AIMING FOR THE BEST OF HEALTH:
HOW WE PLAN TO COMMISSION HEALTH CARE FOR THE RESIDENTS
OF LAMBETH, SOUTHWARK AND LEWISHAM IN 1992/93
South East London Commissioning Agency
(October 1991)

There was a time when the National Health Service was little more than a rotten borough for the Labour Party. It employed a vast tribe of ancillary workers whose ugly, stinking bodies made every patient wish he were rich or had fallen sick abroad, but who could be trusted to vote Labour. Of course, the current reforms are doing much to end this abuse. I read, for example, that the management of Guy's Hospital is planning to sack several hundred of its porters, starting with the ugliest and dirtiest. Not surprisingly, the Opposition is in a tremendous sweat, and will soon have trouble concealing its real motives behind its facade of mewling concern for "the old, the ill and the poor".

We must not, however, be deceived by any of this into thinking that the Health Service is really being reformed. It is beyond reform. No administrative changes or increase of budget can cure its defects. These are terminal. It cost £8 billion in 1979, and was a mess. It costs £32 billion today, and is still a mess. By the end of the next Parliament, it may cost £70 billion - but, most assuredly, will still be a mess. It is like a dog with worms. No matter what sustenance it is given, it will not grow healthier. There will simply be more waste and more hungry worms. But where a dog can be wormed, the only cure for the Health Service is abolition.

The Government, I suspect, knows this. Certainly, the practical effect of its reforms has not been to improve the standard of medical care, but to start shifting the electoral balance within the Service. Labour worms are being replaced with Tory worms. This explains the startling growth of higher management. It is inconceivable that the accountants and copywriters now being hired in their thousands will hasten or improve the cutting out of a single haemorrhoid. Perhaps they will be less offensive to the medical staff than the old porters were, and drink better coffee. But they are there to ensure that at least some of that £32 billion goes to Conservative voters.

I am confirmed in this belief by the Report now before me. It is as sure a sign of an underworked managing bureaucracy as little droppings are of mice. Let me describe its physical appearance. A deep burgundy cover with black and white print and ten sheets of the finest 120 g/m2 art paper are folded into an A4 booklet. The pages are printed black and red, and there are numerous graphs and other charts.

The Chairman of The South East London Commissioning Agency is a Mr Ron Kerr. When I telephoned his office, he was unavailable for questioning. The person to whom I spoke refused to give his name, and refused to tell me even if he knew how many people, working how many hours at the public expense, had been involved in the Report's preparation.

But I was able to take my copy to a local printer. Assuming a run of 1,500, from word-processed copy, anything of mine of similar length, and published to the same standard, would cost me £7,550 plus VAT. A run of 20,000 would cost me £11,350 plus VAT. Since economies of scale always impress a committee, I imagine that a very large run was ordered. I have no wish to offend my Editor, but thousands and thousands would need to have been printed for one to be sent out to a magazine as obscure and as far removed from South East London as Free Life

On page 11 of the Report, I read that "[t]he amount of money SELCA currently spends on health care is greatly in excess of what we will receive in future. As a result we will have to reduce our expenditure by at least £22 million (7 percent) in the next four years on hospital and community health services". Yes, the Commissioning Agency has a clear understanding of its priorities.

As for the rest of its contents, these vary between the sort of platitudinous drivel one finds in Department of Health circulars and increasingly inventive ways of spending a reduced budget on anything but medical salaries and equipment. Sometimes, they combine both. Thus, I read that no one in the area lives more than a 27 minute bus ride away from the next nearest hospital; and that lots of small hospitals - or "polyclinics" - are to be built, so that "health care" can be made "community based". This will please the local estate agents and builders, not to mention the clerical recruitment agencies.

Unless one happens to believe that the National Health Service can and ought to be made into an efficient provider of medical treatment free at the point of use, this Report is in every sense an encouraging document. I look forward to many more like it during the next few years.

Anthony Furlong