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SHAs get the Hammer Horror treatment


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Friday, 28 May 2010

SHAs get the Hammer Horror treatment

Whenever van Helsing walks into the local inn nestling at the foot of the mountain on the way to Dracula’s castle, the place falls silent, the villagers treat him with a mixture of pity and hostility and he leaves with a very clear message that like all meddling fools about to take on a monster he is doomed, and it was all his own silly fault.

SHAs must know exactly how this feels. The surly villagers of the NHS are busy glowering into their tankards, shaking their heads and muttering curses against them.

Right now, it’s easy to forget that the SHAs are supposed to be good guys, holding PCTs to account and maintaining standards of public health across the regions. Read any discussion thread and wise-after-the-event commentators are lining up to explain why the system was bound to fail, that SHAs or PCTs must go (or both, now that there’s a third option), that there are too many layers of bureaucracy, that we’ve seen it all before with PCGs and fundholding, and that we’re all doomed anyway.

Yet the fact remains that similar structures keep getting reinvented. If the press speculation is true it may be with something as simple as new names. But the regional outposts of the new NHS board may have quite different roles.

Having a small number of organisations to hold to account is attractive: without SHAs or something like them, you are going need a pretty big table around which to gather PCTs and something on the scale of Castle Dracula to discuss anything with GPs.

What the latest round of debate really tells us is that the problems of the NHS are not structural. If they were, there is a statistical probability we would have solved them at some point in the past 61 years. The real requirement is for fundamental cultural change, which is why most people continue to focus their attacks on the system, which is an easy target.