Tuesday, 13 July 2010

Reforming the NHS

Lansley is, of course, doing nothing useful. Ostensibly taking the levers of power away from the unaccountable managerial twats who control the purse strings in the current version of the NHS, he is instead giving that power to the only people who I would less prefer to have it: GPs.

Now I realise that I alone in this entire country have been unlucky enough to find only useless, incompetent makeweights in GP practices in three different counties, but I'm afraid that it has coloured my perception of them.

Unable to diagnose a splinter without a battery of blood, urine and stool samples, I wouldn't trust a single fucking GP I've met to find their own arsehole with a map, Grey's Anatomy and fucking assistant. How giving them control of what happens to you after you've left their tender and astute care is going to help anybody is fucking entirely beyond me.

The problem isn't the fucking managers or the bureaucracy, the problem is specifically that the cunting GPs are entirely useless. How giving the fuckers the reward of controlling how money is spent is going to suddenly make them better, I don't fucking know.

How a service that is free at the point of delivery is not going to be abused by freeloaders and hypochondriacs, I don't know. How a system which does not reward a doctor for the quality of his work but rather his run rate is ever going to provide decent primary health care, I don't know.

We are truly uniquely blessed in the UK: we pay through our nose for health care service that needlessly kills more people that pretty much all the things they pronounce upon with such disdain and we have absolutely no fucking control over how any of that money gets spent. The worst incompetent cuntish fuckwits in the entire system are being rewarded with control over the money.

Oh yeah, and that bonfire of the quangos has yet another new "commissioning board" to add to its list of amazing accomplishments.

So: more money being wasted on the NHS, more quangos, taxpayers getting raped, patients getting killed, lectures from doctors about how sinful we are.

Meet the new politics, completely different from the old politics.

Oh yes.


Anonymous said...

Then why not bang on instead about privatising the NHS?

This morning I have read countless blogs, all complaining about the NHS but none raising the prospect of privatisation.

Only by raising this repeatedly as an issue might the politicians start to take it as a serious possibility.

Privatising the NHS will achieve enormous benefits with absolutely no downside but, like drugs and prostitution, the politicos treat it as a sacred topic, not to be discussed in mixed company.

The NHS is a failed socialist experiment and nobody should be suprised at its massive failings.

Roger Thornhill said...


Define "privatise"

Labour did it in spades, but just created private monopolies instead of public ones, which, IMHO, is far worse.

We need plurality, accountability, choice. We need people voting with their feet to scare the bejeezus out of the participants so that they know that if they screw up they will be at least out of work, shut down, abandoned because another, better participant is eager to take their revenue streams away form them.

I do not see this in this "change" to the NHS. "change" it is. "improvement"? I doubt it.

I will be blogging about this once I have read more in detail about how this new regime is going to be structured. I was going to say "meant to work" but that is just PR.

Generalfeldmarschall said...

3 fucking wonderful rants. And it's not even 10 a.m.

Well fucking done!

Anna Chen said...

The GPs even say themselves they'll be useless at admin. They don't want to do it, they don't have the skills to do it, so making them running a business instead of what they're good at (spurting blood and stool samples notwithstanding) is perverse.

Catosays said...

GPs don't need to be good at admin.

Surgeries have Practice Managers to do that little thing.

Perhaps I'm lucky but my local GP is bloody good.

Pogo said...
This comment has been removed by the author.
AntiCitizenOne said...

GPs the equivalent of first line IT support, and don't they just show it?

Jill said...

I've had two excellent GPs - and both have advocated for me with regards to so-called postcode lotteries (long and largely unwanted familiarity with the NHS for me). This aspect of GP care will presumably be lost if the GP is holding the purse strings. Good thing? Bad thing? Dunno. But nobody seems to be mentioning it.

MrAngryman said...

As a staff nurse who works for a large teaching trust, and who has personally felt the 'benefit' of having to bail the local PCT out from bankruptcy twice. (My wife was made redundant once and 'redeployed' once.) I can say that im not looking forward to the changes in the NHS with joy in my heart. GP's have consistently (at least in my area) shown themselves as unable to balance the books when run as a large PCT, so fuck knows how they are going to manage as smaller consortium.

Jim said...

