Lansley’s NHS reforms will undermine fairness

Another organisational shake-up does not surprise doctors, but this is a much bolder move towards pr

Andrew Lansley has launched a white paper that has been heralded as the biggest shake-up of the NHS in a generation.

The key proposals are:

  • Abolishing ten strategic health authorities by 2012 and scrapping the 152 primary care trusts by 2013. This would mean that up to 30,000 managers face being cut or redeployed.
  • Replacing these management structures with about 500 GP "consortiums" (not optional), meaning that family doctors will have control of £80bn of public money.
  • Allowing hospitals to leave public ownership to become "not-for-profit" companies.

The first thing to note is that the NHS has been in a state of almost continuous reform for nearly three decades. There has been some form of organisational change almost every year since the early 1990s. Many of these changes resemble each other; 2002's primary care trusts were difficult to distinguish from 1982's district health authorities. The same goes for NHS trusts and foundation hospitals.

The cumulative effect -- apart from the fact that most new structures don't have time to show positive effects before they are changed again -- is cynicism in the medical profession, as evident in this doctor's blog:

As the ministers and commentators observe the effects of their "bold vision" and "strategic planning", I am happy to tell them how much difference this will make to most Jobbing Doctors -- very little. You see, we have seen this all before.

Under the internal market established by Margaret Thatcher, and not-much-changed by Tony Blair, GPs surgeries already operate much like private businesses that commission services from hospitals. Equally, under private finance initiatives, private companies have been involved in building numerous new hospitals.

But what the new plans do amount to is a much bolder and more open step towards privatisation of the National Health Service. As with so many of the coalition's reforms, the move towards less bureaucracy is not matched by guarantees of accountability, which are needed to maintain a consistent standard countrywide.

Oddly enough, Melanie Phillips makes a good point about this:

It also surely runs the risk of fragmenting the service, since GPs will try to look after their own clinical patch rather than the general good. And this gets to the crux of the problem. A national service needs to offer unified provision throughout the country in order to be seen to be equitable.

Yesterday, Lansley spoke of the need for competition and choice, echoing Thatcher's market ideology, ignoring that last time this was implemented, we were left with a hugely unfair postcode lottery. Lest we forget, the much-reviled target culture did produce results, with waiting list figures, among others, drastically improved (LabourList has some numbers here).

The NHS was founded on the principle of fairness. Let's not undermine that by restructuring the system in such a way that it has no mechanisms to help that fairness flourish.

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Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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All the Premiership teams are competing to see who’s got the biggest stadium

It’s not just a financial, but a macho thing – the big clubs want to show off that they have a whopper.

Here in NW5, where we live noisily and fashionably, we are roughly equidistant from Arsenal and Spurs. We bought the house in 1963 for £5,000, which I mention constantly, to make everyone in the street pig sick. Back in 1963, we lived quietly and unfashionably; in fact, we could easily have been living in Loughton, Essex. Now it’s all changed. As have White Hart Lane and Highbury.

Both grounds are a few metres further away from us than they once were, or they will be when White Hart Lane is finished. The new stadium is a few metres to the north, while the Emirates is a few metres to the east.

Why am I saying metres? Like all football fans, I say a near-miss on goal was inches wide, a slow striker is a yard off his pace, and a ball player can turn on a sixpence. That’s more like it.

White Hart Lane, when finished, will hold 61,000 – a thousand more than the Emirates, har har. Meanwhile, Man City is still expanding, and will also hold about 60,000 by the time Pep Guardiola is into his stride. Chelsea will be next, when they get themselves sorted. So will Liverpool.

Man United’s Old Trafford can now hold over 75,000. Fair makes you proud to be alive at this time and enjoying the wonders of the Prem.

Then, of course, we have the New Wembley, architecturally wonderful, striking and stunning, a beacon of beauty for miles around. As they all are, these brave new stadiums. (No one says “stadia” in real life.)

The old stadiums, built between the wars, many of them by the Scottish architect Archibald Leitch (1865-1939), were also seen as wonders of the time, and all of them held far more than their modern counterparts. The record crowd at White Hart Lane was in 1938, when 75,038 came to see Spurs play Sunderland. Arsenal’s record at Highbury was also against Sunderland – in 1935, with 73,295. Wembley, which today can hold 90,000, had an official figure of 126,000 for the first Cup Final in 1923, but the true figure was at least 150,000, because so many broke in.

Back in 1901, when the Cup Final was held at Crystal Palace between Spurs and Sheffield United, there was a crowd of 110,820. Looking at old photos of the Crystal Palace finals, a lot of the ground seems to have been a grassy mound. Hard to believe fans could see.

Between the wars, thanks to Leitch, big clubs did have proper covered stands. Most fans stood on huge open concrete terraces, which remained till the 1990s. There were metal barriers, which were supposed to hold back sudden surges, but rarely did, so if you were caught in a surge, you were swept away or you fell over. Kids were hoisted over the adults’ heads and plonked at the front.

Getting refreshments was almost impossible, unless you caught the eye of a peanut seller who’d lob you a paper bag of Percy Dalton’s. Getting out for a pee was just as hard. You often came home with the back of your trousers soaked.

I used to be an expert on crowds as a lad. Rubbish on identifying a Spitfire from a Hurricane, but shit hot on match gates at Hampden Park and Ibrox. Answer: well over 100,000. Today’s new stadiums will never hold as many, but will cost trillions more. The money is coming from the £8bn that the Prem is getting from TV for three years.

You’d imagine that, with all this money flooding in, the clubs would be kinder to their fans, but no, they’re lashing out, and not just on new stadiums, but players and wages, directors and agents. Hence, so they say, they are having to put up ticket prices, causing protest campaigns at Arsenal and Liverpool. Arsène at Arsenal has admitted that he couldn’t afford to buy while the Emirates was being built. Pochettino is saying much the same at Spurs.

It’s not just a financial, but a macho thing – the big clubs want to show off that they have a whopper. In the end, only rich fans will be able to attend these supergrounds. Chelsea plans to have a private swimming pool under each new box, plus a wine cellar. Just like our street, really . . . 

Hunter Davies is a journalist, broadcaster and profilic author perhaps best known for writing about the Beatles. He is an ardent Tottenham fan and writes a regular column on football for the New Statesman.

This article first appeared in the 11 February 2016 issue of the New Statesman, The legacy of Europe's worst battle