A poisoned chalice?

The white paper euphemistically referring to liberating the NHS has made everything clear. The NHS as we know it is to be dismantled. In England anyway. Governments no longer want to be responsible for things. Career politicians want to be politicians. They want to give speeches and spin stories about their achievements. But they do not want to be responsible for running anything. When the NHS fails in some way they want it to be somebody else's fault. Governments have always been like this. They want to distance themselves from trouble. They want to blame others.

Looked at in this light Lansley's white paper is a master stroke. The health service will be delivered not by employees of the NHS but by employees of social enterprises. Lansley will create the largest social enterprise sector in the world. These organisations will deliver healthcare. They will do it for money. And they will make a profit. They will have the imprimatur of the NHS but they won't really be the NHS. Not, anyway, the NHS as it is now. That might sound pretty bad but you may not notice. Most people probably think their GP is an NHS doctor. The reality is that GPs are independent contractors. Patients don't notice so it clearly doesn't matter. It almost certainly has some advantages. GPs can actually be quite innovative and quick to respond to change.

In case it has escaped you, general practices are already social enterprises. They are independent. They work for money. They make a profit. Despite this anomaly many would say they are the jewels in the crown of the NHS. GPs are advocates for their patients. Patients trust them. They still provide the backbone of a cradle to the grave service. GPs know more than most about what their patients need. They have a sense of the sort of quality they want from organisations supplying those needs. They understand the crucial difference between needs and wants. And they have a good feel for the reputation of the suppliers of those needs.




The problem, of course, is that GPs are really just small businessman. They are small businessmen whose main interest is not in the business aspects of their social enterprise but in the good practice of medicine for the well-being of their patients. As things stand most of them have neither the time nor the inclination to commission NHS services on behalf of Andrew Lansley. Those in the know, an example would be Sir Richard Sykes, say they don't have the expertise either. But, frankly, neither did the previous incumbents.

Lansley's main aim has been met. Handing £70 billion of taxpayers' money to a bunch of independent commissioning amateurs distances the Con-Dem government from the NHS. It puts doctors in the driving seat which has been seen as being essential if change is to be effected. And it puts the blame for when things go wrong onto GPs.