‘We can look forward to the vision for the next five years that we have all agreed on. We all agree that we don’t know what it is.’

To: Don Wise

From: Paul Servant

Re: Five more years

The general election looms and we find ourselves in a pretty similar situation to the political parties in terms of current position and future plans.

Basically we are not doing really badly but we could do better – we all love our NHS and have a bold vision for the future but not a clue how to get there, nor two farthings to rub together for the fare.

We are safer than we were five years ago but financially incoherent.

We use the word “patient” in every sentence where we haven’t used “sustainable”.

We’ve promised not to close anything (until at least 7 May) but, just like our politicians, we are considering coalitions with people we can’t stand.

‘Just like our politicians, we are considering coalitions with people we can’t stand’

We seem to have agreed a rough one-third/two-thirds split with the politicians on the £30bn black hole in NHS finances, which has all the credibility of the risk split between commissioners and providers in the new NHS budget.

Everyone seems to agree that honesty about how tough it is going to be is needed but no one wants to be genuinely honest about what that means.

We have all agreed to rule out top-down reorganisations when the main concern about doing them is that they have been ruled out. Instead we will be doing lots of non-top-down reorganisations, everywhere.

We have also agreed that the NHS is far too hospital centric but have focused all our attention on hospital performance and access, and couch our plans in terms of reducing pressure on hospitals.

So at the end of these five years of coalition health policy, characterised by two years of trying to implement reforms, followed by three years trying to unravel them, we can look forward to the vision for the next five years that we have all agreed on.

We all agree that we don’t know what it is.

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