The British Medical Journal is running an editorial this about NHS reform, called “Dr Lansley’s Monster”.

It is accompanied by a picture of Frankenstein’s laboratory.

Here are some passsages:

What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.

The scale of ambition should ring alarm bells. Sir David Nicholson, the NHS chief executive, has described the proposals as the biggest change management programme in the world—the only one so large “that you can actually see it from space.” (More ominously, he added that one of the lessons of change management is that “most big change management systems fail.”)

Of the annual 4% efficiency savings expected of the NHS over the next four years, the Commons health select committee said, “The scale of this is without precedent in NHS history; and there is no known example of such a feat being achieved by any other healthcare system in the world.” To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded.

Like all the other structural reorganisations of the NHS, this one aims to improve health outcomes. What’s lacking is any coherent account of how these particular reforms will produce the desired effects, a point only underlined by the prime minister’s attempts to justify the reforms earlier this week.

On GP commissioning:

Whatever the eventual outcome, such radical reorganisations adversely affect service performance. As Kieran Walshe wrote, they are “a huge distraction from the real mission of the NHS—to deliver and improve the quality of healthcare” that can absorb a massive amount of managerial and clinical time and effort. Even the earliest days of the transition have proved disruptive, with employees of the doomed primary care trusts and strategic health authorities choosing to jump ship rather than to go down with it.

With an estimated one billion pounds of redundancy money in their pockets, many of the survivors are likely to be employed by the new GP consortiums in much their same roles. It raises the question: if GP commissioning turns out to be simply primary care trust commissioning done by GPs, aren’t there less disruptive routes to this destination?

It ends:

Given their scale, securing these efficiency savings should take priority over the massive upheaval proposed in the new bill. For the time being, we agree with the King’s Fund that those GPs who are successfully involved in practice based commissioning should be given real rather than indicative budgets for some services and their performance monitored closely.

All other proposals should be kept on hold, pending an evaluation of whether this iteration of GP commissioning can bear the responsibility that the new bill seeks to place on it. If it turns out that it can, then the full introduction of the government’s ambitious health reforms will have been delayed a few years. If it can’t, then the country—and its government—will have got off lightly.

When what is essentially the official mouthpiece for British doctors is expressing this kind of alarm at government policy, it indicates that a dispositionally conservative body is very out of step with the present administration.

Which reinforces a point I’ve already made: that this is a government of radicals, led by some most unconservative Conservatives.
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Hat-tip to Stuart White

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1. Liberal Conspiracy

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