A few days ago I met with the chairman of a large health promotion and education society. Over the course of the conversation it became clear that he and several others in the society were making progress in influencing health policy at the highest level. As is often the case this was behind the scenes with access conditional on confidentiality. However, to those on the outside, by which I include the rank and file members, there was largely silence, which could lead to questions such as: ‘what are they doing?’; ‘how are they giving voice to my concerns?’; ‘what do I pay my money for?’ So, the very mandate that gave them access and legitimacy to influence was bound by another condition, that of secrecy that in turn risks undermining the original mandate.
The circle is of course broken (or ‘managed’) by on-going carefully crafted communication, ‘listening exercises’, leaks and informal briefings so as to give some public voice to provide conversation.
What becomes worrying is when this cycle breaks down. In the current health reforms we have seen the Royal College of Midwives, Royal College of Nursing and the British Medical Association disengage from discussions. Also, the all-party Health Select Committee has openly voiced its clear objection to the endeavour. And today we have the Nursing times, Health Service Journal and the British Medical Journal united in in the view that the reforms are an ‘un holy mess’.
The hope is that somehow the processes of private conversation and public engagement will continue and the latest distractions will be seen as an uncomfortable but important part of the process.
Dr Robert Warwick 