Blair's empty populist spin

History will not be kind to Tony Blair. Government by charm, spin and focus group means actions are taken because they are popular, not because they are principled or carefully thought through. Once Blair goes, without his spin the utter emptiness and disjointed nature of his policies will become all too apparent.

In the NHS, constant restructuring has led to expensive chaos. It is here that the Blairite doctrine of advocating change because change is cool has wrought havoc, dismembered a system that worked (more or less) and replaced it with a much more expensive one that is over-managed and highly unstable. After nine years of continual reorganisation, we are largely back where we started, with amalgamated countywide PCTs replacing the old county health authorities. Only the name has changed, but a lot of money and effort has been wasted along the way.

In exactly the same fruitless manner, the present government terminated fundholding, only to introduce practice based commissioning - fundholding by another name, but only clumsier.

Then there was the introduction of private firms, bringing potentially destabilising competition for existing hospitals, trusts and practices.

'Creative destruction' is what one commentator called Blair's attitude to the NHS. I believe differently: I just don't think he understands the long-term implications of his meddling.

In the mean time, the real needs of the NHS have been ignored. We have choice where patients don't want it, and no choice at all where we ask for it. Instead of controlling demand, his government has positively encouraged it, giving GPs even more work to do, yet at the same time failing to provide money for enough primary care building.

After Shipman, the nation might have expected revalidation would be introduced promptly: instead, we got the expensive and ineffectual window-dressing of the appraisals system.

Blair is full of charm, addicted to change and control and great on rhetoric.

We will be paying for his legacy for many years. We are about to hit an economic downturn and the nation's demography is ageing by the minute.

So, Tony, it's time to retire, because the NHS can't wait any longer.

- Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haynet.com.

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