Editor's blog Thursday 6 May 2010: A non-NHS election: inside Pandora's Box with Schrödinger's cat

Evening, all.

Sit down and have a relaxing drink - you deserve it.

So does HPI associate director Tom Smith, whose fresh dose of Health Policy Today summarises where we are tonight and likely to be come Monday morning better than anything else I have seen. Enjoy.

Tonight's editor's blog is, as ever, being brought to you from the 'home of UK health policy'.

And for almost all of the (first?) 2010 general election campaign, UK health policy has been The Dog That Didn't Bark.

Which un-barking dog was to be found sitting with Schrödinger's cat, inside Pandora's Box.

The public spending cuts, which we all know are coming at much greater scale than any politician has dared to describe, are inside Pandora's Box. What a weird situation it is, to be putting our crosses in the box for representatives of political parties who are basically bullshitting us on an epic scale about the financial consequences for the UK over the next five years.

Three reasons why the NHS has not been a key election issue
There are three main reasons why the NHS has not been a subject of significant political discussion at this election.

The first is that superficially, the NHS is not broken to most people who use it. Access is broadly improved; HCAI rates are dropping; estate is much renewed; staffing and wages are up, up up.

Given the huge increases in spending, it couldn't really be otherwise.

As ever, money has not been able to buy happiness - particularly among the clinical workforce. It has clearly bought off a lot of misery overall, but it remains a miracle of the age that such pay rises have still left us with a workforce that is so often grumpy.

The NHS in 2010 is far from being as good as it could and frankly should be.

Professor Aidan Halligan's resignation-hastening lines, written for me while I edited British Journal of Healthcare Management a few years back, have been much on my mind lately:
"We have learned that doing more of what we have always done gives us more of what we have always got. Any suggestion of real reform has been a deceit: working patterns, practices and customs are at the heart of many capacity issues, and have never been challenged".

He wrote that while he was Deputy Chief Medical Officer. It is the most honest comment from a figure on the NHS policy scene that I have witnessed.

You don't have to believe Aidan is right about everything to see that he told a seismic truth there: one which the system still does not truly acknowledge - perhaps, does not even understand.

The second reason is the wholehearted embrace of the NHS by Cameron Conservatism. Detoxifying the Tory brand led to the effulgent embrace of the NHS by the party which opposed its creation (in proud company with the BMA).

There is personal conviction in this, with Cameron's experiences of the care given to his late son Ivan. There is also political pragmatism of the kind shown by the late Tory health minister Enoch Powell when describing his support as a free marketeer for the NHS: "the people have willed it, so they must have it."

The third reason is that you have to know quite a bit about the NHS to understand the depth of trouble it is just about to enter.

Regulation is beginning to expose some bad things (it is also over-reacting at the same time, but that's another story).

Vertical integration is all the policy rage, yet risks becoming, in the words of David Colin-Thomé, "the biggest provider capture ever".

Health economics remains a minority sport, rather than the mainstream pastime it needs to be for austerity not to rock the NHS to its foundations.

If commissioning is to endure, it requires functional interoperable IT to deliver data fast. Insert your own hollow laughter here.

The NHS is going to have to close things and stop things, quickly and taking public and political support with it. The NHS is no good at doing this.

There are serious and smart people talking about the return to block contracts and ending the purchaser-provider split.

Still ... mustn't grumble.

Stiff upper lip! Dunkirk spirit!

Blue shy thinking
I do not know whether the 'shy Tories', who told opinion pollsters one thing about their voting intentions back in 1992 and shocked many by re-electing John Major (with a little help from Neil Kinnock's Sheffield rally hara-kiri), are set to deliver a comfortable Cameron majority by the morning.

The Conservative language has been evolving, too. The Tory leader's unambiguous party conference promise to doctors that "those targets you hate - they're gone" has softened in Andrew Lansley's mouth to being "no more political targets" and "no targets without clinical justification".

Like the moveable definition of "front-line services", this is political language - so much more usefully evanescent than all-rock-no-roll electoral rhetoric.

Nobody knows what is coming next.

But if it's Mr Dave MP PM, there will be interesting times ahead.

The lesser-known content of Pandora's Box
In the words of the late, great Kurt Vonnegut's classic novel Slaughterhouse Five, "so it goes".

And there was something else inside Pandora's Box.

As well as all the evils of the world, the legend says that Pandora's Box contained hope.

You can read that as a cynical line about hope. Or you can take it that while there's life, there's hope. Which is how I choose to take it.

The NHS is only ever as broken or as fixed as we let it be.

I may pop back in throughout the evening and night to post bits and pieces.

Have a good one.