New health minister with not-so-new idea

Once again in the NHS we seem on the brink of the triumph of ideology over practicality. This time it is the fate of the NHS in London that is in the balance.

New health minister Professor Sir Ara Darzi was previously commissioned to review the state of the health service in London. While his report raises many important points about the variable standard of care available to patients in the capital, it also contains proposals tantamount to rearranging the deckchairs on the Titanic.

On the face of it there are sensible proposals such as access to diagnostic and outpatient services in the community and extended hours (fine if properly funded). But that is before you look a bit more closely at the ideas.

Professor Darzi believes these revamped services should be delivered in large polyclinics that would house a number of GP surgeries, X-ray and MRI and a range of other services.

This is all very well in theory but where do you site these services?

Existing primary care premises are too small or unsuitable in other ways.

No problem, says the professor, we'll use PFI to have new premises built - conveniently forgetting the statistics that show PFI projects such as LIFT cost the health service more than other approaches in the long term.

But large areas of London are built up, you might point out. That's okay too, we're told: you site the clinics on the existing NHS estate. In other words on hospital sites.

Yes, the great plan to improve services in London involves moving secondary care activity into the community by doing it in the same place, which turns out to be quite close to the community anyway. But it moves GPs further away from their patients and into unused hospital buildings.

Looked at like that, the focus of the London improvement plan seems skewed.

There are many places in the UK, including outer London, that might benefit from these suggestions, but they are clearly the wrong kind of emphasis for much of the area they are designed to help.

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