The second Peasants Revolt?      

Despite pleasing headlines, to doctors that is, in the serious England national dailies such as “We should treat our doctors like gods” - author/journalist Andrew O’Hagan and “Leave our doctors alone, Sir Liam” – journalist Liz Hunt on the egregious England Chief Medical Officer (aka its ‘most senior  doctor’, spare me), locally and nationally the NHS is boiling, not just simmering, as public and professionals strive to preserve such health services as they have. This is notwithstanding new premier Gordon Brown’s promise of handing power back to the public and medical professionals.

I have written here before about the South-East of England which includes my Chichester base. Stand at any busy roundabout and you will notice flags streaming from car windows rather as I recall Gaelic football supporter cars sporting flags emblazoned with the favoured county colours, converging on Sunday from three compass points on Croke Park. Here the colours declaim ‘Save St Richard’s’ – the local DGH. Many believe that despite ostentatious ‘public consultation’ its fate has already been stealthily sealed: that it will lose its greatly valued A&E, maternity and paediatric services within a massive revamping of services by a monolithic faceless South East Coast Strategic Health Authority covering a massive population involving Sussex and Kent.

The (health authority) planned ‘public consultation’ dates and venues have been spelt out. The faceless ones may need to arrange a quick and safe exit as the general public ire – not just some trade union type demonstration – is aroused. The average English person is slow to anger but when so provoked, can show an unexpected intensity of hostile response. Their abiding default setting is live and let live. But when something is rotten…feel free to call me alarmist, but, this is where I live.

There is just one DGH consultant in post who has spoken out publicly against the threatened trimming of services. I don’t think doctors in Southern Ireland realise how cowed – I do not exaggerate - senior hospital doctors are by management: how their right to speak out and influence policy has been constructively diminished as previously legal clauses which ensured proper professional right to publish or speak out publicly were abolished.

The centre - Government – also draws widespread opprobrium by its Modernising Medical Careers (MMC) policy and the shambolic Medical Training Application service (MTAS) imbroglio that engulfed and is convulsing postgraduate training over the several thousand shortfall on August 1 places for home-grown trainees. Already there is an established exodus of trainees to Australia and New Zealand while imports of foreign doctors with ill-vetted overseas qualifications are seduced in to plug gaps and face an uncertain future in the national health service..

The BMA, and I remain a member, has greatly failed the profession over many years as it endorsed the envy-of-the-world NHS and effectively colluded with politicians in well nigh asphyxiation of an honourable and rightly proud great profession. It (BMA) seems to comment almost as detached observer, rather than vigorously opposing where appropriate. Both revealing and puzzling are some recent resignations. On March 31 a Professor Alan Crockard (‘an eminent neurosurgeon‘, I’d never heard of till then) resigned. It was revealed he had been the government appointed hotshot responsible for the thoroughly discredited,  MTAS for appointing trainees..

His defence was that he became increasingly aware that he ‘was given responsibility but less and less authority’. Doctors, including neurosurgeons, are not stupid. Yet it took him a year to find this out as medical voices appealed to, and roared at, the deaf Academy of Royal Medical Colleges not to cede to government its (Academy) own power to decide medical training policy and thus allowed itself to endorse poodle tenth rate government medical policy.              

Then on 20^th May the chairman of the BMA for the past 4 years, Mr James Johnson, fell on his sword (I trust duly anaesthetised beforehand) because, he alleged, as a consequence of his attempt to defend the government’s Chief Medical Officer , Sir Liam Donaldson. The latter species is sometimes described as ‘England’s most senior doctor. Well. I never…

Now I respect the work of public health doctors as much as the next medical man or woman. But this particular physician who has probably not formally treated a patient in upwards of twenty or thirty years has advised that the GMC Fitness to Practice body should operate on civil court’s level of proof – balance of probability – rather than that of criminal courts’ ‘beyond reasonable doubt.’ This has profound litigation implications for doctors. He also pushed for the MMC changes which so incensed the profession that there is talk of expelling him from the BMA (now there’s a threat).

He (England’s ‘most senior doctor’) is in effect a straightforward civil servant who will do his political masters’ bidding whatever ‘modernisation’ they come up which might reasonably be expected to complete the evisceration of the medical profession and undermine good patient care as we have known it.

This brings me to the rapid rise of Professor Sir Ara Darzi MP, another noted neurosurgeon with an impressive clinical record who hails from my old Alma Mater and surely that should bring a glow to this Jeremiah. Now new broom Gordon Brown and his Health Secretary Alan Johnson have declared not exactly a moratorium (“breathing space”) on more reorganisation of the NHS etc but, Lo, Sir Ara is now a Health Minister appointed by Health Secretary Alan Johnson and is expected to produce, yes you are right, a new health service reorganisation. It appears that Sir Ara favours the development of ‘super hospitals’ over DGHs which would then be downgraded to cottage hospital level.

A surgeon (thank goodness not another neurosurgeon) David Nunn has observed that 15 years ago government thought it a good idea for consultants to do clinics in GP surgeries. The problem with that was that doctors were taken away from their hospitals, reducing the level of cover, increasing the level of risk for patients. And, it eventually emerged , the unhelpful Working for Patients (1989) policy affecting profoundly the working environment of hospital consultants during the later Mrs Thatcher years was the brainchild of – no ,not another neurosurgeon- but a single GP. Subsequently he was struck off the medical register for drug addiction.

So, while it initially gave me a vicarious warm glow that a graduate of my old medical school was getting on well, an arctic chill has beset my bones on hearing the curse he has accepted. I truly hope my pessimism will be replaced by optimism. Effective health delivery systems and a politician cherry picked individual one man band have proved a capricious mixture in the past.

The NHS is now Europe’s odd-man-out and over the past fifteen years the formerly Marxist states have moved to pluralistic healthcare systems in which private and public, together with a true insurance component, complement each other and in which state funding is not assumed to imply state management. Now, Cuba is the last country to share the British model and that is unlikely to survive Fidel Castro’s departure.

It is good when neighbours, such as Britain and Ireland borrow helpful hints from each other. But where health services are concerned let me ‘umbly suggest caveat emptor.

 Dr. Dermot Ward