As the starting pistol fired and the pundits yelled “And they’re off!”, I heard myself mutter “… and let the shroud waving begin!” Elections cause perfectly reasonable and intelligent people – well maybe not the MPs – to behave irrationally about NHS changes.
People who can at other times see that in too many places we have the wrong services being delivered to the wrong populations in the wrong settings and who accept that decommissioning and reinvestment make sense, suddenly become seized with a “thou shall not close anything anywhere” fervour. Otherwise people will die. Candidates look shifty and shuffle their feet when challenged by the media. One leader pledges no “forced” closures of A&E or maternity units. You know the drill by now.
Years ago I stood on a public platform somewhere west of Wimbledon trying to explain the logic for rationalising the number of casualty departments and acute beds in the sector (and good luck to those trying to do the same again now) when an A&E consultant got up and shouted proprietorially “people will die if you close our A&E”. His unfurled shroud instantly turned the room fractious. The health authority CEO and I knew we’d lost the persuasion battle. I was glad we didn’t lose anything else. People didn’t die. And of course, in time, that casualty unit in a crumbling building did make way for a new community hospital and walk in centre, soon to be the hub of a polysystem offering a much better mix of services to the local population.
I have a dream for this election. It looks like this.
1. Spare us another “War of Jennifer’s Ear” about legitimate demand management of ineffective or unsafe procedures. Everyone loses those battles and public confidence nose dives.
2. Beware the siren song of underemployed surgeons keen to blame everything they don’t like on McKinseys.
3. Let commissioners be accountable for evidence-based planned differences reflecting health needs of their populations. Now is the time to strengthen commissioning, not trash it.
Trying to provide everything for everyone everywhere all of the time cannot be value for money and just encourages unsafe services. And there is the small matter of saving £20bn and reducing management overheads by 30%.
It isn’t too much to ask. We are actually all in this together – to pinch a slogan. We can’t make the changes that the NHS must have without clinical engagement and leadership of service transformation from GPs, the most trusted part of the NHS. And neither can we do it without the informed consent of users and carers. So we should all get out there and inform, inform, inform and persuade, persuade, persuade.
But I suspect it won’t be like that. I can already see the shrouds being unpacked. Will someone please keep “those Save our [fill in the blank]” placards out of the hands of candidates. Just remember to duck the flying pigs.