I bumped into the health secretary this morning. (Well, if it wasn’t him, he bore an uncanny resemblance to Andrew Lansley).
I’ve spent the tail end of the week on the north Norfolk coast with my family. My kids were ‘crabbing’ on the quay side and I was in search of a Sunday morning expresso.
It was a beautiful, clear morning with a back drop of mud flats, geese and the sea. At this time of year thousands of Brent geese amass, rallying themselves for the long migration north.
As I walked up what passes for a ‘high street’ in Blakeney I’m pretty sure I passed Lansley. He looked tired. Maybe, like me, he’d been out to grab some fresh air and clear his head.
We have met in the past, but there was no flicker of recognition on his part this time. I’ll get over it.
But, it did make me contemplate the pressure he must be under. The coalition government is taking an enormous risk with the Health and Social Care Bill, and his career is on the line.
The problem he’s got - and I’m guessing from the look on his face this morning he knows it - is that he’s starting to lose the support of the profession.
Despite the initial optimism of GPs signing up to become ‘pathfinders’, research now suggests that suspicion is growing.
As Dr Hamish Meldrum, chair of BMA council, told MPs at the committee stage of the Bill: “We are conducting a large survey of about 20,000…there are some enthusiasts and some total rejectionists. There is also a very large group - probably about 70% or so - who are pretty sceptical.”
Few doctors are going to argue with more clinical control over commissioning, but a lot are uncomfortable with aggressive marketisation. Many can still remember the shortcomings of the ‘internal market’.
The BMA is holding a Special Representatives Meeting next month to discuss the way forward. The feeling is that the leadership could be forced to harden their approach with the government by the grass roots. Their current approach of ‘critical engagement’ is being, well, heavily criticised.
BMA opposition will not stop the Bill progressing. But, it would heighten the level of scrutiny around the approach and threaten the success of its implementation.
There’s no doubt that the health secretary has to renew his efforts to win the hearts and minds of the medical profession for the reforms. Indeed, I hear he is currently visiting clinicians all over the country in a bid to get his message across.
Certainly, recent developments suggest the government has realised how unpopular the spectre of the private sector is proving and is now trying to play down its influence.
It might be too late to keep the profession on board. Doctors fear the double whammy of top-down change and unprecedented rationalisation - and Lansley can’t do anything about that. Just when he needs clinicians most, the government is freezing consultant pay, slashing CEAs and looking to hike doctors’ pension contributions.
I hope he found some time for reflection on the north Norfolk coast. Something has got to give - whether it be the timescales or the extent of the reform. Like the migration of our feathered friends, who shared our crisp winter morning, the journey is only just beginning and there’s every chance they will be blown off course en route to their final destination.
Tags: Health policy
