"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Friday, 27 August 2010


The Tories are well known for their admiration for the work of Richard Thaler, the author of Nudge: Improving Decisions About Health, Wealth, and Happiness. basically, you give people a nudge and then they do what you want (well, I guess there is more to it than that).

So here is one example of a nudge:

  1. Take an authoritarian who will not listen to anyone else and will not compromise
  2. Get the authoritarian to write his plans for the future which scares everyone shitless with the audacious scope for disaster
  3. Tell them that there is no alternative (TINA (c) Margaret Thatcher) 
  4. Wait and see what happens
After running around like headless chickens for a month or so most of the people will decide that since TINA the only way that they can guarantee any future for themselves is to try and be the first to implement the plans.

This appears to be the case with Lansley's plans for so-called social enterprises. Let's just put to one side that no one in the world has ever created the large number of large social enterprises att at the same time that Lansley plans. Let's just put aside that when the public finds out that by making all hospitals and community health services social enterprises is actually privatising the majority of the NHS. Let's just put all of that aside for a moment. Let's just consider commissioning.

The nudge here is a big bloody punch in the solar plexus: PCTs will be abolished by 2013. The big problem with this plan is that the PCTs do something useful: they have the expertise to be able to plan for the healthcare needs of an area. Lansley says that GPs will have to do this in the future, but most GPs say that they don't have a clue how to do this. This may mean that in some cases PCT commissioners will take on jobs with the new GP commissioning consortia and continue their work there. The problem is that there are expected to be about 500 consortia, as opposed to the 152 PCTs which means that the economies of scale are in the wrong direction. (No one explained this simple fact to Commissar Lansley, but then I guess they decided not to annoy him in fear of their jobs.) Another option is for the PCT commissioners to move to private sector companies, but contrary to what Cobnservatives tell you, the private sector is invariably more expensive than the public sector.

So now we hear from Pulse thatPCTs are thinking of becoming social enterprises and selling their expertise to the GP consortia:
'The advantages are there are a lot of skills within PCTs. I think it would be a disaster for the health service to make all these people redundant, put them into private companies to be sold back to the health service at increased rates. Nor do I think the private sector currently has the people or the skills to support all the potentially 500 consortia.' Dr Nigel Watson, chair of the GPC’s commissioning and service development subcommittee
So the Commissar gets his way. Before the law has even been written people are already doing exactly what he wants. Nudges clearly work.

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