Editorial 31 December 2011: The Curious Incident Of The Debate That Didn't Move On

So. If we were going to have a debate about priorities in the healthcare landscape, it might be a timely thing, no?

And it might be useful to have a range of experts?

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How about this list of topic headings?

We'll start off looking at the impact of current government policy. It shouldn't take us long.

Next, we have a look at acute hospitals, with the emphasis on the consequence of a wave of recent expansion of hospitals. Then, let's take a look at confusion of functions between small, medium-sized and mega-teaching hospitals.

So far, so topical. After that, we could avoid ducking really tricky subjects by moving on to the question of medical audit of activity and performance. That should be uncontroversial.

Then we might have a quick cup of tea before moving on to regional inequalities and funding formulae, touching again on variations and what is affordable.

Next, we could move on to the role of the third sector, and then provision for the frail elderly in community settings.

After that, we could move on to the challenging question of whether throwing money into primary care has improved services.

It would be good to discuss what an ideal medical service would look like and what can be achieved with strained resources, and the levels of tolerance and crisis measures.

We could not possibly leave out social care, and so we would not leave out social care.

Then we might as well treat ourselves to a topical chat about 'nudge', as we look at whether persuasion or compulsion would be the better upstream approach to get people to avoid getting unnecessarily ill in the first place.

To round off the conversation, we could discuss how responsibilities for health should be apportioned between the profession and the public.

That actually sounds like quite a good agenda, doesn't it?

I'd go to that meeting. The main problem being that I'd need to borrow Dr Who's TARDIS, because it was already held by the BMJ in 1976.

Some things never change. As Rudolf Klein notes at the conclusion, "We badly need a vigorous, informed debate on these priorities and the medical profession is admirably placed to start it".