My GP told me I couldn't possibly have the illness I went to him about (having self diagnosed via internet) because he had never seen a case of it.

So I ignored him, took the necessary action, and solved a health issue that had been making my life a misery for 20 years.

I dread the thought of him being in charge of all the funds for his patients.

On a slightly different tack, would it not be possible to privatise the medical providers, but make the payment still free?

IE if you go to the doctor you have to pay, but you then get reimbursed your expenses from the State directly. So you create a system of actual customers for medical services. Because if you are paying for something, even if you get it back later, you are much more likely to demand good service. And as you are suddenly the doctor/hospital's only source of income, they would be more likely to treat you like a customer, not some sort of hindrance (as they do now).

More private medical hospitals/clinics/doctors would spring up, making a much wider choice in each area too, introducing competition.

The only flaw is the poorest would be unable to pay in the first place, but I can't see why a system could operate whereby those on benefits (say) could get treatment and send the bill direct to the State.

But the crucial thing is to devise a system whereby GPs and hospitals get their money ONLY via their patients, and not directly from the State.

AntiCitizenOne said...

Jim, Just have a Health Only credit card.

Kingbingo said...

“Now I realise that I alone in this entire country have been unlucky enough to find only useless, incompetent makeweights in GP practices in three different counties”

Obviously your agenda is to find fault in every single thing any politician ever does to validate your anarchist position. But you missed the key plank of the policy. That you can sign up for any GP you like, not just the one you are dictated to by virtue of what post code you happen to have. If you have a bad GP then a good one can come along which you will switch to, and the bad GP will lose all his patients and income.

If you continue to have a bad GP it’s a bit like having a bad accountant. Because you fail to be bothered to move to a better one.

“We are truly uniquely blessed in the UK: we pay through our nose for health care service that needlessly kills more people”

Of course, but because the statists have won this debate changing the model in its entirety is not on the table. Only making baby steps. If you want the fundamental model to be an open question you need to first win the debate.

Mark Wadsworth said...

Fair enough, I have linked.

sques said...

Sorry to spoil the party, but I have mostly praise for the health care people who look after me. My GP practice has good doctors, the local hospital has always cared for me adequately, my consultant in the Royal Infirmary in Glasgow I trust completely. The surgeon who has chopped bits out seemed to know what he was doing, and I have not paid directly for any of it. I am here because of doctors.

It may not be the cheapest system in the world. Im sure there are mistakes made all the time - but we are all going to die anyway, so its fairly accademic when. But I am happy with the service I dont pay for.

I have seen wards stuffed with the self inflicted. I have seen stabbing victims, drunks and people cuffed to policemen. Obese people, smokers who's wounds wont heal because they smoke. Chewing gum on carpets and staff subject to abuse. Don't knock it. The alternative may be worse. Remember the promise of privatisation of phones and gas and water? Are we better off or are just the directors of the privatised corporations better off?

Obnoxio The Clown said...

"But I am happy with the service I dont pay for."

There are two ways of looking at this:

1. You're a dole-scrounging cunt and you really don't pay for it, like most of the fucking cunts I see when I do go to my GP, with their horde of children called Chardonnay and Chlamydia.

You don't pay for it, but I fucking sure as hell do.

2. You're not a dole-scrounging cunt in which case you're fucking stupid because you are paying for it, there's just no association between you paying for it and you receiving the service.

If you actually had to pay for it, even if you got the money straight back, you'd be horrified at how much that "free" service was costing you and maybe you would realise that actually, it's not all that good considering what you're actually paying for it.

"I have seen wards stuffed with the self inflicted. I have seen stabbing victims,"

They all stabbed themselves, did they? Idiot.

" drunks and people cuffed to policemen."

You're a real fucking snob, aren't you? Drunks are the same as criminals?

"Obese people, smokers who's wounds wont heal because they smoke."

Smokers pay more into the NHS coffers than they use. I'm pretty sure the same is true of fatties. These people are subsidising your neo-nazi arse.


"Chewing gum on carpets and staff subject to abuse."

Precisely because people think it's free, innit? If they were actually paying for the service, maybe they'd have more respect for it because they'd know that some of the money they were paying would be going to cleaning up the gum and not to their care.

