Rapid Responses to:

FEATURE: David Brindle Seeing red BMJ 2007; 334: 976-977 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Tilting at an icon: Richard Smith responds to Julian Tudor Hart (perhaps unwisely)

Richard Smith   (16 May 2007)

Tilting at an icon: Richard Smith responds to Julian Tudor Hart (perhaps unwisely) 16 May 2007
Richard Smith, Executive Director UnitedHealth Europe, London SW1 Send response to journal: Re: Tilting at an icon: Richard Smith responds to Julian Tudor Hart (perhaps unwisely)	David Brindle is impressed that Julian Tudor Hart should be as angry at 80 as he was at 18, but is this really a good way to be? I'd prefer if I make it to 80 to be calm and understanding of human frailty and the world's imperfections. What is the point of railing against life at 80? I worry that becoming an icon has been bad for Julian, a man whom I much admire. I'm flattered that Julian should be as angry with me as he is with Tony Blair. I don't deserve such attention, and I fear that he “doth protest too much,” perhaps reflecting anxieties about his “unswavering socialist line.” Has he seen Tom Stoppard's “Rock 'N' Roll,” where the unreconstructed communist cuts a somewhat ridiculous if attractive and amusing figure? Famously, if you were not a communist under 40 (as both Julian and I were) then you had no heart but if you were still one over 40 you had no brain. I feel that telling my grandchildren that I was a communist will be like telling them I believed in the phlogiston theory. Did Julian notice the Berlin Wall coming down? I have no doubt, however, that Julian and I still want the same from the NHS—high quality, accessible, responsive services for all and particularly for the most deprived. This an argument over means not ends, and our disagreement may have something to to do with our different historical perspectives. Julian says in his interview that “In almost all dimensions, everything is unrecognisably better than it was in the 40s and 50s.” The NHS brought services to those who had none. But my memories of the health service begin in the 70s, and I know that the NHS has failed to reduce the huge gap in life expectancy between rich and poor. I know too that the better off have consistently received better services, particularly in primary care. I also know from Hugh Gravelle's work that inequity in access to GPs is becoming worse—despite there being more GPs. Worse, I fear that the NHS has actually worked in favour of the middle classes—because it's so hard to fight your way through the system. My bet is that many BMJ readers have had to do that for members of their family. It's time to try something different, and I believe that the private sector can contribute to the NHS—through adding capacity, new skills, and competition. All the political parties agree, but we must wait and see. Competing interests: I was the editor of the BMJ, now work for a private company that provides primary care within the NHS, and have angered Julian Tudor Hart, the interviewee.