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The editorial on Leading Health Care in London and the King’s Fund Report to which it refers set out concisely the current issues in London. Sadly these are just one more episode in the wild problem of London’s hospitals over the past two centuries, set out in The Development of the London Hospital System, the second edition of which has just been published to bring the saga up to 2013. (www.londonhospitalsystem.co.uk)
What has clearly emerged is that the development and implementation the 2012 Act is as messy as the multiple schemes leading to the 1974 reorganisation, and beats 1974 hands down in terms of its unworkable complexity. The Grey Book could at least be understood. The more complex a system is, the more it is likely that something will go wrong. The new set-up is unstable, under stress and the cracks will show first in London. In the many overlapping bodies now setting up shop, there is an echo of the failed experiment in consensus management in 1974 when nothing happened unless everyone agreed.
We have lost NHS London, the only central board we have had in 200 years, and will end with coordinating bodies to coordinate each other. The description of the present confusion up as ‘a self-regulating eco-system’ ii is courteous but ‘savours of the calm of the academic cloister,’ in a phrase of the LCC’s great MOH Sir Frederick Menzies. iii For us to look to health promotion for our financial salvation, (we all die sometime), to the unsubstantiated hope that a lot of money can be saved by transferring care into the community or by mega mergers, is whistling in the dark. Kathleen Whitehorn’s law states that any economy campaign that does not increase expenditure must be considered successful. Totally integrated schemes such as Kaiser-Permanente or the VA probably are an alternative worth piloting,i though when I once suggested to Kenneth Clarke that, as a patient, I would like the choice of several integrated schemes, he said that was a bridge too far. Academic Health Science Centres are great but they were not designed to run the NHS.
So what should we do? Hold on tight and let things run, but be prepared to change in three years’ time as sadly we will have no option. By then the way forward will be clearer.
i BMJ 2013;347:f4711
ii Leading health care in London, Time for a radical response. Ham C et al. King’s Fund, June 2013
iii Rivett G C .The Development of the London Hospital System, 1823-2013. Print to order online at www.londonhospitalsystem.co.uk.
iv DHSS. Management arrangements for the reorganised NHS. London: HMSO, 1972.
Re: Leading healthcare in London: time for a radical response?
Sir
The editorial on Leading Health Care in London and the King’s Fund Report to which it refers set out concisely the current issues in London. Sadly these are just one more episode in the wild problem of London’s hospitals over the past two centuries, set out in The Development of the London Hospital System, the second edition of which has just been published to bring the saga up to 2013. (www.londonhospitalsystem.co.uk)
What has clearly emerged is that the development and implementation the 2012 Act is as messy as the multiple schemes leading to the 1974 reorganisation, and beats 1974 hands down in terms of its unworkable complexity. The Grey Book could at least be understood. The more complex a system is, the more it is likely that something will go wrong. The new set-up is unstable, under stress and the cracks will show first in London. In the many overlapping bodies now setting up shop, there is an echo of the failed experiment in consensus management in 1974 when nothing happened unless everyone agreed.
We have lost NHS London, the only central board we have had in 200 years, and will end with coordinating bodies to coordinate each other. The description of the present confusion up as ‘a self-regulating eco-system’ ii is courteous but ‘savours of the calm of the academic cloister,’ in a phrase of the LCC’s great MOH Sir Frederick Menzies. iii For us to look to health promotion for our financial salvation, (we all die sometime), to the unsubstantiated hope that a lot of money can be saved by transferring care into the community or by mega mergers, is whistling in the dark. Kathleen Whitehorn’s law states that any economy campaign that does not increase expenditure must be considered successful. Totally integrated schemes such as Kaiser-Permanente or the VA probably are an alternative worth piloting,i though when I once suggested to Kenneth Clarke that, as a patient, I would like the choice of several integrated schemes, he said that was a bridge too far. Academic Health Science Centres are great but they were not designed to run the NHS.
So what should we do? Hold on tight and let things run, but be prepared to change in three years’ time as sadly we will have no option. By then the way forward will be clearer.
i BMJ 2013;347:f4711
ii Leading health care in London, Time for a radical response. Ham C et al. King’s Fund, June 2013
iii Rivett G C .The Development of the London Hospital System, 1823-2013. Print to order online at www.londonhospitalsystem.co.uk.
iv DHSS. Management arrangements for the reorganised NHS. London: HMSO, 1972.
Competing interests: No competing interests