Honouring your prophets

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Adlai Stevenson had his finest hour in October of 1962.

JDHe was the American ambassador to the UN, and presented the US position during the Cuban Missile Crisis. Stevenson is famous for his retort to the Soviet ambassador, who denied the evidence put before the UN: “I am prepared to wait for my answer until Hell freezes over”. It was a riveting moment.

Stevenson had the unfortunate timing to run as president twice against the war hero Dwight Eisenhower, in 1952 and 1956. He did not give up, and was nominated again in the 1960 Democratic convention by Eugene McCarthy, who exhorted delegates: “Do not reject this man… Do not leave this prophet without honour in his own party”.

The Democrats did reject this prophet, in favour of John Kennedy.  McCarthy went on to run in 1968 as the anti-war candidate, holding the flame for those of us who did not fancy Vietnam.

The point is that prophets are often rejected, all too easily, in favour of alternatives. This is not to say that the alternatives are always bad, but rather that local expertise is not readily given the credence that it should have. If you’re an expert in health care in England, then you have a big hurdle to overcome.

Take for instance the irrational fixation with all things American vis-à-vis health care. I simply do not understand this. Any system that spends 18% of GDP on health care and gets the results they get makes me question what we can learn. I now it’s a very isolated example, but my sister-in-law’s brother and wife have one set of teeth between them – they can’t afford dental care. The Washington State National Guard found that 20% of their soldiers were un-deployable in 2004 because of their dental care needs. This harks back to the example of the British army in deploying soldiers for the Boer War over 100 years earlier, where 1 in 3 recruits was rejected on medical grounds.

Whether it’s Kaiser Permanente, Intermountain, UnitedHealth, Veteran’s Administration, IHI or Don Berwick, all things American appear to be the Holy Grail. Excuse me? As the wag observed at the time of the launch of the internal market in 1991 on the back of Alain Enthoven’s musings, ‘if the civil servants spoke anything other than English, then we might have adopted a different model’. America has a different payment system, culture and set of incentives. Why not look towards similar systems on the continent, or areas where we can learn what to do with limited resources, such as Cuba or South Africa?

All this is about looking for local expertise. There are many folk who have real insight, have made beneficial changes, and achieved replicable results – but aren’t prone to blowing their own trumpet. It’s an English thing. Americans on the other hand will tell you how good they are. And we still suffer in England from the ‘not invented here syndrome’.

I think Simon Stevens will search for the prophets across NHS England.  I absolve him from being all things American, but rather celebrate his experience outside the silo of the NHS, drawing on experience in 10 Downing Street and Minnesota.

So help by searching for and honouring the prophets in your own land.

One thought on “Honouring your prophets

  1. Nice blog John. Reminded me of a youtube clip (http://youtu.be/qSjGouBmo0M) from John and Hank Green (the VlogBrothers) which gives an amusing but informative look at US healthcare vs Europe / Rest of World. John and Hank are great educators worth following