BMJ  2008;336 (24 May), doi:10.1136/bmj.39588.493449.47

Editor's Choice

Reds

I’d like a pound for every new idea that’s been rolled up into Lord Darzi’s NHS review. Hardly a week goes by without the addition of another one. Last week there were two: expanding the programme that has patients evaluating their own treatment, followed the next day by a proposal to use these evaluations to adjust the prices paid to hospitals. (Darzi’s review was "not about changing the way the NHS is funded or structured," you may recall.) IT professionals call this proliferation of objectives "scope creep," and it’s the commonest reason why IT projects crash and burn.

Whitehall watchers say that paralysis has gripped the Department of Health ever since Lord Darzi embarked on his review. Anything other than strictly normal business has been put on hold, pending the publication of his report. Maybe that partly explains the government’s assessment of the Department of Health as the second worst performer among the 18 departments assessed. Health was one of only two departments to receive a red rating, which requires immediate action. Health earned its red for "serious concern" over its ability to set direction (Financial Times 12 May 2008:3; http://us.ft.com/ftgateway/superpage.ft?news_id=fto051120081302533397).

The Department of Health was awarded another red card this week from Sheila Leatherman and Kim Sutherland in their 10 year evaluation of the government’s quality reforms. (Nick Black discusses this evaluation in his editorial on p 1143; doi: 10.1136/bmj.a127). What caught their eye was "a predisposition to structural change and reconfiguration that undermines morale and produces widespread confusion," which they attributed to the political imperative to "make one’s mark." They detected a "‘flavour of the month’ tendency, where certain discrete instruments are infused with magical powers and implemented with haste as the sword that will slay the bad performance monster."

Polyclinics, anyone? This week we have assembled a range of articles to help people make up their minds. The logical starting point is Virginia Berridge’s surprising history of London polyclinics in the 1930s (p 1161; doi: 10.1136/bmj.39583.414572.AD). These were inspired by changes in health care in the Soviet Union after the October revolution. The Pioneer Health Centre in Peckham had a swimming pool, gym, boxing rings, dance hall, library, crèche, and a café serving "compost grown" food produced at the centre’s farm. But I digress.

Nigel Hawkes brings the polyclinic story up to date (p 1158; doi: 10.1136/bmj.39581.507627.AD). He can’t shake off his scepticism regarding Lord Darzi’s promise of consultation about something that has already been ordered by central diktat. (Ah, those Soviets!) The government’s 2008-9 operating framework specifies that all of England’s 152 primary care trusts will procure a polyclinic (or health centre, the favoured term).

Correspondents have spotted examples as far afield as Havana, Whitby, and Dorset, although the general practitioner behind the Hove polyclinic, which featured in the BMJ last month (p 916; doi: 10.1136/bmj.39552.381053.DB), says that this "building of useless spaces" was as far from the polyclinic concept as you will find (p 1145; doi: 10.1136/bmj.39583.689433.3A). Elsewhere Michael Dixon and Stewart Kay go head to head over whether polyclinics will benefit patients (p 1164; doi: 10.1136/bmj.a130, 10.1136/bmj.39577.412905.AD)—surely the only question that matters.

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