Dobson’s dilemma: to make haste slowly

So far, so good. (Except for that nonsense about charges to patients.) The new government has made a sensible decision to do nothing much about the health service, and instead to concentrate on ‘health’, where it can appear decisive and determined without even getting out of bed.

And it has made a sensible choice in appointing Frank Dobson to take charge of health and the health service, because he is a plain speaking, relaxed and affable man-of-the-people who is politically skilled enough to squeeze the maximum gain out of ‘health’ and politically shrewd enough to balance the clamorous interest groups in the NHS.

The ‘health’ line is paying off already. Not only do we have telephone advice lines about health, and magazines on Men’s Health, but we now have a Minister for Public Health. The new Minister will be able to use the language of inequalities to talk about healthier living and working in healthier environments, and she will be able to use empowerment, exhortation, facilitation and enablement as her methods.

Apart from the feelgood factor in health, there is an immediate gain from this approach. The structure of the NHS is stuffed with public health-type people whose perceptions and efforts are validated by the Government’s new stance. Although the NHS may have no more resources, a core group of its erstwhile movers and shakers will feel happier than at any time in the last decade, at surprisingly little cost to the taxpayer. All that is now needed to top off this tactic is a showdown with the tobacco industry from which the Government can emerge righteous and virtuous. Watch this space!

In the health service the professionals may be feeling the heat, but the Government genuinely values them and their perceptions, while also understanding that smugness, complacency and corruption are always just around the corner in a public service. Everybody needs some gravel in their shoes to keep them on their toes, but how to get it there without upsetting the front line workers? Here Mr. Dobson must play a waiting game, letting the old order seep out of the system and the demands of the different fiefdoms emerge.

Fine to put fundholding on hold and to end the featherbedding of existing fundholders, so that the fainthearted can rediscover their reluctance and return to the NHS fold whilst the friendless zealots get bogged down in the struggle to survive. Wise to review the PFI schemes case by case, allowing local pressures and the market itself to erode the unsustainable and contain the workable. Perfect to let re-configuration of primary care proceed at a slow pace, reshuffling the energies and skills in a service dulled by age and tradition. As for resources, of course we need more, but when did we ever need less?

So what is the problem? It is risky, that is the problem. The United States has an amazing, innovative and dedicated Public Health service in a ‘health’ conscious nation with third world health indicators and unequal health care for its citizens. We could have the same, for fundholding, PFI and the ‘primary care led NHS’ are all privatisation levers, and they remain in place.

We have all spent so long feeling and being powerless that we may have to re-learn how to act politically. The new Government is giving us breathing space to do just this, but must also give it to its opponents — who will work strenuously against equity in health care while being indifferent to inequality in health. Who will occupy the high ground first? Watch this space!