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Ours is a participatory democracy—startling chiefly for the lack of participation. Membership of the hopelessly debt laden political parties is at an all time low, and the esteem in which parliament is held is likewise low. A variety of means to improve the situation have been mooted, but little seems to change. Could we doctors make a change? It is often noted that that public has more trust in doctors and other healthcare workers than in politicians; this is the right time, a last chance perhaps, to take our approval ratings out for a psephological test drive.
We have witnessed problems arising from the healthcare “reforms” and can predict more of the same. As a group we have been on the receiving end of much government inspired unpleasantness: the precedence of budgets over care of patients, fragmentation of care, Modernising Medical Careers and the medical training application service (MTAS), crassly incompetent management at all levels, contract chaos, hostile press briefings, black propaganda, downright lies, tendentious media comment, privatisation, unfeasibly complex recertification, licensure, and appraisal procedures, and so on. Is alerting the populace to the problems and offering alternatives in some way problematic or unprofessional? Are parliamentarians, their advisers, and the commentators more competent at generating and implementing reform than we are?
The broad sentiment of the profession toward the current reforms is negative, although no one shrinks from the need to improve continuously in personal as well as system performance and standards. If we are sincere in our reservations about the course proposed for health care in the United Kingdom, is it legitimate or excusable to do nothing? If we are not sincere in our reservations, then we should put off Luddism and apply all our strength to the task. Malcontent, whining, or acquiescence is neither a sustainable posture nor a pretty sight. Choices can be placed before the electorate. “Contestability,” in so far as it has a meaning, need not apply only to the supply of health services. If anything, with the dearth of inspiring policy on so many aspects of national life, national government itself stands in greater need of a searching assessment of contestability than the NHS.
With few exceptions, healthcare workers—not just doctors—are hard working, dynamic, committed, educated, adept at problem solving, resilient under pressure, articulate, imaginative, disposed to serve the community, of broadly liberal outlook, and of beneficent intent. These surely are the sort of values that the electorate might care to see more widely represented in parliament. By comparison, parliamentarians are increasingly narrowly confined in their views on policy, preoccupied with party matters to the exclusion of governing effectively.
Although the hope for a 2007 election has come to nothing, we now have time to marshal our forces. Please may we have an independent candidate in every constituency: a healthcare worker who can offer the electorate a better choice of health policies than those on offer from the established parties? We can do this. We can make a change. The formalities involved in becoming a candidate at a general election are trifling. The entire procedure is detailed in the Electoral Commission's Guidance for Candidates and Agents: UK Parliamentary General Election in Great Britain, February 2005 (available at www.electoralcommission.org.uk).
The application paperwork, from your local acting returning officer, is available only after an election has been called. The papers must be returned at least two weeks before polling day, along with £500 in cash or a banker's draft—no personal cheques or credit cards are accepted.
MPs are not better than the rest of us and do not deserve the unopposed scope for harm that the electorate has so far given them. Acquiescence is complicity—examine your conscience before discounting yourself as a candidate in your own constituency.
At the least, an all constituency health professional candidacy will push the health issue up the political agenda, and that might promote fresh thinking and debate. It's time to put up or shut up.
Please may we have an independent candidate in every constituency: a healthcare worker who can offer the electorate a better choice of health policies than those on offer from the established parties?
Competing interest: SDF intends to stand at the next general election.