"To clarify, one SHA is equivalent to five PCTs in terms of population, and five PCTs are equivalent to one ICB. By performing some basic calculations and cancelling out the common factor, we can conclude that 1 SHA is equal to 1 ICB.
However, because in the interim, 1 CCG equated to 1.5 PCTs, no one noticed that the reconfiguration of services from SHA to PCT, then to CCG, and finally to ICB ultimately resulted in a return to the original position, with the addition of numerous managers and substantial extra costs. All clear?"
No. Not clear at all. Reminds me of the Register's units of measurement (handy converter here! https://www.theregister.com/Design/page/reg-standards-converter.html). Except that those are _funny_. Funnily enough, "NHS Budget" is one of their units of measurement of money!
It's making my head spin. Which is, no doubt, precisely the intention.
We need an evidence base for the strong hypothesis that, actually, there _is_ one group of NHS users who are utterly satisfied - nay, delighted - with the NHS? _Management consultants_.
I'm old enough to remember the 1980's and Regional HAs, Areas, Districts and Units (the Units might cover e.g. Mental health or a small group of Acute hospitals. Primary care services were the remit of a different body.
Thatcher largely replaced this four tier cumbersome arrangement with new unitary Commissioning Boards and Health Trusts - a misnomer if ever there was one - as why would anyone trust an NHS Trust that was designed to compete for business with other neighbouring Trusts in a totally gratuitous 'Pretendy' Internal Market?
Oh God, you've triggered me. Now I remember those times when "marketising" everything - perhaps even your relationships with your children - was The Solution. Those were the days!
Cost Centres. Internal Markets within companies. HR could compete with IT for building maintenance, Customer Services could compete with Marketing for toilet-cleaning! Thanks to all that, we are living in the best of all possible worlds, and all is for the best in it. We just haven't noticed.
(Though LNER still "competes" with Scotrail, whichever version of BR is running West Coast this month, Cross-Country and GWR to get you from Newcastle to London. You have the choice! Direct Newcastle-Kings Cross, or via Edinburgh, Glasgow, Carlisle, Birmingham and Reading. Fabulous!)
But it's really helpful to remember that Thatcherite bullshit. Because the interesting thing - in retrospect - is not that it was Thatcherite, but that it was _bullshit_. But it was bullshit _everyone_ adopted as if it was absolute truth.
The Universal Solvent. Reduces all elements (by extension, all human problems) to a base, fluid, fungible state, out of which the alchemist can produce anything, perhaps the ultimate good: but without losing the essence of what was originally there. Wow. I want it. Now!
This "market" nonsense - which had nothing to do with the limited, but completely sound (within their limits) ideas of free-market theory - was an Alkahest. It's gone (well, mostly) - thank God. But there are new Alkahests today. So many!
What's the difference? Well, I believe that the alchemists - well, the best ones - were sincere in hoping - and trying their hardest - to find the Alkahest. Isaac Newton was an alchemist, in his "private mix-tapes" as it were; and Paracelsus and Agrippa were very sharp thinkers. But they were private thinkers (by necessity: no-one likes having their books - or possibly their person - chucked on a fire).
But now the politico-scientific world is a gigantic, public pageant of Alkahests. Solutions! Universal Solutions! Simple Solutions! Because Science! If Only... there actually was one...
Your remembrance of the Thatcherite Alkahest is very helpful, because that ridiculous frenzy is far enough in the past for us to see its shape clearly. It's much harder to delineate the shape of the present Alkahests, because we're all living to some extent inside them - though the tireless work of the old geezers exposes the absurd pretensions of some of them. Modelling. "AI". Citation-recycling (hey, very climate-friendly!) as a route to truth. Surrogate end-points. "Disease? Vaccine!"
What I love about the people on the cusp of alchemy and science is that they got right down and dirty into the _matter_, trying to find the harmony of God there but realising that matter just _does not behave_. Matter (even more, people) is rebarbative to universal law, but it's what we're faced with, and you can wrestle some tentative predictions out of it. They learned, centuries ago, that there is no Alkahest, not even an intellectual Alkahest apart from the extensible intellect itself, which is an Alkahest only asymptotically.
Spinoza had it figured it out, Leibniz (the Monadology Leibniz, rather than the Theodicy Leibniz) had it figured out. 300 years later, the world is full of self-important dicks who want us to believe that forgetting the enormous intellectual effort which turned alchemy into science is _progress_. Alchemists, without the good alchemists' eager curiosity, or the cool robes.
A rant. Apologies. I just think you hit on something, and wanted to expand on it.
My Board Chairwoman in those early 1990's days as a Health Board Strategic planning manager in my 30's was a Thatcherite Appointee Hardcore Tory Bitchista in her fifties - (these days she would probably have an OnlyFans channel as a dominatrix -) and I think she fancied getting into my pants. It was like a sleazy out-take from Mrs Robinson and Dustin Hoffman. Fat chance! I have no idea what qualifications she had apart from being married to a Tory MP or some other high head yin donor.
