Published: 06/12/2001, Volume III, No. 5784 Page 19
The NHS has been called a few things in its 50-odd years - not all of them flattering - but the last week must take the prize for sustained attempts to talk down the service.
Just as the government has reassured us all that it is determined to hang on to a taxfunded NHS free at the point of delivery, media, think-tanks and politicians seem hellbent on telling us just how dreadful it is.
Right-wing Politiea describes the NHS as a Dickensian system that has never worked, and shadow chancellor Michael Howard tells us it is a Stalinist organisation. To the health secretary, it is an outdated monolithic monster - albeit one that is changing.
For a government renowned for spin, the inability of Messrs Blair, Brown and Milburn and their teams to talk up the NHS in the face of mounting attacks - or even to appear to have a clue about what they want to do with it - is startling.
Having agreed, following the publication of Derek Wanless's interim report, that they would like to generate a debate in the media and across the country at large about the future of the NHS, the prime minister, chancellor and health secretary have allowed all those opposed to the continued existence of the NHS in its current form to set the agenda.
The government appears to be constantly on the back foot when it comes to criticism of the health service and its own policy development.
One senior minister after another assures the public that more money for healthcare will in future be tied to reform - those running the NHS are not going to 'have it easy' any more; they will have to meet targets and listen to patients.
And while managers wonder exactly what it is they have been engaged in since Labour came to power and recall that the NHS plan addressed precisely this issue - the relationship between performance and funding - the media 'reveals' that Downing Street has ordered a top-level inquiry into the management of the NHS.
Since Adair Turner's review began a couple of months ago (and was reported in HSJ on 11 October), it could be assumed that this is yet another announcement that had been made before but which officials have decided to make again, just to be on the safe side. Or we could be tempted to conclude that this is further evidence - if any were needed - that some sections of government do not know what other parts are up to.
By allowing the public to believe that yet another inquiry into NHS 'failures' is under way and that tough-talking ministers are demanding more from 'fat-cat' managers, the government is indicating that it has little confidence in those engaged in the daily slog of making patients - and the NHS - better.
And when the week's big announcement is that the private sector is being called on to 'bail out' the NHS by providing the first new treatment and diagnostic centre, it is time to ask why there seem to be no support or encouragement for the efforts of those working in the NHS (was it simply coincidence that this was announced on the public sector unions' day of action? ).
Managers and staff have been exhausted by the ever-increasing demands of reform, fed up with hearing that the organisation they work for is a mess, sick of being branded 'not good enough'.
Senior managers and clinicians are being driven out of the NHS at an alarming rate. Week after week, HSJ reports the departure of chief executives, board members and chairs who have been deemed not up to the job - undoubtedly there are more to come.
This month Pamela Charlwood, a dynamic, successful and charismatic leader, walks away from the NHS after 27 years' service with as much relief as sadness, a victim of the reforms NHS staff apparently need more of.
Unless politicians start briefing for rather than against it, there may not be much left of the NHS to save.