Monday, 7 July 2008

Chewing Darzi's cud

Not a pleasant thought I know, however I thought I'd deliver my general thoughts on Lord Darzi's NHS review. Given Darzi's background of providing the DoH with what they want to hear, only the ultra naive would have thought that Darzi's review contain something insightful and intelligent. Alas Darzi's review has arrived echoing many government cliches that we have been accustomed to enduring such as 'world class commissioning' and 'patient choice'.

The Darzi review is verbose but lacks detail in the few areas in which it has any promise. For example as regards the formation of a new 'independent' body that will oversee medical training called NHSMEE, one has to assume that the body will be genuinely' independent' for it to have any hope of working, given PMETB's similar 'independent' status one could forgive a few groans from the medical establishment. There is no attempt to address the problems that EWTD have created in training with Darzi appearing keen to fall back on more educationalist fodder in the form of 'modular credentialing'.

As regards Primary Care the review is just more privatisation dressed up in the same old lies. The Darzi 'GP-led' health centres have been railroaded through by the DH in very PCT independent of the local needs that Darzi pretends to care so much about. I suspect the disingenuous 'GP-led' nature of the them will mean that it will be rather hard to see a doctor in Darzi's New NHS. There is more emphasis in 'reinvigorating' commissioning and 'patient choice', again this is the government's way of handing out sweeties to its friends in big business while pretending to give a monkeys for the sick and elderly. Dr Crippen has aleady commented on this being rather lucrative for Branson and chums.

There are many other little chestnuts hidden in the many pages of DH propaganda and spin. NICE is presented as being the envy of every other country in the world, while the word 'clinician' is dishonestly re branded in Orwellian manner as meaning anyone who has every seen a patient in their lives. PBC is seen as an overwhelming success, while PCTs are set to be handed even more power to waste millions of our money on 'healthy living' schemes. There is also a lot of talk about more and more measurement of care quality, surely another surefire way to waste money on more bureaucracy and QUANGOs.

The question as to the nature of Darzi's motivation is posed by Dr Grumble, this report offers me little choice but to go for the 'tethered goat' option. The worst thing about Darzi's review is the pretence that it has been constructed in partnership with front line NHS clinicians, nothing could be further from the truth. Darzi's review represents yet another pretence at consultation by this dishonest regime, a pretence at listening and a pretence at responding to local needs. The only needs being represented by Darzi's review are those of the ruling political classes who see further developing a market in heath care as the best way for them to continue their privatisation campaign.

Darzi's review has been a sham from the start, the consultation process was beyond a joke while the reform started even before the interim report had been produced. The reforms will result in good GP practices closing while the sick have to travel further to see less trained staff for lower quality care. The continuation of these destructive reforms will see health inequalities worsen, more money wasted on bureaucracy and more money gifted to the cherry pickers from the private sector. There is no easy answer, we can either have a locally driven service with a postcode lottery or have a Soviet style top down disaster. The artificial state managed market in health care will only be good for the cherry picking private sector, it's about time it was scrapped, the chances of seeing this bulldozer being stopped are pretty slim though. I'd like to finish by summing up Darzi's review as being:

"Centrally driven by a politician for politicians against the interests of both doctors and patients"

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