Lucky seven?

Over the past 13 years, six people have held the post of Secretary of State for Health - their tenures varying from 11 to 44 months. Now, with the new coalition, we see the seventh, Mr Lansley, with a chance for a fresh start and a chance to make radical reforms within this most important public service keeping service improvement rather than political gain as the ultimate goal. Will he grasp the opportunity? Indeed - can he grasp it? Many would argue that his hands are rather tied by the financial constraints within which we now all need to abide for the next few years but I would contest this and furthermore suggest that, as the old military adage has it: there are never problems, only opportunities.
So can I offer Mr Lansley some pointers as to how to turn the apparent checkmate position of years of over- and mis-management plus a financial crisis to his (and the nation's) advantage? Certainly.
1. The already announced cut in manager bonuses is good, but does not go far enough. There is no earthly reason for there to be bonuses in any public service at all. Fine in the private sector where profits are all driving (except where the profits are made by the gambling of our money, of course) but the ethos in the public sector should be so different and be aimed at service, not profit. As such, the last people one wants to attract into this sector are those who are driven principally by the desire for wealth. The argument that the highest quality people would then not join is not valid for two reasons: one is the security of pubic sector jobs (with their still relatively generous pension plans); the other is that the public sector accounts for such a large proportion of the UK workforce - 1 in 5 - that it is impossible for everyone to 'migrate out' into the the private equivalent.
2. Manager numbers have doubled in the last decade. The reason for many of these was to monitor centrally set government targets. Abolish the targets to allow local hospitals and GPs to create services best suited to their own region - and at one stroke one can radically reduce manager numbers. The tail should stop wagging the dog.
3. Abolish Strategic Health Authorities. Even now they are often referred to as "The Health" (as they have neither strategic vision nor wield any genuinely respected authority), these bodies are a bar to progress that add nothing to the health of the nation. Three quarters of what they spend is on education - itself an area where an entire cottage industry of needless courses has sprung up - and this could be both cut and locally administered. This limb of bureaucracy could be safely cut with few to mourn its passing.
4. Following on from the above point the need to have a certificate for every activity thus creating the industry of educators can be drastically pruned. From the inability of ward staff to make a patient some toast because they lack the 'proper training' to the annual online self-assessment health & safety and equality awareness training that is a waste of everyone's time, education should be overhauled to include only the valuable for knowledge consolidation and to encourage innovation.
5. Scrap Clinical Excellence Awards for consultants who do private practice. This outdated system is much abused and is simply another method of distributing bonuses - and these bonuses are annual and pensionable. Given the high salary differential already present within the NHS this would help even out the terrain.
6. Along with the abolition of SHAs there should be a severe slimming down of the National Programme for IT (NPfIT), responsibility for which has rested with the SHAs for over three years now without any significant progress having been made. It is a costly utopia that we cannot currently afford and the idea of an integrated electronic patient record is still a long way off. Whilst laudable as an ultimate goal it is not achievable in the current NHS where stand-alone IT systems rub shoulders with commercial off-the-shelf ones and the whole, on the frontline, is still very much underpinned by pen and paper.
7. Cancel the ISTC contracts as soon as possible. The Independent Sector Treatment Centres are a financial drain on the NHS and do not provide the competition that they were misguidedly introduced to do. The cherry-picking of 'low-risk, high-volumes' cases, the upfront guaranteed payments irrespective of performance and the lack of accountability in standards all driven purely by the need to make a profit is hardly a recipe for healthcare success.

£6 billion pounds in cuts in the first year? Mr Lansley could do it all alone. Lucky number seven.