medical Journal does not pull its punches:
What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.
The scale of ambition should ring alarm bells. Sir David Nicholson, the NHS chief executive, has described the proposals as the biggest change management programme in the world—the only one so large “that you can actually see it from space.” (More ominously, he added that one of the lessons of change management is that “most big change management systems fail.”) Of the annual 4% efficiency savings expected of the NHS over the next four years, the Commons health select committee said, “The scale of this is without precedent in NHS history; and there is no known example of such a feat being achieved by any other healthcare system in the world.” To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded.
Mad and deluded.
From a calm, professional journal of a profession that has an extraordinary public standing, this is powerful - and in my opinion wholly appropriate - comment.
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“Most big change management systems fail” – of course, its designed to fail. Its designed to bring the NHS to its knees so that only the private sector could save it.
Seems pretty obvious to me – if I wanted to privatise an organisation that was much loved and had generally high satisfaction ratings, I would make people hate and fear it, and generally make people unsatisfied with it
Then, when the people are crying out for something to be done you roll out the thacherite – “There are no other alternatives”, chuck on telly a few tame economics professors to remind us all that the private sector is far better than the public sector at delivering these things, tell us all that the IMF agree with your plans (really, why do we care about the IMF if we are not going to be borrowing funds? Its not as if they’ve every got things right in the past!) and then start the whole dirty job of privatising that organisation.
When you look at what the Tories are doing with that in mind, it seems perfectly logical to be doing what they are doing, and not especially clever or subtle.
I’ve said it before – Osborne is not especially clever (which I might add, is why he is so inflexible – he can only repeat what hes been told and can’t comment on plan B – nobody’s told him what it is!)
Brass Tacks, I would say that the running down of the NHS has been going on long enough already for people to want change. I think people do not realise what a good thing they have though – the press is so full of anti-NHS articles.
Sadly, I have been witnessing the stream-lining of services for the last few years, to enable departments to be able to compete economically with the private sector. Usually this is done to the detriment of quality – preventing practice based on systematically-reviewed research even. This really shows how competiton will reduce patient care.
Now, in my county, good applicants are turning down 2nd interviews, as soon as they are told we are to become a social enterprise trust. So it’s not just the business structure and management being run down – even the staff is (are?!) changing.
The Lancet has a rather good piece today entitled The End of our National Health Service.
PS the staff have not been asked if they want to leave the NHS