One or two others…

Training Primary Care - NHS - GPs - One or two others

News and Comment from Roy Lilley

It’s a big old lump of a book. Seven hundred, plus pages.

Reflections, insights, a peep behind the curtain of government and written with a melancholic frankness I never expected.

For the Record is David Cameron’s autobiography, a readable, lucid and well written work.

Cameron makes a powerful point that our NHS is, ‘his NHS’.

There are painful and poignant passages about how reliant on the NHS, even this wealthy couple were, for the care of their son Ivan, born with Ohtahara Syndrome.

The Camerons provided round the clock care in relays, he often slept beside Ivan and headed off to the Commons in the morning.

A predicament familiar to carers everywhere.

I sense a genuine attachment to the NHS and nowhere in the book is a hint of wanting to do anything but right by the Service.

Cameron makes the point; he would have liked to have matched the funding generosity of the Blair and Brown years but was unable to do so as, by that time, the economy was in a tailspin following the banking crisis. He says;

‘Our most precious national institution was at a perilous moment – but so were our public finances…’

He increasing funding by £10 billion in real terms. Cameron says he knew the NHS needed structural change.

And, that is what most of us will remember him for; the disaster of the Andrew Lansley Reforms.

I recall those days, clearly. Every one and every organisation opposed the reforms… with the exception of the National Association of Primary Care, who Lansley had courted in the run-up to the election and the Royal College of Surgeons, whose members stood to gain from the relaxation of private practice being encouraged in NHS hosptials.

Forgive me for singling out this quote about opposition;

‘One of the problems with the BMA is that you know it will oppose absolutely anything, whether it is a good idea or not.’


There are frank admissions. Cameron writes;

‘The Lansley reforms had been too much of a solution in search of a problem.’

‘He was too submerged in the detail…’

‘I trusted Andrew Lansley too much, and was blinded by his science. I could and should have stepped in earlier…’

The decision to disband PCTs was insisted upon by the coalition partners the Lib-Dems.

Ironically, the controversy came to a head when the Lib Dems voted against the reform bill at their annual conference. They were ignored.

Cameron had repeatedly pledged ‘no more pointless reorganisations of the NHS‘. Indeed the Coalition Programme for Government said, ‘We will stop the top-down reorganisations of the NHS.’

Cameron writes;

‘We weren’t lying; our reorganisation was never meant to be top-down.’

He never meant to do it? Then, we have to ask; how did reform get so out of hand?

His up-sum;

‘Looking back, I see the health reforms not as a triumph, nor as quite the disaster our critics predicted; but as something that took up a lot of energy.’

If only we could write off the past with those 29 words.

Cameron, Lansley, the Lib-Dem coalition, their legacy has been a disaster, a confusion, a waste of time and money, cost jobs and destroyed careers. We are still trying to put the pieces back together again.

There were two sentinel events that came to light during the Cameron years.

The first, Mid-Staffs. His analysis;

‘Patient care was taking second place to meeting targets and Whitehall diktats. The situation was only set to get worse.’

He was right then and he would right today. The destructive influence of regulators, top-down management and the corrosive CQC.

The second, the junior doctor’s strike, of which there is but a passing reference.

The Cancer Drugs Fund comes in for special mention, arising from Cameron’s friendship with Clive Stone, a constituent. It saved lives but in reality just put rationing in a different pair of shoes.

As always you have to read between the lines.

My conclusion, for the record, about

For the Record?

Bluntly, as far as the NHS is concerned; Cameron was too trusting and a weak leader. He avoided tough decisions and has left us with a hell of a problem.

… oh, and one or two others.

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Reproduced at by kind permission of Roy Lilley.