On 23rd February on the Daily Politics, Clare Gerada (CG) appeared with Anna Soubry (AS) to debate the NHS bill. I’ve included a rough transcript at the bottom of this piece to try and show what happened, along with a link to a recording of the debate on the BBC website. I think, for me, it exemplifies what has gone on during the NHS bill debate.
The debate begins with CG explaining how she has consulted with her GP colleagues, and how her views can be claimed to be representative of them. She says some parts of the bill are good, but the results of the RCGP consultation suggest that her members don’t want it.
Andrew Neill (AN) then tells AS that CG represents 90% of GPs, AS replies ‘I think she’s wrong’. AS explains that CG is wrong because she has spoken to ‘Real GPs, on the ground’ in her constituency, that consortia were formed there before the government were even elected, and that she was approached by a GP from her constituency (who doesn’t practice there) who told her that she had to get the bill through so he could, in his words, ‘deliver the treatment to my patients that I want do do’.
AN then challenges what AS is saying, saying it is ‘anecdotal evidence’,.
AS replies ‘It may well be’.
AN challenges AS to explain why her evidence is more important than CGs. AS replies she didn’t say it was.
After a period when everyone tries to pick the discussion again, CG explains that her own practice was one of the commissioning pathfinders, and suggests perhaps the GP AS spoke to was one of the 56 out of 2,500 who voted….but is cut off by AS who asks ‘What about the doctors in my constituency….what about the 95% of other areas of the country?’
CG suggests that AS’s views are not reflected in what she is hearing from 18 months of consultations.
AS replies ‘We’ve consulted as well’.
AN then suggests that CG has a ‘strong ideological opposition to competition or further choice’. CG asserts that the bill is ‘an attempt to privatise the NHS’ (AS then engages in much shaking of her head), and that there is nothing in the bill to prevent a mixed-funding system (as per the US) appearing.
AS then asserts that is ‘an opinion. That is not a substantial fact…’
CG then replies that the RCGPs are not against competition, but against ‘the full, fettered, any qualified provider where you have everybody competing for the same hip, the same knee’.
The debate then ends.
What his shows for me is the two very different styles of argumentation and evidence presentation that we have seen during the bill.
CG is attempting to use first, the argument that the RCGPs have consulted widely during the bill, and so she knows the opinions of the 90% of GPs she represents. This argument is based on legitimacy through repeated consultations. Legitimacy through democracy.
AS attempts to refute this by claiming that the GPs she speaks to in her constituency say differently, and one GP in particular has urged her to press ahead with the reforms. She admits this may well be anecdotal. She then gets herself into a tangle when AN asks her why we should view this anecdote as being more important than CGs consultations, to which AS replies ‘I didn’t say it was’. This leaves us wondering why she mentioned it in the first place.
The argument for the NHS bill has often been outright anecdote, or anecdote dressed as science. Outright anecdote is the position adopted by AS here, as well as by David Cameron in PMQs where he has repeatedly claimed the medical profession back his reforms because he has spoken to a particular doctor or small doctor group that supports him.
The strategy of using anecdotes as evidence is one increasingly used in British politics. Remember the last election, during the debates, when all the leaders had spoken to someone in their constituency who had told them (something that supported their view)? It is almost as if politicians only believe there is a problem if they’ve heard it themselves from one real-life person (not sure there is another kind), but also that this is the only kind of evidence that actually counts.
In the second burst of exchanges we see another NHS bill argumentative strategy – claiming something is, or isn’t fact. AS claims that CG’s view that there is nothing in the bill that prevents a US-style mixed-funding system is ‘your opinion. That is not a substantial fact….’
Now from someone who has just presented anecdote as evidence, this is an odd strategy to take. Having confused anecdote with evidence, AS is now saying that CGs view of the bill is just an opinion (or perhaps, an anecdote?).
What is odd is the mixing up of anecdote and fact from AS, but also the way the government more generally have presented anecdote dressed as science on repeated occasions. During the debate, the government has repeatedly attempted to present claims about the need for reform as being based on scientific fact, but which appear to disintegrate upon any scrutiny. Chris Mason’s blog on government leaflets explaining issued after the listening exercise show this clearly (http://justanotherbleedingblog.blogspot.com/2011/04/nhs-reform-from-liberating-to.html).
