In the grip of spin

“Congratulations, Mr Blair, you have managed to alienate the whole profession,” stormed Dr Ian Bogle, chairman of the BMA council, in Belfast on Monday 5 July. The lack of consultation over NHS structural changes, low morale, the private finance initiative, and the enduring crisis over junior doctors' pay and working conditions were enough reasons for delegates to reward Dr Bogle's attack on the government with a standing ovation at the BMA's annual representative meeting. But the subtext of his opening day speech was anger at New Labour's doctors of spin. “We don't want spin with a grin. We don't want smile with guile,” fumed Dr Bogle, who even managed to look a picture of glumness in the following day's newspapers. Ironically, it was the first blast in the war of spin that reached its height in the middle of the week.

On 6 July, Dr Bogle's speech had seized the initiative. “BMA's dire warnings must not be ignored,” warned the Express, “The worst thing the government can do is fail to listen to the doctors.” The Sun's health correspondent, Lisa Reynolds, was more blunt: “Doctors yesterday launched a scathing attack on Tony Blair's handling of the health service and rammed home this message: The PM is bad for your health.”

On the contrary, that same day the government was launching a campaign for wellbeing—the delayed white paper on public health. The suspicion was that, as the government was expecting a lukewarm response, the white paper had been rescheduled to coincide with the BMA meeting, to be buried amid the abundance of health news that week. Even so, it would deflect some attention from the expected discontent in Belfast, especially over junior doctors' working conditions. While health minister Frank Dobson was launching the white paper, on the same day in Belfast, junior doctors' leader Dr Andrew Hobart was emotionally telling colleagues that they would even strike to improve their lot.

Meanwhile, the government published its response to former chief medical officer Sir Donald Acheson's report Independent Inquiry into Inequalities in Health as a supplement to its white paper, unannounced and largely unnoticed. Whether this was intentional or a blunder is unclear.

Would the next day's (7 July) press give the limelight to the plight of junior doctors? With the government keen to divert attention, Tony Blair decided to weigh in, obviously piqued at the BMA's criticism of NHS initiatives like NHS Direct, walk in clinics, and the private finance initiative: “People in the public sector are more rooted in the concept of ‘If it has always been done this way, it must always be done this way’ than any other group of people I have come across.”

His office also released advance briefings of a speech he was due to give later on Wednesday. “‘The BMA, like any trade union, is there to represent and promote the interests of its members. The government is here to govern for all the people,’ Mr Blair will say on a visit to the site of a hospital in Greenwich,” reported the Daily Telegraph. The next day, however, the paper noted that the prime minister had toned down his actual speech, perhaps in response to a robust defence of the public sector by the deputy prime minister, John Prescott. But Downing Street's spin doctors had done the trick: heart-wrenching stories about down-trodden junior doctors were given less prominence than Blair's frustration at the public sector.

Both, however, were outdone by the controversy over a kidney donated for “whites only” and accepted by the transplant authority. That story was on the front page of four national newspapers on Wednesday, while Tony Blair's outburst hit three front pages, and the junior doctors came in last with only one front page appearance.

The “whites-only” kidney was actually donated in July 1998, so how was it that the scandal broke a year later? Doctors and journalists at the BMA conference were suspicious that it was another diversionary ploy by the government, while some columnists suggested that the story was put about by the BMA to focus attention on its debate on presumed consent.

In the weeks leading up to the BMA meeting, Matthew Hill, health correspondent for the BBC's Newsnight programme, was alerted to the situation by members of the trade union UNISON working at the headquarters of the UK Transplant Support Services Agency in Bristol. Newsnight planned to run the story on Thursday 8 July, the day of the BMA's debate on presumed consent, and Matthew Hill contacted Frank Dobson on Tuesday 6 July to arrange a comment from him on the day of the programme. He didn't have to wait that long, however. By the Tuesday evening, the Department of Health had contacted the Press Association with a statement by Frank Dobson deploring the incident and ordering an immediate inquiry.

Was this merely damage limitation or was it pure opportunism, to wrench the health agenda away from the BMA and deflect criticism from the government? In view of their renowned proficiency in the art of spin, it is difficult to imagine that New Labour's media managers weren't pulling the strings. Colin Brown and Jeremy Laurence explained to their readers in Wednesday's Independent about Tony Blair's attack on the public sector: “Senior government insiders said last night that the offensive was part of a strategy by Downing Street to get a grip of the domestic agenda after setbacks in the European elections and damaging speculation of internal division. One senior source said Peter Mandelson's hand was behind the strategy. ‘It is classic Mandelson stuff. You create conflict to get your own agenda in the papers,’ he said.”

Behind the headlines are the men who create the news, usually doctors of spin rather than medicine, although sometimes both. The goal is simply to win public support and influence the debate, but the route is often tortuous, murky, and secretive. The rest of us are caught in the web of spin, hunting for the truth—if we can be bothered.