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Clamour for NHS autonomy grows

6th June 2007

29092006_voting1.jpgHave you ever had the experience that there's an opinion shared by lots of people but because it's considered outlandish, or insurrectionist, or just plain bad politics, no one says anything?

Until one day someone decides to step up and speak the unspeakable and suddenly it becomes clear that everyone has been thinking the same thing all the time but no one has wanted to put their head above the parapet.

Last week the "influential" Nuffield Trust called for an autonomous NHS free from day-to-day political control. Is it just coincidence that this comes just a week or so after the BMA called for exactly the same thing? And was it a coincidence that the BMA's announcement came about a week after a leading group of academics reached the same conclusion?

The thing that puzzles me is why the government would want to hang onto the management of the NHS? It's not as if they get any credit when the service improves (which, in terms of waiting times at least, it undoubtedly has over the last decade). But they do stand in the firing line every time something goes wrong and seem so often to reach their own stock conclusion that the answer to the NHS's difficulties is wholesale reorganisation.

So far this has achieved very little except instability and low morale - with the end result that we have gone round in a big circle and arrived back where we started. The commissioning command structure of SHAs and PCTs today is very similar to the Regional Office and District Health Authority structure of ten years ago.

The government response to the calls for greater NHS autonomy might be viewed by some to be quite patronising. Paraphrasing, they have simply stated that the NHS is not yet fit enough to manage itself and needs the government to oversee it. But that perhaps misses the point. What all these eminent institutions are saying - paraphrasing again - is that the government is not capable of managing the NHS and needs to let someone more competent do it.

So who is right? Well I know what I think....

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