Peter Bailey: The emperor’s finery

It was not of course in relation to the NHS that Tony Blair famously said “I only know what I believe.” His assertion was in defence of military action in Iraq despite the millions on the streets saying “Not in my name.” It is however a convenient method of ignoring the troublesome masses who disagree and it has a hint of direct communication with higher powers as an infallible guide to action.

Are we seeing something similar now with the Health Bill? I am observing from the sidelines, having retired three weeks ago after 28 years and many tens of thousands of consultations as a general practitioner.  I have also served on more than my share of committees and danced the quadrille with managers, hospital consultants, and politicians all trying to square the circle of funding and demand.  What I see is an outpouring of concern for the fundamental core of the National Health Service being expressed by its users and its practitioners, united in disbelief as the unholy coalition pushes on with reforms that no one believes will achieve the improvements in productivity that are necessary in order to secure the future stability of the Service.

Sceptics and unbelievers are surplus to requirements when a dogged policy of face saving is to be pursued. One can imagine the Emperor, having been unnerved by the shrill cry from the little boy sitting on his father’s shoulders drawing attention to the imperial nakedness, hastily calling together a crisis meeting of such courtiers whose acquiescent views could be assured, in order to bolster his confidence in his belief that he is indeed dressed in finery.

I may be wrong of course.  Today’s exclusion of the British Medical Association and the Royal College of General Practitioners from the Downing Street meeting chaired by Mr Cameron may indeed be necessary in order to allow a rigorous analysis of the risks and benefits of pursuing the bill without the inconvenience of dissent clogging up the free flow of belief.

On a positive note though, I think that it is not too late to make a decision to retain a key load bearing element in the structure of the NHS: dedicated NHS managers who are public employees with no conflict of interest and only the public and the ideals of the NHS to serve.  Let us keep the Primary Care Trusts, and build on the involvement of clinicians in decision making that we were working on long before the bill distracted us. It seems probable to me that a majority of doctors, nurses, and patients would support this step; politicians could have their faces saved and we could all get on with the day job.

Peter Bailey is a retired general practitioner, Cambridge