Examination of Witnesses (Questions 60
THURSDAY 31 OCTOBER 2002
60. This is hugely embarrassing for the BMA,
is it not, because your consultants' committee negotiated this
contract? You were backing it.
(Dr Bogle) Yes. It is not the best day for the BMA.
On the other hand, if you do go out to an open ballot, occasionally
you get a result that maybe was not quite what was expected. That
is why I need to get back and assist in dealing with it.
61. We were talking about death rates and you
suggested that you would choose to do less risky operations. Might
that be a good thing, that the less good surgeons do the less
risky operations, leaving the best surgeons to do the more difficult
ones and reduce death rates overall?
(Dr Bogle) Life is not like that. It might be all
surgeons deciding to just do simpler operations and nobody at
all copes with the other ones. It is just a question of looking
into all statistics and saying why is your rate worse than others.
That is all I would ask for: listen to the reasoning before you
make a judgment.
62. David Hart has embarked on the same course
of action as the BMA. No doubt you are anxious about the prospects
of failure and it would be embarrassing if, like the BMA, you
failed. But we have been arguing this morning along a continuum
where, at the one end you have detailed targets with rigorous
implementation, punitive consequences for failure and generous
rewards for success; and at the other end you have "get off
our backs and trust uswe are professionals." David
Hart said that we have to get the balance right. I do not see
any evidence from the discussions this morning or from the wider
debate that that will happen. It seems to me that this situation
leads to an inevitable failure to agree and a search for a different
approach. We see evidence of that from those who argue for the
introduction of more choice, letting the market decide and so
on. Is that the inevitable consequence of failure to agree or
is it worse than that? Is that what the profession wants, in the
case of the medical profession?
(Dr Bogle) I believe the profession wants to work
in a health service that has increased investment, gives better
service to patients and they wish to retain or regain some clinical
freedom in the consulting room as to the way they deal with their
patients. There are vast areas between the government and ourselves
where there is agreement. We have focused on targets setting.
That is your remit. I have set views, but there is a raft of other
things that we are talking about with the government where there
is agreement. I would ask you not to take such a pessimistic view
either of the future or of the BMA's contribution.
(Mr Hart) In the education service, the danger is
that schools will simply get on with the job, as they have always
done, of sorting their own targets out, challenging the achievable
at school level and will increasingly ignore what the local authorities
may have signed up to with central government and will say, "Fine,
if the Chancellor wants to enter into PSAs and the departments
want to sign up to them and those are the targets, so be it."
At the end of the day, the ministers will be accountable to you.
Perhaps they should be more accountable to you in terms of progress
against these targets across the board and the electorate will
decide at the next election as to whether the government has or
has not achieved its aspirations in educational terms. It will
not damage the relationship between heads and central government
to the degree you think it will because that is a good relationship
and I think it will continue to be. We will always have these
odd squalls which we will have to try and sort out. This is an
issue which does disturb head teachers a great deal because of
the impact it has on them in terms of running their schools and
relationships with local authorities, but maybe we will have to
agree to disagree. The government can have its targets and we
will do our very best to try and make sure those targets are met.
63. How can you agree to disagree?
(Mr Hart) Because the government simply cannot macro
manage 24,000 schools. Otherwise it would get rid of local education
authorities tomorrow. It has to have local authorities for all
sorts of good, strategic reasons. It has to rely on the local
authorities to deliver its agenda. The problem we have at the
moment is that the government tends to want to both steer and
row the boat. It can steer the boat, if it wants to, if we row
the boat. We have to respect our roles. I am absolutely certain
we will improve results across the spectrum. Whether we will achieve
the 85 per cent that the government wants us to achieve by 2004
remains to be seen. It will not be for want of trying. We will
not stop trying because we do not necessarily agree with the targets,
but it would be nice if we could get some consensus around how
that agenda lives with our common belief that there should be
more autonomy and more respect for the professionalism and judgment
64. Dr Bogle, why is it that over a quarter
of all consultants could not be bothered voting in this ballot
on the contract?
(Dr Bogle) I have not a clue. 75 per cent in a ballot
is quite a high turn out. I would have hoped it was not disinterest
because it is something that affects their future in a big way,
but I do not know.
65. I am looking at it down the other end of
(Dr Bogle) We could look down telescopes at election
Chairman: I think more work in the office when
you get back! May I thank you both very much? It may be unusual
for you to come together to talk in this way about services but
it is very valuable for us both in what you have said and in the
memorandum that you have given us. You are both distinguished
leaders in your professions and we are very grateful to you for
all the help that you were able to give us. Thank you very much.