And frankly, most of the "couldn't care less" staff deserve to be abused. They get paid whether they fix you or not, and it shows in their attitude.

"Don't knock it. The alternative may be worse."

I've tried alternatives and they were all much, MUCH better.

The NHS is easily the worst healthcare system I have experience of.

Jim said...

"Remember the promise of privatisation of phones and gas and water? Are we better off or are just the directors of the privatised corporations better off?"

Well those three examples show precisely where privatisation works, and where it doesn't.

If you compare the level of service, choice and price available in the Telecoms market now, compared to 30 years ago, well, it's a different planet. In those days you had to go on a waiting list for a phone. Phone bills have come down and down in cost, plus we get life changing services such as mobiles, broadband etc. And all provided by a free market.

Unfortunately the gas/electric market is not so competitive, but there is still a market - you can get your fuel from any one of a massive number of providers. Prices have fallen, but are subject to our fluctuating pound, and also govt impositions of things like the climate levy, which adds 11% to all our fuel bills.

The obvious cuckoo is water - no competition whatsoever, leading to no choice, no downward pressure on prices. Water bills have moved steadily upwards each year.

I think your example provides conclusive proof that what the NHS needs is its monopoly breaking up, a good dose of competition.

Anonymous said...

"I've tried alternatives and they were all much, MUCH better.

The NHS is easily the worst healthcare system I have experience of."

Go use them, then! You are free to move. You tapping away on a blog will change nothing, apart from give you the status you need.

Obnoxio The Clown said...

"Go use them, then! You are free to move."

Yes, you're quite right. It's much better for me to piss off elsewhere than try to enlighten others about the fact that the healthcare system they venerate and idolise is the biggest cause of avoidable death in the country, killing more than smoking or drinking or overeating or drugs.

You deserve the miserable care you get, you ignorant fuck.

Anonymous said...

So enlightening you are! Thank god I dont live in your miserable country (most of the time) with your terrible healthcare system! The saviour of Britain OTC! What is your job by the way? The question bloggers never answer!

AntiCitizenOne said...

My Job is as the director of a small business employing a few people.

Due to my experience of the british extortion funded treatment rationing system compared with foreign and private healthcare, I've come to the conclusion that the NHS is totally shit.

Anonymous said...

Roger Thornhill "Define privatise"

FCS I mean sell the lot in nice easy slabs to the highest bidder so that in the end there is nothing for the state to manage other than the inspection system.

Sell the hospitals and put the insurance scheme out to tender so that the state can have resort to the market for its own safety net to assist the needy.

Nothing should be left for the state to interfere with other than the inspection of private hospitals and the determination of who is classed as needy.

They may well fuck this up too but it will be much easier to nail than the myriad of issues presently unaddressed

Anonymous said...

Don't care what you do Mr Citizen, I was talking to OTC!

AntiCitizenOne said...

I'm sure OTC would have a similar story, except he's an database consultant.

Obnoxio The Clown said...

"What is your job by the way? The question bloggers never answer!"

Perhaps if you read my blog you'd know that I was a database consultant.

What that has to do with my experience as a customer of the NHS is something I don't entirely understand.

Obnoxio The Clown said...

"Then why not bang on instead about privatising the NHS?"

I've written about it so many times before, it's not even funny.

I'd happily privatise it, but not like the railways were privatised. I would declare each medical institution, whether it be a GP practise or a hospital or a clinic or whatever a business on its own with every employee getting an equal share of the business.

Payment would change to a state-funded insurance policy whereby people would pay for their medical treatment and claim it back from the state.

Phase two would be to reduce the things that the state would fund to A&E facilities and long-term care, allowing private insurers to provide different levels of care for everything else.

The consumer would fund this through reduced NI contributions.

Not where I'd want to be, but definitely better than where we are now and (hopefully) still acceptable to statists.

Anonymous said...

I'd listen to your considered opinion on a radical reform of the NHS database system but not the whole thing in that case. Privatization has failed in 2 areas of the NHS that I have personal experience - cleaning services and supply of oxygen.

Anonymous said...

I'd listen to your considered opinion on a radical reform of the NHS database system but not the whole thing in that case. Privatization has failed in 2 areas of the NHS that I have personal experience - cleaning services and supply of oxygen.

Anonymous said...

