A philosopher visits the Ministry of Health

The ‘phone rings. A philosopher answers.

‘Good morning Dr Seedhouse. This is the Ministry of Health calling. We were wondering if you could come along and help us with our policy making?’

‘That would be quite a challenge,’ the philosopher replies. ‘But I would be delighted to try. What did you have in mind?’

‘Well as you know we have, for the past three years or so, been assessing our outputs in terms of health gain. You may have seen some of our publications on this. You may even have been to one of our regular health gain seminars.’

‘No, I can’t say I have. But how would you like me to help you?’

‘It’s a little embarrassing actually.’

‘Do go on.’

‘Well,’ says the civil servant. ‘Some of us have come to realise that we are perhaps not as clear as we should be about what we mean by health gain. We’re not really sure what we’re measuring, how to measure it, nor even who should be measuring it.’

‘I see’, chuckles the philosopher. ‘So you’d like me to help you work out what you are talking about?’

‘I wouldn’t put it quite like that - but yes, if you could sort out a few points for us we would be very grateful.’

Regular readers will be convinced that this is another Seedhouse fantasy - a jocular impossibility presented to impress a point. But it isn’t, I assure you. The conversation actually happened. What’s more, I did attend the Ministry, and gave a whole day’s seminar on the nature of health gain to nearly 100 senior healthcare decision-makers.

And they listened. They didn’t all like what they heard - I explained that they do not have a practically useful understanding of health gain because they do not have a decent theory of health - but most conceded I had a point. They even proved it for themselves.

During the day I gave out three simple questionnaires to discover the audience’s interpretation of health gain. As I expected, though to the surprise of most of the assembly, the surveys produced all manner of interpretations - a lot of them plain contradictions. For some at the Ministry, health gain means decrease in morbidity, for others it should only be measured by each patient, for others health gain implies improvement in function, and for yet others health gain always has to be tied to cost.

I made full use of this disturbing finding. If the Ministry can’t agree what health gain is, what hope is there for consistent policy? I argued that the Ministry must develop a theory of health, and (naturally) suggested my own.

Apparently the Ministry is radically divided. There are now two camps. There is a ‘we must develop a theory’ faction and a ‘we already have a theory’ faction. Even though the latter can offer no evidence of any credible theory of health I suspect they will win the day (the status quo is usually the safest bet).

But they may not always have the upper hand - and it is exciting that the Ministry was brave enough to welcome a person so critical of its most basic assumptions. How courageous of Mr Dorrell. How public-spirited of the Ministry’s officials. What an example to set to other departments.

It would have been. But of course this is fantasy. I was invited to the Ministry of Health in New Zealand. Only in my dreams will I ever be invited to the Department of Health in London.

David Seedhouse