A couple of things strike me this morning about the tension in current policy debates between the personal/local perspective and the collective/national view. First, Andrew Lansely's beleaguered Health Bill with its emphasis on GPs as commissioners on behalf of patients risks failing to convince that it takes account of the health system as a whole and the range of vested and legitimate interests within it. The patient's relationship with a GP is unarguably important in health terms, but it is not the only important thing. At the moment it feels like GPs have been put in the driving seat, which would be fine, if everybody else was on the bus. Strategic leadership and governance require attention to detail at the local level - outcomes for people are what we are all about - but keeping an eye on the whole system, sensing where the weaknesses are and being able to deal with them are also vital.
And why does it have to be either/or when it comes to local and strategic needs. It should be and/and, surely. The debate about the future of the Welsh Streets area of Liverpool rightly puts residents at the centre, but why is demolishing housing that could be reused the solution for these particular residents? If the homes are demolished,the residents will be rehoused. Why can they not be rehoused now , given the current poor condition of the housing, and the buildings retained to form the basis for reuse and redevelopment. If it is a matter of cost, we know that recylcing costs more in the short term, but on a whole life basis, reusing existing resources is a necessary element of our sustainable future. What we probably need is a new business model?
These are not either/or issues, they are and/and situations.
Think now and into the future. Think personally/locally and strategically/collectively.