I'd listen to your considered opinion on a radical reform of the NHS database system but not the whole thing in that case. Privatization has failed in 2 areas of the NHS that I have personal experience - cleaning services and supply of oxygen.

AntiCitizenOne said...

As a patient the NHS has failed me every-time.

What about the privatisation of say Opticians?

Think about the waiting lists for those awful NHS glasses. Now think about the sheer presence and service from say Specsavers the super low cost of Laser eye surgery, or even the low waits for private MRI machines.

Face facts. The NHS sucks, and it sucks because the patient is a cost not a customer.

Anonymous said...

Guess what lansley's wife's job is?
Correct, she's a GP!

Obnoxio The Clown said...

"I'd listen to your considered opinion on a radical reform of the NHS database system but not the whole thing in that case. Privatization has failed in 2 areas of the NHS that I have personal experience - cleaning services and supply of oxygen."

My considered opinion on the NHS database system is that it's entirely unnecessary. But that's because I've been treated quite effectively in other countries which knew bugger all about me and I can't see why the NHS has to make my medical history widely available. It's got nothing to do with my knowledge of databases.

As to my qualifications for commenting on healthcare provision overall, I've been a customer in other European countries where the waits have been shorter, the hospitals have been cleaner and the doctors have been much more useful, despite them not necessarily even speaking English and me not speaking anything other than English.

Similarly, I've been to 3rd world countries where only A&E is "free at the point of delivery" and you pay quite handsomely to see a doctor.

But then that doctor wants to own the relationship with you and wants to keep you coming back to him. So rather than shipping you off to a specialist, or rather a queue for a specialist, whenever it's something that he can't immediately identify, he is much more motivated to do more to keep you spending your medical money with him.

And if you're not happy with the service he gives you or you feel like he's not curing you quickly enough, there's forty pages of alternatives in the local Yellow Pages.

Unlike the GPs in the UK, who have all been as much use to me as a Kashmiri call centre, GPs who get paid by their customers have a vested interest in curing their customers. The only interest a UK GP seems to have is getting you turned around as quickly as humanly possible.

And because there's no link between the visit and the payment, people will go to the doctor for any old shit as well.

So: the doctors are useless, the patients take the piss and it's dangerous to your health and mind-bogglingly expensive.

The very best of all worlds, eh?

Anonymous said...

A well travelled young man and quite a sick one on those travels it seems. Not sure that qualifies you as an expert but anyway. Are u also saying that the health care system in the developing world is better than the NHS??

Obnoxio The Clown said...

Things happen when you travel abroad, you know.

"Are u also saying that the health care system in the developing world is better than the NHS??"

Not always, but depressingly often. It's unlikely that the poor that live in those countries can afford decent healthcare, but if you have even a bit of money, there are outstanding doctors pretty much everywhere.

Even in the UK.

You just have to pay for them.

AntiCitizenOne said...

To put it another way, if the UK was as poor as oneof those African countries and still had an NHS healthcare would be worse than the African country.

Obnoxio The Clown said...

I suppose I should clarify. I haven't just travelled to other countries, I've lived in other countries.

Lest you think I'm some kind of serial malingerer.

Like I care.

Anonymous said...

As have I. Bully for us hey!! Not sure personal experience is a strong basis to be an expert on National health policy reform. It gives u an opinion as valuable as mine. Nothing more nothing less. But a guess that is what a blog is.

Obnoxio The Clown said...

The customer experience is what gives you an opinion worth having.

Unfortunately, to the NHS we are not customers, we are a cost to be endured. The government is the customer, which is exactly why the NHS is so insufferably shit.

Anonymous said...

Recently the NHS has saved the lives of 2 people, one close friend and the other a close relatively. So on personal experience it is perfect but that obviously not quite true. Yes reform is needed but privatization is not the way to go in my opinion. On the customer front - I am a customer of many private companies and many have proved to bit utter rubbish.

Obnoxio The Clown said...

"On the customer front - I am a customer of many private companies and many have proved to bit utter rubbish."

But if there's competition, you can fuck off elsewhere.

The problem is that we have an effective monopoly provider, apart from the insanely expensive Harley Street types. So for the very rich, health care is great and they don't have to trouble the NHS, but for the rest of us, we're just fucked.

