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The more things change, do they remain the same?

What do we make of the appointments of Ara Darzi & Dawn Primarolo as ministers at the Dept of Health?

Dawn Primarolo made a mess of big projects as Paymaster General at HM Revenue & Customs and is better known as the paymaster for EDS. She was in fact expected to resign or be sacked not so long ago! Private Eye has long been interested.

Ara Darzi is someone from a central London teaching hospital who has previously supported the “Reform” agenda & is enamoured by big hospitals & hi-tech medicine. Surgical robots & nurse robots while valuable advances are not exactly ready for prime-time. His plans for the reconfiguration of services in North London are not expected to be sympathetic to patients.

But today’s news of note is the cut in NHS capital expenditure unearthed by the FT.

Prompted by the tightness of the public finances, the new prime minister, who has placed the NHS as his “immediate priority”, cut the capital budget of the English NHS for 2007-08 from £6.2bn to £4.2bn. The move could delay the government’s hospital building and reconfiguration programme in England.

Those familiar with the situation said the cut to NHS capital spending implied a very tight settlement for the health department for the next three years in October’s Comprehensive Spending Review and indicated a slowdown in hospital building.

I think caution is indicated here, especially with the well known tendency among managers to cut services with promises of transformational redevelopment but to then skimp on the replacements.

The health department’s surrender of £2bn in capital is all the more remarkable because the NHS needs the money and it had not been given greater day-to-day money to spend.

The private finance initiative hospital programme has already been cut from a future programme of £12bn to £8bn, with further reduction likely, amid worries the inflexible payments PFI demands do not fit well with the new system of money following the patients. Big hospital reconfigurations are due in some parts of the country that will inevitably require capital.

A reduction in the number of white elephants will be welcome but given the quality of decision-making I am afraid that the baby will be thrown out with the bath-water.

The cut was slipped out in the March Budget, when Mr Brown referred only to spending on day-to-day NHS services when he said “the money available for investment and reform in the NHS in England will be £8bn more than this year, the biggest cash increase ever”.

The details will need careful watching.

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Alan Johnson is being welcomed as a credible health secretary. Let us hope that he comes with no preconceived ideas or agendas & is willing to listen.

He is quoted as saying that the govt should have listened less to the BMA & more to Unison. Hopefully that was a comment about their respective policies & not an attempt to play one professional group against the other. Time will tell.

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I have to apologise for the recent lack of activity here. A sudden attack of ennui, in addition to personal issues caused me to take time out from this blog for the past month, triggered by the bullish unwillingness of people to listen. Frustration creeps in occasionally at the brazen shamelessness of the lies.

A lot has been said & done over the past month including the resignations of Richard Granger & Patricia Hewitt. There are some however who cannot be helped & the only thing I can do is to try to hold them to account in whatever way I can.

The NHS & the Dept of Health are public service organisations & should be run to deliver benefit to us all. Any part of this machine that deviates from those ideals needs corrective action to being it back into line. Poor decisions taken by people with questionable motivation & those made by following poor directions rigidly certainly fall under this category.

Since it appears that the normal checks & balances that would act to govern such acts of omission or commission are being ignored and there seems to be no appetite for effective supervision of rogue departments, the public are entitled to know just what is going on.

I am being driven to the conclusion that linking individual names to the action under scrutiny is one of the few tools available to the public. Let us see if it makes a difference. This lady for one seems to be doing well with this strategy.

But on the first day of the new administration & with changes expected at the top, I hope to resume regular service & keep an eye on the movers and shakers.

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