I am finding it increasingly difficult to blog about what I know well. Other medical bloggers seem to be having similar problems and dropping out or posting infrequently. I think I know why. The targets are becoming less obvious.
My broad-brush understanding of what Nu labour has always wanted to achieve is the wholesale destruction of the network of DGHs which provide the majority of secondary care (and NHS hospital doctor and nurse employment) in the UK. Once DGHs have gone, the vast army of NHS staff could be re-employed by the private sector at locally negotiated rates with disregard for the complex and expensive banding structure.
When Nu labour started their micromanagement of the NHS they chose a very direct, in your face, approach to dealing with the profession. This came to grief when Dr Richard Taylor successfully stood for Parliament and overturned a Labour majority in Kidderminster over the downgrading of the local DGH.
There followed a more subtle approach of "divide and rule" by which they hoped to drive a wedge between Hospital Doctors and General Practice. Separately negotiated contracts made both groups suspicious of each other and more easily manipulated by government. For example, in hospitals, the basic wage was set on a downward path relative to living costs with the additional remuneration through additional sessions and CEA awards being increasingly at the whim of managers. Similar mechanisms for political interference were set up in the GP contract. Plans were then put in place to "encourage" GPs to shaft their local NHS hospitals. An example is the provision of NHS MRI scanning by the private sector, which, had it succeeded, would have closed down DGH x-ray departments over the next few years and thus made DGHs non-viable.
It surprised me, and I think it surprised Nu Labour, that GPs put their patients' long term interests first and failed to support the 2nd wave diagnostics program and over the last few months many of these schemes have been quietly dropped.
I don't think Nu Labour have changed their ambitions but they have clearly changed their plan of attack. Alan Johnson (remember him?) has been remarkably quiet and non-confrontational, unlike his predecessors. In the meantime the focus has drifted to a direct attack on GPs. Wave after wave of bad-mouthing and spin have been used to soften them up and now the private sector (such as Boots and Virgin) are being encouraged to provide direct competition to them by providing a parallel system of primary care clinics run by the "iffy for the iffy".
These clinics will be providing some diagnostic services "in the community" and will presumably have a financial interest in referring to their own facilities rather than the consultant staffed local hospital. They are also unencumbered by notions of "professionalism" and "patients best interests" and will opt for using the service which provides the biggest profits. Thus our system of general practice, widely acknowleged to be a well performing part of the NHS, is to be sacrificed to get at the DGHs.
These are the classical tactics of a long term siege. First try an open direct attack on the walls of the castle. If that doesn't work bring in some high tech mobile equipment to undermine or scale the walls. If the high tech equipment only proves as good as the morons operating it, settle down for a long process of attrition and starve the besieged out. If supplies continue to be smuggled in, destroy the surrounding countryside too and bring in your own food supplies from a secure source elsewhere.
There are similar moves to destroy state education in rural areas. Under the guise of Building Schools for the Future local authorities in metropolitan areas are more generously funded than rural areas and in rural areas funds for new schools are only provided if widespread closures ("modernisation" in the Nu labour sense) of rural schools takes place. This is currently occurring in Herefordshire and is bringing the population close to mass civil disobedience. Public meetings are being attended by a full third of the population (almost the whole adult population once children and babysitters are accounted for) in some market towns and plans for street marches are being drawn up. Head teachers, local councillors, local MPs and even the Church have denounced the proposals.
I have been involved in my own little way which explains the drop off in postings on this blog. I haven't gone away. Nu Labour seems to have shifted its attention to destroying State Education and this is now the more important battle to be fought.