Take a 180 degree look around

On my way to London on the train this morning I was momentarily confused by a double illusion of motion and stasis. To explain - the train was stationary at a platform alongside another when this second one moved off giving the familiar sensation that my own train was pulling off. However, this was not mirrored by the expected simultaneous sensation movement that ought to come with this and for a few moments I was disorientated, not to say actually quite dizzy. Only when I looked through the opposite window to see a branch of a well known coffee shop reassuringly static On the platform did my equilibrium return as my brain was able to make sense of the conflicting messages that had previously been passed to it.
And this got me thinking as we all relentlessly plunge into the daily routine, having and giving little time for reflection on even the most major issues that affect us in the longer term. The reason I was on the train in the first place was to attend a conference at The King's Fund on the implications of the election result on the NHS. Speakers from both the Fund and outside outlined their views on the times ahead - but in truth of course nobody knew anything for sure. There was a fair degree of consensus that the pledge to cut administration would be enforced somehow but, understandably, there was anxiety in the air in this management heavy audience. Many views on how to improve efficiency and the same for achieving quality in commissioning but surprisingly nothing about the proposed independent board. Much food for thought but little to aid the digestion, one might say.
And so I thought about my train analogy: perhaps we need to look in completely the opposite direction to achieve some clarity of thought. Rather than try and modify the system we currently have we should rethink it root and branch. The internal market, in place for nearly two decades, has not brought about the revolutionary change that was expected by the introduction of free market principles into a closed market. It should not feature as a part of our future. Rather, let us focus on the patient's journey along disease paths and fund these accordingly using well validated incidence and cost data and thus end the artificial division between primary and secondary care, surgeon and physician, acute and chronic care. Like it or not, the next generation of doctors and nurses will need to be well versed in the nuts and bolts of how the service is run and funded. This is not unique and applies in other countries so we should not be afraid of a slimmer, more accountable and transparent service that has patients at it's heart and healthcare workers as the drivers for change. Those who work within the service are best placed to advise on the way to change it for the better. This way we can achieve more agreement on what constitutes best practice and how to roll it out across the country. And the management infrastructure that has manifestly not succeeded in this to date can hence be drastically slimmed down.
If we miss this opportunity to revolutionize the way the NHS functions we may not have the chance again as then either the service will fail due to lack (or waste) of funding, or survive in some fiscally healthier future climate that allows this wastage to go unchecked again. We should not put ourselves in the position of seeing the train of opportunity leave without us being on it.
"The train now leaving ...." are not words we want to hear from the platform; rather we should seek to shout: "The old stations are behind us" as we travel down a new track.