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The new health secretary and the curse of Einstein


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Friday, 11 June 2010

The new health secretary and the curse of Einstein

Everyone secretly hopes that the new boss will be just like the old boss. Before the new health secretary took up his post, people were queuing up to explain how his arrival would amount to no change.

Comment writers and water-cooler opinion formers were quick to point out that there was no difference between Andrew Lansley’s idea of hard budgets for GPs and the old fundholding era, how we had seen it all before with PCGs and RHAs, how what goes around comes around and how there is nothing new under the sun.

This complacency is built on two long-standing beliefs – that politicians are powerless to change the NHS and that this resistance to change is somehow a good thing.

We have become used to the endlessly repeating pattern of “reform” based on restructuring of institutions and re-engineering of processes. It’s Groundhog Day but without the laughs.

What changes most often is the terminology. Our touching faith in the power of renaming things is a symptom of our obsession with form.

We invent new strategies that are not strategic and come up with initiatives that discourage people from taking any.

For every new idea, we can produce a tired and discredited precedent and a reason why it can’t work.

Successive politicians have gone along with this charade, either because the political price of despoiling a national treasure was too high or because whatever reformist zeal they started out with was soon sapped by the immovable weight of the system.

What a lot of NHS people don’t like about the new health secretary is that he isn’t exhibiting any of the normal behaviours. He is not evading questions, he is not equivocating, he has not announced a bold plan to re-carpet the NHS and he has not unveiled a strategy peppered with bureaucratic newspeak.

Andrew Lansley is not a fan of form. He is not proposing to restructure the status quo or to shuffle the same pack of jokers into “new” jobs where they can be left to get on with business as usual. He is talking instead about fundamental changes to roles, responsibilities and relationships. No wonder some people are worried.

The new model of GP commissioning may or may not succeed. It will have problems, setbacks and drawbacks, flaws and detractors, failures and disasters, and scathing headlines in the Daily Mail – in all these respects it will be just like the current set-up. The difference is that it won’t be the current set-up. No one has ever put this better than Einstein, who defined insanity as doing the same thing over and over again while expecting a different outcome.

Calling all commissioners: information needed

It has become a cliché to demand evidence-based decisions – what other kind are there? But where is the evidence and how easy is it to find? NHS Networks is doing some work on the information needs of commissioners with particular emphasis on two existing websites. If you work in a PCT or a PBC group and have commissioning somewhere in your job description, please give us five minutes of your time and take our survey.