Wednesday, 25 January 2012
Government By The Woodentops
With all the complicated debate going on about the National Health Service and the positions being taken up by the very large number of interest groups and lobbies I have been lost in the fog as far as personal thinking goes.
As someone who remembers life before the NHS and the period of transition from local/mutual/private provision into a “national” service it is not difficult to feel that more than once we have lost our way.
Patrick Dunleavy, however, has provided a longish, informed think piece on the latest round of proposed reorganisations, reshaping and refinancing. He is very pessimistic on the costs, organisation or lack of it and the potential for disaster in the future.
The NHS clearly cannot stay the same, clearly cannot be just a vehicle for those currently employed and yet has to deal each year with a large proportion of the population. Amongst the patients the patterns of disease and illness will not remain the same.
In her much quoted book "The March of Folly", the historian Barbara Tuchmann noted that:
“Wooden-headedness plays a remarkably large role in government. It consists in assessing a situation in terms of preconceived fixed notions while ignoring or rejecting any contrary signs. It is acting according to wish while not allowing oneself to be deflected by the facts.”
Given the rapidity of change, medical and technological let alone demographic, it is all too likely that in 2012, as in 1948 and 1974, we are embarking on a period of reform on the basis of ideas that already out of date.
And the money that was assumed would be available will not be and cannot be.