And this slavish idolisation of the NHS doesn't fucking help.

Anonymous said...

I am not slavishly idolising the NHS, just pointing out the irrational argument that it was shit for me so change the whole thing. It needs change, I have already said that but I don't think privatization is the way to go.

AntiCitizenOne said...

Just let people opt out of the NHS.

It will have the right effect over time.

Kingbingo said...

"Payment would change to a state-funded insurance policy whereby people would pay for their medical treatment and claim it back from the state."

Awful idea, that's close to what the yanks do and their healthcare system is over priced and far too bureaucratic.

As usual the Swiss have the answer.

Kingbingo said...

"I'd listen to your considered opinion on a radical reform of the NHS database system but not the whole thing in that case. Privatization has failed in 2 areas of the NHS that I have personal experience - cleaning services and supply of oxygen."

That's because the NHS managers have zero profit motive and don't give a rats ass about services they contract in. All they care about is has the supplying firm ticked all the bureaucratic boxes.

A profit making hospital would actually care about getting value for money.

Kingbingo said...

@ Ayn Rand Forum:

The political froth notwithstanding, the failings of the NHS are manifest. It has grown into a staggering leviathan of bureaucracy. There are countless reports, articles, essays and books that will give you all the statistics, anecdotes and arguments you could possibly want (please see the links at the end of this article). I don’t want to debate figures here; plenty of misinformation is swirling around on both sides of the political divide and I see no value wading in to fight over the shifting minutiae. I’m interested in exploring the underpinning ideas.

Complaining about the NHS is almost as common as complaining about the weather. Whining about some specific personal outrage is generally acceptable, but if your criticism broadens to encompass the institution you can reasonably expect at least one member of your group to take on the aspect of beetroot. It’s as if you’ve assailed their religion. It’s even worse if a foreigner launches into a critique of our “national treasure” – doubly so if they happen to be American. The BBC has gleefully shown some carefully selected sound-bites from across the pond. They feature remarkably misinformed individuals mouthing wildly exaggerated statistics and horror stories about our NHS. I can understand the irritation this causes here in the UK.

Why do people get so upset? Most people have, at some point, either had their lives or the life of a loved one saved by the NHS. They feel an obligation; a profound debt of gratitude. The high likelihood that they would have had the same happy outcome under another kind of healthcare system is irrelevant. These are the doctors and nurses who helped them and, when you criticise the NHS, they see it as an attack on these individuals.

It is undeniable that the NHS is sustained by many thousands of extraordinarily dedicated men and women. They do an amazing job under terribly difficult circumstances. But they are not the system and, although I imagine many of them probably wouldn’t agree, it punishes the best of them. This unfair collectivisation of individuals goes some way to explaining why the electorate is so attached to the institution. But there are other reasons.

Fear is a big factor. People may be unhappy about the quality of healthcare they receive under the NHS but they’re terrified of the idea it could be taken away. They feel they’d be helpless. I’m sure that many of them believe, if they suffered an accident and didn’t have a healthy bank balance, they’d actually be left to die.

The primary reason, however, that the NHS has a death-grip on the psyche of our nation is tied to its founding beliefs. It is no coincidence that the NHS was sold to the British public during wartime. In a country conditioned by emergency measures, nationalised industries and rationing the idea of an egalitarian “free” health service, based on need not ability to pay, struck a powerful chord. No-one would be left behind; everyone would be treated the same; we were all in it together.

The wartime spirit is palpable in NHS hospitals even today. Nowhere else in 21st Century British life do you feel this atmosphere. The staff seem to be constantly fighting a losing battle. As a patient you’re a supplicant, not a customer, pathetically grateful for what you receive. You’re just one of the many faceless victims waiting to be treated. Waiting, for everything, is a matter of course. Queueing, filling in forms, being moved by harassed looking nurses, more waiting. But you mustn’t grumble; stiff upper-lip and all that.

Kingbingo said...

Today, few people remember what healthcare was like before the NHS. There’s a popular impression that we lived in a Dickensian nightmare where the poor went untreated. This is not true. The vision that Clement Attlee, William Beveridge and Aneurin Bevan sold to the electorate was a moral one. Their pamphlets, reports and speeches were notable in that they did not attack the existing quality of healthcare (other than some minor complaints about remote rural areas). Doctors and hospitals were then very well respected by the British public. No, their vision was not designed to fix a failing system but to launch a new era of centralisation, standardisation and redistribution.

