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The long march through the Royal Colleges.

Filed Under (Big Society, Health Policy) by Paul on 12-04-2012

In the last few months, during the political tussle that took place before the final passage of what is now the Health and Social Care Act, some very strange claims were made about the power of various Royal Colleges to reverse government policy.

There was a strong belief amongst medical opponents of the Bill that if all the Royal Colleges called for its withdrawal this would have stopped the Bill. I commented at the time that this was an odd view of political power, but was understandable coming from people who were rarely involved in the politics of legislation.

In the spring of 2011 the Prime Minister was surprised at extent of the medical opposition to the Bill. After all when it came to power the Government had believed  it would gain the support of the medical profession when they abandoned what they had been told were the ‘hated’ targets agreed by the previous Government. However once the Government abandoned the targets the medical profession – that had appeared to so passionate in wanting to get rid of them – simply stopped caring about them.

The Government therefore gained no political ‘brownie points’ from the medical profession for these actions. The Government was also led to believe that ‘giving commissioning power to doctors’ was actually what the medical profession wanted and that it would get doctors on their side.

So the strength of opposition from the leaders of the medical profession came as a surprise to the Government. It was one of the pressures that had led the Prime Minister to pause the Bill in the spring of 2011. He believed that amendments made to the Bill in June had drawn the sting of the medical opposition.

(In fact, as I wrote at the time, the one thing that the BMA can spot from a long way off is weakness in a Government opponent. The Government pause in the passage of the Bill was an obvious display of such weakness. Once the BMA had the Government on the run the last thing it was going to do was to stop applying pressure).

So the Prime Minister’s belief, that medical opposition to the Bill would desist after the Bill was amended, was not well founded. In making this judgement – in June 2011 – the Prime Minister could not of course rely upon the judgement of his Secretary of State. Andrew Lansley had promised him the support of the medical profession for the original Bill.

By late autumn 2011 medical opponents to the Bill believed that if only they could achieve unanimity in calling for it to be dropped the Government would have no alternative but to do so. Throughout last winter a lot of time and effort went in to getting the Academy (the joint body of all the Royal Colleges) to oppose the Bill.

People really did seem to believe that a motion from the Academy calling on the Government to drop the Bill would bring about its demise. The constitutional problem was that the Academy needed unanimity amongst all its member Colleges before it could make such a political stand.

Unsurprisingly, unanimity on a matter such as calling on the Government to change its whole health policy is not easy to achieve.

This led opponents to the Bill to develop a second strategy – the ‘long march’ through the Royal Colleges. Colleges that had failed to call upon the Government to drop the Bill were expected by opponents to call extraordinary meetings to discuss that opposition. Within each Royal College in turn opponents to the Bill said that if they were to oppose the Bill, it would be a ‘defining moment’ and that the Government would drop the Bill.

My problem with this is that the entire strategy is based upon the belief that medical organisations have the power to change the whole direction of Government policy. Probably the biggest example of this belief in action occurred in February 1948 when 93% of the BMA voted to boycott the NHS.

Nye Bevan did not however change his policy and despite this near unanimity of opposition, 6 months later, in July, there was near unanimity from the same doctors to joining the NHS.

But that did not stop the long march of opponents to the Bill through the Royal Colleges. Extraordinary meeting after extraordinary meeting called for the Bill to be dropped.

Yet – because the Coalition Government has large majorities in both Houses of Parliament – the Bill was passed.

But the long march through medical institutions continues. Some Royal Colleges have longer time spans for calling emergency special meetings than others.

On April 21 the Royal College of Pathologists have a special meeting to call on the Government to drop the Bill. This was called because a number of opponents to the Bill really believed that if the Royal College of Pathologists called on the Government to drop the Bill, they would.

Some people have strange views of where political power lies.


