17 November 2013

Who's in charge?

Interesting problem, which is almost philosophical in nature, revealed by The Observer:
The government's drive to introduce more competition into the NHS is having the perverse effect of holding up the creation of world-class cancer treatment centres, the Observer can reveal.
Investigations show that individual hospitals whose roles would be downgraded under reorganisations are blocking moves to concentrate cancer services into fewer top-performing specialist centres, by claiming such mergers would be anti-competitive and would reduce patient choice.
NHS leaders, who are deeply concerned about the effect that legal disputes are having on progress, have admitted some cancer units are being allowed to carry on operating even though they do not meet the latest official guidelines on how services should best be organised.
In one case, a "rationalisation" of cancer services in and around Manchester, proposed by NHS England as a way to improve "outcomes" to world-class levels, is being challenged and held up by complaints from south Manchester NHS foundation trust and Stockport NHS foundation trust on legal grounds.
In the good old days, before the Coalition (and indeed New Labour) got their grubby mitts on it, the NHS was for most purposes a top-down, centrally controlled service where patients (customers?) were expected to take what they were given and where priorities were determined (and rationed) by Ministers and a few health bureaucrats at the centre.  This is still the case in Scotland.  This system worked more or less adequately for fifty years from its inception in the 1940s.

The attempt to introduce competition/patient choice into the system was, rightly or wrongly, a reaction against the dead hand of central control.  But of course Ministers and bureaucrats wanted to retain the option of central direction where they deemed it necessary.  Alas, once you give "the little people" a taste of freedom, they insist upon exercising it.  And as competition spreads further into the NHS, we can expect further local/central conflicts to emerge.


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