THERE was an outcry recently over the attack by Sir Paul Flynn
on proposals to run routine health services on a seven-day-a-week
basis as "catering for the convenience of the middle class". At
first sight, it is the kind of remark one might expect from the NUT
in full conference flight, not from the head of the British Medical
Association's Consultants' Committee. But behind Sir Paul's
apparent sneer is a raging debate about what constitutes
professionalism in medicine.
Sir Paul fears that the Government is importing business models
that are distorting the health service, and that doctors are
increasingly managed by those who do not have patients' interests
at heart. Others point out that not using clinical facilities at
weekends is a waste of valuable resources, as well as a danger to
patients. Sir Bruce Keogh, the Medical Director of the NHS, argues
that a seven-day health service would be "patient-centred,
compassionate, and convenient".
Those who support him would ask why a woman who has found a lump
in her breast on a Friday has to wait through the weekend because
most facilities are shut until Monday. And why are we so complacent
about the fact that hospital patients are more likely to die at
weekends because there are no consultants to see them?
Doctors are among the few professionals who are still held in
high esteem by the public. They are highly trained and relatively
well paid. GPs, in particular, did well under New Labour, when
their salaries were increased and their hours were effectively cut.
The issue for them now is what kind of professional freedom is
compatible with the privileges that they enjoy.
Professionalism is about bringing specialised knowledge and
experience to bear on complex human problems. It requires a
constant updating of skills, judgement, empathy, and that elusive
quality of wisdom, which tempers what is possible with what is
right. To be truly effective, it must be accessible to those who
need it - and that is the nub of the current argument.
Not so long ago, health professionals enjoyed greater autonomy.
Although their hours were long, they commanded unquestioned
respect. At home, most were supported by spouses who took it for
granted that their husbands' work should come first. Times have
Sir Paul wants to protect his members' interests, which is
understandable. But professionals should earn the respect due to
them by a willingness to initiate reform. If doctors really put
patients first, governments might be less inclined to
The Revd Angela Tilby is Diocesan Canon of Christ Church,
Oxford, and Continuing Ministerial Development Adviser for the
diocese of Oxford.