I confess I’ve always been sceptical about the idea of leadership. I haven’t seen a great deal of it in my career, and when I’ve read books about it I’ve come out more confused that I was before.
I think I was wrong.
I’m very struck at what difference leadership has made during the debate surrounding the NHS Bill. On the government side the Secretary of State, since the ‘pause’ last year, has been largely absent. When he does appear, it is noteworthy, not least because he’s usually getting shouted by a member of the public. If you think about the debate over the last year though, more often than not the government have sent someone else along to talk about the NHS bill. Some have fared better than others. I’m not convinced all the people who have spoken for the bill on behalf of the government have read it. Some of them don’t appear to have read very much at all. Not a great deal of leadership on the government side then.
I’ve been shouting about the lack of medical leadership in this country for some time. In 2006 I attempted to goad doctors into life in the BMJ (http://www.bmj.com/content/333/7569/660 – but behind paywall) as I though the profession were sleep-walking into the government’s changes. Not a lot happened – lots of doctors wrote to me to ask me if I’d organise opposition for them, but I wondered why it was they were looking to an academic to this.
I’m delighted that we now have a medical leader who has stepped up the mark, at some personal cost, to organise opposition to the bill. Clare Gerada has shown a great deal of personal courage and selflessness in taking on this role, often with what seems little support from the other medical representative institutions. I hope in time the public will realise how important her contribution has been.
Today the Royal College of Physicians have had an extraordinary meeting to discuss the bill. It sounds from the tweets (which the leaders of the College say they are unhappy about) that things were pretty fraught. However, the numbers of those at the meeting who believe it will damage patient care (89%), or who believe the bill should be withdrawn (79%) say a great deal. It is interesting, however, that there still seems to be something of a leadership vacuum. I don’t see the leaders of the RCP entering the public fray to argue against the bill. The contrast with the Royal College of GPs, led by Clare Gerada, is extremely noticeable.
Then we have the BMA. The BMA went through a process at the weekend where they voted to ballot their membership about pensions. Now the pension cause might be a worthy one, but my worry is that in focussing attention on pensions rather than the bill, the bigger picture is being lost. If the BMA were launching a vigorous campaign against the bill, of which pensions were a part, that would be one thing. Interviews with the leadership since the weekend, however, seem to be about pensions only. This is playing straight into the government’s hands, who will talk about self-interest at a time when organising to the greater cause of subjecting the bill to scrutiny is crucial. Again, I have to ask questions about leadership here. It is one thing to represent your members’ financial interests, but another to use that to argue for a greater good. And professionalism is meant to be about not only about doing good in your job, but having an eye on doing good for wider society as well. That’s why we give professionals good rewards and high status.
Now imagine how strong a united medical leadership could be – if the rest of the Royal Colleges and BMA had followed Clare Gerada’s example. Instead we’ve seen prevarication and delay, and even now there seems to be a reluctance, to use a quote from an RCP tweet today, to ‘rock the boat’. Instead it has been left to individual members such as Clive Peedell, who ran six marathons in six days to bring attention to the bill, and today Max Pemberton (http://www.telegraph.co.uk/health/9106880/Read-this-and-prepare-to-fight-for-your-NHS.html) , to make the case.
It is not the medics, but the government who are doing the boat-rocking here. They have a bad bill, badly presented by Lansley. If we end up with a thoroughly bodged reorganisation, which is surely now the most likely outcome, Clare Gerada will know she did all she could to prevent it. I’m really not sure the other medical leaders will be able to say that. Now we have seen leadership from Dr. Gerada, the contrast with both the government and other medical organisations serves them very badly.