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)