Nik Darlington 2.02pm
Medicus est timendum magis quam morbi.
'The doctor is to be feared more than the disease.'
Some Conservative MPs are wobbling, having signed a critical motion insisting that Andrew Lansley reconsiders his healthcare reforms. There will be some concessions in light of the Lib-Dem spring conference but the Health Secretary has insisted that changes will not be significant.
Unsurprisngly, therefore, Ed Miliband played on the acrimony and led with healthcare today. The Prime Minister described his opponent as “feeble” for relying on the work of others, scorning, “just as he has to back every other trade union, he comes here and reads a BMA press release.”
The Spectator's Peter Hoskin instantly termed David Cameron's remarks a declaration of war on the BMA. James Kirkup for the Telegraph described it as “opening fire” with a ”full-frontal attack”. However you portray it, battle lines are drawn.
If you know your history, you will be aware that the BMA has form when it comes to opposing healthcare reforms. In 1946, the doctors stood aggressively in the way of the biggest reform of them all - the Labour Government’s creation of a National Health Service. When a survey was taken in 1948, only 4,734 doctors were in favour of a National Health Service (out of 45,148 polled), which puts the pitiful vote over the weekend into embarrassing context.
They even went so far as to equate Nye Bevan’s grand plan to Nazism. These are the words of a former BMA chairman:
"I have examined the [NHS] Bill and it looks to me uncommonly like the first step, and a big one, to national socialism as practised in Germany. The medical service there was early put under the dictatorship of a ‘medical fuhrer’. The Bill will establish the minister for health in that capacity."
When Bevan held a summit with BMA leaders, one of them, Dr Roland Cockshot, recalled:
"We screwed our nerves up, we might have been going to meet Adolf Hitler. We were quite surprised to discover he talked English."
We should be thankful that these mild-mannered family doctors have outgrown such hyperbole. They no longer refer to Government ministers as genocidal Nazis, limiting their accusations to “damaging” and “ideological”.
These doctors have an amnesic institutional memory. The irrational and irascible opposition to the NHS in 1946 was founded partly on the belief that the Labour Government was eroding doctors’ cherished independence. How ironic, then, that the intention of a significant amount of this Government’s reforms is to hand power back to doctors and other healthcare professionals.
The Conservatives have been offering greater independence to doctors and nurses since the early years of David Cameron’s leadership, and long before that. Like the Tories, the Liberal Demcrats pledged in their 2010 manifesto to “scrap Strategic Health Authorities”, “sharply reduce centralised targets and bureaucracy”, put “front-line staff in charge of their ward or unit budgets”, and give “Local Health Boards the freedom to commission services for local people”. The two coalition partners’ plans last May were remarkably similar.
If David Cameron does fear the doctors, he is not showing it, and nor should he. Constructive dialogue is one thing, and the doctors - who are working day in, day out tirelessly to save lives - have a right to be concerned about aspects of the reforms and the pace of change. Changes must be made, yet the BMA motion insisted on the complete withdrawal of the NHS Bill.
The UK’s health outcomes have for some time been falling behind other countries, in spite of record investment. Meanwhile, pressures on our system continue to increase, with new technologies, more expensive drugs and an ageing population. Reform is vital.
The Prime Minister made reference to Gordon Brown as the ‘roadblock of reform’, and Ed Miliband as the ‘son of roadblock’. He was, of course, speaking not only to the man opposite him across the despatch box, but to men and women in white coats resistant to change in any form.
Throughout the history of the NHS, every step of the way, the vested interests of the BMA have dragged their feet. Nye Bevan defeated the doctors through bloody-minded will and character. As a result, we have a National Health Service that, in spite of its quirks and quandaries, is the envy of the world. David Cameron must display a similar force of character to that great Labour politician, and thus give the NHS a fighting chance of justifying its iconic status.