Everybody hates re-organisations in the NHS, don’t they? The public, people who work in the NHS and of course, the politicians – everyone is agreed that we should stop fiddling with structures and concentrate on performance. Hence the Conservatives going into the last election committed to there being no top-down re-organisation of the NHS and Labour making the same pledge at this election.
That’s clear then. Except that the Conservative-led government did, of course, introduce a re-organisation “so big you could see it from space” and Labour have also talked about the need for “fundamental changes” in the organisation of the NHS and even repealing the 2012 Health & Social Care Act (presumably a repeal that would be visible from space…).
So if everyone hates re-organisations so much, why do they keep happening?
The analogies that come to my mind are public health ones – most smokers want to give up smoking, but find it very difficult to do so, or the difficulty many people feel in resisting fatty foods. The NHS is so central to national life and the political dangers of failing it so great that every politician feels obliged to have a go at re-shaping it. Re-organisations are easier than improving performance and have the benefit of the smack of firm government. At least as far as Manchester is concerned, the NHS is undergoing a re-organisation as we speak.
The Lansley reforms started with the touchingly naive idea that running the NHS should be put beyond the reach of politicians. Whatever the merits of that idea – and personally, I think they are many – this was interpreted as an attempt by the Secretary of State to shirk his responsibilities for reporting to Parliament. The idea was binned. I don’t think we have heard a lot of politicians responding to questions in election debates by saying “I really think the answer to that should be left to NHS England…”.
The NHS was re-organised, is being re-organised and will be re-organised again. Seeking the views of frontline staff, who often have the clearest picture of what needs changing, doesn’t seem to be on anyone’s agenda. It is as difficult to see that changing as it is to see the next re-organisation making a real difference to performance or outcomes.