Tuesday 10 April 2012

Critical Mass

A long weekend in Bristol, a bit of a favourite with me as you can see from previous posts on this Blog. On Good Friday I clock up 28,000 steps on the pedometer as we climb up to Clifton, cross Brunel's suspension bridge (scarily high above the Avon!) and back around the docks to the centre.

On Saturday I bump into a demo by local NHS staff with whom I have a good chat. They are worried about the new (English) Health Act, creeping privatisation, etc. This is another reminder of the frustration which those of us who believe in reform face as a consequence of the dog's breakfast which is this Act. It has probably set back real reform by a decade or more because of the suspicion it has raised in the public's mind about the UK Government's intentions. And it's the public's view that matters - I was never going to persuade the demonstrators in Bristol that there is a case for reform but the public could buy into reform (which actually has strong cross-party support though you may find it hard to believe after the furore over the Act) if it was thought through, explained properly, and piloted and tested rigorously.

My own prediction is that, without radical reform according real choice and control to patients, the principle of the state ensuring that quality health services are available to all will come under severe pressure. The middle classes will increasingly insure privately because they resent and don't trust the present "take-it-or-leave-it" and "when-we-get-round-to-you" system and then use their votes to beggar the NHS because they will have little or no personal stake in it.

The critical mass of privately insured citizens (who are much more likely to vote of course) could be reached quite quickly when prosperity returns and living standards start to rise again - assuming this ever happens of course!

And here's a snap of another of Brunel's engineering feats the SS Great Britain (top tip: you can get this close without paying the exorbitant entrance fee by peeking over the fence by the gift shop).