Editor's Choice

Prophesying doom

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2070 (Published 15 March 2012) Cite this as: BMJ 2012;344:e2070
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}bmj.com

In Greek mythology, Cassandra prophesied the destruction of Troy, but no one believed her. Allyson Pollock may understand something of Cassandra’s frustration. Pollock has been prophesying the destruction of the NHS for years, with increasing command of evidence and language. Her warnings have become more dire as the threats she sees to the basic tenets of the NHS have grown.

This week, with colleagues, she presents a bleak view of what the latest reforms to the NHS in England will bring (doi:10.1136/bmj.e1729). Their legal analysis of the legislation concludes that the changes will enable commissioning groups to charge for health services that are currently free, exclude patients on eligibility criteria as yet undefined, and shake off responsibility for providing services for everyone living within a defined area. They see this as the route to reducing government funded provision, signalling a shift away from a mainly tax funded health service.

Whether Pollock will suffer the same fate as Cassandra—to be right and be ignored—only time will tell. With the bill likely to be passed next week, even the outspoken Royal College of General Practitioners, whose members must bear the brunt of the reforms, has offered to work with the government if the bill does go through (doi:10.1136/bmj.e2043). This news should come as no great surprise. By and large doctors are pragmatists, with their patients’ interests at heart. They will get on and deliver the service. The GPs’ concerns about the bill—fragmentation of care, conflicts of interest, being made responsible for rationing services—have been strongly felt and strongly expressed (http://blogs.bmj.com/bmj/category/nhs-reform/). But the college has taken the only reasonable course in seeking “an acceptable way forward” for the future stability of the NHS.

The BMJ will need to make a similar shift, away from focusing on the many inadequacies of the bill and towards limiting its damage once enacted. But meanwhile there’s more to be said about the poverty of the debate and political process that got us here. David Hunter and Gareth Williams offer their own scathing view (doi:10.1136/bmj.e2014). “Rescuing the debate about the kind of health system we want to nurture and sustain means removing it from the simplistic market based nostrums of economists,” they say.

Readers in other parts of the British Isles, not to mention other parts of the world, are likely to find our coverage of England’s health reforms boring at best and highly annoying at worst. In our defence, England encompasses 53 million people, compared with some nine million in the rest of the UK. And the world looks to the NHS as an exemplar of sorts, even if it’s one that no one else has chosen to emulate. Last week I spoke to the president of the American Society of Nephrology, who wanted his members to understand why so many voices, including the BMJ’s, were raised against the UK government. I did my best to explain. We agreed that, with Obama’s health reforms stumbling towards more socialised medicine, somewhere in the mid-Atlantic there may be a sunlit patch of sea enjoying the perfect health system.


Cite this as: BMJ 2012;344:e2070


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