In Whom We Trust

It seemed like Andrew Lansley had been shadow Health Secretary throughout Labour's three terms in office. Certainly he's had a huge amount of time to devise the rationale behind the massive health care changes he wanted to see under a Tory Government.

So it is something of a surprise to hear his plans for 'reform' now he is in office; they sound ill-considered and entirely reactionary. First, he said Jamie Oliver's programme for healthy school dinners was "lecturing" and "nannying" and was largely "a failure". Although there is nothing to support those arguments, such as they are.

"Ministry insiders" hinted heavily on Monday, the Food Standards Agency and would be abolished and in its stead would be an inert Ministerial sub-Committee chaired by Andy himself. The food giants must have wept with joy over that one. Let us not forget the FSA was established following the BSE outbreak where big business's lack of moral scruples led to the extermination of the entire national beef cattle herd. Over 1,500 people in the UK have died of CJD.

But these issues are piffling compared to Lansley's plan for transferring four-fifths of NHS budgets to 5-600 consortia of GPs, as "doctors know best how to manage treatment for patients."

This facile philosophy is applied by Tories to schools too, "where parents know best how their child should be educated." This is patently idiotic. We are not the experts and GPs can't be expected join up all the right decisions and gain the full economy of scale for the health service.

But when pressed on the point by Martha Karney on Newsnight, Lansley opted for an ad hominem argument, "Don't you trust your Doctor to make these decisions?"

It takes seven or more years to train to be a GP and yet there are still no modules for financial management nor strategic planning. Trust is not the point: it is simply about competence and managerial capacity. These plans rather treat GPs as some sort of homegenous group with consistent outlook and skills. It would have been advisable to canvass their views first but these vast changes appear ready to be implemented without consultation nor piloting.

The purpose of this dramatic structural change is to rid the NHS of "bureacracy". The term is used in place of many inefficiencies and red tape. But huge organisations rely on a level of bureacracy to function at all; they provide the levers to pull. LAnsley beleives there are 68,000 managers carrying out superfluous duties.

Lansley and Cameron sound like those Leninists who attacked the agrarian "management" of kulaks. The ensuing chaos may not be quite so tortuous as Soviet Union in 1920s but the judgement is almost as dubious and prejudicial. It is a huge gamble and Lansley has not even started to explain why it is necessary.