Winding Up Broad Churches and Playing Shops
Over the last few years those of us working within the National Health Service in the United Kingdom have been struggling to swallow the Thatcherian prescription of a hefty dose of sound market principles'. Although all of the money comes from the government coffers, we have had to divide into teams as it were and become either purchasers or providers of health care. We then go through theÐbureaucratically expensiveÐ business of buying things from each other or maybe pretending to do so. I have heard the whole business described as playing shops' and there is indeed something strange and unreal about the process. Nevertheless, it does mean that we are coming to talk the same economic language as our colleagues elsewhere who work within private or insurance based systems. And of course the issues of ®nance and resources are real enough everywhere.
Another British, or in this case more speci®cally English, phrase which is often bandied about by politicians is that of the `broad church'. It comes from the self description of the Church of England which since its inceptionÐto facilitate the divorce of Henry VIIIÐhas often managed to accommodate within its breadth all manner of belief and practice. (Some have even suggested that this has recently extended to embrace atheism.) Political parties frequently seek to claim similarly wide and accepting boundaries.
So what has this to do with our topic of eating disorders? Well, it seems to me that these disorders are themselves a `broad church' in the sense that the term includes disorders and states which vary widely in their severity and implications including the therapeutic responses which are appropriate. The dying anorexia sufferer, the self cutting adolescent and the woman who has made a kind of life around her disorder for the last 30 years may all be part of the broad church of the eating disordered but their needs are very different. This means that when we start to play shops and either offer or purchase services, we need to be open, honest and precise about what we are or are not talking about. Not all services are the same. Not all services can provide for the whole range of disorder nor should they try to do so. Providers need not provide a comprehensive service but they should be clear about what they can do and more especially what they cannot do. On the other hand, purchasers should go shopping for a complete range of services for their people. There is CCC 1072±4133/97/040301±02$17.50