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Giving to get

Ellis Croft
Negotiation Healthcare [Converted]
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Last week I was lucky in two respects: I got to see the excellent Nye at the National Theatre, but – second slice of luck - only because I’d uncharacteristically put a calendar invite in for the week before, having booked the tickets last October and knowing that in the absence of doing so I’d likely fail to book childcare or miss it entirely through forgetfulness.

The play covers a broad chunk of Bevan’s life and career and does so with humour, pathos and no small amount of drama. It’s a lot to squeeze into a 2hr 40 minute run time – possibly as a result of this, one of the most dramatic sequences flashes by with almost indecent haste. The scene I have in mind is the final approach of July 5th, 1948 – the day on which the National Health Service (NHS) replaces all that went before it in terms of the UK’s health care.

Prior to the NHS, access to medicine across the UK was largely determined by the ability of patients to pay GPs or consultants. The other means of accessing healthcare were via charitable hospitals or, more recently, community health services whereby the local population all paid in to cover the entire community (as pioneered in Tredegar by Bevan himself). It was clear that this patchwork quilt of differing standards, layers of access and concentration of resources was sub-optimal, particularly following the Second World War which had seen a massive increase in how closely the state monitored public health, morale, and more. The Beveridge Report which paved the way for Bevan specified that universal healthcare that was accessible to all would lead to dramatic improvements in the nation’s collective health.

The run-up to the birth of the NHS did come with more conflict than might be imagined from our vantage point more than 70 years later – conflict that required some insight and action that is still utterly relevant to negotiators today. Strange as it may seem today, not only was the NHS bitterly opposed before its creation – but the strongest opponents were led by the British Medical Association (BMA), effectively the trades union for Britain’s GPs, doctors and consultants. A philosophical objection to the socialisation of a profession – Bevan’s role as Health Minister was even sniped at as being “Medical Fuhrer” as opponents sought to use recent memory to demonise the idea of the NHS – was accompanied by very pragmatic opposition to moving from a consulting/practise based remuneration to being state employees. In other words, money. The BMA’s opposition to the NHS was implacable and they had seen off previous Health Secretaries before Bevan. And yet Bevan got what he wanted; and this is where, as a negotiator, I’m fascinated by the story. What can we learn?

  1. Be clear on your objective: Bevan wanted universal health care free at the point of service (a principle which still largely operates today). He got that. Which means that…
  2. Prepare to be flexible: recognising that many BMA members were opposed to the change in employment and remuneration structure, rather than the principle of universal access, Bevan’s strategy was simple – make concessions that would get around this obstacle in pursuit of the actual objective itself. Leading to…
  3. Negotiation is the art by which we give in order to get. The skill lies in making sure that what we give is of lesser value to us than what we get in return. Bevan’s concessions (GPs were allowed freedom to run their practices, consultants retained the ability to practise privately as well as through the NHS, and Doctors and Nurses were offered more by way of salary) enabled him to secure agreement, delivering what by any measure was and remains a worthwhile objective.

The broad lessons in objective setting, keeping a simple and flexible strategy and preparing in advance the variables with which you can trade to agreement are as relevant today as they were in 1948. We might not be doing deals that lead to the kind of outcomes the UK has benefitted from in terms of the creation of the NHS, but they’ll only ever be better deals when we remember those lessons.

Ellis Croft
More by Ellis Croft:
Crystal Balls
Power play
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