Sorry. If you were hoping to find out what a polysystem is, Dr Grumble doesn't know either. It is probably a few months since Grumble first heard the term but he still doesn't know what it means. Words without meaning frighten Dr Grumble. It's perverse for a word not to have a meaning. It is the raison d'être for a word to have a meaning. Sometimes words without meaning have a dangerous purpose. Their purpose can be not to convey a meaning. Not the real meaning anyway. Do you think that might apply to the word 'polysystem'?
What is the essence of the polysystem approach? Ostensibly it is about providing care for patients closer to their homes. That sounds laudable. It is also supposed to be cheaper. Why it should be cheaper Dr Grumble has no idea. If you provide the same services that are in a hospital to patients that are in the community it is not at all obvious to Dr Grumble that it will be both better and cheaper. The MRI in the polyclinic at the end of the road has never been a realistic option. And while handheld ultrasound scanners may get us a fraction closer to the dream of Spock-style Star-Trek diagnostics the reality is that in the 21st century a scanner is only as good as the bit between the ears of the person operating it. Quality diagnostics is not just about providing the necessary hardware at the street corner.
The more you think about the idea of moving care into the community the more daft it becomes. It is not a bad ideal but it just can't be cheaper and better. In the current financial climate it may not even be affordable. So why the headlong rush for a model of healthcare that has never been tried, is totally untested and has not been costed? That is today's big healthcare mystery.
But wait. Dr Grumble is making the mistake of assuming that the primary purpose of polysystems is to move care closer to patients' homes. That after all is what we are being told. But is this the real purpose? Are our masters so misguided as to really believe that polysystems are going to be both better and cheaper? Of course not.
The horrid truth is that this polysystem thing is about chopping up the National Health Service into lots of little pieces and then getting rid of it. It could be privatisation or it could be something else. Exactly what doesn't trouble our masters too much. What it won't be is the NHS. The components of the polysystem will be called NHS providers and the NHS will pay but the provision of care will come from bodies that are not actually the NHS as we know it. The details are vague and uncertain - quite possibly deliberately so. Vague enough to be depicted as a Rich Picture (pdf). For some it will be a very rich picture. For most of us it will be quite the opposite.