Editor's blog Monday 28 February 2011: Shirley, you can't be serious

It is a truth universally acknowledged that Airplane! was one of the funniest films of the 1980s, spoofing the highly successful genre of 1970s disaster movies (Airport, Towering Inferno et al).

Thus we think of its most famous lines of dialogue - "Surely you can't be serious?" "I am serious, and stop calling me Shirley" - as we read Baroness Williams' op-ed today for The Times (paywalled).

It brings to mind another anecdote (only tangentially relevant, but then it is Monday) about the definitive Doctor Who, Tom Baker. Baker said that on the only occasion he encountered unpleasantness from the public, he was forthrightly told, "I can never forgive you for what you did to the grammar schools". He was initially bemused, later realising that his accuser had mistaken him for Shirley Williams.

Williams' article describes SOS Lansley's health policy as "a dilemma ...  that cannot easily be resolved", and highlights the "unresolved tension between an emphasis on good management for obtaining efficiencey savings and the plans for radically reducing NHS staff".

She suggests that the key areas are cost, accountability, the private sector and patient choice. Some of her points around cost are incomprehensible: she suggests that managers from outside the NHS are likely to cost more. Baroness Williams is obviously either unaware of NHS management salaries, or inhabiting a different economy to the rest of us.

She is broadly correct on accountability, but misses the significant point about commercial-in-confidence inhibiting public access to knowledge on decisions and deals. And she has noticed Monitor chair David Bennett's game-changing points about reconceptualising the NHS along the lines of privatised utlilities, which we highlighted last week.

On patient choice, Williams notes that such systems tend to favour the more articulate and educated (though the system favoured them pre-choice anyway; and there is evidence that the impact on inequality may be less than assumed).

However, she misses some key points about choice: many doctors are sceptical, and do not seem to offer it to their patients (according to patients' recollections in the patient survey); choice requires spare capacity; and choice potentially acts against co-ordinated pathways of care.

It is of course a short piece, and you can't do everything in 500-odd words. She also reaches the correct coinclusion: that "why we should dismember this remarkably sucecessful public service for an untried and disruptive reorganisation amazes me".

Will this intervention have an impact, though? Will it split the One Nation Liberals from their Orange Book colleagues?

Perhaps slightly in the membership. Less likely at Westminster.

It might make for a nice little row at their Spring conference, though.