What if...

[whole diary]

[Trowres]

The conservative MP^▸ (Member of Parliament, or Mile Post (a method of measuring the railway in miles and chains from a starting point - usually London), depending on context), a minister in the coalition government said:

“The current structures are not fit for purpose as they focus on competition and not enough on the integrated approach to transport that is so badly needed by passengers. We need to return to a more streamlined command and control structure for the transport system that is more in keeping with [the 1945 Labour government's] original vision for transport.”

The above has been edited by me to refer to transport instead of health, and a suitable substitute for Aneurin Bevan.

Otherwise, it is taken from a quotation in Thursday's Guardian:
https://www.theguardian.com/society/2020/jul/10/boris-johnson-plans-radical-shake-up-of-nhs-in-bid-to-regain-more-direct-control

What if this idea was contagious and spread from health to the DfT^» (Department for Transport - about)?

[TaplowGreen]

The conservative MP^▸ (Member of Parliament, or Mile Post (a method of measuring the railway in miles and chains from a starting point - usually London), depending on context), a minister in the coalition government said:

“The current structures are not fit for purpose as they focus on competition and not enough on the integrated approach to transport that is so badly needed by passengers. We need to return to a more streamlined command and control structure for the transport system that is more in keeping with [the 1945 Labour government's] original vision for transport.”

The above has been edited by me to refer to transport instead of health, and a suitable substitute for Aneurin Bevan.

Otherwise, it is taken from a quotation in Thursday's Guardian:
https://www.theguardian.com/society/2020/jul/10/boris-johnson-plans-radical-shake-up-of-nhs-in-bid-to-regain-more-direct-control

What if this idea was contagious and spread from health to the DfT^» (Department for Transport - about)?

Been tried already hasn't it? Remember British Rail?

[ellendune]

The conservative MP^▸ (Member of Parliament, or Mile Post (a method of measuring the railway in miles and chains from a starting point - usually London), depending on context), a minister in the coalition government said:

“The current structures are not fit for purpose as they focus on competition and not enough on the integrated approach to transport that is so badly needed by passengers. We need to return to a more streamlined command and control structure for the transport system that is more in keeping with [the 1945 Labour government's] original vision for transport.”

The above has been edited by me to refer to transport instead of health, and a suitable substitute for Aneurin Bevan.

Otherwise, it is taken from a quotation in Thursday's Guardian:
https://www.theguardian.com/society/2020/jul/10/boris-johnson-plans-radical-shake-up-of-nhs-in-bid-to-regain-more-direct-control

What if this idea was contagious and spread from health to the DfT^» (Department for Transport - about)?

Been tried already hasn't it? Remember British Rail?

No that was still arms length - this is talking about putting ministers in control  - was that more like the Railway Executive?

[Electric train]

No that was still arms length - this is talking about putting ministers in control  - was that more like the Railway Executive?

Good grief NO NO NO, the Railway Executive was responsible for the "Modernisation Plan" in the 1950's while some good did come out of it; it was a massive missed opportunity.

The conservative MP^▸ (Member of Parliament, or Mile Post (a method of measuring the railway in miles and chains from a starting point - usually London), depending on context), a minister in the coalition government said:

“The current structures are not fit for purpose as they focus on competition and not enough on the integrated approach to transport that is so badly needed by passengers. We need to return to a more streamlined command and control structure for the transport system that is more in keeping with [the 1945 Labour government's] original vision for transport.”

The above has been edited by me to refer to transport instead of health, and a suitable substitute for Aneurin Bevan.

Otherwise, it is taken from a quotation in Thursday's Guardian:
https://www.theguardian.com/society/2020/jul/10/boris-johnson-plans-radical-shake-up-of-nhs-in-bid-to-regain-more-direct-control

What if this idea was contagious and spread from health to the DfT^» (Department for Transport - about)?

Been tried already hasn't it? Remember British Rail?

No that was still arms length - this is talking about putting ministers in control  - was that more like the Railway Executive?

British Rail was not all bad, when the Government allowed the Railways to manage its self, innovations like Intercity, containerisation of freight, HST^▸ (High Speed Train (Inter City class 43 125 units))'s, TOPS^▸ (Total Operations Processing System), the RoRo computerised booking system for cros channel ferries a world first ........... and lots more.

The next stage in Government thinking is, I suspect, once NR^» (Network Rail - home page) has finished its devolution process into Regions and a light tough HQ^▸ (HeadQuarters); very akin to BR^▸ (British Rail(ways)); and the move from franchised ToC to concessions you are likely to see a merging of NR Region and ToC ................. essence of the Big Four 

[ellendune]

No that was still arms length - this is talking about putting ministers in control  - was that more like the Railway Executive?

British Rail was not all bad, when the Government allowed the Railways to manage its self, innovations like Intercity, containerisation of freight, HST^▸ (High Speed Train (Inter City class 43 125 units))'s, TOPS^▸ (Total Operations Processing System), the RoRo computerised booking system for cros channel ferries a world first ........... and lots more.

That is precisely not what is being proposed for NHS England it is Ministers taking control.  Did Minsters have control under the Railway executive?

[CyclingSid]

Taking out the personalities, I can see where they are coming from with NHS England. But please please spare us another NHS reorganisation.

[TaplowGreen]

Taking out the personalities, I can see where they are coming from with NHS England. But please please spare us another NHS reorganisation.

The NHS needs to be organised before it can be reorganised.

[Clan Line]

But please please spare us another NHS reorganisation.

The trouble is with all the previous NHS reorganisations is that they are always carried out by the people who have made the NHS the bureaucratic nightmare that it is today. They are hardly likely to come out and say that the job they do themselves is a total waste of time and money - and that money would be far better spent on a couple of extra nurses. They never make any improvement.

[ellendune]

Many years ago after the Hatfield crash there was a national newspaper journalist who said that Railtrack should be scrapped and we should reorganise and bring back BR^▸ (British Rail(ways)) as this would improve safety.  I wrote a letter of reply (which was published) pointing out that reorganisations take management's eye off the ball and are things like safety usually suffer as a result.  A major reorganisation would therefore be the last thing to do to improve safety.

A select committee reported that what the NHS needed was a period of stability with a few minor changes not a reorganisation.  I expect if this is a major reorganisation then service will suffer and there will be more problems with quality.

If reorganisation is necessary the I would suggest evolution is better than revolution.

If ministers want control then I am not sure they need a major restructure, just remove the independence of NHS England at the top.  Any other changes can surely be done as evolution. 

[TaplowGreen]

Many years ago after the Hatfield crash there was a national newspaper journalist who said that Railtrack should be scrapped and we should reorganise and bring back BR^▸ (British Rail(ways)) as this would improve safety.  I wrote a letter of reply (which was published) pointing out that reorganisations take management's eye off the ball and are things like safety usually suffer as a result.  A major reorganisation would therefore be the last thing to do to improve safety.

A select committee reported that what the NHS needed was a period of stability with a few minor changes not a reorganisation.  I expect if this is a major reorganisation then service will suffer and there will be more problems with quality.

If reorganisation is necessary the I would suggest evolution is better than revolution.

If ministers want control then I am not sure they need a major restructure, just remove the independence of NHS England at the top.  Any other changes can surely be done as evolution. 

I think for any meaningful reform of the NHS is to be achieved, 2 things need to happen (forgive the mixed metaphors), it needs to stop being treated like a sacred cow/political football, and it needs to be looked at in the context of something that worked 70 years ago but is now held together with string & bits of sticky tape, notwithstanding the superhuman efforts of its staff.

Probably worth looking at other systems around the World too, many  are very successful, few (if any) copy the NHS model end to end.