Command and Control

January 21st, 2011
It was interesting that Michael Gove made his impassioned criticism of the current national curriculum in the same week that the new national health bill was released. Gove’s traditionalist rant seemed to be based on his perception that young people do not get taught enough facts, they don’t know enough about history.

On the same day  the Government released the Bill which will fundamentally change the way that the NHS works, possibly forever.

Since the Government made their plans public in July of last year I have seen a wide variety of theories on why this is happening. I work in the NHS so this isn’t overly surprising, we all have a theory. They range from the attempt to privatise the NHS through to an ideological experiment to create an untested model of health services.

I don’t really subscribe to the former. The NHS is and has always been reliant on the private sector to deliver services. GPs are independent contractors and whilst we rely on their philanthropic motives, they are not that different from BUPA or any of the other players we imagine will enter the market.

Anyone who watched GPs take the Government to the cleaners in contract negotiations a few years ago will be fully aware of their keen sense of market forces.

There will be a greater involvement of the private sector in providing health care but I think that is more as a result of the  Labour initiative of independent treatment centres rather than proposed legislation.

I do have some sympathy with the ideological experiment theory, but in thinking about history I realised this is far from untested. Michael Gove wants us to learn lessons from history and I think there is a very important one that the NHS needs to consider as it goes into rapid change.

Far from being aligned with a rampant free market the Conservative Bill actually is replication of the Soviet model of collectivisation. The theory of collectivisation came from Stalin who perceived there was a benefit in taking small free holders and combining them, often by force into larger collectives.

In Primary Care, in the UK, we are taking independent traders, GPs, combining them, through legislation, into larger arms length Government bodies. In some cases against their will but thankfully without the genocide involved in collectivisation.

One of the consequences of collectivisation in the Soviet Union was the removal of the local flexibility to grow food that was needed. In a similar manner the decisions to commission local health services will now be dictated by a central Government body called the NHS Commissioning Board. GPs will be free to implement commissioning any way they want as long as it is consistent with the central dictat.

This move to command and control is further emphasised by the move to remove regional representation of things like the Health Protection Agency and replace them with a monolithic single Public Health Department.

The history of the NHS has always had GPs sitting outside and passing comment on the Government of the day. In many cases this was useful because they could champion the cause of patients over the frivolity of policy. These changes will see GPs, for the first time since the creation of the NHS forced to follow the party line.

I’m intrigued that the Conservatives would seek to implement something modelled on the very worst excesses of Communism but am all the more impressed that they seem to have convinced people it is just the will of the market.

Posted in Politics | Comments (1)

One Response to “Command and Control”

  1. Daz Wright’s Blog » Blog Archive » Love it or Hate it Says:

    […] organised a  consultation event relating to the recent Government White Paper on Public Health, I gave my somewhat flippant views on that a few weeks ago. I won’t bother […]

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