Margaret McCartney: The NHS needs a new era of political leadershipBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j393 (Published 30 January 2017) Cite this as: BMJ 2017;356:j393
All rapid responses
Margaret McCartney is right when she calls for a consensus, saying "The NHS isn’t a one party stand but a marriage of population to philosophy". But it isn't happening, and at the moment the marriage seems pretty rocky. Why?
We are fiddling while the NHS burns, watching it deconstruct around us without any obviously coordinated movement to defend and develop it. It remains as overwhelmingly popular as ever, and commendable protest movements are speaking up for it, notably within social media. But the great national bodies concerned with the NHS are offering little in the way of concrete, strategic proposals, seemingly content to focus on detail.
Contrary to popular perception, the BMA can be proud of its advocacy concerning the NHS. In 1938 it was amongst the very first to propose one – long before Aneurin Bevan picked up and ran with the Conservative’s 1944 White Paper on an NHS. It was the BMA that responded to the desperate plight of GPs in the 1960s, demanding and quickly getting them proper support and working conditions, for the benefit of patients and the NHS ever since.
But where is the strategic drive now, when arguably the NHS is under a greater threat than ever before, both economically and politically?
If there are people who would like the NHS to fail, and for the UK to move to a fragmented, USA style of partial, health care market that makes a far smaller demand on the treasury, then they are very unlikely to propose a strategic assessment of how to maintain and improve the existing service. They will not be commissioning a Dawson Report, a Beveridge Report or a Royal Commission into the NHS, all of which in their times were highly influential in moulding national strategy.
If the government will not commission a strategic review, then national bodies concerned for the NHS should do so. The medical Royal Colleges, BMA, National Association of Social Workers and academic bodies such as The King’s Fund and Nuffield Trust could work together to commission a non-partisan, overarching way forward for a modern NHS that upholds its founding principles of equitable accessibility for all.
Just the formation of such a grouping and commission would send out powerful messages to government and public alike.
But they would need to be quick; there is not long to do so and still make a difference.
Competing interests: Andrew Willis is the author of "Practice Matters: the Early Years of Modern General Practice within the NHS."
I agree with Margaret McCartney’s point that “political leaders need to work for the population, towards goals that extend beyond the lifetime of their political careers.” As we know gathering robust evidence, either from primary research or from systematic reviews takes time and effort and I’m not convinced if all our policy makers in Westminster and the devolved administrations fully understand the process.
How often when presenting at a conference are we preaching to the converted? We need more of our politicians to engage with the evidence based process.
Competing interests: No competing interests
Good piece! Unfortunately, though, the idea that there should be consensus because all major parties are committed to the NHS and notably the principle that it is 'free at the point of need' misses out the way in which the 'free at the point of need' leaves too much unsaid. It's an oft-heard commitment that is part of what needs to be guaranteed - but by itself, it leaves a lot of room to redefine downwards, WHAT the NHS provides, ie, for it to be cut back so that it is no longer anything like the comprehensive and universal service that are its founding principles. So for example, US Medicare is 'free at the point of need' - but it is not comprehensive or universal.. The post-2012 and STP direction of travel suggests that sadly too many of our politicians are in fact happy to see the NHS retrenched to be exactly towards that kind of fall back system, with plenty more space for private involvement filling up the gaps. For more on this, see here. https://www.opendemocracy.net/ournhs/nhs-theresa-mays-dowry-gift-to-dona....
Ideally any cross-party talks would take as a starting point, the evidence based position that a comprehensive, universal, and public system is way more cost effective and administratively effective than such a two-tier system, as well as what the public expect.
Unfortunately again, attempts at cross-party talks so far have failed to commit to any red lines regarding the evidence and public feeling in favour of, nor to the maintenance of, a public, universal, comprehensive system. This is the reason that campaigners were opposed to the Milburn/Lamb suggestion of a cross party commission (see here https://www.opendemocracy.net/ournhs/ournhs/nhs-campaigners-say-no-to-nh...) and why Caroline Lucas MP withdrew her support from that attempt (see here https://www.opendemocracy.net/ournhs/caroline-lucas/why-i-have-removed-m...).
Without such red lines, the fear is that cross-party talks may merely facilitate a drastic escalation of cuts in what the public can and should be able to expect from the NHS whilst deflecting political blame. In terms of what parliamentarians and experts might sit on such a commission, sadly, we're a long way from the Black Commission of the late 70s.
Whilst day to day running and clinical decisions should be in the hands of doctors, questions about what resources go into it, from where, and the extent to which private sector involvement is presented as part of the solution (or part of the problem), are matters that need to be accountable to the public. So they are inherently political, not to mention matters on which there are considerable ideological divides both between and indeed within the main political parties.
Competing interests: No competing interests