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BMA chief crossed lanes to face 'perfect storm'

I realise on the way to interview Jill Vickerman, the new Scottish secretary of the British Medical Association, that I have made a mistake.

I should not be asking her questions and scribbling down answers in a notebook in her office, I should be talking to her off the record over a pint.

That way I might really have found out why she left her job as policy director for the Scottish Government's health and social care quality unit - a top job driving forward Scotland's NHS and care services.

After all, while it might just be coincidence, Derek Feeley, the chief executive of NHS Scotland, left last summer after a relatively short time in office and now Chief Medical Officer Sir Harry Burns has handed in his notice.

I'm not suggesting the secretary of BMA Scotland is unimportant, but it is hard to see how you can make a bigger difference to the standard of healthcare outside the system than within - unless, of course, you feel the system is missing something.

This is not a case of gamekeeper turned poacher, more gamekeeper turned leader of animal rights.

So I ask her straight, why has she switched jobs? She talks about spending time in her last post bringing together the views of clinicians and NHS managers and government officials to produce their 2020 health care vision and it being a real privilege, then explains: "Where I got to was a very clear understanding that if we were going to deliver that, we needed to understand more clearly what was required for actual changes on the ground. My view was it was about working with clinical leaders."

I agree with her, but surely the Scottish Government would tell me they already work closely with the medical profession when it comes to new policies.

She says: "The government do clearly have access to medical professionals but we are not working with them and understanding their issues in quite the same way as you get the opportunity to, I believe, in the organisation the BMA is …

"There is more opportunity to really get to know the detail of how it feels to be operating."

She describes the realities of the growing elderly population, heightened public expectations from the NHS and the constant evolution of new technology and drugs - all of which carry a price tag - as "that perfect storm" and seems genuinely driven to do something about it.

Her comments then seem to suggest she feels doctors should be playing a greater role in sorting the problem out.

Ms Vickerman, who moved to the BMA on December 2, says: "I do think we are in a moment of time where there's been a change in public perception of the profession and the leadership that doctors can provide to this agenda and in my last year or so in leading this national policy in government I was very aware of the need to have a more honest discussion with the public about what the priorities are for their health service going forward.

"I think again - and I was thinking about this from where I was before - there is a really good opportunity for the clinical leaders to lead that conversation with the public."

Pressed on this further she says the public perception of a range of professionals has shifted, continuing: "Some of that has been a bit damaging for the public. They have lost their respect and trust for doctors in a way that undermines the doctors' ability to really provide that leadership in discussions about the future of the NHS."

Given her previous foothold in the government camp, she is perhaps ideally placed to address this.

Ms Vickerman originally joined the civil service as a statistician and quickly became more interested in what they were trying to achieve on the ground than how results are measured. She moved through performance management, into planning and policy.

As she obligingly adopts different positions for The Herald's photographer, she talks about maintaining her networks and using her insight into the government and the BMA camps to the benefit of both sides.

In many ways it makes good sense - but there are tensions. Not long ago BMA Scotland was balloting on strike action over pension reforms, accusing the Scottish Government of "talking up its opposition" to the changes "but failing to deliver on these words."

There will be times, I suggest, when serving the interests of the BMA will mean saying things which are critical of her former colleagues.

Ms Vickerman says: "I have a very clear understanding of when and why the government has to take the lines and actions that it does. In the same way, my ex-colleagues will understand why I have to take the lines and actions that I need to."

She goes on, I am glad to say, to acknowledge it is important for the BMA to shine a light on issues in patients' interests when the government does not.

But for now, understandably, she is choosing her words with the tiptoe care of a civil servant.

Contextual targeting label: 
Health

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