The NHS reforms have thrown up many ironies. Charities have found themselves defending PCT-based commissioning (despite spending many years criticising its inadequacies), the Conservative right have rallied to the defence of Andrew Lansley (despite spending many years decrying his ‘wetness’ on health spending) and the way in which the NHS is managed has become more politicised (despite a stated intention of the reforms being to ‘free’ the NHS from political interference).
The extent that democratic involvement should play in shaping the NHS at a local level is a key dividing line within the Coalition. As I have written before on this blog, there is evidence that greater political involvement in commissioning may not lead to a better quality of decision-making. Nonetheless, the role that politics can play in improving health outcomes should not be discounted.
Healthcare is, and always will be, inherently political. It is an issue that touches everyone – repeatedly – throughout their lives and goes right to the heart of their sense of personal and family security, which is always an important determinant of voting behaviour. How much we spend on healthcare and the extent to which we are prepared to permit the state to intrude into people’s lives to improve health are big political issues and will therefore always require political involvement.
Few people would argue that health services have not improved as a result of increasing spending on the NHS and few people would argue that health outcomes have not improved as a result of measures to restrict smoking and prevent tobacco manufacturers from marketing their highly addictive and dangerous products. Both of these gains would not have occurred without political involvement health: the politicians made it easier for medicine to do its work.
In his superb book The Emperor of All Maladies: a biography of cancer, Siddhartha Mukherjee details the way in which scientific development, public concern and political commitment combined to deliver improvements in cancer services and outcomes for some forms of cancer. A critical breakthrough for those concerned with tackling cancer was the recognition that a disease needed to be transformed politically before it could be transformed scientifically. From action on tobacco and other carcinogens, to screening programmes, funding for research or approval processes for new treatments, the role of politics and communications has helped to facilitate, and indeed has stimulated, medical progress.
Of course the role of politics is not always positive. Without effective engagement between the worlds of politics and medicine, the impact can be damaging. Mukherjee describes how politicians have served to block or delay important initiatives to reduce smoking or prevent exposure to other carcinogens. Equally, poorly thought-through national research ‘crusades’ can divert attention away from areas where more meaningful, but perhaps less high profile, progress could be made. Clinicians and politicians both have a responsibility to engage to ensure these risks are averted.
The Emperor of All Maladies focuses primarily on the American experience of cancer. Yet, a similar pattern is seen in the UK. Investment in cancer treatment facilities, efforts to cut waiting times, encourage earlier diagnosis and improve access to treatment, as well as initiatives to encourage greater collaboration in cancer research have all required decisive political action. A couple of weeks ago Professor Sir Mike Richards was awarded the Communiqué Healthcare Communications Advocate award in recognition of his long-term contribution to improving cancer services in the UK. In making the award, the judges acknowledged that Sir Mike’s contribution went beyond medical excellence or indeed high quality administration to encompass his role as a diplomat and a communicator. It has taken more than medical credibility, expertise or skill (important as they are) to deliver these changes: diplomacy, communications and an ability to engage, reassure and excite politicians are equally important. The Department of Health and NHS Commissioning Board would do well to recognise this as they consider the future role that national outcome strategies and national clinical directors will play.
Our health is inherently political and improving our health outcomes will require more than just scientific or medical excellence. If the Government is to achieve its goal of improving health outcomes, then it should not forget the role that politics and politicians can play in the process: from focusing attention on a particular problem to taking brave steps to improve public health to targeting resources at issues which, if left to the vagaries of medical processes will never receive the attention which is required to deliver substantial improvements, politics and policy can be a vital ally of medicine.
The last year has undoubtedly led to a politicisation of medicine but perhaps also a medicalisation of politics. As politicians and healthcare professionals head off on their respective summer holidays, they would do well to recognise that, although this can cause frustrations, it also presents possibilities. Politics and medicine should never be contraindicated. Indeed, working in combination they can be a potent force.