Martin McShane: A tale of two citizens?

Four years ago I participated in scenario planning. The document that emerged is as relevant today as it was then – perhaps because it was looking “Over the Horizon,” taking a ten year view and considering plausible alternative futures for health care. We envisaged four scenarios: Fools Gold, Swimming Upstream, Red Arrows,  and A Tale […]

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Douglas Noble on the fragmentation of public health

Talk to almost any public health specialist and they’ll express their biggest concern about the current NHS reforms in England as fragmentation of the public health service. To understand why fragmentation is a bad thing, we first need to know what it is that could be broken up.  Public health has traditionally consisted of three main domains […]

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Martin McShane: One organisation?

In a recent letter Sir David Nicholson began to make clearer how he sees the NHS commissioning board and GP commissioners working together. It is a very important letter and warrants reading very carefully. The appointment of Sir David as the Chief Executive designate of the NHS commissioning board, late last year, seemed to signal that […]

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Richard Smith: Competition versus integration

“Competition in health care should be tactical not ideological.” That was the main message from a recent debate on “Competition versus integration in the NHS” organised by the Cambridge Health Network and the King’s Fund.  In case you haven’t heard of the Cambridge Health Network, it might crudely and unkindly be described as the opposition […]

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Martin McShane: The dog that hasn’t barked

As we wrestle with uncertain futures, financial stringencies, and retaining a focus on ensuring services continue to get delivered, there is a creeping realisation that something is missing. There is a bill before Parliament which details, in jargon that defeats me, the changes to the structures for commissioning. It lays out the way the system […]

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Paul Hobday on another NHS reorganisation

This is about the 13th reorganisation I’ve seen in my 3 decades as a GP. Up until now I’ve put it all down to the fact that politicians can’t resist “fiddling,” and if we called all managers administrators instead, they’d administer rather than think they too have to introduce change for change’s sake or to […]

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