I met with several of my general practice colleagues recently. Amongst them were GPs who had been qualified for over 25 years, nurses with over 20 years experience and administrative members of staff that had been working in the NHS for even longer. I asked them what they thought about health think tanks. The majority had no idea. In a room of almost 30 people they could only think of three, The Kings Fund, The Nuffield Trust and The Health Foundation. We struggled to think of any differences between them. “I’m pretty sure the Nuffield Trust is part of the Kings Fund”, said one doctor, and a couple of others nodded uncertain agreement. Some of the doctors were aware that other think-tanks had written reports undermining the NHS in general and GPs in particular, but the impression was that these had no expertise in health and so were of no relevance, being of interest only to sympathetic tabloid journalists.
In her introduction to Grassroots GPs, a website set up for GPs concerned about the direction that general practice is heading, recent president of the Royal College of GPs Iona Heath wrote,
In 1956, the writer George Ewart Evans published his masterpiece of oral history which he called ‘Ask the Fellows who Cut the Hay’ … There is a pervasive and disturbing lack of knowledge of the daily experience working at the frontline of public service let alone any valuing of or respect for that experience … It is undoubtedly true for those working in general practice and primary care which is particularly sad as we see, every day, the effects of structural violence and social injustice working themselves out in premature illness and disease and in blighted and shortened lives. This initiative can be seen as an attempt to redress this balance with a commitment to ask the fellows who cut the hay of general practice.
The business of ‘cutting the hay’ is a partnership between patients and professionals and the Centre for Health and the Public Interest is a partnership in the shape of a forum for debating and thinking about health policy. We believe that better health is created by expert partnerships rather than by public consumers and corporate merchants of healthcare or health policy. We want to hear the voices of patients and whistleblowers, carers and campaigners and all those who cut the hay. We want to think as widely as possible about health policy. Economists and politicians have been predominant in health policy in recent years and whilst their inputs are valuable, we wish to see more emphasis from social, anthropological, philosophical and other perspectives.
We believe that health is a social good and a healthy society is in the public interest. It follows from this that we believe that health policy making is in the public interest. There are many different vested interests in health policy, just as there are in the provision of healthcare and we want to see more open and transparent debates in order to restore the public interest.
There is a gulf between those who make health policy and those who have to deal with its consequences. The Centre for Health and the Public interest is here to open up the debate, reinvigorate it and help bridge that gulf.
I have been writing and will continue to write about the importance and complexity of the relationships between doctors and patients on my own blog at www.abetternhs.wordpress.com. Trust is a fundamental part of therapeutic relationships and the present pressures of an increasingly commercialized, competitive NHS put this in grave danger. Patients will rightly question whether treatment decisions are made according to their clinical needs or their doctor’s financial interests.
I hope to contribute to the blog from my own perspective as a GP working in a deprived neighbourhood in Hackney, deeply concerned with the ethical foundations of my own practice, and I extend a warm welcome to everyone and anyone who wishes to contribute.