She wetted her knickers one night over a wee dram in some fancy golf hotel whisky bar expressing her lust for selling all my bright ideas - to the rest of the NHS - as 'Intellectual Capital". I mean she was a capitalist drunk and off her trolley: for decades we NHS Managers shared all our ideas for free - I used to write articles in the journals like the HSJ without even getting a penny piece in payment - just because that was the ethos of the day. We just shared useful stuff - that was our mission and how we worked.
Looks like that's the point of the exercise: doing the same for the same number of people under a new name - but needing more money for more people to administer it: success, innit - if one's a bureaucrat. After all, somehow the relationship between 'frontline medical staff (i.e. doctors, nurses and the like) and the clipboard wielders must be increased, e.g.1 part medical frontline, two parts admin ...
Three ICBs combining will take us back to the Regional Health Authorities eg North West RHA from the southern border of Cheshire to the Scottish Border on the west of the Pennines. I'm convinced that's where we are going because ICBs have had their running costs decimated (50% cut if memory serves) the only way to deal with that is to move to a strategic level and leave-hands on to others. Don't think we need the 10 year plan - we can see where its going now!
Can we go back to the structure with the DHAs before the Internal Market was introduced? A fascinating analysis would be a detailed check of the aims, outcomes and costs of each reorganization. I read work by Colin Leys and Allyson Pollock many years ago on this. The increasing bureaucracy seems more concerned with covering up mistakes rather than introducing systems to minimise them as Portsmouth surgeon Peter Brennan advocates.
The NHS has become its own propoganda machine. Drinking its own paid for coolaid. Current model entirely unfit for purpose. Author mentioned Red Army the other is Indian State Railway employing 1million plus acolytes. Patient centric it isn't and inefficient it is! Wasteful and highly political.
actually I think I know what the answer is to all these problems: appoint more managers and ensure much more micromanagement; that was surely turn everything around quickly?
Talk about rearranging the deck chairs on the Titanic.
"To clarify, one SHA is equivalent to five PCTs in terms of population, and five PCTs are equivalent to one ICB. By performing some basic calculations and cancelling out the common factor, we can conclude that 1 SHA is equal to 1 ICB.
However, because in the interim, 1 CCG equated to 1.5 PCTs, no one noticed that the reconfiguration of services from SHA to PCT, then to CCG, and finally to ICB ultimately resulted in a return to the original position, with the addition of numerous managers and substantial extra costs. All clear?"
No. Not clear at all. Reminds me of the Register's units of measurement (handy converter here! https://www.theregister.com/Design/page/reg-standards-converter.html). Except that those are _funny_. Funnily enough, "NHS Budget" is one of their units of measurement of money!
It's making my head spin. Which is, no doubt, precisely the intention.
We need an evidence base for the strong hypothesis that, actually, there _is_ one group of NHS users who are utterly satisfied - nay, delighted - with the NHS? _Management consultants_.
I'm old enough to remember the 1980's and Regional HAs, Areas, Districts and Units (the Units might cover e.g. Mental health or a small group of Acute hospitals. Primary care services were the remit of a different body.
Thatcher largely replaced this four tier cumbersome arrangement with new unitary Commissioning Boards and Health Trusts - a misnomer if ever there was one - as why would anyone trust an NHS Trust that was designed to compete for business with other neighbouring Trusts in a totally gratuitous 'Pretendy' Internal Market?
Oh God, you've triggered me. Now I remember those times when "marketising" everything - perhaps even your relationships with your children - was The Solution. Those were the days!
Cost Centres. Internal Markets within companies. HR could compete with IT for building maintenance, Customer Services could compete with Marketing for toilet-cleaning! Thanks to all that, we are living in the best of all possible worlds, and all is for the best in it. We just haven't noticed.
(Though LNER still "competes" with Scotrail, whichever version of BR is running West Coast this month, Cross-Country and GWR to get you from Newcastle to London. You have the choice! Direct Newcastle-Kings Cross, or via Edinburgh, Glasgow, Carlisle, Birmingham and Reading. Fabulous!)
But it's really helpful to remember that Thatcherite bullshit. Because the interesting thing - in retrospect - is not that it was Thatcherite, but that it was _bullshit_. But it was bullshit _everyone_ adopted as if it was absolute truth.
There is a lovely word for this, especially for history-of-science geeks like me: the Alkahest. https://en.wikipedia.org/wiki/Alkahest.
The Universal Solvent. Reduces all elements (by extension, all human problems) to a base, fluid, fungible state, out of which the alchemist can produce anything, perhaps the ultimate good: but without losing the essence of what was originally there. Wow. I want it. Now!
