I am very fond of my regular GPs. But Dr A treats the NHS’s budget cautiously, as if it was his own life savings, while Dr B is usually quite happy to fork out on my behalf.
I love contrasting what they actually do on the front line with what the health secretary of the day is saying.
The other day I asked Doc B why I have been sneezing so much lately. Is it hay fever and, if so, is it old age, an unusual spring or worsening air quality? Out came the prescription pad. On behalf of Andrew Lansley, I protested, “No, we can’t afford that any more.” “You pay your taxes,” B replied and wrote the scrip anyway.
Naturally this exchange was in mind when I read Lansley’s first big speech as Mr NHS. It confirms him as something of a Tory Trotskyite: he really does believe in workers’ control by doctors and other health professionals, listening to patients - “the heart of everything we do” - and probably singing the Song of the Volga Boatmen in harmony as they do.
Admirable in its focus on a patient-centric world, Lansley’s call for an “information revolution” even anticipated by several days The Guardian’s exposé of the persistent NHS failure to collect meaningful performance data.
Alas, The Guardian analysis also highlighted the extra risks inherent in small hospitals, which Lansley’s rhetoric often seems bent on saving.
It is not the only point where the health secretary’s good intentions have helped him snooker himself.
I thought we were promised no further structural tinkering? But we seem to be facing the stripping down of primary care trusts in favour of 500 or so wholly GP consortia, full of chaps like cautious Dr A but also generous Dr B.
Sir Richard Sykes, newly resigned head of NHS London, broke his silence on the BBC this week to express scepticism about this, especially at a time of renewed austerity. Most GPs are not entrepreneurs: this will cost, he predicts.
There is also that new independent operating board - look at the army or the Bank of England to see how brilliant that will be - and elected councillors on the PCTs who (as HSJ’s sceptical leader noted last week) don’t expect to be ignored. Abolish strategic health authorities? Maybe that as well.
As former health secretary Andy Burnham said when I caught up with him, it looks like the biggest NHS reorganisation ever and it is hard to see how it all fits together.
“It seems an illogical mishmash of the two coalition manifestos,” he suggests.
In the Commons, Burnham supported his successor’s decision to hold a public inquiry over the Mid Staffs hospital disaster, as he promised (I was wrong on this point) before the election. But if Labour’s original terms of reference to Robert Francis QC had embraced the wider failure - the SHA, the regulator, the PCT - Francis II might not have been necessary, Lansley reminded MPs.
I remain sceptical that the revised legal basis, open testimony under oath with the power to compel reluctant witnesses, will make much difference - and point to the 1998-2010 Bloody Sunday inquiry melée this week.
But it is what ministers do in their idealistic phase. Look at Frank Dobson’s 1998 whistleblowers act which Lansley now plans to strengthen in the light of Mid Staffs’ “culture of fear and secrecy” where lonely whistles were blown but ignored.
You can see why a wider blame game is problematical: Sir Ian Kennedy headed the Healthcare Commission, Cynthia Bower, now heading the Care Quality Commission but then at the local SHA (as was Sir David Nicholson before her), Monitor’s Bill Moyes, all left fingerprints on this one.
Good luck, minister.