In extracts from her final interview as president of the RCP, Professor Dame Jane Dacre talks to Commentary magazine about the future of the NHS, Bawa-Gaba, and dealing with former health secretary Jeremy Hunt.
COMMENTARY: Going into the role of president you must have had certain expectations, has it been how you thought it would be?
PROFESSOR DAME JANE DACRE: I knew that there were going to be some big issue that I was going to have to lead on and deal with. They were going to come at some point, but I didn't know what they were going to be. What I underestimated was quite how many issues there would be: two general elections, two prime ministers, Brexit, the junior doctors’ strike, the Hadiza Bawa-Garba case… and that's just off the top of my head!
What’s been the biggest lesson over your 4 years?
The biggest lesson I've learnt is that when I become more adversarial, I’ve achieved less. I learnt very quickly that if you're very adversarial, you're not invited [to the table], people don't want to talk to you.
What I underestimated was quite how many issues there would be: two general elections, two prime ministers, Brexit, the junior doctors’ strike, the Hadiza Bawa-Garba case…
You’ve also continued to practise as a rheumatologist throughout your term. Do the two roles speak to each other?
Yes, in both directions. It's been really important [as president] to have my feet on the ground clinically, to go and work in a trust, spend time there, talk to colleagues and appreciate their experience of the issues that I'm trying to tackle on a national scale. That's been hugely helpful.
The government recently announced plans for significantly more NHS funding after years of marginal increases, what do you think changed their approach?
I feel that the government is now listening. We have got more medical student numbers. OK, not enough. We have got more money for the NHS. OK, it’s not enough. The government can't give us everything that we want because they don't think they've got the resources, but they have listened to what we said and we have made some big in-roads. I think we have made progress.
You worked closely with [former health secretary] Jeremy Hunt across your presidency, what was the relationship like?
Well, to start with we had a few difficult moments and a few tricky meetings where we were not getting through to each other at all. What changed things was – or what contributed to changing it – was the 2017 general election. I think after that, he understood that actually I wasn't just being difficult, that I was saying some things that were true. After [the election] we did understand each other and respect each other more, and that's been quite a work in progress.
Can you talk about chairing the NHS pay gap review which you’re heading?
I've been interested in equality and inclusivity for some time, and have done some research in this area before [notably as chair of RCP research steering group ‘Women and Medicine: The Future’] while also supervising some research students in this area. I just happened to be on some trust visits with Jeremy Hunt when there was a bit of publicity about the BBC gender pay gap. We talked about it, and a couple of days later he sent me a text to say they were embarking on a pay gap review, and asked if I would be interested in leading it. It seemed to be a very interesting thing to do, particularly now as I'm moving on from the RCP.
We’ve slipped into a culture of thinking – not just in the NHS, it’s in our world – that if something goes wrong it’s somebody’s fault. If you think you’re going to be blamed, it affects your practice.
There’s been a lot of discussion about the culture of the medical profession and the NHS post Bawa-Garba, what kind of culture does the NHS need to have in future?
Without a doubt we need a no-blame culture. We’ve slipped into a culture of thinking – not just in the NHS, it’s in our world – that if something goes wrong it’s somebody’s fault. If you think you’re going to be blamed, it affects your practice. I'm a rheumatologist, and there’s a risk in injecting someone's joint if they've got a big swollen knee that needs fluid taking out. If you don't do it that patient can't walk. If you do it you're taking a risk that it might get infected, but also the patient might get better. You have to feel safe enough that even if there's a risk that it might go wrong then you've still got to be able to do it.
You were given a damehood in the latest honours list, what does that mean to you?
I'm not going to say I hated it! It wasn't something that I set out to achieve, but it's something that I'm very pleased to have [been awarded]. I thought that the stance that I'd taken about not being 'complicit', and sometimes being a bit adversarial and trying to be influential might not go down too well with the authorities. So I'm really pleased that speaking truth to power hasn’t seen me shut out in the cold.
Finally then, what will you miss about the role?
So many things. I'll miss the friendship, the colleagues, the staff, the building. I’ll miss the opportunity to get out and network with physicians. I feel a huge bond with physicians. I feel as if we're all the same inside. Even internationally, you go somewhere and meet a physician, within a couple of minutes you've bonded and you're their friend and you can talk to them. I'll miss the opportunity to do that as much as I have done.
Professor Dame Jane Dacre is president of the RCP. You can follow her on twitter at @DacreJane
The full interview appears in the August edition of Commentary magazine
