23 Sep 2019
In this week’s budget the Chancellor reaffirmed the Government’s commitment to reducing the deficit. Deficit reduction is the Coalition Government’s one paramount policy objective and the definitive register for their political rhetoric. I’m now beginning to wonder whether we have unwittingly found ourselves in a deficit reduction paradigm, where the response to all political questions is ‘reduce the deficit’. (Like the ‘law of the instrument’, also known as ‘Marslow’s hammer’: ‘if all you have is a hammer, every problem looks like a nail’.
The reason I wonder whether public policy as a whole has fallen into a deficit reduction paradigm is that this deficit reduction appears to have defined the official line in an area that I’m currently working in, namely, the use of biological and health data. I’ll explain what I mean presently. We all know that a lot of criticism of NHS England’s care.data programme has been reported in the media. (This is the proposal to centralise social care and health care data – from both primary and secondary care records – in the Health and Social Care Information Centre, and to make them available for certain uses, including commissioning, service development and biomedical research.) However widespread public suspicion of official motives may be, there certainly appears to be widespread uncertainty about the details of how the data will be used and why this is a good or bad thing. This may not be just the result of poor communication or paternalistic obfuscation, since the uncertainty appears to be on the NHS England side as well as among the wider public. In any case, a large number of people seem to have no recollection of the leaflet by which notice of the programme was served on them. This put a spanner in the works.
What’s the response? ‘Reduce the deficit!’ The Health Secretary has announced an ambitious deficit reduction programme that would reduce the deficit to zero – in just six months! (I imagine the Chancellor, at this point, fainting over the Cabinet table from amazement at the scale of this ambition.)
It’s not only the government and its official organs that are guilty of rushing back to the deficit model when the implicit public mandate for their policies appears to slip through their fingers. Some medical research charities have been at it too. (In fact, I might be able to offer the Chancellor some small assistance with his own problems if I had a pound for every time I’ve heard or seen the phrase ‘if only the public understood’ or its cognates in discussions of the benefits of care.data.)
As I implied in a recent post on this blog, my fear is that instead of a genuine public debate we simply have a PR offensive. PR is a game that all can play. But lots of media stories about the benefits of biomedical research will not do the job and nor will anecdotes about identity theft and discrimination. (And we know which kind of story plays better in the press.) Cheering for abstract benefits and booing imagined costs leave the question of uncertainty unmediated on both sides. That is not to say that we can reasonably quantify the likely benefits or harms of a programme like care.data (I don’t think we can) but that we need to think about what they mean and how they should be approached. And this thinking needs to be undertaken collectively in some way, since we are all implicated. We need to establish a common moral ground.
I have been reflecting recently on why some controversial issues of public policy (like assisted conception) proceed in a relatively orderly way and others (like genetic modification of plants) have repeatedly blown up in official faces. From where we are now, engaging meaningfully in public debate must be crucially important, not simply ‘educating’ the public, and especially not hectoring or cajoling them. Care.data might have something to learn from the experience of GM Nation and subsequent attempts to get the GM ball rolling again. Which is, perhaps, a question for another time...