Events at the National Blood Authority last week carry a far-reaching symbolic significance. Health secretary Frank Dobson's very public dismissal of NBA chair Sir Colin Walker is destined to form a memorable milestone on the long trek from the Conservatives' market-based NHS to New Labour's so-called 'modern, dependable' one.
As the man who controversially oversaw the introduction of competition into a blood service which had been largely unchanged for 50 years, Sir Colin had become a rather conspicuous dinosaur in an NHS where collaboration is now the watchword. Even the Tory health spokesman, Patrick Nicholls, welcomed his dismissal. That Sir Colin apparently could not see this - he responded to Mr Dobson's requests for his resignation with letters from his solicitors - reinforces the criticisms in Professor John Cash's review of the NBA's performance.
In a damning report, Professor Cash says Sir Colin had misunderstood briefings or else had been misinformed. Evidence pointed overwhelmingly to the conclusion that the NBA 'was failing to maintain appropriate operational connections with many of its management teams'. This evidence, and other concerns described in the report, are hardly startling discoveries newly unearthed during the course of Professor Cash's inquiries. The Journal - one of the first to air misgivings about the impact of the internal market on the blood service - was writing about them as long ago as 1994. But the NBA's typical response to media criticism was to issue press releases asserting ever greater improvements in its service. It did just this last year, claiming a better quality service in Oxford and Cambridge where Professor Cash subsequently found serious problems.
Alas, this easy relationship with the facts characterised much PR work at the height of the NHS internal market. Indeed, the NBA's shortcomings reflect many of the iniquities to afflict the NHS during the 1990s. Consider these phrases from Professor Cash's report: headquarters was isolated to a disturbing degree from operational realities; instructions were inappropriately researched and not subject to effective consultation; a central management structure and command-and-control culture had insufficient regard for the views of staff and customers, as well as for the interface between patients and the service. Sounds familiar? The Cash report's lessons need to be applied more widely than simply within the blood service.