Public accountability

BMJ 1997; 315 doi: (Published 01 November 1997) Cite this as: BMJ 1997;315:1167
  1. James Owen Drife, professor of obstetrics and gynaecology
  1. Leeds

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    Every year, around the autumnal equinox, our trust holds its annual general meeting. For weeks beforehand posters in exotic languages appear beside the lifts. I wonder what we would do if non-English speaking members of, say, the Thai community actually turned up. We could give them a synopsis of our report to read. “Last year we treated more patients than ever before” probably sounds quite fresh in Thai.

    Before the meeting the board gathers for a briefing on possible googlies. Some members are shaking their heads. For the past five years our AGM has passed off bloodlessly, but this time things will be different. In this postelection year our deficit will not be quietly massaged away and cuts in services have been trailed.

    The podium in our lecture theatre is not quite long enough to accommodate the board with dignity. We shuffle chairs and the chap on the end looks apprehensive. Lined up behind the draped table like a low budget party conference, we gaze impassively at the public.

    The same faces as last year gaze back. This is an annual reunion, with everyone in their traditional places. In the front rows is the Hard of Hearing Club. In the aisle are the guide dogs, and to our right are a few familiar members of the community health council. Behind them rise row after row of trust employees and, standing at the back, men who don't want the commitment of a long term seated relationship.

    We look up expectantly. Where is he? Our usual latecomer arrives at the last minute—a short, bearded man with pebble glasses and a pointed woolly hat, like a myopic Big Ears. At question time he always asks excitedly if there are any MPs present and then complains that he has not seen the meeting advertised. His accent defies location. Bolivia? Kazakhstan? Lancashire?

    One of the standees keeps leaning accidentally on the dimmer switch. The chief executive reports that our major purchaser is underfunded and we cannot go on treating patients for free. The finance director's report is aimed at the person on the Cleckheaton omnibus. Even I can understand it. Our deficit is clearly illustrated with a computer graphic. The plan for financial recovery involves doing less work.

    The chairman invites questions. Two hundred people fall silent, depressed by the Powerpoint graph. The patients' advocates tell us kindly that we are doing the best we can in the circumstances. After years of listening to self serving economists they really believe the mantra that the demand for health care is limitless. The MPs, of course, have moved on. Goodbye Aneurin Bevan, hello Gordon Gecko.

    The few sparks come from the hard of hearing, well organised and grumbling through their sign language interpreter about acoustically insensitive architecture. As we leave the blood free auditorium we smile grimly. We get the message. The public is bored with the NHS. The only able bodied people who wanted to protest were trapped on the podium, staring at the stoical yeomanry, and waiting for angry shouts that never came.

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