The fiercest opponents of this new order were the doctors. They did not fight it on financial grounds; most of them spent a large portion of their time working for free. They were concerned that their independence, the relationship with their patients and the standard of medical care would be compromised. They were eventually cowed by a combination of threats, bribes, political manoeuvring and the electoral mandate.

It is now a well-worn bromide that the National Health Service is “the envy of the world” but long before it existed British hospitals were renowned for their high quality of service. Britain led the world in medical research. The Labour government didn’t create hundreds of efficient modern hospitals; it seized them.

Before the NHS people could pay for healthcare in a number of ways. They could use their insurance, join a friendly society, pay a regular sum to a hospital as a subscription or simply pay directly out of their savings. The few that had no insurance and couldn’t afford to pay through any other means were helped by a large and growing network of charities. Today only the wealthy can afford the high quality healthcare that private insurance provides.

The American healthcare system, which is often contrasted with ours, is usually held up as an example of the free market. This is mistaken. Healthcare in the United States is now so intertwined with the machinations of government that it is on the brink of collapse. There’s no doubt it needs reform; it’s expensive, uneven and surprisingly bureaucratic. People have very little control over their health insurance and not nearly enough choice. The few elements of the free market that remain, however, are not the problem.

In 1965 President Lyndon B. Johnson established Medicare, to provide free healthcare to the elderly, and Medicaid, to provide it to the poor. Again, the doctors opposed it and, again, they were ignored. The selling point was the indignity of having to rely on private charity and “means testing”. The government claimed it didn’t want to control the industry; it just wanted to pay the bills for the small number who were in need. Healthcare is a fundamental human right, it said. But this is a deliberate perversion of the very concept of individual rights. Healthcare is not a right. Rights, as the Founding Fathers very clearly understood, pertain to freedom of action not free benefits.

What were the consequences? Imagine what happens when a valuable resource, with practically infinite demand, is suddenly made free. Imagine how it would work with food, clothing, or computer equipment. The expenditures doubled, then doubled again, and again. America cannot afford it. Medicare has metamorphosed into a middle-class entitlement program.

The U.S. government realised they had to do something about it but, of course, would not countenance cancelling the program. Instead they imposed greater controls and bureaucracy in an attempt to limit “inefficiencies” in the system. Does this sound at all familiar?

Kingbingo said...

In the NHS, as in all healthcare systems, doctors generally work long hours under great stress. They must be able to recall vast amounts of specialised knowledge. They have to remain focussed, even when tired. Their job requires them to keep up to speed with a tidal wave of technical information. They must think, clearly and scientifically. They must weigh difficult decisions and not allow themselves to be distracted. Can you imagine how much more difficult, and dangerous, their job is made if they have to balance political considerations alongside the interests of their patients?

People often assume that removing financial incentives encourages virtue and will somehow simplify the decision making process, but resources are limited and the need for medical care is infinite. If money is taken out of the equation other, less direct, constraints become necessary and the remaining incentives are twisted. Long waiting times, mushrooming administrative bureaucracy, rationing of care and lack of transparency are not simply a matter of insufficient funding; they’re inescapable components of this type of system.

Here’s an example. You come in for a check-up and your doctor notices a minor discrepancy. It’s probably nothing but to eliminate all doubt she needs to order an expensive test. If you were paying for your healthcare, or had control over your insurance, she could explain the situation candidly and leave the decision up to you. You would need to balance the small risk against the expense, or – depending on the nature of the potential problem – a change in your lifestyle. You might even shop around for a cheaper kind of test; it’s your money after all. But if your doctor is required to give you free treatment the situation changes drastically. She must now consider the fact that if she tells you the whole truth you will naturally demand the test. It doesn’t matter to you how much it costs or how tiny the risk; you’re not paying for it. Your doctor, however, has to think about the hospital targets, the other patients waiting for tests and, if you’re elderly, the effectiveness of continuing treatment considering your age.

As far as I can tell, most doctors maintain their integrity. They’re honest with their patients and zealously fight their corner against the hospital managers. But what kind of system sets up a clash between the interests of the patient and the doctor? What kind of system punishes virtue?

