With today’s launch of the NHS Commissioning Board I notice that Sir David Nicholson, NHS Chief Executive, was quoted as saying: “Building this new system over the next two years, while delivering for our patients, increasing productivity and improving the quality of care, is a major challenge. But I firmly believe that what we are trying to achieve – a stronger, more innovative and more coherent commissioning system – will be critical to sustaining the NHS in years to come”: a realistic balance between the realities of today and the challenges of tomorrow. (http://www.dh.gov.uk/health/2011/10/commissioning-board/).
It seems a long time ago since the Coalition Agreement of 2010 was signed that set the tone for the changes we are now experiencing, particularly in health (http://www.cabinetoffice.gov.uk/news/coalition-documents). In order to “… free NHS staff from political micromanagement, increase democratic participation in the NHS and make the NHS more accountable to the patients that it serves” it
aspired to:
- … stop the top-down reorganisations of the NHS that have got in the way of patient care
- …. strengthen the power of GPs as patients’expert guides through the health system by enabling them to commission care on their behalf
- … ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT)
- … act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.
The NHS Commissioning Board will be holding Clinical Commissioning Groups and others to account for their promises. And the public will hold the politicians to account for theirs. In all of the uncertainly of change we shouldn’t lose sight of these important pledges whilst keeping the NHS working. The challenge reminds me of what Otto Neurath (1944) once said about everyday life, sociology and the messiness of change:
Imagine sailors who, far out at sea, transform the shape of their clumsy vessel… They make use of some drifting timber to modify the skeleton and hull of their vessel. But they cannot put the ship in dock … to start from scratch. During their work they stay on the old structure and deal with heavy gales and thundering waves. A new ship grows out of the old one, step by step … [they] may already be thinking of a new structure, and they will not always agree with one another. The whole business will go on in a way we cannot anticipate today. That is our fate (p47).
Although change will be difficult in these uncertain waters, I daresay there will be little forgiveness from the voters if promises are not kept. And then as Otto pointed out new ideas and demands will take us on ventures new.
Ref: Neurath, O (1944) Sociology and the Practice of Life, International Encyclopaedia of Unified Science – Foundations of the Social Sciences, Vol 1, No 1, p 42 – 47, University of Chicago
Dr Robert Warwick 