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Editor's blog Tuesday 16 November: When the going gets weird, the weird turn pro

"When the going gets weird, the weird turn pro" was one of the greatest lines by one of the late twentieth century's most original journalists: Dr Hunter S Thompson.

Rarely has it seemed more aposite than of late, looking at health policy.

You have heard of the theory that life imitates art?

In the realm of public policy, the generally-accepted theory is that life imitates a particularly far-out episode of Yes, Minister.

The Guardian's Felicity Lawrence reported on Friday that McDonalds and Pepsi are being invited to help in the formulation of public health policy for the forthcoming consultation document.

No, it was not April 1st.

Lawrence unpacked matters further with another piece on a pre-election Lansley policy meeting at Unilever HQ, which would explain the meeting Andrew Lansley had with Unilever staff in July 2010.

Satire has its limits, as Tom Lehrer reportedly remarked of the genre in the aftermath of Henry Kissinger's receipt of the Nobel Peace Prize.

It is impossible to know whether there is any meaningful commentary to be made about this decision. The fundamental concept that the solution to obesity lies with the retailers of lard is a cute one, but its practical relevance is oblique.

But never mind! We have redundanices to focus our minds; 27,000 of the things, according to the RCN.

The report describes, "large-scale vacancy freezes, delays in recruitment, and the inappropriate replacement of nurses with unregistered staff. These ‘stealth cuts’ threaten the quality of patient care, the safety of hospital environments, and the very future of the health service.

"As the report outlines, we have also been sent more than 1,200 examples of waste in the NHS. From the thousands of pounds spent on unused facilities to inefficient systems that hinder nurses instead of helping them, it is clear that the NHS is wasting huge amounts of money

"A total of 17,932 posts are earmarked to be lost over the next four years across NHS England – a dramatic rise from the figures for April (5,600) and July (9,973).
These posts include nurses, midwives, health care assistants, support clinical staff, doctors, medical consultants, allied health professionals, administrative, clerical, estate and housekeeping staff.

"But these totals do NOT include the potential jobs losses resulting from a 45 per cent reduction in management (3) and the abolition of strategic health authorities (SHAs) and primary care trusts (PCTs) by 2013".

So - are we surprised?

No, probably not. The Chartered Institute of Personnel and Development, in association with management consultancy KPMG, has suggested that public sector de-recruitment is already under way broadly, sugesting that 40% of public sector employers have begun to cut posts.

This, however, has not deterred the brave souls in the Department of Health from planning, according to Charlotte Santry in Health Service Journal, to redeploy secondary care commissioning staff from the existing  PCTs (prior to Liberatin' Lansley's brought-forward early closures, ignoring the advice of NHS CE Sir David Nicholson).

This wannabe"universal" reassignment will be quite interesting. I would have thought it tricky for GP commissioning consortia - organisations that do not yet legally exist (and will not exist at the beginning of next year; the time-frame that Sir Neil McKay states) - to employ people when they are not legal entities, and so cannot issue employment contracts.

But I'm probably missing the obvious, somehow.

Today's BBC Radio 4 Today programme featured a thoughtful piece from Sarah Montague looking at some of the issues. In a response interview, Liberatin' Lansley denied that his reforms are risky, claiming instead that the real risk would be that of no reform.

Lansley told Montague that the White Paper proposals on NHS structural reorganisation were "not a surprise", citing Tony Blair as the reason to make swift change.

Oh Lord, hear our prayer.

The Liberator also sketched out some accountability scenarios, parts of which which were simply wrong - particularly that now, today, he has no responsibility for what is decided in PCTs.

Tell that to your accountable officers who are PCT CE's, Andrew. Read their employment contracts: accountability is clear as day. What you're laying out is as clear as mud.

Which wasn't what the majority of policy experts speaking today to the Commons health select committee were saying. Dr Jennifer Dixon of the Nuffield Trust put it conscisely that the White Paper's proposals are simply "too risky, too much, too soon". She also suggested that as outlined, patient choice "is not going to be a major lever for efficiency or effectiveness".

New RCGP chair Dr Clare Gerada revealed to Pulse that she has quite a different attitude to her predecessor Steve Field, calling the White Paper's goals "well meaning but misguided" and laying out clear opposition to the plans to neuter NICE and change the registered list (allowing patients to choose their GP). She also put down a wishful marker against consortia taking on inherited PCT debt.

It's all starting to simmer quite nicely.