Hilary Thomas on changing healthcare

Hilary Thomas

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The past year has been one of huge transition for me, professionally and personally. I have phased out seeing patients and crossed to the dark side, which has been a stimulating and steep learning curve.

On the personal front, I have moved back to London, found a new home, one of my daughters has reached maturity and the other has fallen in love for the first time. My partner and I have been together for quarter of a century and our fourth home is proving to be our most challenging joint project to date, apart, that is, from the children.

So how has the NHS changed over this period? I have the privilege of being a member of the clinical advisory group for Healthcare for London, or Darzi London as it has been dubbed. One of the highlights of this membership is the erudition of my colleagues. Most recently, one entreated us to consider a "Clause IV moment" and this motivated me, through the illumination of Wikipedia, to research the phrase.

It seems, thanks to one Tony Blair, that it marked the transition to a new statement of aims and values for democratic socialism. In 1993, Blair wrote a pamphlet for the Fabian Society criticising the wording of Clause IV for confusing ends with means.

In removing it, he deleted the party's stated commitment to "common ownership of the means of production and exchange", previously interpreted as a reference to wholesale nationalisation. Wiki trivia also informed me that Neil Kinnock named his cat Claws 4.

Pivotal moment

Has the medical profession stumbled on its own Clause IV moment? Well, my own union is conveying a sense of municipal ownership and consumer co-operatives at present. Who would have thought the British Medical Association, that bastion of middle class self-regard, could ever look like old Labour?

At the moment, the BMA is in danger of disappearing into its navel thanks to the intemperate and ill-judged ramblings of some of its GP members, and it will be hard for the public to be sympathetic when inequalities and poor services are most prevalent in areas of greatest deprivation. Do GPs really see themselves as part of the NHS family? Do they believe the public sees them as safeguarding their best interests?

My recent experiences of primary care - and my comparative notes with others - are not all positive. When my daughter made her first unaccompanied trip to the GP recently, she had a small list of requests - including a blood test for hepatitis B, required for medical students. After request number two, she was told there were people waiting and she would have to come back another time.

Not a great experience and one that will encourage her, along with increasing numbers of young people, to use a more convenient system in future - a commuter walk-in centre, perhaps even a polyclinic - moving away from the traditional loyalty of patients to their local doctor.

Inverse care law

More importantly, there is overwhelming evidence that the inverse care law is alive and thriving in urban and rural areas, particularly in minority communities. The dramatic data that life expectancy falls by one year for each stop travelling east from Westminster on the Jubilee line has been embraced by the Socialist Worker and Boris Johnson's campaign alike. In any event, it is a striking reason why we must be more ambitious for Healthcare in London.

As a profession, we must not delude ourselves that we have all the answers. I find it increasingly difficult to equate what the doctors' union hopes to achieve with the best interests of patients.

We need a Clause IV moment to prevent a situation where the articulate middle classes get better healthcare paid for by the state, while those in greatest need of health gains are unable to discern what good care looks like and are served by a system they are reluctant to use and in which they cannot exercise their autonomy.