Dr Grumble's reader has been in touch with him to find out why he has not been posting recently. The answer is that he has been worn down. The progressive changes that have been taking place to the NHS are approaching their zenith. Always inexorable they are now unstoppable. The faux listening exercise and the apparent response has silenced the dissent. For Grumble it is very sad. The service that he has devoted his working life to is on the verge of destruction. The NHS the public loves will be no more. Not, anyway, in its present form.
That is the negative view. Others, like the redoubtable Clare Gerada, take the alternative view. Clare, or St Clare as Dr Grumble likes to call her, takes the view that all is not lost. Is she right?
Mrs Grumble has noticed the depths of Grumble's depression over the reforms. She took Grumble back to the time of the Iraq war when millions protested and reminded him that he stayed at home that day and left others to waste their time demonstrating. And she reminded him that this is a decision that he now regrets. Not, of course, that it made a blind bit of difference. Is there any point in simply registering a protest when it's clear that it's not going to alter anything?
What puzzles Dr Grumble most about major governmental decisions is just how wrong they can be. You just would not think that any committee of sensible people could get things so utterly wrong. Committees do make mistakes but not on the scale the government does. There must be a reason for this.
What is the reason when it comes to the NHS? There is evidence that relatively dispassionate parliamentary committees, after listening carefully to the evidence, can actually see the truth. Here's what Kevin Barron, Health Committee Chair, said about commissioning:
"It is a sorry story if, after 20 years of attempting to operate commissioning, we remain in the dark about what good it has actually done. The Government must make a bold decision: if improvements fail to materialise, it could be time to blow the final whistle."
The final paragraph of his Committee's report reads:
A number of witnesses argued that we have had the disadvantages of an adversarial system without as yet seeing many benefits from the purchaser/provider split. If reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.
So there you have it. The problem is not with committees. The problem is at the highest level of government where decisions are made based on a prevailing dogma driven by intense outside financial interests. The latter have enormous resources at their disposal and they use them to maximum effect. They are very clever, clever enough to defend the indefensible. Only this week Grumble nearly crashed his car as he heard somebody from KPMG extolling the virtues of PFI. The piece was masterly. But wrong. All the pros came across but none of the cons. It didn't take Grumble long to find evidence of a vested interest.
What interests Grumble are the drivers to the government's NHS reforms. Why have successive governments got it so wrong? How is it that the ConDems are able to press on with their misguided plans to essentially sell off our NHS against the wishes of the electorate? Read Liberating the NHS: source and destination of the Lansley reform to find out more.