My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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A final post (for now) on central state power, doctors and the NHS.

Filed Under (GPs, Health Policy) by Paul on 25-04-2012

I will come back to this later on in the summer, but I just want to raise an issue that really puzzles me about some of the supporters who work in the NHS, and who also support a centralised, Whitehall run NHS.

Many of the people who support this form of organisation look a bit rebellious to me. Looking at the things they say on their blogs and on Twitter they don’t strike me as people who like doing what they are told to by the state – or anyone else.

Let me say that, on a personal level, I have nothing but sympathy with that stance. I don’t like the state or anyone else telling me what to do. Which leads me to question whether that is the sort of thing the state should do.

Many of the people in debate with me about this are doctors, and they seem to fight tooth and nail against being told what to do by the state. Their personal and professional lives are very successfully based upon the expectation that the state should not tell medical staff what to do.

If they are GPs they fight for a form of organisation of primary care which precisely does not have a central state telling them what to do, or how to practice. They believe in as much professional autonomy for themselves as possible and they will fight hard and long to maintain that.

But they also want a strong, centrally run NHS.

They certainly don’t want to be told how to practice. So I am left with the sneaking suspicion that they want a strong centrally run NHS to tell everyone but them what to do.

They don’t want an NHS of fragmented organisations, but they do want an NHS of very, very fragmented professional autonomy.

So they want David Nicholson to tell local NHS organisations what to do. But they don’t want those organisations to tell them what to do.

Comments:

4 Responses to “A final post (for now) on central state power, doctors and the NHS.”


  1. Paul – that is a bit disingenuous. Doctors who have spent years learning their trade don’t and won’t be told how they should practise it by politicians who have spent years learning the skills of quite a different trade. I say this with great confidence even though I do not belong to either.

    I thought the original model was simply the government raised the money and paid the nurses, doctors, surgeons and the support staff. They all got on with their jobs.

    The nearer we are to that model, the better. The farther we drift, steer or reform ourselves from it, the worse it performs and the more it costs.


  2. Dear Eddy
    The point is not that most doctors want to be left alone to practice. Of course they do. What is odd is that some of those doctors, over much of the last few months have been strongly arguing in favour of a centralised NHS. My point is that they seem to want a centralised NHS to tell everyone else but them what to do.
    Paul


  3. OK – who do you (or they) mean by everybody else? Nurses? Surgeons? Is it cleaners? Or is it those dreaded ‘Managers’ responsible for some of the outrageous treatment whistleblowers get?

    Or do they want what I would call “joined up leadership” from the NHS to ensure patients see a joined up service?

    And would you have an issue with that?


  4. Doctors have always sought/expected autonomy and authority e.g. being in charge of multi disciplinary teams. One of the best learning experiences for my doctor husband, from my perspective, was being a patient in a large hospital ward. very disconcerting to be the controlled not the controller. As for state v regional control, isn’t change most threatening for those who fear a loss of personal control? Listen to any conversation anywhere about anything and criticism and blame will feature. Doctors have been blaming the generally faceless state for years, might it be more difficult to vent ire on a regional service whose members may be known individuals? The government proposals as I understand them, which is not well,and leaving aside potential for greater efficiency, appear to be a recipe for tribal warfare. Interesting times.

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