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New faces, same old rubbish

Jobbing Doctor ponders on whether the election of a new Government will change anything in the NHS.

Over the next few months we shall see significant change in the NHS. There will change in management, change in emphasis on targets, new ‘initiatives', new people, new quangos, all change.

Except, of course, there won't.

When I sit down with my patients in my consulting room, and start to take a history and perform an examination, there will be no change. That goes on as before. People know what to expect as well. They understand the job of a GP. I'm a doctor; that's what I do.

As we survey the wreckage following the election. Our old Secretary of State for Health - a youngish MP called Andrew - is to be replaced by another Secretary of State for Health - who is a youngish MP called Andrew. Hardly need to change the brass plate on the door.

In other areas of policy we will also see no change. The ruinously expensive and poor value for money scam, the Private Finance Initiative (PFI) will rumble on, sucking good money out of the budget.

The PFI was a Tory policy designed to hide expenditure by (a) keeping it off the books and (b) expecting our children to pay the bills. It is a disgraceful piece of short-termism designed to buy votes, that didn't even do that. PFI should be relabelled Payments for Infinity. Labour should be ashamed of themselves.

Other dreadful policies that New Labour have dreamt up and introduced will continue. The artificial, and largely irrelevant, internal market for health has gobbled up most of the extra funds from the taxpayer and delivered nothing as yet.

So much time and effort has been spent putting the building blocks of this in place, and all it has yielded, as far as I can see, are burgeoning departments within the individual hospital and community trusts whose sole purpose is to send each other bills and receipts, and then other departments to oversee and audit the whole process. At the end of the year we have a situation where one trust is in surplus, and one is in deficit.

Does this matter to Jobbing Doctors? No, not really. It really has changed virtually nothing in my job. It might do in the future, if the money runs out. There are likely to be fewer front-line staff as finance departments freeze recruitment and retention, and retiring people are not replaced.

It really is a mystery to me why so much money has been wasted on this process. I don't believe a market in healthcare can ever exist, in a true Friedmanesque form, in a civilised country. In the end it will implode on its own contradictions. Sooner or later.

If the internal market is scrapped, what can replace it? I think localism is the answer here. But also a willingness by policy-makers to listen to the professionals, and not the siren voices of management consultants.

Over the next few years, we will stumble on with this mish-mash of policies. Months will come and months will go. Jobbing Doctors will just carry on doing their jobs as before, as policy after policy spews out from the corporate centre. Much sound and fury signifying nothing.

I have a suggestion. We should get rid of every job that cannot accurately be described by a panel of the general public. Five-a-day facilitator? Goodbye. Director of the Patient Experience? Goodbye. Managerial carnage, but little change seen.

Another thought. An outgoing quangocrat was once asked what he thought that the incoming Government should do in a major area of public governance.

The answer was ‘less'.

Jobbing Doctor