Jon Bright (London, OK): Hearing yesterday's news of wide ranging plans to increase screening on the NHS to turn it into a 'preventative' rather than 'curative' health service, I couldn't help but be reminded of the following Solzhenitsyn quote. I will leave you the fairly easy task of guessing who the quote is about (let's just say it wasn't Mr. Bean):
Night was [his] most fruitful time. His mistrustful mind unwound slowly in the morning. With his gloomy morning mind he cut back expenditures, ordered two or three ministries merged into one. With his sharp and supple nighttime mind he decided how to increase the number of ministries by dividing them up, and what to call the new ones; he signed new budgets and confirmed new appointments
As has already been pointed out many times on OurKingdom, we live in what can fairly accurately be described as an 'elected dictatorship'. Power is concentrated solely in the hands of the executive, who are able to make sweeping institutional changes almost at whim. This is something that came out with the hasty creation of the Ministry of Justice, and seems to appear again with this major plan for the NHS.
Debating the proposals on Newsnight last night, Laurence Buckman of the BMA made several points about them - the most telling for me were, firstly that he felt his organisation had not been consulted, and that the proposals seemed to contradict earlier pre-Christmas budget cutbacks in similar areas, and secondly that what was being promised could end up being extremely expensive, especially a promise to make screening available "whenever you want". Health Minister Ben Bradshaw contradicted Buckman on the second point, flatly denying Brown had made such a promise. Which, it has to be said, makes it sound like he's only heard of the proposals recently as well - because Brown did, in the following passage:
And we will extend the availability of diagnostic procedures in the GP surgery - making blood tests, ECGs and in some cases ultrasounds available and on offer not only when you are acutely unwell or if you can pay, but when you want and need them, where you need them, at the local surgery
This could be nitpicking, of course. Perhaps Brown meant when you "need" them, rather than when you "want and need" them (though you, personally, will never be able to decide with a degree of authority when you "need" a scan). Perhaps Buckman was talking about slightly different screening methods to blood tests and ECGs. But, the point is, if major organisational changes are announced in such rapid fashion, without much prior discussion with stakeholders, then minor nuances of single speeches end up being all some people have to go on. And speechwriters, hurrying to a deadline, might not quite realize the magnitude of what is being promised when the word 'want' is interchanged or added to the word 'need'. So the question really is, not whether these proposals are a great idea, but how long did it take to draw them up - and were they thought of in the morning or at night?
