It’s a traditional part of the theatre of health policy for trade unionists to give secretaries of state for health a hard time. The latest example of this was the vote of no confidence in Jeremy Hunt taken by the British Medical Association (BMA), which represents hundreds of thousands of doctors and medical students in the UK.
They did the same for Andrew Lansley after he pushed through his unpopular Health and Social Act. The act was passed but by then he had to go. Hunt, meanwhile says he’s not surprised the BMA passed the vote over criticism of hospital staff and patients.
It’s all very reminiscent of a Punch and Judy show. No wonder Hunt finds it all very “predictable”.
The traditional role of Mr Punch is to behave outrageously and accumulate a series of victims of his violent behaviour. This seems to be a nice description of the BMA’s political activity. Meanwhile Judy, a naïve soul who leaves their baby in the care of Punch, resulting in his sitting on it and feeding it into a sausage machine. Unfortunately this fits the bill for silly health secretaries whose evidence-free enthusiasms regularly cause hostility and inefficient reform.
As the playwright George Bernard Shaw said, professions are “a conspiracy against the laity”. And the powerful doctors lobby is a perfect example.
Punch with no follow-up
The BMA loves to criticise the continuous “re-disorganisations” of the NHS made on based on faith by successive Labour and Conservative health secretaries - but rarely offers evidence-based alternatives to politicians’ games with the NHS.
BMA Punch is, of course, also vigilant in maintaining the terms and conditions of employment of GPs and hospital consultants which keep him in the style to which he is accustomed.
Ideas such as paying all family doctors a salary - rather than keeping the current practice of partnerships, patient lists and capitation payments, where GPs are paid a set amount for each person they enroll - are treated with scorn in public. However, in private BMA members are willing to change - so long as they are compensated financially and end up better off. This happened in 2004, when a new GP contract was negotiated and GP earnings rose.
Earnings have since been falling but the average GP partner still earned £104,100 before tax in 2010/11 from both NHS and private work.
As ever the issue about such money grabbing is that if Punch and his members get more, who loses out? Ultimately, it’s patients and taxpayers who are the victims.
Instead of largely negative lobbying, the BMA should offer constructive, evidence-based proposals to remedy NHS woes. Instead, evidence of a fall in patient safety and serious incidents that affect the public are ignored. There’s no crusade to improve how we evaluate the ongoing healthcare reforms and learn from this experience. Or to deal with avoidable deaths, chronic disease and inflated healthcare costs.
As long as Punch’s flock maintains its clinical autonomy then all is good in BMA Punch’s world.
“Judy” Hunt, like his predecessors believes he knows what he is doing. He and his tribe declare they only make decisions based on evidence and that they demand more. But sadly, they tend to act more like comedy characters from Yes Minister.
Step one: we must do something.
Step two: this is something.
Step three: therefore we must do it.
Ministers of each generation and political creed “do it” without regard to evidence and rarely with any meaningful evaluation. For example, politicians love to talk about “community care” and “integrated care” but both policies still lack and evidence to show how effective they are, let alone whether they are the best idea when it comes to cost.
They also particularly like to emulate policies from the US and elsewhere, which like those produced locally are thick on rhetoric and lack any evidence that they’re cost effective.
When one reform fails what do they do? Repeat structural re-disorganisation. As Albert Einstein is alleged to have argued, folk who insist on “doing the same thing over and over again and expect different results” are clearly insane.
No amount of beating of “Judy” Hunt with votes of no confidence from Punch and his friends in the BMA is going to improve patient care and make better use of the resources we have. It’s a wearisome theatre that needs to be replaced by a constructive dialogue that mobilises evidence and evaluated what works in order to design better and efficient policies in health.
Unfortunately many in the media encourage this fruitless theatre as they like a good punch-up rather than more careful debate - even if that is what will improve care for patients and at the least cost.