Many people, who would normally oppose nationalisation, are under the illusion that healthcare is a special case because it saves lives. Well, food saves lives too. It is at least as much a necessity to human life as medicine. Does it follow that we should therefore nationalise all food production and distribution? Can you imagine what would follow if it did? No, the system doesn’t work for healthcare just as it doesn’t work for any other provision of goods and services. It doesn’t work because there’s something fundamentally wrong with its assumptions.

Kingbingo said...

The government can provide “free” healthcare only by forcing others to pay for it. The socialist ideal of “from each according to his ability, to each according to his need” is unjust. It is moral cannibalism. It drains the life blood from the productive and feeds it to scoundrels. It makes beggars and slaves of us all. Those who implement such a system, whether they know it or not, are forging manacles for mankind.

The NHS works today only to the extent that it is inconsistent. It is kept running by the work outsourced to private companies, the contractors, the imported skills, medicine and technology, the constantly increasing infusion of money expropriated from tax payers, the stoic patients and, above all, the heroic efforts of thousands of men and women who, quietly and conscientiously, pull out every stop to deliver the best care they possibly can. Nevertheless it’s a losing battle; no matter how much money is pumped in to it the system will fail.

There is an alternative. It doesn’t require us to copy the current American model, or to somehow turn back the clock, but it does require us to reject the Marxist doctrine of collectivism and self-sacrifice behind the idea of the NHS. I don’t pretend that the current system can be removed quickly. It cannot disappear overnight; too many are dependent upon it. But it can be gradually replaced, and with something that is so much better people will look back at what we suffered under in complete disbelief. I do not have the space here to outline the practical steps that could be taken to move towards such a goal. I may return to this subject in a future article but, in the meantime, I refer you to some of the ideas on reform articulated by the Adam Smith Institute and in Daniel Hannan’s book, The Plan: Twelve Months to Renew Britain.

There are encouraging signs that people are beginning to lose their unquestioning faith in a monolithic welfare state. If the government tried to impose something on the same scale today it would be roundly rejected. We are not children and our memories are not as short as politicians like to think. We can provide a healthcare system superior to any that exists in the world today, one that provides inexpensive, cutting-edge and prompt medical procedures for everyone. The reason the NHS cannot work in practice is because its theory is dishonest; its moral principles are wrong. It is only by identifying, repudiating and replacing these principles that we can begin to rebuild.

AntiCitizenOne said...


MrAngryman said...

I work in the NHS and feel a strong affection for it. However i feel that in its current state it cannot continue. It fails everyone in the end, patients and staff. Patients have their care compromised by political decisions (patients discharged early to free up beds or 'outlyed' to other non specialist areas.) Staff are left demotivated by the struggle of fighting the system, to gain even the most simple of things for their patients (have you ever tried to get hospital linen out of hours? The struggle of getting someone something as simple as a hot meal out of hours is a nightmare of giegeresque proportions.) The system sets wards and specialist environments in the same hospital as direct competitors for the same scarce resources, it sets hospital against hospital against each other even though they belong to the same trust.

The pressure applied to staff to get 'results' (even though those results are arbitrary and in some cases may even case harm i.e the 4 hour A+E wait) is immense. Clinicians are now unable to just care for patients without some target chasing manager ensuring all the paperwork is completed, the 30 pages of admission document filled out, the 12 page assessment document checked, the patient is the last thought, the very last concern in the list of things that need to be completed.

The NHS rewards mediocrity and promotes incompetence. Good at your job? Motivated and driven? well you wont be after your managers have bullied you for highlighting poor practice on 'their' ward and your colleagues have ostracised you as 'one' of those people. Witness poor practice? report it? watch as that individual is allowed to continue to practice despite all the evidence? watch as a well respected and experienced colleague is hung out to dry because they forgot to fill out one of the massive amounts of risk assessments, yet the dangerous ones are allowed to get away with it?

Despite all of this, (though probably because of it i Love the NHS and i am proud of what i achieve on a daily basis ) as a previous commenter stated that its the 'wartime spirit' that carries it through and this is true.

The NHS fails everyone equally but i love it.

MrAngryman said...
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