Sacred Cows

Sacred cows: to the abattoir!

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7174.1730 (Published 19 December 1998) Cite this as: BMJ 1998;317:1730
  1. David Orchard, specialist registrar in palliative care
  1. Llandough near Cowbridge, Vale of Glamorgan CF71 7LZ

    Doctors' autonomy

    It was 1947. As the door closed behind Lord Moran, Nye Bevan turned to his permanent secretary, who was pouring generous measures of pre-war whisky. “Rotten negotiators, doctors. I would have given consultants twice that salary if he'd asked.”

    Sir Bartholomew sat down before replying doubtfully, “He certainly seemed anxious to conclude negotiations, even if it meant accepting a rather low offer.” He paused. “Minister, what were you hoping to achieve?”

    “Keep down expenses in this new National Health Service, obviously.”

    “Hmm.” Sir Bartholomew frowned. “Minister, no doubt you recall the proportion of costs that will go on doctors' salaries.” He slid a sheet of foolscap in front of the minister and tapped a column of figures. Bevan scanned them quickly and registered surprise.

    Sir Bartholomew smiled. “Not much, is it, Minister ? The real expense is here.” He pointed to a different column. “Drugs, investigations, other treatments. It all mounts up. And who tells patients they need these things?”

    “The doctors, naturally. That's their job.”

    “precisely. Negotiating a small salary for consultants will do little to contain healthcare expenditure. What you should have done, Minister, was to negotiate away their power. It is not inconceivable that Lord Moran's …

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