In summary: nice try, Guardian, but over-ambitious with establishment platform and a chair who was not strong enough. A lot of aspirational statements, quite a bit of politics, and precious little on WHAT should be done and most importantly HOW to do it. Flawed yet stimulating, ultimately frustrating. Nothing new that was significant.
The event was organised by The Guardian as part of their GuardianLive series was on 20 Jan 2015 in Conway Hall, London.
It must have been a sell-out (£15 a seat) as the hall was stuffed - the audience predominantly white, middle-class from what I could see, yet not over-polite ... there was some shouting as people lost patience with the proceedings.
Meeting Organisation
The Guardian was over-ambitious in expecting everyone to load a special app on smartphones and participate in polls and enter questions and rate questions online during the meeting. There were 6 or 7 poll questions, yet only one was briefly examined. Many questions were entered yet only the top 2 were addressed as one item together. The app on my android phone did not have all the functionality compared to the iphone of my neighbour. A number of people objected that they were disenfranchised by not having smartphones or not being willing to load the app. The chair allowed a show of hands on the one poll examined, to placate the crowd. I personally find it hard to vote online and type questions when listening intently to speakers.
Lesson Learned: do less and do it well, anticipating people's reaction to the use of technology. The polls could have been available before the meeting started, and a separate screen used to display the results continuously - that would have been valuable rather than distracting.
Meeting Management
It will always be frustrating when 2 days worth of debate is crammed into less than 2 hours, however the chair (Denis Campbell, Guardian health Correspondent) was not strong enough. He allowed the panel to give long answers, sometimes off the point of the question, and when the audience lost patience and started shouting comments he looked briefly like a rabbit in the headlights. He also took up time asking his own questions when the audience was gagging to ask theirs. he only took audience questions with 15 minutes left of the meeting time.
Lesson Learned: the chair of course needs to be knowledgeable in the field, but also independent from the debate - Denis had too much 'skin in the game' to be able to sit back and manage the debate to best effect. Short answers must be enforced. Get the audience involved early.
Debate Panel
Here are my key notes against the main panel members - 3 establishment figures and 1 very well-connected thinktank CEO - harsh perhaps but this is what stayed with me:
Dr Mark Porter (BMA) - stop the use of markets, it has failed - no more re-organisations
Sir Bruce Keogh (NHS England) - prevention is better than cure (otherwise I heard political aspirational statements)
Rt Hon Norman Lamb MP (LibDem Minister of State for Care and Support at the Department of Health) - next 5 years is crunch time - want to pool health and social care by area, give control to that area
Julia Manning (CEO 2020health thinktank) - we cannot do everything, technology costs too much (gets my vote as 'most insightful of the evening', which does not say much for the others)
Lesson Learned: the audience around me felt rather 'talked down to' by the great-and-good panel, influential and eloquent though they are. I think the audience would have preferred to have one or two NHS practitioners from the front line on equal footing up on the platform. All the staff are 'amazing' and engagement is the thing, so let's have them up there alongside the top brass.
Content
I heard some figures that are surprising on the face of it: NHS is one sixth of national public expenditure, yet UK (or was that England) spends less than the average across Europe (per head, or as %age of what was not stated), and we only spend half what USA spends (ah but you cannot compare tax-funded free at point of delivery with an insurance based system surely?!).
The two top-rated audience questions (and the only ones taken by the panel) were about privatisation. The audience is dead against it. Julia Manning pointed out that it is not a simple black & white issue - she as an optician was self-employed and contracted to the NHS. Much IT provision is out-sourced. These are rather different to a private equity owner dumping a non-profitable secondary care facility.
The audience wanted to talk about TTIP - they were rabidly against it. The panel, specifically Norman Lamb, asked them to be sure of their facts and reassured them that the EU had written to our government confirming that the NHS is not affected by TTIP.
The Health and Social Care Act came in for much general stick - I didn't hear anyone specifically defending it. Norman Lamb pointed out that the PFI schemes are effectively just mortgages with huge repayments by government to private sector - that's an interesting perspective, and my respect for this MP is growing.
No one, apart from Julia Manning in passing, addressed what I see as the elephant in the room: we should be talking about the next 5 years as tactical - the strategy should be the next 25 years; the current and predicted growth in NHS funding is simply not sustainable - economic growth will not magically solve the problem (that's not sustainable either); therefore we need a really radical review and prioritisation of health and care services across the board, with some serious expectation management; no government is ever going to do that because it's political suicide; so we need a beefed-up equivalent of the Office for Budget Responsibility for the NHS, to provide the logical advice and take the blame for the (correct) difficult decisions.
Ok, I have finished on an off-the-wall suggestion, and the above notes are incomplete and of course it is a personal view - that's the whole point.
