Delan Devakumar et al: Politicians need to first do no harm

It’s been a monumental year. The UK’s decision to leave the European Union and the Chilcot report on the Iraq war prompt us to wonder why these self-inflicted problems ever happened. The legacies of David Cameron and Tony Blair will be dominated by Brexit and Iraq respectively. Different in many ways, but each was a self-inflicted political wound, with profound consequences for us all. Why cause these problems?

For Brexit, the political play was yielding to Europhobe factions in the Conservative party and agreeing to hold a binding “In-Out” referendum. Plebiscite democracy then ensued. Engaging in the Iraq war was global geopolitics, at its extreme. Both decisions have changed the course of history, leaving future generations to deal with the consequences.

The Brexit referendum was not the Cameron government’s first example of political self-harm. The Health and Social Care Bill created more crises than it solved, at huge and unnecessary cost, exacerbating the effects of continuously rising demand, on a background of national and global financial crisis.

The most important conclusion from these reflections is that these events did not need to happen. Despite the nearly 4 million votes UKIP received in the last election, there was no great clamour to leave the EU, nor was there for invading Iraq. Why do politicians feel the need to transform things? Do they need to be seen to act? Paternalistic politics, taking over from the doctor of years gone by? This goes beyond politicians to all kinds of leaders. A new leader comes in, makes changes to show decisiveness and action, afraid that minding the status quo is not enough. Change for change’s sake. Sometimes good, sometimes not, change is costly and stressful. In debate in The BMJ a few years ago, health professionals were asked to choose their best health secretary. A leading candidate was Kenneth Clarke. The reason being… he did the least.

In a representative democracy, politicians mindful of those who will need to re-elect them, do what will keep them in power. Would you vote for someone who says, “I’ll make no changes, but mind the shop really well” or who says “I’ll only try to make small incremental changes?” Novelty and grand plans sell. But the cold hard reality of the morning after inevitably dawns—an important cautionary nod towards the United States. This is not to say that change is not needed, but the extent and manner of change are not often given sufficient thought. The wise decision may be to improve the current system; to evolve, rather than revolve. Sometimes revolution and visionary leadership are needed, but politicians should follow one of the central tenets of medical ethics: first do no harm.

Delan Devakumar, clinical lecturer in public health, University College London.

Tazeem Bhatia, specialty registrar in public health.

Ingrid Wolfe, clinical senior lecturer public health, King’s College London, and consultant paediatric public health, Evelina London Children’s Healthcare, Guy’s and St Thomas’ NHS Foundation Trust.

Competing interests: none declared.

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