Thursday, November 20, 2003

So it looks like we're getting foundation hospitals, after much toing and froing between the Commons and the Lords.

This whole Foundation Hospital thing is really confusing me, probably because it epitomises the conflict I'm currently trying to work out, namely decentralisation or no.

As I understand it (which, I'll admit, isn't saying a lot) Foundation Hospitals would allow hospitals to split off from the NHS, to be allowed to run their own as NPOs. Naturally, this places less responsibility on the NHS/government to increase the service as a whole.

Implementation and NHS difficulties aside, I find the extremes of complete independence and completely centralised rule both equally foul. I think there is a paradigm I'm missing that captures both sides, but organises the structure in such a way that it is more efficient than either. It's like we're looking at the wrong targets, which means things are crap whichever way we go about it.

So I find it hard to decide between a liberal, decentralised (although the LibDems voted against it) view, and a controlling central view in this case. The NHS is a horrible, lacklustre, top-down organisation that needs a good kick. But gradually feeding parts of it off into the semi-private sector can't be that good either.

That's the other thing - is decentralisation a liberal or conservative ideology? On one hand, it encourages each node to act as it sees fit. On the other hand, it perhaps discourages interaction and tolerance.

I think a lot of it depends on the implementation. But confused, I am. I think I need to redefine the terms I'm using, nice and simple. Time to go through everything with a fine dictionary.

Of course, if anyone wants to explain it to me in nice simple words (it's been a long day...), please mail me or something. graham at

The world's so complicated. I'm just going to become a farmer and grow potatos forever.

p.s. Trafalgar Square looks quite busy at the moment...

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