This approach – anecdote pretending to be evidence – is perhaps even more bizarre than presenting anecdotes and expecting to be believed.
What this highlights above all perhaps, is that the government don’t appear to be interested in any kind of informed discussion about the bill. This isn’t about making the NHS better, or about what doctors think, but about putting in place change no matter what. That is deeply depressing – we deserve higher standards of political debate than they have given us, and a great deal more honesty too.
Gerada and Soubry transcription from Daily Politics, 23rd February 2012
AN: Anna Soubry’s boss, Simon Burns, he claims that you don’t represent the views of GPs up and down the country in these health reforms, what do you say to that?
CG: I think I do. I represent 44,000 general practitioners, of which over 90% when we’ve surveyed them very recently wanted me to ask for withdrawal of the bill and that’s against a background of one and half years of consultation. Three surveys, five counsels, five executive councils, a national conference. Endless consultations. I can categorically tell you my members, the members of the Royal Colleges of GPs, do not want this bill. Some of the parts of the bill are good. I mean putting GPs on control of money, putting patients first, addressing health inequalities. But in its totality, the bill is a mess, the bill is flawed, and the bill will not achieve what you and Andrew Lansley and the Prime Minister are setting it out to achieve, and the more Colleges…
AN: We haven’t got too much time. She represents 90% of GPs .
AS: I think she’s wrong.
AS: No hang on, let me finish.
AN and AS talk over one other
AN: You said your views represent…
AS: I didn’t say that. Andrew you asked me a question. I didn’t say that. But let me tell you what I think.
AS: I go into my constituency. I talk to GPs. Real GPs, on the ground. In my area, the consortia was formed before we got elected into government they were in existence. They are putting into operation already what we are seeking to achieve
AS: Let me finish, I don’t wish to be rude. But let me finish and explain. That is my experience in my constituency with my GPs, and let me tell you this. I was approached by a doctor who lives in my constituency but practices in Nottingham. And he took hold of me and he said ‘For God sakes get this bill through, so I can deliver the treatment to my patients that I want to do’
AN: But that’s anecdotal evidence
AS: it may well be
AN: Her evidence is surveys and conferences and..
AS: yeah, but I’m talking about
AN: Why would your anecdotal evidence be more important than hers?
AS: I didn’t say it was
CG: I would as a general practice, we were one of the first waves of
AS: Part time
CG: We were one of the first pathfinders. We have lots of practices across London. I speak to general practitioners. The doctor you spoke to might be one of the 56 that voted, the 56 out of two and a half thousand
AS: What about the doctors in my constituency, that have formed a consortia, that are doing it. What about the 95% of other areas of the country
CG: But that’s not being reflected in what we are hearing in the Royal College of GPs. I’m not a politician, I’m head of GPs. All I’m doing is reflecting the views, and we have consulted over the last 18 months. GPs write to me every day
AS: We’ve consulted as well
AN: Let’s bring..back in. You say your are not a politician. Reading your case against the bill and so on you do have a strong ideological opposition to competition or further choice
AN: You’ve even said that this is an attempt to privatise and turn it into an American-style system
CG: It is an attempt to privatise the NHS
AS Shaking her head with eyes shut
CG: We are not against competition
AN; Turn it into an American-style system
CG: Turn it into a mixed funding system with a state funding so core services with individuals
CG: There is nothing in the bill that prevents that from happening
AS: But that’s your opinion. That is not a substantial fact where you can say
CG: that is the opinion…
AN: The American system involves private insurance, that’s at the core, is that what they’re going to do?
CG: I would like to ask what there is in the bill that prevents that from happening and what you’ll find is that
CG: Is that there is nothing in the bill that prevents that from happening. You ask about competition. We are not against competition, we have never been against competition where it adds value to patients. What we are against is the full, fettered, any qualified provider where you have everybody competing for the same hip, the same knee.