I have just emerged from three years stuck between the medical profession and NHS managers on one side and the public, the media, and local politicians on the other. The only issue was whether or not the NHS could continue to run a blue light accident and emergency department at Kidderminster Hospital, one of the smallest district general hospitals in the country, with no paediatric department and just a single consultant in emergency medicine.
Outwardly popular but dangerous services simply cannot be allowed to continue
I was the local member of parliament, a government minister, and the husband of a general practitioner. What could an MP do in these circumstances? Well there were only two choices—either back the changes recommended by professionals or back a futile, misguided but popular (and populist) campaign against them. No MP could try to sit in the middle of this storm.
Arguments for scaling down the emergency department to a minor injuries unit were overwhelming. The local consultants said that the department wasn't safe and the King's Fund, brought in by the campaign, said it wasn't viable. Local GPs, alienated by how insensitively the health authority handled the case for change, at first kept their heads down. When they finally went public with their support for the changes, local people simply disbelieved them. “It's a case of patients against doctors; someone has to stand up for the NHS,” a fervent woman said to me. I took the view that, unfortunate as it was, change was inevitable. The health authority didn't make the case for change very competently, but basically it was medically right.
What effect did all this have on me? Well, working as an MP became impossible and it led to my defeat at the General Election. Local people, whipped up into a state of high emotion, felt justified in abusing me while I was out shopping, pushing my children in the park, or attending a local football match. They complained that I did not understand local feeling. They claimed that I was just following the party line or that ministerial office had bought me off (which to anyone involved in Westminster is clearly nonsense). Eventually I was accused of being singlehandedly responsible for nothing short of mass murder. For three years I felt as if I was under siege.
It was not without its ironic moments. For example, someone who thought he was going to die as a result of having “his” accident and emergency department taken away from him slammed a door in my face. At that moment, my mobile went off. It was the president of a Royal College who called to say he was appalled about the turn of events and wanted to offer every support.
Am I glad it's over? You bet. Defeat was hard but not as hard as what went before. Life is more peaceful now. I have an anonymous life again and my children have their dad back.
How do I feel about it now? Well I don't blame the medics. They were right to follow the advice of their Royal Colleges, the King's Fund, and every other independent body that looked into the situation. When Professor Robert Winston came to Kidderminster and tried to explain how what was going on was precisely right, the local media dismissed his views. Lord Winston might be one of the world's leading doctors, the campaign complained, but what did he know about Kidderminster!
What will happen now? Well, the extra services for Kidderminster for which I argued while an MP are coming following a Royal College inquiry. Has my opponent, Richard Taylor, a retired doctor and now the MP, produced a plan to bring back blue light accident and emergency, the one issue on which he was elected? No, of course not, and health ministers say that he has no plans to do so. If there were a way to bring it back, Dr Taylor would have explained how to do it long ago.
Where does this leave local people? Well, like the Duke of York's army, they've been marched up the hill and down again. They've been told that in losing their emergency department, a great wrong has been done to them and that their lives are in danger. The local paper has repeated this claim week after week.
Where does this leave structural change in the NHS? That's the real question. I'm a lawyer and so had a career to return to. Losing my seat was a disappointment but not a disaster. Other politicians, learning the lessons from Kidderminster, may think twice before opposing any campaign against a change in medical services, however essential. Local medics don't see it as their job to sell change in the NHS to the public, and who can blame them? They are busy, pressurised, and most have no allegiance to the government or their local health authorities.
That leaves a vacuum—whose job is it to face down public anger? The Bristol children's heart surgery saga shows that outwardly popular but dangerous services simply cannot be allowed to continue. Unfortunately I cannot see there being many recruits for the job of being vilified as public messenger for essential NHS changes. We will all be the losers.
Footnotes
david@davidlock.net