NHS Health Chat at The Kings Fund – Roy Lilley in Discussion with Mark Porter

Dr.Mark Porter, Council Chair BMA.- in conversation with Roy Lilley

Roy on his way in...

Roy on his way in…

Where to start? Well, Roy told a story of either Samuel Johnson or Pepys seeing a very sick patient in bed and saying that the best thing to give them was a good dose of Porter.  And that’s what we got…

(A quick aside that Roy also mentioned his mum having passed away – the duchess as all who read the e newsletter will know – and he was working even with that big hole in his life, “because she always said you must just get back on your bike”. There’s nothing more to say, Roy except say goodbye well, and remember the good times because that’s how people live on).

Background learnt? No-one in the family had been to University. Why medicine? Popular science on BBC, it seems…Attenborough, Civilisation, Desmond Morris’s Man Watching. This, in a week when the lack of scientific knowledge in news reporting had Prof. Brian Cox berating and then debating with John Humphreys on The Today Programme.  It does feel (vested interest – I’m originally one myself) that science gets either fictionalised or editors (all either PPE or English graduates?) give equal billing to opposing arguments when one has 99.9% of peer reviewed evidence and the other side has opinion dressed as fact. (e.g. Climate Change)

And that became for me a central recurring theme. As you know if you have been here before, this is my take on the evening – so is biased and opinionated – but here’s my personal highlights….

The young Dr Porter got involved in Medical Politics very early on.  It was seeing a poster held up by two junior doctors outside a London hospital saying “I have worked an 88 hour shift and now I am going to operate on your child…”. The campaign eventually worked (aided by the EC Working Time directive later), but I suppose he at least saw the power of words to move and engage people?

Is the BMA just a Trades Union? Well, that was 1970’s legal push. You couldn’t negotiate national pay structures without being one. The BMA had been a representative body for 140 years before then…but now every item on the news media says “The BMA ( the Doctors Trades Union)…That must be exceptionally frustrating.

Other controversies? Does the BMA have any influence? Well, governments don’t ask for inputs before legislation now. They consult on implementation problems.  Sounds like the BMA were very against The Lansley Experiment ….and have been proven correct, in my (and many other’s) views.  The Health and Social Care Act was an expensive failure, and continues to inform management decisions.

But what of the Managerialism that has grown like Topsy?  The BMA did push for Nurse and Medical Directors to be on Trust Boards. Roy worried about the potential to be conflicted – another recurring theme.  The pressure on Trust executives is immense – making whistle blowing even harder, I think.

Yes, the NHS is a complex system.  We talked all night in isolationist bites “The GPs.  The DoH.  NHS England.”  My view?  No one – but no-one – is taking a whole Systems view – a Holistic approach if you will. This is epitomised in the Social versus Medical care conundrum…evidenced in knee jerk condemnation of A&E failures, bed blocking, and GP access.  Do GPs need to be available 8 to 8, 7 days a week in their surgeries?  Probably not – most of the care is not urgent need led?  We already have 24/7 NHS. It is where you offer the service that is important to us users.

How can we magic up more GPs?  Dr Porter talked of stopping the haemorrhaging, the painfully skewed age profile, people not wanting to become GPs, the hate Mail (capitalisation fully intended). The carrots offered today by Secretary of State Hunt feel to me like rearranging the deck chairs on the Titanic.  As with everything else, we need to go back to patient needs and wants.  Like Quality and Outcomes Framework (QOF) – if we measure the wrong things, we will get the wrong results.

Maybe the government should have asked the BMA for their ideas first?  The problem will always be that any solution, however well researched and implemented will always look like an economic fix rather than patient results and safety focused.  I think the BMA sounds like it can still offer great input here.  Mark Porter looks up for the job – and re-election will at least preserve a modicum of continuity!

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