Intended for healthcare professionals

Editor's Choice

Old, new—worse, better?

BMJ 2011; 342 doi: (Published 02 March 2011) Cite this as: BMJ 2011;342:d1381
  1. Jane Smith, deputy editor, BMJ
  1. jsmith{at}

As the bill that will radically change the NHS in England goes through parliament, people are starting to worry about the detail—as a series of news stories shows.

One concern has always been that the loss of strategic health authorities would lead to a loss of rational planning. Drawing on experience in south east London, where the SHA had to step in to organise a major reconfiguration of acute services, a King’s Fund report argues that the new NHS Commissioning Board must have responsibility for strategic commissioning because GP consortiums cannot do it (doi:10.1136/bmj.d1355).

Yet others worry that the NHS Commissioning Board may end up being too powerful. The BMA thinks that powers given to the health secretary and the commissioning board undermine government pledges to “put doctors in the driving seat” (doi:10.1136/bmj.d1343). It also fears that the bill will allow them to obtain and disclose confidential patient information without safeguards (doi:10.1136/bmj.d1291).

Iona Heath also worries about politicians’ intentions in her Observations column (doi:10.1136/bmj.d1273). She cites the prime minister’s claims that NHS health outcomes lag behind the best in Europe. These, she says, seem “to exploit the latent health related fears of the general public” to make otherwise unwelcome changes more acceptable.

There’s a Machiavellian intent too behind Darrel Francis’s filler on “How many consultants should you invite to a meeting to ensure it will never happen?” (doi:10.1136/bmj.c5906). He plots the chances of NHS consultants being available for a meeting—and shows that it approaches zero as the number of consultants reaches six. A delve into the BMJ’s archive shows that 35 years ago EJ Moran Campbell and M Gent made a similar set of observations in a Christmas article under the more neutral title, “On the probability of a committee meeting” (BMJ 1976;2:1551). Their maths are more complex, with more variables and decimal points—and the messages are gentler. “Responsibilities should be given to individuals … Committees should meet only to deliberate, not to disseminate or communicate.” Although the most powerful item in their probability table is the number of people involved in the meeting, the next most powerful is the number of uncommitted hours: “Herein is the second best hope of improvement: constrain the committed hours and protect the uncommitted time by habits which, as well as increasing effectiveness, if not ‘efficiency,’ are also more civilised. Thus do not have coffee at your desk—go to the cafeteria, the common room, the ward … at the same times as other people.” At rounds and seminars, “arrive early and hang around afterwards; have lunch together.” Oh for a more relaxed era.

But it wasn’t all better then. In his review of Dangerous Pregnancies: Mothers, Disability, and Abortion in Modern America James Owen Drife reminds us that within his medical lifetime the contraceptive pill was not available, termination was illegal, criminal abortion was England’s leading cause of maternal mortality, and “a woman who contracted rubella in early pregnancy could only hope, knowing that her baby had a 50% chance of being affected” (doi:10.1136/bmj.d967). Yet what impresses him more than the medical advances is the change in attitudes—“ to women, to ethnic minorities, to disability, to ethical dilemmas.”


Cite this as: BMJ 2011;342:d1381


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