Turning round NHS deficits

Editor—With these words, we were introduced to the idea of clinical governance: “A commitment to deliver high quality care should be at the heart of everyday clinical practice. In the past many health professionals have watched as board agendas and management meetings have become dominated by financial issues and activity targets. The government's white paper on the NHS in England outlines a new style of NHS that will redress this imbalance. For the first time, all health organisations will have a statutory duty to seek quality improvement through clinical governance.”¹

I was doubtful about clinical governance, although pleased that financial matters were to be thought less important than clinical ones.

In the Guardian of 23 January, secretary of state Patricia Hewitt was reported to be demanding that financial management be once again put ahead of clinical objectives.² By 26 January, apparently responding to the earlier story, strong financial discipline was to be a “prerequisite” instead of “top priority.”³ I fail to understand the difference.

Ham in his editorial asked whether private finance would really help the NHS.⁴ In an earlier editorial,⁵ about an earlier set of reforms, he asked the question that all governments refuse to ask. That question is: “What is the purpose of a national health service?” Until this question is answered, we will stagger from crisis to crisis, pressure groups forcing the government to give in on expensive but dubious therapies, while the government imagines that all it needs is the next big restructuring to get things right.

It didn't work for clinical governance, and it won't work for whatever comes next. The sort of courage needed to even ask, let alone answer, the question does not go with the need for re-election.