Jobbing Doctor laments the loss of democracy shown in the NHS reforms
The ducks are lining up.
In the last week we have had thoughtful and well-argued editorials from the British Medical Journal and the Lancet. In both these respected journals (which have been publishing for more than 150 years) the opinion is unanimous.
Organisations representing those who actually do the work in the health service: the nurses, the doctors, the ancillary staff and others are unanimous as well, as was demonstrated in their joint letter to The Times.
All the people who write blogs and columns are also fore-square against the current proposals of change to the NHS.
The chief executive of the NHS, Sir David Nicholson, says the changes will be ‘visible from space’.
Currently, the NHS is not an issue for many people, as it is performing better than ever and levels of satisfaction are at a record high. There was virtually nothing in the election manifestos of 2010 to prepare for these changes, in either of the ruling parties’ stated plans. Eight weeks later we have a white paper that is bigger and longer than the original plans setting out the start of the NHS.
The Conservatives promised no top-down changes in the NHS. Within eight weeks they have on the table complex and detailed proposals for the biggest top-down change in 60 years.
This is not how democracy works. In my version, you state your plans and your vision. You take this to the country and the people vote on the choice laid before them. The politicians then govern on the basis of what they promised. This is how democracy works.
Either the coalition were appalled at what the old Labour government left behind, and worked ceaselessly through the night to get this plan ready. Or they lied to the people.
The inescapable conclusion that I have reached is that we were lied to. The politicians, the advisers and fellow-travellers need not ask why we, the people, despise them. The evidence is plain to see.
Many colleagues are bemused by the latest changes. The huge majority of us are simply ignoring the swirling of rhetoric and the smootching around TV studios by senior politicians. We tend to remember the old aphorism said, originally, about Harold Wilson:
Q: ‘How do you know when a politician is lying?’
A: ‘When they move their lips’
Three out of four GPs are critical of the white paper in a recent poll. I’m tempted to say I am surprised it isn’t nine out of ten.
I believe we are beginning to reach a watershed in the passing of the new health bill. The second reading of the bill was debated and passed by parliament in a day, with all the political parties voting on tribal lines – not a single dissenter from the Conservatives or Liberals. The debate, which I read through, was pretty puerile in my view.
My patients are asking me what I feel about the NHS changes, and what it must be like to have all that power. I don’t have time to lay out all my reservations to them (or I’d be working till midnight), so I tell them that it is all very difficult and not what it seems.
In another forum I have been accused of being a cross between an ostrich and a dinosaur. I object to the ostrich metaphor, but accept in part the dinosaur one – an effective and influential creature that was wiped out by sudden change.
As for the title of the White paper – Equity and Excellence: Liberating the NHS – this is hubristic beyond belief.
So says the dinosaur.
The Jobbing Doctor is a general practitioner in a deprived urban area of England.
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