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Let’s rip up the page



John Lee-Thompson argues the Tories need to be more radical and think about a whole new model of healthcare

Conservative party leader David Cameron says his priority is the NHS.

So what’s new? That statement has been the mainstay of election manifestos for as far back as I can remember.

The Conservatives’ draft health manifesto, which came out last month, seems heavy with aspiration but lacking in substance. And although this is probably the most opportune time to deliver radical change in the NHS, Cameron stops far short of real transformation, opting instead for tinkering with the current models of delivery.

PBC is one arena where a demonstrably good idea hasn’t been followed up or endorsed heavily enough by the Department of Health to make it work effectively. Giving GPs the power to hold patients’ budgets and commission care is a good idea but it isn’t innovative. Years ago it was being espoused by Frank Dobson, Alan Milburn and the other secretaries of state for health. Commissioning by clinicians is still viewed with suspicion by PCT paymasters. That’s why many PBC entities have their hands tied because they are still working to indicative budgets and are not empowered to deliver change.

Likewise, the drive to provide ‘real’ patient choice by expanding the market to include more independent and third-sector providers might be way off the mark. One of the privileges of working in the NHS is that one gets the opportunity to listen to patients. And guess what? The majority don’t give a tuppenny damn about choice. They don’t want to be dazzled by confusing statistics or morbidity/mortality rates for neighbouring hospitals, or to be treated in private hospitals. They want better, more effective treatment closer to home. So where do they go for advice? To their GP, the one clinician they trust to give them an honest opinion. They don’t, it seems, go to the NHS online portal.

I believe that Cameron and the Conservative party are missing a trick. There are real opportunities to embrace and implement radical change. They should listen not just to the bright young things at Tory HQ but to the often-ignored messages of the ‘real’ experts. These are the front-line clinicians, the patients and even some of those much-maligned NHS managers.

It’s a perfect time for a serious rethink. For instance, are the various tsars telling us anything we don’t know? What does the much vaunted Care Quality Commission do that’s of real value – and if they’re that good, how do they miss so much that is poor? What do strategic health authorities bring to the party, what do they add that’s of benefit and can anyone say hand-on-heart that they aren’t just another layer of clumsy administration?

Cameron says: ‘We will measure our success against those countries with most effective systems of healthcare.’ Here’s a tip: why not measure your success against the expectations of the users of the NHS? If you can begin to match those, at last the NHS might be deemed a success.

John Lee-Thompson is deputy director of performance at Milton Keynes PCT.

The views expressed are John’s private opinions and not those of the organisation