NHS reorganisations: who's kicking whom, who's protesting?

Editor—Hawkes' description of English healthcare is uncannily accurate: painfully so for those of us that have given much of our time (the best years of our lives?) to supporting the “New NHS”; for which, now read the “Old NHS.”¹ He is right to identify the kicking hierarchy as being important.

Figure 1.

I have often wondered how it is that we are all so proud of the National Health Service—as we tell people that we meet on our foreign holidays—but that we complain endlessly about the NHS. Are they not the same? I would argue that they are not.

The National Health Service (although invented by a far sighted politician) is a much-loved collaboration between patients, the public, doctors, nurses, and the UK government. Like the British constitution, or a well functioning family, it works without very much being written down. It is immensely powerful—any government that was seen to threaten it would be doomed—but the power exists only because people care for it.

The NHS is an administrative agency of the government that exists to ensure that the money collected by the government for the National Health Service is spent well. Unlike the National Health Service itself, the NHS is prone to being officious, bureaucratic, over-controlling and frequently just a pain. The NHS is meant to be a supporting structure and, at its best, it can do this very well. Even so, the NHS is relatively weak, and trembles at the sight of government ministers—just as government ministers tremble at the sight of the National Health Service.

So here we have the true hierarchy. The National Health Service kicks the government, and the government kicks the NHS. So next time you get an unintelligible letter with the NHS logo on it, remember that it has come from one of your servants.