Author: dr-no

Dr No is getting increasingly bored by the futility of the gesture politics flaming round the NHS reforms. Being bored, he found himself, by quirk of a daydream, thinking of another kind of bored, a chess board, and for a moment he saw the end game of this blasted bill as a game of chess, played not on a square, but on a triangle. Three opposing GP sides – for as Dr No has said many times, it is in the hands of GPs that the fate of the bill now rests – face each other across this lone and level triangle, one side dark, another light, and the third grey.

Who, then, do we find on the opposing sides in this end game? On the dark side, we find, as we did last Sunday, the likes of Hot Burning Coales, pro-government, pro-competition, pro-private sector and so pro-reform. Their strength is that they are aligned with government, and government with them, but their evidence is blown, and their arguments in tatters. Neither stridency nor volume could save HBC’s case for the reforms, as they wilted and folded, a styrofoam cup of competition coffee microwaved in the radiant beam of Evan Harris’s glare.

Broken Arrow is today staggering around, two daggers in his back. Earlier this week, Downing Street let it be known that there was a view that he should be ‘taken out and shot’; today, the editor of ConservativeHome has let it be known that three cabinet ministers want pretty much the same thing. That’s right: within the space of a few days, both Downing street and a bevy of cabinet ministers have let it be known: Lansley, and with him his blasted bill, must go. Other Tories, including Dodders, have been twiddling knives, but Dodders is a gentle man, and one suspects a stab in the back from him would be more Private Godfrey bear-hug than Corporal Jones bayonet.

It is fair to say that Snatcher Thatcher was and for many still is the high priestess of marketisation and privatisation, and of choice and competition, and so in the interests of brevity, Dr No will call the commissioning measures contained within the Health and Social Care Bill Snatcher Commissioning. Such a name also has the utility of high-lighting what will be one of the defining characteristics of the bill’s reforms, should they come to pass: hundreds if not thousands of private concerns all competing to snatch their share of the commissioning cake.

It is also fair to say that a bill running to hundreds of pages, and an amending bill at that, now further burdened by hundreds of amendments to the amendments, lacks clarity. It may even be that it is so complicated that it lacks internal coherence; Dr No cannot be sure, because he has yet to master the feat of holding hundreds of amendments, further amended by other amendments, in his head at one time. Nor is it any surprise, given the weight of complexity, that many, including politicians and health care staff, not to mention the public, have little concept, let alone understanding, of how Snatcher Commissioning will work in practice. And so, in the interests of shining a light into those dark recesses where the sun don’t shine, and the milk of human kindness sure don’t flow, here is Dr No’s back of the (large) envelope guide to how Snatcher Commissioning will work in practice.

“Is there any other point to which you would wish to draw my attention?”

“To the curious incident of the dog in the night-time.”

“The dog did nothing in the night-time.”

“That was the curious incident,” remarked Sherlock Holmes.

–Sir Arthur Conan Doyle, Silver Blaze, 1892

Like Dr Watson, Dr No is in awe of Sherlock Holmes, and forever baffled by his cryptic utterings. Unlike Dr Watson, who had the delight and privilege of watching Holmes in action at first hand, the rest of us must enjoy Holmes at our leisure, and many will already know that the reason the dog did not bark was because the visitor was someone whom the dog knew well. Dr No finds himself wondering whether a similar reason might explain the BBC’s ongoing curious incidents on the Health and Social Care Bill. The BBC should be barking like a Baskerville about it, but instead much of the time it remains silent. When it does make a noise, it is more whimper than bark. Could it be that the BBC knows who its master is?

The government has now tabled yet more ‘amendments to the amendments’ to the HSCB – this time 137 of them, complete with ‘briefing notes’. The pace of developments is making Dr No quite giddy, so he settled down with his opium pipe, and before long it dawned on him: the government isn’t making laws, it’s making movies…

After the success of the 1994 movie Speed, starring Sandra Bullock and Keanu Reeves, and the dismal sequel Speed 2: Cruise Control, there was for a while a suggestion of a triquel, Speed 3: Ignition, but it turned out to be a hoax. No doubt the catastrophic bombing of Speed 2 blew up any chance of Hollywood making Speed 3, but never mind – for we have our very own Speed 3, already up to speed and running fast at an NHS trust near you. It is, of course, Speed 3: Health and Social Care Bill, produced by David “Wide-screen” Cameron, and directed by Andrew “One-track” Lansley.

Over on Paul Corrigan’s blog, we learn that Dr Smith has been updated. Whether the update was achieved by a Freeview over-the-air broadcast, or plugging Dr Smith into a USB port isn’t clear, but, following the update, Dr Smith is now crystal clear on how the new NHS commissioning structures will work. This put him way ahead of Mr Corrigan, who in more normal circumstances understands more about healthcare than the entire medical profession put together. But then, it’s amazing what you can do with a bit of IT these days. We shall just have to wait until Mr Corrigan gets updated, and perhaps then he can explain it all to the rest of us.

Dr No started his medical career in a surgical specialty (O&G), and in many ways, he still thinks like a surgeon. Physicians, with their pills and potions, and frock coats and baffling cardiac murmurs, were and still are quite beyond him. So he naturally expected that he would understand the Royal College of Surgeons stance on the Health and Social Care Bill. But instead he finds today it is the RCS’s position that is baffling him. If ever surgery was called for, it is a for a wide resection of the malignant tumour that is the Health and Social Care Bill. Yet the RCS wants to not just leave the tumour in place, it wants to encourage its growth. Dr No is indeed baffled.