Editor’s blog Wednesday 7 July 2010: Tory backbenchers agitate for NHS cuts, and the afterlife of Total Place

Hello. This is going to be a bit brief - my back's in intermittent spasm, making most things difficult. Still, if I can do the upper lip Viagra thing, no doubt you can too. You can cope with shortish rations today.

Andrew Grice of The Independent notes the emerging discontent on the Conservative back benches about the ring-fencing of the NHS budget. He also, however, says that Restoration-faced Chancellor George Osborne has told backbenchers they are flogging a dead horse.

Nothing wildly surprising is actually happening here. We previously reported that Health Select Committee member and ex-nurse Nadine Dorries opposed the ring-fence, and yesterday noted Randeep Ramesh's piece in The Guardianwhich reported Health Select Committee chair Stephen Dorrell as concurring with the view.

Today, the money-wasting theme baton passed to my old mucker Sir Gerry Robinson. Gezza  joined the fray, telling BBC2's Daily Policicsthat the NHS is just a big money-wasting factory.

Now, some of you may know that I disliked Gerry Robinson's BBC2 / OU NHS TV series a great deal. I found it sanctimonious, self-regarding and deceitful (putting the bit where the business genius asks about the finance five minutes from the end). Gerry wore too much of a black polo neck for my taste, and looked up to the Heavens (or TV lights) for inspiration like the seminary student he once was too often for me.

I was forced to think again when he made a much better programme about dementia care homes last year. He had genuine engagement with staff, and had difficult meetings with proprietors. It seemed to matter to him, and I'm a sucker for that sort of thing. I ended up thinking he was OK.

Back he rolled onto familiar territory today, with much asserted but little proved.

Of course there is waste and inefficiency in the NHS. Money has been used to paper over the cracks - deep fissures, in some places - and it is going to have to be possible to do more with less. There are ways of making the systeml work well al lower cost - role substitution, generic prescribing wherever appropriate, improved integration of services for people with long-term conditions, pooling budgets to avoid ill-health arising.


A massive difference could arise by making clinicians face their own activity, prescribing and referral data, benchmarked, often and with short time lags (even if it is a bit 'dirty' quality-wise.

These will all work to some extent. They are also all at least a bit difficult..

The afterlife of Total Place
You were probably as depressed as I was when you heard rumours that the Coalition government was set to announce the end of Total Place. Total Place is an unmitigatedly good idea.

Hopefully, you will be happy to learn that this was discussed yesterday at a think-tank meeting, and somebody who is in a good position to know (Chatham House rules OK?) stated that Total Place may go as a name, but the concept and methodology will endure.

Don't you love a change of government?

It was interesting, thinking about this, to read this story in the MJ about NHS un-co-operativeness with Total Place. Anybody in the local NHS in the areas in question who would like to comment, please email editorial@healthpolicyinsight.com