Since WW2, there has been no mainstream politician more toxic by association than Enoch Powell. It is now half a century since his ‘Rivers of Blood’ speech set a nadir for political discourse, which even the worst efforts of today’s politicians have so far failed to match.
But one of Mr Powell’s ideas remains curiously enduring. His hospital plan, implemented as Health Secretary in the early 1960s, put the district general hospital at the centre of the NHS, where it has remained ever since. Or as one hospital nurse put it to me recently, ‘the story of the NHS is that everything comes through acute.’ It’s not just rhetoric. Think of the A&E nurses you know, who will spend hours this winter dealing with elderly patients who should have been picked up by an adequately funded social care system.
To be fair, the Five Year Forward view does attempt to address this, and there are some reasons for optimism that new Health Secretary Matt Hancock wants to shift the NHS towards primary and community health in a new focus on preventative measures.
Mr Hancock’s problem is that his focus on personal responsibility will fall short of what is needed. Smoking rates haven’t just come down because people decided to mend their ways. Governments acted aggressively on imposing punitive duties, and banning advertising. Local authority chiefs might also allow themselves a wry smile at a Minister’s conversion to public health, when their budgets have been cut so deeply. If Mr Hancock wants his plan to work, he will have to get his hands dirty as well.
But any move away from a care model conceived at a time when the discovery of DNA was fairly recent news is a good thing. Mr Hancock prides himself on his techie image. Let’s see if he really can reboot the NHS.