The late Sir Douglas Black wrote of the (calamitous) 1974 NHS reorganisation as “the first major step in a long series of vain attempts to improve function by tampering with structure”. All subsequent political initiatives have proved his point. The constraints of the electoral timetable; the self-defeating obsession with accountability and lack of trust; and the fantasy that there is some single panacea for the NHS have all combined to bring what was, before 1974, the best model for universal healthcare in the world to the verge of ruin.

Sir Raymond Hoffenberg, another distinguished president of the Royal College of Physicians, pointed out that while there is a universal wish for a health service that is good, fast and cheap, no service can ever be more than two of these. Once the Government has allocated the funds, the decisions on how it is to be most advantageously spent are surely better left to those who work in it.

They will have to grapple with impossible choices but decisions made by those who have to implement them should escape the more absurd effects of “the law of unintended consequences” that regularly turns the fine-sounding proposals of politicians to dust.

There will need to be a debate about what is strategic and what is tactical in healthcare; but the proposal that the Government will step back and remove the NHS from direct political control is probably the best news the NHS has had in the past 30 years.

SIR PETER LACHMANN
Past president of the Royal College of Pathologists and past president of the Academy of Medical Sciences
Cambridge

Explore Letters

• Feedback