Wednesday, 22 June 2011

All change?



When the great war of NHS liberation was declared we were told that this would not be a top down reorganization. A certain Mr Cameron even said 'We are not reorganising the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS.'

Which bit did we miss about the non top down reorganization of the health service combined with the abolishing the bureraucracy of the NHS?

True a few managers have been made redundant locally but not nearly enough and those most incompetant survive to continue to wreak havoc and do remember this is one of the few local Soviets where all local NHS Commissars have either a Harvard or Yale MBA in contrast to those who failed in the too thick to fail comprehensive school system who as a result are found in most PCTs.

A small piece in the GP journal Pulse shows us how far the lack of top down reorganization is progressing. It says that cluster PCTs which do certain bits of NHS bureaucracy for the remains of the real PCTs who are still supervised by the Strategic Health Aurthority are now to be "outposts" of the new super uber quango the NHS Commissioning Board.

So the old system of

SHA > PCT > GPs

is now

NHS Commissioning Board in parallel with the SHAs > cluster PCTs now NHS Commissioning Board outposts > PCTs > GP commissioning consortia > GPs.

So much simpler now don’t you think?

(If you want a laugh read the article in the link and you might even find a new word or more for the buzz word bingo card. Anyone know what commentarit means? Or is it misspelling of commissariat?)

Admittedly some bits will disappear at some point but we suspect in order for the Party not to maintain its top down control that most of the “change” or “reform” will consist of merely rebranding the same groups of incompetant bureaucrats but essentially keeping the same structures with different names.

Commissioning and the concept of an internal market is merely a bureaucracy based on a failed Soviet style state price fixed model of a market. All GP led commissioning is at present is rearranging the deck chairs on the Titanic while all the time the space being left to rearrange the deckchairs gets smaller and smaller as more top down reform via the new state organ the NHS Commissioning Board and its new “outposts” is implemented.

If the price is centrally fixed and all commissioning activity is to be controlled by the NHS Commissioning Board and its new "outposts" what role do GPs have in the commissioning process as the Party tightens its grip?

We almost forgot what our role is that of the fall guys. For who do you blame when GP “led” non top down reorganzation all goes horribly wrong?

The GPs of course but now with added consultant and nurse members.

Praise be to the Party for continuing to support the lack of a top down reorganization and for continuing to abolish NHS bureaucracy. Aren’t they doing well?

3 comments:

blackdog said...

The Politbureau is dead, long live the Politbureau! Politicians of all parties seem unable to grasp the concept of less is usually more, and that the bureaucrats will always hoodwink them and rebuild their empires in the new paradigm their so-called masters invent.

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