Stagecoaches
were the main means of long-distance travel before the advent of the railways.
Drawn by horses, each journey required regular stops to change the tired horses
for fresh ones. Travelling at slow speeds (4-7 mph), a lot of effort was
involved just to cover short distances. Indeed, it could take an entire day’s
journey to travel from Barton upon Humber to Boston; a long, arduous journey
without any meaningful change of scenery.
Last
week saw the Prime Minister change many of his horses in a mid-term re-shuffle
of the Cabinet. Amongst the ministers put out to grass was the former Secretary
of State for Health, the Rt Hon Andrew Lansley. Vaunted as the architect of the
Health & Social Care Act 2012, many would prefer to see him cast as a
demolition man rather than a designer; in this case, the destruction of the
National Health Service. Having spent almost nine years holding a health
portfolio (the first six in Opposition), it is astonishing that he so
spectacularly failed to understand that the National Health Service works
better as a functioning whole rather than as fragmented bits. After all, who in
their right mind buys a jig-saw puzzle ready made up, dismantles it into 1,000
pieces, and then stands back to admire the result?
That,
however, is what Andrew Lansley has managed to bring about after nine years of
studying the NHS. Albeit rickety and demanding high-maintenance, what was once
a functioning and coherent service is now lying in broken chunks scattered over
the landscape. The irony is that Aristotle understood the principle as far back
as the 3rd century BC, commenting that ‘The whole is better than the
sum of its parts’. Integrated health care is something clinicians have desired
for many years. Yet, the concept of co-ordinated, comprehensive and seamless
care has been laid to waste by a Secretary of State who was deluded into
thinking he understood the complexities of life at the forefront of health
care. For someone who holds a degree in politics, it is astonishing that he was
unable to assimilate the lessons of the past, and in particular the Porritt
Report of 1962 which stated ‘We have concluded that in future one
administrative unit should become the focal point for all the medical services
of an appropriate area’. That was what the now terminally-ill Primary Care
Trusts were for.
The
Prime Minister’s change of horses has produced Jeremy Hunt as the new Secretary
of State for Health. Hunt is on record as holding controversial views on health
care, which do not exactly encompass Aneurin Bevan’s vision of free-at-the-point-of-use
medical care for everyone. A failed exporter of marmalade, Hunt is clearly the
right person to pull the NHS on to its final stage of destruction.
The
only real hope of rescue is a change of government with the next election when,
as one senior NHS executive said to me recently, another major reform will be
needed to stitch the NHS back together again. Perhaps the French novelist,
Jean-Baptiste Karr had it right when he wrote ‘Plus ça change, plus c'est la
même chose’; the more it changes, the more it is the same thing. After all,
even after a long arduous journey, the Wash still looks a bit like the Humber.
(First
published in the Scunthorpe Telegraph,
Thursday 13th September 2012)
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