Vir Cantium

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Before We Defend It, Know What “It” Is

I’m not sure where the overhyped#welovethenhs” twitter thing is going to go now, since even the great Obama has said that he doesn’t want a British-style NHS for America.

Anyway, apparently we are all rallying round to defend the NHS. The trouble is, what is the NHS?

In the eyes of many of the public, the institution of the NHS has become synonymous with the principle of “healthcare free at the point of delivery”. The two are not the same. The NHS is merely a tool for delivering that principle, it is not an ideal in itself and, dare I say, it is a particularly old-fashioned and inefficient tool. There are other ways of achieving Beveridge’s ideals, as many other countries have found. Any of the stories of lives “saved by doctors, nurses, drugs the NHS” need not be taken as endorsements of the state running the hospitals in which those patients were treated, or of the monolithic bureaucracy frustrating managing the staff who worked in them.

I’m afraid I’m getting close to mentioning the evil “p” word here. “Private”? No, worse than that, “profit”! Now if you’re one of those people who only uses the word “profit” pejoratively and never without spitting, then you’re going to get wound up here. Of course, I could foresee many hospitals also being run by not-for-profit organisations, but the provision of publicly funded healthcare and profit-making are not incompatible, just as local councils collecting the rubbish have found that profit making companies have produced a better service for less money. Profit isn’t dirty. It provides the incentive to do things better and more efficiently.*

All this being said, David Cameron was right to defend the NHS. Why? Because after 50 years, so many people do regard the NHS and the “free” healthcare principle as synonymous. The scaremongers have done their job well, and are easily a match for some of the more silly claims of the anti-Obama elements in the States. Some talk of the vested interests of the private sector, yet the vested interests (the unions, the bureaucracy) of the public sector still hold sway in this arena. Just as defenders of the BBC licence fee warn of a future utterly devoid of culture, so anyone who dares criticises our present public healthcare delivery system risks standing accused of wanting to leave the poor dying in the gutter, or decrying the dedication of the “doctors’n’nurses”.

The separation of the principles of the NHS and the NHS itself, as well as from the good work of the clinicians, will take a long time to achieve. Until then, we can never move forward to a more sustainable system for delivering decent medical care free at the point of delivery, for until then we will not be able to properly examine or discuss the alternatives.

*As a slight interlude: cue here, I guess, the examples of private cleaning contractors leaving wards dirty. This, goes the orthodox view, is because the contractors skimp on their work to make bigger profits. Yet even an in-house team could make a slapdash effort at their work for all sorts of reasons (laziness, incompetence, lack of resources). What would be the ultimate sanction? The errant workers get the sack (assuming you can make it through the employment tribunal and trade union objections). The private contractor, on the other hand would … be given the sack (OK, “have their contract terminated”). The issue, therefore, is not whether the service is delivered privately or publicly, but the quality of the management.


One response to “Before We Defend It, Know What “It” Is

  1. randy August 16, 2009 at 12:10 pm

    Something you should read …

    Harriet Harman’s Lies About Rape Exposed Today



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