Diagnosis Salons are usually convivial gatherings, meetings of people who are all singing from the same Clinical Leadership hymn sheet. Tonight didn’t feel quite like that. Brought together in the Kings Fund basement were 60 or so Diagnosers, the Prime Minister’s health advisor, a deputy director of the think tank Reform, and me. We were there to talk health policy. I attempted to raise some interest in discussing global health policy, but it was difficult. A mile down the road from us, the Lords were debating the Health & Social Care Bill. Global health wouldn’t get much of a look-in. A fierce debate about NHS reform was clearly the order of the day.
As we chewed over one issue after another, the tension started to clear and we found ourselves airing a rich debate. A debate far more nuanced than was being heard across most of the NHS. We started off a bit polarised: ‘private sector = evil’ versus ‘private sector = efficient, innovative, answer to our prayers’. NHS reorganization is such a controversial and emotional issue that it is easy to default to over-simplistic debate. We managed to get away from this quite quickly. What do we actually think about issues like competition? As individuals, don’t we want to be able to choose to see to a GP who we know is good, even if it’s a bit of a drive? But does this argument really work with hospitals when – outside of London at least – convenience has a lot more to do with it? And what do we think about politics and the NHS anyway? The traditional complaint is that politicians should just stop interfering. But at least the arrangement means that somebody is accountable to the population for the NHS, in a way that systems elsewhere in the world are not. And what about the independent sector? Not to be trusted? Why? And aren’t GPs independent contractors anyway? And have you heard about Circle, the company that now runs an NHS hospital, owned half by City investors and half by doctors, nurses and other healthcare staff? What on earth do we make of that?
As the evening progressed, more shades of grey emerged, concessions were made. And we acknowledged that we – and most people in the NHS – had not had enough of this kind of grown-up debate. Somehow the Health & Social Care bill had almost been passed, and what we had mainly been surrounded by was anger, vitriol, and less-than-complete understanding on all sides of the debate. And of course, it is not as if there was just a single debate: it is difficult to be for or against everything in the Health & Social Care Bill.
I couldn’t say that we all left the room speaking with one voice, arm-in-arm, the problems of the world put to rest. But that there was perceptibly more mutual understanding than when we started, more acknowledgment of the complexities, more appreciation of the alternative perspective. Most still left the room feeling overall that Andrew Lansley was doing a terrible thing to our NHS. The majority were particularly upset that he felt the need for structural reorganisation, when most of the Bill’s aims could have been achieved without it. And why didn’t he communicate properly before he pulled this out of his back pocket? But there was a stronger collective conclusion: that surely more of this engaged debate between clinicians and policy makers would be a good thing.
So that’s the challenge to all of us doctors and other Diagnosers: the next time a Health Secretary pulls a shiny new Bill from their pocket, let’s do better. Whether it’s a good shiny new plan or a bad shiny new plan, let’s get ourselves faster to a position of informed and intelligent debate than we did this time round.
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