Tethered goat, honest broker or government stooge?

Many have dismissed Darzi as a government stooge. Even Alan Johnson referred to him disparagingly as a tethered goat. But when Lord Darzi became a GOAT, Dr Grumble was quite delighted - though he was not at all sure he was the right person for the job. A government of all the talents seemed a good idea. If there had been a snap general election he would have optimistically considered voting Labour. As things have turned out, that general optimism might have been misplaced. But the key question now is whether or not the noble lord has done a good job in his final report on the NHS.

So what is in this long-awaited report? Is it all motherhood and apple pie? Are there any horrors signalling more backdoor privatisation? Is it farewell to a free NHS?

Dr Grumble was actually heartened by a lot of what he read. But he does know that you really do have to read carefully between the lines of these reports. There is plenty of evidence out there that this government wants to privatise as much of the NHS as it can. But is Allyson Pollock right that Darzi's report signals that we are on the way to a US system with two tier care and charges? Perhaps Dr Grumble is losing his touch but it is not the message he got from a first reading. But reading between the lines of a lengthy document is a challenge and, on reflection, Dr Grumble is worried about strange experiments such as personal budgets. As Allyson points out this passes risk down to the patient. And what could be the point if privatisation is not the aim?

There are certainly some wonderful things in the report that will enthuse any clinician. There's talk about how we go to work to deliver health care, how we all want to do a good job and how we strive to improve. There's the implication that clinicians should be in the driving seat and that all that holds us back is lack of empowerment. There's talk of quality, measuring quality and making things better. Who could object to that? It's what we all want, patients and staff alike. There's no argument. But some of the detail such as the lack of payment for never events makes no sense unless Allyson is right.

So read what Allyson Pollock says carefully. And read carefully between the lines of the Darzi report. And then decide. Honest broker? Tethered GOAT? Or government stooge? Is the NHS as we know it safe? Or is this a preamble to US style care?

You decide.



Addendum

As a final postscript Dr Grumble does want to point out that Darzi does say in quite a few places how bad things are now in the NHS. This is a common theme from the government. And they repeatedly knock doctors - especially GPs. Quite often it does not seem to be justified. Quite often if you look for the evidence it is just not there. Quite often you find the truth is quite the opposite. Here is an example:

On page 28 of his report, after slagging off GPs for not giving their patients advice on diet and exercise and referring to a claim from patients that GPs do not ask about emotional issues Lord Darzi states: "We lag behind our peers internationally" and gives a reference to the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Now it just happens that Dr Grumble has read this report and is well aware of its conclusions. How the noble lord can possibly conclude that we lag behind is baffling. So why is that? It could be just a mistake. Or it could be deliberate. It could be that Allyson Pollock is right.

Lest you do not believe Dr Grumble's interpretation of the 2006 Commonwealth Report, below are unselected graphs from the relevant Commonwealth Fund press release (pdf). Do we really lag behind?

Decide for yourself.