And I can see why we have got here. The White Paper and the Bill have been part of the collective consciousness now for 18 months, and in that time, I have seen a couple of things happen. I have seen lots of people take a long time to get a feel for what they think the Bill represents, and what its impact on the health service will look like. This is understandable, it is a complicated beast. Secondly, there has been the show of movement from the government, which has resulted in a staggering number of amendments, to a staggeringly large bill (but apparently about 700 amendments involved changing ‘GP consortia’ to ‘Clinical Commissioning Groups’) but little actual compromise; for many people, these amendments have been shadow dancing, and have only added to the sense of fragmentation that override the whole process.
These are real and heartfelt concerns, and whether the actual risks are real or perceived, the reworking of the Bill has served only to cement the view, that a Bill as remodeled as this one will result in a patchy implementation of a debatable model of progress. The whole sense of control, cohesion and accord has disappeared.
Add to this the added anxiety that we are being hoodwinked, and there is ample reason to get very intransigent about the whole affair. It reminds me of the story about the Cyclops I was told as a child (although I am not sure that the story is correct) that the Cyclops gave up an eye in a bargain they struck with some God - they thought the swap would give them the ability to see the future, but inevitably they were tricked, and the only future they were able to divine was the manner and time of their own death. ‘What would we really be signing up for?’ is a question that has lingered for many people when thinking about the health reforms
But it is important to remember that however poorly one thinks the government has handled this process, it would be odd indeed if they were motivated by a desire to do something harmful to the health service. It is in fact, highly likely, that Andrew Lansley thinks he is doing the right thing, and has come up with a very clever way of making the NHS more responsive to patient needs, while improving its efficiency. There are certainly a lot of people that he has failed to convince, but this does not mean that he does not think he is right.
And here we face a choice. We can either dig in, slog it out, and ensure that one side loses, or we can take a broader approach to the issue.
The scale of the debate is larger than any I have ever taken part in, but the principles are exactly the same as every disagreement we face at work. Remember how people behave when you tell them that you disagree. The first, and natural reaction, is to become defensive. If you tell people that their idea is bad, they will start by justifying their plans. No one will move, no will agree, and no one will end up happy. This is what happens when polarised views collide.
There is no point having an argument or debate if no one is prepared to modify their opinions. If you find yourself in this position, go and do something pointless but energetic, like squat thrusts, or star jumps. At least then you might gain some cardiovascular benefit.
What happens instead if you take a much more positive approach to disagreement? Instead of simply saying that the thing that is being done or proposed is wrong, or dangerous, propose what you would like to see happen instead. By doing so, one demonstrates where you actually stand, and measuring the distance between you becomes easier. It also allows you to establish what is really important to both sides, and what can be sacrificed. But most of all, it shows the person that you are debating with that you are not just being obstructive, but that you are prepared to be constructive, and engaged.
So, although I think it’s OK to ask the government to drop the Bill, we should also be offering our vision of what we should be doing instead. If we have no concept of how we are going to deal with rising expectations, rising technological costs, an ageing population and a flat budget, then we really shouldn’t be obstructing the passage of some legislation that Andrew Lansley has designed to deal with all of those things.
He may not be successful, but at least he has laid out a vision. And that’s important. So oppose the Bill, do so with gusto, but please, please have a think about what you would like to see happen instead. If we can all do that, then we can become people with whom the people in power are prepared to debate with.