Editor's blog Thursday 13 January 2011: The battalions gear up for uncivil war

Of late, two 20th-century political figures have been much-quoted in regard to NHS reform.

Both men - Stalin and Mao - were highly-effective Communist dictators who also killed a lot of their own people.

Yes, I'm hoping there isn't a subtext too.

We did the Stalinism thing shortly before Christmas, and Mao came up in the debate about radicalism among political commentators: Andrew Rawnsley's Observer piece was, I think, the first.

The clash of civilisations is going to come into very sharp focus next week, with the publication of the Health Bill. The Old World and the New World are shaping up like oil and water.

Already today, the BMA and the RCN joined Unison in suggesting that NHS Employers can go and love themselves as regards the proposals for a two-year increment freeze for guarantees of minimal redundancies.

Following the money
So it's money over jobs. That's the way the world goes round ... and it will be interesting to see whether this gamble by the unions comes up trumps or snake-eyes in the court of public opinion.

Another front has been opened in the battle by a suspiciously spoon-fed-looking piece on BBC News on consultants' overtime payments for Waiting Time Initiative (inevitably, WTI) work (including comment from the great Alan Maynard of this parish).

I thought it was a mildly open secret that waiting time had provided for a new Porche or two in the consultant fraternity. The implication of the story is that there has been inept job plan management - which, if true, is probably not very surprising. Agenda For Change wouldn't be intrinsically inflationary if the NHS was seriously good (or even serious) on the issue of whether there were meaningful regular reviews of staff performance.

Alan's point is, comme d'habitude, a good one - that more transparency on pay for senior staff is A Good Thing as a doctrinaire point, if you'll excuse the pun.

(Oh, wasn't there one?)

As a point of principle, it is wholly reasonable to want to know how public money is being spent, and on what. Perhaps, if this had been an accepted principle far earlier in the day, we would not be facing the sub-prime economic legacy of PFI.

Another interesting reflection would be to ask why Newton Europe (whose healthcare practice you can learn about here) are releasing this data to BBC News now, at this time.

Obviously, it's no names, no pack-drill as to clients - so we can't verify the stuff.

Nor even can we verify how many NHS trusts have bought Newton Europe's consultancy services.

Typically, Newton Europe's business manager Ed Burns says tells the BBC that examples of consultant overtime payments of over £100,000 a year are "not the norm. They make up for only a handful of payments; typically, you might find that only 5% of consultants earn over £20,000 of these overtime payments a year.

"Hospitals, if they focus on efficiency in the right way (as Newton's experience has shown time and time again) can deliver an improved quality of patient care and reduce the cost of these overtime payments at the same time ... I don't think poor management is wasting money in the NHS ... what we're talking about here is being able to take a more sophisticated approach to looking at how efficiently we're running the hospitals, and using that sophisticated approach to deliver better efficiencies and quality of care in order to be able to reduce these overtime payments".

Money and power
I once programmed a conference on NHS reform called 'Following The Money'. That is always the way to go. It all comes down to money and power.

People love money: it represents a crude liberation.

People love power: it is the chance to shape how much liberty others may have.

Money and power make the ultimate double-act: leaving for dead such canonical pairings as Abbott and Costello, Laurel and Hardy.

Or Leiber and Stoller,  Jagger and Richards.

Or Wallace and Gromit, Bill and Ben.

Or Heckler and Koch, Smith and Wesson.

Which brings me back to where we came in - and to Mao, who famously said, "political power grows out of the barrel of a gun".

And who also apparently said, "Stalin is our greatest father and teacher ... Leader of both the world's working class and Communist Internationale — Ten thousand years of life to Stalin!".

And back to Joe Stalin, who infamously asked Pierre Laval (according to the history books of PM Winston Churchill), "how many battalions does the Pope have?"

God help us - if she's free, and willling.