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.

Subscription offer: Get 12 issues for just £12 PLUS a free copy of "The Idea of Justice" by Amartya Sen.

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

Kevin Doncaster/Creative Commons
Show Hide image

For 19 minutes, I thought I had won the lottery

The agonising minutes spent figuring out my mistake paired beautifully with hard, low wisdom tooth throbs.

Nineteen minutes ago, I was a millionaire. In my head, I’d bought a house and grillz that say “I’m fine now thanks”, in diamonds. I’d had my wisdom tooth (which I’ve been waiting months for the NHS to pull the hell out of my skull) removed privately. Drunk on sudden wealth, I’d considered emailing everyone who’s ever wronged me a picture of my arse. There I was, a rich woman wondering how to take a butt selfie. Life was magnificent.

Now I’m lying face-down on my bed. I’m wearing a grease-stained t-shirt and my room smells of cheese. I hear a “grrrrk” as my cat jumps onto the bed. He walks around on my back for a bit, then settles down, reinstating my place in the food chain: sub-cat. My phone rings. I fumble around for it with all the zeal of a slug with ME. Limply, I hold it to my ear.

“Hi,” I say.

“You haven’t won anything, have you” says my dad. It isn’t a question.

“I have not.”

“Ah. Never mind then eh?”

I make a sound that’s just pained vowels. It isn’t a groan. A groan is too human. This is pure animal.

“What? Stop mumbling, I can’t hear you.”

“I’m lying on my face,” I mumble.

“Well sit up then.”

“Can’t. The cat’s on my back.”

In my defence, the National Lottery website is confusing. Plus, I play the lottery once a year max. The chain of events which led me to believe, for nineteen otherworldly minutes, that I’d won £1 million in the EuroMillions can only be described as a Kafkaesque loop of ineptitude. It is both difficult and boring to explain. I bought a EuroMillions ticket, online, on a whim. Yeah, I suffer from whims. While checking the results, I took a couple of wrong turns that led me to a page that said, “you have winning matches in one draw”. Apparently something called a “millionaire maker code” had just won me a million quid.

A

Million

Quid.

I stared at the words and numbers for a solid minute. The lingering odour of the cheese omelette I’d just eaten was, all of a sudden, so much less tragic. I once slammed a finger in a door, and the pain was so intense that I nearly passed out. This, right now, was a fun version of that finger-in-door light-headedness. It was like being punched by good. Sure, there was a level on which I knew I’d made a mistake; that this could not be. People don’t just win £1 million. Well they do, but I don’t. It’s the sort of thing that happens to people called Pauline, from Wrexham. I am not Pauline from Wrexham. God I wish I was Pauline from Wrexham.

Even so, I started spending money in my head. Suddenly, London property was affordable. It’s incredible how quickly you can shrug off everyone else’s housing crisis woe, when you think you have £1m. No wonder rich people vote Conservative. I was imaginary rich for nineteen minutes (I know it was nineteen minutes because the National Lottery website kindly times how much of your life you’ve wasted on it) and turned at least 40 per cent evil.

But, in need of a second opinion on whether or not I was – evil or not - rich, I phoned my dad.

“This is going to sound weird,” I said, “but I think I’ve won £1 million.”

“You haven’t won £1 million,” he said. There was a decided lack of anything resembling excitement in his voice. It was like speaking to an accountant tired of explaining pyramid schemes to financial Don Quixotes.

“No!” I said, “I entered the EuroMillions and I checked my results and this thing has come up saying I’ve won something but it’s really confusing and…”

Saying it out loud (and my how articulately) clinched it: my enemies were not going to be looking at butt selfies any time soon. The agonising minutes spent figuring out my mistake paired beautifully with hard, low wisdom tooth throbs.

“Call me back in a few minutes,” I told my dad, halfway though the world’s saddest equation.

Now here I am, below a cat, trying to explain my stupidity and failing, due to stupidity.  

 

“If it’s any consolation,” my dad says, “I thought about it, and I’m pretty sure winning the lottery would’ve ruined your life.”

“No,” I say, cheese omelette-scented breath warming my face, “it would’ve made my life insanely good.”

I feel the cat purr. I can relate. For nineteen minutes, I was happy too. 

Eleanor Margolis is a freelance journalist, whose "Lez Miserable" column appears weekly on the New Statesman website.