I recently had the pleasure of listening to a talk by Professor David Colin-Thome, the former Primary Care Clinical Lead at the Department of Health. Although being a self-declared Labour man – more “new” than “old” I hasten to add – David gave an impassioned defence of the rationale behind the Government’s Health and Social Care Bill (HSCB). Why, you might ask? After all, with lashings of real politick Red Ed’s posse have ossified their position as virulent opponents of anything that comes out of the mouths of David Cameron and Andrew Lansley.
Actually, as Professor Colin-Thome pointed out it is quite simple. The NHS in its current form is frankly not good enough – not bad, but simply not good enough. Not good enough in terms of outcomes; not good enough in terms of productivity; not good enough in terms of value; not good enough in terms of optimising the unavoidable basic health economic problem; and not good enough in terms of concreting patient choice and the patient voice.
Cue the apoplectic faces, the clenched fists and the dropped jaws of crestfallen NHS conservatives (small “c”). “Did he just say what I thought he said?” and “You cannot say that” are the all too inevitable, and increasingly boring, text book responses we hear from the intransigent non-reformers. Given their success in forcing the recent “pause” and listening exercise, no wonder Professor Colin-Thome describes himself as a “depressed reformer”. I share his depression.
Although like me Professor Colin-Thome is a passionate advocate of a National Health Service that is universal, comprehensive and free at the point of need, to achieve these objectives the NHS has to change – and by change I mean evolve into a better and more responsive healthcare service. That word “evolve” is all-important. The general thrust of the Government’s reforms is more evolution, than the widely perceived revolution, building on the reform agenda pursued by successive governments of all colours. And this evolution (something all governments have concluded is necessary and unavoidable) is needed not just because of an ageing population and the concurrent increase in chronic long-term conditions, but also because healthcare itself is rapidly changing; all amidst ineluctable economic pressures and financial austerity.
This therefore begs a simple question. What is so wonderful about the current NHS that those who oppose the HSCB so defiantly defend? Although the HSCB in by no means perfect and can be improved, I have yet to hear a decent answer. I don’t see Ed Miliband and the BMA chaining themselves to their local PCT in protest of their pending abolition. That is because the level of debate over the HSCB is appalling low having now descended into an unreal debate in a parallel universe where politics more than policy rules the day. Indeed, some opponents of the HSCB are opposing things that aren’t even in the Bill. It recently dawned on me that many have not even read the HSCB and attendant White Papers. Either that or politics really is at play.
As the journalist Simon Jenkins recently propounded on BBC’s Question Time, you are damned if you do but damned if you don’t when it comes to the NHS – it is rightly a national treasure, but perversely is the one public service that is seemingly beyond reproach and reform in the eyes of the wider public. As Jenkin’s argued, for decades people have bemoaned the fact that the NHS gets booted around like a political football. So an SoS comes along who pledges to “get politics out of the NHS” through the creation of GP consortia and the NHS Commissioning Board, and people are up in arms demanding Lansley is shown the red card. It’s a perverse business health policy. Certainly potently political.
There is no escaping the car crash that has been the Government’s communication strategy over its NHS reforms. Being good on policy and wanting to get stuff done is not enough. Governments have to be able to effectively and reassuringly set out the case, and do so with emotional intelligence particularly when it is the public’s cherished institution.
But as Professor Colin-Thome said last week, for those of us who get it, see the need for reform and want to see the NHS survive never mind prosper, we all have an incumbent responsibility to go out there and make the case.
Responding to the Professor’s “call to arms”, I say to all “depressed reformers” shout loud and come join the evolution (not revolution). Your NHS needs you.