Editor's Comment

Comings and goings

I write this a year to the day since the Health & Social Care Bill got its first reading in Parliament.

Opposition among the main medical professional groups and unions has hardened since then, into outright and full-throated antagonism in some cases, but the Bill is almost law and things have been changing rapidly ‘on the ground’ over the last year anyway in anticipation of its eventual Royal Assent.

Concerns that the rhetoric for public consumption will not match the reality are surely bang on; the idea that GPs alone, or GPs allied with a nurse and a consultant or two, could commission everything on their own was always a red herring.

They were always going to need organisational support, but Andrew Lansley’s condemnation of ‘bureaucrats’ and ‘administrators’ getting in the way was always a hostage to fortune: we’re getting a whole new set of them, but increasingly they won’t be in the public sector.

He surely did a whole raft of nonclinical NHS staff and management a huge disservice when writing them off in this way in the name of an easy soundbite, because he knows that public understanding of NHS commissioning, financing and resourcing is minimal, compared to the easily-understood idea of putting the family doctor in charge of everything.

We are also seeing a vast reform in two areas strongly linked but traditionally slightly separate from the main body of NHS: social care and public health. We’re seeing many NHS public health staff moving into local government, while some social care staff are moving the opposite way. It’s mostly in the name of integration, but in general the social care integration seems to be better planned and better received than what’s happening in public health.

We feature two interesting views on this topic in this edition, one based on the second NHS Future Forum report, which has a strong public health and lifestyle intervention focus, and the other the report by Solutions for Public Health and others following a national colloquium at the end of last year that seeks to get a real grip on what public health commissioning and co-production could look like under the new structures.

While all these changes are going on, the DH tells us that savings as part of QIPP are pretty much on track. Efficiency is everything, as we explore in our special supplement on digital dictation and speech recognition, which is proving a notable success at some trusts, while others have found its implementation more of a struggle, as the technology tries to cope with the way real life works.

That’s no doubt what we’ll see with clinical commissioning and a reformed NHS, too, which will most likely be neither the panacea some claim, nor the disaster others fo resee; but the changes during the course of 2012 will certainly lay the groundwork for the future.

Adam Hewitt - Editor

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