6 Responses to “The long march through the Royal Colleges.”

  1. I really like this blog Paul. It is astonishing how much time and energy is being wasted by professionals in medicine who have little ‘political power.’ I think their energy is needed on the ground to manage and understand these reforms rather than fight them. Becky F

  2. Well, Paul, you seem to have returned to vague generalisations and have focussed on a sideshow in this whole process. Firstly, assuming that all targets were “hated” is an absurd oversimplification, although some of them were purely political and had deleterious side-effects in health (e.g Keeping patients in Ambulances outside A & E so that the 4-hour target was less often breached; or treating minor illness in preference to major problems as the minor problem was in threat of ‘breaching’ etc etc).

    Secondly, I do not believe that we try to ignore targets, as you would have it. Some of them have been good, and we aspire to keeping with them.

    Commissioning has never had majority support within the medical profession. It is simply a process that is too complex, too nuanced and too impossible to achieve. It cannot work effectively within the Lilliputian ropes that tie it down. It is doomed as far as I can see, and always has been.

    The Royal Colleges did their best, because they consist of members who are doctors who believe in the NHS. My own Royal College (RCGP) led the way, and most others followed – some more reluctantly than others. Simply because the Bill is now an Act, does not make it right, and should not affect the way we respond to it.

    Some of your blogposts have been outstanding, and a ‘must read’ for Jobbing Doctors like me.

    This one is somewhat wide of the mark.

  3. Where to start? We (the profession) were faced with legislation which we believed would be highly damaging to the NHS and the interests of patients. The government wasn’t listening and our union was confining its efforts to calling for ‘significant amendments’ which it was clear would never be made

    Our politicians and our union weren’t asking or representing our views. In a democracy where undemocratic things are happening (such as legislation that was never mentioned before the election and the majority of the population don’t want) it was difficut to know where to turn next and remain within the bounds of the law.

    It was thus natural to turn to our professional bodies to ask them to publicly oppose the legislation. Up till then they had hidden behind the claim that – being non political – it was none of their business, despite their remit of teaching, training and standards being an obvious victim of the bill. Only the RCGP had taken a public position of opposition and only the RCGP had asked its members’ opinions on the bill.

    The mystery is why this action should merit derision, sarcasm and an entire blog. Did you really expect us to watch this appalling piece of legislation being railroaded through by the coalition without a fight? That would have been worthy of comment

    DoI co founder of, which surveyed grassroot doctors and allowed them to call on their professional bodies for EGMs

  4. Humanity is not one of the talents required for a career in politics. Being hard nosed and having the ability to talk the hind legs off a donkey is all that seems to be required. It is all too easy for the politicians to dress up wolves in sheep’s clothing and then step aside. Even now very few people understand the direction in which the NHS has been sent. It is only when they find themselves in need of medical help that they begin to realise. However, even then, they are largely unaware of when they are being short-changed or exploited. In individual cases our efforts on behalf of patients only serve to label us as sanctimonious whistle blowers.

  5. The blog doesn’t mention all the reasons why the Bill should not have become law an why the majority of health professionals opposed it—-> The threat to equitable care/the lack of political mandate/the massive top down reorganisation that we were promised wouldn’t happen/the ongoing march of the private sector into the NHS/the enormous threat to the doctor/patient relationship etc etc. You can read more at my blog here

    The medical profession woke up too late to the enormous problems with the Bill. I was one of those who worked on the campaign to lobby the Royal Colleges. It would have made a difference if the AoMRC had published a statement. The Bill may not have fallen but in its final weeks in Parliament it was in extreme difficulty and further opposition from the Academy could have pushed it nearer the edge of the cliff.

    But it is now an Act and we must continue to fight and oppose this dreadful legislation. Doctors want the NHS to be there for their patients no matter what their background or income is. This Act threatens that and that is why we fought so hard.
    We will not stop the fight.

    Dr David Wrigley
    BMA UK Council

  6. I have yet to hear one single rational argument for the Bill/Act. It was passed because the coalition has a majority not because it has any merits

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