Looking ahead

MY predecessor, Gordon Dickson, produced a typically thoughtful piece in the last issue of Summons, looking back on his remarkably successful decade in the hot seat at MDDUS. Moving gently into his chair makes me recall the advice given to me many years ago by an old civil service mentor to "choose your predecessor with care".

I doubt if I have ever failed to do that more thoroughly in coming to MDDUS, as Gordon has set me a remarkably high benchmark to aim at. Indeed, the only way to stay sane is to resolutely look forward, rather than keeping an eye on the rear view mirror, so as not to be too daunted by my inheritance.

Looking forward is a timely thing to do at the moment. People are looking ahead to the forthcoming general election, for example. They are looking ahead at implementation of changes following the Smith Commission Report and also at how the continued political ferment in Scotland will play out in next year’s Holyrood elections. And there is also a sense of change around the NHS on both sides of the border, perhaps reflecting a move away from grand visions of change to much more practical measures to keep a vitally important show on the road at a time of continued high expectations and tough economic conditions.

More political change

Where does the MDDUS sit in the middle of all this change? I don’t normally like reaching for glib management consultancy tools any more than I suspect most of you like reading about them. But one helpful way to think about the future is to look at trends in the current environment using so-called PESTLE analysis. That is a typical consultant acronym (albeit not one of three letters) for political, economic, social, technological, legal and environmental factors. What is remarkable when we look at each of these features is that all are fluid at the moment.

I have probably said enough about politics already, but you certainly do not need me to tell you that health issues are going to be a decisive factor quite possibly in both general elections. What will be interesting to see, beyond the noise, is how much different parties actually have surprisingly common visions.

All the parties, in England at least, seem to be interested in making the boundaries between primary care and hospital services rather more fluid. If done well, that could be a good thing for patients in terms of continuity of care – and it may also benefit professionals, bringing new, stimulating challenges. But if done badly, it could add pressure to a system which already can appear close to overheating. Whatever the outcome, things will occasionally go wrong and we will continue to stand behind our members and to find the right, fair solution as quickly as we can.

Economics at all scales

Of course, it is to some extent the economics of healthcare which will determine how far and how fast progress is made. The political noise about how green and numerous the shoots of recovery are will no doubt continue for the next few months, but it is clear that budgets will continue to be constrained. That might stimulate fresh thinking with some of the benefits I have talked about earlier, but it may also lead to more pressure. At the MDDUS, we are very mindful of the fact that many of our members continue to see a squeeze on their incomes and we will therefore continue to price our services as competitively and effectively as we can, making sure our rates properly reflect genuine risks rather than additional padding. We will also be as rigorous in challenging our own costs as we know you have to be in challenging yours.

A better informed, more engaged patient base can only be a good thing for the practice of effective evidence-based medicine

One reason for growth in activity at MDDUS is that we continue to live in a period of social change where patients are less and less deferential and more willing to challenge their doctor or dentist, sometimes with good justification though sometimes on a more tenuous basis. Overall, a better informed, more engaged patient base can only be a good thing for the practice of effective evidence-based medicine. We will continue to help equip our members to develop their practice through the production of more risk-based educational material and the enhancement of our newly launched website. But we will also continue to stand robustly behind you when the social forces driving the so-called "litigation culture" lead to members being unfairly pilloried either in the court system or the regulatory process.

Technological and legal challenges

Technology, considered more widely, is a two-edged sword. It opens new possibilities for clinical practice and for communication with patients but also makes possible new kinds of "innocent" error and new ways of accusing practitioners. At MDDUS we are constantly alert to how we can improve our own digital services and how we can also help our members to work effectively in a digital age, both, for example, by increasing our own use of social media but also (as we did recently) warning our members about the dangers of inappropriate use of Facebook, Twitter and the like.

The world of legal change is where I have just come from. As Chief Executive of the Legal Services Board in England and Wales, I was constantly pushing the legal profession to open itself up to greater competition and to put the consumer at the heart of the services being offered. But I was also very mindful of the need to maintain the highest professional standards. There is an awful lot of continuity here with the challenges faced by our ever-expanding legal team at the MDDUS. We have to keep our members at the heart of the work, whilst maintaining our own professional standards and duties to the Court which can sometimes mean giving bad news about the best way forward.

But it also means being tough in the extreme when we see cases which should never have been brought. That’s why we welcome some of the changes brought about by the Jackson Report in England and the Taylor Report in Scotland. We think changes to Court process and funding mechanisms, far from obstructing access to justice for worthy claims, will allow those claims to be addressed more quickly by helping remove from the system those challenges which are frankly tendentious and mischievous and whose existence simply causes unnecessary anxiety to doctors and dentists doing their best on behalf of their patients. We will therefore continue to encourage legal reform in our areas of expertise, seek to continue to improve our own methods of legal working, but, above all, stay true to the highest standards of professional integrity as we do so.

I think I have to pass on trying to find an environmental theme for MDDUS (although we are doing our level best to adopt the highest carbon management standards) but as I write this, trying to look forward, I am conscious that so much of what I have said actually has been in the life blood of the Union, not simply under Gordon’s distinguished tenure, but since our beginning in 1902.

Being tough, realistic and driven by value (in every sense of the word, not just financial) is absolutely what the Union has stood for and will continue to stand for. So maybe I can occasionally risk looking in the rear view mirror, with a view to feeling inspired by what has been achieved so far, rather than being intimidated at having to live up to it!

Chris Kenny is CEO of MDDUS