When I went to a meeting at the PCT in November 2009 to voice my complaint about the patient registration policy, I said that if the KGB had infiltrated the Department of Health and Parliament with the intent of undermining British general practice, this is the sort of policy they would design and implement.
A succession of New Labour health ministers introduced policies which eroded and undermined quality in general practice and called them ‘reforms’. To me, a ‘reform’ is a change you introduce which makes something better. Some (not all) of New Labour’s ‘reforms’, in primary care and in secondary care, made things worse. Can we therefore, please, not call them ‘reforms’?
The following is the first sentence in the current Wikipedia entry for ‘sabotage’:
Sabotage is a deliberate action aimed at weakening another entity through subversion, obstruction, disruption, or destruction. In a workplace setting, sabotage is the conscious withdrawal of efficiency generally directed at causing some change in workplace conditions. One who engages in sabotage is a saboteur.
Andrew Lansley’s plans for primary care (and here I am thinking mainly of the plan for people to register with the GP practice of their choice anywhere in England, but it certainly applies to the other ambitions as well) will weaken and undermine the quality and efficiency of primary care. I don’t think he is deliberately setting out to destroy general practice, but were he consciously and deliberately setting out to do so he would not really have to change much. In that sense, he is an unconscious saboteur, and the workers at the Department of Health are unconscious accomplices.