Been to a health care conference in Cardiff today arranged by the Institute of Welsh Affairs. Part of my ongoing efforts to broaden my knowledge. We all enjoyed listening to a Cardiff Business School professor comprehensively rubbished the Assembly Government's case for NHS restructuring - or more accurately pointing out that there's been no effort whatsoever to provide any evidence base on which to build justification for the Minister's proposals. And there's no meaningful attempt being made to establish a mechanism for judging in the future whether the reorganisation has been a 'success'. I daresay Cardiff Business School would do it for £100k!
I've never trusted reorganisations. During my eight years as an Assembly Member the two most significant reorganisations were the creation of the NHS structure that the current Minister, Edwina Hart is now demolishing, and the ill-considered, prejudice-driven incorporation of the quangos. Its accepted by all that the first was a disaster, and accepted by some that the second was the same. There was no attempt to base either of them on evidence, or to put in place any attempt to measure whether they were successful.
Now to the point of this post. A contribution by Sir Leszek Borysiewicz, the Chief Executive of the Medical Research Council helped clarify my thinking today - on a subject he wasn't even talking about. His subject was innovation in the NHS, and he was asking why on earth any senior manager should act innovately. Any failure of innovation inevitably leads to public condemnation, with demands to know why the money wasn't invested in the tried and tested. And unlike in the private sector, there is no bonus structure to reward success, thus making the risk associated with innovation worthwhile. So there's no innovation.
Regular readers will know that this blog has been struggling to arrive at an opinion about 'presumed consent' with regard to human organ donation. And this is what Sir Leszek's comments caused me to think. Under the present system of 'opt-in', there is a systemic incentive driving the desire to persuade people to become organ donors. The more people who 'opt in' and carry a donor card, the more organs there will be available for transplant. Now if a system of 'presumed consent' was introduced and people were to be required to 'opt out', the only systemic incentive would be have no publicity, no public awareness and no public discussion at all. There will be howls of protest that the new 'presumed consent' will be set up with all sorts of safeguards, but in my opinion its always as well to look at the inherent interests when making a judgement..