In the current climate of despondence over the probity of our parliamentary representatives Dr Grumble's view that all politicians have now become essentially the same may strike a chord with some of his readers. It not so much their pay and allowances that worries Dr Grumble. It is the sameness of their policies which is the focus of Grumble's concern. For democracy to thrive you need to have a variety of policies to choose from. When major policies are up for discussion in parliament you need an opposing view, a devil's advocate. If you do not have proper debate you will make wrong decisions. Far from cautioning the New Labour government when it has been heading in the wrong direction, the Tories have egged the government on. Deregulation of banking or independent treatment centres for NHS patients are examples that spring to mind. If you want something even more serious, what about the Iraq war?
Consensus might sound a nice word but in politics it is just not healthy. Politicians tutored by management consultants now have their political thinking dominated by what they believe to be inalienable truths about our world. How often do you hear politicians talk about globalisation? The world has always been a globe. A century ago a quarter of the world's population was administered from our own small island. You can't get much more global than that. Globalisation is not something that must dominate our policies any more now that it did when we ran the world. Especially when it comes to healthcare. This is just manager speak. Nonsenses follow from this thinking. You hear stories about manufacturing in the UK being a thing of the past. Finance is more important for us, they say. People in China will make things more cheaply than we can. We can never compete. But they don't tell you that they will be able to do finance in China too. Or that we have been earning more in the UK from manufacturing than from finance. Or that manufacturing provides 60% of our exports. Or that even the Japanese may base their Formula 1 team in the UK because we are actually quite good at making things. And politicians seem to forget that we have people in this country who do not actually have the intellect to work in finance but could manage to work on a production line. Tell that to the manager types and they will tell you that these people just need to go to university to become bankers. It's madness. In any case, what is wrong with giving people apprenticeships so that they can learn to do honourable and valuable work with a spanner? This blinkered management thinking really is nonsense. They have done the same to doctors and nurses. Somebody somewhere seems to think that training just needs lectures and simulations. The apprenticeship element of medicine is rapidly being eroded. More nonsense from those that just do not know.
You might think that our politicians would be free thinkers who could generate new ideas but there is not much evidence of that. The love affair between Tony Bair and Margaret Thatcher is well known and it seems that even his successor wanted some of her reflected glory. Gordon Brown's admiration for her as a conviction politician is fair enough but Grumble has belatedly realised that Blair and Brown not only admired her for her convictions they actually shared those convictions. It must now be clear to all that Blair was the first Tory to lead New Labour and Brown was more of a soulmate than we once believed.
OK. Where is this all going, I hear you ask. Grumble is not often quite so engaged in the nuances of party politics. But the house of cards is collapsing for Brown. Everybody now believes that we are rapidly heading for a Blair look-alike in Number 10. So what does this mean for healthcare? Can we hope for some really innovative policies from the opposition or are they going to be constrained by what the management types tell them is the way forward? The answer is clear and it is not at all surprising. It is going to be yet more of the same. It is all here in this attack on nice Alan Johnson from Andrew Lansley. It's great to have an attack from the opposition but for God's sake can't we have some original policies. To say that the present incumbent it heading the right way but just hasn't yet implemented enough of the policies is not exactly impressive and plainly shows no understanding of the rapid and often damaging pace of reform that has been taking place in the NHS. If some of this had been done more slowly perhaps all the mistakes GP (out-of-hours care springs to mind) that the government partially recognises might not have been made. And, as for wastage, Dr Grumble would love to know how much has been spent on new quangos and all the mechanisms for implementing change and running a market within the NHS. How can anybody be enthused with more of the same from Andrew Lansley?
Here's some of Dr Grumble's thinking on the Lansley speech in crude bullet points:
- More choice of GP and abolishing practice boundaries is nonsensical and an exacerbation of the current government's wrong thinking. The whole point of a GP is that they are close and there's continuity.
- More choice of hospital is rather an irritating thing to hear because in the old days GPs could send patients absolutely anywhere. Which government stopped that, Mr Lansley? In any case most patients are quite content to go to the nearest hospital. Even Dr Grumble does not know who is the best doctor to see and, no, you really are not going to be able to find out from masses of spreadsheets.
- Criticism of the pace of introduction of Foundation Trusts is a little worrying because some of us believe that clinical disasters have resulted from too fast a pace. It is better to get things right rather than get them done too quickly.
- Criticism of the rolling back of the independent treatment centres seems odd to Dr Grumble as there seems to be ample evidence of these places wasting taxpayers money and not always being up to NHS standards. Which, frankly, was quite predictable.
- And then the final ludicrous canard. That it's all the fault of patients who need to pull themselves together eat less, exercise more and drink less alcohol. This are laudable aims but government policy and not lectures is more likely to affect these behaviours and, sorry Mr Lansley, if people live longer it actually ends up costing you more. Eventually we all die and quite a few of us get ill on the way.
- Oh, there's one more thing. It's going to be tough and £20 billion is going to have to be saved. Another policy that would be the same whoever wins the election.
Mr Lansley deserves a more in-depth critique but Dr Grumble has to mow the lawn.