The key to a good party consultation

The great Professor Darzi has graced the Internet forum run by Netmums with his mighty presence this week. The question below is an example of the great cunning that has gone into our NHS review consultation:

"Hospitals: best or nearest?

When thinking about hospitals.... Is it better to have access to the best treatment possible or the nearest? (Bearing in mind it is not possible to have the best treatment at all hospitals, because the degree of specialisation means it cannot be provided in every location.)"

Something that we have learnt after many years of fine-tuning the art of conning the public with dishonest consultations is that by starting with a false premise in the question, one can cynically get the answer one is looking for. I'll explain how it works. It is pretty obvious that the best structure for a health service like the NHS is a kind of pyramid structure, primary care to secondary care to tertiary care and so on.

At the party we are keen to sell of primary care to our friends in the altruistic private sector in an attempt to raise funds for the forthcoming election, part of the privatisation process is the undermining of good specialist services at local hospitals and replacing them with polyclinics. The polyclinics are a little unsafe for patients as they do not have the adequate clinical backup for when things go wrong, but they will be very lucrative for our friends in the city. Instead of asking the public a fair question like:

"Would you like a sensible mix between big specialist centres and medium sized local hospitals so that most of your needs could be catered for locally, but for slightly rarer problems you would occasionally have to travel a bit further?"

We couldn't ask this question because it would result in the service remaining as it is, ie a sensible service that balances complex needs against each other. We had to create a false choice between the biggest specialist centre and smaller local hospital, so that we can then use answers as evidence that people want the best care, then shut local hospitals down; do you see the genius now? The question also ignores the fact that by replacing local hospitals with polyclinics patients will get a poorer standard of care than they previously got at the local hospitals, the beauty of the polyclinic is that it can be spun as 'care near to home'. Imagine if we actually followed through the 'best' care to its logical conclusion, we would be left with one super size hospital in the whole country, even a small child can appreciate that this is a daft way to run a health care system.

So there we have it, to get the answer you are looking for in a consultation, make sure that you start with a false premise in the question that gives the respondent no option other than to add evidence to your predetermined plan of action. This is what we are doing for the NHS review consultation. We want to shut local hospitals, privatise primary care and save money; so we are using these devious consultation techniques to get exactly the answers we want to hear. There are many other tips for a successful consultation, such as not consulting the experts who can show your plans up to be the corrupt dross they are: for the NHS review we are completely ignoring the medical profession. Many thanks for your support though, we will keep you updated on our consultation tactics and ideas.