I have been an NHS GP for 30 years, have grown up with the service, been immersed in it, and it has a special place in my heart and my psyche. However, only the most blinkered would fail to recognise that it is also a vastly bureaucratic and inefficient organisation.
The last Labour government tried to modernise the service by employing a vast number of administrators in a top-down command and control system, and the creaking, sluggish system responded, producing a few results according to ‘target analysis'.
These achievements, though, were at the cost of a continued decline in NHS productivity and an enormous undermining of staff morale. GPs were treated almost with contempt and many of them seemed oblivious to the Government's deliberate undermining of NHS general practice – why else was a parallel system of walk-in centres and new GP-led health centres developed?
Interestingly, the agenda only changed a few months before the general election when the Department of Health obviously instructed PCT managers to try and finally get a move on with the 10-year-old ‘modernisation' agenda, and a degree of urgency, or panic, surfaced. So the Labour Party's centralised control, and enormous expenditure, demonstrably failed as a means of improving the NHS.
What has never been explored before is how the NHS's own personnel, in conjunction with patients themselves, could design a better, more responsive NHS.
The Health and Social Care Bill is perhaps the last chance for the NHS. It has to modernise and become ‘fit for purpose', to use the management speak of those who failed to do this under the last government.
The alternative will be the gradual destruction of the NHS as it fails to deliver services in a world where resources are limited – and where efficiency is a lifeline and not something to be sneered at. The Prime Minister and health secretary Andrew Lansley deserve praise for their courage in proposing this bill, which is one the NHS desperately needs.
From Dr Andrew Hardie, Birmingham
