Perhaps we should look back to Charles Darwin’s theory of evolution to see who’ll survive in the dog-eat-dog world of health policy.

  • To: Don Wise
  • From: Paul Servant
  • Re: evolution

I have barely been able to keep pace with the monumental changes sweeping the NHS.

Almost every day there is a new announcement and I think Darwin himself would have to consider a new chapter to On the Origin of the Species to reassess the speed of evolution. He might have called it “re:evolution”.

I am considering writing a chronicle of this phenomenon called At the Margin of the Species. In it I intend to highlight how the reproductive efficiency of the amoeba and Sir David Nicholson have so much in common - they divide, duplicate and replicate. However, I think only when things are clearly spelt out will people really appreciate how much has changed.

In the “New NHS”: Sir David is in charge. Ian Dalton (surely a K is not far off now), Sir Ian Carruthers, Dame Ruth Carnall and Sir Ian MacKay are also in charge. Public health is not part of the NHS.

And now Lord Crisp, of Sub Sahara SHA, is back too, with a book out to remind us just how much better life was when he was in charge. To be fair he has a point.

But he also had a better boss back then. The NHS Plan was the fruit of a secretary of state who had three things going for him - loadsamoney, brutal determination and the huge relief that he wasn’t Frank Dobson. No wonder everyone signed on the dotted line.

It had also another rather important feature going for it. It was a plan to fix a problem. And by 2001 everyone agreed the NHS was a big problem and patients deserved better treatment.

Today we have a plan to fix a broken secretary of state, a big problem too, but perhaps one that could be fixed far more easily by perhaps letting this weak example of the species die out.

Darwin would have approved.