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Nicholas Hancock

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Copyright  ©  2008 Nicholas Hancock.  Permission  is granted  to  distribute  in  any  medium, commercial or non-commercial, provided author attribution and copyright notices remain intact.



Long before the concrete of history is dry, thereís never a shortage of people eager to stand on it in order to leave their mark. Such a person is fifty-eight-year-old Patricia Hewitt, Secretary of State for Health from May 2005 and former pupil of the Canberra Grammar School for Girls. Her smile, no doubt a defence mechanism, is contagious Ė like Spanish flu or the bubonic plague, for example.

[M]eet it is I set it down,
That one may smile, and smile, and be a villain;
At least Iím sure it may be so in Britain¹

     Does the reader detect traces of venom Ė say, of paraquat or strychnine or even of ratsbane? Yes, I admit that my bodyís awash with poisons. My local hospitalís been obliged to close its toxicology department, so I can do nothing about it.

     Letís return to our Secretary of State. She emigrated from Australia to the United Kingdom in the 60s, studying English literature at Newnham College, Cambridge Ė surely an ideal preparation for the root and branch reformation of a health service; from there she went on to Nuffield College, Oxford, where she obtained two masterís degrees.²

 After leaving university she worked for Age Concern and Liberty and was subsequently Neil Kinnockís press and broadcasting officer from 1983 to 1989. During the following eight years she worked in two think tanks before being elected in 1997 to Leicester West. Married, Ms Hewitt has two children and a burning ambition to leave her imprint on the NHS.

     Despite our Harold Shipmans, our Bristols and our adequate share of incompetent or skiving doctors, the NHS has struggled since its inception in 1948 to provide us with a by and large reliable, caring service that has endeared it to Britons of all political shades. Half a century later this heroic shambles of a system let out a warning death rattle when Alan Milburn, Secretary of State at one remove from Patricia Hewitt, made a speech in the Commons thatís now referred to as Shifting the Balance of Power:

Today I want to argue this shift can only happen if the centre of gravity within the health service itself moves from Whitehall to the NHS frontline.


The NHS today stands at a crossroads. After decades of neglect the NHS is finally getting the investment it needs.

[. . .] the time has come to liberate the NHS frontline.

To expand staff numbers and to value staff more [. . .]

To realise the immense potential of our million,
brilliant staff.

And above all else, now to shift the balance of power
from Whitehall to the NHS frontline.

     In 2002, as a direct consequence of the programme outlined in Milburnís speech, the Health Authorities were abolished and Primary Care Trusts or PCTs created by the incumbent Secretary of State; by the end of 2005 all patients were offered a choice of four to five hospitals as well as the time for their treatment. It all seemed as if heaven were descending on earth and that the NHS would truly be brought round. Not even the clinicians around the bedside knew that NOT TO BE RESUSCITATED had been written in her notes.

     First signs of approaching extinction came when the tariff for orthopaedic work wasnít set high enough to reimburse hospitals, some of which were forced to close these units: and if you take out one card the whole A & E pack tumbles to a floor contaminated with MSE.

     As politicians gathered round the corpse, PCTs were beginning to direct GPs to cut their hospital referrals by as much as 25% in order to achieve economies. Seven thousand job cuts have already been announced, and the figureís expected to climb to thirteen thousand Ė some say as high as twenty.
Already four thousand beds short and a further two thousand five hundred threatened with closure, ministers are bringing back old cottage hospitals from the brink of death to fill the bed need while sixty hospitals are on the point of closing their doors.
So this is shifting the balance of power? Milburnís rallying words echo through the months:

[. . .] the time has come to liberate the NHS frontline.
To expand staff numbers and to value staff more [. . .]
To realise the immense potential of our million, brilliant staff.

     Everywhere opinion hardens against this Alice in Wonderland expansion. Listen to Lib Dem John Hemming speaking in the debate of 20 March 2006:

We are caught up in a horrible administrative mess. The Prime Minister said that every time he reformed something, he wished later that he had gone a bit further. When everything in the health service settles down, we will look back and think, ĎNo, we did that a little too fast.í There is far too much change. The well organised managers who can add up are reeling with the pace of change, and we get more and more change.

or to Labour MP Paul Farelly in the same debate:

Even if eyes have been taken off the ballóamid all the change in my area, they certainly haveówhat is important now is that the response to tackle the deficits must not veer out of control.

   And is it out of control? When you consider our Prime Ministerís farsightedness is that of a stag beetle with 12-diopter myopia itís difficult to reach any other conclusion: the NHS has slipped over the edge and is at present hurtling to certain annihilation. Nothing triggers Blairís enthusiasm as much as an almost unanimous national opposition: you have only to think of Iraq and its disastrous consequences. He will destroy Bevanís legacy if it kills him and is adamantly certain that weíll thank him for it in the end.

¹Denmark in Shakespeareís original Hamlet, I, v, 107-109
²I cannot yet discover in which subject(s).