5 min read

Editor’s blog Friday 9 July 2010: Telegraphing the changes in the NHS White Paper

I laughed until I stopped.

Then I laughed some more.

The Daily Telegraph reaches new peaks of irony-mit-satire with its efforts to present the Green-tinged White Paper (which thanks to being bounced via the media, may now limp out at the back end of next week, rather than on their preferred date of Monday - UPDATE: or even on Monday - realpolitik moves fast) as a victory of sorts for Andrew Lansley and company.

Few will be fooled.

Where to start with the silliness?

To begin at the beginning, Dylanesquely - ladies and gentlemen, it's not just SHAs being flung into the dustbin of history; PCTs are to go as well - if the leaker in question is to be believed.

It's not what the revised Operating Framework, or the Coalition agreement or the Queen's Speech said, of course.

But when you are this deep in the mire, why worry about such details?

No - why worry about the fact that the Coalition agreement quite clearly states that:
• "We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.
• "The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations."

Who needs PCTs when there's a headline to be won?

The next chortle
See if you can spot any dissonance between the following phrases from this awesomely silly article:

"Under these plans, GPs — who are currently not responsible for paying for hospital referrals — would receive the money instead and pay the hospitals directly.

"The change will be compulsory.

"The Coalition hopes the new system will be less bureaucratic."


So. GPs don't do something as of now. The Coalition wants them to start doing this something, and it's compulsory. And the Coalition hopes it will be less bureaucratic. So they reckon: 1) GPs will start doing stuff for free ... and 2) handling the money for hospital care won't be bureaucratic.

I don't know what these people are smoking, but I would certainly like some.

Low-flying pigs alert!
Oooh dear. "GPs will also have to organise out-of-hours services, which may see family doctors offering 24-hour care once again". No, you really don't know many GPs, do you? I like the conditional use of "may", but it's purely substitution for "will certainly get the cheapest provider who is not them".

The realm of the silly
"The decision represents a victory for Andrew Lansley, the Health Secretary. He has been backed by David Cameron in his fight with the Treasury over his decision to give taxpayers’ cash directly to doctors."

Oh Jenny. Jenny, Jenny, Jenny.  Isn't this above your pay grade?

"It is understood that Mr Osborne has been assured by Mr Lansley that there will be safeguards in place to ensure GPs do not “waste” the money". Mmm. Yeah, 50 new intermediate health authorities will fix the accounting officer gig, eh? No more top-down reorganisations of the NHS ...

Oop! You've caught up, Jenny (well done) - "The move to scrap the 150 primary care trusts and strategic health authorities, which cover a range of NHS trusts and supervise local NHS services, will come as a shock to Conservative and Liberal Democrat MPs" - yes, but not as much as it will to the authors of the Coalition  agreement, the Queens Speech, and the revised Operating Framework ...

"The Coalition agreement explicitly vowed to “stop the top-down reorganisations of the NHS that have got in the way of patient care”."- couldn't have put it better myself.

"Rather than talking about scrapping trusts, the document explained the role they would continue to play." Yeeeesssss ...

"However, Mr Lansley will point to the commitment in the joint Tory-Lib Dem document which states: “We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf”."

Oh, well that gets you out of jail perfectly. Nobody will think - 'ah, they've panicked, screwed up what they took to the Treasury (let alone the Coalition committee) and now they need to make up a justification to abolish one bureaucracy in PCTs while creating another bureaucracy in the new, made-up-to-be-accountable-officers-even-though-they-won't-spend-the -actual-money health authorities'. No problemo!

"Mr Lansley hopes to have the changes in place by next April.". NYYYYYYYEEEEOOOOOOOWWWWWW! Blimey. The pigs are on an easterly wind take-off pattern tonight. Not normally that much engine noise.

"A new contract which makes GPs more accountable is likely to be part of the package of measures included in the white paper." NYYYYYYEEEEOOOOOOOOOOOOOW-BOOOOOOOOOOMMMMMMM! Jesus! That low-flying pig just hit the church steeple. I mean, you can just dictate a new contract to GPs like that, can't you? They'll take it very meekly.

"Responsibility will be handed to GPs working in local groups, who will commission services or provide them by working in rotas through co-ops. Mr Lansley believes that if GPs are responsible for their own budgets and have to commission out-of-hours care, most will decide to go back to offering weekend and evening cover themselves or in local groups." I'm laughed out. Mr Lansley's beliefs seem not to be quite au fait with people who have got very used to earning an average £110,000 a year for not doing out of hours and additional work like commissioning, which is not easy. I know Mr L's wife is a GP. So OK, there may be one who will do it.

"A senior government source told The Daily Telegraph last night that the Coalition’s attempt will succeed because of the political will behind it. The source said: “GP fund-holding was voluntary. This is going to be compulsory. This is pushing through the whole lot of policy that either Tory or Labour governments have tried in the NHS’s history but have never gone through with properly.” Oh dear, oh Lord. We are deploying "political will" as a clarion call now?

More to the point, there may be a reason why governments with large majorities in their own rights have not pushed this stuff through.

But of course, you would need to think about that.

"The reaction of GPs to the changes will be crucial if the Coalition is to avoid confrontation. Ministers will hope that they embrace the opportunity, but some are likely to oppose the moves." Have you met the British Medical Association? Justice Secretary and former health secretary Kenneth 'Chubby Tobacconist' Clarke described his current travails with the Police as easy by comparison.

In conclusion? This looks like a desperate punt from Lansley and co to try to get the White Paper back on track for next week - pushing it to be a fait accompli through the front cover of the Conservative Party's former house journal.

It's an attempt to bounce the White-Green-Blank Paper through, via the media.

It might work. Shabbier and sillier tricks have done.

But it might fail, too. In which case, Mr Lansley's long, six-and-a-half-year shadowing of the role of Health Secretary may not have the happy ending of casting a long shadow - but rather, a very short-lived one indeed.