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There is an ideological fight going on in the NHS between those who think that patients will be better served if they can choose between competing providers and those who think collaboration and integration, not competition will improve patient experience and outcomes. The new NHS structure is a mess because the Lansley free-marketeers did not have enough power to get what they wanted in the end, and now the intergrationists are dragging things back their way. For my money, the real problem is that we have to start seeing health care and social care as one and the same (the purpose of care being to help those that need help to function in society) but even that does not get over the ideological issue of who pays - society (the taxpayer) or the individual. Systems thinking has a lot to offer, and (gasp) is even used effectively in my organisation to improve patient care and outcomes and to get rid of wasteful, unnecessary processes but can it get us over and past fundamental ideological issues such as who pays and competition versus integration - thoughts please....
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