“So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself…”

—Franklin D. Roosevelt: First Inaugural Address: Saturday, March 4, 1933

Now that the elections and referendum are over, and the results have knocked the egg out of Clegg, the talk has turned, as it will, to what the Lib-Dems must do to lay themselves sunny-side up again. The general thrust is that they need to get tough, rattle a few sabres, perhaps even fire a few arrows, and so assert their identity in the face of their coallusion partners, the Tories. A top candidate for the sabre rattling treatment is of course the NHS reforms.

Dr No has no doubt that the most devastating blow to be wrought by the Tories on the National Health Service in their Health and Social Care Bill is the abolition of the Secretary of State’s duty to provide a comprehensive health service. At a stroke, it removes ministerial responsibility and accountability, and so renders the NHS as an army without a chief, a supertanker with no one on the bridge, a body without a head. And when mayhem arrives, as it surely must, when the troops run wild, or the tanker strays off course, there will be no one in charge, no one on whose door we can knock, and demand redress. So long as the Secretary of State has ‘acted with a view’, an invidious wording blessed with the legal slipperiness of a bar of soap, he can profess to have done his duty, and declare, even as the tanker hits the rocks: ‘not my problem’.

“The best argument against democracy is a five-minute conversation with the average voter.”

–Sir Winston Churchill

The hills may be alive with the sound of music, but the UK medical blogosphere is alive with the sound of rebellion. Virtually all British medical bloggers – and much superb research and writing has been and is being done – are singing off the same hymn sheet: Broken Arrow’s NHS reforms will be at best disastrous, at worst will kill off the NHS.

The Royal College of Nursing has come out staunchly against the reforms; while the British Medical Association has been, to its shame, woefully timid, but is nonetheless critical of the proposals. And of course we have the wonderful Professor Allyson Pollock, the thinking doctor’s crumpet, writing sterling material in the medical journals and elsewhere.

Broken Arrow – so-called because he doesn’t work, and can’t be fired – stood up red-faced in the Commons on Monday. A nervous tie-fingering moment later, he launched into a resentful defensive downcast drone about his beloved Titanic Bill. It was already more than four fifths of the way across the Atlantic, he declared – it had concluded its committee stage, and eighty-seven percent of GPs covering forty-five million patients had already signed up to join the party. Labour jeered and heckled, and Broken Arrow’s face got redder. But a spectre of icebergs had loomed, and through gritted teeth, he admitted the most unTitanic of conduct: a slow down. The government, he said, would take advantage of a ‘natural break’ in the passage of the Bill to ‘pause, to listen, and to engage’. Labour, of course weren’t having any of it. Broken Arrow hadn’t listened before, so why should he start listening now?

After a quiet few days, there have been some yelps squeaks and barks from UK medical bloggers about the British Medical Association’s SRM (Sham Representative Meeting) called earlier this week to decide the Association’s position on the government’s proposed NHS reforms. Dr Grumble meanwhile has adopted an “I’ve been telling you for years, will you believe me now” tone under a reckless headline on the ways of parliament. Or perhaps it isn’t so reckless after all – for who knows how many tens of thousands will die unnecessarily if the Tory health reforms become reality.

The trouble with all these yelps squeaks and barks (and Dr No has been at it too) is that they are faux-outrage at what is in fact inevitable. It is the inevitable result of what many of us call democracy, but which is in fact nothing of the sort, being instead something which Dr No called Sham Dem eighteen months ago; and the thing about Sham Dem is that it is anything but democracy, by any accepted definition of the term. It is, to give it a more descriptive but less snappy name, serial, or perhaps more accurately, interval, oligarchy. If that sounds a bit technical, Dr No apologises, but hopes to make all plain.

Lord Mildew of That Ilk, Chief Pongo at the British Medical Association, is worried about his eggs. Speaking at the Association’s Special Representative Meeting yesterday, the first such meeting in nearly twenty years, he implored his delegates not to put all their ‘negotiating eggs in one basket’. To Dr No, the pleas of The Lord of the Ilks sounded more in line with a foolish game-keeper laying out all his eggs individually, the better that the foxes might easily pick them off later, one by one, than a fighting chief calling his clan to arms.

The reason for the exceptional SRM was that the BMA wanted to vote on a number of motions to do with the government’s proposed changes to the NHS. As is BMA way, the agenda was pre-loaded with motions deploring the decline in the standard of NHS biscuits, but in amongst the chaff there was no mistaking the wheat. The BMA mill was spinning for none other than the government’s chief architect of, and ambassador for, its ruinous Health and Social Care Bill, Secretary of State Andrew ‘Ribbentrop’ Lansley. The crux of the meeting, to be decided at the final vote, was whether to oppose this architect of doom by gentle jaw-jaw, or by the husk shattering steam hammer of war.