This article was originally published in Student BMJ magazine. An online version can be found on their website here.
Sarah Wollaston is a GP who wanted to make a difference. After graduating from King’s College London in 1986, she spent 23 years working in clinical medicine, first in paediatrics and then in general practice. During that time she also worked in medical education teaching junior doctors and as an examiner for the Royal College of General Practitioners. In 2009 she turned her attention to politics, after being selected as the Conservative Party candidate for Totnes, Devon. A year later she was elected as the member of parliament for the constituency. She successfully re-contested her seat in the 2015 general election and now chairs parliament’s health select committee.
What motivated you to get involved in politics?
As a GP, I often felt that a lot of health policy seemed to be divorced from the issues that faced my patients. So when I heard David Cameron say that he wanted more people who hadn’t been traditionally involved with politics to put themselves forward to become an MP, I picked up the phone and applied.
When you stood to be an MP, you campaigned on the fact you were “someone with a real job.” Have your colleagues valued your experience in healthcare?
I think that in parliament we do see more people who have real life experience, and several of my colleagues have experience of working in the NHS. What’s been surprising to me is how little use is made of that. When you arrive in parliament, there is no training in how to be an MP. Does anyone ask what areas you’re interested in and what you can contribute? Surprisingly, no.
You’re the chair of the health select committee. What does that involve?
The health committee’s job is to hold the government to account, to say challenging things, and to keep saying them. Having somebody who’s got a background in health is probably helpful; if you’ve worked in the system you understand how it works, so you’re in a better position to hold people to account. I love chairing the health committee. It’s probably one of the best jobs in politics.
Has your independent mindedness caused friction with senior members of your party?
Of course government ministers would much prefer that you always agreed with them. But that’s why it’s important that you have the select committee system, because you can speak without fear or favour. You want to have a constructive working relationship, but a constructive working relationship doesn’t mean agreeing with people all the time.
Your criticisms of the Health and Social Care Act 2012 were well publicised. Do you think the legislation has been successful?
I still think that it was a hand grenade into the primary care trusts. A lot of the areas that I was particularly concerned about were amended during the passage of the act, but the thing we all struggle with is some of the fragmentation as a result of the act. One of the things that I pushed for when the act was going through was that I felt that integration should trump competition. I was repeatedly assured that’s what would be the case, but we still find clinical commissioning groups putting huge amounts out to tender because they’re anxious about facing legal challenges. I’d like to see the process made clearer so that we don’t see so many of these annual contracting rounds, which are a waste of our money.
You mention concerns about fragmentation and competition. Do you think there is an ideological motivation behind policies that lean towards these trends?
People write to me sometimes and say “it’s all about privatisation” and that “the Tories want to sell off the NHS,” but it’s really not true. What’s more annoying is this ideological fixation that you get on the other side of the argument, which says that everything must be run by the state and the NHS. For example, primary care right from the outset was [made up of] independent contractors to the NHS, acting as small businesses and making a profit. Yet nobody looks at the GP and thinks “this is an evil organisation that makes money from the NHS.” It’s efficient, works well, is locally facing, and is on a human scale. But I think there is a difference between that and the fear that people have about large corporations.
At the moment, we probably have the balance about right. From the point of view of patients, what they want is the best service at the best value for money. If that is better provided by an outside organisation providing it free of charge for the patient, that doesn’t worry me. So I’d like to see us move away from this little false argument about privatisation to a discussion about the best value for money and quality you can get.
Much has been said about the NHS funding crisis. Do you think current funding frameworks are sustainable?
If you compare [UK health spending] directly with other countries like France, Germany, or Italy, those systems use many more top-ups and insurance models. So, if you want to stick with the taxpayer funded mode—which I think we should do—then there’s a trade-off. We have to decide how much of our national taxation we want to spend on health. I would certainly like to see it move up to 10% of our GDP [currently 8.5%]. The fact that we have a huge increase in demand means that if we try and stick where we are, we won’t be able to care for our ageing population in a way that we would like to.
Since joining parliament, what do you think your biggest achievement has been?
I think if you ask that to any MP, they’ll all tell you a case of when they intervened for an individual. One area I’m very pleased about is the use of police cells where children are detained on Section 136. It always struck me as being monstrous that if you have an acute mental health crisis, you don’t get taken to a casualty department but to a police cell. I lobbied hard in the last parliament and I hope that in coming years we’ll see an end to that practice.
What are your thoughts on the dispute between the government and the BMA on junior doctors’ contracts?
Whenever I speak on this issue, I need to make it clear that I’ve got a personal conflict of interest, because I have a daughter who is a junior doctor. I think both sides should step back. I hope that junior doctors will not decide to take industrial action, a strike would be enormously damaging. It would have grave consequences for patients, and I also think it will undermine junior doctors’ position in the eyes of the public. It would be a huge error.
I think there has been poor communication from both sides and I’d urge anyone to look directly at what the contract proposals are. I think there will need to be further concessions from the government. I’d also like to see the BMA come forward with its own proposals about what they would do.
You can set out two shared objectives. Firstly, how do we get more doctors to go into shortage specialties? It can’t be right that we still have so many junior doctors going into fields where there aren’t consultant posts for them. The other issue is how do we deal with variation in care. Of course I don’t believe that there are 11 000 preventable deaths due to the “weekend effect”—it’s wider than staffing numbers and it goes into issues like access for diagnostics, the speed at which procedures can be carried out, and the effect of sicker patients coming into hospital at weekends. But, there is a weekend effect in every health system, and it’s right to look at how we can address this variation in care.
I also think that we’re missing an opportunity to tackle some wider issues that are causing a great deal of unhappiness for junior doctors, such as the loss of hospital accommodation, the fact that junior doctors have a nomadic existence pushed from pillar to post and are not as much a part of a team as perhaps they used to be. Lots of things have been lost from the system that makes it, in many ways, much more difficult to be a junior doctor than when I qualified in 1986. We were working outrageously long hours, there was no life outside the hospital at all, but at least there was a sense of camaraderie.
Do you think Jeremy Hunt has deliberately misled the public with the weekend mortality figures?
No, I think that there is a great misunderstanding about statistics in politics, it takes the misinterpretation of statistics to a whole new level. If you had continuing professional development for politicians, one thing I’d send everybody on is a course in statistics.