10 February 2008

I told you so

Regular readers (there are two) may be wondering how Dr Grumble got on over dinner with Lord Warner, Minister of State for Reform. Unfortunately, it seems that Dr Grumble might have upset him as the next day he announced his resignation. Anyway, the dinner was good. The great and the good were there - at least three lords and a baroness - all in their finery. Dr Grumble went in his best suit. Richard Horton came in his corduroys. When you're really well known you can do that. He amused everyone by introducing himself as working for 'a medical journal'.

Was this the problem leading to Lord Warner's resignation?
Lord Warner, of course, made a speech. That's what he does. It wasn't quite an after dinner speech, more a middle of dinner speech - between the lamb noisettes and the pear in muscat wine. He was introduced as being 'above average' which he is according to they work for you. One of Dr Grumble's readers would have been pleased because Lord Warner stated that front line clinicians, not managers, are the cornerstone of the NHS. In fact that's how he started his speech. Clever man. Get the audience onside from the start.

The surgeon who introduced the noble lord professed not to understand the terms 'plurality' and 'contestability'. Perhaps goaded by this, Lord Warner did set out on some definitions. He needed to. 'Contestability' is not in Dr Grumble's rather old dictionary nor his spell checker. As for 'plurality' it is defined but what does Lord Warner mean by this? Dr Grumble listened carefully. He is suspicious when words like these are used. Why use words to obfuscate? Dr Grumble's patients are never haemorrhaging, they just bleed. Of course, as Dr Grumble has already pointed out Lord Warner is clever so one can only conclude that obfuscation is exactly what the noble lord has in mind. And if obfuscation is what he wants that must be because the truth, the unobfuscated nub of his thinking, is not what he wants to convey to his listeners.

So let Dr Grumble cut to the chase. The words contestability and plurality in the context in which Lord Warner uses them essentially mean privatisation - though presumably Norman himself would never say so. It does not necessarily mean that the whole of the NHS is to be privatised but it does mean that the government wants to rid itself of as much of the ownership of the NHS and its staff as it can. Looked at from the government's point of view, this makes some sense. Public expectations of the NHS are rising faster than they can possibily be met. Health costs are running out of control - not, according to Lord Warner, just in the NHS but also in France and Spain where deficits run at £8,000,000,000. The over 85s that cost us so much are going to increase, according to Lord Warner, by two thirds. He didn't say quite how much that can be expected to cost but it will be something enormous. And the NHS staff will be amongst these elderly folk and that means pensions to pay. No wonder the government wants to divest itself of all these yokes. But will privatisation solve the problems?

The thing about a blog is that you can be ahead of the game. This post was originally published on 17th December 2006 and was entitled Plurality and Contestability. It takes longer to write a book. But a book outlining the meaning of obfuscated words that are being used in the NHS has now been published. It's aptly called Confuse and Conceal.

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