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“On the one hand ... but on the other hand ...”

Martin B Van Der Weyden
Med J Aust 2008; 189 (9): 473.
Published online: 3 November 2008

Amid the recent celebrations for the 60th anniversary of the United Kingdom’s National Health Service (NHS), a report appeared that outlined future directions for Britain’s cherished free health care system. Entitled High quality care for all, it had been assembled by Lord Ara Darzi, a practising surgeon and professor of surgery, a peer in the House of Lords, and Parliamentary Under Secretary of State for Health. It detailed reforms designed to ensure high-quality care for patients and programs to promote the health of the public at large.

The report also proposed an NHS Constitution that proclaimed the purpose, principles and values of the NHS, along with the rights and responsibilities of patients, the public and NHS staff. Lord Darzi’s report is a classic of measured reform and epitomises both leadership and vision.

This seminal report was preceded by the release of an equally impressive report on reform to promote quality medical practice, entitled Good doctors, safer patients, by England’s Chief Medical Officer, Sir Liam Donaldson.

* Bush GW. President Bush discusses economy, trade [presidential speech]. 2 May 2008. http://www.whitehouse.gov/news/ releases/2008/05/20080502-8.html (accessed Oct 2008).

This activity begs the question of why our own politicians and health bureaucrats fail to spawn similar reports. Instead, we have an undue reliance on the recommendations of expert working parties and committees. Such bureaucratic reliance recalls President Truman’s famous wish for “one-handed” experts, as the advice he received from experts was perpetually prefaced by double-speak: “On the one hand ... but on the other hand ...” This desire prompted President George W Bush to add, in desperation: “If [these experts] had three hands they’d say, ‘on the one hand, on the other hand, and then on the third hand’.”*

But there is a more fundamental question. Where are the one-handed, clear-headed and creative advocates such as Lord Darzi and Sir Liam in creating Australian health policy?

  • Martin B Van Der Weyden


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