Sunday, 6 February 2011

Big Society? No - Big Responsibility

Well, it never really looked like living, did it? The last week has witnessed several pre-terminal gasps from Mr Cameron's Big Idea. Charities leaders are lambasting the public sector cuts that are severing the lifeline that should have fed the initiative and a flagship council withdraws from the programme citing, again, cuts.
The fundamental flaw with the Prime Minister's idea is that although the British public are by and large very keen and able volunteers there is a vast difference between helping to run something and running it. This he has failed to grasp. The financial, legal and moral implications of taking on ultimate responsibility for an enterprise, be it library, school or local swimming pool, is a world away from donating even large amounts of time to it. And so it is that the Big Society will die a rapid death, unmourned by most, leaving the Coalition's flagship ideological legacy in tatters.
What implications this will have for the Health Service remains to be seen. Whilst I am sure that not even in his wildest dreams did Mr Cameron envisage local people clubbing together to run a 'failing' hospital (I am crossing my fingers here) there may yet be knock-on effects with respect to GP commissioning. This other half-misguided policy leaves GPs holding much of the NHS budget to purchase care for the patients (purchasing care, you will notice, that is also given by themselves). Who gets a, for example, physiotherapy contract is no longer a given but groups could tender bids just as in the world of business. Whilst clearly these sort of bids are outside the general level of Big Society thinking it is not hard to shift the ideology up a level and expect suitably qualified groups of independent specialists in this field or that to make bids for fragments of contracts for a myriad of services.
The more fragmentation that goes on, the less smooth the patient's journey from one medical staging post to the next. Those with chronic diseases will be proportionally more affected as they need more 'fragments' of care.
The death of the Big Society, its own highly suitable acronym, might help limit the amount of this breaking up of our national treasure that can go on. Perhaps there is after all a silver lining.

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