By David Jolley

It is 50 years since we became a decimal currency. Do you remember the difficulty of working out that a shilling had become 5p? A pound which had been 20 shillings, 240 pennies (d), had become 100 pence (p) – and d was eventually to disappear altogether. Maybe we have never regained a sense of real monitory values ever since.

We are living through a tumultuous multi-facetted change imposed on us by the Covid-19 pandemic. Economies are struggling to come to terms with the rules of repeated lockdowns, loss of key staff and loss of confidence. Care and healthcare systems and their staff are working harder, under more pressure, and with ever-present stress of illness and death themselves.

My appointment as a consultant psychiatrist in the NHS 1975 came very soon after the implementation of the first reorganisation of the NHS NHS Reorganisation Act 1973 | Policy Navigator (

It seemed like a good idea and we set to work to deliver better services within the new framework. Sadly, since that time there has been almost continuous modification – sometimes modest, sometimes radical, and often associated with the name of a new Minister of Health Reform of the National Health Service Chronology (

Now, in amongst the turmoil of the pandemic, we have a proposal to change the way the NHS and other care agencies are organised. Many will feel that change will be beneficial, but most will agree with Professor Philip Graham that honest address of the most basic problems of inequality is needed, whatever the arrangements of delivery of care we have:

Counting the cost of NHS reorganisations | NHS | The Guardian

 Most of the changes to the NHS proposed in the government’s white paper (NHS and social care blueprint: key points, 11 February) are sensible and welcome, but there should be no illusion that they will make the slightest impact on the two major problems affecting health and social care: the neglected social determinants of health, and a depleted workforce. If people can’t afford to eat healthily, for example, no amount of information on food packaging will reduce rates of obesity. Only lifting people out of poverty will make a difference to the obesity epidemic. Integrated care systems are desirable, but only pooled NHS and local authority social care budgets combined with greatly increased funding will enable the workforce to become fit for purpose.
Prof Philip Graham

Integrated Care Systems are surely fine. They speak of collaboration rather than competition between the parts – we could almost be back to 1975.

Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England | The King’s Fund

And whenever reorganisation is mooted, we are referred to the quotation attributed to Petronius Arbiter, a Roman official at the time of Nero: ‘We tend to meet any new situation by reorganising, and a wonderful method it can be for creating the illusion of progress while producing confusion inefficiency, and demoralization. ‘

We have become aware that Petronius probably never said anything like this. It might have been coined during the Second World War – but its presentation to print came from a magazine article “Merrill’s Marauders” (Harper’s Magazine, 1957) by Charlton Ogburn.

 In full, it read: We trained hard, but it seemed that every time we were beginning to form up into teams we would be reorganised. Presumably, the plans for our employment were being changed. I was to learn later in life that, perhaps because we are so good at organising, we tend as a nation to meet any new situation by reorganising; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization.

This is not to say that all change is bad – change is invigorating and necessary to survive and flourish in a changing environment, but it needs to be carefully planned and conducted. The thrill of ‘radical’ can lead to damage which we neither want nor should afford.

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