The Institute of Economic Affairs, reckoned by Diamond Marr to be a mustard cutting outfit if ever there was one, has come up with a plan to nuke not just the NHS, but anybody even remotely concerned with providing healthcare. Dr No has studied this plan, and can reveal that it is in fact a typical skipload of NeoCon tosh; it may even be a NeoTosh con. Dr No has a much better, simpler and eminently more practical plan, and he proudly takes this opportunity to present it to his readers:
• Perhaps most importantly, shoot Lansley, and abolish the DoH. To be fair, some brighter Tories have suggested the former, but in typical political fashion, have failed to execute any plan, let alone Lansley.
• Abolish the internal market. This cack-handed comedy-market has never been more than a rude attempt at control by Tory ideologues running on the backs of B grade economists, and has failed by every conceivable measure. Worse still, it has distorted priorities, inflamed costs and encouraged widespread system gaming. Such anachronistic practices have no place in a modern health service.
• All targets, performance indicators, guidance, frameworks, patient journey pathways, milestones-going-forward and all the other myriad distractions should be abolished. Those best placed to make decisions about care and treatment – individual nurses and doctors with their individual patients – must be given full and unimpeded authority to do as they see fit for their individual patient.
• Pro-market think tanks should be told to shut it, and go back to meddling in things they might stand a chance of understanding, like how the hell they got to be in a tank in the first place. Management consultants, commissioning support organisations and other systemic parasites should be told to stick their contracts where the sun don’t shine.
• Arms Length Bodies like the GMC, CQC and NCB would be rendered headless and should be eliminated. Similarly, all SHAs, PCTs, CCGs, ABCs and XYZs etcetera will become surplus to requirements and so also should be eliminated.
• The GMC should be replaced by an invitation-only Gentleman’s Medical Club that nonetheless with typical British perversity also allows women full membership. The GMC’s committee and officers should be elected by secret ballot by the membership, and given full and exclusive powers to set club rules. Similar arrangement should be put in place for nurses, midwives and the other healthcare professions.
• The NHS Annual Budget should be decided by a single vote in Parliament, and then distributed pro-rata on a capitation weighted by deprivation basis by the treasury to hospitals and GPs, who would then spend the money as they see fit in the best interests of their patients. Political interference in allocations and how the money is spent should be expressly banned by primary legislation.
• Hospitals (all publicly owned) and general practices should be administered (not managed) by boards and partnerships who should include amongst their responsibilities a requirement to foster a sense of spirit and belonging in the institutions in which they serve. Matrons should be found on wards not in offices, and staff identifiable by uniform: white coats for doctors, and starch for nurses. Succour for patients should be provided by chintzy ladies pushing WRVS tea-trolleys, and porters become once again the oil that keeps the hospital wheels turning…
And, do you know what? This isn’t another cack-handed blueprint by an air-headed doctor: something remarkably similar has been tried before, and found to work. It was called, of course, the NHS, circa 1957.
Footnote: Those who weren’t around at the time can get a feel for how it worked from the excellent BBC drama ‘Call The Midwife’. Dr No weeps through every episode for what we are about to lose. The last episode is tomorrow (Sunday) night on BBC1 (8:30pm) – don’t miss it!