‘Imagine - under the Tories, we are going to have new NHS organisations called foundation trusts, a tariff payment process, a choose and book system, a quality and outcomes framework for paying GPs and a formula that channels NHS funds to poorer areas’

To: Don Wise

From: Paul Servant, assistant chief executive

RE: Manifest nonsense

I felt sure I had put aside enough time to read the Conservative health manifesto. A whole half hour of private toilet time, but it was all over in five minutes. Luckily, I had the operating framework for 2010-11 to hand to keep me enthralled for the rest of the time. Needless to say, neither document left the privy.

So what was new in the Tory plans? Well… they are going to set everyone free and make them foundation trusts; focus on health results that matter (which ones don’t?); enable patients to rate hospitals and choose provider; implement “payment for results”; link GP pay to quality; end mixed sex wards to control infection (hmm - not sure which infections they’ve got in mind); reform NHS Direct and introduce a single number for all urgent care (err… that would be the NHS Direct single number); and fund councils to do public health (after their huge success in social care).

So that’s all really, really new and revolutionary. Imagine - under the Tories, we are going to have new NHS organisations called foundation trusts, a tariff payment process, a choose and book system, a quality and outcomes framework for paying GPs and a formula that channels NHS funds to poorer areas. I won’t recognise the service in 12 months.

I’m afraid that you and I won’t be around to frolic in this radically different NHS because we will part of the layers of bureaucracy and bureaucratic checks that will be replaced by nurses and doctors answering to patients.

Can anyone spot the incy-wincy flaw in that? Doctors and nurses will have to comply with Monitor and Care Quality Commission regimes, respond to Department of Health enquiries and parliamentary questions, organise contracts, negotiate with suppliers, handle complaints, hire and fire and stand up in public and be accountable.

It’s almost worth losing my job to watch that happen.