Not black and white

Brown – it’s not quite black and white

Over the past twelve months I have been one of the foremost critics of the government’s management of the NHS. Patricia Hewitt, before she embarked on a career in politics, was a management consultant, and she vigorously applied the techniques of that background to the NHS with the consequences with which we are all too familiar. Performance management and targets have been developed with an enthusiasm that has not always been shared by staff, and almost unimaginable sums have been spent on IT systems and management whiz-kids. So how should critics such as myself react to there being a new Prime Minister and a new Secretary of State for Health?

After ten years as Chancellor of the Exchequer, Gordon Brown knows better than anyone that the extra money which he made available for health has been spent, and that not always to best effect. Last year, £500 million was spent by the NHS on management consultants, and the ambitious NHS IT scheme CfH is already billions of pounds over budget and years behind schedule; PFI is a financial millstone which will burden some hospitals for the next thirty years. He cannot be best pleased that after all the extra financial resources, the NHS remains the government’s most obvious Achilles heel ; no wonder that it was very early in his recent national tour of meetings of Labour supporters that he announced that the NHS was to be his number one domestic priority, although in his first bruising week in office it already had to give way to floods, a postal strike and a security crisis.

The mere fact that he has recognized that the NHS is in such a precarious position, with many Trusts facing financial pressures, a collapse in morale of junior doctors created by the MTAS fiasco, and a general exhaustion from meddling, reorganization and the chasing of arbitrary and often irrelevant targets, must be a positive. Relieving us of Mrs Hewitt, and replacing her with Alan Johnson must also be a move in the right direction; Johnson is not the sort of politician who is going to set the world alight, but a bit of dull efficiency might be just what the doctor ordered. Indeed his first statement to parliament (Hansard, 4^th July) was as close to an apology for the mayhem as we are likely to get. Furthermore, Independent Treatment Centres, which carry the real risk of cherry picking the easy cases for the private sector and leaving the NHS to bear the burden of care of the rest, seem to be being quietly dropped.

The appointment of Professor Sir Ara Darzi, a practicing surgeon, to a junior ministerial post is also clearly intended to send out appeasing signals; I cannot find a precedent for a government minister taking on his duties part-time, whilst continuing his previous job. However Darzi is said to be a enthusiastic proponent of super hospitals, with a downgrading of the traditional DGH to the status of cottage hospitals; how compatible this is with patient choice is difficult to imagine.

So far so good, but there are some ominous signals. Brown, in one of his last acts as Chancellor cut NHS spending on equipment and building in England by 25% in the current financial year, in order to have money available to bale out trusts in deficit. He also, in the same speech (11^th May) in which he said that he wanted to listen to those in the front line, stated that he was looking for an expansion of NHS Direct and of Drop-in centres for primary care , ideas which few of use would regard as a wise use of resources. He also called for an extension of GP opening hours, which is scarcely likely to endear him to doctors whose work has been even more target driven than their hospital colleagues, and which even if achievable is likely to be enormously expensive.

Meanwhile PFI, Choose and Book, performance management, CfH and expensive management gurus still seem flavour of the month. I am happy to give our new Prime Minister every encouragement and I have already written to Alan Johnson offering him an olive branch, but I fear that the battle is not yet won. At least the NHS is at the very centre of the political agenda.