Opinion: NHS feeling the winds of change - again

Peter Cardy, chief executive of Macmillan Cancer Relief

General Elections and reorganisations of the NHS follow each other like night and day. Patricia Hewitt, the latest Secretary of State for Health, reminds me of me when I got a new washing machine - excited by a new gadget but not sure what all the buttons do.

The Long Term Medical Conditions Alliance and Marie Curie Cancer Care are just two of the bodies with big commitments to the NHS that have pleaded for respite from reorganisation. But the process is already under way and yet another public consultation is set to follow, with a heart-sinking resemblance to Labour's Big Conversation of 2004.

The aim is to turn primary care trusts into larger bodies to commission services for their entire populations, instead of clubbing together for technologies and specialised services. PCTs will stop providing services - they will only be commissioners, buyers from other bodies.

This reorganisation will dwarf all its predecessors, however, because there is also choice, payment by results and the advent of foundation hospitals, with their charade of local democracy. There is contestability and other fundamental changes.

Certainly, it carries the prospect of an improved co-ordination of services.

If you're an ordinary patient, however, you have no chance of understanding what's going on and who is responsible for your healthcare - and that is not the only price. Five years ago, the last reorganisation produced a couple of years of chaos as staff applied for their old and new jobs, titles and powers were changed, corporate memory evaporated and plans and commitments were abandoned.

As far as Macmillan is concerned, it has specific effects. This year, we shall be spending about £70m on improving cancer care - big bucks for a charity. Next year, we will have to spend our funds in different ways; like in the last reorganisation, decision-makers will be awol, but probably for much longer. The signs are ominous - as PCTs start their merger arrangements, threats exist to key posts and services paid for from charitable funds.

It will be true for every voluntary body that works with the NHS, but commercial suppliers and providers will find themselves in the same boat.

Because of the commissioner-provider split, there will be a whole new raft of organisations with which we will all have to build relations from scratch.

What, then, will be the cost of all this? Is anybody counting and, above all, is anybody listening?

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