This "market" nonsense - which had nothing to do with the limited, but completely sound (within their limits) ideas of free-market theory - was an Alkahest. It's gone (well, mostly) - thank God. But there are new Alkahests today. So many!
What's the difference? Well, I believe that the alchemists - well, the best ones - were sincere in hoping - and trying their hardest - to find the Alkahest. Isaac Newton was an alchemist, in his "private mix-tapes" as it were; and Paracelsus and Agrippa were very sharp thinkers. But they were private thinkers (by necessity: no-one likes having their books - or possibly their person - chucked on a fire).
But now the politico-scientific world is a gigantic, public pageant of Alkahests. Solutions! Universal Solutions! Simple Solutions! Because Science! If Only... there actually was one...
Your remembrance of the Thatcherite Alkahest is very helpful, because that ridiculous frenzy is far enough in the past for us to see its shape clearly. It's much harder to delineate the shape of the present Alkahests, because we're all living to some extent inside them - though the tireless work of the old geezers exposes the absurd pretensions of some of them. Modelling. "AI". Citation-recycling (hey, very climate-friendly!) as a route to truth. Surrogate end-points. "Disease? Vaccine!"
What I love about the people on the cusp of alchemy and science is that they got right down and dirty into the _matter_, trying to find the harmony of God there but realising that matter just _does not behave_. Matter (even more, people) is rebarbative to universal law, but it's what we're faced with, and you can wrestle some tentative predictions out of it. They learned, centuries ago, that there is no Alkahest, not even an intellectual Alkahest apart from the extensible intellect itself, which is an Alkahest only asymptotically.
Spinoza had it figured it out, Leibniz (the Monadology Leibniz, rather than the Theodicy Leibniz) had it figured out. 300 years later, the world is full of self-important dicks who want us to believe that forgetting the enormous intellectual effort which turned alchemy into science is _progress_. Alchemists, without the good alchemists' eager curiosity, or the cool robes.
A rant. Apologies. I just think you hit on something, and wanted to expand on it.
Oh, you fecking nailed it.
My Board Chairwoman in those early 1990's days as a Health Board Strategic planning manager in my 30's was a Thatcherite Appointee Hardcore Tory Bitchista in her fifties - (these days she would probably have an OnlyFans channel as a dominatrix -) and I think she fancied getting into my pants. It was like a sleazy out-take from Mrs Robinson and Dustin Hoffman. Fat chance! I have no idea what qualifications she had apart from being married to a Tory MP or some other high head yin donor.
She wetted her knickers one night over a wee dram in some fancy golf hotel whisky bar expressing her lust for selling all my bright ideas - to the rest of the NHS - as 'Intellectual Capital". I mean she was a capitalist drunk and off her trolley: for decades we NHS Managers shared all our ideas for free - I used to write articles in the journals like the HSJ without even getting a penny piece in payment - just because that was the ethos of the day. We just shared useful stuff - that was our mission and how we worked.
Looks like that's the point of the exercise: doing the same for the same number of people under a new name - but needing more money for more people to administer it: success, innit - if one's a bureaucrat. After all, somehow the relationship between 'frontline medical staff (i.e. doctors, nurses and the like) and the clipboard wielders must be increased, e.g.1 part medical frontline, two parts admin ...
Three ICBs combining will take us back to the Regional Health Authorities eg North West RHA from the southern border of Cheshire to the Scottish Border on the west of the Pennines. I'm convinced that's where we are going because ICBs have had their running costs decimated (50% cut if memory serves) the only way to deal with that is to move to a strategic level and leave-hands on to others. Don't think we need the 10 year plan - we can see where its going now!
And still none of us can get to see a GP.
Can we go back to the structure with the DHAs before the Internal Market was introduced? A fascinating analysis would be a detailed check of the aims, outcomes and costs of each reorganization. I read work by Colin Leys and Allyson Pollock many years ago on this. The increasing bureaucracy seems more concerned with covering up mistakes rather than introducing systems to minimise them as Portsmouth surgeon Peter Brennan advocates.
You could compare England with Scotland and Northern Ireland, which did things differently.
tell us more
Well, I think they all screwed up, but differently!
ha! ha! ha! ......... thanks
Integrated health and social care always struck me as intriguing.
In theory, its a great idea.
The problem is this though: Doctors always dominate anything and fuck it up, because they are so fucking arrogant and entitled.
forgive them Lord; for they know not what they do
The NHS has become its own propoganda machine. Drinking its own paid for coolaid. Current model entirely unfit for purpose. Author mentioned Red Army the other is Indian State Railway employing 1million plus acolytes. Patient centric it isn't and inefficient it is! Wasteful and highly political.
actually I think I know what the answer is to all these problems: appoint more managers and ensure much more micromanagement; that was surely turn everything around quickly?